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Phase 3b > Ophthalmology > Flashcards

Ophthalmology Flashcards

(162 cards)

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1
Q

What are the differential diagnosis for a painless red eye?

A

Conjunctivitis
Episcleritis
Subconjunctival haemorrhage

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2
Q

What are the differential diagnosis for a painful red eye?

A 
Glaucoma
Anterior uveitis
Scleritis
Corneal abrasions or ulceration
Keratitis
Foreign body
Traumatic or chemical body
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3
Q

What are the red flags for a red eye?

A

Impaired vision
Pain/photophobia
Lack of ocular discharge

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4
Q

Define conjunctivitis

A

Inflammation and redness of the conjunctiva

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5
Q

Symptoms of conjunctivitis

A 
Red eyes
Unilateral or bilateral 
Vision unaffected
Bloodshot
Itchy or gritty sensation
Discharge from the eye
Does not cause pain, photophobia or reduced visual acuity
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6
Q

Symptoms of bacterial conjunctivitis

A 
Purulent discharge -> pus
Eye may be stuck together in the morning
Highly contagious
Starts in one eye and spreads to other
Papillae
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7
Q

What are the causative organisms for bacterial conjunctivitis?

A

Staphylococcus
Streptococcus
Haemophilus
Neisseria

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8
Q

Symptoms for viral conjunctivitis

A

Clear discharge (serous)
Dry cough, sore throat, blocked nose
Preauricular lymph nodes (in front of ears)
Recent URTI

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9
Q

Commonest cause of viral conjunctivitis?

A

Adenovirus -> causes follicles

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10
Q

What type of hypersensitivity is allergic conjunctivis?

A

Type 1 hypersensitivity

Caused by contact with allergens

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11
Q

Symptoms of allergic conjunctivitis

A

Most frequent type of conjunctivitis
Watery discharge - serous
Itch
Caused by contact with allergens

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12
Q

Treatment for allergic conjunctivitis

A

Antihistamines (oral or topical) used to reduce symptoms

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13
Q

Treatment for bacterial conjunctivitis

A

Chloramphenicol

Fuscidic acid

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14
Q

General treatment for conjunctivitis

A

Reassurance (resolves after 1-2 weeks)

Good hygiene

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15
Q

Define ophthalmia neonatorum

A

Conjunctivitis in the first 3 weeks of life

Purulent discharge

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16
Q

Causes of ophthalmia neonatorum

A

Chlamydia
Herpes simplex
Gonorrhoea
Staphylococcus/streptococcus

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17
Q

Treatment for chlamydia

A

Erythromycin

Azithromycin

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18
Q

Treatment for gonorrohoea

A

Cefotaxime and chloramphenicol

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19
Q

Define episcleritis

A

Thin vascular layer between sclera and conjunctiva

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20
Q

Symptoms of episcleritis

A 
Common, benign
Acute onset
Unilateral (bilateral in 30%)
Typically not painful
Segmental redness
Dilated episcleral vessels
Watering of eye
No discharge
Visual acuity is normal
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21
Q

Treatment for episcleritis

A

Self-limiting and will recover in 1-4 weeks
Artificial tears
Topical or systemic NSAIDs (e.g. naproxen)

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22
Q

Define subconjunctival haemorrhage

A

Small blood vessel within the conjunctiva ruptures and releases blood into the space between the sclera and the conjunctiva

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23
Q

When is a subconjunctival haemorrhage likely to occur?

A

After episodes of strenous activity such as heavy coughing, weight lifting or straining when constipated

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24
Q

Causes of subconjunctival haemorrhage

A

Hypertension
Whooping cough
Trauma
Medications (Warfarin, NOAC’s antiplatelets)
Bleeding disorders (e.g. thrombocytopenia)

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25
Symptoms of subconjunctival haemorrhage
Sudden onset Painless - does not affect vision Bright red covering white section
26
Management of subconjunctival haemorrhage
Resolves spontaneously roughly two weeks
27
Define scleritis
Inflammation of the full thickness of the sclera More serious than episcleritis Rare
28
What is the most serious type of scleritis?
Necrotising scleritis | Can cause visual impairment and perforation of the sclera
29
What conditions are associated with scleritis?
``` Rheumatoid arthritis SLE Inflammatory bowel disease Sarcoidosis Wegener's granulomatosis ```
30
Symptoms of scleritis
``` Constant, severe dull ache Severe pain Pain with eye movement Eye watering -> no discharge Photophobia Reduced visual acuity Headache Abnormal pupil reaction to light Tenderness to palpation of the eye ```
31
Management of scleritis
Urgent referral within 24 hours Oral NSAIDs Oral high-dose prednisolone Treat underlying condition - Methotrexate for rheumatoid arthritis
32
Define anterior uveitis (iritis)
Inflammation in the anterior uvea (comprises the iris and ciliary body) Posterior uvea contains the choroid (inflammation here is termed choroiditis)
33
Causes of anterior uveitis
``` Ankylosing spondylitis Inflammatory bowel disease Reactive arthritis Sarcoidosis Syphilis Lyme disease TB Herpes simplex Behcet's disease ```
34
Symptoms of anterior uveitis
``` Unilateral Dull, aching painful red eye Ciliary flush (ring of red spreading from the cornea outwards) Reduced visual acuity - blurred vision Photophobia Pain on movement Lacrimation (excessive tear production) Floaters and flashes Miosis (constricted pupil) Abnormally shaped pupil due to posterior synechiae (adhesions) ```
35
Questions to ask when suspecting anterior uveitis?
``` Headaches Mouth ulcers (Behcet's disease) Joint problems Chest and skin disease GU symptoms ```
36
Investigations for anterior uveitis
Slit lamp with dilated pupil to visualise inflammatory cells (leucocytes), measure IOP too Fundus fluorescein and indocyanide green-angiography
37
Treatment for anterior uveitis
Urgent same day referral to ophthalmologist Topical prednisolone Cyclopentolate or atropine -> to dilate the pupil DMARDs or TNF inhibitors for immunosuppression Laser therapy/surgery (vitrectomy) in severe cases
38
Define keratitis
Inflammation of the cornea
39
Causes of keratitis
``` Viral = herpes simplex Bacterial = psuedomonas or staphylococcus Fungal = candida or aspergillus ```
40
Symptoms of herpes simplex keratitis
``` Painful red eye Photophobia Vesicles around the eye Watery discharge Foreign body sensation Reduced visual acuity ```
41
Investigations for viral keratitis
Staining with fluorescein - shows dendritic corneal ulcer Slit lamp examination Corneal swabs or scrapings
42
Management for viral keratitis
Same day urgent referral to ophthalmologist Aciclovir (topical or oral) Don't use steroids without expert opinion
43
Symptoms of bacterial keratitis
Painful red eye Loss of vision Signs: Hazy cornea with central abscess
44
Management of bacterial keratitis
Requires specialist | Intense antibiotics
45
Define corneal abrasions
Scratches or damage to the cornea
46
Causes of corneal abrasions
``` Contact lenses - may have psuedomonas infection Foreign bodies Finger nails Eyelashes Entropian (inward turning eyelid) ```
47
Symptoms of corneal abrasions
``` History of contact lenses/foreign body Painful red eye Foreign body sensation Watering eye Blurring vision Photophobia ```
48
Investigations for corneal abrasions
Staining with fluorescein -> yellow/orange colour | Slit lamp examination
49
Management for corneal abrasions
``` Same day referral to ophthalmologist Analgesia - paracetamol Lubricating eye drops Antibiotic eye drops - chloramphenicol Cyclopentolate eye drops - dilate pupil and improves photophobia ``` Usually heal over 2-3 days
50
Define keratoconjunctivitis sicca
Dry eyes
51
What are the components of tears?
``` Watery layer (main, middle) - lacrimal glands Oily layer (thin outer) - meibomian glands Mucus layer (inner) - conjunctiva ```
52
Causes of dry eyes
Old age Medications (beta blockers, antihistamines, antidep, diuretics) Systemic illness (RA, sarcoidosis, Sjogren's) Blepharitis (decreased tear production) Allergic conjunctivitis Increased evapouration
53
Symptoms of dry eyes
Irritation Sight blurring Photophobia - discomfort when looking at bright lights
54
Investigations for dry eyes
Schirmer's test - strip of filter paper Slit lamp Assessment of corneal damage - fluorescein stain
55
Treatment for dry eyes
Artificial tears Drops Gels
56
Define blepharitis
Inflammation of the eyelids
57
Symptoms of blepharitis
``` Gritty, irritable eyes Itching Dry sensation Loss of eyelashes Thick, red, inflamed eyelids Watery discharge ```
58
What can blepharitis lead to?
Styes and chalazions
59
Treatment for blepharitis
Eyelid hygiene - baby shampoo Oral antibiotics - erythromycin Hot spoon bathing Lubricants
60
What are the two types of styes?
Hordeolum externum - Staphylococcus infection of the glands of Zeis or gland of Moll. Can cause tender red lump along the eyelid that may contain pus Hordeolum internum - Infection of Meibomian glands. They are deeper, tend to be more painful and may point inwards
61
Management of styes
Hot compression | Analgesia
62
Define Chalazion
Occurs when a Meibomian gland (may develop from hordeolum internum) becomes blocked and swells It is typically not tender and hard
63
Management of Chalazion
Hot compression | Consider topic antibiotics (Chloramphenicol) if inflamed
64
Define entropian
The eyelid (usually lower lid) turns inwards with the lashes against the eyeball
65
Management for an entropian
Tape the eyelid down | Definitive treatment is with surgical intervention
66
Define ectropian
Outward turning of the eyelid, with the inner aspect of the eyelid exposed It usually affects the bottom eyelid
67
Symptoms of an ectropian
Watering Exposure keratitis Eye irritation
68
Associations with an ectropian
Old age | Facial palsy
69
Management of an ectropian
Lubricating eye drops | Surgical correction
70
Define trichiasis
Inward growth of the eyelashes
71
Symptoms of trichiasis
Pain, corneal damage and ulceration
72
Management of trichiasis
Remove eyelash - epilation | Recurrent cases - electrolysis, cryotherapy, laser treatment
73
Define acute closed-angle glaucoma
Optic nerve damage as a result of a raised intraocular pressure. This raised IOP is caused by a blockage in aqueous humour trying to escape the eye. Aqueous has to escape through the lens and the cornea, when the iris comes into contact with the lens the humour cannot pass through. Fluid and pressure then builds up the in the posterior chamber Acute closed-angle glaucoma is an ophthalmology emergency
74
What is a raised intraocular pressure?
>30 mmHg | Normal = 10-21 mmHg
75
Risk factors for acute closed-angle glaucoma
``` Increasing age (40-60 years old) Female 4x more likely Family history Chinese and Asian Medications (Adrenergic - noradrenalin, anticholinergic - oxybutynin, tricyclic antidepressants - amitryptyline) ```
76
Symptoms of acute closed-angle glaucoma
``` Headache Nausea and vomiting Painful red eye Halos around lights Blurred vision Decreased visual acuity Dilated pupil Photophobia ```
77
Investigations for acute closed-angle glaucoma
Slit lamp - large cup and nerve fibre loss Static perimetry - visual field loss Gonioscopy - trabecular meshwork not visible
78
Treatment for acute closed-angle glaucoma
Pilocarpine drops - constrict the pupil Acetazolamide (carbonic anhydrase inhibitor) - reduces the production of aqueous humour Timolol (beta blocker) - suppress aqueous humour production Mannitol Laser iridotomy - piece of iris removed - definitive, prevents recurrence
79
Define open angle glaucoma
A gradual increase in resistance through the trabecular meshwork - difficult for aqueous humour to flow through. Pressure slowly builds. Slow and chronic onset. Increased pressure causes a cupping of the optic disc. A small indent in the optic disc. An optic cup greater than 0.5 the size of the optic disc is abnormal.
80
Risk factors for open angle glaucoma
``` Increasing age Family history Black ethnicity Nearsightedness Hypertension Diabetes ```
81
Symptoms of open angle glaucoma
``` Often asymptomatic Peripheral vision lost first -> tunnel vision then lost Fluctuating pain Headaches Blurred vision Halos appearing around lights ```
82
Triad for open angle glaucoma
``` Raised IOP (>21 mmHg) Abnormal disc - cup:disc ratio asymmetry - severe cupping Visual field defect ```
83
Investigations for open angle glaucoma
Goldmann applanation tonometry - measures IOP Fundoscopy - checks optic disc cupping and optic nerve health Visual field assessment
84
Management for open angle glaucoma
Prostaglandin analogues e.g. Latanoprost - 1st line Beta blockers e.g. Timolol Carbonic anhydrase inhibitors e.g. Dorzolamide Alpha agonists e.g. Brimonidine Laser therapy - trabeculoplasty
85
What prostaglandin analogues do? and their side effects?
Increase uveoscleral outflow | SE: eyelash growth, iris pigmentation, bronchospasm
86
What do beta blockers do, side effects and contraindications?
Block production of aqueous humour SE: dry eyes, bronchospasm, bradycardia, heart block, hyptension CI: Asthma/COPD, Heart failure
87
What do carbonic anhydrase inhibitors do, side effects and contraindications?
Reduce production of aqueous humour SE: Burning/tearing, blepharoconjunctivitis CI: Renal/liver failure
88
What do alpha agonists do?
Reduce production of aqeuous humour and increase uveoscleral outflow
89
Define cataract
When the lens in the eye becomes cloudy and opaque
90
Risk factors for a cataract
``` Increasing age Smoking Alcohol Diabetes Steroid use Hypocalcaemia ```
91
What are different types of cataracts?
Nuclear Cortical Posterior subcapsular
92
Symptoms of a cataract
``` Asymmetrical Blurred vision - diplopia Reduction in vision - reduced acuity Colours become more yellow/brown 'Starbursts' can appear around lights Loss of red reflex White colour of pupil (leucocoria) ```
93
Management for a cataract
Cataract surgery - day case, under local anaesthetic | Process of phacoemulsification, an intraocular lens implant and removal of the current lens
94
Complications for cataracts
Endophthalmitis - red, painful, loss of vision/eye itself | Treat with intravitreal antibiotics
95
Define age related macular degeneration (ARMD)
Degeneration in the macular Drusen and sometimes blood is found at the macula during fundoscopy Chief cause of registrable blindness
96
Risk factors for age related macular degeneration
``` Increasing age Smoking Cardiovascular disease Family history White or chinese ethnicity ```
97
What are the four layers of the macula?
Photoreceptors Retinal pigment epithelium Bruch's membrane Choroid layer
98
What degeneration occurs to the macula in both wet and dry ARMD?
Drusen - between retinal pigment epithelium and Bruch's membrane Atrophy of retinal pigment epithelium Degeneration of the photoreceptors
99
Symptoms of ARMD
Reduced visual acuity Gradual worsening central visual field loss Visual fluctuation Metamorphopsia (distortion of visual images) Wavy appearance to straight lines
100
Symptoms of wet ARMD
``` Presents more acutely Development of new vessels Loss of vision over days -> progresses to full vision loss over 2/3 years Progress to bilateral disease Distortion Linked with VEGF ```
101
Define dry ARMD
Much slower (over decades)
102
Investigations for ARMD
Snellen chart - reduced acuity Scotoma Fundoscopy - drusen Slit lamp
103
Investigations for a wet ARMD
Optical coherence tomography - diagnoses wet ARMD | Fluorescien angiography
104
Management for wet ARMD
VEGF inhibitors - decrease formation of new blood vessels, increase acuity. E.g. bevacizumab, ranibizumab Stop smoking Diet rich in green vegetables PHotodynamic laser therapy
105
Management for dry ARMD
``` Vitamin supplementation (Vit A/E/zinc) Stop smoking ```
106
Define myopia
``` Short sight The eyeball is too long, only close objects focus the retina Genetic causes (chromosome 18p and 12q) Treatment = concave contact lenses ```
107
Define hypermetropia
Long sight The eye is too short Corrected with convex lens
108
Define retinal vein occlusion
Less sudden visual loss than retinal artery occlusion Much more common than retinal artery occlusion Occlusion occurs when a blood clot forms in the retinal veins and blocks off the drainage of blood Causes macular oedema and retinal haemorrhage Also the release of VEGF - formation of new blood vessels
109
Risk factors for retinal vein occlusion
``` Incidence increases with age Hypertension High cholesterol Diabetes Smoking Glaucoma SLE ```
110
Central retinal vein occlusion symptoms
Sudden onset Painless blurred vision in one eye Never asymptomatic Blood spread out and not as dark
111
Branch retinal vein occlusion symptoms
Can be asymptomatic Blurring of vision Blood concentrated in one area (that branch vein)
112
Investigations for retinal vein occlusions
Fundoscopy - flame and blot haemorrhages, macular oedema, optic disc oedema Fluoresein angiography BP - for hypertension
113
Treatment for retinal vein occlusions
Immediate referral to ophthalmologist VEGF inhibitors - ranibizumab, bevacizumab Laser photocoagulation Intravitreal steroids - dexamethasone implants
114
Define central retinal artery occlusion
Visual loss within seconds Occurs when something blocks the flow of blood through the central retinal artery Less common than retinal vein occlusion
115
Risk factors for central retinal artery occlusion
``` Atherosclerosis Old age Family history Smoking Alcohol Hypertension Diabetes Poor diet - cholesterol Obesity/inactivity ```
116
Symptoms of central retinal artery occlusion
Sudden painless loss of vision Total loss of vision = central retinal artery Top half or bottom half visual loss = branch retinal artery Afferent pupillary defect
117
Investigations for central retinal artery occlusion
Fundoscopy - pale, white retina. Cherry red spot at the macula, thin retinal arteries
118
Treatment for central retinal artery occlusion
``` Immediate referral to ophthalmologist Ocular massage Removal of fluid to reduce IOP Inhaling carbogen - to dilate the artery Sublingual isosorbide dinitrate - to dilate the artery ```
119
Long term management for central retinal artery occlusion
Treat risk factors: stop smoking cholesterol Hypertension
120
Define giant cell arteritis
Medium to large vessel systemic vasculitis (rupture or stenosis of blood vessels) Typically seen in patients >70 years old Rapid onset e.g. <1 month
121
Symptoms of giant cell arteritis
Headache Jaw claudication (chewing pain) Scalp and temporal artery tenderness (when combing hair) Neck pain Sudden blindness, typically in one eye -> amaurosis fugax Hip and shoulder morning stiffness (polymyalgia rheumatica)
122
Investigations for giant cell arteritis
ESR >50 mm/hr CRP raised Temporal artery biopsy - shows skip lesions - do within one week of starting prednisolone
123
Treatment for giant cell arteritis
Prednisolone (60mg) - high dose for two years
124
Define optic neuritis
Unilateral loss of acuity occurs over hours or days Colour vision is affected (dyschromatopsia): red appears less red Eye movements hurt Afferent defect Associated with multiple sclerosis
125
Treatment for optic neuritis
High-dose methylprednisolone (then prednisolone) | Full recovery over 2-8 weeks
126
Define retinal detachment
Where the retina separates from the choroid underneath, this is usually due to a retinal tear that allows vitreous fluid to get under the retina and fill the space between the retina and the choroid Sight threatening emergency The outer retina relies on the blood vessels of the choroid for its blood supply
127
Risk factors for retinal detachment
``` Trauma to the eye Posterior vitreous detachment Diabetic retinopathy Retinal malignancy Older age Family history ```
128
Symptoms of retinal detachment
4 F's: Flashes and floaters (vitreous haemorrhage), Field loss (blurred or distorted vision), fall in acuity (peripheral vision loss) - like a shadow coming across
129
Management of retinal detachment
Virectomy (removal of vitreous fluid) Scleral buckling Pneumatic retinopathy Management of retinal tears: Laser therapy, cyrotherapy
130
Define vitreous haemorrhage
Arises from: retinal neovascularization (diabetes & retinal vein occlusions), retinal tears, retinal detachment, trauma
131
Symptoms of vitreous haemorrhage
``` Vitreous floaters (small bleeds) - small black dots Sudden vision loss in large bleeds ```
132
Investigations for vitreous haemorrhage
B-scan US | Ophthalmoscopy
133
Treatment for vitreous haemorrhage
Virectomy - removes blood
134
Define posterior vitreous detachment
The vitreous body is the gel which keeps the retina pressed on the choroid. With age it becomes less firm and less able to maintain its shape. Posterior vitreous detachment is where the gel comes away from the retina Common in the elderly
135
Symptoms of posterior vitreous detachment
Painless Flashing lights (photopsia) in peripheral vision Floaters - in temporal side of vision Spots of vision loss
136
Management for posterior vitreous detachment
Over time symptoms improve | Can cause retinal tears and detachment
137
Define retinal pigmentosa
Congenital inherited condition where there is degeneration of the rods and cones in the retina Rods degenerate more than cones, leading to night blindness Onset 10-30 years old
138
What time of inheritance is retinal pigmentosa?
It can be autosomal dominant, recessive or x-linked
139
Symptoms of retinal pigmentosa
Night blindness - 1st symptom | Peripheral vision loss -> followed by central vision loss
140
Investigations for retinal pigmentosa?
Fundoscopy - shows pigmentation, narrowing of arterioles, waxy or pale optic disc
141
Associated diseases with retinal pigmentosa
Usher's syndrome Bassen-Kornzweig syndrome Refsum's disease
142
Management for retinal pigmentosa
Refer to ophthalmologist + genetic counselling Inform DVLA + wear sunglasses Vitamin A/Beta carotene supplements Oral Acetazolamide
143
Define hypertensive retinopathy
Damage to the small blood vessels in the retina. | Can be as a result of years of chronic hypertension or can develop quickly in response to malignant hypertension
144
Signs of hypertensive retinopathy
``` Silver or copper wiring - arteriole walls become thickened Arteriovenous nipping Cotton wool spots Flame haemorrhage Hard exudate Papilloedema ```
145
What are the stages in the Keith-Wagener classification for hypertensive retinopathy?
Stage 1 = mild narrowing of arterioles Stage 2 = focal constriction of blood vessels & AV nicking Stage 3 = Cotton-wool patches, exudates & haemorrhages Stage 4 = Papilloedema
146
Management for hypertensive retinopathy
Control BP- stop smoking, diet, exercise
147
Define diabetic retinopathy
The blood vessels in the retina are damaged by prolonged exposure to high blood sugar levels (hyperglycaemia) causing retinal damage Increased vascular permeability leads to leakage from the blood vessels, blot haemorrhages and the formation of hard exudates Damage to the blood vessel wall leads to microaneurysms and venous bleeding Damage to nerve fibres in the retina causes cotton wool spots Neovascularization can occur
148
What categories can diabetic retinopathy be split into?
Non-proliferative Proliferative Diabetic maculopathy
149
What are the symptoms of non-proliferative diabetic retinopathy?
Mild: Microaneurysms -> dots Moderate: Microaneurysms, blot haemorrhages, hard exudates, cotton wool spots, venous bleeding Severe: Microaneurysms, blot haemorrhages, hard exudates, cotton wool spots, venous bleeding + intraretinal microvascular abnormality Can progress to sight-threatening proliferative
150
Symptoms of proliferative diabetic retinopathy?
Neovascularization | Vitreous haemorrhage
151
Symptoms of diabetic maculopathy
Leakage from vessels close to macula Macular oedema Ischaemic maculopathy Retinal thickening and hard exudates
152
Investigations for diabetic retinopathy
Dilated fundus photography 25% of type 2 diabetes mellitus have retinopathy at diagnosis
153
Management for diabetic retinopathy
Laser photocoagulation - treats proliferative and maculopathy Anti VEGF medications e.g. ranibizumab,bevacizumab. SE: endopthalmitis Vitreoretinal surgery - keyhole surgery on the eye. SE: cataract/haemorrhage
154
Complications of diabetic retinopathy
``` Retinal detachment Vitreous haemorrhage Rebeosis iridis (new blood vessel formation in iris) Optic neuropathy Cataracts ```
155
Risk factors for diabetic retinopathy
``` Pregnancy Dyslipidaemia Hypertension Smoking Anaemia Renal disease ```
156
Define Horner's syndrome
Ptosis (drooping of upper eyelid) Miosis (constriction of the pupil) Anhydrosis (loss of sweating) May also have enopthalmos Caused by damage to sympathetic nervous system Does not dilate to cocaine eyedrops
157
Causes of Horner's syndrome
Stroke Multiple sclerosis Swelling (tumours) - Pancoast's tumour Syringomyelia (cyst in the spinal cord)
158
What is Holmes Adie pupil?
Unilateral dilated pupil Slow responses to light and accommodation Young female, impaired sweating Holmes Adie syndrome = absent ankle and knee reflexes
159
What is Argyll Robertson pupil?
``` Bilateral Occurs in neurosyphilis Does not react to light Accommodates Bilaterally small ```
160
What is third nerve palsy?
Ptosis (eyelid droops) Divergent strabismus (down and out pupil) Dilated non-reactive pupil
161
Causes of third nerve palsy
``` Idiopathic Tumour Trauma Cavernous sinus thrombosis Posterior communicating artery aneurysm Raised ICP ```
162
What is a retinoblastoma
Most common ocular tumour found in children The average age of diagnosis is 18 months Signs: Strabismus, absence of red reflex, white pupil (leukocornia), visual problems Treatment: Enucleation, chemotherapy, radiotherapy, photocoagulation

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