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Flashcards in Ophthalmology Deck (217)
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1

Signs of retinal vascular disease

Vascular changes: Arteriosclerosis, AV crossing changes, venous tortuosity, cotton wool spots
Microaneurysms
Haemorrhages
Hard exudates
Neovascularization

2

What are microaneurysms and what can they suggest

Little round dots from vessel outpouchings
Need to think about an OCT scan to check for macular oedema

3

What are the different categories of haemorrhage

Dot and blot
Flame
Pre-retinal
Roth spots

4

Describe dot and blot haemorrhages

Haemorrhage in the middle retinal layer due to diabetes/HTN

5

Describe flame haemorrhage

Haemorrhage in the superficial nerve fibre layers due to CRV occlusion

6

Describe pre retinal haemorrhage

Haemorrhage near the vitreous, between the retina and the posterior hyaloid
Caused by trauma, valsalva, neovascularisation

7

Describe roth spots

Haemorrhage with central opacity
May be due to seeding of septic emboli (IE), anaemia or haematological diseases

8

What are hard exudates and what can cause them

Lipid deposition in the outer layer due to abnormal vascular permeability
Ill defined, discrete
Assoc w diabetes

9

What is a macular star and what causes it?

Star of cream on the macula due to swelling and exudate of the optic nerve head
Due to cat scratch disease or ocular syphilis

10

What are cotton wool spots and what cause them

Ischaemic infarction in the nerve fiber layer
Assoc with diabetes, HTN, SLE, leukaemia, HIV

11

What is neovascularization and what causes it

Hypoxia leading to vasoformative factors and neovascularization
May occur in the retina, optic disc, iris or angle
Caused by diabetes, RVO, retrolental fibroplasia (of prematurity), sickle cell disease and inflammatory diseases

12

What do you do for neovascularization and what risk does it pose?

Treated with laser to prevent further development
Neovascularization increases the risk of new bleeds

13

What does venous occlusion look like

Dilated venules, haemorrhage, oedema
Increased venous tortuosity
May occur centrally or at a branch

14

What does arterial occlusion look like

Retinal pallor and oedema
arteriole construction
column interruption
cherry red spots
visible emboli
retinal pallor

15

What does retinal degeneration look like and what should you do?

Atrophy, pigmentation and scarring of retina
Presence of drusen- collection of material in pigment layer of retina
If present, get an OCT to check for macular oedema

16

What are the types of retinal elevation?

By fluid- retinal detachment
By solid mass- tumour, choroidal neovascularization
Vitreous detachment
Retinal tear

17

What is cystoid macular oedema

Hard exudates and swelling at the back of the eye
Petalloid appearance on FFA

18

What does viritis look like

Stranding and tiny cells at the back of the eye

19

What does multifocal choroiditis look like

Similar to cotton wool spots
Differentiate with lack of diabetes hx and lack of haemorrhages

20

What does retinitis look like and what causes it

One large cotton wool spot
Likely see vitreous cells in the anterior chamber
Mostly due to toxoplasmosis

21

What do granulomas look like and what causes them

Pale white spots at the back of the eye
Caused by sarcoid or TB

22

What is a good exam system for eye trauma

From front to back of eye
Start with visual acuity, end with 5 neuro exams- vision, pupils, visual fields, movement and colour vision

23

Describe metal trauma to the eye

Often secondary to grinding metal
Presents with red, sore and irritated eye
Fluoroscein shows scratches
Can sometimes see foreign body in eye or inner upper eyelid
Use a small needle to flick out of eye unless over pupil

24

Describe blunt trauma to the eye

Eyelid bruising, subconjunctival haemorrhage (blood between conjunctiva and scleara)
Reassure if otherwise visually intact

25

What is hyphaema

Anterior chamber haemorrhage between cornea and iris
Blocks angle, risks increase of pressure and angle crisis
Compresses, steroid drops, 1/52 off work
Continue to assess for risk of rebleeding

26

What is orbital blowout fracture

Fracture of bones surrounding eye
May present with poor eye movements due to trapping of muscles in bone shards or inflammation

27

Describe chemical ocular trauma management

Irrigate eye under tap until at hospital, then use bags of saline attached to Morgan lens- several litres will be needed
Assess limbus as this is stem cell site and may influence need for corneal transplant
Complication- anaesthetic cornea with conjunctiva overgrowing

28

Which is worse between acid and alkali burns

Alkali as it causes liquefactive necrosis as opposed to coagulative necrosis

29

Describe management of UV/IR trauma

Can only give lubricating drops

30

Describe penetrating/intraocular trauma

Usually a result of high speed metal such as bullet
Comes complaining of eye pain and blurring
Can see part of iris prolapsing to plug hole (teardrop pupil) or opacification of the lens causing an absent red reflex. There may also be a vitreous bleed
Management is usually surgical