Ophthalmology Flashcards Preview

Year 3: Sofia COPY > Ophthalmology > Flashcards

Flashcards in Ophthalmology Deck (29)
Loading flashcards...
1

What is cataracts?

Opacification of the lens of the eye

2

What is the aetiology of cataracts?

Majority of cases are idiopathic age-related (senile cataracts). Numerous secondary causes including:
- Local: Previous eye trauma, uveitis, intraocular tumours
- Systemic: DM, metabolic disorders (hypocalcaemia, Wilsons disease), skin disease (atopic dermatitis, scleroderma), drugs (steroids), X-ray and UV radiation, myotonic dystrophy, genetic syndromes (Down's)
- Congenital: Congenital rubella syndrome

3

What is the aetiology of cataracts?

Major cause of treatable blindness worldwise

4

What are the presenting symptoms of cataracts?

- Gradual onset painless loss of vision
- Glare from bright light, vision may worsen in bright light (especially with central lens opacity)
- May experience monocular diplopia and see haloes around lights
- May notice that they can read without glasses (nuclear sclerotic cataract may increase lens-converging power)
- In infants, may be amblyopia or nystagmus

5

What are the signs of cataracts on examination?

- Loss of reflex and hazy lens appearance
- Reduced visual acuity

6

What are the investigations for cataracts?

Unnecessary unless occurring at an early age or in background of systemic disease

7

What is conjunctivitis?

Inflammation of the lining of the eyelids and eyeball caused by bacteria, viruses, allergic or immunological reactions, mechanical irritation or medicines

8

What is the aetiology of conjunctivitis?

- Most common bacterial pathogens in infective include Pneumococcus, Staphylococcus aureus, M. catarrhalis and H. influenzae
- Viral: adenovirus, herpes simplex, Epstein-Barr, varicella zoster and enteroviruses
- Contact lens wear may lead to a keratoconjunctivitis
- Mechanical caused by chronic conjunctival irritation especially while sleeping.

9

What is the epidemiology of conjunctivitis?

Commonly affects males and females of all ages

10

What are the presenting symptoms of conjunctivitis?

- Watery discharge
- Itchy predominant symptom
- Eyelids stuck together
- Eyelids stuck together in mornings

11

What are the signs of conjunctivitis on examination?

- Ropy, mucoid discharge
- Prululent discharge
- Tender, pre-auricular lymphadenopathy

12

What are the risk factors for conjunctivitis?

- Exposure to infected person
- Infection in one eye
- Environmental irritants
- Allergen exposure
- Camps, swimming pools, military bases
- Asian or Mediterranean young male
- Atopy
- Contact lens use
- Ocular prosthesis
- Mechanical irritation

13

What are the investigations for conjunctivits?

- Rapid adenovirus immunoassay: 2 visual lines equal positive
- Cell culture
- Gram stain
- PCR

14

What is glaucoma?

Optic neuropathy with typical field defect usually associated with ocular hypertension (intraocular pressure more than 21mmHg)

15

What is the aetiology of glaucoma?

- Primary causes: Acute close angle glaucoma (ACAG), primary open-angled glaucoma (POAG), chronic closed-angle glaucoma
- Secondary causes: Trauma, uveitis, steroids, rubeosis iridis (diabetes, central retinal vein occlusion)
- Congenital: Buphthalmos, other inherited ocular disorders

16

What is the epidemiology of glaucoma?

- Prevalence 1% in over 40 years
- 10% over 80 yrs (POAG)
- 3rd most common cause of blindness worldwide

17

What are the presenting symptoms of glaucoma?

- ACAG: Painful red eye, vomiting, impaired vision, haloes around lights
- POAG: Usually asymptomatic, peripheral visual field loss may be noticed
- Congenital: Bupthalmos (ox eye), watering, cloudy cornea

18

What are the signs of glaucoma on examination?

By slit-lamp
- ACAG: Red eye, hazy cornea, loss of red reflex, fixed and dilated pupil, eye tender and hard on palpation, cupped optic disc, visual field defect (arcuate scotoma), moderately raised IOP
- POAG: Optic disc may be cupped. Usually no signs

19

What are the investigations for glaucoma?

- Goldman Applanation Tonometry: standard exam to measure ocular pressure
- Pachymetry: Detect pathologically cupped disc
- Gonioscopy: Assess to iridocorneal angle
- Perimetry (visual field testing): For arcuate scotoma (early), tunnel vision (late)

20

What is uveitis?

Inflammation of the iris and ciliary body (iritis or iridocyclitis)

21

What is the aetiology of uveitis?

- Anterior uveitis may be caused by infection (e.g. herpes simplex, herpes zoster)
- Can occur as manifestation of systemic inflammatory conditions e.g. juvenile chronic arthritis, HLA B27-related spondyloarthritides, sarcoidosis, Behcet's disease

22

What is sympathetic ophthalmia?

Inflammation of the contralateral eye weeks/months after penetrating injury (rare)

23

What is the epidemiology of uveitis?

- Associated with sponduloarthritis
- 2x more common in males

24

What are the presenting symptoms of uveitis?

- Pain (ciliary spasm and inflammation, pain increases on accommodation)
- Photophobia
- Red eyes
- Blurred vision
- Lacrimation
- May rarely be associated with tubulointerstitial nephritis (flank pain, haematuria, proteinuria, sterile pyuria and acute renal failure)

25

What are the signs of uveitis on examination?

- Reduced visual acuity
- Ciliary flush (redness may be confined to the corneoscleral junction
- Hyponyon (proteinaceous exudate and inflammatory cells in the inferior angle of the anterior chamber)
- Small irregular due to posterior synechiae (adhesions of the iris to the lens)

26

What are the signs of uveitis with a slit lamp?

Keratic precipitates (deposits of leucocytes of the corneal endothelium)

27

What are the signs of uveitis with fundoscopy?

Excludes retinal detachment
Posterior inflammation or a tumour that may give rise to anterior uveitis

28

What are the signs of the complications of uveitis?

- Raised intraocular pressure
- Cataract

29

What are the investigations for uveitis?

Investigate for associated systemic conditions depending on associated symptoms:
- U&E's
- Spondyloarthritides (sacroiliac joints X-ray, HLA typing)
- Sarcoidosis (CXR, serum calcium, serum ACE)
- Syphilis serology