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MSRA > Ophthalmology > Flashcards

Ophthalmology Flashcards

1
Q

Name the condition:

  1. small, irregular pupils
  2. Accommodation reflex present (ARP)
  3. Pupillary reflex absent (PRA) (no response to light)

Causes (2)

A

Argyll-Robertson pupil

Causes

  1. Syphillis
  2. Diabetes
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2
Q
  1. Dilated pupil
  2. Unilateral
  3. Slowly reactive to accommodation
  4. Minimal if at all response to light
  5. Once pupil constricted it remains small for an abnormally long time
A

Holmes-Adie pupil

Benign condition common in women

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3
Q

What is Holmes-Adie syndrome?

A

Association of Holmes-Adie pupil with absent ankle/knee reflexes

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4
Q 
Glaucoma types (3) 
Caused by?
A
  1. Closed angle/ angle closure glaucoma
  2. Opened angle glaucoma
  3. Normal-tension
    Caused by raised intraocular pressure secondary to impairment of aqueous flow
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5
Q

Closed angle/ angle closure glaucoma (8)

Insidious vs sudden 
Pain or no pain 
Red or not red
Sight 
Dilated or restricted 
Other features (2) 
Worse with restricted or dilated pupils
A

Raised IOP due to narrow angle between iris and cornea, passage for outflow of aq. humour is too narrow. Due to lens being pushed against iris.

Features

  1. Sudden onset eye/ head pain
  2. Hard, red eye
  3. Haloes
  4. Decreased visual acuity
  5. Semi-dilated non reacting pupil
  6. Worse with mydriaisis
  7. Systemic upset e.g N&V, AP
  8. Corneal oedema, dull/ hazy cornea
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6
Q

What does hypermetropia mean?
What does mydriasis mean?
What does myopia mean?

A

To be long sighted
Dilated pupils
Short/near sighted

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7
Q

Closed angle/ angle closure

Predisposing factors

A
  1. Hypermetropia
  2. Pupillary dilatation
  3. Lens growth associated with age
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8
Q

Closed angle/ angle closure

Mx

A

Emergency - refer to ophthalmologist

  1. Pilocarpine (increased outflow of the aqueous humour))
  2. BB (e.g. timolol, decreases aqueous humour production)
  3. alpha-2 agonist (e.g. apraclonidine, dual mechanism, decreasing aqueous humour production and increasing uveoscleral outflow)
  4. intravenous acetazolamide (reduces aqueous secretions)

Post acute attack
1. Laser peripheral iridotomy
Creates a tiny hole in the peripheral iris → aqueous humour flowing to the angle

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9
Q

Primary open angle glaucoma

RFs (6)

A
  1. HTN
  2. DM
  3. Steroids
  4. FH
  5. Black
  6. Myopia
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10
Q

Primary open angle glaucoma

Features (3)

A
  1. Insidious onset
  2. Peripheral visual field loss/ tunnel vision/ scotomas
  3. Optic disc cupping
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11
Q

Fundoscopy signs of primary open-angle glaucoma (5)

A
  1. Optic disc cupping
  2. Optic disc pallor
  3. Bayonetting of vessels
  4. Cup notching (usually inferior where vessels enter disc)
  5. Disc haemorrhages
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12
Q

Primary open angle glaucoma

Mx

A

First line
1. prostaglandin analogue (PGA) eyedrops
Second line
2. BB, carbonic anhydrase inhibitor, or sympathomimetic eye drops
If more advanced
3. surgery or laser treatment can be tried

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13
Q

What is transient monocular visual loss (TVML)

Name four causes:

A 
Visual loss lasting less than 24 hours
Causes
1. ischaemic/vascular (e.g. thrombosis, embolism, temporal arteritis etc). e.g. occlusion of central retinal vein/artery
2. vitreous haemorrhage
3. retinal detachment
4. retinal migraine
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14
Q

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
Retinal tear

A

Retinal detachment

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15
Q

features include afferent pupillary defect, ‘cherry red’ spot on a pale retina
Due to thromboembolism

A

Central retinal artery occlusion

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16
Q

severe retinal haemorrhages are usually seen on fundoscopy
causes: glaucoma, polycythaemia, hypertension
=

A

Central retinal vein occlusion

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17
Q

causes: diabetes, bleeding disorders, anticoagulants
features may include sudden visual loss, dark spots
=

A

Vitreous haemorrhage

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18
Q

Flashes of light (photopsia) - in the peripheral field of vision
Floaters, often on the temporal side of the central vision
=

A

Posterior vitreous detachment

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19
Q

Herpes zoster ophthalmicus

Mx

A
  1. PO antivirals for 7-10 to be started within 72 hours of rash - IV if immunocompromised or very severe
  2. Topical steroids in any inflammation of the eye

If eye involvement –> ophth review

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20
Q

Features of herpes zoster opthalmicus

A
  1. vesicular rash around the eye, which may or may not involve the actual eye itself
  2. Hutchinson’s sign
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21
Q

What is Hutchinson’s sign?

A

rash on the tip or side of the nose. Indicates nasociliary involvement and is a strong risk factor for ocular involvement
Seen in herpes zoster opthalmicus

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22
Q

RA ocular manifestations (5)

Iatrogenic ocular manifestations (2)

A
  1. keratoconjunctivitis sicca (most common)
  2. episcleritis (erythema)
  3. scleritis (erythema and pain)
  4. corneal ulceration
  5. keratitis

Iatrogenic
steroid-induced cataracts
chloroquine retinopathy

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23
Q

Scleritis

Features (4)

A
  1. red, watery eye
  2. classically painful (in comparison to episcleritis)
  3. photophobia
  4. gradual decrease in vision
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24
Q

How to differentiate between scleritis and episcleritis

Mx episcleritis

A

Sclertitis painful, episcleritis isn’t

phenylephrine drops can be used to differentiate between the two. If eye redness improves after phenylephrine –> episcleritis

Mx artificial tears

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25
Q

What is keratitis?

Common bacteria (2)

A

Inflammation of the cornea
Microbial keratitis is potentially sight threatening and should therefore be urgently evaluated and treated

  1. Staph A
  2. Pseudomonas aeruginosa is seen in contact lens wearers
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26
Q

Keratitis

Features (4)

A
  1. red eye: pain and erythema
  2. photophobia
  3. foreign body, gritty sensation
  4. hypopyon may be seen
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27
Q

Painful red eye in a contact lens wearer
Diagnostic test
Mx

A 
Keratitis
Slit lamp 
Mx
1. Topical quinolone
2. Cycloplegic for pain relief
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28
Q

Age Related Macular Degeneration (ARMD)
Features (5)

Speed of visual loss 
What type of sight is lost first? (2) 
Other features (2)
A
  1. Subacute visual loss
  2. Near field loss
  3. Deterioration at night
  4. Photopsia, (a perception of flickering or flashing lights),
  5. Crooked or wavy appearance to straight lines
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29
Q

ARMD
Ix including fundoscopy findings (5)
Fundoscopy findings in wet ARMD

A
  1. Amsler grid testing - distortion of line perception
  2. Fundoscopy: drusen + central scotoma
  3. slit-lamp microscopy + colour fundus photography
  4. fluorescein angiography (wet ARMD)
  5. ocular coherence tomography (wet ARMD)

Fundoscopy- wet ARMD well demarcated red patches may be seen which represent intra-retinal or sub-retinal fluid leakage or haemorrhage

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30
Q

ARMD types

A

Dry 90% of cases

Wet 10% of cases
- worse prognosis

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31
Q

What is the role of vascular endothelial growth factor (VEGF) in ARMD?

A

VEGF stimulates new vessel growth in wet ARMD which leads to oedema and more rapid loss of acuity.

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32
Q

ARMD
Mx
Dry
Wet

A
  1. Dry ARMD zinc with anti-oxidant vitamins A,C and E

2. Wet ARMD anti-VEGF agents, e.g ranibizumab, bevacizumab and pegaptanib - 4 weekly injection.

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33
Q 
Define: 
Blepharitis 
Stye 
Chalazion 
Entropion 
Ectropion
A

blepharitis: inflammation of the eyelid margins typically leading to a red eye, grittiness and discomfort
stye: infection of the glands of the eyelids
chalazion = Meibomian cyst
entropion: in-turning of the eyelids
ectropion: out-turning of the eyelids

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34
Q

What is a chalazion?

Mx

A

Retention cyst of the Meibomian gland. It presents as a firm painless lump in the eyelid. Resolve spontaneously some require surgical drainage

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35
Q

What is a stye? How does it differ from a chalazion?

A

Chalazion are cysts of the meibomian gland/ oil glands deep in the eye lid (internal)
Stye’s are usually an infected an eyelash caused by Staph Aureus (external)

Mx hot compresses and analgesia, only give abx if assoc. conjunctivitis

36
Q

Blepharitis features (4)

Rx

A
  1. Usually bilateral
  2. grittiness and discomfort, particularly around the eyelid margins
  3. eyes may be sticky in the morning
  4. eyelid margins may be red and swollen

Rx

  1. Hot compress BD
  2. Lid hygiene
  3. Artificial tears
37
Q 
Anterior uveitis 
Genetics
Features (5)
Acute/ insidious 
Restricted or dilated pupil 
Other (3)

Is visual acuity affected?

A
  1. HLA B27

Features

  1. Acute onset, painful red eye
  2. Pupil irregular and small
  3. Photophobia
  4. Blurred vision
  5. Lacrimation

Visual acuity is initially normal, then becomes impaired

38
Q

Anterior uveitis

Mx

A
  1. urgent review by ophthalmology
  2. cycloplegics (dilates the pupil which helps to relieve pain and photophobia) e.g. Atropine, cyclopentolate
  3. steroid eye drops
39
Q

What is papilloedema?

A

Optic disc swelling that is caused by increased intracranial pressure.
Bilateral

40
Q

Papilloedema

Features (6)

A
  1. venous engorgement: usually the first sign
  2. loss of venous pulsation
  3. blurring of the optic disc margin
  4. elevation of optic disc
  5. loss of the optic cup
  6. Paton’s lines: concentric/radial retinal lines cascading from the optic disc
41
Q 
Name the condition: 
severe pain (may be ocular or headache)
decreased visual acuity, patient sees haloes
semi-dilated pupil
hazy cornea
A

Acute angle closure glaucoma

42
Q 
Name the condition: 
acute onset
pain
blurred vision and photophobia
small, fixed oval pupil, ciliary flush
A

Anterior uveitis

43
Q 
Name the condition: 
severe pain (may be worse on movement) and tenderness
may be underlying autoimmune disease e.g. rheumatoid arthritis
A

Scleritis

44
Q

Name the condition:

purulent discharge if bacterial, clear discharge if viral

A

Conjunctivitis

45
Q

Name the condition:

history of trauma or coughing bouts, painless, red eye

A

Subconjunctival haemorrhage

46
Q

Name the condition

typically red eye, pain and visual loss following intraocular surgery

A

Endophthalmitis

47
Q

Retinitis pigmentosa
Features (2)
Fundoscopy findings

A
  1. night blindness
  2. tunnel vision due to loss of the peripheral retina

Fundoscopy:

  1. black bone spicule-shaped pigmentation in the peripheral retina
  2. mottling of the retinal pigment epithelium
48
Q
  1. Cherry red spot
  2. Sudden loss of vision
  3. Due to thromboembolism
A

Central retinal artery occlusion

49
Q
  1. sudden, painless reduction or loss of visual acuity
  2. unilaterally
  3. Fundoscopy: severe retinal haemorrhages
A

Central retinal vein occlusion

50
Q
  1. Reduced vision
  2. Faded colour vision: making it more difficult to distinguish different colours
  3. Glare: lights appear brighter than usual
  4. Halos around lights

Defect in red reflex

A

Cataracts

51
Q

Cataracts

Ix (2)

A
  1. Fundoscopy: normal fundus and optic nerve

2. Slit-lamp examination. Findings: visible cataract

52
Q

Complications post cataract op (4)

A
  1. Posterior capsule opacification: thickening of the lens capsule
  2. Retinal detachment
  3. Posterior capsule rupture
  4. Endophthalmitis: inflammation of aqueous and/or vitreous humour
53
Q

Chorioretinitis

Causes (5)

A 
syphilis
cytomegalovirus
toxoplasmosis
sarcoidosis
tuberculosis
54
Q

Fluorescein examination: yellow stained abrasion which is usually visible to the naked eye.

Mx

A

Corneal abrasion

Topical antibiotic

55
Q

Corneal ulcers
Common in which type of pt?
Features (4)

A

Contact lens wearers

  1. eye pain
  2. photophobia
  3. watering of eye
  4. focal fluorescein staining of the cornea
56
Q

Diabetic retinopathy

Types

A

Non proliferative

Proliferative

57
Q

Non proliferative diabetic retinopathy features
Mild
Moderate
Severe

A

Mild
=>1 microaneurysm

Moderate

  1. microaneurysms
  2. blot haemorrhages
  3. hard exudates
  4. cotton wool spots
  5. venous beading/looping
  6. intraretinal microvascular abnormalities (IRMA)

Severe

  1. blot haemorrhages and microaneurysms in 4 quadrants
  2. venous beading in at least 2 quadrants
  3. IRMA in at least 1 quadrant
58
Q

Proliferative diabetic retinopathy

Features

A
  1. retinal neovascularisation - may lead to vitrous haemorrhage
  2. fibrous tissue forming anterior to retinal disc
    (more common in T1DM, 50% blind in 5 years)
59
Q

Diabetic maculopathy

A
  1. hard exudates and other ‘background’ changes on macula

More common in T2DM

60
Q

A patient presents with an acute, painful red eye associated with photophobia and epiphora. Fluorescein staining reveals a ragged area on the cornea

Mx

A

Herpes simplex keratitis

  1. Ophth review
  2. Topical aciclovir
61
Q

Horner’s syndrome

Features

A
  1. miosis (small pupil)
  2. ptosis
  3. enophthalmos* (sunken eye)
  4. anhidrosis (loss of sweating one side)
62
Q

Congenital Horner’s

A

heterochromia (difference in iris colour)

63
Q

Keith-Wagener classification of hypertensive retinopathy

A

I - Arteriolar narrowing and tortuosity
- Increased light reflex - silver wiring

II - Arteriovenous nipping

III - Cotton-wool exudates
- Flame and blot haemorrhages

IV - Papilloedema

64
Q

Serous discharge
Recent URTI
Preauricular lymph nodes
=

A

Viral conjunctivitis

65
Q

Purulent discharge

Eyes may be ‘stuck together’ in the morning)

A

Bacterial conjunctivitis

66
Q

Mx conjunctivitis

A

Usually settles without treatment within 1-2 weeks

  1. Topical chloramphenicol - drops every 2-3 hours or ointment QDS
  2. Topical fusidic acid for pregnant women
67
Q

What is the most common cause of a persistent watery eye in an infant?
Common age
Mx

A

Nasolacrimal duct obstruction
1 month

Mx
Massage the lacrimal duct
Sx resolve in 95% by the age of one year.
If unresolved refer to ophthalmologist for consideration of probing

68
Q

Optic neuritis causes:

A

multiple sclerosis
diabetes
syphilis

69
Q

Optic neuritis
Features (5)
Mx

A
  1. unilateral decrease in visual acuity over hours or days
  2. poor discrimination of colours, ‘red desaturation’
  3. pain worse on eye movement
  4. relative afferent pupillary defect
  5. central scotoma

Mx
high-dose steroids
recovery usually takes 4-6 weeks

70
Q 
Explained the Relative afferent pupillary defect
What is it also known as? 
What is it caused by?
How do you test for it?
Seen in which conditions?
A

Marcus-Gunn pupil
‘swinging light test’.
Caused by a lesion anterior to the optic chiasm i.e. optic nerve or retina

Dilatation of the eye when light is shone on the affected eye

MS (optic neuritis)
Retinal detachment

71
Q

What is the pathway of the pupillary light reflex
Afferent
Efferent

A

afferent: retina → optic nerve → lateral geniculate body → midbrain
efferent: Edinger-Westphal nucleus (midbrain) → oculomotor nerve

72
Q 
Spreading upper respiratory tract infection from the sinuses
1. reduced visual acuity
2. proptosis
3. ophthalmoplegia/pain with eye movements 
4. Redness, swelling 
5. Eyelid oedema + ptosis 
6. Drowsiness/ nausea/ vomiting 
Medical emergency --> ADMIT IV abx
A

Orbital cellulitis
Caused by commonly
Mx

73
Q

Orbital cellulitis
Ix

Most common organisms (3)

A
  1. Bloods - raised infection markers
  2. Ophthalmological assessment- decreased vision, afferent pupillary defect, proptosis, dysmotility, oedema, erythema.
  3. CT with contrast – Inflammation of the orbital tissues deep to the septum, sinusitis.
  4. Blood culture and microbiological swab to determine the organism.

Most common bacterial causes – Streptococcus, Staphylococcus aureus, Haemophilus influenzae B.

74
Q

Squint

Types

A
  1. Concomitant
    - Due to imbalance in extraocular muscles
    - convergent
  2. Paralytic
    - Due to paralysis of extraocular muscles
    - divergent
75
Q

Ix (2)

Mx (2)

A
  1. corneal light reflection test - holding a light source 30cm from the child’s face to see if the light reflects symmetrically on the pupils
2. Cover test
ask the child to focus on an object
cover one eye
observe movement of uncovered eye
cover other eye and repeat test

Mx
referral to secondary care
eye patches may help prevent amblyopia

76
Q

Cataracts causes

A
  1. Ageing
  2. Smoking
  3. Increased alcohol consumption
  4. Trauma
  5. Diabetes mellitus
  6. Long-term corticosteroids
  7. Radiation exposure
  8. Myotonic dystrophy
  9. Metabolic disorders: hypocalcaemia
77
Q

Severe dry eyes management:

A

Punctal plugs if there is frequent use of eye drops without features of inflammation

78
Q

white focal retinitis with overlying vitreous inflammation.

A

= toxoplasmosis

79
Q

‘pizza pie’, with retinal spots and flame haemorrhages-

A

cytomegalovirus

central retinal vein occlusion

80
Q

Mydriatic drops are a known precipitant of ?

A

acute angle closure glaucoma

81
Q

Intermittent squint in newborns less than 3 months

Mx

A

normal and does not need to be investigated

82
Q

night blindness + tunnel vision =

A

Retinitis pigmentosa

83
Q

Preauricular lymph nodes

bacterial or viral conjunctivitis?

A

viral

84
Q

Punctate fluorescein staining of the cornea is common in patients with

A

dry eyes

85
Q

Dots + blots + haemorrhages and lipid exudates =

A

background retinopathy

86
Q

vision improving with a pin hole =

A

refractive error

MSRA (22 decks)

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