Opthalmology Flashcards
(55 cards)
decreased vision in left eye, eye pain,
central area of reduced vision (central scotoma) and a relevant afferent pupillary defect. what is the most likely diagnosis?
investigation?
management?
optic neuritis!!
RAPD = key sign, a pupil fails to constrict -> shows damage to optic nerve
central scotoma is seen in demyelinating lesions eg also in MS - associated with this
MRI!!! of brain and orbits with contrast
+ high dose steroids
reduced colour vision may be present
Central retinal artery occlusion typical presentation?
sudden, unilateral PAINLESS vision loss +/- RAPD
painless = distinguish from optic neuritis. CRA occlusion also does not have scotoma
anterior uveitis typical presentation?
small, irregularly shaped pupil with a potential hypopyon
Painful red eye
Photophobia!!!!
HLA-B27 conditions e.g. ankylosing spondylitis,
Blepharitis symptoms?
causes?
risk factors?
grittiness and discomfort, particularly around the eyelid margins
eyes may be sticky in the morning
eyelid margins may be red. Swollen eyelids may be seen in staphylococcal blepharitis
styes and chalazions are more common in patients with blepharitis
secondary conjunctivitis may occur
caused by gland dysfunction or sebbhorriec dermatitis/staph infection
rosacea = risk factor
manage w hot compresses and removal of lid debris
What investigations for Acute angle-closure glaucoma? (painful red eye, DILATED pupil (vs constricted in anterior uveitis) )
initial management?
definitive management?
tonometry to assess for elevated IOP
and gonioscopy
eye drops - eg timolol, pilocarpine or apraclonidine, IV acetazolamide
definitive = Laser peripheral iridotomy!!! (creating small hole in iris to relieve pressure)
picture of unilateral red eye. PAINFUL eye movements. history of joint pain treated. most likely diagnosis?
management?
most common association?
scleritis!!! - can also cause gradual reduction in vision
episcleritis is NOT painful!!
urgent review by opthalmologist
scleritis most commonly associated with rhuematoid arthritis!!! (but also sle, sarcoidosis)
what are the risk factors for retinal detachment?
diabetes mellitus!!!
(occurs as a result of breaks in the retina due to traction by the vitreous humour
these tears may proceed to detachment if left untreated)
myopia!!!!!
age
previous surgery for cataracts (accelerates posterior vitreous detachment)
eye trauma e.g. boxing
how does cataracts present?
insidious blurring of total visual field
why do contact wearers with painful red eye showing dilated vessels need to be urgently referred to eye casualty same day!!!?
most common pathogen causing?
to exclude keratitis
psuedomonas aueruginosa
Can also be acanthomeba after swimming in open water with lenses
age related macular degeneration
presentation?
findings in 2 subtypes?
management?
worsening of CENTRAL vision/ central scotoma type picture (in a 75 year old, this is more likely than optic neuritis). Worsening night time vision. Visual hallucinations.
Dry macular degeneration = DRUSEN = yellow spots
Wet macular degeneration = choroidal neovascularisation + red patches representing hemorrhage
slit-lamp microscopy is the initial investigation of choice, to identify any pigmentary, exudative or haemorrhagic changes affecting the retina
fluorescein angiography is utilised if neovascular ARMD is suspected, as this can guide intervention with anti-VEGF therapy.
supportive measures in dry version - Vitamin supplementation!!!! High dose of beta-carotene, vitamins C and E!!
VEGF in wet version - ranibizumab, bevacizumab and pegaptanib!!
*visual hallucinations may occur in ARMD
Blot hemorrhages and cotton wool spots are seen in what eye disease?
hypertensive retinopathy
(meanwhile microaneurysms seen in both Hypertensive retinopathy and diabetic retinopathy)
orbital cellulitis investigation?
CT with contrast
primary open angle glaucoma presentation?
risk factors?
treatment?
gradual worsening of peripheral vision
diabetes, myopia
offerselective laser trabeculoplasty (SLT) first-line to people with an IOP of ≥ 24 mmHg !!
prostaglandin analogue (PGA) eyedrops should be used next-line = LATANOPROST.
Then consider beta blockers, carbonic anhydrase inhibitors
findings in moderate non proliferative diabetic retinopathy?
Mild NPDR
1 or more microaneurysm
Moderate NPDR
microaneurysms
blot haemorrhages!!!!!
hard exudates!!!!
cotton wool spots !!!!(‘soft exudates’ - represent areas of retinal infarction), venous beading/looping and intraretinal microvascular abnormalities (IRMA) less severe than in severe NPDR
Severe NPDR
blot haemorrhages and microaneurysms in 4 quadrants
venous beading in at least 2 quadrants
IRMA in at least 1 quadrant
treatment of diabetic retinopathy?
laser photocoagulation
any evidence of maculopathy = VEGF
A 34-year-old man with a history of ankylosing spondylitis presents with a painful right eye associated with mild photophobia:
Cycloplegic drops have recently been given. What is the most likely diagnosis?
name some associated conditions
anterior uveitis!!!
unlike scleritis, anterior uveitis is treated with cyclopecig eyedrops!!! which helps dilate the pupil which is typically constricted!!! = key finding + steroids
ankylosing spondylitis!!!
reactive arthritis
ulcerative colitis, Crohn’s disease
Behcet’s disease
sarcoidosis: bilateral disease may be seen
19-year-old bitemporal hemianopia with predominately the lower quadrants being affected. What is the most likely lesion?
cranipharyngioma!!
Bitemporal hemianopia
lesion of optic chiasm
upper quadrant defect > lower quadrant defect = inferior chiasmal compression, commonly a pituitary tumour
lower quadrant defect > upper quadrant defect = superior chiasmal compression, commonly a craniopharyngioma
subscapular cataracts risk factors?
diabetes, steroids and hypermetropia
acute loss of vision, pain and redness with hypopon post cataract surgery. most likely diagnosis?
endopthalmitis
A 30-year-old man with a family history of early blindness is concerned that he is developing ‘tunnel vision’.
what is most likely diagnosis?
retinitis pigmentosa
A 22-year-old man is referred to urology with possible urinary retention. He is passing huge amounts of urine. Post void bladder ultrasound is normal.
what is the most likely visual field defect?
Lower bitemporal hemianopia
patient has diabetes insipidus due to a craniopharyngioma.
A 53-year-old man is admitted to the vascular ward for a carotid endarterectomy. His CT head report confirms a left parietal lobe infarct.
what is the most likely visual field defect?
Right inferior quadranopia
if there are hard exudates in macula and blot hemmorhages elsewhere in a patient with a history of diabetes and hypertension
no changes in vision
most likely diagnosis?
pre proliferative diabetic retinopathy
not proliferative as new blood vessels not forming
not diabetic maculopathy as this is SIGHT threatening, in severe diabetes, visual changes. Also blot hemmorhages are seen outside the macula
not hypertensive retinopathy as typical early changes eg AV nipping or silver wiring, arteriolar narrowing not seen. hard exudates are typically only seen in advanced disease, at which point one would expect a history of vision changes - also hemorrhages, cotton wool spots
A 67-year-old man who is known to have raised intraocular pressure is prescribed dorzolamide eye drops. What is the mechanism of action of this drug?
carbonic anhydrase inhibitor
