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Y6 Senior Med COPY > Opthalm > Flashcards

Opthalm Flashcards

(64 cards)

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1
Q

what is the aetiology of closed angle glaucoma

A

drainage angle is blocked > raised IOP > optic nerve damage

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2
Q

what is the aetiology of open angle glaucoma

A

drainage angle is open but the drainage system is clogged (trabecular meshwork blocked) –> decreased absorption of aqueous humour

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3
Q

what are risks factors for acute closed angle glaucoma

A

female
pupilary dilatation
hypermetropria (long sightedness)
lens growth asso w/ old age

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4
Q

risk factors for primary open angle glaucoma

A
  • Family history
  • Afro-Caribbean
  • Myopia (short sighted)
  • Hypertension
  • Diabetes mellitus
  • Corticosteroids
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5
Q

definition of intraocular hypertension

A

intra-ocular pressure > 21 mm Hg

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6
Q

Symptoms of closed angle glaucoma

A
  • hard, red, painful eye and blurred vision
  • severe pain: ocular or headache
  • reduced visual acuity
  • N&V, abdo pain
  • halo around light
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7
Q

signs of acute closed angle glaucoma

A
  • Semi-dilated non-reacting pupil (fixed, dilated)
  • Loss of red reflex
  • Corneal oedema –> dull/hazy cornea ~ opaque cornea
  • visual field defect
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8
Q

Ix glaucoma

A
  • fundoscopy (cloudy cornea, fixed and dilated pupil)
  • visual field testing
  • Goldmann Applanation Tonometry = GOLD STANDARD -> Standard method of measuring intra-ocular pressure

Gonioscopy with slit lam

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9
Q

Mx for acute closed angle glaucoma

A
  • MEDICAL EMERGENCY
  • Refer immediately to ophthalmology to save sight
  • medical mx: Aims to lower intraocular pressure by inc drainage or reducing production of aqueous humour
    • eye drops: pilocarpine 1-2% drops, beta blocker (timolol), alpha 2 agonist (brimonidine)
    • IV acetazolamide 500mg
  • surg: laser peripheral iridiotomy of both eyes (essentially drill small hole through iris > do this on both eyes as other eye is likely to be affected)
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10
Q

mx for POAG

A
  • 1st line: Topical Prostaglandin analogue e.g. latanoprost
  • 2nd line: Topical β-blocker (timolol), carbonic anhydrase inhibitors, alpha 2 agonist/sympathomimetics (brimonidine)
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11
Q

what is anteror uveitis

A

inflammation of the anterior uvea (iris, ciliary) aka iritis

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12
Q

sx anterior uveitis

A

acute onset, unilateral orbital pain (worse when reading)
red eye
photophobia
blurred vision
pus in anterior chamber

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13
Q

what do you see on fundoscopy for anterior uveitis

A

irregular small pupil

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14
Q

investigations for anterior uveitis

A

CLINICAL DIAGNOSIS
Fundoscopy: exclude detachment
Slit lamp
Bloods: FBC, ESR, CRP, antibodies
Investigations for associated systemic conditions (e.g. spondyloarthritides - sacroiliac joint X-ray, HLA-B27)

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15
Q

explain the different types of conjunctivitis

A

viral: watery, bilateral OR unilateral, recent URTI, preauricular lymph nodes

Bacterial: sticky purulent, always unilateral

allergic: pruritic, bilateral

bilateral red eye, irritation, discomfort, grittiness/stickiness

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16
Q

mx of conjunctivitis if contant lense wearer

A

refer to same day opthalm review as difficult to distinguish between conjunctivtis and microbial keratitis

prompt tx required to save sight

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17
Q

conservative mx of conjunctivitis

A

o Artificial eye drops
o Cool compress
o Do not share towels
o Avoid known allergens
o Avoid contacts lenses

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18
Q

mx for different types of conjunctivitis

A

bacterial: chlorpenicol eye drops
allergic: histamine eye drops
viral: nil

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19
Q

what is corneal abrasion

A

scratch to epithelium of eye

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20
Q

ix corneal abrasion

A

slit lamp fluoroscein staining defect green

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21
Q

mx corneal abrasion

A

infection prophylaxis (chlorphenicol ointment)

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22
Q

what is keratitis

A

Inflammation of the cornea -> breakdown of corneal epithelium (corneal ulcer)

more severe than conjunctivitis = Cornea is not vascularised and needs to be transparent -> a scar on the cornea -> opacity -> vision compromised

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23
Q

what is keratitis caused by

A

compromised corneal epithelium (severe dry eyes, ocular trauma) –> penetration and invasion by:
* Bacterial e.g. s aureus, p aeroginosa (contact lenses)
* Fungus
* Amoeba (Acanthamoeba keratitis ~ wearing contact lenses in a body of water)
* Viiral - HERPES SIMPLEX KERATITIS (dendtritic ulcer)

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24
Q

S/Sx of keratitis

A
  • eye: pain, erythema, lacrimation, discharge
  • sensation of foreign body ~ grittiness
  • photophobia
  • reduced visual acuity ~ blurred vision
  • hypopyon may be seen (white corneal opacity)
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25
corneal ulcer complications
corneal scarring glaucoma corneal perforation | visual loss
26
ix for corneal ulcer
* corneal scrapings MCS and PCR (if bigger than 1mm) * HIV test * slit lamp * ulcer stains with fluorescin eye drops and observed under blue light
27
when to refer keratits
if contact lens wearers--> same day referral to an eye specialist to rule out microbial keratitis
28
management for keratits
* stop using contact lens until the symptoms have fully resolved * topical antibiotics -> 1st line = quinolones (ciprofloxacin) * cycloplegic for pain relief -> e.g. cyclopentolate
29
what is opthalmic shingles / activation of herpe zoster opthalmicus
CN v1 reactivation of VZV
30
how does opthalmic shingles present
pain | blistering rash
31
how do you manage opthalmic shingles
refer > oral aciclovir > topical corticosteroids
32
causes of sudden loss of vision
ischaemic/vascular (**amarousis fugax = lack of blood flow to retina**) * central retinal artery occlusion * central retinal vein occlusion * TIA * temporal arteritis Others: * optic neuritis * vitreus haemorrhage * retinal detachment * retinal migraine
33
Central Retinal Vein Occlusion s/sx and ix
sudden painless loss of vision (or blurred) unilateral fundoscopy: dot-blot and flame haemorrhages, disc oedema
34
sx/s optic neuritis (Inflammation of the optic nerve)
* **unilateral deterioration of visual acuity and colour vision** * **Central scotoma** (rapid loss of central vision) * **diplopia** * **pain on movement** * may develop **RAPD** later
35
causes of optic neuritis
MS DM drugs infection e.g. lyme, VZV
36
whatr is a viteus haemorrhage caused by
angiogenesis (DM) | retinal tear, detachment, trauma (e.g. warfarin)
37
what is retinal detachment
neurosensory tissue separates from the retinal pigment epithelium --> loss of vision
38
sx retinal detachment
**Sudden-onset painless, progressive visual field loss** - described as a curtain progressing from the **periphery to the centre of the visual field** **new onset floaters and flashes**
39
retinal detachment under fdilated fundal examination
- **red reflex lost** - retinal folds appear as **pale, opaque or wrinkled forms**
40
biggest risk factor for Retinal Detachment
**DIABETES**
41
mx retinal detachment
- ANY PATIENT WITH **NEW ONSET FLASHES AND FLOATERS --> URGENT REFERRAL (<24 HRS) TO OPTHALMOLOGIST** they will do slit lamp exam) - needs urgent surgery
42
explain age related macular degen
MOST COMMON CAUSE OF BLINDNESS in <60
43
ssx ARMD
**BILATERAL central vision loss** old age blurring of small words straight liness appear curvy **perception of flashing lights** (photopsia) **visual hallucinations** **light lgare**
44
ix for armd
**fundoscopy** --> drusen (yellow pigment deposition **amsler grid** - to determine changes in central vision field
45
management of ARMD
*** Refer urgently for ophthalmology assessment within 1 week ** dry - stop smoking, **zinc with anti-oxidant vitamins A, C and E** --> slow progression wet - **intravitreal injections of anti-VEGF** (bevacizumab)
46
what is catarach
clouing of the lens of the eye
47
causes of cataract
age steroids smoking DM
48
S/S catARACT
myopia blurred vision, gradual vision loss dazzling in bright lights, night vision loss halos
49
mx cataract
1. glasses, sunglassses, glycaemic control 2. medical: mydriadic eye drops (tropicamide) 3. surg: cataract surgery (laser)
50
stages of diabetic retinopathy
1. Background 2. Pre-proliferative 3. Proliferative
51
Describe background diabetic retinopathy
- venodilation - microaneurysm (red dots) - hard exhudates
52
describe pre-proliferative diabetic retinopatthy
soft exhudates (COTTON WOOL SPOTS) = ischaemia in retina (will lead to angiogenic factor release and new vessel formation later)
53
describe proliferative diabetic retinopathy
new vessel growth!!! may burst and cause haemorrhage in vitreus
54
what are the four stages of hypertensive retinopathy
1. Arteriolar narrowing, silver wiring 2. AV nipping 3. Flame-shaped haemorrhages, cotton wool spots 4. Papilloedema
55
how do you treat pre-prolif / prolif diabetic nephropathy?
pan retinal laser photocoagulation
56
management of uveitis
- urgent review by **ophthalmology** - cycloplegics (dilates the pupil which helps to relieve pain and photophobia) e.g. **Atropine, cyclopentolate** - **steroid eye drops**
57
what is a stye
infection of glands of eyelids (usually s.aureus) | On lifting the eyelid a yellow head pointing at the lid margin is seen
58
how do you treat a stye
analgesia and warm compress
59
what is a chalazion (Meibomian cyst)
o Retention cyst of meibomian gland
60
how do you treat a chalazion (cyst)
self limiting but some require surgical drainage
61
entropion vs ectropion
entropion: in-turning of the eyelids ectropion: out-turning of the eyelids
62
what is blepharitis and causes of common types
**inflammation fo eyelid margins**
63
clincial features of blepharitis
* Usually **bilateral** * **Grittiness and discomfort** * **Sticky eyes** in morning * **Eyelid margins red** * **Swollen eyelids** (staphylococcal blepharitis) * Styes and chalazions more common * May get secondary conjunctivitis
64
how to manage blepharitis
* **hot compresses** twice a day -> Softens lid margin * **Lid hygiene**: remove debris from lid margins (Cotton wool buds dipped in mixture of cooled boiled water and baby shampoo) * **Artificial tears** for **symptom relief in dry eyes **

Y6 Senior Med COPY (29 decks)

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