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3b specialties > Ophthalmology > Flashcards

Ophthalmology Flashcards

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1
Q

What is age-related macular degeneration?

A

Degeneration of the macula

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2
Q

Name some RFs for ARMD

A

Age, smoking, hypertension, dyslipidaemia, DM

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3
Q

S+S of ARMD?

A 
Subacute onset of visual loss
Decrease in visual acuity
Decrease in night-time vision
photopsia
Fluctuating visual disturbance
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4
Q

What is DRY ARMD?

A

Presence of drusen

90% of cases

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5
Q

What is WET ARMD?

A

Worse prognosis

Choroidal neovascularisation

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6
Q

Ix of ARMD?

A

Slit lamp microscopy

Fluorescein angiography- looking for neovascularisation

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7
Q

Tx of ARMD?

A

Wet- Anti-VEGF (ranibizumab)

Dry- vitamins ACE and zinc

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8
Q

What are cataracts?

A

Cloudy lens

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9
Q

RFs for cataracts?

A

Age, smoking, alcohol, trauma, DM, radiation, steroids, TORCH infections

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10
Q

Types of cataracts?

A

Nuclear- old age
Polar- inherited
Subcapsular- steroid use
Dot opacities- DM, myotonic dystrophy

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11
Q

S+S of cataracts?

A 
Gradual onset decrease in vision
faded colour vision
glare
haloes around lights
Loss of red reflex
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12
Q

How to diagnose cataracts?

A

Visible of slit lamp examination

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13
Q

Tx of cataracts?

A

Stronger glasses

Surgery

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14
Q

What are RFs for vitreous haemorrhage??

A

DM, bleeding disorders, retinal tear, trauma, wet ARMD

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15
Q

S+S of vitreous haemorrhage?

A

Small bleed= floaters, dark spots
Large bleed= sudden painless LOV
Absent red reflex
retina not visible

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16
Q

Tx of vitreous haemorrhage?

A

Usually spontaneously resorbs

If severe -> vitrectomy

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17
Q

What is CRAO?

A

Central retinal artery occlusion

considered a form of stroke from thromboembolism or temporal arteritis

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18
Q

RFs for CRAO?

A

same a stroke- CV RFs

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19
Q

s+s of CRAO?

A

Sudden painless loss of vision
Marcus-GUNN pupil- relative afferent pupillary defect

Fundoscopy- cherry red spot on a white retina

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20
Q

Tx for CRAO?

A 
CT head
Exclude GSA (DO ESR)
intraocular hypotensives (acetazolamide)
Decreaes intraocular pressure by intraocular massage

Secondary prevention- CV risk factors

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21
Q

What is more common- CRAO or CRVO?

A

Vein

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22
Q

What are the 4 features of fundoscopy of CRVO?

A

cheese and tomato pizza

  1. Cotton wool spots
  2. Swollen optic nerve
  3. Macular oedema
  4. Severe retinal haemorrhage
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23
Q

What is Tx of CRVO?

A

Call ophthalmology immediately
Intra-vitreal anti-VEGF therapy
dexamethasome

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24
Q

What is optic neuritis?

A

Inflammation of the optic nerve

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25
Rfs for optic neuritis?
MS, syphilis, SM, leber's optic atrophy, vitamin deficiency
26
S+S of optic neuritis?
``` unilateral, subacute LOV pain of eye movement dyschromatopsia (poor colour discrimination- red seems washed out) Marcus gunn pupil central scotoma ```
27
Tx of optic neuritis?
IV methylprednisolone for 72 hours then oral pred for 11 days MRI if ?MS
28
What is retinitis pigmentosa?
Inherited degeneration of the retina- >300 different mutations more common in males associated with Usker syndrome and Alport syndrome
29
What are feature of retinitis pigmentosa?
night blindness= first sign | tunnel vision- due to loss of peripheral retina
30
Tx of retinitis pigmentosa?
Visual aids and blind registration electrical stimulation of retinal ganglion cells neuralprosthetics
31
What is diabetic retinopathy assocated with?
vitreous haemorrhage
32
What is the pathophysiology of diabetic retinopathy?
hyperglycaemia increases retinal blood flow which damages endothelial cells -> increased vascular permeability -> exudates seen on fundoscopy
33
Classification of diabetic retinopathy?
Non- proliferative mild- 1 or more microaneurysm moderate- microaneurysms, blot haemorrhages, hard exudates, cotton wool spots, venous beading looping severe- blots and micros in 4 quadrants, venous beading in >2 quadrants Proliferative retinal neovascularisation, fibrous tissue forming anterior to retinal disc, high risk of blindness
34
Ix of diabetic retinopathy?
dilated retinal photography with accompanying ophthalmoscopy
35
Tx of diabetic retinopathy?
good glycaemic control laser therapy intra-vitreal steroids anti- VEGF
36
How is diabetic retinopathy different to maculopathy?
changes on macula | more common in T2DM
37
Causes of hypertensive retinopathy?
``` exacerbation of essential HTN intrinsic renal disease renal artery stenosis pheochromocytoma cushings and conns ```
38
Features of HT retinopathy?
``` micro-infarcts silver wiring of the artery (increased light reflex) AV nipping flame haemorrhages exudates papilloedema neovascularisation ```
39
Classification of HT retinopathy?
``` Kieth- Wagner classification 1- arteriolar narrowing and tortuosity, increased light reflex (silver wiring) 2- AV nipping 3- Spots, dots (exudates) and blots 4- papilloedema ```
40
tx of HT retinopathy?
Control hypertension manage stroke risk regular eye checks- yearly
41
Causes of corneal ulceration/abrasion?
Contact lens wearers infection mechanical trauma or nutritional deficiencies steroid eye drops -> fungal infections
42
S+S of corneal ulcers>
Eye pain Photophobia watery eye
43
Ix of corneal ulcers?
Focal fluorescein staining of the cornea and slit lamp exam
44
Tx of corneal ulcers?
Stop contact lenses for 1 week cool compress good hygiene topical abx- chloramphenicol;
45
Common causes of red eye? (non urgent)
Conjunctivitis, foreign bodies, corneal ulceration, subconjunctival haemorrhages
46
Urgent causes of red eye?
``` Acute angle closure glaucoma Anterior uveitis Scleritis Conjunctivitis Subconjunctival haemorrhage Endophthalmitis following intraocular surgery ```
47
Features of acute angle closure glaucoma?
``` severe pain (may be ocular or headache) decreased visual acuity, patient sees haloes semi-dilated pupil N&V peripheral visual field loss hazy cornea ```
48
Features of anterior uveitis?
``` acute onset pain blurred vision and photophobia small, fixed oval pupil, ciliary flush (red or purple ring spreading outwards from the cornea) red eye decreased visual acuity ```
49
Features of scleritis?
``` severe pain (may be worse on movement) and tenderness red eye may be underlying autoimmune disease e.g. rheumatoid arthritis, CTD, vasculitis ```
50
Features of conjunctivitis?
purulent discharge if bacterial, clear discharge if viral | red eye
51
Feautures of subconjunctival haemorrhage?
history of trauma or coughing bouts, bleeding disorders etc bleeding of small vessels into conjunctiva Sudden onset, bright red blood, distinct border
52
Features of endophthalmitis?
typically red eye, pain and visual loss
53
Features of episcleritis?
Common, benign, no systemic associations, 50% bilateral causes mild irritation, localised redness, watery, no discharge, no LOV
54
tx of episcleritis?
NSAIDs for pain | eyedrops e.g. phenylephrine to ease irrigation
55
tx of scleritis?
NSAIDS oral prednisolone cyclophosphamide or other immune suppressants to tackle vasculitis or CTD
56
tx of subconjunctival haemorrhage?
no official tx unless other injuries present
57
tx of anterior uveitis?
dilate eye to relieve pain- atropine or cyclophenolate steroid eye drops (prednisolone acetate) review by ophthalmology
58
what is keratitis?
infection/inflammation of the cornea
59
What is a viral cause of keratitis?
HSV
60
Features of keratitis?
``` dendritic shape corneal ulcer red, painful eye photophobia watering decreased visual acuity foreign body sensation ```
61
Ix of keratitis?
fluorescein staining to look for ulcer
62
tx of keratitis?
urgent referral if viral cause- topical acyclovir if bacterial cause- abx
63
What are bacterial causes of conjunctivitis?
staphylococcus. streptococcus, haemophilus, Neisseria, chlamydia reactive conjunctivitis= chlamydia or campylobacter
64
Viral cause of conjunctivitis?
adenovirus
65
general advice for conjunctivitis?
no contact lenses, don't share towels, no need for school exclusion
66
tx for bacterial conjunctivitis?
self-limiting topical abx- chloramphenicol if pregnant- topical fusidic acid
67
pointers towards viral conjunctivitis?
recent URTI serous discharge re-auricular lymphadenopathy
68
tx of viral conjunctivitis?
oral analgesia and artificial eye drops | self-limiting
69
features of allergic conjunctivitis?
hay-fever symptoms itchy,swollen conjunctiva, erythema sticky mucous discharge large papillae if caused by pollen
70
tx of allergic conjunctivitis?
topical or systemic anti-histamines | topical mast cell stabilisers (sodium cromoglicate, nedocromil)
71
what is acute angle closure glaucoma?
raised IOP that causes damage to optic nerve IOP >21mmHg
72
RFs of acute angle closure glaucoma?
hypermetropia (long-sightedness), pupillary dilatation
73
Ix of acute angle closure glaucoma?
``` slit lamp examination- showing large cup and nerve fibre loss Gonioscopy visual field examination automated perimetry measure IOP- tonometry ```
74
tx of acute angle closure glaucoma?
1. lower the pressure - prostaglandin analogues e.g. lantoprost (increase uveoscleral outflow) - beta blockers e.g. timolol (decrease aqueous secretion) - sympathomimetics (alpha-2 adrenoceptor agonists)- e.g. brimonidine (decrease secretion and increase outflow) - carbonic anhydrase inhibitors e.g. dorzolamide (decrease aqueous secretion) 2. constrict the pupil - e.g. pilocarpine drops (increase uveloscleral outflow) 3. prevent recurrence- laser iridotomy (hole in iris) and surgery
75
AEs of lantoprost?
brown pigmentation of iris | increase eyelash length
76
CIs of timolol?
asthmatics and heart block
77
CIs of brimonidine?
avoid if taking TCAs or MAOI
78
AEs of pilocarpine
headache, blurred vision, prolonged constricted pupil
79
RFs of chronic glaucoma?
age, FH, short-sightedness, HTN, DM, afro-caribbean
80
Diagnosis of chronic glaucoma?
>21mmHg, abnormal disc (cupping, pallor, notching, disc haemorrhage), visual field defect Can be routine finding in opticians or symptoms of tunnel vision or decrease visual acuity
81
tx of chroic glaucoma?
1st line- lantoprost (eye drops) 2nd line- timolol, carbonic anhydrase inhibitor, alpha 2 agonist 3rd line- trabeculectomy
82
When to screen for chronic glaucoma if +ve FH?
annually from the age of 40
83
what is retinal detachment and what can precede it?
holes/tears in the retina allow fluid to separate the sensory retina from the retinal pigmented epithelium vitreous detachment can precede it (flashers and floaters)
84
RFs of retinal detachment?
``` myopia (short-sightedness) cataract surgery DM HTN trauma vasculitis ```
85
features of retinal detachment?
4Fs and no Pain 1. flashers 2. floaters 3. fall in acuity 4. field loss- usually central straight lines appear curved Dense shadow that starts peripherally progresses towards the central vision A veil or curtain over the field of vision
86
ix of retinal detachment?
B-scan USS ophthalmoscopy slit lamp exam- peeling away of retina
87
tx of retinal detachment?
``` urgent referral if superior detachment- lie flat if inferior detachment- sit at 30 degrees with head up laser therapy urgent surgery ```
88
Causes of CRVO?
causes: glaucoma, polycythaemia, hypertension
89
Causes of sudden painless LOV?
- ischaemic/vascular (e.g. thrombosis, embolism, temporal arteritis etc). This includes recognised syndromes e.g. occlusion of central retinal vein and occlusion of central retinal artery - vitreous haemorrhage - retinal detachment - retinal migraine
90
What is temporal arteritis?
occlusion of the ciliary arteries which supply the optic nerves
91
features of temporal arteritis?
sudden loss of vision with pain central scotoma unilateral then bilateral associated temporal headache and/or tenderness over the temporal arteries
92
Dx of temporal arteritis?
ESR >40 Biopsy of temporal artery ophthalmoscopy- swollen optic disc test both eyes
93
mx of temporal arteritis?
prednisolone 60-100mg STAT and continue for a week before tapering
94
differentials of tunnel vision?
``` papilloedema glaucoma retinitis pigmentosa chorioretinitis optic atrophy secondary to tabes dorsalis ```
95
what is papilloedema?
optic disc swelling
96
causes of papilloedema?
``` SOL malignant hypertension IIH hydrocephalus hypercapnia hypoparathyroidism, hypocalcaemia, vit A toxicity ```
97
signs of raised ICP?
headache worse on morning blurred vision tunnel vision vomiting
98
features on fundoscopy of papilloedema?
``` venous engorgement loss of venous pulsation blurring of optic disc margin elevation of optic disc loss of optic cup paton's lines ```
99
What is a chalazion?
granuloma of Meibomian glands (reactions to accumulation of lipid following duct blockage) hard and inflamed lump on eyelid
100
tx of chalazion?
warm compress, chloramphenicol ointment | incision and curette under anaesthesia
101
What is a stye?
infection of lash follicle red,tender swelling head of pus
102
tx of stye?
warm compress and analgesia
103
what is blepharitis?
chronic condition with sore, gritty eyes and sore eyelids blocked Meibomian glands inflamed lid margins conjunctiva may be inflamed
104
tx of blepharitis?
``` keep lids open treat infection hot compress mechanical removal of lid debris artificial teats acute ulcerative form- staph or herpes virus ```
105
what is the classic appearance of BCC?
pearly smooth edge with necrotic centre
106
What is ectropion vs entropion?
ectropion- out-turning of eyelids | entropion- in-turning of eyelids
107
how to tell the difference between 3rd nerve palsy and horner's syndrome?
3rd nerve palsy= ptosis and dilated pupil | horner's syndrome= ptosis and constricted pupil
108
causes of keratitis?
Viral infection with herpes simplex Bacterial infection with pseudomonas or staphylococcus Fungal infection with candida or aspergillus Contact lens acute red eye (CLARE) Exposure keratitis is caused by inadequate eyelid coverage (e.g. eyelid ectropion)

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