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AKT > Opthal > Flashcards

Opthal Flashcards

1
Q

subconjunctival haemorrhages - traumatic haemorrhages are most commonly in which region?

A

Temporal region

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2
Q

Subconjunctival haemorrhage on examination would show what findings of the fundus?

A

NORMAL fundus

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3
Q

When do subconjunctival haemorrhages warrant investigation?

A

Recurrent
Bilateral

Traumatic with other eye injury
No obvious border

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4
Q

In age-related macular degeneration, there is degeneration of retinal photoreceptors that results in the formation of…

A

DRUSEN

which is seen on fundoscopy and retinal photography

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4
Q

What is the most common cause of blindness in the UK

A

Age related macular degeneration

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4
Q

Two types of age-related macular degeneration - what are they and which one is more common

A
  1. Dry macular degeneration (90%)
  2. Wet macular degeneration
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5
Q

Dry macular degeneration is also known as…

A

ATROPHIC

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6
Q

Wet macular degeneration is also known as…

A

EXUDATIVE or NEOVASCULAR macular degeneration

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7
Q

What is wet macular degeneration (10% of ARMD) characterised by?

A

Choroidal neovascularisation

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8
Q

What is dry macular degeneration (90% of ARMD) characterised by?

A

Drusen - yellow round spots in Bruch’s membrane

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9
Q

Which type of age related macular degeneration carries the worst prognosis

A

Wet (exudate, neovascular) macular degeneration

Leaks serous fluid and blood - rapid loss of vision

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10
Q

Distortion of line perception may be noted (i.e. in diseases such as age-related macular degeneration) using what test?

A

Amsler grid testing

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11
Q

In fundoscopy of in wet ARMD, red patches may be seen which represent …

A

intra-retinal or sub-retinal fluid leakage or haemorrhage

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12
Q

What is the investigation of choice to identify any pigmentary, exudative or haemorrhagic changes affecting the retina, and age-related macular degeneration?

A

Slit lamp microscopy

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13
Q

What investigation can be used to guide intervention for neovascular (wet) ARMD to help with anti-VEGF therapy?

A

Flureoscein angiography

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14
Q

What investigation can be used to visualise retina in 3D - better than microscopy

A

Optical coherence tomography

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15
Q

Treatment of ARMD

A
  1. Zinc, vitamins A, C, E
  2. Anti-VEGF agents - 4 weekly injection
  3. Laser photocoagulation for new vessel formation
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16
Q

What is acute angle-closure glaucoma caused by

A

Increased intra-ocular pressure due to impaired aqueous outflow

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17
Q

If you struggle to see nearby objects, what is this called

A

HYPERMETROPIA
Long-sightedness

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18
Q

If you struggle to see far away objects, what is this called

A

MYOPIA
Short-sightedness

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19
Q

What eye condition has a semi-dilated non-reacting pupil?

A

Acute angle closure glaucoma

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20
Q

What investigations are used for glaucoma

A

Tonometry - looks for elevated IOP
Gonioscopy - special lens for slit lamp to visual the angle

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21
Q

Acute angle glaucoma management

A
  1. Eyedrops (e.g. pilocarpine, timolol, apraclonidine)
  2. IV acetazolamide - reduces aqueous secretions
  3. Topical steroids
  4. Laser peripheral iridotomy
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22
Q

What 3 types of eyedrops are useful in acute angle closed glaucoma

A
  1. Direct parasympathomimetic e.g. pilocarpine - contracts ciliary muscles to increase outflow of aqueous humour
  2. B-blockers e.g. timolol - reduces aqueous production
  3. Alpha-2 agonist e.g. apraclonidine - decreases aqueous production and increases outflow
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23
Q

Visual loss, eye pain and red desaturation (poor discrimination of colours) are all classical symptoms of

A

optic neuritis

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24
Q

What are 3 causes of optic neuritis

A
  1. multiple sclerosis
  2. diabetes
  3. syphilis
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25
Q

Central scotoma is seen in which eye condition

A

optic neuritis

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26
Q

Investigation of optic neuritis

A

MRI of brain and orbits with gadolinium contrast

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27
Q

Management of optic neuritis

A

High dose steroids
recovery usually 4-6 weeks

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28
Q

If MRI brain in optic neuritis shows >3 white matter lesions, what is the 5 year risk of developing multiple sclerosis

A

50%

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29
Q

What is the leading cause of curable blindness worldwide

A

Cataract

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30
Q

Cataracts are usually caused by ageing. Other risk factors include smoking, diabetes, steroids, Down’s syndrome and what metabolic imbalance?

A

HYPO calcaemia

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31
Q

Gradual onset of:
reduced vision
faded colour vision
glare
haloes around lights
defect in red reflex

what is the diagnosis?

A

cataracts

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32
Q

What investigations are done for cataracts?

A

Opthalmoscopy - normal fundus and optic nerve
Slit lamp - visible cataract

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33
Q

What are the 4 types of cataract that they be classified into

A
  1. Nuclear - old age, change lens refractive index
  2. Polar - localised, inherited
  3. Subcapsular - due to steroid use
  4. Dot opacities - DM, myotonic dystrophy
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34
Q

Management of cataracts

A
  1. Non-surgical - glasses, optimise vision
  2. Surgery - removal of cloudy lens and replacing it with artificial one
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35
Q

4 complications following cataract surgery

A
  1. Posterior capsule opacification - thickened lens capsule
  2. Retinal detachment
  3. Posterior capsule rupture
  4. Endopthalmitis - inflammation of humour
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36
Q

Watery eyes in babies are usually caused by

A

delayed development of the nasolacrimal ducts

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37
Q

What condition presents with absent red reflex

A

Retinoblastoma

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38
Q

Management of nasolacrimal duct obstruction

A
  • teach parents to massage the lacrimal duct
  • 95% resolves by age of 1 year
  • unresolved cases have probing under GA with opthalmologist
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39
Q

what is Hutchinson’s sign in Herpes zoster opthalmicus

A

Shingles rash on tip/side of nose
Indicates nasociliary + ocular involvement

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40
Q

Treatment for shingles

A

Oral acyclovir for 7-10 days

ideally start within 72 hours
topical steroids for eye
ocular involvement needs urgent opthal review

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40
Q

Anterior uveitis is associated with which 5 conditions

A
  1. ankylosing spondylitis
  2. reactive arthritis
  3. inflammatory bowel disease/UC/CD
  4. Behcet’s
  5. Sarcoidosis
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40
Q

Painful
Blurred vision
Red eye
Lacrimation
Ciliary flush
Hypopyon (pus in anterior chamber)
Small and irregular, oval, constricted pupil

What is the diagnosis

A

Anterior uveitis

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40
Q

if a patient has blurred vision, and pinhole occluder improves their vision - what is the likely cause

A

needs glasses!

  • refractive error
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40
Q

Treatment for anterior uveitis

A
  1. urgent review by opthalmology
  2. cycloplegics e.g. atropine - dilates pupil
  3. steroid eye drops
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40
Q

Those with a positive family history of glaucoma should be screened annually from what age

A

40 years

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41
Q

Primary open angle glaucoma may present slowly. What 4 signs on fundoscopy are shown?

A
  1. Optic disc cupping
  2. Optic disc pallor (atrophy)
  3. Vessels break, bayonette
  4. Cup notching / haemorrhages
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42
Q

Peripheral visual field loss (tunnel vision)
Decreased visual acuity
Optic disc cupping

Slow progression
what is the diagnosis

A

primary open angle gaucoma

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43
Q

Who makes diagnosis usually of primary open angle glaucoma

A

Optometrist
GP refers to opthalmologist

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44
Q

Investigations for primary open angle glaucoma

A

Automated perimetry - assess visual field
Slit lamp exam
Tonometry - measures IOP
Gonioscopy - checks angle

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45
Q

Diabetic retinopathy 3 classifications

A

Non-proliferative diabetic retinopathy
Proliferative retinopathy
Maculopathy

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46
Q

Within Non-proliferative diabetic retinopathy, what is mild NPDR

A

1 or more microaneurysm

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47
Q

Within Non-proliferative diabetic retinopathy, what 4 factors are in moderate NPDR

A

microaneurysms
blot haemorrhages
hard exudates
cotton wool spots

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48
Q

Within Non-proliferative diabetic retinopathy, what 3 factors are in severe NPDR

A

blot haemorrhages and microaneurysms in 4 quadrants
venous beading in at least 2 quadrants
IRMA in at least 1 quadrant

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49
Q

What 3 key features are part of Proliferative diabetic retinopathy

A

retinal neovascularisation - may lead to vitrous haemorrhage
fibrous tissue forming anterior to retinal disc
more common in Type I DM, 50% blind in 5 years

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50
Q

what 4 key features are part of maculopathy (diabetic retinopathy)

A

based on location rather than severity
hard exudates and other ‘background’ changes on macula
check visual acuity
more common in Type II DM

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51
Q

treatment for maculopathy

A

if there is a change in visual acuity then VEGF inhibitors

52
Q

treatment for non-proliferative retinopathy

A

regular observation
if severe then panretinal laser photocoagulation

53
Q

treatment for proliferative retinopathy

A

panretinal laser photocoaghulation
intravitreal VEGF inhibitors +/- panretinal laser photocoagulation
if severe or haemorrhage then vitreoretinal surgery

54
Q

red eye
painful
watering and photophobia
GRADUAL decrease in vision
full thickness inflammation

what is the diagnosis?

A

scleritis

55
Q

treatment for scleritis

A

same day assessment by opthalmologist
oral NSAIDs
oral glucocorticoids for more severe
immunosuppressants for resistant cases

56
Q

4 risk factors for scleritis

A
  1. rheumatoid arthritis
  2. SLE
  3. sarcoidosis
  4. granulomatosis with polyangiitis
57
Q

how should a patient lie with acute closed angle glaucoma when they are waiting for treatment

A

ask the patient to lie flat, face up with their head unsupported by pillows to relieve pressure on the angle

58
Q

herpes simplex keratitis commonly presents with…

A

dendritic corneal ulcer

59
Q

management of herpes simplex keratitis (dendritic corneal ulcer)

A

immediate referral to opthalmologist
topical aciclovir

60
Q

in-turning of the eyelids is called

A

entropion

61
Q

out-turning of the eyelids is called

A

ectropion

62
Q

infection of the glands of the eyelids is called

A

stye

63
Q

inflammation of the eyelid margins typically leading to a red eye is called

A

blepharitis

64
Q

Meibomian cyst is also called

A

chalazion

65
Q

2 types of stye

A
  1. external (hordeolum externum): infection (usually staphylococcal) of the Zeis or Moll sebum/sweat glands
  2. internal (hordeolum internum): infection of Meibomian glands. May leave a residual chalazion (Meibomian cyst)
66
Q

Management of stye

A

hot compresses and analgesia

CKS only recommend topical antibiotics if there is an associated conjunctivitis

67
Q

chalazion (Meibomian cyst) is a retention cyst of the Meibomian gland. It presents as a firm painless lump in the eyelid. what is treatment

A

most resolve themselves

some need surgical drainage

68
Q

Which is painful vs painless:
(a) scleritis
(b) episcleritis

A

(a) scleritis - painful
(b) episcleritis - painless

69
Q

5 ocular manifestations of rheumatoid arthritis

A
  1. keratoconjunctivitis sicca
  2. episcleritis
  3. scleritis
  4. corneal ulceration
  5. keratitis
70
Q

Blood in anterior chamber of eye is called

A

hyphema

71
Q

treatment of hyphema in context of trauma

A

urgent same day referral to opthalmology
strict bed rest
they will assess for orbital compartment syndrome

72
Q

Management of orbital compartment syndrome (e.g. secondary to retrobulbar haemorrhage - eye pain, proptosis, rock hard eyelids, RAPD)

A

Lateral canthotomy to decompress the orbit

73
Q

Corneal foreign body - refer to opthalmology if

A
  • sharp object
  • suspected eye injury due to high velocity injury
  • chemical injury (irrigate for 30min first)
  • organic material foreign body
  • in or near the centre of cornea
  • red flags e.g. severe pain, dilated/non-reactive pupils, reduced visual acuity
74
Q

Blepharitis is inflammation of..

A

eyelid margins

75
Q

Blepharitis is more common in patients who suffer from

A

rosacea

76
Q

Bilateral grittiness/discomfort
Eyes sticky in morning
Eyelid margins may be red
Styes + chalazions are more common

What is diagnosis

A

Blepharitis

77
Q

Blepharitis treatment

A
  1. hot compresses
  2. lid hygiene - baby shampoo, cooled boiled water, sodium bicarbk
  3. artificial tears
78
Q

keratitis is inflammation of the ..

A

cornea

79
Q

Causes of keratitis

A
  1. Bacterial - Staph, Psuedomonas in contact lens
  2. Fungal
  3. Amoebic - acanthamoebic (5%) with soil or water contimated
  4. Parasitic - onchocercal (river blindness)
  5. Viral - HSV
  6. Environmental - photokeratitis (welder’s arc eye), contact lens acute red eye (CLARE)
80
Q

contact lens wearers who present with a painful red eye require what referral

A

same-day referral to an eye specialist is usually required to rule out microbial keratitis

81
Q

management of keratitis

A
  1. stop using contact lens
  2. topical Abx
  3. cycloplegic for pain relief e.g. cyclopentolatec
82
Q

4 complications of keratitis

A
  1. corneal scarring
  2. perforation
  3. endopthalmitis
  4. visual loss
83
Q

If suspecting age-related macular degeneration, referral to opthalmology urgently within ..

A

1 week

84
Q

Children with viral conjunctivitis school exclusion period

A

no exclusion

85
Q

Purulent discharge
Eyes stuck together in morning

Bacterial or viral conjunctivitis?

A

Bacterial

86
Q

Serous discharge
Recent URTI
Preauricular lymph nodes

Bacterial or viral conjunctivitis?

A

Viral

87
Q

Infective conjunctivitis treatment

A
  1. Self-limiting within 1-2 weeks
  2. Topical Abx e.g. chloramphenicol
  3. Topical fusidic acid for pregnant women
  4. Contact lens users - topical fluorescein stain to identify any corneal issue. Stop using contacts
  5. Do not share towels
  6. Can continue going to school
88
Q

management of subconjunctival haemorrhage

A

reassure

AND CHECK BLOOD PRESSURE

89
Q

if immediate admission is not possible for acute closed angle glaucoma, emergency treatment should be started in primary care which includes

A

oral acetazolamide
topical pilocarpine

90
Q

What is the name for an infection of the lacrimal sac, secondary to obstruction of the nasolacrimal duct

A

dacryocystitis

91
Q

What patients with blepharitis should be referred for same day opthalmology assessment

A

Corneal disease symptoms
e.g. pain and blurred vision

92
Q

acute angle closure glaucoma is associated with hypermetropia
what is primary open-angle glaucoma associated with?

A

myopia

93
Q

what eyedrops increase eyelash length

A

latanoprost

94
Q

Papilloedema describes optic disc swelling caused by

A

increased intracranial pressure

95
Q

5 causes of papilloedema

A
  1. space occupying lesion
  2. malignant hypertension
  3. idiopathic intracranial hypertension
  4. hydrocephalus
  5. hypercapnia
96
Q

treatment of herpes simplex keratitis

A

aciclovir eye ointment

97
Q

Retinitis pigmentosa main symptoms

A

Night blindness
Tunnel vision

98
Q

fundoscopy: black bone spicule-shaped pigmentation in the peripheral retina, mottling of the retinal pigment epithelium

what condition is this

A

retinitis pigmentosa

99
Q

episcleritis 2 associated conditions

A

inflammatory bowel disease
rheumatoid arthritis

100
Q

what eyedrops can be used to differentiate between episcleritis and scleritis

A

phenylephrine

blanches conjunctival and episcleral vessels, but not the scleral vessels

101
Q

management of episcleritis

A

conversative
artificial tears may be used

102
Q

who can certify patients as blind or partially sighted

A

consultant opthalmologist

103
Q

children with a squint management

A

referral to opthalmology

104
Q

NICE advises to arrange a 2-week wait referral if a malignant eyelid tumour is suspected, for example, if the meibomian cyst has an atypical appearance such as …

A

distortion of eyelid margin
loss of eyelashes
ulceration
bleeding
or it recurs in the same location

105
Q

corneal ulcer risk factors

A

contact lens
vitamin A def

106
Q

organism causes of corneal ulcer

A
  1. bacterial keratitis
  2. fungal keratitis
  3. viral keratitis - HSV, herpes zoster
  4. acanthamoeba keratitis - a/w contact lenses
107
Q

the most common 4 causes of sudden painless loss of vision

A
  1. ischaemic/vascular (VTE, GCA)
  2. vitreous haemorrhage
  3. retinal detachment
  4. retinal migraine
108
Q

ischaemic/vascular causes of sudden losses of vision may respresent a form of TIA. what should the treatment be?

A

aspirin 300mg

109
Q

what type of conditions would cause sudden loss of vision ‘curtain coming down’

A

Retinal detachment

  • dense shadow that starts peripherally and progresses towards central vision
  • straight lines appear curved
110
Q

3 causes of central retinal vein occlusion

A

Glaucoma
Polycthaemia
Hypertension

111
Q

Central retinal artery occlusion causes

A

VTE (from atherosclerosis)
Arteritis e.g. GCA

112
Q

RAPD
sudden visual loss
painless
unilateral
cherry red spot on a PALE retina

what is the diagnosis

A

central retinal artery occlusion

113
Q

Flashes of light/floaters
Sudden loss of vision

What are the two conditions that can cause this?

A

Vitreous or retinal detachment

114
Q

Causes of vitreous haemorrhage (sudden painless visual loss, floaters/dark spots)

A

Diabetes
Posterior vitreous detachment
Bleeding disorders
Anticoagulants

115
Q

straight lines appear curved in which 2 conditions

A

retinal detachment
age related macular degeneration

116
Q

What eye condition is related to syphilis (Trepnoema pallidum)

A

Argyll-Robertson pupil

also caused by diabetes

117
Q

What are the pupils like in Argyll-Robertson?

A

Small and irregular
Accommodate but do not react to light

(ARP = accommodation reflex present, PRA = pupillary reflex absent!)

118
Q

Hypertensive retinopathy - what stage?

Arteriolar narrowing + tortuosity
Increased light reflex - silver wiring

A

Stage 1

119
Q

Hypertensive retinopathy - what stage?

AV nipping

A

Stage 2

120
Q

Hypertensive retinopathy - what stage?

Cotton wool exudates
Flame + blot haemorrhages

A

Stage 3

121
Q

Hypertensive retinopathy - what stage?

Papilloedema

A

Stage 4

122
Q

Horner’s syndrome 4 features

A

Miosis (small pupil)
Ptosis
Enopthalmos (sunken eye)
Anhidrosis

123
Q

Congenital horner’s versus horner’s - what is different

A

heterochromia - difference in iris colour in congenital

124
Q

the location of anhidrosis in Horner’s syndrome can help distinguish where the lesion is. where is the lesion for:
(a) anhidrosis of face, arm and trunk
(b) anhidrosis of face
(c) no anhidrosis

A

(a) face, arm and trunk - central lesion e.g. the ‘S’ - Stroke, Syringomelia, multiple Sclerosis, tumourS
(b) face - the ‘T’ - pancoast Tumour, Thyroidectomy, Trauma
(c) no anhidrosis - the ‘C’ - carotid dissection, carotid aneurysm, cluster headache, cavernous sinus thrombosis

125
Q

what is the usual first line treatment for childhood squint after referral to paeds team

A

occlusion therapy of normal eye with eye patch

126
Q

what is the medical term for squint

A

strabismus

127
Q

how can squints be categorised

A
  1. concomitant - due to imbalance in extraocular muscles. covergent > divergent
  2. paralytic - due to paralysis of muscles
128
Q

Why are squints important to detect and correct

A

Uncorrection can lead to amblyopia (brain favours one eye > other for inputs)

129
Q

How to detect a squint

A

Corneal light reflection test

hold light source 30cm from child’s face to see if light reflects symmetrically on pupils

130
Q

6 causes of tunnel vision

A
  1. papilloedema
  2. glaucoma
  3. retinitis pigmentosa
  4. choroidoretinitis
  5. optic atrophy secondary to tabes dorsalis
  6. hysteria
131
Q

management of central retinal artery occlusion

A
  • treat cause e.g. IV steroids for GCA
  • if they present acutely then can attempt intra-arterial thrombolysis
132
Q

What is the diagnosis

Sudden painless loss of vision
Unilateral

Fundoscopy shows:
severe retinal haemorrhages (stormy sunset)
widespread hyperaemia (redness)

A

Central retinal vein occlusion

133
Q

Holmes-Adie pupil
Is it constricted or dilated
And what does it react/not react to?

A

Dilated
Slowly reactive to accommodation
Very poorly (if at all) to light

134
Q

Holmes-Adie pupil - dilated pupil
Is it unilateral/bilateral in most cases?

A

Unilateral 80%

135
Q

Holmes-Adie is associated with what reflexes

A

Absent ankle/knee reflexes

136
Q

5 causes of mydriasis (dilated large pupil)

A
  1. 3rd nerve palsy
  2. Holmes-Adie pupil
  3. Trauma
  4. Phaeochromocytoma
  5. Congenital
137
Q

What two eye drops can cause dilated large pupil (mydriasis)

A

Tropicamide
Atropine

AKT (25 decks)

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