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Year 5 Special Senses > Ophthalmology > Flashcards

Ophthalmology Flashcards

(62 cards)

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1
Q

What happens in acute angle closure glaucoma?

A
  • Angle of anterior chamber narrows
  • Acute obstruction
  • Rapid intraocular pressure (IOP) >30mmHg (norm= 15-20)
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2
Q

What is the difference between Primary + Secondary acute angle closure glaucoma?

A

Primary: anatomical predisposition, e.g. narrow angle (Asians), thin iris, thick lens.
Secondary: traumatic haemorrhage, which pushes posterior chamber anteriorly.

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3
Q

What is the background anatomy associated with acute angle closure glaucoma?

A

Normal eye: ciliary body (behind iris) produces aqueous humor > drains into trabecular meshwork (angle between iris + cornea: anterior chamber angle)
AACG: Iris opposes trabecular meshwork > blocks aqueous drainage > ^IOP!

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4
Q

Clinical presentation of acute angle closure glaumcoma?

A

Onset occurs over hours-days.

  • Severe painful eye
  • Blurred vision/ coloured haloes around lights
  • Red eye
  • Pupil fixed + dilated (due to axonal death)
  • Hard Globe upon palpation
  • Systemic: malaise, N&V
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5
Q

Management of acute angle closure glaucoma?

A
  1. Urgent referral to opththalmology!!!!
  2. Avoid eye patches/ dark rooms- pupillary dilation will worsen angle closure.
  3. Triad of treatment
  4. Definitive: Peripheral Iridectomy- once IOP is controlled, involves removing iris segment to allow aqueous flow.
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6
Q

What is the triad of treatment in acute angle closure glaucoma?

A
  1. TOP B-blockers (timolol): suppresses aqueous humour production
  2. TOP Pilocarpine: miosis (constriction)- opens closed drainage angle. (Phenylephrine if lens replacement)
  3. IV Acetazolamide: for aqueous formation.

May also use steroids (pred)

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7
Q

Complications of acute angle closure glaucoma?

A

Visual loss

Central retinal artery/vein occlusion

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8
Q

Pathophysiology behind Cataracts? (opaque protein deposits in lens)

A
  • Lens capsule is elastic (collagen), epithelium (regulates homeostasis + lays down new fibres), fibres= bulk of lens!
  • Transparency maintained by structure of lens proteins
  • Disruption of crystalin fibres > protein aggregation
  • Age > accumulation to yellow-brown pigment in lens.
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9
Q

Presentation of cataracts?

A

Onset is gradual

  • Blurred vision > loss of vision (painless)
  • Loss of acuity, failure to recognise faces, trouble with nocturnal vision.
  • Dazzle/glare
  • Biplopia
  • Haloes/ opacity
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10
Q

What can be seen in fundoscopy/slit lamp whilst investigating cataracts?

A
  • Red light reflex: present if early, absent if late.

- Lens appears brown or white if bright light shone.

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11
Q

Different types of cataracts seen and their presentations on fundoscopy?

A
  • Nuclear cataracts (old age): refractive index variation.
  • Cortical cataracts: spoke-like wedge shape, milk effect on acuity.
  • Posterior subcapsular cataract: classic glare from sunlight/lights whilst driving at night, fast progression.
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12
Q

What are some types of management in cataracts?

A
  1. Conservative: mydriatic drops/ sunglasses
  2. Surgery:
    - Ocular biometry (pre-op), measure curvature of cornea + length of the eye to determine lens size.
    - Phaecoemulsion + intra-ocular lens implant

If congenital, must act within 4wks!

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13
Q

Prophylaxis of cataracts?

A
  • Sunglasses
  • Oxidative stress (anti-oxidants such as vit C + caffeine)
  • Stop smoking
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14
Q

What is a complication of cataracts? And what are the red flags for this?

A

Posterior sub-capsular cataracts! (progress faster)

  • Glare (from bright light)
  • Subcapsular opacity deep to lens capsule
  • Dot opacity

More common in diabetics/steroids

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15
Q

How does a corneal ulcer (aka ulcerative keratitis) develop?

A

Inflammation/infection of cornea > disruption of epithelial layer > ulcer.

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16
Q

What are some causes of corneal ulcers?

A 
Bacterial
Herpetic (dendritic appearance)
Fungal (candida, aspegillus)
Protozoal (acanthamoeba)
Vasculitis (RA)
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17
Q

What are some risk factors for corneal ulcers?

A

Contact lenses
Trichiasis (abnormally positioned eye-lash can abrade cornea)
Ectropion (droopy lower eye lid > dry eye)
Steroid eye drops

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18
Q

Clinical presentation of corneal ulcer?

A
  • V painful eye, causes a squint
  • Red eye
  • Tearing + watery
  • Red
  • Reduced visual acuity
  • Photophobia
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19
Q

Investigations to do for a corneal ulcer?

A
  1. Refer to opthalm (same day)
  2. HIV testing! (important!)
  3. Slit lamp with 1% Fluorescein (differentiate between keratinic + dendritic ulcers)
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20
Q

Management of corneal ulcers?

A
  1. Chloramphenicol eye drops (gram +ve)
  2. Oflaxacin (gram -ve)
  3. Cefuroxime drops with Gentamicin drops
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21
Q

Red flag in corneal ulcers?

A

Herpes simplex dendritic corneal ulcers !! (HSV1 commonly manifests with corneal ulcers)

  • Acute pain, photophobia, watering.
  • Can lead to blindness (rapid progression)
  • TOP Aciclovir eye ointment !!!
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22
Q

What is a Chazalion?

A

Meibomian cyst! (non-infective)
Blocked meibomian (tarsal) gland (normally secretes sebum to hydrate eye > granulomatous inflammation in eye lid.
Most common lid lump.

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23
Q

What is a Hordeolum?

A

Stye!! (infective)

a) Internal (rare): meibomian gland infected > abscess
b) External (common): acute infection of last follicle + associated sebaceous glands of Moll/ Zeis.

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24
Q

Clinical presentation of a Chalazion?

A
  • Gradually enlarging round firm lesion: upper (common) or lower eye lid.
  • Can be painful initially (mostly non-tender)
  • Blurred vision/astygmatism if it compresses cornea.
  • Drains through inner eye lid/ absorbed in 2-8wks
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25
Clinical presentation of Hordeolum?
- Tender swelling, gradually enlarges. - Yellow swelling at base of eye lash (external hord) - Discharges anteriorly/posteriorly eventually - May develop rigors/fever
26
Management of a Chazalion?
1. Warm compress (twice daily) + massage lids 2. Resection under LA 3. Triamcinolone injection 4. If persistent use Abx trial: Doxycycline
27
Management of a Hordeum?
Antibiotics (TOP Choramphenicol or Doxycycline) | + Curetting if necessary
28
What causes conjunctivitis?
Infectious: viral (adenovirus 80%), or bacterial (staph) | Non-infectious: allergic (15-40% of all), mechanical/irritative/toxic, immune-mediated.
29
Clinical presentation of conjunctivitis?
- Red eye (generalised, often B/L) - Irritation, grittiness, discomfort - Discharge (watery (serous= viral), mucoid/string (allergic), sticky/purulent (bacterial) Altered visual acuity/ intense pain- suggests alternative diagnosis.
30
How do you investigate conjunctivitis?
1. Examination of external eye + conjunctiva 2. Ophthalmoscope: - dilated vessels - chemosis (conjunctival oedema) - Follicles (typically viral/bacterial/toxins) - Papillae (typically allergic immune response- cobblestone appearance of flattened nodules)
31
Management of conjunctivitis: | 1) Viral
1) Self limiting 1-2wks. Sx relief: TOP artificial tears + TOP anti-histamines e.g. Emedastine or olapatadine. TOP antivirals do not work!
32
Management of conjunctivitis: | 2) Bacterial
Self-limiting 1-2wks | TOP Chloramphenicol, or Fusidic aid drops
33
Management of conjunctivitis: | 3) Allergic?
a) Cold press b) TOP anti-histamines e.g. Emedastine or olopatadine c) Sodium Cromoglicate + steroid drops
34
What are signs of abrasion from a foreign body?
Conjunctival or ciliary injection (red), epithelial defects that stain with fluorescein.
35
Foreign Body in Eye! RED FLAGS?
- Evidence of open globe injury? (Distorted globe, leaking humour, subconjunctival haemorrhage) REFER immediately! - Evidence of deep eyelid laceration - Hyphaema (fluid level), irregular pupil, ^IOP (FP in anterior chamber)
36
Management of an abrasion?
Abx: TOP Chloramphenicol (1st line) Or Fusidic acid if pregnant. Re-evaluate in 24hrs
37
Management of a corneal foreign body/ penetrating corneal injury?
``` FB: remove under TOP anaesthetic. Irrigate eye with water. Penetrating: -DO NOT TOUCH/ manipulate/ pad eye -Give rigid eye shield to protect eye -REFER IMMEDIATELY -? tetanus shot ```
38
What gene is Acute Anterior Uveitis associated with?
HLA-B27 | (therefore associated with Anky Spond, reactive arthritis, UC/CD, Behcet's dis.
39
What is the classical presentation of Acute Anterior Uveitis?
- Acute onset hours-days - Pain, red eye, blurred vision, photophobia - Pupil appears small (initially due to iris spasm), then becomes irregular + dilates due to adhesions. - This causes painful consensual reaction (constriction hurts) - May see Hypopyon (puss in anterior chamber)
40
How do you investigate for Acute Anterior Uveitis?
Slit lamp!! (Diagnostic!) -Leukocytes visible in anterior chamber (no cells?- consider posterior uveitis)
41
Management of Acute Anterior Uveitis?
- REFER asap! - Cycloplegics to dilate pupil + relieve pain/ photophobia. + prevent formation of adhesions: TOP Atropine, cyclopentolate. - Steroid eye drops to reduce inflam: Prednisolone.
42
Explain the terminology of the following (found in hypertensive retinopathy) - Tortuous vessels - Silver/Copper wiring - AV nipping - Cotton wool spots - Flame haemorrhage - Papilloedema
- Tortuous vessels: dilated, abnormal path/shape - Silver/Copper wiring: shiny walls of blood vessels - AV nipping: narrowing where arteries cross veins - Cotton wool spots: fluffy areas indicating retinal infarction. - Flame haemorrhage: how a haemorrhage appears on a retina - Papilloedema: optic disc swelling from ^ICP
43
What does the different grading mean in HTN Retinopathy?
1. Arteriole narrowing or tortuosity and ^light reflex i.e. silver/copper wiring 2. Arteriovenous (AV) nipping 3. Cotton-wool exudate + Flame/Blot haemorrhages 4. Papilloedema
44
What does non-proliferative Diabetic Retinopathy look like ?
(Mild/moderate/severe depending on degree of ischaemia) Signs: micro-aneurysms (seen as dots), haemorrhages (flame/blot), hard exudate (yellow patch) Severe signs of ischaemia: soft exudate (cotton wool), large blot haemorrhages.
45
What does proliferative Diabetic Retinopathy look like?
Fine new vessels appear (neovascularisation) on optic disc, retina + causes vitreous haemorrhage.
46
What does maculopathy look like (in diabetic retinipathy)?
Leakage from vessels close to macula causes oedema, and then reduced acuity.
47
Grading of Diabetic Retinopathy?
1. Mild NPDR: 1 microaneurysm 2. Moderate NPDR: >1 microaneurysm, hard exudate, cotton wool, dot/blot haemorrhage. 3. Severe NPDR: more than moderate basically. More intra-retinal microvascular abnormalities. 4. Proliferative DR (common in t1DM, 50% blind in 5yrs) 5. Maculopathy (common t2DM)
48
Symptoms/signs of Posterior Vitreous Detachment?
- Flashes of light (photopsia)- in peripheral field of vision. - FLoaters, often on temporal side of central vision
49
Symptoms/signs of retinal detachment?
- Dense shadow (starts peripherally, goes towards central vision) - A veil/curtain over field of vision - Straigh lines appear curves - Central visual loss
50
Symptoms/signs of vitreous haemorrhage?
- Large bleeds cause sudden visual loss | - Small bleeds: floaters
51
What are some retinal signs of papilloedema?
- Venous engorgement (1st sign) - Blurring of optic disc contour/margin - Elevation of optic disc - Loss of Optic Cup - Paton’s lines: concentric lines cascading from optic disc
52
Associated symptoms of papilloedema?
- Severe throbbing headache (^ICP) - N^V (projectile) - Pupils will be normally equal + reactive to light!
53
What is an Entropion?
Inversion of eyelid margin. | Caused by involution, secondary to ocular irritation.
54
What is a common differential of entropion?
Trichiasis (misdirection of eyelashes)
55
Management of Entropion?
1. Lubricating eye drops 2. Botox injections 3. Surgical correction
56
What is Ectropion? And what are some causes?
``` Eversion of eyelid margin. Causes: -Involuted (age-related) -Paralytic (CNVII palsy) -Mechanical (tumour= displacement) -Congenital ```
57
What eye condition is MS associated with? | And how does this present?
Optic neuritis!! (often unilateral) - Decreased visual acuity, progressive blurred vision, pain worse with movement, reduced colour vision. - Relevant Afferent Pupillary Defect (KEY!!) - Papilloedema
58
What is the most common cause of persistent watery eye in infants?
Nasolacrimal duct obstruction. | teach lacrimal duct massage to parents, sx resolve in ~1year
59
What is the most common cause of blindness in the UK?
Age Related Macular Degeneration (ARMD)
60
What is the presentation of ARMD?
- Degeneration of central retina (macula) - Dry: characterised by Drusen (yellow spots in Bruch's membrane) - Wet (severe + rapid): choroidal neovasc, leakage of serous fluid/blood.
61
What is the key symptom of Primary Open Angle Glaucoma?
Optic neuropathy, leading to reduced peripheral visual field! =Tunnel vision!!
62
What is 1st line in the management of Primary Open Angle Glaucoma?
Lantoprost (prostaglandin analogue)

Year 5 Special Senses (2 decks)

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