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Opthalmology Flashcards

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1
Q

What is angle recession glaucoma?

A

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

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2
Q

What is pseudoexfoliation syndrome?

A

Type of glaucoma

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

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3
Q

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?

A

Age related macular degeneration

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4
Q

What is an amsler grid?

A

Grid on which the patient is asked to draw what they see

Used to detect distortions or scotomas in visual fields

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5
Q

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

A

Dry - drusen, small yellow deposits around the macula

Wet - retinal bleeding

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6
Q

What are ocular involvements of juvenile idiopathic arthritis?

A

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

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7
Q

What does a cherry red spot seen on ophthalmoscopy show?

A

Central retinal artery occlusion

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8
Q

What signs might be seen in central retinal artery occlusion?

A

Pale retina

Cherry red spot

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9
Q

What can be causes of central retinal artery occlusion?

A

Thromboembolism

Arteritis

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10
Q

How can giant cell arteritis lead to amaurosis fugax?

A

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

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11
Q

How do you diagnose giant cell arteritis?

A

Temporal artery biopsy

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12
Q

What are symptoms of retinal detachment?

A

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

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13
Q

How are different types of conjunctivitis treated?

A

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

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14
Q

What is used to treat dry eyes?

A

Hydroxyethylcellulose drops

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15
Q

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

A

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

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16
Q

What is usher syndrome?

A

Autosomal recessive disorder

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

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17
Q

What is retinitis pigmentosa?

A

Night blindness and tunnel vision

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18
Q

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

A

Night blindness
Thin cornea
Corneal ulcers and perforations

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19
Q

What are the symptoms of acute angle closure glaucoma?

A

Acute onset of pain
Vomiting
Reduced vision
Halos around lights

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20
Q

What is cogans syndrome?

A

Keratitis that occurs in patients with takayasus arteritis

Decreased visual acuity and glare due to opacification of the cornea

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21
Q

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

A

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

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22
Q

What could be causes of bacterial conjunctivitis?

A

Staph
Strep
Haemophilus

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23
Q

What can cause viral conjunctivitis?

A

Adenovirus

Para influenza

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24
Q

What symptoms would you expect with a viral conjunctivitis?

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

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