Ophthalmology Flashcards
(84 cards)
1
Q
What do you need to do before fundoscopy?
A
dilate pupil
-eg atropine
2
Q
Describe optic disk
A
Colour
Contour
Cup
Circulation
3
Q
3 causes of retinal haemorrhage
A
- Diabetic retinopathy
- SAH
- Valsalva
- Hypertensive retinopathy
4
Q
What are cotton wool spots?
A
Micro infarcts
5
Q
What are drusen?
A
Pale, round and grey –> sign of age-related macula degeneration
6
Q
Black pigmentation in peripheral retina?
A
Retinitis pigmentosa (inherited retinal degeneration)
7
Q
What is a scotoma?
Causes?
A
Blind spot
Lesion in the optic nerve, before the chiasm.
eg ON
Macular degeneration –> central scotoma
8
Q
What is slit lamp for?
A
Examining anterior segment of the eye (in front of the vitreous body)
9
Q
Where in the retina has the highest concentration of cones?
A
Macula
10
Q
What do cones do?
A
Colour vision and acuity
11
Q
What do rods do?
A
Outer retina, night vision
12
Q
What provides O2 for outer retina?
A
Choroid
13
Q
Test for visual acuity?
A
Snellens at 6m
14
Q
What is a cataract?
A
Opacity/clouding of the lens.
Progressive over years.
Usuall b/l
15
Q
RFs of cataracts?
A
Sunlight, age, smoking, alcohol, steroids, DM
16
Q
‘The angle’ in open angle glaucoma is what?
A
Space between posterior cornea and anterior iris.
The space where aqueous humour leaves the eye.
17
Q
Where is aqueous humour produced? What does it do?
A
Ciliary body
Circulates and nourishes the lens
18
Q
What is chronic open angle glaucoma?
o/e?
A
Chronic, progressive optic neuropathy with characteristic changes in optic nerve head and corresponding visual field loss.
Enlarged optic disc cup. Progressive visual field loss –> tunnel vision.
Raised IOP >21.
19
Q
Triad of glaucoma
A
- raised IOP (not always present)
- Abnormal cup:disc ratio
- VF defect (tunnel vision)
20
Q
Screening for chronic open angle glaucoma
A
IOP
VF
Fundoscopy
21
Q
Drops used in open angle glaucoma
A
- Timolol (reduces aq production)
- Latanoprost (increases outflow)
- Dorzolamide (reduces aq production)
22
Q
Non-medical mx for glaucoma?
A
- Laser therapy (trabeculoplasty)
- Surgery (trabeculotomy)
23
Q
Dry macular degeneration
- fundoscopy
- VF loss
A
- Atrophy of RPE, drusen
2. Central scotoma
24
Q
Wet macular degeneration
- fundoscopy
- VF loss
A
- Choroidal neovascular membrane, leaking vessels, exudate, haemorrhage, scarring
- Distorted central vision
25
Mx of wet MD
Anti-VEGF injection
26
DDx of sudden visual loss
- Vascular [CRVO, CRAO]
- Inflammatory [ON]
- Retinal detachment
27
CRAO
1. pres
2. o/e
1. Sudden, total (or altitudinal) painless loss of vision
2. RAPD )
Cherry red spot at fovea
28
3 ix in retinal artery
- Carotid artery doppler
- Fasting serum lipid
- ECG, FBC, CT head, Clotting screen
29
What is amaurosis fugax?
Loss of vision for 30 mins (ocular TIA)
30
CRVO
1. pres
2. o/e
1. sudden painless u/l loss of vision
| 2. flame haemorrhages, leaking veins, intact arteries, swollen optic disc
31
mx of CRVO
1. Anti-VEGF injection e.g. Ranibizimab
| 2. pan retinal photocoagulation
32
How to identify retinal non perfusion?
RAPD
Blots + microinfarcts
Fluorescein angiography
33
What is anterior ischaemic optic neuropathy?
| Assos?
- Sudden visual loss due to disruption of bloody supply to the head of the optic nerve
- GCA
34
Optic neuritis assos?
MS
35
Retinal detachment
1. Cause?
2. What happens?
3. Pres?
1. Retinal tear
2. Potential space between photoreceptors and RPE fills with fluid
3. Flashes, floaters, field loss
36
Mx of retinal detachment?
Surgery
37
Hypertensive retinopathy
1. what
2. features
3. mx
1. HTN causes damage to retinal blood vessels
2. arteriolar changes, microinfarcts, flame haemorrhages
3. manage BP!
38
What is the complication of dropping BP too fast in accelerated hypertension?
Can cause ischaemic optic neuropathy and blindness
39
Diabetic retinopathy pathophysiology?
- Microvascular leakage
| - Occlusion
40
Visual loss in diabetic retinopathy?
Patchy visual loss (like cow spots)
41
2 signs on fundoscopy of diabetic macular oedema?
- Retinal thickening
- Exudates approaching fovea
- Microaneurysms
42
Mx of diabetic retinopathy?
- Optimise glycaemic control + BP
- Consider pan-retinal photocoagulation
- When proliferative, vitrectomy
43
How often to monitor diabetic retinopathy?
| In pregnancy?
- 12 months
| - Every trimester
44
Red flags of red eye
- Impaired vision
- Pain/photophobia
- Lack of ocular discharge
45
Blepharitis
1. what is it?
2. how does it present?
3. mx
1. Inflam of eye lid
2. Gritty, irritable eyes, watery discharge, foreign body sensation
3. lubricants, hygeine + topical abx, hot spoon bathing
46
Sx of herpes zoster in eye
- Severe keratitis (corneal inflammation)
- Vascularisation
- Corneal clouding + thinning
47
Sub-conjunctival haemorrhage
1. presentation?
2. mx
1. Sudden onset, bright red (stays bright red)
| 2. No treatment required. If post-trauma check for orbital/ocular injury..
48
Sx of conjunctivitis? Visual change?
Red eye, discharge, swollen eyelid.
| No visual disturbance
49
Usual cause of viral conjunctivitis?
| mx?
- Adenovirus
| - Self limiting
50
Cause of bacterial conjunctivitis?
| Mx?
- Staph, Strep, Neisseria, Haemophillus
| - Chloramphenicol / fusidic acid eye drops
51
Recurrent conjunctivitis?
?nasolacrimal duct obstruction
52
Conjunctivitis in neonate?
?chlamydial --> starts in one eye and spreads to the other
| Risk of conjunctival scarring, pneumonitis
53
Hypersensitivity types
```
ABCD
1 - Allergic, Anaphylaxis, Atopy
2 - antiBody
3 - immune Complex
4 - Delayed
```
54
Mx of allergic conjunctivitis?
Topical steroids
55
Pres of allergic conjunctivitis?
V swollen conjunctiva, itchy eyes, usuall u/l
56
Check for corneal abrasion?
Fluorescein dye
57
Keratitis
1. what is it?
2. usual viral cause?
3. Ix
4. sx
5. mx
1. inflammation of the cornea
2. Herpes simplex
3. Characetristic shape with fluorescein stain
4. foreign body sensation, photophobia, watery discharge
5. topical aciclovir
!!Topical steroid is CONTRAINDICATED!!
58
Steroids for a red eye?
NO!!
Seek specialist opinion
Risk of enlarging dendritic ulcer --> amoeboid ulcer
59
Bacterial keratitis?
1. Sx
2. Sign
3. Ix
4. Mx
RARE
1. painful red eye + loss of vision
2. hazy cornea w/ central abscess
3. Scrapes + gram-stain and culture
4. SPECIALIST (intense abx cef +gent)
60
Anterior uveitis associations?
HLA-B27
- IBD
- Psoriatic arthritis
- Ankylosing spondylitis
Granulomatous disease
- Sarcoid
- Syphillis
Behcet's disease (multisystem, mouth ulcers)
61
Mx of anterior uveitis?
- Atropine
- Steroid eye drops
- Refer to ophthalmology
62
Acute angle closure glaucoma
1. pres
2. o/e
1. Unilateral, painful red eye with profound loss of vision + nausea + vomiting + photophobia
2. Very high IOP
63
Mx of acute angle closure glaucoma (medical)
- Lower the pressure [timolol, latanoprost, acetazolamide]
- Constrict the pupil [Pilocarpine]
- Treat the other eye prophylactically
64
Non-medical mx of acute angle closure glaucoma
- Laser +/- surgery
- Laser iridotomy
- Treat the other eye prophylactically
65
What is more worrying? u/l or b/l red eye
u/l is more worrying!
66
Which eye conditions are asymptomatic in early disease?
- Chronic glaucoma
- Diabetic retinopathy
- HTN
- Papilloedema
67
Sx of retinitis pigmentosa?
Pathophysiology?
Ring scotoma and night vision problems at 10-30yo
Hereditary, progressive dystrophy of photoreceptors in retina and RPE
68
Mx of retinitis pigmentosa
- Refer to ophthalmology + genetic counselling
- Screen for complications (cataracts, glaucoma, macular oedema)
- Inform DVLA + wear sunglasses
69
Ix in dry eyes
Schirmer's test (look for Sjogrens)
70
Scleritis sx
Intense pain, blurred vision, swollen sclera, choroidal effusions
71
Mx of scleritis
Refer to ophthalmo
Steroids --> indomethacin
Cytotoxic therapy in severe disease
72
Pres of uveitis
PPPR
- Pain
- Photophobia
- Poor vision
- Red eye
73
Pres of closed angle glaucoma
- Raised IOP
- Red eye
- Rainbow halos around lights
- Photophobia
- Pain (+headache)
- Blurred vision
- N+V
- Abdo pain
74
DDx of red, painful eye.
Which are emergencies?
Keratitis, conjunctivitis, uveitis, scleritis, episcleritis, close angle glaucoma
EMERGENCIES
Closed angle glaucoma
Keratitis
Uveitis
75
Clinical findings of acute angle closure glaucoma?
Semi-dilated non-reacting pupil
Corneal oedema --> hazy
Raised IOP
76
Treatment for acute angle closure glaucoma?
| Give 2 and their route
Acetazolomide PO
| Pilocarpine eye drops
77
Laser treatment for acute angle closure glaucoma?
| What is the mechanism?
Peripheral iridotomy - allows aqueous humour to drain - decreasing IOP
78
RFs for acute angle closure glaucoma
Hypermetropia (long-sightedness)
79
Clinical findings of anterior uveitis?
Pupil abnormally shaped
Cells in aqueous humour --> becomes cloudy with 'FLARE'
Hypopyon
Keratic precipitates - inflammatory cells clumped
Ciliary flush - violaceous ring around cornea
80
Treatments for anterior uveitis?
| Give 2 and their route
Steroid eye drops
| Cycloplegics (atropine, cyclopentolate) --> to dilate pupil
81
Causes of floaters?
Diabetic retinopathy
Retinal detachment
Posterior vitreous detachment
Aging
82
Causes of retinal detachment?
Rhegmatogenous - due to PVD
Exudative
Tractional
83
Pres of retinal detachment?
Floaters
Flashes
Sudden onset, painless, progressive visual field loss
84
Investigations in retinal detachment?
| What would you see?
Fundal examination - Schaffer's sign
Ophthalmoscopy
USS - flying angels sign
