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Year 5 > Ophthalmology > Flashcards

Ophthalmology Flashcards

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1
Q

What is a cataract?

A

Opacification of the proteins in the lens of the eye leading to loss of visual acuity

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2
Q

Give 3 causes of cataracts

A 
Old age 
UV light 
Trauma
Smoking
Alcohol
Diabetes 
Metabolic disorders
Uveitis
Steroids 
Congenital
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3
Q

What are the symptoms of cataract?

A

Painless loss of vision
Misting/blurring
Change in refractive error

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4
Q

Give 2 examples of common complaints a patient with cataract may express

A

Difficulty reading
Difficulty recognising faces
Difficulty driving at night
Halos around lights

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5
Q

What 2 conditions may cause halos around lights?

A

Cataract

Glaucoma

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6
Q

What features may be seen on examination of a patient with cataract

A

Reduced visual acuity

Reduced red reflex

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7
Q

How are cataracts managed?

A

Surgery (vision worse than 6/12) - phaecoemulsification with synthetic lens replacement

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8
Q

What should a patient be informed about regarding the recovery period for cataract surgery?

A

Eye patch for 24 hours
Avoid driving, swimming and heavy lifting for 5 days
Steroids, antibiotics and dilating drops may be prescribed

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9
Q

What are the contraindications to cataract surgery?

A

Diabetic retinopathy

Intraocular inflammation

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10
Q

What are the complications of cataract surgery?

A 
Posterior capsule opacification 
Choroidal haemorrhage (bleeding)
Endophthalmitis (infection)
Glaucoma 
Vitreous loss 
Visual disturbance 
Retinal detachment
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11
Q

What is posterior capsule opacification and how is it managed?

A

Cloudy layer of scar tissue (residual lens epithelial cells) at the back of the lens capsule after replacement
YAG laser capsulotomy

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12
Q

What is the most common complication of cataract surgery?

A

Posterior capsule opacification

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13
Q

What do phakic, pseudophakic and aphakic mean?

A

Phakic - natural lens
Pseudophakic - natural lens removed and artificial lens inserted
Aphakic - natural lens removed but not replaced

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14
Q

Other than treatment of cataract, what other reasons may a patient undergo cataract surgery?

A

Treatment of angle closure glaucoma

Improve visualisation of retina to manage co-morbidity (e.g. diabetic retinopathy)

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15
Q

What is biometry?

A

Measurement of corneal curvature and length of the eye prior to cataract surgery to allow selection of the most appropriate intraocular lens implant

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16
Q

Name 3 types of cataract and their cause

A

Nuclear sclerotic - age, yellow/white
Posterior subcapsular - steroids and diabetes, inflammation
Congenital - inherited or idiopathic, amblyopia
Traumatic - blunt/penetrating trauma

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17
Q

What is glaucoma?

A

Gradual death of the optic nerve due to high intraocular pressure, usually due to an imbalance in the production and drainage of aqueous humour

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18
Q

Where is aqueous humour produced and drained?

A

Produced - ciliary body

Drained - irido-corneal angle -> trabecular meshwork -> canal of Schlemm

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19
Q

What is open angle (chronic) glaucoma?

A

Defect of the trabecular meshwork slows down the flow of aqueous humour which increases ocular pressure leading to optic nerve damage and gradual vision loss

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20
Q

What is closed angle (acute) glaucoma?

A

Narrowing of the irido-corneal angle which prevents aqueous fluid drainage, leading to rapid rise in ocular pressure and damage to the retina via stretching and decreased blood supply

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21
Q

Which type of glaucoma is most common?

A

Open angle

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22
Q

What are the risk factors for open angle glaucoma?

A 
Family history 
Age
Black ethnicity 
Thin cornea
Large vertical nerve cupping 
High ocular pressure
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23
Q

How is open angle glaucoma screened for?

A

Strong family history - screening every 2 years from age 30

Otherwise - every 5 years from age 40 and 2 years from age 60

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24
Q

What are the symptoms of open angle glaucoma?

A

Gradual peripheral visual loss - patient may not be aware of this

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25
Give 2 features of open angle glaucoma seen on examination
Elevated pressure Optic disc changes - increased cupping, haemorrhage, thinning and notching of rim, optic atrophy Peripheral visual loss - central spared
26
What is a normal ocular pressure? When is it at its highest normally?
10-22 mmHg | Morning
27
How is ocular pressure measured and how is it affected by corneal thickness?
Tonometer Thin cornea = lower reading than actual value Thick cornea = higher reading than actual value
28
How is open angle glaucoma managed medically?
Topical beta-blocker (timolol) - decrease aqueous production Prostaglandin analogues (latanoprost)- increase aqueous outflow Carbonic anhydrase inhibitor (brinzolamide) - decreased production Alpha 1 agonist (brimonidine) - both
29
How is open angle glaucoma managed surgically?
Trabeculectomy - with mitomycin C Laser trabeculoplasty - burn meshwork/ciliary body to increase aqueous outflow/decrease aqueous production Shunt - Molteno tube, Ahmed valve
30
What are the symptoms of acute angle closure glaucoma?
Extremely red and painful eye Associated nausea and vomiting Halos around light
31
What features may be seen on examination of acute angle closure glaucoma?
Sluggish dilated pupil Elevated pressure (>60mmHg) Rock hard eye on palpation
32
How is acute angle closure glaucoma managed medically?
Topical - pilocarpine (reduces pressure) | Systemic - IV acetazolamide
33
How is acute angle closure glaucoma managed surgically?
YAG laser iridotomy - create communication between anterior and posterior chambers to relieve pressure gradient Both eyes, even if only 1 was affected
34
What is the ISNT rule?
Pattern of neural rim width ``` (thickest) I - inferior rim S - superior rim N - nasal rim T - temporal rim (thinnest) ``` This rule is lost in glaucoma
35
What investigations can be done for glaucoma?
``` Tonometer Slit lamp Visual fields (scotoma) OCT optic disc Gonioscopy ```
36
What are the complications of trabeculectomy for open angle glaucoma?
Hypotony Infection Cataract Bleb leakage
37
What populations are at higher risk of acute angle closure glaucoma?
Elderly Hypermetropic (abnormal ability to focus of distant objects; far-sightedness) Chinese ethnicity
38
Give 3 features of congenital glaucoma
``` Large, watering photophobic eyes Increased corneal diameter Cloudy cornea Reduced vision Raised pressure Treatment - goniotomy, trabeculotomy ```
39
How does neovascular glaucoma occur?
Diabetic retinopathy or retinal vein occlusion VEGF produced from ischaemic retina which leads to neovascularisation of iris Fibrous membrane forms over trabecular meshwork which closes drainage angle Needs surgery
40
What is pigment dispersion syndrome?
Occurs in young caucasian myopic (near-sighted) males Pigmented iris rubs against zonules -> pigment sheds and clogs meshwork Can be caused/worsened by exercise
41
What is pseudoexfoliation syndrome?
Systemic disorder in which a fibrillar, proteinaceous substance is produced in abnormally high concentrations within ocular tissues
42
What are the 2 types of macular degeneration?
Dry/atrophic (slow decline) | Wet/exudative (rapid decline)
43
What are the risk factors for macular degeneration?
``` Age >55 Smoking Family history Diabetes Previous history of macular degeneration in other eye ```
44
What type of macular degeneration is more common?
Dry
45
What are the symptoms of macular degeneration?
Decline in visual acuity - central vision, distortion (e.g. of lines)
46
What may be seen on examination of macular degeneration?
Normal visual fields Reduced visual acuity No pupillary defect
47
What investigation can be done for macular degeneration and what features will be seen in dry and wet types?
Fundoscopy/retinal imaging Dry - drusen, atrophy of retina, darker macula Wet - scarring and haemorrhages, neovascularisation
48
How is dry macular degeneration managed?
No treatment High dose vitamins Smoking cessation Annual eye examination
49
How is wet macular degeneration managed?
Anti-VEGF injections into the eye | Laser therapy to target new blood vessels
50
What are the main features of central retinal vein occlusion?
``` Sudden painless loss of vision (central) Unilateral Vision not improved with pinhole May have RAPD if severe Elderly ```
51
What signs may be seen on examination of CRVO?
``` Hyperaemic retina with engorged veins Swollen optic disc Multiple haemorrhages Cotton wool spots 'Stormy sunset' appearance ```
52
What are the causes of CRVO?
Raised ocular pressure (glaucoma, HTN) Hyperviscosity (polycythaemia) Vessel wall disease (diabetes, sarcoidosis, hyperlipidaemia)
53
How is CRVO managed?
No treatment needed - address cause and CV RFs | Fibrinolysin/laser therapy may be useful
54
What is central retinal artery occlusion?
'Stroke of the retina'
55
How does CRAO present?
Sudden painless loss of vision Unilateral Curtain across vision
56
What features may be seen on examination of CRAO?
RAPD Reduced visual acuity (no perception of light) Ophthalmoscopy - retinal emboli, may be normal, pale retina with cherry red spot (macular sparing due to supply from posterior ciliary artery)
57
What should be ruled out in CRAO and how?
Temporal arteritis - ESR
58
What are the causes of CRAO?
Arterial embolus from carotid/valvular heart disease/AF Temporal arteritis Vasculitis (polyarteritis nodosa) Atherosclerosis (diabetes, HTN)
59
How is CRAO managed?
<30 minutes from onset - globe massage to dislodge embolus Rebreath CO2 (paper bag) IV acetazolamide - reduce pressure Bloods - ESR
60
What is amaurosis fugax?
'TIA of the retina' | Transient loss of vision due to temporary occlusion of retinal artery
61
Give 4 causes of sudden painless loss of vision
``` Retinal detachment Vitreous haemorrhage CRVO Amaurosis fugax CRAO Wet AMD Posterior vitreous detachment ```
62
How does retinal detachment present?
Sudden painless loss of vision Flashing lights, floaters, visual field defects Classic curtain over vision Macular involvement = central vision affected
63
What features may be seen on examination of retinal detachment?
RAPD Abnormal red reflex May be able to visualise fold in eye May be normal
64
In what patients are retinal detachments more common?
Myopic (near-sighted) Diabetic retinopathy Previous surgery (e.g. cataracts)
65
What is the main differential for retinal detachment?
Posterior vitreous detachment
66
How is retinal detachment managed?
Minor - laser to encourage inflammation and healing | Major - retinal surgery +/- vitrectomy
67
Give 4 causes of a red eye
``` Conjunctivitis Corneal abrasion Corneal ulceration Anterior uveitis Episcleritis Scleritis Subconjunctival haemorrhage ```
68
What are the symptoms of conjuncivitis?
``` Gritty irritation Itchiness Discharge Injection Normal vision (improved on pinhole if mildly reduced) ```
69
What are the causes of conjuncitivis and their defining features?
Bacterial - purulent sticky discharge Viral (e.g. adenovirus, HSV) - watery discharge, lymphoid follicles on conjunctiva, pre-auricular lymphadenopathy Allergy - itchy, watery
70
How are bacterial, viral and allergic conjunctivitis managed?
Bacterial - antibiotics Allergic - self-resolving, anti-histamines Viral - lubricating eye drops, frequent cleaning, hygiene measures
71
What symptoms should be asked about in a patient presenting with a red eye?
``` Blurred vision Sticky/gritty/discharge Photophobia Pain/halo/headache/vomiting Discomfort/dryness Foreign body sensation Redness/swelling Itch Watering Hearing loss/jaw claudication ```
72
How should a red eye be examined?
``` Visual acuity (plus pinhole) External examination Slit lamp - fluoroscein, topical anaesthetic, eversion of eyelids Pupils Eye movements ```
73
What is chemosis?
Swelling/oedema of the conjunctiva
74
What features can be seen on eversion of the eyelids? What types of conjunctivitis do they correspond to?
Papillae - cobblestoned nodules; bacterial, allergic | Follicles - lymphoid hyperplasia; viral
75
What is trachoma?
Most common infectious cause of blindness Repeated episodes of infection with chlamydia trachomatis in childhood lead to severe conjunctival inflammation, scarring, and potentially blinding in-turned eyelashes (trichiasis or entropion) in later life
76
What is the difference between a corneal ulcer and abrasion?
Ulcers involve the stroma and are opaque and uneven
77
Give 3 features of bacterial keratitis
``` Rapid onset Contact lens user, dry eyes, abrasion Pain, foreign body sensation, reduced vision, photophobia Round/oval white lesion Lasts 7-14 days ```
78
Give 3 features of viral keratitis
``` Insidious onset History of cold sores/feeling run down Pain, irritation, reduced vision Dendritic appearance (HSV), raised IOP Lasts <7 days ```
79
Give 3 features of fungal keratitis
Onset over several days Outdoors, vegetative trauma Pain, photophobia, red eye, reduced vision Feathery edges, satellite lesions, necrotic slough Lasts 1-2 months
80
What are the risk factors for corneal ulcers?
``` Trauma Contact lens use Ocular surface disease (e.g. dry eyes, blepharitis, corneal anaesthesia) Lid disease (e.g. entropion) Systemic condition (e.g. RA, DM) ```
81
What are the symptoms of corneal ulcers?
``` Pain Foreign body sensation Redness Photophobia Tearing Discharge Reduced vision Injection Single/multiple white foci Hypopyon ```
82
What are the complications of corneal ulcers?
Scleral extension Corneal perforation Endophthalmitis Corneal scarring
83
What investigations can be carried out for a corneal ulcer?
``` Corneal scrape (>1mm) Contact lenses - send lenses, solution and case for culture Swabs - viral PCR ```
84
How is HSV keratitis/dendritic ulcer managed?
Aciclovir ointment
85
How are corneal ulcers managed before a cause is know?
Empirical antibiotic therapy (e.g. cefuroxine and gentamicin) Cyclopentolate (dilate pupil to reduce photophobia)
86
What are the symptoms of scleritis?
Acute red eye Pain on eye movement Globe tenderness Severe pain - keeping patient up at night
87
How is scleritis managed?
Oral steroids | Investigation of cause/vasculitis
88
What are the symptoms of episcleritis?
Diffuse or sectoral red eye Mild pain Self-limiting
89
How is episcleritis managed?
Topical NSAIDs | Topical steroids
90
What is uveitis?
Inflammation of the uveal tract (iris, ciliary body, choroid) and neighbouring structures
91
How is uveitis classified?
Based on anatomical location | Anterior, intermediate, posterior, panuveitis
92
What causes uveitis?
``` Idiopathic (50%) Trauma Infection Autoimmune (e.g. RA) Neoplastic ```
93
What are the symptoms of uveitis?
Anterior - photophobia, redness, watering, pain, reduced vision Intermediate - reduced vision, floaters, photopsia Posterior - reduced vision, floaters, photopsia, scotoma
94
What features may be seen on examination of uveitis?
``` Limbal injection (circumcorneal) Anterior chamber (AC) cells AC flare Posterior synechiae Keratic precipitates (KP’s) (mainly inferiorly) +/- fibrin and hypopyon ```
95
What are the complications of uveitis?
Raised IOP Cataract Cystoid macular oedema Optic neuropathy
96
Why is a systemic review important in uveitis?
``` May give clues to underlying cause Joint pain/swelling/back pain - ank spond, RA, JIA Cough - TB, sarcoid Rash - sarcoid, Behcets Diarrhoea - IBD (crohns/UC) Dysuria - Reiters IV Drug use, sexual history - HIV Immunocompromised - CMV Recent Travel - TB ```
97
How is uveitis managed?
Treat cause if known Anterior - topical steroids and cyclopentolate Intermediate - as above Posterior - systemic steroids (if infectious cause ruled out)
98
What ocular issues may result from trauma?
``` Foreign body Abrasions Lacerations Hyphaema Penetrating trauma Retrobulbar haemorrhage Orbital wall fracture ```
99
What is a corneal abrasion?
'Scratch on eye' | Defect in epithelium
100
How is corneal abrasion managed?
Chloramphenicol ointment 4x day for 3 days
101
How is a foreign body managed?
Topical anaesthetic and use a green needle to remove | Chloramphenicol ointment 4x day for 3 days
102
How should chemical injuries be managed?
Irrigate immediately with at least 2L of water and evert eyelids Check pH after irrigation and then at 5 and 20 mins
103
What is the difference between acidic and alkaline chemical injuries?
Acidic (e.g. sulfuric acid) - coagulative necrosis | Alkaline (e.g. lime) - worse than acid, causes liquefactive necrosis which can penetrate further
104
What signs may be seen on anterior segment blunt trauma?
Cornea - abrasion, oedema Hyphaema (blood) Iris - miosis or mydriasis, sphincter rupture Lens - cataract, subluxation
105
What signs may be seen on posterior segment blunt trauma?
Vitreous - detachment, haemorrhage Retina - bruising, bleeding, tears, detachment Choroid - rupture Optic nerve - traumatic neuropathy
106
What are the symptoms of globe rupture?
``` Extreme pain Obvious penetrating trauma or suspicious mechanism of injury Irregular pupil 360 degree subconjunctival haemorrhage Flat anterior compartment ```
107
How is suspected globe rupture managed?
``` Do not press on the globe Measure visual acuity Slit lamp and pupils if able CT (thin slice) Refer to ophthalmology ```
108
How should lid lacerations be assessed?
Clean Assess for associated injuries Check if - full thickness, involves lid margin, puncta involvement Suture
109
How does retrobulbar haemorrhage present?
``` Reduced vision RAPD Raised pressure Pain Proptosis Reduced motility ```
110
What type of orbital fracture is most common and how is it managed?
Floor | Most suitable for OP review
111
What are the symptoms of orbital cellulitis and how does this differ from preseptal?
``` Proptosis Painful/restricted movemement Reduced visual acuity Reduced colour vision RAPD (None of these features occur in preseptal) ```
112
How is orbital cellulitis managed?
Ophthalmic emergency IV antibiotics CT
113
What bacteria are commonly implicated in orbital cellulitis?
Strep pneumoniae Staph aureus Strep pyogenes Haemophilus influenzae
114
What is Hutchinson's sign?
Relates to involvement of the tip of the nose from facial herpes zoster It implies involvement of the external nasal branch of the nasociliary nerve (branch of the ophthalmic division of the trigeminal nerve) and thus raises the spectre of involvement of the eye
115
What is amblyopia?
A reduction in visual acuity due to a problem with focusing in early childhood
116
What causes amblyopia?
Stabismus (lazy eye) Refractive defects Congenital cataracts
117
What is strabismus?
A condition in which the eyes do not properly align with each other when looking at an object AKA lazy eye/squint
118
How is amblyopia diagnosed?
Visual acuity | Eye movements
119
How is strabismus managed?
Eye patches or drops (atropine) to obscure the good eye and force the brain to process information from the affected eye for 4-6 hours/day
120
How is amblyopia caused by refractive error managed?
Glasses
121
Give 3 differentials of dry eye
``` Allergy Conjunctivitis Glaucoma HSV VZV Thyroid disease Sjogren's syndrome ```
122
Give 3 causes of dry eyes
``` Elderly - reduced tear secretion Contact lenses Staring at screens - reduced blinking Diabetes Cataract surgery ```
123
How do dry eyes present?
``` Watery eyes Dry, gritty sensation Worse towards end of day Eyelids may be red and sticky Usually bilateral ```
124
What are the red flags for dry eyes?
``` Eye pain Altered visual acuity Photophobia Significant redness Diplopia Acute onset ```
125
What investigation can be done for dry eyes?
Schirmer's test - strip of filter paper in fornix to measure advancing edge of tears
126
How are dry eyes managed?
``` Artificial tears/ointment 3-4 times/day Acetylcysteine drops (disperse mucus) Medication review Smoking cessation Minimise contact lens wear Blink more frequently, break from screens Temporary punctal plug ```
127
What are the complications of dry eyes?
Conjunctivitis Keratitis Ulceration Infection
128
What is blepharitis?
A condition where the edges of the eyelids become red and swollen
129
What is a chalazion, how does it present and how is it managed?
Granuloma of meibomian glands Hard, inflamed lump visible on lid eversion Warm compress, chloramphenicol, incise
130
What is a stye, how does it present and how is it managed?
Infection of the lash follicle Red, tender swelling of lid margin which may have a head of pus Warm compress and chloramphenicol
131
What is a marginal cyst, how does it present and how is it managed?
Cysts of sweat (Moll) or lipid (Zeiss) glands Dome shaped, no inflammation Removal for cosmetic reasons only
132
What is the most common eyelid malignancy, how does it present and how is it managed?
Basal cell carcinoma Mainly lower lid, does not metastasise, local infiltration Pearly smooth edge with necrotic core or diffuse indurated lesion Excision or radiotherapy
133
How does blepharitis present and how is it managed?
Inflamed lid margin, blocked meibomian glands, margin crusting Keep lids clean, treat infection, artificial tears
134
What eye movement/s are controlled by the superior rectus muscles?
Abduction | Elevation
135
What eye movement/s are controlled by the lateral rectus muscles?
Abduction
136
What eye movement/s are controlled by the inferior rectus muscles?
Abduction and depression
137
What eye movement/s are controlled by the inferior oblique muscles?
Adduction | Elevation
138
What eye movement/s are controlled by the medial rectus muscles?
Adduction
139
What eye movement/s are controlled by the superior oblique muscles?
Adduction | Depression
140
How do you describe a squint?
Persistence - manifest squint (present all the time), latent squint (present on dissociation) Direction of deviation - exotropia (divergent), esotropia (inwards), hypertropia (upwards), hypotropia (downwards)
141
Give 3 causes of a squint?
``` Blowout fracture Diabetes Hypertension Aneurysm (posterior communicating artery) Cavernous sinus thrombosis Acoustic neuroma Glioma Sarcoidosis Vasculitis Raised ICP Cataracts Retinoblastoma High refractive error ```
142
What is ischaemic optic neuropathy and what are the 2 different types?
Damage of the optic nerve caused by a blockage of its blood supply Arteritic (e.g. GCA) and non-arteritic
143
What are the symptoms of giant cell arteritis?
``` Headache Jaw claudication Malaise Myalgia Depression ```
144
How is GCA diagnosed?
Clinical features and suspicion Elevated ESR and CRP Temporal artery biopsy
145
How is GCA managed?
High dose systemic steroids - 1-2 mg/kg/day with daily ESR monitoring Prophylaxis - bisphosphonate, PPI
146
What is Charles Bonnet syndrome?
A disease in which visual hallucinations occur as a result of vision loss
147
What are the symptoms of Charles Bonnet syndrome?
Hallucinations - simple (lines, light flashes) or complex (people, animals), not disturbing, patient aware they are not real, often on wakening, last several minutes
148
How is Charles Bonnet syndrome managed?
``` Optimal eye care Low vision aids Avoidance of - stress, anxiety, social isolation, sensory deprivation Reassurance Medication - olanzapine, clonazepam Rapid eye movements/blinking Repetitive TMS ```
149
What is endophthalmitis?
Inflammation of the interior cavity of the eye, usually caused by infection. It is a possible complication of all intraocular surgeries, particularly cataract surgery, and can result in loss of vision or loss of the eye itself.
150
What organisms can cause endophthalmitis?
Staphylococcus Streptococcus Gram negatives Fungi
151
What are the risk factors for endophthalmitis?
Surgical - increased operative time, posterior capsule rupture, wound leakage Contamination - patient's bacterial flora, instruments, corneal transplant donor Patient - diabetes, immunosuppression, HIV
152
What are the symptoms of endophthalmitis?
Visual loss Pain Redness Photophobia
153
What are the signs of endophthalmitis?
``` Lid oedema Conjunctival chemosis and hyperaemia Corneal haze Cells and flare in anterior compartment (exudate/hypopyon) Absent/sluggish pupillary light reflex Absent red reflex ```
154
What are the differentials for endophthalmitis?
Post-operative inflammation without infection Acute red eye - anterior uveitis Vitreous haemorrhage
155
How is endophthalmitis managed?
Anterior chamber/vitreous tap or vitrectomy followed by microbiology of specimen Antibiotics Steroids
156
What is retinoblastoma?
Most common intraocular malignancy in children
157
How does retinoblastoma present?
``` Age <3 years Leukocoria (white pupillary reflex) Strabismus Pseudo-orbital cellulitis Visual disturbance Ocular pain ```
158
What are the risk factors for retinoblastoma?
RB1 gene mutation HPV exposure Advanced parental age Family history
159
How is retinoblastoma investigated?
``` Examination under anaesthesia USS MRI LP Bone marrow aspirate Bone scan Genetic testing ```
160
How is retinoblastoma managed?
Small - cryotherapy, laser therapy, radioactive plaque, thermotherapy Large - chemotherapy, enucleation (removal of eye), radiotherapy
161
How might the normal function of the eye be affected by drugs used in ITU?
Muscle relaxants - reduce tonic contraction of orbicularis muscle which normally keeps lids closed Sedation - reduced blink rate and reflex
162
What type of ITU patients are at higher risk of eye damage?
Mechanically ventilated Greater length of stay Use of sedatives/paralytics Those on positive pressure ventilaton
163
What conditions can affect the eye in ITU?
``` Corneal abrasion Exposure keratopathy Chemosis Conjunctivitis Keratitis ```
164
What is lagophthalmos?
Incomplete closure of the eyelid
165
What measures can be taken to protect the eyes in ITU?
Manual closure/taping of eyes shut | Lubricating ointment
166
How is exposure of the eyes graded in ITU?
Grade 0 - no exposure Grade 1 - any conjunctival exposure Grade 2 - any corneal exposure
167
Give 4 complications of contact lens wear
``` Microbial keratitis Allergies Papillary conjunctivitis Corneal abrasion CL induced acute red eye (CLARE) Corneal infiltrates Dry eyes Neovascularisation ```
168
What can be used to predict diabetic eye disease?
Measures of renal microvasculature damage - proteinuria, blood urea nitrogen, creatinine
169
What is the most accurate predictor of diabetic retinopathy? What are the additional risk factors?
Duration of diabetes | Smoking, hypertension, pregnancy
170
What are the 2 different types of diabetic retinopathy and which is most common?
Non-proliferative (most common, 95%) | Proliferative
171
What features of non-proliferative diabetic retinopathy may be seen on fundus exam?
``` Vessel microaneurysms Dot and blot haemorrhages Flame haemorrhages Cotton wool spots Beading of retinal veins ```
172
What is the defining feature of proliferative diabetic retinopathy seen on fundus exam?
Neovascularisation
173
What are the complications of neovascularisation in proliferative diabetic retinopathy?
Blindness Detachment Haemorrhage
174
What is the most common cause of blindness in diabetic patients and how does this occur?
Macular oedema | Leakage of capillaries and aneurysms at the macular retina which causes fluid swelling
175
What features of macular oedema can be seen on fundus exam?
Macula appears cloudy and elevated | Hard yellow exudates
176
How is diabetic retinopathy managed?
Tight diabetic control | Surgical treatment - laser or vitrectomy
177
How is macular oedema treated with laser?
Laser seals off leaking vessels and microaneurysms by burning them - selective for small areas or grid photocoagulation for larger areas
178
How are advanced retinopathy and neovascularisation treated with laser?
Pan-retinal photocoagulation (PRP) - thousands of spots are burned around the peripheral retina to destroy the ischaemic part and reduce angiogenic signals
179
What are the complications of PRP?
Peripheral vision loss | Decreased night vision
180
How is a vitrectomy carried out?
Removal of vitreous humour from the eye and replacement with saline - removes haemorrhaged blood, inflammatory cells and other debris

Year 5 (10 decks)

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