Opthalmology Flashcards
(128 cards)
1
Q
Contact lens wearer with red painful eye?
A
Refer to opthalmology to exclude microbial keratitis
2
Q
Management of children with squint?
A
Refer to ophthalmology
3
Q
What is seborrhoeic dermatitis associated with?
A
Blepharitis
4
Q
fixed dilated pupil with conjunctival injection
A
acute closed angle glaucoma
5
Q
How to manage patient who presents with new-onset flashes or floaters?
A
Urgent referral by opthalmology for ?vitreous detachment
6
Q
What is myopia (near-sightedness) a risk factor for?
A
Retinal detachment
7
Q
Bacterial vs viral keratitis?
A
Viral would have contact with herpes infection or recurrent episodes triggered by stress, immunosuppression or trauma
8
Q
central scotoma and red patches on the retina on fundoscopy in an older person?
A
Wet age-related MD
9
Q
Mydriatic drops precipitate what?
A
Acute angle closure glaucoma
10
Q
Metamorphopsia (wavy distortion of straight lines) is the initial symptoms of what?
A
Choroidal neovascularisation
11
Q
Hutchinson’s sign (rash on the tip of the nose) is a predictor for what in HZO?
A
Ocular involvement
12
Q
Ankylosing spondylitis is associated with what?
A
Anterior uveitis
13
Q
Side effects of prostaglandin analogues e.g latanoprost?
A
increased eyelash length, iris pigmentation and periocular pigmentation
14
Q
How does latanoprost work?
A
increasing uveoscleral outflow
15
Q
Management of patients with organic foreign body in their eye?
A
Refer to ophthalmology for same day assessment
16
Q
How does diabetic maculopathy present?
A
based on location rather than severity, anything is potentially serious
hard exudates and other ‘background’ changes on macula
check visual acuity
more common in Type II DM
17
Q
How is diabetic maculopathy managed?
A
if there is a change in visual acuity then intravitreal vascular endothelial growth factor (VEGF) inhibitors
18
Q
Management of dry MD?
A
High dose of beta-carotene, vitamins C and E, and zinc
19
Q
Investigations for acute angle-closure glaucoma?
A
Both tonometry and gonioscopy
20
Q
night blindness and tunnel vision?
A
Retinitis pigmentosa
21
Q
What is Holmes-Adie pupil?
A
A benign dilated pupil seen in young women
22
Q
How does Holmes-Adie pupil present?
A
- Unilateral dilated pupil
- Slow reactive to accommodation and poorly to light
- Associated with Holmes-Adie syndrome where ankle/knee reflexes are absent
23
Q
What is Argyll Robertson pupil?
A
- Small irregular pupil, usually bilateral
- No response to light
- Responds to accommodation
- Associated with neurosyphilis
24
Q
What is the most common complication following laser photocoagulation?
A
Reduction of the visual field - especially night vision
25
Which eye condition is associated with IBD?
Anterior uveitis
26
Conjunctivitis vs orbital cellulitis?
Conjunctivitis would not cause any orbital swelling
27
Dense shadow that starts peripherally progresses towards the central vision/A veil or curtain over the field of vision?
Retinal detachment
28
Localised headache, neck pain and neuro signs e.g Horner's suggests what?
Cartoid artery dissection
29
red eye, haloes, hazy cornea?
Acute glaucoma
30
blurred vision, haloes?
Acute glaucoma
31
MD vs primary open angle glaucoma?
MD - central visual field loss
Open angle glaucoma - peripheral visual field loss
32
What is a possible complication of corneal transplant surgery?
Corneal graft rejection -> requires urgent assessment by ophthalmologist with topical steroids
33
Wet vs Dry MD?
Wet develops over months whereas dry develops over years
34
Dendritic ulcer?
Herpes simplex keratitis
35
AV nipping ?
Hypertensive retinopathy
36
What is Keratoconjunctivitis sicca a complication of?
Bells palsy
37
What should not be affected in conjunctivitis?
Visual acuity
38
Which organisms cause conjunctivitis?
Viral - adenoviruses, herpes
Bacterial - staph aureus, h influenzae, staph epidermidis
39
What can occur after facial trauma?
Orbital blow out fractures
40
When treating acute glaucoma, what should be treated?
BOTH eyes
41
A 56-year-old patient presents complaining of a red eye. On examination, you notice that the patient's left conjunctiva is severely injected and that the left eye is displaced forwards. Additionally, when you ask the patient to look left you notice that only right eye is able to do so
Carotid cavernous fistula - complication of conjunctivitis/trauma
42
What is an complication of CRVO?
Neovascular gaucoma -> develops over a few months
43
painful red eye, blurring of vision and photophobia with hypopyon?
Anterior uveitis
44
First line treatment for chronic glaucoma?
Prostaglandin analogues e.g. latanoprost
45
Lid lag is a sign of?
Thyroid eye disease
46
How enlarged should the optic disc: cup ratio be to diagnose open angle glaucoma?
>0.7
47
Complication of untreated squint?
Amblyopia- lazy eye
48
Most common risk factor for CRVO?
HTN
49
What should be given for corneal abrasion?
Topical Abx
50
Elderly female with painless loss of vision with scalp tenderness/headaches/jaw claudication?
Think arthritic ischaemic optic neuropathy caused by GCA
51
Long sightedness is a risk factor for what?
Acute glaucoma - smaller eyeball therefore iris-cornea angle is smaller
52
Orbital vs preorbital cellulitis?
Preorbital will have no proptosis, no pain on eye movements, no swelling on conjunctiva and normal optic nerve function
53
What are examination findings for cataracts?
- Clouding of lens
- Absent red reflex
54
What is the name of cataract surgery?
Phacoemulsification
55
What is an early and late complication of cataract surgery?
Early - posterior capsule rupture
Late - posterior capsule opacification
56
What is used to measure intraocular pressure and what is the normal upper limit?
Tonometry - 21
57
What is gonioscopy?
Measurement of the iridocorneal angle -> distinguishes between open-angle and closed-angle
58
What investigations should be done when suspecting macular degeneration?
Amsler chart, fundoscopy, OCT, fluorescein angiography
59
What are the management options for wet ARMD?
- Photodynamic therpay
- Laser photocoagulation
- anti-VEGF
60
What causes the blurred vision in acute closed angle glaucoma?
Corneal oedema
61
What can cause resolution of acute glaucoma symptoms upon going to bed?
Pupil constricts which pulls iris out of the angle
62
What is the immediate management of central retinal artery occulsion?
High dose steroids
63
What agent is used to visualise any ulceration of the cornea?
Fluorescein
64
What should be examined in the eye in someone with ophthalmic shingles?
Corneal sensation due to risk of corneal ulceration
65
Contact lens wearer who swims?
Acanthanoeibc keratitis
66
What are Amsler grids and Snellen charts used for?
Amsler - tests for distortion of line perceptions
Snellen - tests visual acuity
67
What are signs of orbital compartment syndrome?
- Blood in anterior chamber
- Proptosis
- Stiff eyelid
- RAPD
68
How should orbital compartment syndrome be managed?
Immediate canthotomy to reduce pressure then can do imaging like CT
69
What is the finding of a RAPD?
Affected and normal eye dilated when light is shone on the affected -> usually optic nerve/retina affected
70
What is papilledema?
Blurring of the optic disc margin on fundoscopy
71
What screening test can be done for squints in children?
Hirschberg test - corneal light reflection test
72
red-tinged vision along with dark spots
Vitreous haemorrhage
73
What are risk factors for vitreous haemorrhage?
- Diabetes
- Trauma
- Anticoag/coagulation disorders
74
What is the management of vitreous haemorrhage?
- Laser photocoagulation
- Anti VEGF injections
- Vitrectomy
75
Main causes of tunnel vision
- Papilloedema
- Glaucoma
- Choroidoretinits
76
Management of proliferative diabetic retinopathy?
Intravitreal VEGF injections + pan retinal photocoagulation laser
77
Congruous vs Incongruous loss of vision?
Congruous - complete/symmetrical visual field loss -> optic radiation lesion/occipital cortex
Incongruous - incomplete/asymmetrical visual field loss -> optic tract lesion
78
Initial management of glaucoma?
1. Direct parasympathomimetic e.g. pilocarpine (increase AH outflow)
2. Beta blocker e.g timolol (decrease AH production)
3. alpha-2 agonist e.g Apraclonidine (decrease AH production + improve outflow)
4. IV Acetazolamide (reduce secretions)
79
Proliferative vs Non proliferative diabetic retinopathy on fundoscopy?
Proliferative - new vessel formation/haemorrhages
80
Untreated Proliferative vs treated proliferative diabetic retinopathy?
Treated - dark circular scars around peripheries -> pan retinal photocoagulation / yellow spots/holes all over the fundus -> laser therapy
81
Mild vs Moderate vs Severe NPDR?
Mild - microaneurysms
Moderate - blot haemorrhages, hard exudates, cotton wool spots
Severe - venous beading, blot haemorrhages and microaneurysms in all 4 quadrants
82
What metabolic disorder can cause cataracts?
Hypocalcaemia
83
What is associated with subcapsular cataracts?
Steroids
84
Painful red eye with photophobia + watery eye?
Herpes keratitis
85
HTN retinopathy vs DM retinopathy?
DM will have choroidal neovascularisation
86
Acute vs chronic glaucoma
Acute - hypermetropia (far sightedness)
Chronic - myopia (near sightedness)
87
What can cause worsening of eye disease in Graves?
Radioiodine treatment
88
Cotton wool spots represent what?
Area of pre capillary arteriolar occlusion/infarction
89
What mineral can cause band keratopathy?
Calcium
90
What does superior rectus do?
Move eye up and out + inward rotation
91
Green central disc with spoke like projections?
Wilsons disease
92
What is the earliest feature which can be seen in anterior uveitis?
Aqueous flare
93
What does inferior oblique move eye in?
Down, in and outward
94
Risk factors for AAG
- Hypermetropia
- Shallow anterior chamber
- Thicker lens
- Smaller corneal diameter
95
Care advice for someone with bacterial conjunctivitis?
- Avoid touching eyes
- Avoid sharing towels
- Wash hands using drops
- Return if persists
96
Allergic vs bacterial conjunctivitis
Allergic will have itchy eyes, watery discharge
97
What are risk factors for cataracts?
- Age
- Sunlight
- Eye trauma
- Recurrent uveitis
- Steroid use
98
Which dermatome is affected in herpes zoster opthalmicus?
Ophthalmic division of trigeminal nerve
99
What are risk factors for scleritis?
- SLE
- Sarcoidosis
- TB
- Syphilis
- Trauma
- RA
100
What are examination findings for scleritis?
- Inflammation involving full thickness of sclera
- Anterior uveitis
- Scleral thinning
- Corneal thinning
101
Episcleritis vs Scleritis?
Episcleritis - fast onset, no pain, superficial inflammation, self limiting
Scleritis - gradual, painful, watery discharge, visual disturbances, topical steroids to treat
102
Risk factors for orbital cellulitis?
- URTI
- Retained foreign body
- Post surgery
- Systemic infection
103
Recurrent watery/sticky eye in neonates?
Tear duct obstruction -> self resolves by 1 year
104
What is the prognosis of herpes zoster opthalmicus?
Complete resolution with no complications
105
Causes of lack of red reflex
- Retinoblastoma
- Cataracts
- Retinal dysplasia
- Corneal opacity
106
What are the 2 layers of retina?
- Neurosensory layer which has ganglion cells and photoreceptors
- Retinal pigment epithelium
107
Timolol (beta blockers) is C/I when?
- Asthma and heart block
108
What is leukocoria?
White pupillary reflex - absence of red reflex -retinoblastoma
109
What is ophthalmia neonatorum?
Neonatal conjunctivitis contracted within the first 28 days of birth
Commonly gonococcal in first 5 days and chlamydia after 5 days
110
What are the 4 stages of HTN retinopathy?
1 - silver wiring, arteriolar narrowing
2 - AV nipping
3 - Cotton wool spots, flame haemorrhages
4 - Papilledema
111
Scleritis vs anterior uveitis
Scleritis would not have any pupillary signs i.e. irregularly shaped pupil
112
What is the fluorescein eye drop test used for?
Identify any defects in the corneal epithelium
113
What is the management of endophthalmitis?
Intravitreal Abx
Vitrectomy in severe cases
114
dense shadow that starts peripherally and moves to the patient’s central vision on a background of new onset floaters and flashes
Retinal detachment
115
What is the name given to blood in the anterior chamber of the eye following trauma?
Hyphema
116
What should be done when thinking about any corneal abrasions?
Fluorescein staining
117
Blunt ocular trauma with associated hyphema
High risk for raised IOP -> secondary glaucoma?
118
Herpes zoster opthalmicus is caused by what?
Varicella zoster
119
What is a carotid cavernous fistula?
Abnormal communication between carotid artery and the cavernous sinus
120
What causes carotid cavernous fistulas?
Secondary to trauma e.g. head injuries, surgery
121
How does carotid cavernous fistulas present?
- Pulsatile proptosis
- Bruit
- Severe conjunctivitis
- Cranial nerve involvement
122
What is the gold standard for carotid cavernous fistulas?
- Cerebral Angiography
123
How is carotid cavernous fistulas managed?
Coil embolization or balloon occlusion
124
Which cranial nerves are in cavernous sinus?
3,4,6,5 - opthalmic and maxillary
125
"pizza pie" appearance on fundoscopy?
CMV retinitis -> HIV patient
126
Horners is loss of innervation to what?
Sympathetic chain
127
How to tell right vs left 4th nerve palsies?
Vision improves when head tilts towards the unaffected side
128
