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Fifth Year Medicine > Ophthalmology > Flashcards

Ophthalmology Flashcards

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1
Q

What are the extraocular muscles?

A

Superior, inferior, medial and lateral rectus.

Superior and inferior oblique.

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2
Q

What is the conjunctiva?

A

The white outer coat of the eye.

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3
Q

What is the cornea?

A

The clear front window of the eye which transmits and helps to focus light.

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4
Q

What is the function of the lens?

A

To focus light rays onto the retina.

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5
Q

What is the vitreous?

A

Clear gel filling central cavity of the eye.

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6
Q

What are the photoreceptors on the retina?

A

Rods and cones

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7
Q

What is the choroid?

A

Layer at the back of the eye between the retina and sclera. It contains blood vessels and is associated with macular degeneration.

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8
Q

What is the macula?

A

An area near the centre of the retina responsible for detailed central vision. It deteriorates with age.

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9
Q

Which cranial nerve is the optic nerve?

A

2nd cranial nerve.

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10
Q

How far does your visual field extend?

A

Horizontally to 60 degrees nasally to 100 degrees temporally.
Vertically approximately 60 degrees above and 75 degrees below the horizontal meridian.

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11
Q

What are the parts of the visual pathway?

A 
Optic nerve
Optic chiasm
Lateral geniculate nucleus
Optic radiation
Visual cortex
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12
Q

Where do the optic nerves join?

A

The optic chiasm

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13
Q

What do the numerator and denominator in a snellen chart represent?

A 
Numerator = the distance at which the patient can see the observed line.
Denominator = the distance at which a normal healthy eye could see the same line.
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14
Q

Name some causes of traumatic red eye.

A

Corneal abrasion/foreign body
Subconjunctival haemorrhage/conjunctival laceration
Chemical injury
Penetrating ocular trauma

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15
Q

Name some causes of non-traumatic red eye.

A 
Conjunctivitis
Subconjunctival haemorrhage
Keratitis
iritis
Episcleritis, scleritis
Acute glaucoma
Cellulitis
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16
Q

What are the signs of conjunctivitis?

A 
Papillae
Redness
Follicles
Chemosis
Purulent discharge
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17
Q

What are papillae?

A

Vascular response.

Coblestone arrangement of flattened nodules with central vascular cores. Can be large in size (>1mm) - giant papillae.

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18
Q

What are follicles?

A

Lymphoid hyperplasia. Small done-shaped nodules without a prominent central vessel.

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19
Q

How can you distinguish between papillae and follicles?

A

Papilla clinically appears more red on its surface and more pale at its base, a follicle appears more pale on its surface and more red at its base.

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20
Q

What is chemosis?

A

Swelling or oedema of the conjunctiva.

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21
Q

Is viral conjunctivitis more likely to present with follicles or papillae?

A

Follicles

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22
Q

What is the treatment for bacterial conjunctivitis?

A

Topical antibiotics

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23
Q

What is the most common infectious cause of blindness?

A

Trachoma

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24
Q

What causes trachoma?

A

Repeated episodes of infection with chlamydia trachomatis in childhood.

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25
What is trachoma?
Severe conjunctival inflammation, scarring and potentilly blinding in-turned eye lashes in later life.
26
Where does trachoma occur?
In resource poor areas with inadequate hygiene and crowding.
27
How does a corneal ulcer differ from a corneal abrasion?
A corneal ulcer involves the stroma.
28
What are the risk factors for corneal ulcers?
``` Trauma Contact lens use Ocular surface disease e.g. dry eyes, blephritis Lid disease Systemic disease e.g. RA ```
29
What are the clinical features of corneal ulcers?
``` Pain Foreign body sensation Redness Photophobia Tearing Discharge Reduced vision ```
30
What are the acute complications of corneal ulcers?
Scleral extension Corneal perforation Endophthalmitis
31
What are the long term complications of corneal ulcers?
Corneal scarring - if central can affect vision.
32
What are the investigations for corneal ulcers?
Corneal scrapes If contact lens wearer send lenses, solution and case for culture. Swabs - viral PCR
33
Which virus can cause a dendritic corneal ulcer?
Herpes simplex keratitis
34
What is the treatment of herpes simplex keratitis?
Aciclovir ointment
35
What are the features of acanthamoeba?
Pain disproportionate to clinical findings, ring shape infiltrates, perineurla infiltrates.
36
What is the treatment for corneal ulcers?
Unless clinically very suggestive of a certain cause, usually antibacterial therapy is started until culture results are back. Broad spectrum cover e.g. cephalosporin and gentamicin (amnoglycoside).
37
What are the symptoms of scleritis?
``` Acute red eye Pain on eye movement Globe tenderness SEVERE pain Rare: associated with RA and GPA. ```
38
What is the management of scleritis?
Oral steroids | Investigation for underlying cause or vasculitis.
39
What is episcleritis?
Diffuse or sectoral red eye Mild pain Self limiting
40
What is the management of episcleritis?
Topical NSAIDs Topical steroids Not always required.
41
What is uveitis?
Inflammation of the uveal tract and often neighbouring structure e.g. retina, vitreous and optic nerve.
42
What is the uveal tract comprised of?
Iris Ciliary body Choroid
43
What are the causes of uveitis?
``` Idiopathic Trauma Infectious Autoimmune Masquerade ```
44
What are the symptoms of uveitis?
Anterior: photophobia, redness, watering, pain, reduced vision. Intermediate: reduced vision, floaters, photopsia Posterior: reduced vision, photopsia, floaters, scotoma
45
What are the signs of anterior uveitis?
``` Limbal injection Anterior chamber cells AC flare Poserior synechiae Keratitic precipitates Fibrin and hypopyon ```
46
What are the signs of intermediate and posterior uveitis?
Vitreous haze Snowballs Multicfocal choroiditis Retinitis
47
What are the complications of uveitis?
Raised intraocular pressure Cataract Cystoid macular oedema Optic neuropathy
48
What is the treatment of uveitis?
Treat cause. Anterior: topical steroids Intermediate: topical steroids. Posterior: systemic steroids.
49
What are the risks of angle closure glaucoma?
Older Hypermetrope (long sighted) Phakic
50
What are the symptoms of angle closure glaucoma?
Pain (severe) Headache Photophobia Reduced vision
51
What are the signs of angle closure glaucoma?
Red eye Hazy cornea Fixed, mid dilated pupil Iris bombe
52
What is the management of acute angle closure glaucoma?
``` Urgent referral Reduce intraocular pressure: IV acetazolamide/mannitol Pilocarpine to constrict pupil Topical steroid Topical pressure lowering drops ```
53
What is a corenal abrasion?
A scratch on the eye - defect in epithelium.
54
What is the management of a corneal abrasion?
Chloramphenicol ointment | QDS 3 days
55
What is the management of a foreign body in the eye?
Remove foreign body | Chloramphenicol ointment for 3 days
56
What is the management of chemical injuries to the eye?
Irrigate immediately - at least 2L, evert eyelids. | pH after irrigation, then 5 mins and 20 mins
57
What are the symptoms of globe rupture?
``` Pain +++ Obvious penetrating injury Suspicious mechanism of injury Irregular pupil 360 degrees subconj haem Flat AC ```
58
What is the management of suspected globe rupture?
``` Don't press on it! Measure VA Slit lamp/pupils if able - analgesia - antibiotics - tetanus CT (thin slice) Call opthalmology ```
59
What is the clinical presentation of a retrobulbar haemorrhage?
``` Reduced vision RAPD Raised pressure Pain Proptosis Reduced motility ```
60
What is the most common type of orbital fracture?
Floor fracture
61
What is the management of orbital cellulitis?
IV antibiotics | CT
62
What is Hutchinson's sign in shingles?
Nasociliary nerve involvement.
63
What is the treatment for shingles?
PO aciclovir
64
How does cataract present?
``` Gradual onset Reduced vision Usually bilateral (but asymmetric) Can also cause: Glare Monocular diplopia Progressive myopia ```
65
What are the triad of features of glaucoma?
Raised IOP Optic nerve changes Visual field loss
66
What are the typical symptoms of age related macular degeneration?
Gradual blurring of central vision Difficulty reading Sudden deterioration if develops 'wet' disease
67
What are the risk factors for developing macular degeneration?
``` Smoking Family history Female > Male Caucasian Diet Cardiovascular disease Hypermetropia ```
68
What are the clinical signs of dry age related macular degeneration?
``` Progressive atrophy Loss of RPE and photoreceptors Thickening of Bruch's membrane Drusen Pigment clumping Atrophy ```
69
What is the pathophysiology of wet ARMD?
Neovascular growth of capillaries from choroid into subretinal space Leads to leakage and bleeding
70
What is the management of wet ARMD?
Intravitreal injections - anti VEGF VEGF-A - induces pathological angiogenesis Anti-VEGF: reduces vascular permeability, reduce fluid leakage, halt progression of neovascularisation.
71
What are the clinical features of retinal tear and detachment?
``` Rapid onset Associated flashes and floaters Curtain coming down Unilateral Painless ```
72
What are the possible causes of flashes and floaters?
Retinal detachment Posterior vitreous detachment Vitreous haemorrhage (proliferative diabetic retinopathy) Migraine (coloured lights)
73
Describe vitreous.
Gel-like consistency Provides shape, cushions eye Water (99%), collagen
74
What are the possible complications related to the vitreous degenerating with age?
Posterior vitreous detachment | Rhegmatogenous retinal detachment
75
What are the risk factors for retinal detachment?
``` Age Trauma Myopia Previous cataract surgery Previous laser refractive surgery Family history Fellow eye (1 in 10) ```
76
What are the management options for a retinal detachment?
Vitrectomy (remove the traction) Laser/cryo (seal the hole) Gas/oil (tamponade the break)
77
What is the typical presentation of central retinal artery occlusion?
Sudden onset, painless loss of vision
78
What are the signs of central retinal artery occlusion?
VA <6/60 RAPD Pale/swollen retina Cherry red spot
79
What other pathology is central retinal artery occlusion associated with?
Giant cell arteritis
80
Which further investigations should be carried out in the case of central retinal artery occlusion?
``` TIA referral Carotid dopplers CT head Aspirin/clopidogrel No driving for 1 month ```
81
What is the typical presentation of a central retinal vein occlusion?
Sudden onset, painless loss of vision.
82
What are the clinical features of central retinal vein occlusion?
``` Tortuous vessels Disc swelling Flame haemorrhages Cotton wool spots Macular oedema May have RAPD ```
83
What is the management of central retinal vein occlusion?
``` Address vascular risk factors: BP Lipids Diabetes Smoking ``` Macular oedema: Anti-VEGF Intra-vitreal steroids
84
How do you test the function of the optic nerve?
``` Visual acuity Colour vision Pupils (check for RAPD) Visual fields Optic nerve appearance ```
85
What are the two main pathologies associated with the optic nerve that could cause acute visual loss?
Optic neuritis | Ischaemic optic neuropathy
86
What is the presentation of optic neuritis?
Reduced vision - gradual over 2 weeks. Unilateral Patchy/variable Pain on eye movements
87
What are the clinical signs of optic neuritis?
``` Reduced optic nerve function Disc swelling (sometimes) ```
88
What is the clinical course of optic neuritis?
Gets worse for two weeks Gradually resolves over 3 months IV steroids hasten recovery but don't change outcome
89
Which disease is optic neuritis associated with?
MS
90
What can cause atypical optic neuritis?
``` Infection (TB/syphilis) Inflammation (vasculitis/uveitis etc.) Neuromyelitic optica Anterior ischaemic optic neuropathy Neoplastic Leber's hereditary optic neuropathy ```
91
Which arteries is the optic nerve head supplied by?
Posterior ciliary arteries
92
What causes anterior ischaemic optic neuropathy?
Interruption to the blood supply of the posterior ciliary arteries.
93
What is the clinical presentation of ischaemic optic neuropathy?
``` Reduced vision RAPD Reduced colour vision Visual field defect (altiduinal) Disc swelling ```
94
What causes arteritic anterior ischaemic optic neuropathy?
Giant cell arteritis | Temporal arteritis
95
What are the risk factors for GCA/temporal arteritis?
``` Age >55 Headache Jaw claudication Scalp tenderness Raised ESR/CRP Cranial nerve palsies ```
96
What is the management of giant cell arteritis/temporal arteritis?
Urgent IV methylprednisolone.
97
What is the cause of non-arteritic anterior ischaemic optic neuropathy?
Atherosclerosis
98
What are the risk factors for non-arteritic anterior ischaemic optic neuropathy?
``` Age >55 Vascular risk factors No symptoms associated with GCA Normal inflammatory markers Altitudinal visual field defect ```
99
What is the management of non-arteritic anterior ischaemic optic neuropathy?
There is no treatment. Less severe visual loss. More common than arteritic anterior ischaemic optic neuropathy.
100
What is a cataract?
Clouding of the lens Develops gradually with age. Leading to blurred vision for distance for distance and near vision.
101
Where is the nutrition to the lens derived from?
Aqueous fluid
102
How dose the lens accommodate?
Ciliary body contraction Zonules relax Lens higher power
103
What is presbyopia?
The gradual loss of your eyes ability to focus on nearby objects.
104
What does phakic mean in relation to the lens?
Natural lens
105
What does pseudophakic mean in relation to the lens?
Natural lens removed and artifical lens inserted.
106
What does aphakic mean in relation to the lens?
Natural lens removed but not replaced.
107
How does the lens develop a cataract?
Proteins accumulate inside the lens, they obstruct light and cause a haziness in the lens. This haziness is the cataract.
108
What are the risk factors for developing a cataract?
Diabetes Steroid use Age related Can get congenital cataracts
109
What are the symptoms of a cataract?
Gradual onset painless blurred vision for near and distance. Glare, especially driving at night. Myopic shift.
110
When is cataract surgery required?
When the patient becomes symptomatic. | When the patient's lifestyle is affected e.g. driving or watching tv.
111
When may cataract surgery be required other than due to the effects of a cataract?
To treat angle closure glaucoma. | To improve visualisation of the retina to manage co-pathology e.g. diabetic retinopathy.
112
What is the postential intraoperative complication of cataract surgery?
Posterior capsular rupture
113
What are the potential postoperative complications of cataract surgery?
``` Endophthalmitis Uveitis Cystoid macular oedema Retinal detachment Posterior capsular opacification ```
114
When might endophthalmitis occur in relation to cataract surgery?
3-5 days after surgery
115
What are the symptoms of endophthalmitis?
Rapidly progressive pain Red eye Ocular discharge Blurring
116
What are the signs of endophthalmitis?
``` Decreased visual acuity Lid swelling Hypopynon Vitreous inflammation Dullling of red reflex ```
117
What is the treatment for endophthalmitis?
Urgent intravitreal antibiotics.
118
How does posterior capsular opacification occur?
Residual lens epithelial cells migrate along posterior capsule and opacify.
119
What is glaucoma?
Optic neuropathy with characteristic loss of optic nerve fibres leading to visual field loss. Intraocular pressure is the only modifiable risk factor
120
What are the visual changes in the optic nerve in a patient with glaucoma?
Increased cup:disc ratio Splinter haemorrhages Pallor Peripapillary atrophy
121
What is the pathogenesis of chronic primary open angle glaucoma?
Elevated IOP | Altered vascular supply to the optic nerve.
122
What are the risk factors for chronic primary open angle glaucoma?
Elevated intraocular pressure Myopia Family history Afro-Caribbean descent
123
What are the signs of glaucoma?
``` IOP >21mmHg Optic disc: Gradual thinning of neurosensory rim superiorly and inferiorly Nerve fibre layer defect Optic disc rim notching and cupping Cup:disc ratio enlarged/asymmetrical Visual field changes Gonioscopy - open angle ```
124
What are the treatment options for glaucoma?
Prostaglandin analogue Beta blocker Carbonic anhydrase inhibitor Alpha 1 agonist
125
Give an example of a prostaglandin analogue?
Latanoprast
126
Give an example of a beta blocker?
Timolol
127
Give an example of a carbonic anhydrase inhibitor.
Brinzolamide
128
Give an example of an alpha 1 agonist.
Brimonidine
129
What is the method of action of prostaglandin anglogues?
Inceases uveoscleral outflow.
130
What is the method of action of beta blockers?
Decreases aqueous humour production.
131
What is the method of action of carbonic anhydrase inhibitors?
Decreases aqueous humour production
132
What is the method of action of alpha 1 agonists?
Decreases aqueous humour production and incrreases uveoscleral outflow
133
What are the side effects of prostaglandin analogues?
Eyelash growth | Iris pigmentation
134
What are the side effects of beta blockers?
Bradycardia | Bronchoconstriction
135
What are the side effects of carbonic anhydrase inhibitors?
Metallic taste | Malaise
136
What are the side effects of alpha 1 agonists?
Allergy | Dry mouth
137
What are the laser treatments for glaucoma?
Selective laser trabeculoplasty | Cyclodiode laser
138
What is the possible surgical treatments for glaucoma?
Trabeculectomy with mitomycin C
139
What are the complications of trabeculectomy?
Hypotony Infection Cataract Bleb leakage
140
What are the symptoms of acute angle closure glaucoma?
``` Sudden onset severely painful eye Blurred vision Halos around lights Headache Nausea, vomiting ```
141
What are the signs of acute angle closure glaucoma?
``` Visual acuity reduced Red eye Cornea hazy Pupil - mid dilated and fixed Digitally high IOP Gonioscopy - closed iridocorneal angle ```
142
What is the treatment for acute angle closure glaucoma?
Medically: Topical - pilocarpine, intraocular pressure reduction Systemic - IV acetazolamide - carbonic anhydrase inhibitor YAG laser iridotomy: both eyes - prophylactic to second eye
143
What are the clinical features of congenital glaucoma?
``` Watering photophobic eyes Large eyes - buphthalmos Increased corneal diameter Cloudy cornea Reduced vision Raised intraocular pressure ```
144
What is the treatment for congenital glaucoma?
Goniotomy | Trabeculectomy
145
What is neovascular glaucoma caused by?
Diabetic retinopathy | Retinal vein occlusion
146
What is neovascular glaucoma?
Neovascularisation of the iris Fibrous membrane over trabecular meshwork. Membrane contracts and closes drainage angle.
147
What is the treatment for neovascular glaucoma?
Surgery
148
What happens in pigment dispersion syndrome?
Pigmented iris rubs against zonules. | Pigment is shed and clogs trabecular meshwork.
149
Who is at risk of pigment dispersion syndrome?
Young caucasian myopic males.
150
What happens in pseudoexfoliation syndrome?
Pigment is rubbed off iris and clogs trabecular meshwork.
151
What are the effects of diabetes on the eyes?
``` Increased susceptibility to infection Dry eyes and keratitis Anterior uveitis Cataract Diabetic papillitis Diabetic retinopathy Cranial nerve palsies ```
152
What is diabetic retinopathy?
Disease of the retinal microvasculature associated with prolonged hyperglycaemia.
153
What are the features of diabetic retinopathy?
``` Microaneurysms Blot/dot haemorrhages Hard exudates Cotton-wool spots New vessels ```
154
What is the management of diabetic retinopathy?
Screening programme Education - diabetic control. Proliferative diabetic retinopathy - panretinal photocoagulation laser.
155
What is the ocular manifestation of sjogren's syndrome?
Dry eyes
156
What is the ocular manifestation of juvenile idiopathic arthritis?
Uveitis
157
What is the ocular manifestation of HLA-B27 disease?
Anterior uveitis
158
What is the ocular manifestation of rheumatoid arthritis?
Scleritis
159
What is the ocular manifestation of giant cell arteritis?
Ischaemic optic neuropathy | Cranial nerve palsies
160
What are the features of anterior uveitis?
Mildly painful eye Typically doesn't wake patient from sleep Painful to look at light
161
What are the features of scleritis?
``` Very red eye Wakes patient up Deep, boring pain Tender globe Doesn't blanche with phenylephrine ```
162
What is the treatment of scleritis?
Oral steroids
163
What are the clinical features of giant cell arteritis?
``` >50 years old Scalp tenderness Jaw claudication Visual loss (fleeting/permanent) Stroke/cranial nerve palsies ```
164
What are the investigations of giant cell arteritis?
ESR/CRP Temporal artery biopsy MRI USS
165
What is the management of giant cell arteritis?
High dose steroids
166
What are the features of raised intracranial pressure?
Swollen optic nerves | Enlarged blind spots
167
What are the differentials for raised intracranial pressure?
Space occupying lesion | Idiopathic intracranial hypertension
168
What are the opthalmic features of MS?
``` Optic neuritis Internuclear ophthalmoplegia Isolated visual field defects Uveitis (intermediate) Nystagmus ```
169
What are your eyes like at birth?
Spherical lens Immature macula Vision is black and white
170
At what age can a snellen chart be used to test a child's sight?
5 years
171
How do you visually assess a newborn?
Red reflex
172
How do you visually assess a 6 week old?
Fixing and following | Eye occlusion
173
How do you visually assess a 2 year old?
Kay pictures
174
How do you treat amblyopia?
Spectacle Patching Atropine
175
How do you treat problems with lacrimal drainage?
Bathe the eyes | Antibiotics if the eye is raised
176
What is the investigation of orbital cellulitis?
CT
177
What is the management of orbital cellulitis?
Immediate antibiotics
178
What is eye discharge in the first week of life?
``` Gonococcal (day 1-3) Chlamydial conjunctivitis (day 4-28) ```
179
What are the complications of gonococcal infection in newborns?
Corneal damage
180
What does leukocoria mean?
White pupil
181
What can leukocoria indicate?
Retinoblastoma Congenital cataract Retinal detachment
182
What are the indications for surgery in a congenital cataract?
``` Severe cataract Central 3mm opacity VA <6/24 (older baby) Strabismus Poor visualisation of fundus ```
183
What are possible complications post congenital cataract surgery?
Visual axis opacities Glaucoma Inflammation Endophthalmitis
184
What are the investigations of suspected retinoblastoma?
EUA Fluorescein Ultrasound If optic nerve not seen then MRI (CT avoided due to increased incidence of secondary malignancies)
185
What is the treatment for retinoblastoma?
Chemotherapy Focal laser therapy Enucleation
186
What is retinopathy of prematurity?
In premature babies peripheral retina is not vascularised at birth. There is growth of new vessels and scarring.
187
What are the risk factors for retinopathy of prematurity?
Low gestational age <32 weeks. | Low birth weight <1501g
188
What is the classification of retinopathy of prematurity?
Stage 1: Demarcation line Stage 2: Ridge Stage 3: Extraretinal fibrovascular proliferation Stage 4: Partial retinal detachment (4a - extrafoveal, 4b - foveal) Stage 5 - total retinal detachment
189
What is the treatment of retinopathy of prematurity?
Laser photocoagulation of peripheral retina | Without laser, retinal detachment/blindness
190
What are the ocular features of hypertension?
``` Arteriolar narrowing and A-V nicking Cotton wool spots Retinal haemorrhages Optic nerve swelling Retinal ischaemia and neovascularisation ```
191
What is thyroid eye disease?
An orbital inflammation affecting up to 40% of patients with autoimmune thyroid gland disease.
192
What are the clinical features of thyroid eye disease?
``` Swelling of lids Chemosis of conjunctiva Exposure of cornea Pronounced exophthalmos/proptosis Restricted eye movements Optic neuropathy ```
193
What is the treatment of thyroid eye disease?
``` Artifical tears and lubrication Stop smoking Oral selenium Systemic steroids if sight threatening External beam radiation ```
194
What is the surgery for thyroid eye disease?
Orbital decompression surgery Eye muscle surgery Eye lid surgery
195
What is the definition of papilloedema?
Bilateral optic disc swelling secondary to raised ICP
196
How can papilloedema cause visual loss?
Optic atrophy
197
What are the further investigations of papilloedema?
CT LP Venogram
198
What are the ocular signs of Marfan's syndrome?
``` Ectopia lentis Flattened cornea Keratoconus Myopia Amblyopia Strabismus Retinal detachment ```

Fifth Year Medicine (9 decks)

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