opthalmology Flashcards
(44 cards)
1
Q
Differentials for conjunctivitis
A
- acute glaucoma (SEVERE pain, blurry, corneal clouding, dilated pupil)
- episcleritis
- uveitis
- keratitis (cloudy vision, severe pain)
- corneal ulcer
2
Q
define diabetic retinopathy and types of it.
A
- microvascular complication of diabetes which affects your eye
- major cause of visual loss + blindness
- Early symptoms = asymptomatic SCREENING NEEDED (retinal imaging)
Types:
- Background
- Pre-proliferative
- Proliferative
- Maculopathy
3
Q
Pathophysiology of retinopathy
A
- Hyperglycemia => activation of different pathways (high glucose delivered to retina by retinal arteries)
- Affects endothelial function => retinal ischemia
- Produces factors that increase permeability of blood vessels => factors leak into surrounding vessels => macula oedema
- Erythropoietin factor=> retinal neurovascularisation
4
Q
examination findings of diabetic retinopathy
A
FUNDOSCOPY
background
- hard exudate- cholesterol
- microaneurysms (dots)
- blot haemorrhages
pre-proliferative
- cotton wool spots (ischaemia)
proliferative
- little thin new vessels developing from optic disc (problems => tears can lead to bleeding in vitrious=> BLIND)
Maculopathy
- affects direct vision
- blots/dots (microaneurysms)
- hard exudates
5
Q
Treatment for retinopathy
A
- Background => improve blood glucose control (don’t need glasses change as diabetes is causing changes lens shape) + WARN PATIENT ABOUT DIABETES
- Pre-proliferative/proliferative => refer to eye doctor => PAN retinal photocoagulation (laser off ischaemic areas)
- Maculopathy => Anti-VEGF injections , Grid photocoagulation
6
Q
complications of retinopathy
A
- vitreous haemorrhages- new vessels leaking
- glaucoma- new vessels affect fluid flow => increase pressure in eye => damage optic nerve
- retina detachment - new scar tissue growth pushes eye forwards
- BLINDNESS
7
Q
define uveitis
A
inflammation of the uvea (iris, ciliary body, choroid)
- anterior uveitis (most common)
- intermediate uveitis (vitreous inflammed)
- posterior uveitis (retina/choroid inflammaed)
8
Q
causes of uveitis
A
- IDIOPATHIC (40%)
- systemic inflammatory disorders (ankylosing spondylosis-young men, juvenile arthritis-women, MS, sarcoidosis, IBD, SLE, Behcet’s)
- infection (TB, HSV, HZV)
- trauma
- neoplasia
9
Q
symptoms + signs of uveitis
A
symptoms:
- cloudy/blurred vision
- red around the limbus (cornea-sclera border)
- moderate painful eye
- photophobia
- watery eye
signs:
- pupil irregular/constricted
- flashes and flares (leakage of proteins) - inflammatory cells in anterior chamber
- keratic precipitate in cornea
10
Q
management for uveitis
A
- refer to opthamologist
- medical: (only given by opthamologist)
- non-infectious => topical corticosteroids + cyclopentolate (paralyses cilliary body - relieves pain)
- infectious => antimicrobial + corticosteroids + cyclopentolate
- chronic/ SEVERE => immunosuppressants, TNF inhibitors, laser phototherapy, cryotherapy
11
Q
prognosis + complications of uveitis
A
- most resolve after treatment
- some become chronic=> visual impairment, ocular complications, blindness
COMPLICATIONS:
- cystoid macular oedema
- secondary cataract
- secondary glaucoma.
12
Q
define thyroid eye disease
A
autoimmune disease usually caused by hyperthyroidism (Grave’s) leading to eye inflammation (eye muscles, eyelids, tear glands, fatty tissue behind eye)
- active
- stable phase
13
Q
symptoms of thyroid eye disease
A
- red painful eye
- diplopia (restricted ocular mobility)
- dry/watery eyes
- bulging/STARE eyes
- PROPTOSIS (exopthalmos) not always present
- lid retraction/ lid lag
- difficulty closing eyes
- reduced visiual acuity (more severe)
FHx, more common in females/40-60s
14
Q
investigations for thyroid eye disease
A
- TFTs (T4/TSH levels)
- anti-TSH/TPO/thyroglobulin antibodies (not very specific/sensitive)
- CT/MRI orbital area
- thyroid uptake scan
15
Q
Management for thyroid eye disease
A
- Mild (dry eye/diplopia) => conservative (drops)
Moderate
- corticosteroids (intravenous)
- orbital radiotherapy
- Surgical decompression
Severe (vision loss)
- IV corticosteroids + urgent orbital decompression
Systemic disease:
- anti-thyroid drugs (propylthiouracil, carbimazole)
16
Q
what is conjunctivitis
A
inflammation of conjunctiva caused by infection or allergies usually affecting both eyes
17
Q
causes of conjunctivitis
A
- viral (most common) - adenovirus
- bacterial - strep. pyogenes, staph. aureaus, H. influenza
- allergic
- chemical/ contact lens associated
- reactive arthritis
18
Q
symptoms of conjunctivitis
A
- eye redness (starts in one eye spreads to other)
- eye discomfort - gritty, foreign body, burning
- watery eyes/ discharge => temporary vision blurring
Bacterial => rapid redness, pus discharge with crusted eye lids
Viral => pink eye, watery discharge, previous URTI
Allergic => watery discharge, sneezing/runny/blocked nose, eyelid swelling
19
Q
signs of conjunctivitis
A
Inner upper eyelid
- papillae- raised inflammtion with central vessel (Allergy/bacterial)
- follicles- raised lymphocytes (yellow)- CVT/ chlamydia, toxic, viral
lesions on upper eyelid => HSV
Huthinson’s sign (lesions on nose) => HZV
Conjuctival membrane (yellow fibrin layer above conjuctiva) - severe infection
20
Q
investigations for conjuctivitis
A
- usually none
- if not resolved with treatment => swab => viral PCR for HSV/adenovirus or bacterial culture
21
Q
management for conjuctivits
A
Viral
- self-limiting (7 days)
- eye care - cool compress, saline-wash eye lids, lubricating eye drops
- CONTAGIOUS so avoid contact with others + hygiene
Bacterial
- delayed use of topical antibiotics (chloramphenicol)
- eye care
- avoid contact with others
Contact lens associated
- stop using contact lens
- eye care
22
Q
When to refer to opthamology (for red eye)
A
Red flag symptoms
- reduced visual acuity
- headache/photophobia - meningitis
- recent trauma/ eye surgery
- copious mucus discharge => gonnorrhea
- worried about contact lens associated problems (keratitis)
Symptoms persist 7 days after treatment
23
Q
define scleritis
A
- inflammation of sclera (white part of eye)
- usually due to underlying systemic inflammation
- anterior uveitis (90%)- diffuse, nodular, necrotising
- posterior uveitis
24
Q
symptoms of scleritis
A
- painful red eye
- pain radiates to forehead, brow, jaw
- pain worse on movement
- watery eyes/ photophobia
- associated with systemic inflammation
- +/- gradual loss of vision
Posterior scleritis
- worse symptoms but quiet, white eye
- associated signs - proptosis, lid oedema, optic disc swelling, retinal detachment
25
conditions associated with scleritis
connective tissue disorders
* **rhematoid arthritis** (most common)
* SLE
* GPA (granulomatosis with polyangitis)
* reactive arthritis
* ankylosing spondylitis
gout
Syphillis
IBD
26
Investigations for scleritis
Bloods:
* FBC
* **ESR/CRP** - inflammation
* RA screen - Rheumatoid factors/ anti-CCP (specific)
* Syphillis screen - rapid plasma reagin (antibodies to syphillis bacteria)
Imaging:
* X-rays (chest/sacro-illiac joints)
* CT/MRI of sinus/orbit
27
management of scleritis
* SUSPECTED scleritis =\> refer to OPTHAMOLOGIST
* Treat cause (inflammation)
1. Oral NSAIDs- ibuprofen
2. Oral prednisilone
3. Immunosuppressant drugs (methotrexate/azathioprine)
4. Biologics - infliximab
5. Surgery for complications
28
Complications of scleritis
* scleral thinning
* raised IOP
* uveitis
* retinal detachment (posterior)
* cataracts
29
define optic neuritis
inflammation of optic nerve
30
causes of optic neuritis
* multiple sclerosis (autoimmune)
* infections - lyme disease, measles,mumps, herpes
* sarcoidosis
* Behcet's
* drugs - methanol (antifreeze), ethambutol (treat TB)
31
symptoms + signs of optic neuritis
* **reduced visual acuity**
* **reduced colour vision**
* **eye pain** (worse on movement)
* flashing lights
* visual field loss
* Uthoff's sign - symptoms worse in hotter temp
Signs:
* decreased pupilary light reaction/ RAPD
* scotoma
32
investigations for optic neuritis
* usually clinical (visual acuity, visual field, colour vision)
* if aypical:
1. FBC, ESR, TFTs, autoantibodies, syphillis serology
2. CXR- check for sarcoidosis/TB/malignancy
3. MRI- check for MS risk
33
management of optic neuritis
* refer to opthamology/neurology
* Corticosteroids - **methylprednisilone ,** speeds up visual recovery
34
complications for optic neuritis
* optic nerve damage
* permanenet visual loss
* steroid side effects =\> prone to infection, mood changes, weight gain
35
types of visual field defects
* monocular blindness
* bitemporal hemianopia
* homonymous hemianopia (same side + half)
* homonymous quadrantopia (same side + quarter)
36
retinal causes of visual field loss
* retinal detachment (flasher, floaters, curtains)
* retinal artery/vein occlusion
* age-related macular degeneration
* drugs
* chloroquine
* vigabatrine (treat epilepsy)
37
pre-chiasmal causes of visual field defects
* one eye only, ipsilateral
* optic neuritis
* amaurosis fugax - temporary vision loss in both eyes
* optic atrophy
* retrobulbar optic neuropathy
* trauma
* glaucoma
38
chiasmal causes of visual field defects (bitemporal hemianopia)
* pituitary adenoma
* suprasellar aneurysm
39
post chiasmal causes of visual field defects (contralateral eye, homonymous hemianopia)
* stroke
* tumour
* trauma
40
causes of cranial nerve palsy
1. CN III
2. CN IV
3. CN VI
Oculomotor
* vasculitis
* **aneurysms** (posterior communicating artery)
Trochlear
* **congenital**
* **trauma**
* vascular tumour
Abducen's
* **cranial pressure**
* vascular tumour
41
symptoms of oculomotor nerve palsy
* ptosis
* eye down and out
* mydriasis (dilated pupil), unreactive to light
42
symptoms of
1. CN IV palsy (superior oblique)
2. CN VI palsy (lateral rectus)
CN IV palsy
* prevents moving inwards and down
* some diplopia
CN VI palsy
* prevents eye moving outwards
* diplopia
43
investigations for visual field defects
* visual field testing
* Amsler grid - checks damage to macula/optic nerve
* Full neurological examination
* Special tests: static perimetry, kinetic perimetry
44
management of visual field defects
* treat cause (glaucoma =\> laser)
* increasing head movements + scanning exercises
* prisms
* coloured markers l line guides to help with reading
