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Ophthalmology Flashcards

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1
Q

What is blepharitis?

A

Inflammation of the eyelids

Commonly associated with dry eyes

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2
Q

Treatment for blepharitis

A

Hot compress
Removal of crust
Self-limiting

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3
Q

What is a stye?

A

Infection of a sweat gland

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4
Q

What is a chalazion? What is it called with associated infection?

A

Blockage of a meibomian gland

Hordeolum with associated infection

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5
Q

Treatment for preseptal cellulitis

A

Co-amoxiclav

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6
Q

Warning signs of an orbital cellulitis

A

Proptosis
Diplopia/ ophthalmoplegia
RAPD
Decreased acuity and colour vision

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7
Q

Management of orbital cellulitis

A 
Bloods- FBC, CRP
Sepsis 6 if indicated
CT-head
ENT- spread from ethmoidal sinuses 
IV abx- broad spectrum- Tazocin or cephtriaxone 
Consider surgical decompression
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8
Q

Causes of subconjunctival haemorrhage

A

Often trivial- sneezing, Valsalva manoeuvre, straining, rubbing
Anticoagulation or bleeding disorder

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9
Q

Management of subconjunctival haemorrhage

A

Reassurance
Lubricants if warranted
Do not mistake for retrobulbar haemorrhage

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10
Q

Topical abx used for the eye

A

Chloramphenicol

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11
Q

Corneal sign of abrasion

A

Positive fluorescein stain- shows an epithelial defect

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12
Q

What is a hyopyon?

A

Collection of pus in the anterior chamber

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13
Q

Serious complication of bacterial keratitis

A

Perforation and endophthalmitis

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14
Q

Management of bacterial keratitis

A

Corneal scrape for MC&S- often pseudomonas

Intensive antibiotics for 7 days every 30 minutes- often admitted due to intensity of treatment

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15
Q

Sign of HSV keratitis

A

Dendritic ulceration classically seen on fluorescein stain

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16
Q

What makes up the uvea?

A

Iris and ciliary bodies (anterior) and the choroid

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17
Q

Signs and symptoms of anterior uveitis

A 
Pain
Photophobia
Red eye (conjunctival injection)
Hypopyon 
Blurred vision 
Irregular meiotic pupil- the iris swells and sticks to the pupil- appears to not dilate in areas
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18
Q

Causes of anterior uveitis

A 
HLA B27/ ank spon
Sarcoidosis 
Idiopathic 
Infective- local, STI (including syphilis)
Cataract surgery
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19
Q

Management of anterior uveitis

A

Topical steroids and dilate (to stop sticking of the iris to the pupil)

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20
Q

Risk factors for cataracts

A 
Age
Smoking
Diabetes
UV exposure
Trauma
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21
Q

Signs of background diabetic retinopathy

A

Microaneurysms
Dot/blot haemorrhages
Hard exudates

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22
Q

Signs of pre-proliferative diabetic retinopathy

A

Cotton wool spots- retinal ischaemia
IRMA- intraretinal microabnormalities
Venous changes- beading, looping

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23
Q

Signs of proliferative diabetic retinopathy

A

Neovascularisation

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24
Q

Commonest cause of blindness in the UK (50% at 90y/o)

A

Age related macular degeneration

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25
Appearance of wet AMD and percentage
10% of AMD Neovascularisation, pre-retinal haemorrhage Greyish macula Cystoid macular oedema from leaky vessels
26
Appearance of dry AMD and percentage
90% | Drusen at the macula
27
Gradual loss of vision pathologies
``` Diabetic retinopathy Hypertensive retinopathy AMD Primary open-angle glaucoma Cataracts ```
28
Sudden loss of vision pathologies
``` Central retinal artery occlusion Acute closed angle glaucoma Retinal detachment Vitreous haemorrhage Optic neuritis ```
29
Red eye pathologies
``` Corneal abrasions Subconjunctival haemorrhage Conjunctivitis Anterior uveitis Glaucoma Keratitis ```
30
How to identify a corneal abrasion
Fluoresceine stain and examination under cobalt blue light- epithelial defects will show up green
31
How does a cycloplegic work?
Paralysis of the ciliary muscles to prevent lens movement- eg. in accommodation
32
Management of corneal abrasion
Analgesia Cycloplegic (one dose) Topical abx for 7 days- chloramphenicol Avoid contact lens use until fully healed and 24 hours after abx
33
Management of subconjunctival haemorrhage
Discourage elective use of NSAIDs/aspirin Lubricants for irritation BP control
34
Types of conjunctivitis and signs of each
Viral- follicles from lymphoid aggregation Bacterial- purulent discharge Allergic- papillae on the upper tarsal conjunctiva
35
What is Talbot's test?
Accommodation towards the nose causes pupil constriction and causes discomfort Diagnoses iritis
36
Investigations for anterior uveitis
``` Routine bloods CRP Serum ACE- sarcoid VLDR- syphilis HLA-B27 CXR Systemic disease work ups if necessary ```
37
Symptoms of glaucoma
Painful red eye Systemically unwell +/- nausea and vomiting Haloes around lights- corneal oedema Reduced vision
38
Signs of glaucoma
``` Red eye Corneal oedema Raised IOP Fixed mid-dilated pupil Shallow anterior chamber on slit lamp examination Closed angle on gonioscopy ```
39
What is gonioscopy?
Assess the iridocorneal angle
40
History clues for glaucoma
East Asian/ Chinese decent Hypermetropia Increasing age Medications- SSRIs
41
Management of an acute attack of glaucoma
IV acetazolamide 500mg to rapidly decrease aqueous inflow and reduce the pressure in the posterior chamber Topical drops- timolol, iopidine, pilocarpine and pred forte 1% Analgesia and antiemetics as necessary Once IOP medically managed then peripheral iridotomy
42
What is endophthalmitis? Exogenous causes Endogenous causes
Intraocular inflammation in the vitreous cavity or the anterior chamber Exogenous- post-operative, keratitis, penetrating trauma Endogenous- spread from anywhere in the body
43
Signs of endophthalmitis
Reduced visual acuity RAPD Lid oedema, conjunctival injection and chemosis Anterior eye- corneal oedema, hypopyon and AC cells Posterior eye- poor red reflex, vitreous cells and hazy fundal view
44
How to identify causative organism in endophthalmitis
Aqueous tap and vitreal biopsy
45
Management of cataracts
Phacoemulsification and IOL insertion
46
Cataract locations
Cortical Nuclear- commonest Posterior subcapsular
47
Normal IOP
10-21mmHg
48
Normal flow of aqueous fluid in the eye
``` Secretion by ciliary body Posterior chamber between the iris and the lens Through the pupil Trabecular meshwork Into the venous system ```
49
Screening questions to ask any ophthalmology history
Do you wear glasses or lenses? Any diagnosed issues with your eyes? Any previous surgery? Do you put any drops into your eyes?
50
What is amblyopia?
Lack of visual pathway development due to deprivation of focused stimuli- resulting in a 'lazy eye'
51
What is exotropia?
A form of strabismus in which the eye points outwards
52
Fluorescein staining of dry eye sign
Punctate epithelial erosions
53
Cause of irregular meiotic pupil in anterior uveitis
Swelling of the iris, sticks to the pupil and when the pupil dilates it doesn't appear to in the areas that are stuck to the iris
54
What are cotton wool spots a sign of?
Nerve ischaemia
55
What is a normal cup: disc
<0.5
56
What is a hypopyon?
Collection of pus in the anterior chamber
57
What is a Holmes-Adie pupil?
Pupil dilation and slow to react to light- neurological condition which is usually idiopathic
58
Argyll-Robertson pupil
Bilateral meiosis, accommodate but do not constrict to light Late stage syphilis
59
Marcus-Gunn pupil
RAPD due to damage to the afferent pathway in one of the eyes- MS
60
What is Hutchinson's sign
Vesicles extending to the tip of the nose is strongly suggestive of ocular involvement in shingles
61
Signs and symptoms of retinal detachment
Floaters secondary to vitreous debris Photopsia from reduced vision or persistent vitreous traction New visual loss- 'falling curtain' Central vision may remain intact if no fovea involvement Signs Horseshoe shaped tear in surrounding subretinal fluid
62
Management of retinal detachment
Emergency to prevent macular destruction | Laser therapy along the tear or surgical fixation
63
Signs of scleritis not episcleritis
Non-blanching with phenylephrine application | Bluish hue
64
Treatment of amaurosis fugax
Form of TIA and should be treated with aspirin 300mg Lifestyle control Prompt referral for stroke evaluation to rule out secondary ischaemic events
65
Central retinal artery occlusion signs and symptoms
Sudden and profound visual loss unilaterally May be macular sparing RAPD Cherry red spot on ischaemic retinal whitening (due to underlying choroidal circulation)

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