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Flashcards in Ophthalmology conditions Deck (96):
1

Papilloedema - definition

Optic disc swelling secondary to raised ICP
Subarachnoid space (which surrounds optic nerve) has excess CSF

2

Papilloedema - cause

Accumulation of CSF or inadequate drainage of CSF which leads to a raised ICP
Brain tumour
Head injury

3

Papilloedema - clinical features

Headache
Nausea/vomiting
Blurred vision
Decreased colour perception
Transient black outs of vision
Loss of vision
Painless

4

Papilloedema - opthalmoscopy

Poorly defined disc contour
Optic disc elevated above retinal surface
Very swollen optic disc
No central cup
Swollen nerve fibres
Enlarged optic disc
Acute phase: cotton wool spots, haemorrhages

5

Horner's syndrome - causes

Sympathetic innervation gets compressed and so the innervation is impaired
- root of neck trauma
- carotid dissection
- IJV enlargement
- pancoast tumour

6

Horner's syndrome - clinical features of pupil

Miosis
- small pupils
- excess constriction of the pupils as the sympathetics aren't working to dilate the pupils

7

Horner's syndrome - additional clinical features

Ptosis
- drooping of eyelid
Reduced sweating
Increased warmth and redness

8

Chemosis (acute allergic conjunctivitis) - definition

Swelling of the conjunctiva

9

Chemosis (acute allergic conjunctivitis) - clinical features

Eye is very inflammed
Watery discharge
Itchy
Puffy swollen eyes

10

Chemosis (acute allergic conjunctivitis) - cause

Type 1 hypersensitivity reaction
- release of inflammatory mediators cause symptoms

11

Hydrocephalus - cause

Accumulation of CSF
Subsequent enlargement of the ventricles and an increase in ICP

12

Hydrocephalus - who gets it

Young babies

13

Hydrocephalus - clinical features

Bones of developing skull move apart and the head may enlarge significantly

14

Optic neuritis - who gets it

People with MS
Most commonly females

15

Optic neuritis - clinical features

Pain on eye movements
Progressive unilateral vision loss
Colour vision defect

16

Optic neuritis - definition

Inflammation of the optic nerve

17

Optic neuritis - ophthalmoscopy

Disc is very pale
Loss of blood vessels

18

CRAO - definition

Central retinal artery occlusion
This artery supplies the inner 2/3rds of the retina
It is an end artery, so if blocked there is no blood supply to the majority of the retina. this causes swelling in the retina.

19

CRAO - causes

Atherosclerosis
Hypertension
Aneurysm
Stroke

20

CRAO - clinical features

Sudden loss of vision
Painless
Very profound loss of vision
- won't be able to read top line of snellen chart
- won't be able to count your fingers

21

CRAO - ophthalmoscopy

Retina is pale and milky due to oedema
Retinal nerve fibre layer becomes swollen
Cherry red spot at macula
Cup is very dense and bright white
Blood is struggling to get through circulation - follow an artery and it may disappear

22

CRAO - management

If it presents within 24 hours of onset then try and ocular massage
- aim to push the embolus further down the vascular tree to a retinal branch artery instead of central retinal artery
Anti-platelet therapy

23

Branch retinal artery occlusion - clinical features

Bottom half of vision is lost

24

Branch retinal artery occlusion - ophthalmoscopy

Only the top half of the retina looks pale

25

Amaurosis fugax - definition

Short lasting CRAO

26

Amaurosis fugax - clinical features

Short lasting vision loss (5 mins)
Painless
Darkness/blackness coming down from vision like a set of dark curtains

27

Amaurosis fugax - ophthalmoscopy

No abnormalities

28

Amaurosis fugax - management

Urgent referral to stroke clinic
Aspirin

29

CRVO - definition

Central retinal vein occlusion
Blood travels in with no problems but the blood becomes trapped and can't get back out

30

CRVO - causes

Atherosclerosis
Hypertension
Hyperviscosity
Raised IOP

31

CRVO - clinical features

Sudden onset loss of vision
Painless
Visual outcome is variable - might not loose complete vision

32

CRVO - ophthalmoscopy

Congested fundus
Dilated, torturous veins
Cotton wool spots (areas of ischaemia)
Widespread haemorrhage
Can be difficult to see the optic disc

33

CRVO - investigations

OCT scan
- where the fovea dip is usually present, there is a 'hill' due to intra-retinal fluid build up over the fovea

34

CRVO - management

Laser treatment
Anti VEGF injections

35

Occlusion of optic nerve head circulation - definition

Posterior ciliary arteries (which supply optic nerve head) become occluded

36

Occlusion of optic nerve head circulation - types

Giant cell arteritis
Atherosclerosis

37

Occlusion of optic nerve head circulation - clinical features

Sudden, profound vision loss

38

Occlusion of optic nerve head circulation - ophthalmoscopy

Swollen disc
Pale disc
Margins are fluffy and not well defined

39

Vitreous haemorrhage - definition

Bleeding into the vitreous cavity

40

Vitreous haemorrhage - clinical features

Sudden loss of vision
Floaters in the eye
Loss of red reflex

41

Vitreous haemorrhage - ophthalmoscopy

Red areas

42

Vitreous haemorrhage - management

Identify cause of haemorrhage

43

Retinal detachment - clinical features

Painless
Sudden loss of vision
Sudden onset flashes and floaters

44

Retinal detachment - ophthalmoscopy

Retinal tear

45

Retinal detachment - management

Usually surgical

46

wet ARMD - definition

Age related macular degeneration
New blood vessels grow under the retina and macula
This causes a break in the choroid layer and leakage causes a build up of fluid/blood which lifts the macula up from its normally flat position

47

Wet ARMD - clinical features

Sudden vision loss
Central visual loss
Dark spots in the centre of pts vision due to blood/fluid under the macula
Symptoms are often unilateral to begin with but always end up bilateral

48

Wet ARMD - ophthalmoscopy

Retinal oedema
Localised elevation
Exudates in and around macula
Detachment of retinal pigment epithelium

49

Wet ARMD - management

Dietary supplements
Anti-VEGF injections
- stops new blood vessels from growing

50

Dry ARMD - definition

Dry age related macular degeneration
Build up of waste products (drusen) below the retinal pigment epithelium which causes the retina to be pulled away from the choroid
There is no leakage of fluid and no blood

51

Dry ARMD - clinical features

Gradual decline in vision
Central vision gets lost gradually (scotoma)

52

Dry ARMD - ophthalmoscope

Yellow/white deposits

53

Dry ARMD - management

Supportive treatment
Low vision aids (magnifiers)

54

Cataract - definition

Clouding of the lens in the eye which leads to a decrease in vision

55

Cataract - causes

Age related
Trauma
Diabetes
Obesity
Drug induced - SE of steroids

56

Cataract - clinical features

Gradual decline in vision
Hazy, blurred vision
Faded colours
Halos around light
Trouble with bright light
Trouble seeing at night

57

Cataract - management

Surgical removal of lens with intra-ocular lens implant (if pt symptomatic)

58

Diabetic retinopathy - types

Non proliferative
Proliferative

59

Non proliferative diabetic retinopathy - definition

Early stage
Tiny blood vessels within the retina leak blood or fluid.
This causes retina to swell or deposits to form

60

Non proliferative diabetic retinopathy - ophthalmoscopy

Micro-aneurysm
Dot and blot haemorrhages
Hard exudates (yellow)
Cotton wool patches
Abnormalities of venous calibre
Intra-retinal microvascular abnormalities (IRMA)

61

Proliferative diabetic retinopathy - definition

New vessel formation
- may grow on disc (NVD)
- may grow elsewhere in retina (NVE)
Fibrosis
Scarring (which shrinks the retina and pulls it off)

62

Proliferative diabetic retinopathy - ophthalmoscopy

New vessel formation
- grows into the vitreous
Smal dot haemorrhages in macula
White/black laser scars

63

Why do new vessels form in proliferative diabetic retinopathy?

Due to ischaemia

64

Proliferative diabetic retinopathy - management

Laser ischaemic tissue
- sacrifice some of the peripheral retina in order to save the central retina
PRP
- pan retino photocoagulation
Macular grid

Ablate retina
Surgery

65

Hypertensive retinopathy - definition

Hypertension must be very severe for this to occur

66

Hypertensive retinopathy - ophthalmoscopy

Cotton wool spots
Hard exudates
Retinal haemorrhages
Optic disc oedema
Weakened blood vessels

67

Idiopathic intracranial hypertension - BP levels

Normal

68

Idiopathic intracranial hypertension - ophthalmoscopy

Bilateral disc swelling
No crisp edge to the disc

69

Glaucoma - definition

Progressive optic neuropathy
- optic nerve gets damaged by the pressure of the fluid inside your eye

70

Glaucoma - cause

Increased intra-ocular pressure (IOP) causes damage to nerve fibres
This leads to optic nerve dysfunction

71

Glaucoma - types

Open angle
Closed angle

72

Glaucoma - ophthalmoscopy

Increased cup size due to loss of nerve fibres
Cup:Disc ratio >0.7
Other features of optic disc should be normal

73

Glaucoma - management

Eye drops which decrease aqueous humour production (this decreased IOP) e.g. bimatoprost

Prostanoids eg latanoprost

Beta blockers - block ciliary body and therefore reduce aqueous humour production

Carbonic anhydrase inhibitors - block ciliary body and therefore reduce aqueous humour production

Parasympathomometic eg pilocarpine

Laser treatment

74

Closed angle glaucoma - gradual/sudden vision loss

Sudden

75

Closed angle glaucoma - definition

Aqueous humour struggles to get through the canal of schlemm and so backs up and builds up.
This pushes the iris forward and the iris further blocks the canal of schlemm
Pressure continues to increase
Plugging of drain as iris has anatomically blocked the drainage canal

76

Closed angle glaucoma - clinical features

Sudden vision loss
Painful, red eye
Headache
Nausea
Vomiting
Cloudy cornea

77

Closed angle glaucoma - examination

Limbus injection of vessels
Cloudy cornea
Pupil mid dilated

78

Open angle glaucoma - definition

Iridocorneal angle is open but there is clogging up of the canal of schlemm
Aqueous humour is not draining so the pressure increases and damage occurs
Clogged drain

79

Open angle glaucoma - clinical features

Often asymptomatic
Gradual visual loss

80

What is the commonest cause of blindness in the western world?

ARMD

81

Which is more common: Wet or dry ARMD ?

Dry

82

Anterior uveitis - clinical features

Dull achy pain
- pain may be referred to brow
red eye (limbus)
Reduced vision
Photophobia

83

Anterior uveitis - examination

Ciliary injection around the limbus
Hypopyon (clumps of white inflammatory cells)
Small or irregular pupil

84

Anterior uveitis - management

Topical steroids
Mydratics - cyclopentolate

85

Thyroid eye disease - extra ocular features

Proptosis
Lid retraction
Lid lag
Lid pigmentation
Swelling of periorbital fat

86

Thyroid eye disease - ocular features

Chemosis (oedema of conjunctiva)
Glaucoma

87

Blepharitis - anterior (name the 2 types)

Seborrhoeic
Staphylococcal

88

Blepharitis - anterior - seborrhoeic

Scales on the lashes
Lid margin is more red than deeper part of lid
No ulceration

89

Blepharitis - anterior - staphylococcal

Infection involving the lash follicle
Lashes are distorted
- ingrowing of lashes
Can get a sty
Ulcers of lid margin

90

Blepharitis - posterior

Meibomian gland dysfunction
- lid margin and lashes unaffected
redness is in deeper part of lid
Meibomian cysts
Assoc with acne rosacea

91

Episcleritis - associated condition

Gout

92

Episcleritis - clinical features

Recurrent
Can cause nodular bumps on eye surface

93

Episcleritis - management

Self limiting

94

Scleritis - definition

Serious disease
Assoc with serious systemic vasculitides

95

Scleritis - clinical features

Painful

96

scleritis - management

Injection of deep vascular plexus
Phenylephrine test
Oral NSAIDs
Oral Steroids