Opthalmology Flashcards
(160 cards)
1
Q
What would defect be if there is lesion in the optic nerve prior to the optic chiasm
A
Complete blindness in that eye
2
Q
What is anatomy of visual nerve pathway
A
Optic nerve leaves eye going to the optic chiasm
From optic chiasm it goes to the lateral geniculate nucleus via optic tract
From lateral geniculate nucleus it goes to visual cortex via optic radiations
3
Q
What do you get if lesion in the optic tract
A
Sided homonymous hemianopia
4
Q
What is optic nerve function
A
Carries visual information to the brain
5
Q
What are 3 main functions of CN 3
A
Supply the levator palpabrae to lift eyelid
Parasympathetic innervation to constrict eyelid
Control muscles of eye
6
Q
What muscles in eye does CN 3 innervate
A
Inferior rectus
Superior rectus
Medial rectus
Inferior oblique
7
Q
What see in CN 3 palsy
A
Dilated pupil
Eye down and out
Ptosis
8
Q
Difference between surgical and medical third nerve palsy in terms of presentation
A
In surgical you see mydriasis before down and out palsy as parasympathic supply on outside of nerve bundle which will be seen first however in ischaemia it affects centre of bundle first so there is muscle problem before mydriasis
9
Q
What is function of abducens nerve
A
Supplies lateral rectus
10
Q
What get in a 6th nerve palsy
A
Eye adducted
11
Q
What is function of trochlear nerve
A
Supplies superior oblique
12
Q
What is presentation of 6th nerve palsy
A
Double vision horizontally on gaze towards affected side
13
Q
Presentation of 3rd nerve palsy (vision wise)
A
Multidirectional diplopia
14
Q
What gives pain in eye with white corneal infiltrate in a contact lens user
A
Corneal ulcer
15
Q
Management of corneal ulcer
A
Moxifloxacin drops
16
Q
What is in horners syndrome
A
Miosis
Ptosis
Anhidrosis
Enopthalmos
17
Q
What is enopthalmos
A
When eye sinks into socket
18
Q
How to determine site of lesion in horners
A
Look at where the anhidrosis is
- on face, arm and trunk= central lesion
- just on face= preganglionic cervical area lesion
- absent= post gangionic carotid area
19
Q
Causes of central horners
A
Stroke
MS
Encephalitis
20
Q
Causes of preganglionic horners
A
Pancoasts tumour
Thyroidectomy
Cervical rib
Trauma
21
Q
Causes of postganglionic horners
A
Carotid artery dissection
Carotid aneurysm
22
Q
Presentation of vitreous haemorrhage
A
Seeing floaters
Reddish hue to vision
Sudden painless loss of vision
23
Q
What is most common cause of vitreal haemorrhage
A
Proliferative diabetic retinopathy
24
Q
Painless loss of vision in diabetic
A
Vitreous haemorrhage
25
Fundoscopy finding in dry age related macular degeneration
Drusen- lipid and protein debris
Yellow spots in bruchs membrane
26
Fundoscopy finding in wet age related macular degeneration
Choroidal neovascularisation
27
Difference in presentation of wet and dry ARMD
Wet can be more acute due to leakage of serous fluid
28
Main changes in vision seen in ARMD
Usually unilateral
- Difficulty in dark adaptation
- Central vision affected
- Small words appearing blurry
- Straight lines appearing curvy (metamorphopsia)
29
What do cotton wool spots indicate
Areas of retinal infarction
AKA soft exudate
30
What are 3 types of diabetic retinopathy
Non-proliferative
Proliferative
Maculopathy
31
What makes a diabetic retinopathy, proliferative
Presence of retinal neovascularisation
32
What is diabetic maculopathy
Diabetic changes over macula
- hard exudates
Macula oedema
33
Management of non-proliferative retinopathy
Regular observation
Severe- panretinal laser photocoagulation
34
Management of maculopathy
If visual acuity change then intra vitreal vascular endothelial growth factor inhibitor
35
Management of proliferative retinopathy
Panretinal laser photocoagulation
Intravitreal VEGF inhibitors
36
Presentation of acute angle closure glaucoma
Severe pain
Reduced visual acuity
Red eyes
Dilated
Haloes
Non reactive
Systemically unwell- abdo pain, nausea
37
What is used to determine pressure in the ocular
Tonoscopy
37
What is used to visualise the angle in AACG
Gonioscopy- lens added to slit lamp test
38
Management of acute angle closure glaucoma
Initial medical treatment- combination of drops including pilocarpine, timolol and brimonidine
IV acetazolamide
Once settled can do peripheral laser iridotomy
39
What is use of pilocarpine in glaucoma
Parasymphamomimetic- increased outflow of fluid
40
What is use of timolol in glaucoma
Decreases fluid production
41
What is use of actazolamide in glaucoma
Reduces secretions
42
Management of blepharitis
Hot compress
43
What is holmes adie pupil
Unilateral dilated pupil in women
Slowly reactive to light and accomodation
44
What is holmes adie syndrome
Holmes adie pupil with contaminant absent ankle and knee reflexes
45
Risk factors for cataracts
Age
Smoking
Alcohol
Long term steroid use
46
Presentation of cataracts
Faded colour vision
Glare- bright lights become very bright
Halos around lights
Absent red reflex
47
How visualise a cataract
Slit lamp examination
48
Management of cataracts
In early stages to prevent progression improve glasses and contact lens, use brighter lights
To cure it can use surgery which replaces the lens
- only do if severe impairment, impact on life
49
Most common cause of optic neuritis and 2 other causes
MS
DM and syphilis also causes
50
How image optic neuritis
MRI of brain and orbits with gadolinium contrast
51
Management of optic neuritis
IM corticosteroids
MRI of brain and orbits with contrast
52
Presentation of optic neuritis
Pain on movement of eyes
Scotoma
Relative afferent pupillary defect
Poor discrimination of colours (red desaturation)
53
What is herpes zoster opthalmicus
Reactivation of herpes zoster in the area supplied by opthalmic division of the trigeminal nerve
Effectively shings of V1
54
Presentation of herpes zoster opthalmicus
Eruption of vesicular rash around the eyes
Rash can be on top of the nose or side of nose
55
Management of herpes zoster opthalmicus
Urgent opthal referral
Oral aciclovir for 10 days
56
Presentation of episcleritis
Acute onset red eye localised to one area
Painless
Lacrimation
57
Presentation of scleritis
Painful red eye
Lacrimation
Worse when move eye
Violet or blue discolouration of eye
Can get blurred vision
58
What is scleritis vs episcleritis
Scleritis- Full thickness inflammation of the sclera
Episcleritis- Inflammation of the episclera- a membrane which lies on the sclera
59
Causes of episcleritis and scleritis versus anterior uveitis
Episcleritis
- RA
- SLE
- Vasculitis
Anterior uveitis
- HLS-B27 conditions
- behcets
- sarcoid
60
Management of episcleritis and scleritis
Urgent opthal referral
- NSAIDS orally most commonly
- may use steroid drops if refractory
61
What is keratitis
Inflammation of the cornea
62
What is conjunctivitis
Inflammation of the conjuntiva which is a layer over the cornea
63
What are pathogenic causes of keratitis
Bacterial
- staphylococcus
- pseudomona
Acanthamoeba
HSV
64
What pathogen can cause keratitis in contact lens wearers
Pseudomonas
65
How can you get acanthamoeba keratitis
Swimming in contaminated water
66
How can keratitis present
Red eye
Photophobia
Pain
Feel like smt in the eye
67
Management of keratitis if contact lens wearer
Same day opthal referral
- Stop wearing them until it clears
- Topical quinolone
- cyclopegic
68
How assess keratitis in a contact lens wearer
Slit lamp test
69
What is anterior uveitis
Inflammation of the iris
70
What is a hypopyon
Presence of inflammatory cells and pus in the anterior chamber of the eye
71
What are cyclopegics
Drugs which dilate the pupil
Antimuscarinic activty- atropine
72
What is the purpose of cyclopegics
Dilate the pupil which relieves pain and photophobia
73
Presentation of anterior uveitis
acute onset
ocular discomfort & pain
photophobia
blurred vision
red eye
74
What is management of anterior uveitis
Urgent opthal referral
- cyclopegics
- steroid eye drops
75
What is seen in argylle robertson pupil
Small constricted pupils
React to accomadation reflex BUT NOT LIGHT
76
How does central retinal vein occlusion present
Painless loss of vision in the eye
Widespread haemorrhage present in eye
77
How does papilloedema appear on fundoscopy
Blurring of optic disc
Paton's lines: concentric/radial retinal lines cascading from the optic disc (see in picture)
78
Causes of acute vision loss
Ischaemic
- TIA
- retinal artery occlusion
- retinal vein occlusion
Vitreal haemorrhage
Retinal detachment
Vitreal detachment
Migraine
79
Sudden loss of vision with curtain coming down
Ischaemic cause
80
Rfs for vitreous haemorrhage
DM
Anticogulants
81
What cause of vision loss presents with curtain coming in, seeing spider webs and floaters
Retinal detachment
82
What cause of sudden vision loss presents with flashing lights
Posterior vitreous detachment
83
Causes of blepharitis
Seborrheic dermatitis
Staph infections
84
What is a chalazion
A blocked oil gland which presents as a painless lump
85
What is a stye
Infection of the root of a hair follicle or oil gland in eyelid
86
Difference between a chalazion and a stye
Chalazion is painless and firm
Styes due to infection are painful and tender
87
Viral conjunctivitis causes
Adenovirus most commonly
HSV
VZV
88
Bacterial conjunctivitis causes
Staph aureus
HIB
Strep pneumoniae
89
Presentation of viral conjunctivitis
Recent URTI
Red eyes
Clear discharge
Preauricular lymph node swelling
90
Presentation of bacterial conjunctivitis
Eyes stuck together
Red eyes
Prurulent dishcarge
91
Management of conjunctivitis
Viral
- reassure
- avoid sharing towels etc
- avoid contact lens
Bacterial
- watch and wait
- chloramphenicol drops if needs be
92
How does corneal abrasion present
Reduced acuity in eye
Photophobia
Pain
93
How is corneal abrasion visualised
Using fluorescein in slit lamp test
94
Management of corneal abrasion
Antibiotic eye drops to cover possible bacterial superinfection
95
Management of age related macular degeneration
Both require opthal assessment and management
Dry
- vitamin supplementation- High-dose beta-carotene and vitamins C and E alongside zinc are
Wet
- Intravitreal anti-VEGF agents
96
What is seen here
Hypertensive retinopathy
97
What is AV nipping
arteriole is seen crossing a venule, which results in the compression of the vein with bulging on either side of the crossing.
98
What can cause an acute deterioration in dry ARMD
Progression to wet ARMD- get central vision impaired and demarcated red patches on the retina
99
How to differentiate between central and branch retinal vein occlusion
In central the bleeding would be widespread, in branching it is confined to 1 area
100
How does herpes keratitis present
Red eye
Pain
Photophobia
Crusted lesions/ulcers on face
101
What is a dendritic ulcer on cornea
Herpes keratitis
Appears with abnormal shape as opposed to normal corneal ulcers
102
What factors demonstrate orbital cellulitis
reduced visual acuity
proptosis
pain with eye movements
any visual problem
103
What acute red eye presents with small, fixed oval pupil, ciliary flush
Anterior uveitis
104
Presentation of retinal detachment
Floaters and flashing
Painless loss of vision- curtain coming across vision
RAPD
105
What is management of posterior vitreous detachment
Conservative but requires urgent referral
106
What is definition of glaucoma
Group of eye diseases which may damage the optic nerve due to increased intraocular pressure
107
What is first line for primary open angle glaucoma
Laser trabeculoplasty
108
Which drugs for glaucoma reduce production of aqueous fluid
Carbonic anhydrase inhibitors
Beta blockers
Alpha adrenergic agonists
109
Which drugs for glaucoma increase outflow of fluids
Muscarinic agonists
Prostaglandin analogues
Alpha agonists
110
Which acute cause of vision loss presents with poor colour differentiation
optic neuritis
111
What can cause unilateral papilloedema
Something compressing on optic nerve in that eye like a tumour
GCA
112
Presentation of open angle glaucoma
Reduced peripheral vision
Reduced acuity
Insidious onset
113
Which glaucoma drug can increase eyelash length and increase pigmentation in the eye
Prostaglandin analogues
114
What is entropion vs ectoprion of eyelids
Entropion= in curling of eyelids
Extroption= out curling
115
What is miopia
Short sightednesss where objects close are clear but those farther away can be very blurry
116
What is hyperopia
Long sightedness where objects close are blurry but ones far away are clear
117
How test for refractive errors
Check visual acuity with snellen chart, then use a pin hole occluder to see if this improves the acuity. If improves then requires optician review
118
What is first investigation for blurred vision
Test visual acuity with a snellen chart then use a pinhole occluder to check if this improves it. If so need glasses so optician review
119
What is hyphema
Blood in the anterior chamber of the eye
120
Management of hyphema
Strict bed rest as movement can redistribute blood
121
What concerned about most in ocular trauma
Orbital compartment syndrome
122
Presentation of orbital compartment syndrome
Eye pain
Proptosis
Rock hard eyelids
RAPD
123
Management of orbital compartment syndrome
Urgent canthotomy before even imaging
Where make a slit in skin lateral to the eye
124
What presents with increased cup to disc ratio
Open angle glaucoma
125
What is important point to remember with glaucoma and intraocular pressure
Not all patients with glaucoma have raised IOP and vice versa
126
Presentation of blepharitis
Bilateral most commonly
- grittiness feeling
- eyes sticky in morning
- eyelids swollen
127
What are gritty eyes
Where feel dry and scratchy
128
Management of allergic conjunctivitis
Topical anti histamine
129
Management of herpes keratitis
Topical aciclovir
130
What presents with a pale retina and a cherry red spot
Central retinal artery occlusion
131
Features of central retinal artery occlusion
Sudden painless visual loss
RAPD
Cherry red spot on a pale background
132
What is screening process for glaucoma
If a positive family history then should get annual screening from age 40
133
If childhood squints are not corrected what does it lead to
Lazy eye (amblyopia)
134
If when apply gentle pressure to the eye, the injected vessels move, what is the cause
Episcleritis
135
Differentiating between uveitis and glaucoma
Glaucoma= dilated pupil
Uveitis= small and fixed pupil
136
What is gold standard investigation for wet ARMD
Fluorescein angiography to visualise neovascularisation
137
What pathophysiologically does a RAPD suggest
Problem with optic disc/nerve
138
Patient who has had mydriatic drops recently presents with an acutely painful eye and reduced acuity
Acute angle closure glaucoma
139
What is a richard gunn pupil
Relative afferent pupillary defect
140
What is it get a red painful eye with reduced vision after a surgery on the eyes
Endopthalmitis
141
What causes sudden onset vision loss in a quadrant with floaters
Retinal detatchment
142
What do if acute red eye but reduced visual acuity
Need to refer to opthal ED as shows cornea involved if visual acuity worse
143
Main side effect of panretinal laser photocoagulation
Decrease in night vision
Reduction in visual field
144
What is amsler grid useful for testing
Distortion of line perception in ARMD
145
Signs on examination of anterior uveitis
Hypophyon- inflam cells and pus in anterior chamber of eye
Miosis from constriction of ciliary muscles
Abnormally shaped pupil
Ciliary flush where redness spreads outwards from the pupil
146
What is retinitis pigmentosa
Genetic condition resulting in degeneration of the rods in retina which are responsible for nighttime vision and peripheral vision
147
Retinitis pigmentosa on fundoscopy
Spiculated pattern of increased pigmentation in peripheral retina
148
Management of vitreal haemorrhage
Refer for urgent eye assessment to rule out coexistent retinal detatchment
149
Management of retinal tear
Need to re-adhere, can do via laser or cryo therapy
150
Management of retinal detachment
Vitrectomy- remove vitreal fluid then reinject with air or oil to push retina back
151
What type of drop is brimonidine
Alpha 2 receptor agonist
152
Definitive management of acute angle closure glaucoma
Peripheral laser iridotomy once medical management settles acute phase
153
Rfs for AACG
Pupil dilation- can be from mydriatic drops
Long sighted (hypermetropia)
154
Management of primary open angle glaucoma
Treat if IOP >24, if less than regular follow-up
1st line- Selective laser trabeculoplasty
2nd line if CI- prostaglandin eye drops like latanoprost
3rd line- beta blocker, alpha agonist or carbonic anhydrase
155
If not having laser trabeculoplasty for primary open angle glaucoma, what is first line eye drop
prostaglandin eye drops like latanoprost
156
Main side effect of cataracts surgery
Endopthalmitis
157
Main sign on examination of cataracts
Loss of red reflex
158
Bacterial conjunctivitis management
Conservative
If no improvement after 5 days then topical chloramphenicol drops
159
Herpetic conjuntivitis management
Refer to opthalmologist
Uncomplicated- warm compress and eye drops
Complicated- topical aciclovir
