Ophthalmology Flashcards

Question

Causes of papilloedema

Answer 1

``` Space-occupying lesion: neoplastic, vascular Malignant hypertension Idiopathic intracranial hypertension Hydrocephalus Hypercapnia ```

Answer 2

Cataracts = Age related opacification of the lens Most commonc ause of visual impairment with 30% of >65yo having acuity (Snellen <6/12 - needed for driving) ``` Normal ageing process = most common Smoking Increased alcohol consumption Trauma Diabetes mellitus Long-term corticosteroids Radiation exposure Myotonic dystrophy Metabolic disorders: hypocalcaemia ``` Classification Nuclear: change lens refractive index, common in old age Polar: localized, commonly inherited, lie in the visual axis Subcapsular: due to steroid use, just deep to the lens capsule, in the visual axis Dot opacities: common in normal lenses, also seen in diabetes and myotonic dystrophy

Answer 3

Inflammation of the eyelid margins. Cause It may due to either meibomian gland dysfunction (common, posterior blepharitis) or seborrhoeic dermatitis/staphylococcal infection (less common, anterior blepharitis). Blepharitis is also more common in patients with rosacea The meibomian glands secrete oil on to the eye surface to prevent rapid evaporation of the tear film. Any problem affecting the meibomian glands (as in blepharitis) can hence cause drying of the eyes which in turns leads to irritation Features Symptoms are usually bilateral Srittiness and discomfort, particularly around the eyelid margins Eyes may be sticky in the morning Eyelid margins may be red. Swollen eyelids may be seen in staphylococcal blepharitis Styes and chalazions are more common in patients with blepharitis Secondary conjunctivitis may occur Management Softening of the lid margin using hot compresses twice a day Mechanical removal of the debris from lid margins - cotton wool buds dipped in a mixture of cooled boiled water and baby shampoo is often used* Artificial tears may be given for symptom relief in people with dry eyes or an abnormal tear film

Answer 4

Inflammation below conjunctivae in the episclera Presentation - Red eye - Classically not painful (in comparison to scleritis), but mild pain may be present - Watering and mild photophobia may be present Phenylephrine drops may be used to differentiate between episcleritis and scleritis. Phenylephrine blanches the conjunctival and episcleral vessels but not the scleral vessels. If the eye redness improves after phenylephrine a diagnosis of episcleritis can be made Approximately 50% of cases are bilateral. Management - Conservative - topical/systemic NSAIDs - Artificial tears may sometimes be used

Answer 5

``` Risk factors Diabetes Trauma Anticoagulants Coagulation disorders Severe short sightedness ``` Patients typically present with an acute or subacute onset of: painless visual loss or haze (commonest) red hue in the vision floaters or shadows/dark spots in the vision - cobwebs Signs: decreased visual acuity: variable depending on the location, size and degree of vitreous haemorrhage visual field defect if severe haemorrhage

Answer 6

Mild NPDR 1 or more microaneurysm ``` Moderate NPDR microaneurysms blot haemorrhages hard exudates cotton wool spots, venous beading/looping and intraretinal microvascular abnormalities (IRMA) less severe than in severe NPDR ``` Severe NPDR blot haemorrhages and microaneurysms in 4 quadrants venous beading in at least 2 quadrants IRMA in at least 1 quadrant Proliferative retinopathy retinal neovascularisation - may lead to vitrous haemorrhage fibrous tissue forming anterior to retinal disc more common in Type I DM, 50% blind in 5 years

Answer 7

Aqueous humour produced by ciliary body and is present between cornea and iris (anterior compartment) Ciliary body produces it and it flows into the anterior chamber and then it drains via the trabecular meshwork and canal of Schlemm

Answer 8

Occulomotor (3rd CN): MR, IO, SR, IR Abducens (6th CN): Lateral rectus Trochlear (4th CN): Superior oblique

Answer 9

Group of eye diseases that cause progressive optic neuropathy, and in which intraocular pressure (IOP) is a key modifiable factor. Glaucoma is commonly associated with raised IOP and is characterized by: Visual field defects. Changes to the optic nerve head such as pathological cupping or, as a late sign, pallor of the optic disc.

Answer 10

Fundoscopy 1) Tortuous dilated vessels 2) Diffuse haemorrhages 3) Cotton wool spots Clinical symptoms - Painless sudden loss of vision in eye Complications - Glaucoma - Neovascularisation Investigations - Medical History - BP measurement - Serum glucose estimation - Request laboratory investigations for FBC and ESR

Answer 11

Symptoms - Gradual loss of central vision in dry - Rapid visual decline (sudden/days/weeks) in wet Commonest cause of vision loss in elderly in developed world - PAINLESS Fundoscopy: - DRY ARMD (90%): Drusen (fluffy white spots around macula) - WET ARMD: Aberrant vessels grow into the retina from corrhoid --> haemorrhage --> scarring.AMSLER grid detects distortions Risk factors - Age - Smoking - FH - IHD risk factors Management Age related macular degeneration Drusen: fluffy white spots around macula Painless central vision loss Management: - Dry ARMD: zinc with anti-oxidant vitamins A,C and E reduced progression of the disease by around one third. - Wet ARMD: anti-VEGF agents include ranibizumab, bevacizumab and pegaptanib,. The agents are usually administered by 4 weekly injection

Answer 12

Common - Diabetic retinopathy - ARMD - Cataracts - POAG Less common - Retinitis pigmentosa - HTN - Optic atrophy

Answer 13

peripheral retina pigmentation that spares the macula = Inherited degeneration of macula (mostly AR) Tunnel visison; Night blindness Leads to blindness – usually <30 Fundoscopy - Pale disc: Optic atrophy - Peripheral retina pigmentation spares the maula (bone spicule deposition Management = Isn't any but - High dose vitamin A supplementation may slow progress

Answer 14

Symptoms - Increasing myopia - Blurred vision --> gradual visual loss (PAINLESS) - Dazzling in sunshine/bright lights - Monocular diplopia Conservative - initially correctible - Glasses - Mydriatic drops + sunglasses may provide relief Surgery - eventually will be needed NICE suggests that referral for surgery should be dependent upon whether a visual impairment is present, impact on quality of life, and patient choice. Also whether both eyes are affected and the possible risks and benefits of surgery should be taken into account. Prior to cataract surgery, patients should be provided with information on the refractive implications of various types of intraocular lenses. After cataract surgery, patients should be advised on the use of eye drops and eyewear, what to do if vision changes and the management of other ocular problems. Cataract surgery has a high success rate with 85-90% of patients achieving 6/12 corrected vision (on a Snellen chart) postoperatively. = Day case phaecoemulsion + lens implant Complications of cataract surgery (Only 1%) Posterior capsule opacification: thickening of the lens capsule - Rx with laser capsulotomy (easy) Retinal detachment Posterior capsule rupture Endophthalmitis: inflammation of aqueous and/or vitreous humour --> Blindness in 0.1%

Answer 15

Retinal detachment Holes/tears in retina allow fluid to separate sensory retina from retinal pigmented epithelium ``` 4 F’s 1) Floaters 2) Flashes 3) Field loss (painless and progressive) 4) Fall in acuity Dense shadow that starts peripherally progresses towards the central vision; A veil or curtain over the field of vision; STRAIGHT LINES APPEAR CURVED; Central visual loss ``` Fundus Grey, opalescent retina, ballooning forwards Management Urgent surgery

Answer 16

Fundoscopy: Pale retina + cherry red macula Presentation Unilateral visual loss in seconds Afferent pupil Causes GCA Thromboembolism: clot, infective, tumour Management - Ocular massage - Surgical removal of aqueous +/- acetozolamide - Anti hypertensives (local and systemic)

Answer 17

Result of an infection affecting the fat and muscles posterior to the orbital septum, within the orbit but NOT INVOLVING THE GLOBE. Cause Usually spreading URTI from the sinuses and carries a high mortality rate. Orbital cellulitis is a medical emergency requiring hospital admission and urgent senior review. Periorbital (preseptal) cellulitis is a less serious superficial infection anterior to the orbital septum, resulting from a superficial tissue injury (chalazion, insect bite etc...). Periorbital cellulitis can progress to orbital cellulitis. Epidemiology Mean age of hospitalisation 7-12 years. Risk factors - Childhood - Previous sinus infection - Lack of Haemophilus influenzae type b (Hib) vaccination Recent eyelid infection/ insect bite on eyelid (Peri-orbital cellulitis) - Ear or facial infection Presentation - Redness and swelling around the eye - Severe ocular pain - Visual disturbance - Proptosis - Ophthalmoplegia/pain with eye movements - Eyelid oedema and ptosis - Drowsiness +/- Nausea/vomiting in meningeal involvement (Rare) Differentiating orbital from preseptal cellulitis Reduced visual acuity, proptosis, ophthalmoplegia/pain with eye movements are NOT consistent with preseptal cellulitis Investigations - Full blood count – WBC elevated, raised inflammatory markers. - Clinical examination involving complete ophthalmological assessment – Decreased vision, afferent pupillary defect, proptosis, dysmotility, oedema, erythema. - CT with contrast – Inflammation of the orbital tissues deep to the septum, sinusitis. - Blood culture and microbiological swab to determine the organism. Most common bacterial causes – Streptococcus, Staphylococcus aureus, Haemophilus influenzae B. Management admission to hospital for IV antibiotic Complications - Blindness due to optic N pressure - Local extension --> meningitis and cavernous sinus thrombosis

Answer 18

Oculomotor but also sympathetic fibres

Answer 19

aka Wallenberg Occlusion of inferior cerebellar artery (supplies lateral part of medulla) Presentation 1) Acute syncope 2) Ipsilareral - Ataxia - Nystagmus - Dysphagia - Loss of pain and temperature sensation in face 3) Contralateral - Loss of pain and temperature sensation in limbs/trunk

Answer 20

Features - Young F sudden blurring of near vision - Initially unilateral and then bilateral pupil dilation (dilated has no response to light and sluggish to accommodation) - A "tonic" pupil Ix - Iris shows wormy movements on slit lamp exam Cause - Damage to post ganglionic parasympathetic fibres - Idiopathic: May have viral origin Holmes adie syndrome Tonic pupil + absent knee/ankle jerks and reduced BP

Answer 21

Features - Small, irregular pupils - Accommodate but doesn't react to light - Atrophied and depigmented iris Cause - DM - Quaternary syphilis

Answer 22

Vasculitis of the sclera Presentation - Generalised scleral inflammation - VESSELS DON'T MOVE OVER SCLERA - Severe pain, worse on eye movement - Conjunctival oedema Causes - SLE - RA - Vasculitis - Wegener's Management - Refere to specialist - Most need corticosteroids or immunosuppressants

Answer 23

Hyphema (blood in the anterior chamber of the eye) - especially in the context of trauma warrants urgent referral to an ophthalmic specialist for assessment and management. The main risk to sight comes from raised intraocular pressure which can develop due to the blockage of the angle and trabecular meshwork with erythrocytes. i.e. GLAUCOMA RISK Strict bed rest is required as excessive movement can redisperse blood that had previously settled; therefore high-risk cases are often admitted. Even isolated hyphema will require daily ophthalmic review and pressure checks initially as an outpatient

Answer 24

Herpes zoster ophthalmicus (HZO) describes the reactivation of the varicella-zoster virus in the area supplied by the ophthalmic division of the trigeminal nerve. It accounts for around 10% of case of shingles. Features vesicular rash around the eye, which may or may not involve the actual eye itself Hutchinson's sign: rash on the tip or side of the nose. Indicates nasociliary involvement and is a strong risk factor for ocular involvement Management oral antiviral treatment for 7-10 days ideally started within 72 hours intravenous antivirals may be given for very severe infection or if the patient is immunocompromised topical antiviral treatment is not given in HZO topical corticosteroids may be used to treat any secondary inflammation of the eye ocular involvement requires urgent ophthalmology review Complications ocular: conjunctivitis, keratitis, episcleritis, anterior uveitis ptosis post-herpetic neuralgia

Ophthalmology Flashcards

(48 cards)