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Finals > Opthalmology > Flashcards

Opthalmology Flashcards

1
Q

Describe the pathophysiology of glaucoma

A

Excess fluid in the aqueous humour, resulting in increase intra-ocular pressure.

Acute angle closure glaucoma - iris folds out to obstruct drainage of fluid - fast development

Chronic open angle glaucoma - inability of trabecular mesh to absorb fluid - slow development

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2
Q

Describe the presentation of chronic open angle glaucoma

A
  1. Peripheral vision loss leading to tunnel vision
  2. May be asymptomatic
  3. Myopia - near sightedness
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3
Q

Describe the presentation of acute closed angle glaucoma

A
  1. Peripheral vision loss leading to tunnel vision
  2. Painful, red eye
  3. Headache
  4. Hazy cornea
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4
Q

Describe the fundoscopic findings in chronic open angle glaucoma

A
  1. Optic disc cupping
  2. Optic disc pallor
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5
Q

Give the management of chronic open angle glaucoma

A
  1. Latanoprost eye drops (prostaglandin analogue - increases absorption of aqueous humour)
  2. Timolol eye drops (B-blocker - prevents secretion of aqueous humour)
  3. Trabeculectomy - surgery
  4. Dorzolamide eye drops (carbonic anhydrase inhibitor)
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6
Q

Give the management of acute closed angle glaucoma

A
  1. Urgent opthalmology referral
  2. Pilocarpine eye drops (parasympatheticomimetic miotic medication - constrict pupil)
  3. Timolol eye drops
  4. Laser iridotomy - surgery (hole through iris to allow drainage of fluid) - definitive management to only be used after acute attack has resolved
  5. Intravenous acetazolamide
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7
Q

Describe the pathophysiology of macular degeneration

A

Either dry or wet

Leads to destruction of macula (most photoreceptor dense area of retina)

Dry: gradual atrophy of the retina (most common)
Wet: new vessel growth below the retina (more severe and acute)

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8
Q

Give the management of dry macular degeneration

A
  1. No good management
  2. Vit. A and vit. E supplementation
  3. Zinc supplementation
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9
Q

Give the management of wet macular degeneration

A
  1. Photodynamic lasers
  2. Anti- vascular endothelial growth factor (Anti-VEGF)
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10
Q

Give the fundoscopic findings in macular degeneration

A
  1. Drusen formation
  2. Blood vessel growth below retina
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11
Q

Give the pathophysiology of cataracts

A

Opacity and clouding of the lens, commonly seen in the elderly.

Presbyopia - loss of ability of lens to change shape and subsequent failure of accommodation

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12
Q

Give the presentation of cataracts

A
  1. Leucocoria (white pupil)
  2. Visual loss - gradual
  3. “Browning and yellowing” of colours
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13
Q

Give 1 complication of cataracts

A

Endopthalmitis - inflammation of aqueous/vitreous humour

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14
Q

Give the management of cataracts

A

Surgery - lens replacement

Managed conservatively until symptoms affect lifestyle

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15
Q

Describe the pathophysiology of congenital cataracts

A

Present from birth.

Associated with congenital rubella syndrome.

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16
Q

Give the presentation of congenital cataracts

A
  1. Clouding of lens
  2. Loss of red reflex - diagnosed in NIPE
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17
Q

Describe the management of congenital cataracts

A
  1. Urgent opthalmology referral - prevents amblyopia (vision loss due to brain neglecting the eye)
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18
Q

Give the pathophysiology of vitreous detachment

A

The vitrous gel becomes less firm and less able to maintain it’s shape with age.

This causes it to pull away from the retina.

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19
Q

Give the risk factors for vitreous detachment

A
  1. Age
  2. Traume
  3. Diabetes
  4. Eye surgery
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20
Q

Give the presentation of vitreous detachment

A
  1. Floaters
  2. Flashes
  3. Dark spots
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21
Q

Give the management of vitreous detachment

A
  1. Watch and wait
  2. Refer to opthalmology - to rule out retinal tears or detachment which would require surgery
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22
Q

Describe the presentation of blepharitis

A
  1. Affects all 4 eyelids
  2. Painful and gritty eyes
  3. Loss of eyelashes
  4. Recurrent chalazion and styes

Sx worse in morning

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23
Q

Describe the pathophysiology of blepharitis

A

Anterior blepharitis: Staph. infection or seborrhoeic dermatitis

Posterior blepharitis: meibomian gland dysfunction

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24
Q

Describe the management of blepharitis

A

Incurable

Lid hygiene, hot compress, tear substitutes, chloramphenicol drops

Unilateral blepharitis = red flag –> may indicate cancer

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25
Q

Describe the presentation of styes

A

Discomfort and lump on the eyelid

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26
Q

Give the pathophysiology of styes

A

Infection at the base of an anterior eyelash

Associated with recurrent blepharitis

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27
Q

Give the management of styes

A
  1. Self-limiting
  2. Hot compress
  3. Puncture and drainage if recurrent
  4. Antibiotics
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28
Q

Describe the presentation of a chalazion

A

Non-tender, uncomfortable red nodular lump on eyelid

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29
Q

Describe the pathophysiology of a chalazion

A

Inflammation of the meibomian glands of the posterior eyelid

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30
Q

Give the management of a chalazion

A
  1. Lid massage
  2. Warm compress
  3. Surgery if troublesome
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31
Q

Describe the presentation, risks and management of entropion

A

Presentation: eyelid turned inward

Risk: may cause corneal abrasion

Management: tape eyelid down, eyelid drops, surgery

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32
Q

Describe the presentation, risks and management of ectropion

A

Presentation: eyelid turned outward, with inner aspect of eyelid exposed

Risk: exposure keratitis

Management: prophylactic antibiotic, steroids, surgery

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33
Q

Describe the pathophysiology of periorbital cellulitis

A
  1. Common in children
  2. Commonly caused by Haemophilus influenzae or Strep. pneumoniae
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34
Q

Describe the presentation of periorbital cellulitis

A
  1. Peri-orbital redness, swelling, tenderness
  2. Fever
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35
Q

Give the management of periorbital cellulitis

A
  1. Urgent opthalmology referral to prevent development to orbital cellulitis
  2. Oral co-amoxiclav (adult)
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36
Q

Give the presentation of orbital cellulitis

A
  1. Painful eye movement
  2. Proptosis
  3. Reduced visual acuity
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37
Q

Describe the management of orbital cellulitis

A
  1. CT to assess spread
  2. LP to exclude meningitis
  3. IV cefotaxime
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38
Q

Describe the aetiology of conjunctivitis

A

Viral - commonly adenovirus

Bacterial - Staphylococcal or STI infection

Allergic - acute allergy, hayfever

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39
Q

Give the presentation of conjunctivitis

A

Acute red eye!
1. Uncomfortable, not painful
2. Bloodshot eye
3. Itchy/gritty

Viral: sore throat, clear eye discharge
Allergic: clear eye discharge

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40
Q

Give the management of conjunctivitis

A

Viral: reassurance

Bacterial: topic chloramphenicol

Allergic: oral or topical antihistamine

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41
Q

Give the management of neonatal conjunctivitis

A

Urgent referral due to association with gonococcal infection.

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42
Q

Describe the presentation of subconjunctival haemorrhage

A

Sudden onset bright red eye with blood free to move in the subconjunctival space.

Unilateral and otherwise asymptomatic.

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43
Q

Describe the aetiology of subconjunctival haemorrhage

A

Coughing

Coagulation disorder

Trauma

Heavy lifting

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44
Q

Describe the management of subconjunctival haemorrhage

A
  1. Self-limiting (resolve within 2 weeks)
  2. Avoid aspirin and NSAIDs
  3. Investigate for clotting disorder
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45
Q

Describe the presentation of episcleritis

A

Acute, non-painful reddening of the sclera

46
Q

Describe the aetiology of episcleritis

A

Strongly associated with IBD and RA

More common in younger people

47
Q

Describe the management of episcleritis

A
  1. Self-limiting
  2. Cold compress
  3. Lubricating eye drops
48
Q

Describe the pathophysiology of scleritis

A

Full-thickness inflammation of the sclera.

49
Q

Describe the aetiology of scleritis

A

Affects older people with pre-existing autoimmune conditions.

Strong association with systemic vasculitis, RA and polymyalgia rheumatica.

50
Q

Describe the presentation of scleritis

A

Severe eye pain which is worse on movement.

Photophobia and reduced visual acuity.

51
Q

Describe the management of scleritis

A

Opthalmic emergency

  1. Urgent referral to opthalmology
  2. NSAIDs and immunosuppressants to treat underlying cause
52
Q

Which structures comprise the uvea?

A

Iris, ciliary bodies, choroid

53
Q

Describe the aetiology of anterior uveitis

A

Strong association with IBD, RA and seronegative spondyloarthropathies.

(e.g. may see young person with back pain and eye Sx - ankylosing spondylitis)

54
Q

Describe the presentation of anterior uveitis

A

Acute, unilateral, intensely painful red eye

  1. Reduced vision
  2. Photophobia
  3. Irregular pupil
  4. Hypopyon (accumulation of leukocytes in anterior chamber, appearing as fluid level of pus)
55
Q

Describe the management of anterior uveitis

A
  1. Treat underlying cause
  2. Prednisolone PO
  3. Mydriatic (dilation) drops (e.g. atropine)
56
Q

Describe the aetiology of keratitis

A

Viral: herpes simplex

Bacterial: Pseudomonas or Staphylococcus

Fungal: Candida or Aspergillus

Contact lens acute red eye (CLARE)

Exposure keratitis

57
Q

Describe the risk factors for keratitis

A
  1. Contact lens wearer
  2. Smoker
  3. Poor hygiene
  4. Immunocompromised
  5. Trauma
58
Q

Give the presentation of keratitis

A

Unilateral, rapid onset moderate-severe pain in eye.

Red eye with discharge.

59
Q

Describe the management of keratitis

A

Corneal surface scrape for culture.

Antibiotics (e.g. topical ciprofloxacin)

60
Q

Describe the presentation of HSV keratitis

A

Usually in children.

  1. Unilateral
  2. Photophobia and light sensitivity
61
Q

How are corneal abrasions diagnosed?

A

Fluorescin drops.

62
Q

Describe the management of HSV keratitis

A

Aciclovir

63
Q

Give the causes of mydriasis

A

Causes of mydriasis (large pupil)
1. third nerve palsy
2. Holmes-Adie pupil
3. traumatic iridoplegia
4. phaeochromocytoma
5. congenital
6. topical mydriatics (e.g. atropine)

64
Q

Give the presentation of Horner’s syndrome

A

Ipsilateral:

  1. Ptosis (eyelid drooping)
  2. Anhidrosis (lack of sweating)
  3. Miosis (constricted pupil)
65
Q

Give the pathophysiology of Horner’s syndrome

A

Lesion of sympathetic chain supplying the eye (may be caused due to lung carcinoma)

66
Q

Describe the management of diabetic retinopathy

A

Intravitreal VEGF inhibitors may be used in addition to panretinal laser photocoagulation to treat proliferative diabetic retinopathy

67
Q

Give the presentation of retinal detachment

A

Sudden painless loss of vision.

It is characterised by a dense shadow starting peripherally and progressing centrally

68
Q

Give the presentation of retinitis pigmentosa

A

Night blindness + tunnel vision

69
Q

Give the causes of optic neuritis

A
  1. MULTIPLE SCLEROSIS: the commonest associated disease (MRI indicated if suspected)
  2. diabetes
  3. syphilis
70
Q

Give the presentation of optic neuritis

A

1.unilateral decrease in visual acuity over hours or days
2. poor discrimination of colours, ‘red desaturation’
3. pain worse on eye movement
4. relative afferent pupillary defect
5. central scotoma

71
Q

Give the management of optic neuritis

A
  1. high-dose steroids
  2. recovery usually takes 4-6 weeks
72
Q

Give the presentation of Argyll-Robertson pupil

A

Argyll-Robertson Pupil (ARP) is Accommodation Reflex Present (ARP) but Pupillary Reflex Absent (PRA)

  1. small, irregular pupils
  2. no response to light but there is a response to accommodate

Caused by diabetes and syphilis.

73
Q

Give the presentation of herpes simplex keratitis

A

Dendritic corneal ulcer:
1. red, painful eye
2. photophobia
3. epiphora
4. visual acuity may be decreased
5. fluorescein staining may show an epithelial ulcer

74
Q

Give the management of herpes simplex keratitis

A
  1. Immediate referral to an ophthalmologist
  2. Topical aciclovir
75
Q

Describe the pathophysiology of herpes zoster opthalmicus

A

Reactivation of the varicella-zoster virus in the area supplied by the ophthalmic division of the trigeminal nerve.

76
Q

Give the presentation of herpes zoster opthalmicus

A
  1. vesicular rash around the eye, which may or may not involve the actual eye itself
  2. Hutchinson’s sign: rash on the tip or side of the nose. Indicates nasociliary involvement and is a strong risk factor for ocular involvement
77
Q

Give the management of herpes zoster opthalmicus

A
  1. oral antiviral treatment for 7-10 days, ideally started within 72 hours.
    (intravenous antivirals may be given for very severe infection or if the patient is immunocompromised,
    topical antiviral treatment is not given in HZO,
    topical corticosteroids may be used to treat any secondary inflammation of the eye)
  2. ocular involvement requires urgent ophthalmology review
78
Q

Give the side effects of prostaglandin analogues

A

Key side effects of prostaglandin analogues include increased eyelash length, iris pigmentation and periocular pigmentation

79
Q

What sign is shown here and what is it suggestive of?

What sign is shown here and what isit suggestive of?
A

Optic disc cupping - glaucoma

80
Q

What is this?

A

Blepharitis

81
Q

What is this?

A

Stye

82
Q

What is this?

A

Chalazion

83
Q

What signs are seen in retinal detachment?

A

Examination findings in retinal detachment include reduced visual acuity and loss of the red reflex

84
Q

Describe the presentation of acanthomoebic keratitis

A

Pain out of proportion of clinical presentation, contact lens and recent freshwater swimming is classical of acanthamoebic keratitis

85
Q

Describe the classifications of retinal detachment

A

Rhegmatogenous - traumatic tear leading to build-up of fluid behind retina

Exudative - due to HTN, vasculitis, sarcoidosis, metastases

Tractional - pulling on retina due to proliferative retinopathy (e.g. in diabetes)

86
Q

Describe the presentation of retinal detachment

A

Floaters
Flashes
Field defects - indicate position and extent
Painless drop in visual acuity - “falling curtain”

87
Q

Describe the management of retinal detachment

A

Lie flat
Laser photocoagulation therapy

88
Q

Describe the pathophysiology of scleritis

A

Inflammation of the sclera (where eye muscles penetrate) with oedema of the conjunctiva, scleral thinning and vasculitic changes

89
Q

Describe the aetiology of scleritis

A

Systemic disease - RA, granulomatosis with polyangiitis

90
Q

Describe the presentation of scleritis

A

Constant, dull ache which bores into the eye - worse at night

Pain on ocular movement

Headache

Photophobia

91
Q

Describe the management of scleritis

A

Anterior - oral NSAID, high dose steroid

Posterior/necrotising - prednisolone, systemic immunosuppression, opthalmology referral

92
Q

Describe the pathophysiology of episcleritis

A

Inflammation below the conjunctiva with an inflammatory nodule

93
Q

Describe the presentation of episcleritis

A

Moveable vessels, mild/no pain, red eye

94
Q

Describe the management of episcleritis

A

NSAID, artificial tears

95
Q

Describe the aetiology of optic neuritis

A

Strong association with MS!

SLE

Infectious - syphilis, lyme disease

96
Q

Describe the presentation of optic neuritis

A

Acute unilateral vision loss

Peri-ocular pain

Flashes

Reduced colour vision

97
Q

Give 2 differentials for sudden unilateral vision loss

A

Optic neuritis

Giant cell arteritis

98
Q

Describe the management of optic neuritis

A

High dose IV methylprednisolone

99
Q

Describe the fundoscopic findings in hypertensive retinopathy

A

Flame haemorrhages

Cotton-wool spots

Papilloedema

Tortuous arteries with shiny walls

100
Q

What visual field defect would be caused by a pathology at site A?

A

Unilateral central scotoma

101
Q

What visual field defect would be caused by a pathology at site B?

A

Monocular vision loss

102
Q

What visual field defect would be caused by a pathology at site C?

A

Bitemporal hemianopia

103
Q

What visual field defect would be caused by a pathology at site D?

A

Contralateral hemianopia

104
Q

What visual field defect would be caused by a pathology at site E?

A

Contralateral superior quadrantanopia

105
Q

What visual field defect would be caused by a pathology at site F?

A

Contralateral inferior quadrantanopia

106
Q

What visual field defect would be caused by a pathology at site G?

A

Contralateral homonymous hemianopia

107
Q

What visual field defect is seen in posterior cerebral artery occlusion?

A

Contralateral homonymous hemianopia with sparing of the macula

108
Q

Describe the pathophysiology of diabetic retinopathy

A

Damage to small blood vessels and endothelial cells in retina due to hyperglycaemia

Increased vascular permeability leads to leakage, blot haemorrhages and hard exudate formation (lipid deposition)

Microaneurysm formation

Damage to nerve fibres causes cotton-wool spots

109
Q

Describe the classification of diabetic retinopathy

A

Proliferative - neovascularisation occurs

Non-proliferative - microaneurysm, blot haemorrhage, hard exudate, cotton wool spot formation

110
Q

Describe the complications of diabetic retinopathy

A

Retinal detachment
Vitreous haemorrhage
Optic neuropathy

111
Q

Describe the management of diabetic retinopathy

A

Laser photocoagulation
Anti-VEGF (e.g. ranibizumab)
Vitreoretinal surgery

Finals (11 decks)

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