opthalmology Flashcards

Question

What are the fundoscopy signs of open angle glaucoma?

Answer 1

--> Optic disc cupping - cup-to-disc ratio >0.7 (normal = 0.4-0.7), occurs as loss of disc substance makes optic cup widen and deepen --> Optic disc pallor - indicating optic atrophy --> Bayonetting of vessels - vessels have breaks as they disappear into the deep cup and re-appear at the base --> Additional features - Cup notching (usually inferior where vessels enter disc), Disc haemorrhages

Answer 2

--> 360° selective laser trabeculoplasty - laser is directed at the trabecular meshwork, improving drainage. It may delay or prevent the need for eye drops. A second procedure may be necessary at a later date. --> Prostaglandin analogue eye drops (latanoprost) - first line medical management - increases uveoscleral outflow --> beta-blockers (timolol) - reduce the production of aqueous humour --> carbonic anhydrase inhibitors (dorzoloamide/ azetazolomaide) - reduces the production of aqueous humour --> Sympathomimetics (e.g., brimonidine) reduce the production of aqueous fluid and increase the uveoscleral outflow --> miotics - pilocarpine - increase iveoscral outflow --> Trabeculectomy surgery may be required where other treatments are ineffective. This involves creating a new channel from the anterior chamber through the sclera to a location under the conjunctiva, causing a bleb on the conjunctiva. From here, it is reabsorbed into the general circulation.

Answer 3

--> eyelash growth --> eyelid pigmentation --> iris pigmenetation (browning)

Answer 4

--> progressive condition affecting the macula --> most common cause of blindness in the UK --> often unilateral but can be bilateral --> two types - Wet (also called neovascular), accounting for 10% of cases/ Dry (also called non-neovascular), accounting for 90% of cases

Answer 5

--> centre of retina --> generates high-definition colour vision in the central visual field, has four layers

Answer 6

--> Choroid layer (at the base), which contains the blood vessels that supply the macula --> Bruch’s membrane --> Retinal pigment epithelium --> Photoreceptors (towards the surface)

Answer 7

--> Drusen are yellowish deposits of protein and lipids --> between retinal pigment epithelium and Bruch's membrane --> few small Drusen normal in elderly, larger and frequent can be an early sign of macular degeenration

Answer 8

--> older age --> smoking --> family history --> cardiovascular disease (hypertension) --> obeisty --> poor diet (low in vitamins and high in fats)

Answer 9

--> Dry macular degeneration - 90% of cases - also known as atrophic - characterised by Drusen - yellow round spots in Bruch's membrane --> Wet macular degeneration - 10% of cases - also known as exudative or neovascular macular degeneration caused by vascular endothelial growth factor (VEGF) - characterised by choroidal neovascularisation - leakage of serous fluid can result in rapid loss of vision - carries the worst prognosis

Answer 10

Visual changes associated with AMD tend to be unilateral, with: Gradual loss of central vision Reduced visual acuity Crooked or wavy appearance to straight lines (metamorphopsia) Patients often present with a gradually worsening ability to read small text. Wet AMD presents more acutely than dry AMD. Vision loss can develop within days and progress to complete vision loss within 2-3 years. It often progresses to bilateral disease.

Answer 11

Glaucoma is associated with peripheral vision loss and halos around lights. AMD is associated with central vision loss and a wavy appearance to straight lines. This helps you tell them apart in exams.

Answer 12

--> distortion of line perception may be noted on Amsler grid testing --> fundoscopy reveals the presence of drusen, yellow areas of pigment deposition in the macular area, which may become confluent in late disease to form a macular scar. --> in wet ARMD well demarcated red patches may be seen which represent intra-retinal or sub-retinal fluid leakage or haemorrhage.

Answer 13

Key findings on examination are: --> Reduced visual acuity using a Snellen chart --> Scotoma (an enlarged central area of vision loss) --> Amsler grid test can be used to assess for the distortion of straight lines seen in AMD --> Drusen may be seen during fundoscopy --> Slit lamp examination gives a detailed view of the retina and macula. --> Optical coherence tomography gives a cross-sectional view of the layers of the retina and is used for diagnosing and monitoring AMD. --> Fluorescein angiography involves giving a fluorescein contrast and photographing the retina to assess the blood supply, showing oedema and neovascularisation in wet AMD.

Answer 14

Patients with suspected AMD require specialist ophthalmology assessment and management. There is no specific treatment for dry AMD. Management involves monitoring and reducing the risk of progression by: Avoiding smoking Controlling blood pressure Vitamin supplementation has some evidence in slowing progression Anti-VEGF medications are used to treat wet AMD (not dry AMD). Vascular endothelial growth factor (VEGF) stimulates the development of new blood vessels in the retina. Anti-VEGF medications (e.g., ranibizumab, aflibercept and bevacizumab) block VEGF and slow the development of new vessels. They are injected directly into the vitreous chamber of the eye (intravitreal), usually about once a month.

Answer 15

damage to the retinal blood vessels due to prolonged high blood sugar levels

Answer 16

Hyperglycaemia (high blood sugar) damages the retinal small vessels and endothelial cells. Increased vascular permeability leads to leaking blood vessels, blot haemorrhages and hard exudates. Hard exudates are yellow-white deposits of lipids and proteins in the retina. Damage to the blood vessel walls leads to microaneurysms and venous beading. Microaneurysms are small bulges in the blood vessel walls. Venous beading is where the walls of the veins are no longer straight and parallel and look more like a string of beads or sausages. Damage to nerve fibres in the retina causes fluffy white patches called cotton wool spots to form on the retina. Intraretinal microvascular abnormalities (IRMA) refer to dilated and tortuous capillaries in the retina. These can act as a shunt between the arterial and venous vessels in the retina. Neovascularisation involves the release of growth factors in the retina, stimulating new blood vessel development.

Answer 17

Diabetic retinopathy is graded based on the findings on fundus examination: Background – microaneurysms, retinal haemorrhages, hard exudates and cotton wool spots Pre-proliferative – venous beading, multiple blot haemorrhages and intraretinal microvascular abnormality (IMRA) Proliferative – neovascularisation and vitreous haemorrhage Diabetic maculopathy also exists separately and involves: Exudates within the macula Macular oedema The key feature of proliferative diabetic retinopathy is the development of new blood vessels (neovascularisation).

Answer 18

Non-proliferative diabetic retinopathy (NPDR), proliferative diabetic retinopathy (PDR), and maculopathy.

Answer 19

The presence of one or more microaneurysms.

Answer 20

Microaneurysms, blot haemorrhages, hard exudates, cotton wool spots (retinal infarction), venous beading/looping, and intraretinal microvascular abnormalities (IRMA) less severe than in severe NPDR.

Answer 21

Blot haemorrhages and microaneurysms in 4 quadrants. Venous beading in at least 2 quadrants. Intraretinal microvascular abnormalities (IRMA) in at least 1 quadrant.

Answer 22

Retinal neovascularisation, which can lead to vitreous haemorrhage.

Answer 23

Fibrous tissue forming anterior to the retinal disc and a higher prevalence in Type 1 diabetes mellitus, with a 50% chance of blindness within 5 years.

Answer 24

Hard exudates and other background changes on the macula, with visual acuity needing to be checked.

Answer 25

Type 2 diabetes mellitus.

Answer 26

Because it affects the macula, which is critical for central vision.

Answer 27

Vision loss Retinal detachment Vitreous haemorrhage (bleeding into the vitreous humour) Rubeosis iridis (new blood vessel formation in the iris) – this can lead to neovascular glaucoma Optic neuropathy Cataracts

Answer 28

Non-proliferative diabetic retinopathy requires close monitoring and careful diabetic control. Treatment options for proliferative diabetic retinopathy are: Pan-retinal photocoagulation (PRP) – extensive laser treatment across the retina to suppress new vessels Anti-VEGF medications by intravitreal injection e.g., ranibizumab Surgery (e.g., vitrectomy) may be required in severe disease An intravitreal implant containing dexamethasone is an option for macular oedema.

Answer 29

Cataracts describe a progressively opaque eye lens, which reduces the light entering the eye and visual acuity.

Answer 30

Increasing age Smoking Alcohol Diabetes Steroids Hypocalcaemia

Answer 31

Patients typically present with a gradual onset of: Reduced vision Faded colour vision: making it more difficult to distinguish different colours Glare: lights appear brighter than usual Halos around lights Signs: A Defect in the red reflex: the red reflex is essentially the reddish-orange reflection seen through an ophthalmoscope when a light is shone on the retina. Cataracts will prevent light from getting to the retina, hence you see a defect in the red reflex.

Answer 32

Ophthalmoscopy: done after pupil dilation. Findings: normal fundus and optic nerve Slit-lamp examination. Findings: visible cataract

Answer 33

No intervention may be necessary if the symptoms are manageable. Cataract surgery involves drilling and breaking the lens to pieces, removing the pieces and implanting an artificial lens. It can be performed as a day case under local anaesthetic and generally gives good results. Cataracts can prevent the detection of other pathology, such as macular degeneration or diabetic retinopathy, which can become apparent after surgery. Therefore, they may still have reduced visual acuity after the cataract is treated.

Answer 34

Complications following surgery Posterior capsule opacification: thickening of the lens capsule Retinal detachment Posterior capsule rupture Endophthalmitis: inflammation of aqueous and/or vitreous humour

Answer 35

inflammation of the eyelid margins

Answer 36

--> Meibomian gland dysfunction - which secrete oil onto the eye surface to prevent rapid evaporation of the tear film --> RARE - subhorrhoeic dermatitis --> RARE - staphylococcal infection

Answer 37

--> symptoms are usually bilateral --> 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

Answer 38

--> softening of the lid margin using hot compresses twice a day --> 'lid hygiene' - mechanical removal of the debris from lid margins cotton wool buds dipped in a mixture of cooled boiled water and baby shampoo is often used an alternative is sodium bicarbonate, a teaspoonful in a cup of cooled water that has recently been boiled --> artificial tears may be given for symptom relief in people with dry eyes or an abnormal tear film

Answer 39

--> Hordeolum externum --> Hordeolum internum

Answer 40

--> infection of the glands of Zeis or glands of Moll. The glands of Moll are sweat glands at the base of the eyelashes. The glands of Zeis are sebaceous glands at the base of the eyelashes. A stye causes a tender red lump along the eyelid that may contain pus.

Answer 41

Hordeolum internum is infection of the Meibomian glands. They are deeper, tend to be more painful and may point inwards towards the eyeball underneath the eyelid.

Answer 42

Styes are treated with hot compresses and analgesia. Topical antibiotics (e.g., chloramphenicol) may be considered if it is associated with conjunctivitis or if symptoms are persistent.

Answer 43

--> Meibomian gland becomes blocked and swells --> presents with a swelling in the eyelid that is typically non tender

Answer 44

warm compresses and gentle massage towards the eyelashes (to encourage drainage). Rarely, surgical drainage may be required.

Answer 45

Entropion refers to when the eyelid turns inwards with the lashes pressed against the eye.

Answer 46

--> pain --> coreneal damage --> ulceration

Answer 47

Initial management is by taping the eyelid down to prevent it from turning inwards. Definitive management is surgical. A same-day referral to ophthalmology is required if there is a risk to sight. When the eyelid is taped down, it is essential to prevent the eye from drying out by using regular lubricating eye drops.

Answer 48

Ectropion refers to when the eyelid turns outwards, exposing the inner aspect.

Answer 49

This can result in exposure keratopathy, as the eyeball is exposed and not adequately lubricated and protected.

Answer 50

Mild cases may not require treatment. Regular lubricating eye drops are used to protect the surface of the eye. More significant cases may require surgery to correct the defect. A same-day referral to ophthalmology is required if there is a risk to sight.

Answer 51

Trichiasis refers to inward growth of the eyelashes

Answer 52

--> corneal damage and ulceration

Answer 53

Management involves removing the affected eyelashes. Recurrent cases may require electrolysis, cryotherapy or laser treatment to prevent them from regrowing. A same-day referral to ophthalmology is required if there is a risk to sight.

Answer 54

Periorbital cellulitis (also known as preseptal cellulitis) is an eyelid and skin infection in front of the orbital septum (in front of the eye).

Answer 55

--> Staph. aureus --> Staph. epidermidis --> streptococci

Answer 56

Symptoms The patient presents with a red, swollen, painful eye of acute onset. They are likely to have symptoms associated with fever. Signs Erythema and oedema of the eyelids, which can spread onto the surrounding skin Partial or complete ptosis of the eye due to swelling Orbital signs (pain on movement of the eye, restriction of eye movements, proptosis, visual disturbance, chemosis, RAPD) must be absent in preseptal cellulitis - their presence would indicate orbital cellulitis

Answer 57

Orbital cellulitis Allergic reaction

Answer 58

--> Bloods - raised inflammatory markers --> Swab of any discharge present --> Contrast CT of the orbit may help to differentiate between preseptal and orbital cellulitis. It should be performed in all patients suspected to have orbital cellulitis

Answer 59

All cases should be referred to secondary care for assessment Oral antibiotics are frequently sufficient - usually co-amoxiclav Children may require admission for observation

Answer 60

Bacterial infection may spread into the orbit and evolve into orbital cellulitis

Answer 61

Orbital cellulitis is the result of an infection affecting the fat and muscles posterior to the orbital septum, within the orbit but not involving the globe MEDICAL EMERGENCY - hospital admission needed

Answer 62

spreading upper respiratory tract infection from the sinuses and carries a high mortality rate

Answer 63

--> Childhood - Mean age of hospitalisation 7-12 years --> Previous sinus infection --> Lack of Haemophilus influenzae type b (Hib) vaccination --> Recent eyelid infection/ insect bite on eyelid (periorbital cellulitis) --> Ear or facial infection

Answer 64

--> Redness and swelling around the eye --> Severe ocular pain --> Visual disturbance --> Proptosis --> Ophthalmoplegia/pain with eye movements --> Eyelid oedema and ptosis --> Drowsiness +/- Nausea/vomiting in meningeal involvement (Rare)

Answer 65

reduced visual acuity, proptosis, ophthalmoplegia/pain with eye movements are NOT consistent with preseptal cellulitis

Answer 66

Full blood count - WBC elevated, raised inflammatory markers. Clinical examination involving complete ophthalmological assessment - Decreased vision, afferent pupillary defect, proptosis, dysmotility, oedema, erythema. CT with contrast - Inflammation of the orbital tissues deep to the septum, sinusitis. Blood culture and microbiological swab to determine the organism. Most common bacterial causes - Streptococcus, Staphylococcus aureus, Haemophilus influenzae B.

Answer 67

Streptococcus, Staphylococcus aureus, Haemophilus influenzae B.

Answer 68

admission to hospital for IV antibiotics

Answer 69

--> opthalmic artery --> branch of internal carotid

Answer 70

The most common cause is atherosclerosis. It can also be caused by giant cell arteritis, where vasculitis affecting the ophthalmic or central retinal artery reduces blood flow.

Answer 71

Risk factors for cardiovascular disease (e.g., smoking, hypertension, diabetes and raised cholesterol) increase the risk of atherosclerosis causing central retinal artery occlusion. Risk factors for giant cell arteritis are white ethnicity, older age, female and polymyalgia rheumatica.

Answer 72

--> sudden, painless unilateral visual loss --> relative afferent pupillary defect (pupils react differently to light when shone in each eye) --> 'cherry red' spot on a pale retina (fundoscopy)

Answer 73

--> Retinal detachment --> central retinal artery occlusion --> Central retinal vein occlusion --> Vitreous haemorrhage (Due to diabetic retinopathy) --> amaurosis fugax

Answer 74

--> Management is difficult and the prognosis is poor any underlying conditions should be identified and treated (e.g. intravenous steroids for temporal arteritis) --> if a patient presents acutely then Intraarterial thrombolysis may be attempted but currently, trials show mixed results.

Answer 75

--> inflammation of the conjunctiva --> may be bacterial viral or allergic

Answer 76

--> thin layer of tissue that covers the inside of the eyelids and the sclera

Answer 77

--> Red bloodshot eye --> itchy or gritty sensation --> Discharge --> no pain/ photophobia/ reduced visual acuity --> Bacterial - purulent discharge worse in the morning and highly contagious -->Viral - more common - clear discahrge - dry cough, sore throat, blocked nose, tender pre-auricular lymph nodes, contagious

Answer 78

Acute angle-closure glaucoma Anterior uveitis Scleritis Corneal abrasions or ulceration Keratitis Foreign body Traumatic or chemical injury

Answer 79

--> Conjunctivitis --> Episcleritis --> Subconjunctival haemorrhage

Answer 80

Staphylococcus aureus Streptococcus pneumoniae Haemophilus influenzae Moraxella catarrhalis

Answer 81

Adenovirus (most common) Herpes simplex virus (HSV) Varicella-zoster virus (VZV) Enterovirus

Answer 82

--> normally a self-limiting condition that usually settles without treatment within 1-2 weeks --> topical antibiotic therapy is commonly offered to patients, e.g. Chloramphenicol. Chloramphenicol drops are given 2-3 hourly initially where as chloramphenicol ointment is given qds initially --> topical fusidic acid is an alternative and should be used for pregnant women. Treatment is twice daily --> contact lens should not be worn during an episode of conjunctivitis --> advice should be given not to share towels --> school exclusion is not necessary

Answer 83

--> Ocular inflammatory condition triggered by an immune response to various environmental allrgens eg pollen

Answer 84

--> type 1 hypersensitivity reaction --> initial exposure - sesnitisation of mast cells --> re-exposure release infalmmatory mediators - histamines, prostaglandins, leukotrines --> Cause vasodilation and increased vascular permeability and recruitment of eosinophils --> clinical manifesatation of allergic conjuncitvitis

Answer 85

--> Bilateral ocular itching and redness --> Watery or stringy, mucoid discharge --> Conjunctival chemosis and hyperemia --> Eyelid oedema and erythema --> Tearing and photophobia The severity and duration of symptoms may vary depending on the type of allergic conjunctivitis, which can be categorized as seasonal, perennial, vernal, or atopic.

Answer 86

The management of allergic conjunctivitis aims to alleviate symptoms and reduce exposure to allergens. Treatment approaches include: --> Allergen avoidance: Encourage patients to minimize exposure to known allergens. --> Basic eye care: - avoid rubbing eyes as this may cause mast cell degranulation - cool compresses --> Pharmacotherapy: - Topical antihistamines: e.g. olopatadine, ketotifen - Topical mast cell stabilizers: e.g. sodium cromoglicate, nedocromil - Topical corticosteroids: Reserved for severe cases and used under close supervision due to potential side effects --> Immunotherapy: Allergen-specific immunotherapy may be considered in cases of moderate to severe allergic conjunctivitis that are unresponsive to conventional treatment.

Answer 87

inflammation of the cornea

Answer 88

--> bacterial - typically Staphylococcus aureus - Pseudomonas aeruginosa is seen in contact lens wearers --> fungal --> amoebic - acanthamoebic keratitis accounts for around 5% of cases increased incidence if eye exposure to soil or contaminated water - pain is classically out of proportion to the findings --> parasitic: onchocercal keratitis ('river blindness') --> viral: herpes simplex keratitis environmental --> photokeratitis: e.g. welder's arc eye --> exposure keratitis --> contact lens acute red eye (CLARE)

Answer 89

--> red eye: pain and erythema --> photophobia --> foreign body, gritty sensation --> hypopyon may be seen - (white blood cells pool in the anterior chamber

Answer 90

- contact lens wearers assessing contact lens wearers who present with a painful red eye is difficult an accurate diagnosis can only usually be made with a slit-lamp, meaning same-day referral to an eye specialist is usually required to rule out microbial keratitis

Answer 91

stop using contact lens until the symptoms have fully resolved topical antibiotics typically quinolones are used first-line cycloplegic for pain relief e.g. cyclopentolate

Answer 92

corneal scarring perforation endophthalmitis visual loss

Answer 93

Herpes simplex virus (HSV)

Answer 94

Only the epithelial layer of the cornea

Answer 95

Inflammation between the epithelium and endothelium of the cornea

Answer 96

stromal necrosis, vascularisation and scarring and can lead to corneal blindness.

Answer 97

--> Herpes simplex keratitis most commonly presents with a dendritic corneal ulcer. --> Primary infection often involves mild symptoms of blepharoconjunctivitis (inflammation of the eyelid margins and conjunctiva). Recurrent infection may present with: Painful red eye Photophobia Vesicles (fluid-filled blisters) Foreign body sensation Watery discharge - epiphora Reduced visual acuity

Answer 98

Slit lamp examination is required to diagnose keratitis. Fluorescein staining shows a dendritic corneal ulcer. Dendritic describes the branching appearance of the ulcer. --> Corneal scrapings can be used for viral testing.

Answer 99

immediate referral to an ophthalmologist topical aciclovir

Answer 100

Inflammation of the anterior Uvea - Iris, ciliary body and choroid

Answer 101

--> Iris --> Cilliary body --> Choroid - layer between the retina and sclera

Answer 102

An autoimmune process usually causes it, but it can be due to infection, trauma, ischaemia or malignancy

Answer 103

--> Associated with HLA-B27 conditions --> ankylosing spondylitis --> reactive arthritis --> ulcerative colitis, Crohn's disease --> Behcet's disease --> sarcoidosis: bilateral disease may be seen

Answer 104

Anterior uveitis may present with symptoms of: --> Painful red eye (typically a dull, aching pain) --> Reduced visual acuity --> Photophobia (due to ciliary muscle spasm) --> Excessive lacrimation (tear production) Examination findings include: --> Ciliary flush (a ring of red spreading from the cornea outwards) --> Miosis (a constricted pupil due to sphincter muscle contraction) --> Abnormally shaped pupil due to posterior synechiae (adhesions) pulling the iris into abnormal shapes --> Hypopyon (inflammatory cells collected as a white fluid in the anterior chamber)

Answer 105

urgent review by ophthalmology cycloplegics (dilates the pupil which helps to relieve pain and photophobia) e.g. Atropine, cyclopentolate steroid eye drops

Answer 106

Cycloplegics dilate the pupil and reduce pain associated with ciliary spasm. Cycloplegic refers to paralysing the ciliary muscles. Cyclopentolate and atropine are antimuscarinic drugs that reduce the action of the iris sphincter muscles and ciliary muscles.

Answer 107

--> multiple sclerosis: the commonest associated disease --> diabetes --> syphilis

Answer 108

any condition that causes inflammation of the optic nerve

Answer 109

--> unilateral decrease in visual acuity over hours or days --> poor discrimination of colours, 'red desaturation' --> pain worse on eye movement --> relative afferent pupillary defect --> central scotoma

Answer 110

MRI of the brain and orbits with gadolinium contrast is diagnostic in most cases

Answer 111

high-dose steroids recovery usually takes 4-6 weeks

Answer 112

MRI: if > 3 white-matter lesions, 5-year risk of developing multiple sclerosis is c. 50%

Answer 113

--> Scleritis describes full-thickness inflammation of the sclera. --> It generally has a non-infective cause --> typically causes a red, painful eye.

Answer 114

--> rheumatoid arthritis: the most commonly associated condition --> systemic lupus erythematosus --> sarcoidosis --> Vasculitis - granulomatosis with polyangiitis

Answer 115

--> red eye --> classically painful (in comparison to episcleritis), but sometimes only mild pain/discomfort is present --> watering and photophobia are common --> gradual decrease in vision

Answer 116

--> same-day assessment by an ophthalmologist --> oral NSAIDs are typically used first-line --> oral glucocorticoids may be used for more severe presentations --> immunosuppressive drugs for resistant cases (and also to treat any underlying associated diseases)

Answer 117

Benign and self-limiting inflammation of the episclera, the outermost layer of the sclera, just below the conjunctiva.

Answer 118

It is often associated with inflammatory disorders, such as rheumatoid arthritis and inflammatory bowel disease. It is not usually caused by infection.

Answer 119

Episcleritis usually presents with acute-onset unilateral features: --> Localised or diffuse redness (often a patch of redness in the lateral sclera) --> No pain (or mild pain) --> Dilated episcleral vessels Importantly, there is no photophobia or discharge and normal visual acuity (these symptoms suggest scleritis). Applying phenylephrine eye drops helps differentiate between episcleritis and scleritis. It will cause blanching of the episcleral vessels, causing the redness to disappear. It will not affect scleral vessels and will not impact the redness in scleritis.

Answer 120

--> There is no photophobia or discharge and normal visual acuity (these symptoms suggest scleritis). --> Applying phenylephrine eye drops helps differentiate between episcleritis and scleritis. It will cause blanching of the episcleral vessels, causing the redness to disappear. It will not affect scleral vessels and will not impact the redness in scleritis.

Answer 121

Episcleritis is usually self-limiting and will resolve in 1-2 weeks. In mild cases, no treatment is necessary. Symptoms may be relieved with analgesia (e.g., ibuprofen) and lubricating eye drops. More severe cases may be treated with steroid eye drops.

Answer 122

Thyroid eye disease affects between 25-50% of patients with Graves' disease.

Answer 123

--> autoimmune response to TSH receptor --> retro-orbital inflammation --> results in glycosaminoglycan and collagen deposits in muscles

Answer 124

--> Smoking is the most important modifiable risk factor. --> Radioiodine treatment may increase inflammatory symptoms, with around 15% of Graves' disease patients developing or worsening eye disease. --> Prednisolone may help reduce the risk.

Answer 125

--> exophthalmos --> conjunctival oedema --> optic disc swelling --> ophthalmoplegia --> inability to close the eyelids may lead to sore, dry eyes. If severe and untreated patients can be at risk of exposure keratopathy

Answer 126

--> Smoking cessation --> Topical lubricants may be needed to help prevent corneal inflammation caused by exposure --> Steroids --> radiotherapy --> surgery

Answer 127

--> Exposure keratopathy - most common due to eyelid retraction and proptosis (exophthalmos) → cornea becomes excessively exposed, disrupting the normal tear film → dryness, irritation, and corneal ulceration symptoms include foreign body sensation, pain, and photophobia in severe cases, it can lead to corneal scarring and vision impairment. --> Optic neuropathy one of the most serious complications of thyroid eye disease occurs when enlarged extraocular muscles compress the optic nerve at the apex of the orbit → a reduction in visual acuity, colour vision deficits, and visual field defect it requires urgent medical intervention to prevent permanent vision loss. --> Strabismus and diplopia fibrosis and enlargement of the extraocular muscles can result in restrictive strabismus → misalignment of the eyes → double vision (diplopia)

opthalmology Flashcards

(152 cards)