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Opthalmology Flashcards

(86 cards)

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1
Q

MILD non-proliferative diabetic retinopathy (NPDR)

A

1+ microaneurysm

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2
Q

MODERATE NPDR

A

microaneurysms, blot haemorrhages, hard exudates, cotton wool spots, venous looping

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3
Q

SEVERE NPDR

A

blot haemorrhages and microaneurysms in 4 quadrants, venous bleeding in 2 quadrants

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4
Q

Proliferative retinopathy

A

retinal neovascularisation - may lead to vitreous haemorrhages

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5
Q

Diabetic Retinopathy treatment

A

Control DM and BP
Anti- VEGF injections
Photocoagulation

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6
Q

Diabetic Maculopathy

A

Macular oedema

Ischaemic maculopathy

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7
Q

Complications of Diabetic Retinopathy

A

Retinal detachment
Vitreous haemorrhage (bleeding in to the vitreous humour)
Rebeosis iridis (new blood vessel formation in the iris)
Optic neuropathy
Cataracts

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8
Q

Hypertensive retinopathy classification system

A

Keith-Wagener

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9
Q

Keith Wagener classification grades

A

Hypertensive Retinopathy

1 - Mild generalized retinal arteriolar narrowing
2 - Definite focal narrowing and arteriovenous nipping
3 - -Signs of grade 2 plus retinal haemorrhages, exudates and cotton wool spots
4 - Severe grade three plus papilledema

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10
Q

Hypertensive retinopathy management

A

Management is focused on controlling the blood pressure and other risk factors such as smoking and blood lipid levels.

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11
Q

Hypertensive retinopathy signs

A 
Silver wiring
Hard exudates
Arteriovenous nipping
Papilloedema
Retinal haemorrhages
Cotton wool spots
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12
Q

Congenital cataracts - screening

A

Red reflex at neonatal examination

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13
Q

Cataracts rf

A 
Increasing age
Smoking
Alcohol
Diabetes
Steroids
Hypocalcaemia
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14
Q

Cataracts presentation

A

Very slow reduction in vision
Progressive blurring of vision
Change of colour of vision with colours becoming more brown or yellow
“Starbursts” can appear around lights, particularly at night time

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15
Q

Key sign of cataracts

A

Loss of red reflex

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16
Q

Distinctive signs - Cataracts vs glaucoma vs macular degeneration

A

Cataracts - reduced visual acuity, starbursts around light

Glaucoma - peripheral visual loss and halos around lights

Macular degeneration - Central loss of vision and crooked/wavy straight lines

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17
Q

Cataracts management

A

if needed, artificial lens

Phacoemulsification

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18
Q

What is Endophthalmitis and mx

A

comp. of cataract surgery - requires intravitreal antibiotics

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19
Q

Types of cataracts

A

Nuclear - old age

Cortical - wedge shaped spokes

Posterior subcapsular - steroid use

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20
Q

Inv for cataract

A

slit lamp

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21
Q

Glaucoma definition

A

optic neuropathy secondary to increased intra-ocular pressure (IOP) (>21mmHg)

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22
Q

open angle Glaucoma ivx

A

Perimetry

  • Slit lamp biomicroscopy “cupping”
  • Goldmann tonometry or non-contact Tonometry (pressures)
  • Gonioscopy (visualise iridoangle)
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23
Q

OA glaucoma treatment

A

Prostaglandin analogues like latanoprost (decrease uveoscleral outflow, increased eyelash length)

Beta blockers like timolol (reduced aqueous production, bad for asthmatics)

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24
Q

CO glaucoma risk fators

A

Dilation, cataracts, hypermetropia

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25
AAC glaucoma treatment
``` IV acetazolamide (reduce aqueous production) Pilocarpine drops (pupil constrict) Iridotomy (allow flow) Analgesia/antiemetic ```
26
Pupil constriction mechanism
Parasympathetic Acetylcholine (muscarinic receptors) Oculomotor nerve (third nerve) Miosis
27
Pupil dilation mechanism
Sympathetic, adrenaline, mydriasis
28
Causes of mydriasis
``` Third nerve palsy Holmes-Adie syndrome Raised intracranial pressure Congenital Trauma Stimulants such as cocaine Anticholinergic ```
29
Causes of Miosis
``` Horners syndrome Cluster headaches Argyll-Robertson pupil (in neurosyphilis) Opiates Nicotine Pilocarpine ```
30
Third Nerve Palsy
Ptosis (drooping upper eyelid) Dilated non-reactive pupil Divergent strabismus (squint) in the affected eye.
31
Causes of a full (surgical) Third Nerve Palsy
``` Idiopathic Tumour Trauma Cavernous sinus thrombosis Posterior communicating artery aneurysm Raised intracranial pressure ```
32
Third nerve palsy sparing pupil causes
Diabetes Hypertension Ischaemia
33
Horner syndrome triad
Ptosis Miosis Anhidrosis
34
Location of lesion in horners
Anhidrosis in face - pre-ganglion Anhidrosis in face and trunk - central No anhidrosis - post-glanglionic
35
Congenital Horner syndrome
heterochromia
36
Horner's treatment
adrenalin eye drop | cocaine eyedrop
37
Holmes Adie Pupil
unilateral dilated pupil that is sluggish to react to light with slow dilation of the pupil following constriction. post-ganglionic parasympathetic fibres. The exact cause is unknown but may be viral.
38
Argyll-Robertson Pupil
neurosyphilis. It is a constricted pupil that accommodates | does not react to light
39
Lubricating eye drops
Hypromellose is the least viscous. The effect lasts around10 minutes. Polyvinyl alcohol is the middle viscous choice. It is worth starting with these. Carbomer is the most viscous and lasts 30 – 60 minutes.
40
Blepharitis
inflammation of the eyelid margins. comp styes and chalazions.
41
Stye
Hordeolum externum
42
Stye Tx
Styes are treated with hot compresses and analgesia. Consider topic antibiotics (i.e. chloramphenicol) if it is associated with conjunctivitis or persistent.
43
Chalazion
Meibomian cyst
44
Entropion
Entropion is where the eyelid turns inwards with the lashes against the eyeball. corneal damage and ulceration. A same-day referral to ophthalmology is required if there is a risk to sight.
45
Ectropion
where the eyelid turns outwards exposure keratopathy
46
Trichiasis
Trichiasis is inward growth of the eyelashes. pain and corneal damage and ulceration
47
Periorbital Cellulitis mx
differentiate it from orbital cellulitis, which is a sight and life threatening emergency. CT scan
48
Periorbital Cellulitis tx
h systemic antibiotics (oral or IV). Preorbital cellulitis can develop into orbital cellulitis
49
Orbital Cellulitis presentation and mx
pain on eye movement, reduced eye movements, changes in vision, abnormal pupil reactions and forward movement of the eyeball (proptosis). admission and IV antibiotics. They may require surgical drainage if an abscess forms.
50
Painless acute red eye differentials
Painless Red Eye Conjunctivitis Episcleritis Subconjunctival Haemorrhage
51
Painful acute red eye differentials
``` Glaucoma Anterior uveitis Scleritis Corneal abrasions or ulceration Keratitis Foreign body Traumatic or chemical injury ```
52
Bacterial conjunctivitis treatment
Chloramphenicol and fuscidic acid
53
neonatal conjunctivitis
Patients under the age of 1 month of age with conjunctivitis need urgent ophthalmology review gonococcal infection and can cause loss of sight and more severe complications such as pneumonia.
54
Anterior uveitis acute causes
Acute anterior uveitis is associated with HLA B27 related conditions: Ankylosing spondylitis Inflammatory bowel disease Reactive arthritis
55
Chronic anterior uveitis is associated with:
``` Sarcoidosis Syphilis Lyme disease Tuberculosis Herpes virus ```
56
Anterior uveitis symptoms
Dull, aching, painful red eye Ciliary flush Reduced visual acuity Floaters and flashes miosis Photophobia Pain on movement (lacrimation) Abnormally shaped pupil hypopyon
57
Anterior uveitis management
Same day ophthalmologist referral Steroids (oral, topical or intravenous) Cycloplegic-mydriatic medications such as cyclopentolate or atropine eye drops. Immunosuppressants such as DMARDS and TNF inhibitors Laser therapy, cryotherapy or surgery (vitrectomy) are also options in severe cases.
58
Episcleritis associations
rheumatoid arthritis and inflammatory bowel disease.
59
Episcleritis presentation
``` Typically not painful but there can be mild pain Segmental redness (rather than diffuse). There is usually a patch of redness in the lateral sclera. ``` Foreign body sensation Dilated episcleral vessels Watering of eye No discharge
60
Episcleritis management
If in doubt about the diagnosis, refer to ophthalmology. Episcleritis is usually self limiting and will recover in 1-4 weeks. In mild cases no treatment is necessary. Lubricating eye drops can help symptoms. Simple analgesia, cold compresses and safetynet advice are appropriate. More severe cases may benefit from systemic NSAIDs (e.g. naproxen) or topical steroid eye drops.
61
Scleritis presentation
``` Severe pain Pain with eye movement Photophobia Eye watering Reduced visual acuity Abnormal pupil reaction to light Tenderness to palpation of the eye ```
62
Scleritis management
Consider an underlying systemic condition NSAIDS (topical / systemic) Steroids (topical / systemic) Immunosuppression appropriate to the underlying systemic condition (e.g. methotrexate in rheumatoid arthritis)
63
Scleritis ass. conditions
``` Rheumatoid arthritis Systemic lupus erythematosus Inflammatory bowel disease Sarcoidosis Granulomatosis with polyangiitis ```
64
Corneal abrasion inv.
fluorescein stain | slit lamp examination
65
Corneal keratitis causes
Viral infection with herpes simplex Bacterial infection with pseudomonas or staphylococcus Fungal infection with candida or aspergillus Contact lens acute red eye (CLARE) Exposure keratitis is caused by inadequate eyelid coverage (e.g. eyelid ectropion)
66
Herpes keratitis presentation
``` Painful red eye Photophobia Vesicles around the eye Foreign body sensation Watering eye Reduced visual acuity. This can vary from subtle to significa ```
67
Herpes keratitis inv
fluorescein will show a dendritic corneal ulcer Herpes keratitis Swabs
68
Herpes keratitis mx
Aciclovir (topical or oral) Ganciclovir eye gel Topical steroids may be used alongside antivirals to treat stromal keratitis A corneal transplant
69
Subconjunctival Haemorrhage rf
Hypertension Bleeding disorders (e.g thrombocytopenia) Whooping cough Medications (warfarin, NOACs, antiplatelets) Non-accidental injury
70
Posterior vitreous detachment presentation
Painless Spots of vision loss Floaters Flashing lights It is essential to exclude and assess the risk of a retinal tear or detachment with a thorough assessment of the retina no treatment necessary
71
Retinal detachment rf
``` Posterior vitreous detachment Diabetic retinopathy Trauma to the eye Retinal malignancy Older age Family history ```
72
Retinal detachment presentation
Peripheral vision loss. This is often sudden and like a shadow coming across the vision. Blurred or distorted vision Flashes and floaters
73
retinal tear management
Laser therapy | Cryotherapy
74
retinal detachment mx
Vitrectomy Pneumatic retinopexy Scleral buckling
75
Retinal vein occlusion presentation
sudden painless loss of vision.
76
Retinal vein occlusion fundoscopy
Flame and blot haemorrhages Optic disc oedema Macula oedema
77
Retinal vein occlusion management
Same day referal Laser photocoagulation Intravitreal steroids (e.g. a dexamethasone intravitreal implant) Anti-VEGF therapies (e.g. ranibizumab, aflibercept or bevacizumab
78
central retinal artery occlusion presentation
sudden painless loss of vision. relative afferent pupillary defect Fundoscopy will show a pale retina with a cherry-red spot.
79
GCA management
Giant cell arteritis is an important potentially reversible cause. Testing involves an ESR and temporal artery biopsy and treatment is with high dose steroids
80
Central retinal artery occlusion mx
Ocular massage Removing fluid from the anterior chamber to reduce intraocular pressure. Inhaling carbogen (a mixture of 5% carbon dioxide and 95% oxygen) to dilate the artery Sublingual isosorbide dinitrate to dilate the artery
81
Retinitis Pigmentosa presentation
night blindness. They get decreased central and peripheral vision. (peripheral first)
82
Retinitis Pigmentosa mx
Referral to an ophthalmologist for assessment and diagnosis Genetic counselling Vision aids Sunglasses to protect the retina from accelerated damage Driving limitations and informing the DVLA Regular follow up to assess vision and check for other potentially reversible conditions that may worsen the vision such as cataracts
83
Dry eyes test
Schirmer - filter paper next to conjunctiva
84
Dry eyes mx
Artificial tears
85
Episcleritis vs scleritis dx
phenylnephrine drops - blanches in episcleritis
86
Cranial nerve defects
3rd - unilateral ptosis fourth - bilateral look to one side Sixth unilateral adduction

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