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RW Year 6 > Ophthalmology > Flashcards

Ophthalmology Flashcards

1
Q

Sudden visual loss (unilateral, painless)

Decreased visual acuity

Dilated pupil (non-reactive)

Pale retina

Cherry-red spot

Diagnosis?

A

Central Retinal Arterial Occlusion (CRAO)

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2
Q

Tx of CRAO

A

Lower IOP

  • IV Acetazolamide
  • Anterior chamber paracentesis
  • Digital ocular massage

Vasodilation

  • Re-breathe into paper bag (increase CO2)

Emergency referral to Ophthal

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3
Q

Sudden visual loss (unilateral, painless)

Decreased visual acuity

Pale retina

A

Branch retinal arterial occlusion

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4
Q

How to tell which eye on fundoscopy?

A

Optic disc is always nasal!

Hold the picture up against their face!

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5
Q

Sudden visual loss (unilateral, painless)

Decreased visual acuity

Retinal haemorrhages (all quadrants)

+/- Neovascularisation

A

Complete retinal vein occlusion

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6
Q

Sudden visual loss (unilateral, painless)

Decreased visual acuity

Retinal haemorrhages confined to one area

+/- Neovascularisation

A

Branch retinal vein occlusion

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7
Q

Tx of CRVO

A

Monitoring for neovascularisation

+/- Laser pan-retinal photocoagulation

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8
Q

Optic pathway

A

Retina

Optic nerve

Optic chiasm

Optic tracts

Lateral Geniculate Nucleus

Optic radiations (Meyer’s loop and Baum’s loop)

Primary visual cortex

Extra-straiate cortex

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9
Q

Suprior quadrantanopia

Inferior quadrantopia

Lesion?

A

Tip: PITS (Parietal-Inferior, Temporal-Superior) for Pie in the Sky (PITS) = i.e. quadrantanopia

Superior quadrantanopia ==> Lesion of Temporal lobe

Inferior quadrantanopia ==> Lesion of Parietal lobe

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10
Q

Upper bitemporal hemianopia

vs Lower bitemporal hemianopia

A

Upper quadrant defect (> Lower) ==> Pituitary adenoma

Lower quadrant defect (> Upper) ==> Craniopharyngioma

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11
Q

Visual field defects

A
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12
Q

Monocular blindness

Lesion?

A

Proximal to optic chiasm

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13
Q

Homonymous hemianopia

Lesion?

A

Contralateral to visual defect (optic tract)

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14
Q

Homonymous hemianopia with macular sparing

A

Occipital cortex

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15
Q

Pupillary reflex pathway

A

AFFERENT

  • Rod/Cone photoreceptors –> Bipolar cells –> Retinal Ganglion cells
  • –> Exit the Optic Tract (BEFORE the Lateral Geniculate Nucleus)
  • –> Dorsal Brain Stem
  • Afferent pathway from each eye synapses on Edinger-Westphal nuclei on both sides of the brainstem
  • ∴ Light shone into either eye will elicit pupillary constriction for BOTH pupils to constrict

EFFERENT

  • Edinger-Westphal nuclei
  • –> Oculomotor nerve
  • –> Ciliary ganglion
  • –> Short posterior ciliary nerve
  • –> Pupillary sphincter
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16
Q

Pupillary reflex

R sided afferent defect

R sided efferent defect

R sided RAPD

A
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17
Q

Near response triad

A

Accommodation (ciliary muscle contracts –> reduce tension –> incr Len’s refractive power)

Miosis

Convergence

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18
Q

Washed out colours

Dimmed vision

Myopia

Loss of red reflex

A

Nuclear sclerosis cataracts (central)

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19
Q

Glares and Halos

Worsening visual acuity

Loss of red reflex

A

Cortical cataract (periphery)

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20
Q

Gradual loss of visual acuity

Washed out colour vision

Glare and Halos (worse at night)

Loss of red reflex / White pupil

DIagnosis? Treatment?

A

Conservative

  • Change in glasses prescription

Surgical

  • Extracapsular lens extraction
    • Manual extraction and phacoemulsification
      • ​with intraocular lens implant
  • Post-operative
    • Topical ABx
    • Topical steroids
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21
Q

Treatment for posterior capsule opacification

(“secondary cataract”)

A

YAG laser (make a hole in the capsule)

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22
Q

↑ intra-ocular pressure

Optic disc cupping

Notching of optic disc cup (diagnostic)

Visual field changes

Scotoma (early)

Peripheral field loss (late)

Diagnosis? Ix?

A

Open angle glaucoma

  • Ix:
    • Fundoscopy: optic disc cupping
    • Goldann tonometry: IOP > 21 mmHg (not required for diagnosis)
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23
Q

Tx for open angle glaucoma

A

(1) Topical eye drops (ABCpD)

  • Topical α2-blockers (Apraclonidine, Brimonidine)
  • Topical β-blocker (Timolol, Carteolol, Metipranolol, Betaxolol)
  • Topical carbonic anhydrase inhibitors (Brinzolamide, Dorzolamide)
  • Topical Prostaglandin analogue (Latanoprost, Travoprost, Bimatoprost)

If refractory –> Surgery

  • (2) Laser trabeculoplasty
  • (3) Trabeculectomy or Drainage tube or Sclerostomy or Viscocanalostomy
24
Q

Acute, painful red eye

Blurred vision

Halos

Headache

Fixed dilated pupil

Diagnosis? Ix?

A

Acute closed-angle glaucoma

Ix: Gonioscopy (closed angle)

25
Tx for acute closed-angle gluaoma
Acute * (1) **IV Acetazolamide** * _or_ Topical agents (ABC) * **α2 blockers** (Apraclonidine) * **β** **blockers** (Timolol) * **Carbonic anhydrase inhibitors** (Acetazolamide) * (2) IV Mannitol (20%) * (3) Anterior chamber paracentesis Once stable * (1) **Laser peripheral iridotomy** (in both eyes) * (2) Surgical iridectomy * (3) Lens extraction
26
DDx Haloes around lights
Cataracts Closed-angle glaucoma
27
Acute vs Closed angle glaucoma
28
**PMHx of Diabetes** (proliferative diabetic retinopathy) **Sudden, painless visual loss** **New-onset floaters** Diagnosis? Treatment?
**Vitreous haemorrhage** Management * **Watchful waiting** (resolves within weeks) * Once stable --\> **Laser photocoagulation**
29
**Acute onset, painless loss of _central_ vision**
Age-related macular degeneration
30
Characteristic changes in Dry and Wet AMD
**Dry AMD** (most common - 90%) * **Drusen** (yellow spots) = hall mark of age-related change **Wet AMD** * **Choroidal neovascularisation** * **Haemorrhage**
31
Tx of AMD
Dry ADM and early Wet AMD * **Conservative** (modify risk factors - stop smoking...etc) Advanced wet AMD * **Laser photocoagulation** * **Intravitreal injections of Anti-VEGF** End stage AMD * **Implantable lens** (focus light to functional part of remaining retina)
32
Diagnosis?
**Background diabetic retinopathy** ## Footnote **Microaneurysms (dots)** **Blot haemorrhages (blots)** **Hard exudates**
33
Diagnosis?
**Pre-proliferative diabetic retinopathy** **Cotton wool spots** (sign of ischaemia)
34
Diagnosis?
Proliferative diabetic retinopathy ## Footnote **Neovascularisation**
35
*Diagnosis?*
**Maculopathy** **Hard exudates at macula** SAME as background diabetic retinopathy But changes at the macula
36
Stages + Tx of diabetic retinopathy
37
Stages of hypertensive retinopathy
38
Diagnosis?
Grade 1 hypertensive retionpathy ## Footnote **Silvery wiring**
39
Diagnosis?
Grade 2 hypertensive retinopathy **AV nipping**
40
Diagnosis?
Grade 3 hypertensive retinopathy **Flame haemorrhages** **Cotton wool exudate**
41
**Floaters** **Flashing lights** **Weiss ring (shadow of floaters on retina)** No visual field loss Diagnosis? Complications?
**Posterior vitreous detachment** Complications = Retinal detachment (15%)
42
**Floaters** **Flashing lights** **Sudden onset, painless, visual field loss** Diagnosis? Ix? Tx?
**Retinal detachment** Ix: **Slit-lamp examination** (diagnostic) Tx: * **Surgical reattachment** * or **laser photocoagulation** * or **cryotherapy**
43
**Most common cause of inherited blindness** **Gradual onset** **Decreased visual acuity** **Decreased periphearl vision** Fundoscopy = **Black spindly lesions across retina** Diagnosis?
Retinitis pigmentosa
44
Changes in papilloedema
Symptoms * **Blurred vision** Signs * **Venous engorgement** * **Loss of venous pulsation** * **Blurring of optic disc margins** * **"Doughnut" shaped opacity**
45
Causes of RAFD
**MS (Optic neuritis)** - most common Severe glaucoma Trauma Tumour
46
Medical CN3 palsy vs Surgical CN3 palsy
Medical CN3 palsy * Causes = **Diabetes**, (Hypertension, Vasculitis, MS) * **Down and Out pupil** * **Normal pupil size** (pupil sparing) Surgical CN3 palsy * Causes * **PICA aneurysm** (para NS fibres on outside affected first), * Tumour * Cavernous sinus thrombosis (3, 4, V1, V2, 6) * **Down and Out pupil** * **Fixed, dilated pupil**
47
Complete vs Partial CN3 palsy
Complete CN3 palsy * Down and Out * Ptosis * Dilated pupil Partial CN3 palsy * Dilated pupil
48
CN4 nerve palsy Cause? Sx?
Cause = **_Trauma_** (longest intracranial course), Ischaemic, MS, SOL * **Vertical diplopia** * **Bielchowsky +ve** (worse when tilting to same side) * **Compensatory head tilt** (to OPPOSITE head of lesion) * Affected eye * **Deviates upwards and rotated outwards** * Unable to **move down** * Unable to **move to opposite direction in horizontal plane** (R or L) * Right 4th nerve palsy --\> inability to look Down and Left
49
CN6 palsy Cause? Sx?
Cause = **rasied ICP** (nerve is anchored so prone to stretch) * **Horizontal diplopia** * **Worse on abduction to affected side** e.g. R sided CN6 palsy Look Left * Left lateral rectus + Right medial rectus working * Both eyes look in same direction ∴ no double vision Look Right * Left medial rectus working (looks left) * Right lateral rectus NOT working (unable to abduct) * Eyes looking in different directions --\> double vision
50
Internuclear ophthalmoplegia - Cause, Sx
Cause = **MS** ==\> affecting **Medial Longitudinal Fasciculus** * **Horizontal diplopia** * **Failure of **_ad_**duction of ipsilateral (affected) eye** * **Abducting nystagmus of contralateral (normal) eye**
51
**Painful, red eye** **↓ visual acuity** **Photophobia** **Hypopyon** Diagnosis? Ix?
**Keratitis** (infection of cornea) *_Ix_*: Corneal scrapping --\> MC&S
52
**Acute onset, unilateral, swelling of conjunctiva and eyelids** **Periorbital oedema** **Pain/Tenderness around eye** **Fever** Diagnosis? Ix? Tx?
**Periorbital cellulitis** *_Ix_*: CT (Sinus, Orbit) with contrast IV Antibiotics +/- Incision and Drainage of Abscess
53
**Painful red eye** **Photophobia** **Synechiae** **Flare** **Ciliary flush** **Hypopyon** **Keratic precipiates** Diagnosis?
Anterior uveitis
54
**Painless ↓ vision acuity** **Floaters** **Changes in colour vision** **Retinal exudates and haemorrhages** NO PAIN Diagnosis?
Posterior uveitis
55
**Bacterial and Viral conjunctivitis** Most common causes Presentation Tx
Bacterial conjunctivitis (Neisseria gonorrhoea, Chlamydia) * **Purulent discharge** * **Unilateral** * Eyelids stuck together in morning Viral conjunctivitis (adenovirus) * **Watery discharge** * **Bilateral** (highly infectious) * Eyelids stuck together in morning Tx * Artificial tears * Bacterial * Topical Abx * Viral * Topical anti-histamines * +/- Topical corticosteroids * +/- Topical ganciclovir

RW Year 6 (13 decks)

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