Opthalmology Flashcards Preview

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Flashcards in Opthalmology Deck (94):
1

What is angle recession glaucoma?

Trauma or perforation of corneal ulcer causing pressure in anterior chamber to drop and the lens and iris to collapse forwards, obstructing the trabecular meshwork

2

What is pseudoexfoliation syndrome?

Type of glaucoma
White amyloid type protein deposits in the anterior chamber can block the trabecular meshwork

3

An 81 year old female presents with longstanding slowly deteriorating visual loss. She states that her central vision is often blocked and distorted. What is the likely diagnosis?

Age related macular degeneration

4

What is an amsler grid?

Grid on which the patient is asked to draw what they see
Used to detect distortions or scotomas in visual fields

5

What are different signs seen on a dilated eye exam in dry and wet age related macular degeneration?

Dry - drusen, small yellow deposits around the macula
Wet - retinal bleeding

6

What are ocular involvements of juvenile idiopathic arthritis?

Anterior uveitis which can lead to glaucoma, cataracts and permanent visual damage if untreated

7

What does a cherry red spot seen on ophthalmoscopy show?

Central retinal artery occlusion

8

What signs might be seen in central retinal artery occlusion?

Pale retina
Cherry red spot

9

What can be causes of central retinal artery occlusion?

Thromboembolism
Arteritis

10

How can giant cell arteritis lead to amaurosis fugax?

Occlusion of temporal artery will reduce blood flow in the retinal, ciliary and ophthalmic arteries leading to temporary monocular blindness
Granulomatous inflammation can also affect the central retinal artery and ciliary arteries themselves

11

How do you diagnose giant cell arteritis?

Temporal artery biopsy

12

What are symptoms of retinal detachment?

Like a curtain falling down over part of the visual field
Flashing lights
Floaters

13

How are different types of conjunctivitis treated?

Viral: no treatment
Bacterial: chloramphenicol drops
Allergic: sodium cromoglycate drops

14

What is used to treat dry eyes?

Hydroxyethylcellulose drops

15

What drugs can be used in the management of acute angle closure glaucoma?

Timolol: non selective beta blocker
Latanoprost: prostaglandin analogue, reduce intraoccular pressure by increasing outflow of aqueous fluid
Acetazolamide: carbonic anhydrase inhibitor
Pilocarpine: parasympathomimetic
Brimonidine: alpha adrenergic agonist, lower eye pressure

16

What is usher syndrome?

Autosomal recessive disorder
Presents with retinitis pigmentosa (night blindness and tunnel vision) and sensorineural hearing loss

17

What is retinitis pigmentosa?

Night blindness and tunnel vision

18

What eye signs and symptoms will a patient who is vitamin a deficient have?

Night blindness
Thin cornea
Corneal ulcers and perforations

19

What are the symptoms of acute angle closure glaucoma?

Acute onset of pain
Vomiting
Reduced vision
Halos around lights

20

What is cogans syndrome?

Keratitis that occurs in patients with takayasus arteritis
Decreased visual acuity and glare due to opacification of the cornea

21

What types of infection can cause a red eye? And what characteristics would you expect?

Bacterial: sticky discharge with pus, lids stuck together in morning
Viral: watery discharge with pain
Chlamydia: watery, sticky, pain

22

What could be causes of bacterial conjunctivitis?

Staph
Strep
Haemophilus

23

What can cause viral conjunctivitis?

Adenovirus
Para influenza

24

What symptoms would you expect with a viral conjunctivitis?

Runny nose
Cough
Cold
Sore eyes
Haemorrhages on tarsal conjunctiva
Pre auricula node

25

How do you treat a baby with chlamydia causing conjunctivitis?

Erythromycin

26

What symptoms would you expect with allergic conjunctivitis?

Itchy eye
Watery discharge
Clear sticky strings of mucus
Atopic patient

27

What is the treatment for allergic conjunctivitis?

Remove cause
Anti histamines
Mast cell stabilisers: sodium cromoglycate drops
Topical steroids: only if child with sight threatening disease

28

What signs and symptoms would you expect in a case of corneal abrasion?

Extreme pain
Photophobia
Mechanism of injury
History of foreign body in eye

29

What is the best way to inspect an eye with a corneal abrasion?

Local anaesthetic: benoxinate 1% to help patient open eye
Visual acuity test
2% fluorescein, shine blue light
Fluorescence seen where epithelium lost

30

How do you treat corneal abrasion?

If less than 1/3 cornea should heal overnight
Analgesic
Chloramphenicol eye drops
Pad if patient wants one
Council that it will be very painful, light and wind sensitive for a few days
Refer to ophthalmologist if caused by dirty object

31

What symptoms will a patient with corneal abrasion have?

Extreme pain
Photophobia
Watering
Reluctance to open eye

32

What often causes corneal foreign bodies?

Metal from power tools

33

What is required in a corneal foreign body to exclude perforation into eye?

X-ray

34

What symptoms will a patient with a corneal foreign body have?

Scratching sensation
Photophobia
Watering

35

How do you treat a sub tarsal foreign body?

anaesthetise the eye with benoxinate
Wipe tarsal plate with cotton bud

36

What is acanthamoeba?

Corneal opacity seen in contact lens wearers that have been worn overnight or washed in tap water

37

What is blepharitis?

Staph overgrowth at base of eyelashes - dandruff, tear dysfunction

38

How do you treat blepharitis?

Lash toilette: hot flannel, clean eyelash bases with cotton bud and sodium bicarbonate
Azithromycin

39

What is a meibomium cyst?

Otherwise known as chalazion
Blockage of oily tear gland of lid Fluctuating for long periods
Grows to pea size
Usually resolves spontaneously

40

What signs and symptoms would you expect with a sub conjunctival haemorrhage?

Can't see definition of blood vessels
Painless
Can occur spontaneously

41

How long will a sub conjunctival haemorrhage take to resolve?

7-14 days

42

What are differentials for a red eye with visual loss?

Trauma
Infection: peri orbital cellulitis, infected ulcer, endophthalmitis
Uveitis
Acute glaucoma

43

What signs and symptoms do you get with a perforating injury to the eye?

Loss of vision
Loss of round contour of pupil
Loss of aqueous humour

44

What do you do urgently with an infected corneal ulcer?

Ophthalmology referral
Corneal scrape for MC and S
Start broad spec antibiotics: alternate hourly drops of gent and cefuroxime

45

What is often the source of an orbital cellulitis?

Sinus infection

46

What are signs and symptoms of orbital cellulitis?

Tight red lids
Red conjunctiva
Loss of eye movements
Blurring of vision

47

What is a traumatic hyphaema?

Anterior chamber fills with blood after internal bleed
Pressure rises occur which can be sight threatening

48

What symptoms and signs would you expect with uveitis?

Aching red eye
Blurred vision
Limbal injection
Pupil may be distorted
White spots
Hypopion (leukocyte exudate)

49

How do you treat uveitis?

Topical steroids

50

What symptoms and signs will a patient with acute angle closure glaucoma have?

Halos around lights
Severe pain
Reduced visual acuity
Nausea and vomiting

51

What are clinical signs of acute angle closure glaucoma?

Corneal oedema
Redness
Fixed semi dilated pupil
Tender to touch
Markedly raised intra occular pressure

52

How do you treat acute angle closure glaucoma?

Topical drops and acetazolamide orally
Refer to ophthalmologist immediately

53

When does development of the visual system start?

4 weeks gestation

54

Where do the eyes develop from?

Buds of the forebrain called optic vesicles
Mesoderm of head forms lens
Neural tube forms retina
Surface ectoderm forms corneoscleral and uveal tunics

55

What bones make up the orbit?

Frontal
Sphenoid
Zygomatic
Ethmoid
Lacrimal
Palatine
Maxilla

56

What is the role of the orbit?

Contains lacrimal gland and nasolacrimal ducts for tear production and drainage
Provides fatty bed for eye movement
Thin walls medially and inferiorly
Conducts cranial nerves II, III, IV and VI

57

What is proptosis?

Axial: eye pushed forward along visual axis, space occupying lesion in cone
Non-axial: eye pushed down up or sideways, space occupying lesion outside the cone
Exophthalmos: proptosis due to thyroid eye disease - muscle enlargement

58

What is an orbital blow out fracture?

Orbital floor gives way
Ocular connective tissue may become trapped which restricts movement
Infra-orbital nerve affected, causes numbness on check and upper teeth

59

What are the physiological roles of the eyelids?

Close to protect the cornea
Posteriorly - conjunctiva with lymphoid follicles and goblet cells
Blinking moves tears across eye
Pumps and directs tears down canaliculae into tear duct

60

What happens in a meibomium gland gets blocked?

Chalazion

61

Describe the path that tears take from the eye into the nose

Into ampulla, then canaliculus, then lacrimal sac, then nasolacrimal duct, then valve of Hasner

62

What are functions of tears?

Clean eye
Smooth refractive surface

63

What are the 3 layers to the tear film?

Aqueous
Mucus
Aqueous

64

What happens if you get an imbalance in the 3 layers of tears?

Dry eyes

65

What happens if you get a blocked tear duct or lid malposition?

Overflow of tears - epiphora

66

What is the conjunctiva? What type of cells is it made from and what do they do?

Mucus membrane that covers the front of the globe (bulbar) and back of eyelids (palpebral)
Contains goblet cells which produce basal tear secretion

67

When does the lacrimal gland mainly contribute to tear production?

When there is irritation

68

What is Stevens Johnson syndrome? What relevance does it have to the eye?

Toxic epidermal necrolysis
Epidermis separates from dermis
Hypersensitivity complex affecting skin and mucous membranes
Conjunctivitis occurs in about 30%

69

What is the cornea?

Transparent
Avascular
Main optical surface of the eye
Forms anterior 1/6 of outer fibrous coat of eyeball

70

Where are the stem cells which grow new corneal epithelial cells?

Limbus - corneoscleral junction

71

What are the layers of the cornea?

Epithelial cells
Bowmans membrane
Stroma
Descemets membrane
Endothelial cells

72

What does the cornea do? How does it stay clear?

Refracts light entering the eye
Has rapid turnover of surface cells from stem cells
Contains active pump mechanism
Rich sensory supply of nerves

73

What does a failure of the endothelial pump in the cornea result in?

Oedematous cornea and loss of clarity

74

When might the endothelial pump of the cornea not be able to work?

High pressure inside eye - acute glaucoma, so cloudy cornea

75

Why can a cornea be transplanted without systemic immunosuppressants?

Avascular structure

76

What is aqueous humour?

Produced by ciliary body
Maintains pressure needed to inflate the eye
Provides nutrition for central cornea and lens
Leaves eye through trabecular meshwork and schlems canal

77

What is the clinical relevance of the corneoscleral junction?

Weak area may rupture with blunt trauma
Highly vascular area where anterior ciliary vessels enter eye

78

What happens to the lens of the eye over time?

Grow throughout life and so become more densely packed, this stiffens the lens leading to loss of accommodation - presbyopia
Densely packed cells become opaque - cataract
Enlargement of lens changes refraction and pushes iris forward which closes angle

79

What is vitreous?

Clear gel structure similar to egg white
Attached to parts of the retina and optic nerve
Provides scaffold in developing eye for blood vessels

80

What happens to vitreous over time?

Degenerates and collapses with age
Leads to traction and may pull hole in the retina
Bits break off - floaters

81

What makes up the fundus of the eye?

Retina
Optic nerve
Vascular arcades
Macular and fovea

82

What is choroid?

Part of uvea
Most vascular rich tissue of body, provides blood supply to outer retina
regulates retinal heat
Pigment absorbs excess light so decreasing reflection

83

What features might you look for in an eye with papilloedema?

Blurred margins of disc
Veins engorged and tortuous
Disc swollen/ raised
Congested pink disc

84

What is the macula?

Area between the two temporal arcades
Fovea is small central area of macula containing high density of cones
Fine detailed vision

85

What can cause central retinal artery occlusion?

Embolism: carotid artery stenosis, AF
Temporal arteritis
Vasculitis: polyarteritis nodosa
Atherosclerosis: diabetes, HTN

86

What are some causes of optic atrophy?

Multiple sclerosis
Friedreichs ataxia
Glaucoma
Pituitary tumour

87

What would be symptoms of retrobulbar neuritis?

Blurred or dimmed vision
Pain with eye movement
Bind spot near centre of vision
Colour wash out
Tenderness of eye to touch or pressure
Complete blindness in eye

88

What are cotton wool spots?

Retinal nerve fibre layer infarcts representing ischaemia
Ischaemic retina releases vasoactive substances that stimulate new vessel formation - pre proliferative

89

A 27 year old man is referred for a two week Hx of painful dry eyes. He complains of a feeling of grittiness in his eyes which is worse in a dry cold environment. Over the counter drops are currently providing symptomatic relief. Visual acuity is 6/6 in right eye and 6/9 in left. On examination you notice redness and crusting around the superior palpebrae. What is the likely diagnosis?

Blepharitis

90

What is the management for blepharitis?

Lid hygiene therapy
If severe, topical antibiotics - chloramphenicol

91

How does chloramphenicol work?

Bacteriostatic drug: inhibits proliferation of bacteria by inhibiting protein synthesis

92

What is a rare but serious side effect of chloramphenicol?

Aplastic anaemia

93

A 40 year old male attends a medical insurance health check. On examination of his fundus, the disc is pale and there is cupping of the discs and nasalisation of the vessels. What is the likely diagnosis?

Chronic open angle glaucoma

94

What are the stages of hypertensive retinopathy?

Grade 1: tortuosity, silver wiring of arteries
Grade 2: AV nipping
Grade 3: flame haemorrhages and cotton wool spots
Grade 4: papilloedema