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OPTHALMOLOGY Flashcards

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1
Q

What is the difference between Episcleritis and scleritis?

A 
Scleritis = painful
Episcleritis = not painful
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2
Q

What is a key cause of corneal abrasions?

A

Herpes simplex

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3
Q

What is the most common cause of Episcleritis?

A

idiopathic

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4
Q

What are the four slit lamp signs seen in anterior uveitis?

A

conjunctival injection
keratin precipitates
anterior chamber cells
posterior synechiae

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5
Q

What is glaucoma?

A

Glaucoma refers to the optic nerve damage that is caused by a significant rise in intraocular pressure.

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6
Q

What causes the raised intraocular pressure in gluacoma?

A

The drainage of aqueous fluid is blocked.

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7
Q

What is the normal intraocular pressure?

A

10-21 mmHg

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8
Q

How is normal intraocular pressure maintained?

A

Trabecular mesh

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9
Q

What is the pathophysiology of open angle glaucoma?

A

Thickening of the trabecular mesh slows the drainage of aqueous fluid.

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10
Q

What is cupping?

A

Cup (small indent in the centre of the optic disc) becomes more than 0.5x the diameter of the optic disc.

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11
Q

What are risk factors for open angle glaucoma?

A

Black ethnicity
Age
Family history
Near sightedness (myopia)

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12
Q

When should you receive screening if you have a positive family history of glaucoma?

A

Annual screening from the age of 40

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13
Q

What is the presentation of open angle glaucoma?

A

Often asymptomatic

Visual field changes (tunnel vision)
Headaches
Pain
Halos appearing around lights (worse at night)

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14
Q

How is vision affected?

A

Peripheral vision is affected first

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15
Q

How is open angle glaucoma usually picked up?

A

Optometrist (incidental)

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16
Q

How is intraocular pressure measured?

A
  1. Non-contact tonometry

2. Goldmann applanation tonometry

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17
Q

What is the gold standard way to measure intraocular pressure?

A

Goldmann applanation tonometry (using a slit lamp)

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18
Q

How can cupping be visualised?

A

Fundoscopy

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19
Q

Which three tests are used to make the diagnosis of open angle glaucoma?

A
  1. Goldmann applanation tonometry
  2. Fundoscopy
  3. Visual fields assessment
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20
Q

At what intraocular pressure is treatment commenced for open angle glaucoma?

A

24 mmHg

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21
Q

What is the first-line treatment for open-angle glaucoma?

A

Prostaglandin analogue eye drops (Latanoprost)

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22
Q

Name some side-effects of prostaglandin analogue eye drops.

A

Browning of the iris
Pigmentation of the eyelid
Lengthening of the eyelashes

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23
Q

Name three other medical options for treating open angle glaucoma.

A
  1. Beta-blockers - Timolol
  2. Carbonic anhydrase inhibitors - Dorzolamide
  3. Sympathomimetics - Brimonidine
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24
Q

What is tried if eyedrops are ineffective?

A

Surgery - Trabeculectomy

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25
What is the pathophysiology of acute closed angle glaucoma?
Acute angle-closure glaucoma occurs when the iris bulges forward and seals off the trabecular meshwork from the anterior chamber preventing aqueous humour from being able to drain away. This leads to a continual build-up of pressure in the eye. The pressure builds up particularly in the posterior chamber, which causes pressure behind the iris and worsens the closure of the angle. Ophthalmology emergency
26
What are the risk factors for closed angle glaucoma?
``` Age Family history Chinese/Asian ethnicity Female Shallow anterior chamber ```
27
Which medications can precipitate acute closed angle glaucoma?
Adrenergic medications - noradrenaline Anticholinergic medications - oxybutynin and solifenacin Tricyclic antidepressants - amitriptyline
28
How does acute closed angle glaucoma present?
Painful, red eye Blurred vision Halos around lights Headache, nausea, vomiting
29
What can be seen on examination in closed angle glaucoma?
``` Red-eye Teary Hazy cornea Dilated pupil Decreased visual acuity Firm eyeball on palpation ```
30
What can be done in primary care for acute closed angle glaucoma?
Lie down Pilocarpine eye drops (2% for blue, 4% for brown) Give acetazolamide 500mg PO Give analgesia and an antiemetic if required
31
How does pilocarpine act?
Acts on muscarinic receptors Causes sphincter muscles in the iris to contract Pupil constricts which allows aqueous humour to drain
32
What are the side effects of pilocarpine?
Headaches Blurred vision Constricted pupil
33
What does miotic mean?
Constricts the pupil
34
What is the management of acute closed angle glaucoma in secondary care?
``` Pilocarpine Acetazolamide Hyperosmotic agents - glycerol/mannitol Timolol Dorzolamide Brimonidine ```
35
What is the definitive treatment of acute closed angle glaucoma?
Laser iridotomy
36
What is anterior uveitis?
inflammation in the anterior part of the uvea
37
What conditions are associated with acute anterior uveitis?
HLA B27 • Ankylosing spondylitis • Inflammatory bowel disease Reactive arthritis
38
What conditions are associated with chronic anterior uveitis?
``` • Sarcoidosis • Syphilis • Lyme disease • Tuberculosis Herpes virus ```
39
How does anterior uveitis present?
``` Painful red eye Reduced visiual acuity Floaters and flashes Miosis Photophobia (ciliary muscle spasm) Pain on eye movement Lacrimation Abnormally shaped pupil Hypopyon ```
40
What is the management of anterior uveitis?
Referral for same day assessment Steroids Cycloplegic-mydriatic eye drops Immunosuppressants
41
Name 4 eyelid disorders.
Blepharitis Styes Chalazion Entropion Ectropion Trichiasis Periorbital cellulitis Orbital cellulitis
42
Which eyelid disorders require same day referral to ophthalmology?
``` Entropion Ectropion (if concern over eyesight) Trichiasis Periorbital cellulitis Orbital cellulitis (A&E) ```
43
How can you distinguish between a chalazion and a stye?
``` Stye = tender Chalazion = non-tender ```
44
What is the management of trichiasis?
Epilation Electrolysis Cryotherapy Laser treatment
45
What is the management of periorbital cellulitis?
IV or PO Abx
46
How can you distinguish between periorbital and orbital cellulitis?
CT head
47
Describe the anatomical origin of the central retinal artery
central retinal artery supplies the blood to the retina. It is a branch of the ophthalmic artery, which is a branch of the internal carotid artery.
48
What is the most common cause of occlusion of the retinal artery?
Atherosclerosis
49
Give two causes for central retinal artery occlusion
Atherosclerosis | Giant cell arteritis
50
What are the risk factors for central retinal artery occlusion?
``` • Older age • Family history • Smoking • Alcohol consumption • Hypertension • Diabetes • Poor diet • Inactivity Obesity ```
51
How does central retinal artery occlusion present?
sudden painless loss of vision | RAPD
52
Why does central retinal artery occlusion cause an RAPD?
input is not being sensed by the ischaemic retina when testing the direct light reflex but is being sensed by the normal retina during the consensual light reflex.
53
What is shown on fundoscopy in central retinal artery occlusion?
pale retina with a cherry-red spot
54
What is the management of central retinal artery occlusion?
Same-day assessment by opthalmologist
55
Describe the immediate management of central retinal artery occlusion
* 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 (^aims to dislodge the thrombus)
56
What is the long-term management of central retinal artery occlusion?
Treating reversible risk factors | Prevent CVS disease
57
What is the pathophysiology of CRVO?
Blockage of a retinal vein causes pooling of blood in the retina. This results in leakage of fluid and blood causing macular oedema and retinal haemorrhages. This results in damage to the tissue in the retina and loss of vision. It also leads to the release of VEGF, which stimulates the development of new blood vessels (neovascularisation).
58
What are the risk factors for CVRO?
``` • Hypertension • High cholesterol • Diabetes • Smoking • Glaucoma Systemic inflammatory conditions such as systemic lupus erythematosus ```
59
What is the presentation of CVRO?
Sudden painless loss of vision
60
What is the presentation of CVRO?
Sudden painless loss of vision
61
How do you diagnose CRVO?
Ophthalmoscopy
62
What are the findings on fundoscopy in CRVO?
Flame and blot haemorrhages Optic disc oedema Macula oedema
63
What other tests should be done to check for associated conditions in CRVO?
``` • Full medical history • FBC for leukaemia • ESR for inflammatory disorders • Blood pressure for hypertension Serum glucose for diabetes ```
64
What is the management of CRVO?
Same-day assessment by ophthalmologist
65
What are the treatment options for CRVO?
• Laser photocoagulation • Intravitreal steroids (e.g. a dexamethasone intravitreal implant) Anti-VEGF therapies (e.g. ranibizumab, aflibercept or bevacizumab)
66
What is keratitis?
Keratitis is inflammation of the cornea.
67
Give 5 causes of keratitis.
• 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)
68
What is the most common cause of keratitis?
Herpes simplex
69
What is the presentation of keratits?
``` • Painful red eye • Photophobia • Vesicles around the eye • Foreign body sensation • Watering eye Reduced visual acuity. This can vary from subtle to significant. ```
70
How is herpes keratitis diagnosed?
Staining with flourescein = dendritic ulcer Slit-lamp examination Swabs/scrapings & viral culture/PCR
71
What is the management of herpes keratiits?
• Aciclovir (topical or oral) • Ganciclovir eye gel Topical steroids may be used alongside antivirals to treat stromal keratitis
72
What are the complications of herpes keratitis?
stromal necrosis vascularisation Scarring corneal blindness.
73
What are the two types of macular degeneration?
Dry | Wet
74
Which type of macular degeneration is more common?
Dry
75
Which type of macular degeneration carries the worst prognosis?
Wet
76
What are the four layers of the macula?
Choroid layer Bruch's membrane Retinal pigment epithelium Photoreceptors
77
What are Drusen?
Yellow deposits of protein and lipids (some drusen are normal, but larger amounts are a feature of macular degeneration)
78
What features are common in wet and dry AMD?
Atrophy of the retinal pigment epithelium Degeneration of the photoreceptors Drusen
79
Why is wet AMD described as "wet"?
Associated oedema due to the development of new vessels growing from the choroid layer into the retina. New vessels are stimulated by VEGF
80
Which chemical stimulates the growth of new vessels in wet AMD?
VEGF
81
What are the risk factors?
``` Age Smoking White or Chinese ethnic origin Family hx Cardiovascular disease ```
82
How does AMD present?
Scotoma (gradual, central vision loss)
83
How are drusen detected?
Fundoscopy
84
How is wet AMD diagnosed?
Optical coherence tomography OR Fluorescein angiography
85
What is the treatment of dry AMD?
No treatment Avoid smoking Control BP Vitamin supplementation
86
What is the treatment of wet AMD?
Anti-VEGF medications
87
Which medications block VEGF? When do they need to be started?
* Ranibizumab * Bevacizumab Start within 3 months to be beneficial.
87
Which medications block VEGF? When do they need to be started?
* Ranibizumab * Bevacizumab Start within 3 months to be beneficial.
88
What is posterior vitreous detachment?
Separation of the vitreous membrane from the retina
89
What should be ruled-out in suspected posterior vitreous detachment?
Retinal tears | Retinal detachment
90
What are the risk factors for posterior vitreous detachment?
Age | Near-sighted (myopic patients)
91
How does posterior vitreous detachment present?
``` Flashes Floaters Blurred vision Cobweb across vision Dark curtain descending downwards (retinal detachment) ```
92
What is seen on ophthalmoscopy in posterior vitreous detachment?
Weiss ring (he detachment of the vitreous membrane around the optic nerve to form a ring-shaped floater)
93
What is the management of PVD?
Ophthalmology referral within 24 hours
94
What is the treatment for PVD?
Symptoms gradually improve over a period of around 6 months and therefore no treatment is necessary. If associated retinal tear/detachment = surgery
95
What are the risk factors for cataracts?
``` • Increasing age • Smoking • Alcohol • Diabetes • Steroids Hypocalcaemia ```
96
How do cataracts present?
* 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 Asymmetrical changes
97
What is the management of cataracts?
Cataract surgery
98
Name a complication of cataract surgery
Endophthalmitis Inflammation of the inner contents of the eye, usually caused by infection. It can be treated with intravitreal antibiotics injected into the eye. This can lead to loss of vision and loss of the eye itself.

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