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opthalmology Flashcards

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1
Q

types of conjunctivitis

A

infective (bacterial and viral) And allergic

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2
Q

presentation of allergic conjunctivitis vs infective

A

allergic is bilateral from the start, seasonal, history of atopy, swollen eyelids sometimes, itchy, — infective has more sticky discharge and other stuff

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3
Q

bacterial conjunctivitis presentation

A

purulent sticky discharge
eyes stuck together in morning

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4
Q

viral conjunctivitis presentation

A

serous discharge, pain, preauricular lymph nodes, recent URTI,

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5
Q

management of conjunctivitis

A

usually settles without treatment but topical antibiotics commonly prescribed - chloramphenicol - fusidic acid if pregnant

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6
Q

something to do for contact lens users with conjunctivitis

A

use topical fluoresceins to identify corneal stain

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7
Q

optic neuritis top causes

A

MS, diabetes, syphilis

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8
Q

features of optic neuritis

A

unilateral decrease in visual acuity– fast progression: over hours/. days
and bad colour differentiation,
central scotoma,
increased pain on movement,
and RELATIVE afferent pupillary defect

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9
Q

diagnostic investigations of optic neuritis

A

MRI of brain and orbits -

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10
Q

when is there a 50% 5 year predicted risk of developing MS?

A

when they have optic neuritis with more than 3 white matter lesions seen on MRI

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11
Q

scleritis pathophysiology

A

inflammatory condition - non infective- all layer inflammation of sclera

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12
Q

anatomically what is sclera and what is episclera

A

sclera is all outer layers of eyeball from episclera to epithelium so scleritis more erious and deep than episcleritis

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13
Q

scleritis associated conditions

A

RA and SLE

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14
Q

Features of scleritis

A

red eye, pain, photophobia + watery, gradual decrease in vision

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15
Q

management of scleritis

A

urgent same day rederral to ophthalmologist, usually oral NSAiDS first lne and glucocorticoids if severe
immunosupression if really severe

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16
Q

episcleritis pathophysio and causes/ associated conditions

A

idiopathic and inflammation of episclera - sometimes associaeted with IBS and RA

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17
Q

features of episcleritis

A

red eye, less pain, vessels can be moved with mild pressure vs not in scleritis, no decrease in visual acuity, 50% is bilateral

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18
Q

what eye drop canhelo distinguish episcleritis from scleritis

A

phenylephrine drops

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19
Q

management of episcleritis

A

conservative– maybe aritificial tears

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20
Q

anterior uveitis presentation

A

constricted pupil!! Acute onset: pain, reduced visual acuity progressively worse, red, lacrimation, ciliary flush (red from in out), hypopyon, (pyon below surface and you can tell) ,

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21
Q

anterior uveitis associated conditions

A

ankylosing spondylitis !! think anterior uveitis only eye condition starting with a so Ankylosing spond

reactive arthritis
UC, Crohn’s
sarcoid

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22
Q

management of anterior uveitis

A

urgent ophthalmology referral, cycloplegics, steroid eye drops

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23
Q

with what antigen on white blood cell walls is anterior uveitis associated with?

24
Q

conditions associated with HLA-B27

Study These Flashcards
A

seronegative spondyloarthrites, meaning spondyloarthritic conditions that do not have rheumatoid factor: AS, reactive arthritis (RA, previously referred to as Reiter syndrome), Behçet’s disease, inflammatory bowel disease (IBD), and psoriatic arthritis (PA).

25
visual field defect types
1) homonymous hemianopia 2) homonymous quandrantanopia 3) bitemporal hemianopia
26
3 connections of nerves in visual pathway
1) optic nerve ending in eye, 2) optic tract (optic chiasm happens at that stage) 3) optic radiation
27
what lesions lead to a right homonymous heamianopia
left optic tract lesion, left optic radiation lesion or occipital cortex with macular sparring: left occipital cortex
28
what lesions lead to a right upper homonymous quadrantanopia
left temporal -lower tract lesion
29
what lesions lead to right lower homonymous quadrantanopia
left parietal- upper tract lesions
30
bitemporal hemianopia lesion and upper lower predominance
lesion on optic chiasm if impairment worse in UPPER fields then LOWER lesion so pituitary vs if LOWER fields impaired UPPER problem so craniopharyngioma
31
thyroid eye disease pathophysiology
auto antibodies possibly to TSH receptors deposit on eye muscles at the back of the orbit
32
thyroid eye disease features and situation of thyroid disease at presentation
exophthalmos dry eyes due to inability to close eyes ophthalmoplegia (paralysis of eye muscles) conjunctival oedema optic disc swelling thyroid disease situation irrelevant, may be eu- hypo or hyperthyroid
33
which thyroid condition is eye disease linked with (25-50% of people with this disease get the eye disease)
graves thyroiditis
34
main risk factor of thyroid eye disease and another one
smoking radioiodine treatment of graves
35
management of thyroid eye disease
smoking cessation steroids topical lubricants may be needed to help prevent corneal inflammation caused by exposure surgery radiotherapy
36
complications of thyroid eye disease
exposure keratopathy optic neuropathy strabismus and diplopia
37
Monitoring patients with established thyroid eye disease - red flags to safety net for and look out
unexplained deterioration in vision awareness of change in intensity or quality of colour vision in one or both eyes history of eye suddenly 'popping out' (globe subluxation) obvious corneal opacity cornea still visible when the eyelids are closed disc swelling
38
most common form of diabetic eye disease and second and third commonest
diabetic retinopathy diabetic maculopathy diabetic cataract
39
pathophysiology of diabetic retinopathy
a) hyperglycaemia leads to endothelial and pericyte damage 1) ENDOthelial damage means more permeable endothelium hence exudates 2) pericytes are cells around cappilaries in eye so damage leads to aneurisms b) neovascularisation due to growth factor release because of ischaemia
40
non proliferative diabetic retinopathy classifications and features
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
41
proliferative diabetic retinopathy
retinal neovascularisation - may lead to vitrous haemorrhage fibrous tissue forming anterior to retinal disc more common in Type I DM, 50% blind in 5 years
42
maculopathy features
Key features 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
43
management of diabetic eye disease
All patients optimise glycaemic control, blood pressure and hyperlipidemia regular review by ophthalmology
44
maculopathy management in case of change in case of change in visual acuity?
ntravitreal vascular endothelial growth factor (VEGF) inhibitors
45
Non-proliferative retinopathy managemnt
regular observation if severe/very severe consider panretinal laser photocoagulation
46
Proliferative retinopathy management
1) panretinal laser photocoagulation following treatment around 50% of patients develop a noticeable reduction in their visual fields due to the scarring of peripheral retinal tissue a decrease in night vision 2) intravitreal VEGF inhibitors often now used in combination with panretinal laser photocoagulation examples include ranibizumab 3) if severe or vitreous haemorrhage: vitreoretinal surgery
47
orbital cellulitis pathology
infection affecting the fat and muscles posterior to the orbital septum, within the orbit but not involving the globe.
48
orbital cellulitis common cause / history
previous URTI
49
PRE ORBITAL cellulitis pathology and relation to orbital
Periorbital (preseptal) cellulitis is a less serious superficial infection anterior to the orbital septum, resulting from a superficial tissue injury (chalazion, insect bite etc...). Periorbital cellulitis can progress to orbital cellulitis.
50
orbital cellulitis risk factors
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
51
features orbital cellulitis
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)
52
differences bwtween orbital and periorbital
reduced visual acuity, proptosis, ophthalmoplegia/pain with eye movements are NOT consistent with preseptal cellulitis
53
diagnostics of orbital cellulitis
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.
54
management of orbital cellulitis
admission to hospital for IV antibiotics
55

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