Ophthalmology - high yield Flashcards

Question

What is characteristic of dry macular degeneration?

Answer 1

drusen in buch’s membrane - undigested cellular debris from degeneration of RPE (retinal pigment epithelium) cells as a part of normal ageing process *accumulation leads to atrophy of retinal epithelium

Answer 2

characterised by choroidal neovascularisation - VEGF (vascular endothelial growth factor) is a protein molecule that has critical role in angiogenesis so in wet AMD causes abnormal angiogenesis and vessel leakage *fibrous scar tissue and central vision loss and leads to scotoma

Answer 3

age smoking Caucasian ethnicity high fat diet drugs like aspirin co-morbidities like CVS and HTN ocular characteristics light coloured iris hyperopia genetics complement factor H gene variant Y402H (drusen formation link)

Answer 4

early - few medium sized druse, mild pigmentary abnormalities intermediate - >1 large drusen advanced - gradual vision loss or advanced wet is rapid vision loss

Answer 5

visual changes unilateral with gradual loss of central vision reduced visual acuity crooked or wavy appearance to straight lines (metamorphopsia) gradually worsening ability to read small text

Answer 6

wet AMD - more acutely visual loss within days and progress to complete within 2-3 years often progresses to bilateral disease

Answer 7

- pinhole worsens - reduced visual acuity - snellen chart - scotoma - enlarged central area of vision loss - amsler grid test - assess for distortion of straight lines seen in AMD - drusen - fundoscopy - slit lamp - detailed view of retina and macula - optical coherence tomography - cross sectional view of retina - fluorescein angiography - fluorescein contrast and photographing the retina to assess the blood supply, oedema neovascularisation in wet AMD

Answer 8

no cure, ambler to monitor vitamin supplements in early disease registration with national centre for blind social work involvement, OT, psychology involvement informing DVLA if visual acuity poor

Answer 9

*no cure - maintain functional sight, amsler grid to monitor 2w referral for wet AMD intravitreal anti-VEGF therapy - monthly registration with national centre for blind social work involvement, OT, psychology involvement informing DVLA if visual acuity poor

Answer 10

corneal abrasion chemical injury cataracts diabetic eye disease presbyopia

Answer 11

progressively opaque eye lens which reduces light entering eye and visual acuity *can be congenital or progressive

Answer 12

age related pre-senile steroids DM trauma uveitis congenital

Answer 13

increasing age smoking alcohol DM steroids hypocalcaemia

Answer 14

*asymmetrical - change in glasses prescription - myopic shift with short sighted first as light converges as cataract hardens - slow reduction in visual acuity - progressive blurring of vision - colours more faded - brown or yellow - starbursts around lights at night especially *loss of red reflex

Answer 15

phacoemulsification - if vision 6/12 with sub-tenon block *important to treat as prevents detection of other pathology like AMD, DM retinopathy etc

Answer 16

post-surgery endophthalmitis - inflammation of vitreous and aqeous humour mx: intravitreal abx seondary glaucoma

Answer 17

carotid → ophthalmic → central retinal and posterior ciliary artery

Answer 18

chronic hypoglycaemia damages retinal small vessels and endothelial cells increases vascular permeability -> leaks and blot haemorrhages + hard exudates neovascularisation etc

Answer 19

hard exudates micro-aneurysms and venous beading cotton wool spots intra-retinal microvascular abnormalities neovascularisation

Answer 20

background retinopathy pre-proliferative proliferative diabetic maculopathy ischaemic diabetic maculopathy

Answer 21

micro-aneurysms dot and blot haemorrhages cotton wool spots hard exudates *no tx indicated, annual screening with digital photography

Answer 22

extensive blot haemorrhages and intra-retinal microvascular abnormalities (ischaemia) *4-6m follow up with digital fundus colour photos + retinal laser tx

Answer 23

neovasuclarisation and vitreous haemorrhages *pan retinal photocoagulation targeting new vessels, retinal laser, anti-VEGF

Answer 24

diabetic - exudates within macula and macular oedema! ischaemic - angio needed to diagnose, occlusions within vessels *mx - anti-VEGF bevacizumab, ranibizumab, intravitreal dexamethasone implant to reduce macular oedema

Answer 25

duration of diabetes - 50% at 7 years duration and 90% at 17-50 poor glycaemic control hypertension dyslipidaemia obesity pregnancy

Answer 26

asymptomatic and most present with severe disease floaters blurred vision and distortion if macula affected decreased visual acuity - gradual, painless reduction in quality loss of vision - severe haemorrhage in results in sudden complete and painless vision loss blindness in untreated and uncontrolled

Answer 27

for anyone with diabetes every 1-2 years depends on previous 2 scans

Answer 28

visual acuity - logMAR gold: fundoscopy with slit lamp or through fundus photography OCT: non invasive and infrared Fundus fluorescein angiography dye into arm to see retinal blood vessels

Answer 29

close monitoring and careful diabetic control pre-proliferative: 4-6m follow up with digital fundus colour photos retinal laser treatment given if, only one good eye left attendance to clinic poor prior cataract surgery

Answer 30

Pan-retinal photocoagulation (PRP) - extensive laser treatment across the retina to suppress new vessels aim to kill ischaemic retina so hypoxic drive and oxygen demand is lessened and supply focused to central retina *complications - visual field defects, impaired night vision, accidental macular burn anti VEGF - medication intravitreal injection bevacizumab, ranibizumab surgery - vitrectomy in severe disease macular oedema intravitreal implant containing dexamethasone

Answer 31

retinal detachment central retinal artery occlusion central retinal vein occlusion vitreous haemorrhage (due to diabetic retinopathy)

Answer 32

temporary loss of vision caused by a temporary interruption to the blood supply

Answer 33

obstruction to blood flow through the central retinal artery, which was a brach of ophthalmic artery which is a brach of ICA *cause atherosclerosis, GCA, vasculitis hence CVS RF

Answer 34

sudden painless loss of vision: curtain coming down RAPD

Answer 35

pupil in affected eye constricts more when light shone in other eye than when shone in itself, hence appears to dilate when shone on affected when swung from non-affected input not sensed by ischaemic retina when testing direct but sensed in consensual

Answer 36

fundoscopy: pale retina with cherry red spot (fovea) due to lack of perfusion GCA: ESR, temporal artery biopsy *refer immediately

Answer 37

GCA: potentially reversible so high dose prednisolone +/- IV Methylpred attempt to dislodge blockage: ocular massage, anterior chamber paracentesis, inhaled carbogen, IV acetazolamide+mannitol etc secondary prevention of CVS, treat reversible RF

Answer 38

thrombus forms in retinal veins and obstructs the venous drainage from retina central retinal vein run through the optic nerve - responsible for draining retinal capillaries atherosclerotic thickening of central retinal artery leading to vein compression causes retinal tissue ischaemia, infarction, vessel leakage and neovascularisation

Answer 39

age FHx of vascular atherosclerosis open angle glaucoma inflammatory: sarcoidosis, Lyme hyper coagulable state myeloproliferative states

Answer 40

sudden, painless unilateral visual loss (more gradual than artery occlusion) relative afferent pupillary defect - ischaemia visual field defect

Answer 41

branch retinal vein occlusion (BRVO) - this occurs when a vein in the distal retinal venous system is occluded

Answer 42

fundoscopy: widespread hyperaemia, severe retinal haemorrhages, macular oedema, cotton wool spots BP FBC, glucose, ESR fundal photo fundus fluorescein angio

Answer 43

immediate ophthal referral control BP treatment aim to control complications macular oedema: anti-VEGF, intravitreal steroid implant, laser neovascular complications: pan-retinal photocoagulation

Answer 44

Ischaemic carries poorer prognosis retinal non-perfusion, capillary closure, retinal hypoxia which increases neovascularisation risk may resolve spontaneously, cause vitreous haemorrhages or cystoid macular oedema

Answer 45

involves the neurosensory layer of retina (containing photoreceptors and nerves) separating from the retinal pigment epithelium (base later attached to choroid) *resulting in fluid accumulation in between

Answer 46

due to retinal tear -> vitreous fluid to get under the neurosensory retina and fill the space neurosensory retina relies on blood vessels of the choroid for its blood supply detachment disrupts this causing permanent damage to photoreceptors -> sight threat

Answer 47

lattice degeneration (thinning of retina) posterior vitreous detachment trauma diabetic retinopathy retinal malignancy family history

Answer 48

painless peripheral vision loss - sudden, shadow coming across vision blurred vision or distorted vision flashes and floaters RAPD if optic nerve involved fundoscopy: red reflex might be lost

Answer 49

aim to create adhesions between retina and choroid with laser and cryo aim to reattach retina: vitrectomy, scleral buckle, pneumatic retinoplexy

Answer 50

inflammatory condition of the optic nerve that leads to acute, unilateral, central loss of vision (over hours to days) common in females 20-40

Answer 51

immune-mediated demyelination of the optic nerve as an isolated incident or part of wider disorder acute version of MS also associated with DM, syphillis

Answer 52

acute, central vision loss - unilateral over hours to days poor discrimination of colours - red desaturation pain worse of eye movement photopsia - flashes of light relative afferent pupillary defect visual field defects - central scotoma optic atrophy - chronic

Answer 53

swinging light test: RAPD visual acuity ishihara colour test ophthalmoscopy: mildly swollen disc MRI brain and orbits with contrast: confirm demyelinating optic neuritis LP: elevated protein, lymphocytes,oligoclonal bands

Answer 54

high dose IV steroids - methylprednisolone disease modifying therapies - MS? recovery usually 4-6w

Answer 55

autoimmune condition resulting in inflammation and swelling of extra-ocular muscle, fatty tissue and connective tissue within orbit *follows acute phase for 6m to 2y where damage happens, inactive phase when sx remain

Answer 56

excessive watering ‘gritty’ sensation photophobia eye pain ask - red eye, blurred vision, pressure sensation systemic - pretibial myxoedema, goitre, acropachy

Answer 57

eye lid retraction proptosis lig lag - von Graefe’s sign lid oedema diplopia due to restriction of inferior rectus incomplete eyelid closure strabismus

Answer 58

measure proptosis assess optic disc visual acuity, colour vision, RAPD TFT antibody test anti-thyroid peroxidase, anti-TSH USS extra-ocular muscles CT orbit - nerve involvement MRI orbits

Answer 59

compressive optic neuropathy - Urgent IV methylprednisolone Ophthal + endo review correct thyroid hormone levels smoking cessation steroids to reduce swelling

Answer 60

*compressive optic neuropathy - reduced visual acuity, colour vision → sight-threatening globe subluxation gaze abnormalities raised IOP → glaucoma

Answer 61

result of ischaemia to the retina, choroid, or optic nerve from an arterial embolus, usually in the retinal artery (from ipsilateral carotid artery disease)

Answer 62

over 50 vascular RF HTN, HPL, smoking, previous TIA or stroke

Answer 63

transient vision loss in one or both eyes abrupt, maximum severity within seconds lasting to minutes full recovery negative visual phenomenon - blackout or ‘greying out’ of vision normal ophthal exam

Answer 64

inflammatory markers - rule out GCA carotid imaging for stenosis cardiac investigations - AF other stroke RF neuro-imaging is needed

Answer 65

300mg of aspirin unless contraindicated urgent TIA referral within 24h secondary prevention - statin, antiplt, optimising BP etc

Answer 66

inflammation of the eyelid margins - due to meibomian gland dysfunction (common, posterior bleph), or seborrhoeic dermatitis/ staphylococcal infection (less common, anterior bleph)

Answer 67

bilateral symptoms grittiness and burning discomfort - around lid margins eyes sticky in the morning results in dry eye which could cause redness foreign body sensation margins may be red - swollen in staphylococcal blepharitis styes and chalazions common in these secondary conjunctivitis

Answer 68

anterior - eyelash deformity and depigmentation and loss posterior - dilated and obstructed Meibomian glands

Answer 69

diagnosis - history, examination - slit lamp - swabs maybe done for cultures hot compress lid hygiene artificial tears abx ophthal referral if painful

Answer 70

lid hygiene - mechanical removal of debris from margins cotton wool buds dipped in mix of cooled boiled water and baby shampoo often used alternative is sodium bicarb, teaspoonful in cup of cooled water recently boiled

Answer 71

vitreous body comes away from retina - common in older age vitreous humour is gel inside the vitreous chamber of eye, maintain structure of eyeball and keeps retina pressed on choroid with age, less firm and less able to maintain shape

Answer 72

*exclude retinal detachement brain adjusts overtime safety net for retinal detachment as predisposes

Answer 73

painless can be asymptomatic floaters flashing lights blurred vision

Answer 74

history of symptoms and onset - pain - visual loss - serious - gritty - conjunctivitits, dry eyes, foreign body - itching - allergic, blepharitis examination of both eyes - visual acuity with snellen - evidence of trauma, discharge, swelling - pattern on redness - perform fluorescein examination - assess pupils, RAPD? - BP

Answer 75

reduced visual acuity severe pain, headache, photophobia significant ciliary injection, fluorescein staining unequal pupils and abnormal reactions pain on pupillary constriction, loss of red eye, corneal haze, hyphaema or hypopyon (blood and pus in anterior chamber)

Answer 76

acute angle-closure glaucoma anterior uveitis scleritis corneal ulcerations keratitis foreign body trauma or chemical injury endophthalmitis

Answer 77

conjunctivitis episcleritis subconjuctival haemorrhage dry eye episcleritis

Answer 78

difference in pupil size physiological is ≤2mm and difference same in all light levels

Answer 79

light activates retinal ganglion cells → axons through optic nerve → chiasm → optic tract → synapse at EWN → efferent parasympathetic fibres travel with CN3 → cilairy ganglion iris contains 2 muscles - constricting sphincter innervated by parasympathetic and dilating by sympathetic (which starts at ipsilateral hypothalamus)

Answer 80

greater anisocoria in dark → impaired dilation in small pupil (sympathetic dysfunction) greater anisocoria in light → impaired constriction in large pupil (parasympathetic dysfunction)

Answer 81

Adie’s tonic pupil post viral denervation of the sphincter pupillae and ciliary muscle dilator drops 3rd nerve palsy traumatic mydriasis

Answer 82

horners syndrome pilocarpine drops uveitis

Answer 83

positive - brightness, shimmering, hallucinations → migraine aura, seizure negative - blackness, greyness, shade-obscuring vision → TIA, stroke

Answer 84

visual acuity and colour vision snellen, pinhole, fingers, movement ishihara, red saturation swing test for RAPD visual fields ophthalmoscopy

Answer 85

amaurosis fugax central venous occlusion central arterial occlusion vitreous haemorrhage retinal detachment optic neuritis GCA

Answer 86

misalignment of the two eyes when focusing on one object which could be persistent (manifest or tropia) or latent (phoria)(discovered with cover test)

Answer 87

**Primary** - idiopathic - congenital **Secondary** - cranial nerve palsies of EOM - intracranial infection - intracranial, intraorbital and intraocular masses - orbital # or other trauma - myopathies - MG - endocrine - DM, graves - heavy metals and toxins

Answer 88

- family history - low birth weight - premature birth - maternal smoking

Answer 89

- recent trauma - symptoms of raised ICP - new strabismus in school age child

Answer 90

- onset, reduced visual acuity, diplopia, asthenopia, decreased socialisation, behavioural problems, maladjustment at home or school - other - developmental history, obstetric, previous medical, previous visual acuity

Answer 91

- corneal light reflex - Deflection of the corneal light reflex in one eye suggests a misalignment - Brüchner test - asymmetry of red reflexes suggest ocular disorder - cover test - determine heterotropia (latent stabismus) - cover-uncover test - check covered eye for refixation movement, if phoria present eye will shift back to being orthopic or straight - prism cover test

Answer 92

- orthoptics - measure visual acuity, assess eye movement, assess binocular vision, monitors amblyopia with patching to encourage use of amblyopic eye - patch unsuccessful after age of 7 - refraction to correct deviation and improve acuity - strabismus surgery - EOM operated on

Ophthalmology - high yield Flashcards

(116 cards)