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Opthalmology Flashcards

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1
Q

Strabismus

A

Children don’t grow out of squints

Intraocular pathology must be excluded

Amblyopic requires early treatment

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2
Q

Irritable eyes DDx

A

Dry eyes - use tear supplements

Blepharitis - check lid hygiene, remove crusting

Chronic allergy - avoid steroids

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3
Q

Unilateral red eye DDx

A

Foreign body

Trauma

Corneal ulcer

Iritis

Acute glaucoma

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4
Q

Eyelid ulcer

A

May be BCC

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5
Q

Conjunctivitis

A

Almost always bilateral

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6
Q

Corneal abrasion

Treatment

A

Antibiotic ointment

Review daily

Should heal in 24hrs

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7
Q

Herpes simplex

A

May be painless

History of recurrence and scarring Involvement of the tip of the nose = involvement of the eye

Use antivirals only - never use steroids

Refer to ophthal

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8
Q

Warning symptoms of retinal detachment

A

Floaters

Flashes

Field defects

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9
Q

Steroid

Complications

A

Corneal perforation with herpes simplex

Open angle glaucoma

Cataract formation

Fungal infection

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10
Q

Foreign Body removal

A

Don’t remove foreign bodies that are deep central corneal, intra-ocular or intra-orbital - Refer

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11
Q

Sudden loss of vision

DDx

A

Elderly - temporal arteritis

Optic nerve ischaemia - afferent pupil defect, start high-dose oral steroids

Retinal artery or vein occlusion

Macular haemorrhage

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12
Q

Papilloedema

Signs/symptoms

A

Blurred optic disc margins

Good vision

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13
Q

Optic neuritis

Signs/symptoms

A

Blurred optic disc margins

Reduced vision

Afferent pupil defect

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14
Q

Transient blindness

DDx

A

Carotid artery disease

Migraine aura

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15
Q

Afferent pupil defect

A

Retinal artery occlusion

Optic nerve lesion

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16
Q

Chronic open-angle glaucoma

A

No early signs or symptoms - requires routine screening in adults >40

Familial

Elevated IOP causes optic disc cupping and visual field loss

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17
Q

Acute angle closure glaucoma

A

Rare in those <60 Symptoms - pain, haloes, blurred vision

Signs - shallow anterior chamber, redeye, fixed mid-dilated oval pupil

Treatment - pilocarpine drops, then YAG laser

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18
Q

Admission to hospital

A

Hypaema

Hypopyon

Penetrative eye injuries

Severe chemical burns

Acute glaucoma

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19
Q

Tear drop sign

A

Penetrating eye injury

Due to distortion of the pupil due to a perforated cornea

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20
Q

Entropion

A

The whole eyelid is inverted

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21
Q

Trichiasis

A

One or two aberrant eyelashes are turned in

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22
Q

Viral conjunctivitis

A

Unilateral redness and watering in one eye spreading to the other eye

History of viral illness or contact with red eye

Commonest cause - adenovirus

No loss of vision

Preauricular lymphadenopathy

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23
Q

Viral conjunctivitis Treatment

A

Self-limiting

Cold compress and tear supplements

Resolves in 2-3 weeks

Contagious for first 2 weeks

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24
Q

Bacterial conjunctivitis

A

Purulent discharge

Eyelashes firmly stuck together in the morning

Blurring of vision clears with blinking

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25
Bacterial conjunctivitis Treatment
Topic chloramphenicol or fucidic acid drops
26
Allergic conjunctivitis
Often associated with nasal symptoms Acute but transient bouts of sneezing, itching eyes and redness Seasonal or perennial
27
Allergic conjunctivitis Treatment
Topical mast cell stabilisers e.g. olopatadine drops
28
Blepharitis
Inflammation of the eyelid margin Common Usually symmetrical and bilateral Main symptom is burning and grittiness No discharge Chronic condition Associated with seborrhoeic dermatitis and rosacea
29
Blepharitis Management
Lid hygiene - hot compress, washing away crusting Topical lubricants Oral tetracycline for 2-3 months in severe cases
30
Subconjunctival Haemorrhage
Spontaneous Painless Normal vision May be associated with HTN or heavy bouts of coughing or straining
31
Suconjunctival haemorrhage Treatment
Self limiting within 2-3 weeks
32
Pterygium
Benign fibrovascular growth from the conjunctiva Usually medial and can extend onto the cornea Increased sun exposure is a risk factor Leave alone unless encroaching onto the visual pathway
33
Corneal abrasion Management
Chloramphenicol eye ointment Review daily until healed Oral analgesia - DO NOT USE TOPICAL ANAESTHETICS FOR PAIN RELIEF
34
Arc eye (Welder's flash)
Photokeratitis - sunburn of the cornea Pain like "sand poured into eye" Photophobia Tears ++ Constricted pupil
35
Corneal ulcer
Bulbar conjunctiva would be involved but not eh palpebral conjunctiva Contact lenses - bacterial keratitis leading to corneal ulceration. Always stain the cornea with fluorescein and stop contact lens use until eye condition has fully resolved Treated with intensive topical antibiotics
36
Herpes simplex
Dendritic ulcer of the cornea Recurrent infection is common Frequently have history of oral infections with the virus Always stain the eye with fluorescein Treated with topical antivirals by ophthalmologist - DO NOT PRESCRIBE STEROID DROPS
37
Iritis
Painful eye with mild photophobia Unilateral red eye with circumciliary injection (limbal flush) Possibly reduced visual acuity Half of cases are idiopathic (?autoimmune) - 50% of patients are HLA-B27 positive Investigate recurrent episodes Iris can adhere to the anterior surface of the lens giving an irregular shaped pupil Keratic precipitates seen on slit lamp
38
Iritis Treatment
Topical steroid drops Topical cyclopentolate drops to dilate pupil and break down posterior synechiae, also helps relieve the pain
39
Episcleritis
Affect young adults Moderate ache Milder symptoms than those experienced by patients with iritis Conjunctival inflammation is usually localised to one sector
40
Episcleritis Treatment
Benign, self-limiting Resolves in 2 weeks
41
Herpes zoster ophthalmicus (HZO)
Ophthalmic division of trigeminal nerve Can cause uveitis, keratitis, conjunctivitis Hutchinson's sign - if zoster involves the tip of the nose it is likely that the infection will involve the eye
42
HZO Treatment
Oral and topical antivirals
43
Acute angle closure glaucoma
MEDICAL EMERGENCY Acute onset of pain due to high IOP Redness Mid-dilated, fixed pupil Visual loss Slightly cloudy cornea Abdominal pain and vomiting
44
Acute angle closure glaucoma Risk factors
Age \>40-50 F\>M FHx PHx in the other eye Hypermetropia or long-sightedness
45
Acute angle closure glaucoma Mechanism
Shallow anterior chamber Thickening of lens with age Pupil dilatation
46
Acute angle closure glaucoma Treatment
IV acetazolamide - reduce aqueous secretion Pilocarpine drops - pupillary constriction Surgical or laser iridotomy
47
Sty
Common Small abscess forms at the base of an eyelash Usually due to Staph. Aureus No treatment - hot compress, pull out eyelash on that spot
48
Preseptal Cellulitis
Infection of subcutaneous tissues Unilateral Tender to touch Normal vision and no pain on eye movements Often seen on insect bites Treat with oral antibiotics
49
Orbital Cellulitis
Superficial tissues around the eye and the deeper orbital contents Painful and restricted eye movements Proptosis Abnormal vision Systemically unwell Sinusitis most likely cause Potentially fatal as infection can track into the cranial cavity
50
Hyphaema
Due to injury Needs urgent referral
51
Amblyopia
Decrease in vision with no structural pathology Caused by a failure of visual pathway maturation during childhood Causes include stimulus deprivation, uncorrected refractive error, uncorrected strabismus
52
Strabismus
Squint aka crossed eyes Look for symmetry of the corneal light reflex
53
Cataract
Gradual worsening blurred vision, despite good Snellen acuity. Glare from ongoing headlights at night Defect in the red reflex Lens opacity
54
Cataract Causes
Old age Congenital Metabolic e.g. diabetes Infective, e.g. rubella Physical, e.g. trauma, radiotherapy, UV exposure Drugs, e.g. steroids
55
Glaucoma Management
PG analogues (e.g. latanoprost) Beta-blockers (e.g. timolol) Oral acetazolamide Laser and surgery
56
ARMD
Commonest cause of irreversible visual loss in \>60 Progressive steady decline in central vision Difficulty in reading Distortion of straight lines Bilateral but may be asymmetrical
57
ARMD Management
Modification of risk factors Magnifying aids may help with reading Good lighting (esp. natural light) helps with vision Wet (abnormal new vessels grow and leak) - anti-VEGF intravitreal inections
58
ARMD Risk factors
Old age Smoking FHx Poor diet
59
Diabetic retinopathy
Microvascular occlusion and leakage Commonest cause of blindness ages 20-65 2 types - non-proliferative and proliferative Reduced vision only occurs in advanced disease and may be irreversible
60
Diabetic retinopathy Treatment
Monitor Laser photocoagulation
61
Central retinal artery occlusion (CRVO)
Sudden unilateral loss of vision Reduced visual acuity in that eye Diffuse pallor of the retina due to retinal ischaemia Due to an embolus Cherry red spot
62
Retinal detachment
Unilateral loss of vision Flashing lights and floaters preceding with a shadow coming across the eye Detachment of the inner sensory retina from the pigmented epithelium of the retina Most common cause is due to posterior vitreous detachment or ocular trauma More common in short-sighted people
63
Temporal arteritis Treatment
High dose IV steroids
64
Optic Neuritis
Idiopathic or associated with MS Initially fundoscopy is normal, after a few weeks pale disc due to optic nerve inflammation Enlarged blind spot Slight vision loss with ache in eye, impaired colour vision
65
Amaurosis Fugax
Transient and painless loss of vision in one eye - "curtain passing across the eye" Rapid onset lasting for seconds or minutes Indicates of transient retinal ischaemia Risk for CRAO, stroke Usually associated with stenosis of the ipsilateral carotid artery Systemic workup needed including carotid dopplers, echo, chol/trig levels, BP monitoring
66
Unilateral red eye
FUGIT Foreign body Ulcer Glaucoma Iritis/uveitis Trauma
67
Chemical injuries Management
15-20mins of constant irrigation with saline
68
Herpes simplex
69
Hyphaema
70
Iritis
71
Subconjunctival haemorrhage

General Practice (9 decks)

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