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phase 3b > Ophthalmology > Flashcards

Ophthalmology Flashcards

1
Q

4 types of change in appearance of the eyelid

A

Ptosis
Swelling
Entropion (turning in)
Ectropion (turning out)

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2
Q

Which muscles are innervated by CN3?

A

Medial rectus
Superior rectus
Inferior rectus
Inferior oblique

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3
Q

What is the appearance of the eye due to 3rd nerve palsy?

A

Down and out
Ptosis
Fixed dilated pupil

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4
Q

What is strabismus

A

Misalignment of the eyes (squint)

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5
Q

What vasculitis is important to exclude in transient loss of vision?

A

Giant cell arteritis

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6
Q

What is the management of giant cell arteritis?

A

Steroids
Temporal artery biopsy
Very high inflammatory markers

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7
Q

What common eye condition causes loss of peripheral vision?

A

Glaucoma

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8
Q

5 causes of gradual vision loss?

A 
Glaucoma
Cataracts
Macular degeneration 
Diabetic retinopathy
Increased intracranial pressure
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9
Q

What is phacoemulsification?

A

Fragmentation of lens fibres using ultrasound.

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10
Q

What is the most common type of glaucoma?

A

Chronic open angle glaucoma

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11
Q

What does the ‘angle’ refer to in glaucoma?

A

The angle between the posterior surface of the cornea and the anterior surface of the iris (iridocorneal angle)

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12
Q

What produces the aqueous in the eye?

A

Ciliary body

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13
Q

Where does aqueous leave the eye?

A
  • Trabecular meshwork in the angle

- Enters the episcleral veins

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14
Q

What is normal intraocular pressure?

A

<21mmHg

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15
Q

What is chronic open angle glaucoma?

A

Optic neuropathy where by there is an increase in IOP >21 mmHg, enlargement of the optic disc cup (loss of neurones) and progressive loss of visual field

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16
Q

What sort of vision is characteristic of open-angle glaucoma?

A

Tunnel vision (peripheral visual loss)

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17
Q

Which visual fields do arcuate scotomas begin in?

A

Superior or inferior

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18
Q

What is the 1st line treatment of glaucoma?

A

Topical ophthalmic prostaglandins eg lantanoprost

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19
Q

What classes of medications are used to treat glaucoma other than prostaglandins?

A

Beta-blockers eg timolol
Carbonic anhydrase inhibitors eg dorzolamide
Alpha-2 adrenergic agonists eg brimonidine

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20
Q

What surgical treatment is there for glaucoma?

A

Laser trabeculoplasty

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21
Q

At what part of the retina is visual acuity highest?

A

Macula

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22
Q

Where is the macula located?

A

3mm temporal to the optic disc

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23
Q

What are the 2 types of photoreceptors? Where are they located? What are they responsible for?

A

Rods - Peripheral vision, vision at low light levels (scotopic), not present in fovea centralis of macula
Cones - Central vision, high spatial acuity, vision at higher light levels (photopic vision). Found in the fovea centralis of macula

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24
Q

What 3 things does good visual acuity depend upon?

A
  • Functioning photoreceptors
  • Healthy retinal pigment epithelium
  • Perfusion of the capillary layer of the choroid (the choriocapillaris)
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25
What are drusen?
Yellow fatty lipid deposits (waste material from photoreceptors) which accumulates below the retinal pigment epithelium
26
What is the most common type of age related macular degeneration?
Dry AMD
27
What is the visual loss seen in dry AMD?
Central scotoma with good peripheral vision
28
What is the pathology of dry AMD?
Atrophy of the retinal pigment epithelium, choroid and photoreceptors in retina
29
What can be seen with opthalmoscope in patient with dry AMD?
Drusen and retinal pigment clumping /atrophy
30
What can be seen with opthalmoscope in a patient with wet AMD?
Macular drusen Choroidal neovascular membrane - loads of vessels Subrential or intraretinal haemorrhage
31
What percentage of AMD cases are wet AMD?
10%
32
What is the pathology of wet AMD?
New vessels in choroid are formed (choroidal neovascularisation) New vessels leak fluids, lipids and blood into layers behind retina Localised retinal detachment Retinal scarring
33
Visual loss in wet AMD?
Blurred vision Metamorphopsia - straight lines appear wavy Poor night vision Central visual loss
34
What does myopia mean? What type of lens is required to correct it?
Short sighted | Concave
35
What does hyperopia mean? What type of lens is required to correct it?
Long sighted | Convex
36
3 features of glaucoma
loss of visual fields cupping of optic disc intra ocular hypertension
37
Side effect of carbonic anhydrase?
Fatigue, dyspepsia | Pins and needles
38
What can make the intraocular pressure appear higher than it is?
Thick central cornea - some people are born with this
39
Treatment options for wet AMD?
Laser photocoagulation | Intravitreal anti-VEGF
40
What is the treatment of early dry AMD?
Nutritional therapy - high in antioxidants, carotenoids and omega 3 fatty acids.
41
What can be seen with opthalmoscope in a patient with diabetic retinopathy?
Microaneurysms cause weak cap walls which leak (hard exudates) and bleed (haemorrhages) causing ichaemic infarcts (Cotton wool spots) and neovascularisation
42
Differential diagnoses for causes of microaneurysms?
Diabetes Retinal vein occlusion Ocular ischaemia
43
What are the classifications of diabetic retinopathy in the UK?
Background Background/preproliferative Preproliferative Proliferative
44
What is the management of background diabetic retinopathy?
No treatment as not currently sight threatening Annual review Investigation of other organs that are affected by diabetes.
45
What area does the macular cover?
A circle whose radius is the distance from the foveola to the temporal edge of the optic disc.
46
What is diabetic maculopathy and are the causes of visual loss of diabetic maculopathy?
Leaky or blocked vessels in macula Macular oedema Foveal ischaemia Foveal haemorrhage
47
What are the treatment options for diabetic maculopathy?
Macular grid laser | Anti VEGF injections - ranibizumab
48
How do you determine the sites of leakage in diabetic maculopathy?
Flourescein angiography
49
What are the symptoms of diabetic retinopathy?
painless central visual loss | floaters
50
Symptoms of diabetic maculopathy
central visual loss - blurring of faces and words
51
Treatment options for proliferative retinopathy?
Laser photocoagulation Anti-VEGF injections Virectomy surgery
52
What muscle and nerve is responsible for pupillary constriction?
Pupillary constrictor muscle | Parasympathetic fibres on CN III
53
What neurotransmitter is involved in pupillary constriction? And which receptors does it bind to?
Acetylcholine | M3 muscarinic receptors
54
What muscle is responsible for pupillary dilation and what is it innervated by?
Dilator pupillae muscle | Sympathetic fibres carries to the eye via blood vessels
55
What neurotransmitter is involved in pupillary dilation and what receptors does it bind to?
Noradrenaline | Alpha 1 adrenergic receptors
56
What nucleus supplies the preganglionic parasympathetic fibres to the eye?
Edinger Westphal nucleus (CN III nucleus)
57
What are the 3 pupillary reflexes?
Reaction to light - constriction Reaction to dark - dilation Reaction to near target - convergence
58
What is anisocoria?
Pupils of different sizes
59
What does an afferent pupillary defect indicate there is a problem with?
Pupil or optic nerve
60
What does an efferent pupillary defect indicate there is a problem with?
CN III or sphincter muscle
61
What are the causes of rapid afferent pupillary defect (RAPD)?
Sudden: Retinal vein/artery occlusion, Retinal detachment, GCA Gradual: Glaucoma, Macular degeneration Other: Optic nerve damage eg trauma, radiation, tumour (anterior ischaemic optic neuropathy) Retinal disease Optic neuritis Retinal infection
62
If there was a problem with the retina in the right eye and RAPD was present, what would you expect to see?
Pupils equal before illumination Neither pupil constricts in response to illumination of right eye Both pupils constrict in response to illumination of left eye Appearance of right pupil dilating in response to light when illumination changes from left to right, when in actual fact the eyes are returning to normal state after left eye being illuminated.
63
If there was an efferent defect associated with a problem with the right eye, what would you expect to see?
Right pupil > left pupil Right eye will not response to illumination Left eye constricts in response to illumination from either eye.
64
Causes of anisocoria?
``` Horner's syndrome Adie's pupil (efferent defect) 3rd nerve palsy Drugs eg atropine/pilocarpine Iris damage eg glaucoma, iritis, surgery ```
65
Features of horner's syndrome?
Miosis Ptosis Anhidrosis Enophthalmos
66
Features of 3rd nerve palsy
Fixed dilated pupil Ptosis Eye deviated downwards and out (divergent eye)
67
What is miosis?
Constriction of pupil
68
Causes of horner's syndrome
Apical lung tumour eg pancoast tumour Thyroid surgery Internal carotid artery dissecting aneurysm Cavernous sinus and orbital disease
69
Test to confirm horner's syndrome
Cocaine test Cocaine prevents the reuptake of noradrenaline. It dilates the pupil in the normal eye, but eye affected by horner's syndrome fails to dilate.
70
Features of Adie's pupil?
Caused by parasympathetic denervation. Mydriasis (dilated pupil) Reduced accommodation (blurred vision when reading) Light near dissociation
71
What is important to exclude with 3rd nerve palsy?
Posterior communicating artery aneurysm
72
How is RAPD detected?
Swinging torch test
73
What are the 3 layers of the eyeball?
Sclera, Choroid, Retina
74
Which muscles are responsible for the focussing of the lens?
Ciliary muscles
75
Which muscles are responsible for the dilation and constriction of the iris?
Pupillary dilator and pupillary constrictor muscles
76
Which eye conditions are associated with rheumatoid arthritis?
Sjogren's Episcleritis/sceritis Anterior uveitis
77
What are the 4 symptoms of Horner's syndrome?
Ptosis Miosis Anhydrosis Enophthalmos
78
What tumour causes a bitemporal hemianopia?
Pituitary adenoma - pressing on the optic chiasm
79
What are the causes of Horner's syndrome?
Central: Stroke, MS Pre-ganglionic: Pancoast tumour Post-ganglionic: Carotid artery dissection
80
What are the most common cause of bacterial conjunctivitis?
Staph aureus Haeophilus influenza Staph pneumoniae
81
What antibiotics are used to treat conjunctivitis?
1st line: Chloramphenicol | 2nd line: Fusidic acid
82
Most common cause of keratitis (corneal ulceration)?
Non infectious eg dryness, contact lens injury
83
Most common infectious cause of keratitis?
HSV1
84
What are my 7 differentials for red eye?
``` Conjuntivitis Keratitis Episcleritis Scleritis Subconjunctival haemorrhage Anterior uveitis Acute closed-angle glaucoma ```
85
What is reiter's syndrome?
Conjunctivitis Urethritis Arthritis (reactive)
86
How does keratitis present?
Painful red eye Photophobia Watery eye Blurred vision
87
What investigation is specific for keratitis caused by HSV1?
Branching dendrite is seen on cornea when using Fluorescein and cobalt blue light
88
Presentation of episcleritis?
Can be asymptomatic | Mild pain, redness and irritation
89
How can you tell between episcleritis and scleritis?
Episcleritis - mild pain, vessels are mobile and blanch with phenylephrine drops Scleritis - Severe pain (patient will not let you touch eye) , vessel are not mobile, aderhent to globe and do NOT blanch with phenylephrine drops
90
How do you treat scleritis?
Oral NSAIDs Topical steroid drops Systemic immunosuppression (corticosteroids/cyclophosphamide)
91
How does subconjunctival haemorrhage present?
Harmless collection of blood under conjunctiva, looks a lot worse than it is
92
How does scleritis present?
Severe pain Blurred vision Photophobia Headache
93
What conditions is scleritis associated with?
Rheumatological disease eg RA, SLE, ank spond, GPA
94
What is a complication of scleritis?
Globe perforation
95
Which causes of red eye cause photophobia?
Keratitis Scleritis Anterior uveitis
96
How do you differentiate between keratitis and anterior uveitis?
The redness in anterior uveitis starts at the circumcorneal injection. The pupil may also appear irregular due to the iris sticking to the lens (posterior synechiae). Branching dendrite might be seen in keratitis when due to HSV1 Talbot's test is positive in anterior uveitis
97
What is Talbot’s test?
Pain increases as the eyes converge and pupils constrict (ask the patient to watch their finger approach their nose)
98
How do you treat anterior uveitis?
Steroid eye drops (decreases inflammation) | Cyclopentolate (dilates pupil and prevents iris sticking to lens)
99
What is the pathology behind acute closed-angle glaucoma?
Sudden rise in intra-ocular pressure due to lens pushing up against iris and preventing flow of aqueous humour (pupillary block) Closure of iridocorneal angle preventing drainage Raised intra-ocular pressure leads to fixed dilated pupil and axonal death
100
What is the presentation of acute closed-angle closure?
Extremely red and painful eye Nausea and vomiting Glare, halos around lights Blurred vision
101
What is the management of acute closed-angle glaucoma?
IV Carbonic anhydrase inhibitors eg acetazolamide Topical: B blockers eg timolol Steroids Mitotic eg pilocarpine (constricts pupil to open angle)
102
What investigations are used to diagnose acute closed-angle closure?
Fundoscopy Slit-lamp examination Tonometry Gonioscopy (measures angle)
103
What is seen in fundoscopy for acute closed-angle glaucoma?
Pale cupped optic disc
104
What are the 5 differentials for sudden loss of vision?
``` Central retinal artery occlusion Central retinal vein occlusion Retinal detachment Giant cell arteritis Amourosis Fugax ```
105
How do you differentiate between ischaumic and non-ischaemic retinal vein occlusion?
Fluorescein angiography
106
Complications of ischaemic central retinal vein occlusion
Neovascular glaucoma | Retinal detachment
107
Visual acuity is improved with pinhole when it is due to what cause?
Refractive error
108
What is seen on fundoscopy for central retinal artery occlusion?
Cherry red spot
109
What is the management of central retinal artery occlusion?
``` Occular massage (<100 mins) IV Acetazolamide ```
110
What is seen on funcodscopy for central retinal vein occlusion?
Widespread haemorrhages Swollen optic disc Stormy sunset appearance
111
What is the treatment of central retinal vein occlusion?
No treatment if non-ischaemic | Laser treatment if ischaemic
112
What are the complications of ischaemic central retinal vein occlusion?
Neovascular glaucoma | Retinal detachment
113
What is the presentation of retinal detachment?
Sudden loss of vision preceded by flashing lights, floaters and visual field defects
114
What are the risk factors for retinal detachment?
Trauma Diabetic retinopathy Myopic individuals Previous eye surgery
115
Which artery supplies the optic nerve?
Central retinal artery

phase 3b (15 decks)

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