opthalmology Flashcards Preview

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Flashcards in opthalmology Deck (43):
1

What is acute angle-closure glaucoma?

symptoms? 6

who's most at risk? 3

blockage of aqueous humour drainage -> fast rise in intraoccular pressure
- refer immeadiately to opthalmologist (risk of loosing sight)

- intense eye pain/headache
- red eye
- tenderness around eye
- nausea/vomitting
- blurred vision
- seeing hallows or 'rainbow-like' rings around lights

- increased age
- african/asian ethnicity
- family history of glaucoma

nb other stuff can cause like various eye conditions/congenital variations and prolonged steroid eye dropgs for eg

2

penetrating/perforating eye injury

refer to opthalmologist asap if projectile doesn't wash out or injury is more than superficial
*******

3

orbital cellulitis:
- what is it?
- cause?
- symptoms/signs? 4
- treatment? 1

inflammation of eye tissues behind the orbital septum*

infection (norm bacterial) spread from:
- paranasal sinuses
- upper resp infection
(- recent trauma)
(- systemic infection)

- proptosis
- swelling/redness
- pain with eye movements
- opthalmoplegia
(- fever)

IV Abx in hosp asap!

4

giant cell arteritis:
- risk factors? 2
- symptoms? 4
- treatment?

aka temporal arteritis

- elderly (>55)
- PMH of polymyalgia rheumatica (50%)

- headache (sub-acute)
- temporal artery + scalp tenderness (eg when combing hair)
- jaw claudication
- amaurosis fugax (painless temporary loss of vision in one/sometimes both eyes)

oral steroids (prednisalone) immediately!

5

chemical eye injuries:
- two broad types?
- treatment? 4

- acid
- alkali

- irrigation (with water) to restore norm pH

- Abx (to prevent superinfection)
- steroid eye drops (reduce inflammation)
- artificial tears


6

painful occulomotor (CN3) nerve palsy:
- symptoms/signs? 3
- most serious cause (be specific!)?

- diplopia (dt 'down + out' gaze)
- ptosis (drooped eyelid)
- mydriasis (pupil dilation)

aneurysm in contralateral posterior communicating artery

nb many other acquired causes of third nerve palsy but few (bar above) also cause pain

nb can also get congenital third nerve palsy, which is often mild

7

horners syndrome:
- signs? 3
- most serious cause of painful horner's syndrome?

- ptosis (droop eyelid)
- miosis (constricted pupil)
- anhidrosis

- carotid artery disection (/anyeurysm)

8

conjunctivitis:
- groups of causes? 3
- risk factors for each cause?

infective conjunctivitis:
- old or young
- recently had a URTI
- have diabetes
- on corticosteroids

allergic conjunctivitis:
- ie hayfever, people w atopic triad etc

irritant conjunctivitis:
- cholinated swimming pool water
- shampoo
- stray eyelash
- smoke or fumes

9

conjunctivitis:
- 2 main symptoms?
- other symptoms in infective conjunctivits? 4
- other symptom in allegic conjunctivitis? 1

- eye redness
- a discharge (pussy if bacterial, less so if viral)

infective:
- burning sensation in eyes
- feeling of grit in eyes
- sticky coating on eyelashes
- enlarged lymph node in front of ear

allergic:
- itchy eyes

nb only one eye tends to be affected at first, though often spreads to other eye within a few hours

10

corneal ulcer:
- what is it?
- most common cause?
- who especially at risk?

localised infection of the cornea

bacterial infection, secondary to injury/trauma
- nb can be fungal in immunocompromised

contact lense wearers
- use good hygiene

treated w topical Abx (with or without culture)

11

Uvetis:
- what is it?
- symptoms?
- commonest cause?
- treatment?

Inflammation of middle layer of the eye (uvea)

- eye pain (dull ache)
- eye redness
- photophobia
- blurred/cloudy vision
- floaters

Basically any underlying autoimmune condition (ank spond, RA, MS, sarcoidosis, psoriasis, IBD)

Steroids (eye drops +/or oral)

12

Episcleritis:
- what is it?
- symptoms?
- cause?
- condition sometimes associated with?
- management?

Benign, self-limiting inflammatory disease of the episclera (connective tissue between conjunctiva + sclera)

- red eye
- mild eye ache
- eye tender to touch

Idiopathic

Occasionally associate with RA but not often

- analgesia (NSAIDs)
- artificial tears

Self limiting

13

Corneal abrasions:
- cause?
- symptoms? 4
- treatment?

Any sort of trauma, however minor, can be sand etc getting into eye

- feel like got sand/grit in eye
- pain
- blurred vision
- photophobia

(eye can go red)

Don't rub eye!
- wash out with sterile fluid

Tend to heal on own if shallow, may need antibiotic +/or steroid eye drops if deep!

14

posterior vitreous detachment:
- what is it?
- who does it occur in? how common?
- symptoms?

pulling away of the edge of the vitreous from the retina

75% of people over 65 will get it!! very common!!

- floaters (can be large)
- flashes of light
- blurry vision

nb not painful

nb should get checked out as retinal detachment can present like this too!

no treatment! (vitrectomy or laser can be used but not on NHS if just for PVD)

15

vitreous haemorrhage:
- what is it?
- 3 most common causes?
- symptoms?

when blood leaks into the vitreous humour

- bleeding from diabetic eye disease
- bleeding from vitreous detachment +/- retinal tears/detachment
- trauma to the eye (commonest cause in young people)

nb mostly older people

- floaters +/or cobwebs
- blurry vision/shadows/dark spots
- may be a red tint to vision
- if big bleed may have total loss of vision

normally monocular

nb not generally painful

16

amaurosis fugax
- aka?
- what is it?
- symptoms?

transient monocular blindness

basically a TIA to the retinal artery
- often thrombotic cause but can be embolic

- painless monocular loss of vision - no VPL (curtain coming down over eye)

often brief but may be prolonged, return or can be permanent

often a warning sign for a stroke

17

Age-related macular degeneration (ARMD):
- pathogenesis?
- symptoms?
- management?

dry AMD:
- degenerative damage to RPE and Bruch's membrane and build up of drusen
- gradual vision loss
- 1 in 10 go on to develop wet AMD

Wet AMD:
- damage to macular triggers neovascularisation -> bleeds and acute damage to retina
- can progress very quickly

- blurring of central vision (not corrected w glasses)
- loose contrast sensitivity (red is duller etc)
- images become distorted in centre (more common in wet)
- blind spots or hallucinations (wet)

- peripheral vision not affected
- not painful
- tends to be bilateral (though may start unilateral)

- stop smoking
- leafy greens/vits A, C + E
- anti-VGEF injections (wet only)

18

optic neuritis:
- what is it?
- symptoms?
- conditions associated with?
- typical patient?
- treatment?

inflammation of optic nerve

MONOcular:
- pain (worsened by eye movement)
- visual loss
- visual field loss
- loss of colour vision (red less vibrant)
(- flashing lights, with eye movement)

- MS (50% will have or go on to have)
- some infections (bacterial or viral)
- other autoimmune (sarcoidosis, lupus)
- some drugs (quinine and some Abx)

- caucasian female aged 20-40

- steroids

19

refractive error, for hypermetropia + myopia:
- where see clearest?
- where light focused?
- who's at risk?
- type of glasses needed? (incl+/-)

- symptoms of both? 4

hypermetropia:
- aka long-sighted
- see best far away
- light focused behind retina
- as people age (less able to accommodate)
- convex lenses (reading glasses) (+ is long)

myopia:
- aka short-sighted
- see best close up
- light focused infront of retina
- often FH, large eye, eg in marfans
- concave lenses (- is short)

- headaches
- eye strain
- squinting
- blurry vision

20

cataracts:
- what is it?
- risk factors? 7
- symptoms? 4
- treatment?

clouding of the natural lense

- age
- FH

- eye injury
- long term steroid use

- diabetes
- smoking
- alcohol

nb can get congenital cataracts, either on their own or as part of a syndrome (eg down's)

- blurry/misty vision
- photophobia (bright lights make vision worse)
- harder to see in low mlight
- colours (esp red) looks faded

- surgery

21

open angle glaucoma:
- what is it/pathogenesis?
- risk factors? 5

partial blockage within the trabecular mesh (that drains aqueous humour)

-> build up of aqeous humour -> increased intraoccular pressure -> nerve damage

this happens over many years

nb can get normal-pressure glaucoma (the glaucoma actually refers to the nerve damage

- old
- FH (v important)
- myopia
- diabetes
- african ethnicity

22

open angle glaucoma:
- main symptom?
- treatment?

visual loss (peripheral first, very insidious)

- beta blocker eye drops

23

retinitis pigmentosa:
- what is it?
- who at risk?
- symptoms?

group of inherited conditions of the retina

genetic (different inheritance pattern depending on specific condition)

- night vision + peripheral vision first to go

(later colour and central vision)

slow progression

gene therapy trial ongoing

24

visual field loss patterns, where is lesion? (+ possible causes):
- right monocular blindness? (incl latin name)
- bitemporal hemianopia?
- right homonymous hemianopia?
- left homonymous hemianopia WITH macular sparing?

right monocular blindness
= amaurosis fugax (nb this is painless)
= complete lesion of right optic nerve
- thromboembolic stroke/TIA (to retinal, ophthalmic or ciliary arteries)
- optic neuritis
- giant cell arteritis
- migraine

bitemporal hemianopia
= midline lesion on optic chiasm
- pituitary adenoma
- craniopharyngioma
- meningioma
- ACA aneurysm

right homonymous hemianopia
= lesion in left (contralateral) optic tract/radiation
- stroke
- tumour (or other space occupying lesion)
- migraine

left homonymous hemianopia WITH macular sparing
= lesion in right (contralateral) occipital lobe
- often trauma to back of head
- can also be any other cause (as listed above)

also if have quadranopia then the above applies PLUS superior field defect means lesion in posterior radiation (i.e. all opposites

25

- drugs which can cause dry eyes? 6
- drugs which can cause glaucoma and/or cataracts? 2
- drugs which can cause haemorrhages in eye? 1
- drugs which can cause angle-closing glaucoma? 1

dry eyes:
- diuretics
- anti-histamines
- antidepressants
- statins
- Beta blockers
- OCP
- NSAIDs

glaucoma and/or cataracts
- long-term steroids
- long-term NSAIDs

haemorrhages in eye
- any anticoagulants

angle-closing glaucoma
- sulphonamide Abx

26

blocked tear duct:
- symptoms? 3
- cause in infants?
- causes in adults? 3
- management?

- heavy tearing (norm only unilateral)
- yellow/white build up around eye
- redness/swelling around eye/nose

norm congenital with infants, massage nose to help open, normally opened by 1 year

- trauma
- aging
- URTI

- watch and wait
- if persists in kids, probing, then more complex surgery
- if persists in adults, go straight to surgery

27

dry eyes:
- symptoms? 5
- causes? 6
- treatment? 1

- feelings of dryness, grittiness or soreness (gets worse throughout day)
- burning + red eyes
- eyelids that stick together when wake up
- temp blurred vision (improves when blink)
- paradoxical periods of watery eyes

- increased age
- hot/windy climate
- some conditions (e.g. blepharitis)
- some meds (anti-histamines, antidepressants, B blockers, diuretics)
- hormonal changes in women (incl menopause + OCP)

- lubricating eye drops

nb occasionally use meds to reduce inflammation or surgery to prevent tears from draining away

28

blepharitis:
- symptoms? 7
- management? 3

- itchy, sore & red eyelids that stick together
- crusty or greasy eyelids
- burning/gritting sensation in eye
- photophobia
- swollen eyelid margins
- finding contact lenses uncomfortable to wear
- abnormal eyelash growth (or loss of eyelashes if severe)

- use a warm compress
- gently massage your eyelids
- cleaning eyelids

a long-term condition, gets better and worse

give Abx if secondary infection

29

BCC or SCC on eyelid margin:
- where most common?
- how diagnose?
- how treat?

- on lower eyelid margin

- wedge eyelid biopsy

- surgery (tricky though, reconstruction required if big)

nb BCC 10 times more common

nb can also get sebaceous/meibomiam gland carcinoma on eyelid but this is rare (though more serious)

30

melanoma of eyes:
- two different types?
- symptoms?
- treatments?

choroidal melanoma
= melanoma on retina or in eye
- almost always asymptomatic + picked up on eye exam
1) watch + wait
2) radiotherapy (will damage eyesight in that eye)
3) surgical excision of eye

nb choroidal have relatively good prognosis as harder to spread from eye

eyelid melanoma
= very rare
- looks similar to norm melanoma (irregular, diff colour etc)
1) surgical removal with large margin + reconstruction

31

diabetic retinopathy
- 4 stages? (incl features of each)
- other features of diabetic eye disease? 3

background diabetic retinopathy
- micro aneurysms (dots + blots)
- hard exudate

maculopathy
- any bleeds or anything on macula

pre-proliferative
- cotton wool spots
- soft exudates

proliferative
- new vessel formation (wispy red noodles, often next to ischaemic areas)


- diabetic macular oedema
- cataract
- glaucoma

32

hypertensive eye disease:
- 4 stages? incl features of each

grade 1
- increased tortuosity (nb normal in small peripheral vessels)
- narrowing (dt deposits)

grade 2
- silver/copper wiring
- AV nipping

grade 3
- cotton wool spots (ischaemic areas)
- hard exudates
- flame/splinter bleeds

grade 4
- papilloedema

nb unlike diabetic retinopathy this is reversible

33

thyroid eye disease:
- what % of people with graves will get/have it?
- symptoms/signs?
- common differentials? 2

25% (risk increases if smoker)

- feeling of grittiness in eyes
- dry or watery eyes
- photophobia

- staring/bulging eyes
- swelling in one or both upper eyelids
- bags under eyes

- redness of lids + eyes
- difficulty/pain with eye movement (esp up or sideways)

- hayfever
- HYPOthyroidism (can cause puffy face + eyes)

34

in what forms can arthritis's affect eyes? 6
- which types of arthritis can lead to each one?

keratitis sicca (aka dry eyes)
- RA
- sjorgen's syndrome
- scleroderma

scleritis
- RA
- granulomatosis with polyangitis (formerly Werners)

uveitis
- juvenile arthritis
- ankylosing spondylitis
- psoriatic arthritis
- reactive arthritis
- Behcet's disease

retinal vascular occlusion
- lupus
- scleroderma
- Bechet's disease
- sarcoidosis
- polyarteritis nodosa

glaucoma
- ankylosing spondylitis
- psoriatic arthritis
- other inflammatory arthritis
= glaucoma also a side effect of steroids (used to treat many autoimmune stuff)

cataracts
- RA
- ankylosing spondylitis
- psoriatic arthritis
= cataracts also a side effect of steroids (used to treat many autoimmune stuff)

35

third nerve palsy:
- symptoms? 2
- signs? 3
- causes?

(with each cause say if pupil is spared + whether painful)

- double vision
- pain (some causes)

- pupil down and out
- pupil may or may not be blown (depending on cause!)
- ptosis

congenital
- pupil spared
- painless

microvascular
= diabetes/HTN/atherosclerosis (or stroke)
- pupil spared
- painless
(- patients norm over 45)

external commpression
= tumour/berry aneurysm
- pupil blown (dilated)
- often painful

trauma
- pupil blown

during migraine
- resolves following migraine
- pupil may or may not be involved

(can also be caused by infections)

nb pupil is blown (dilated) due to external commpression as parasympathetic fibres wrap around the third nerve

36

4th nerve palsy:
- main symptoms? 2
- sign?
- commonest causes? 2

double vision
- especially when looking down (e.g. reading)

- subconscious head tilt (away from lesion)

HARD TO ELLICIT ON EXAM ALONE (as often subtle)
- affected eye looks superior and medial

congenital (most common)
- often only picked up on head tilt

following trauma
- can be bilateral
- dt swelling on dorsal surface of brain

37

6th nerve palsy:
- what squint present?
- main symptom?
- commonest cause in children?

affected eye looks medial
- on eye movements it is unable to abduct

- diplopia

nb commonest isolated nerve palsy

- following head trauma (as goes through cavernous sinus)

- ischaemic stroke

loads of other causes too

38

horner's syndrome:
- symptoms? 3

- miosis (pupil constriction)
- partial ptosis (drooping upper eyelid) + apparent enopthalmos (sunken eye)
- anhidrosis

39

optic atrophy:
- what is it?
- causes/risk factors?
- first sign?
- treatment

death of retinal ganglion cell axons that comprise the optic nerve

- glaucoma
- ischaemia (diabetes/HTN)
- compression (e.g. tumour)
- inflammation
- infection

gradual process

loss of contrast + colour vision
- red looks less vivid first (compare eyes)

40

optic disc swelling:
- most common causes? 3
- other causes?

ischaemic optic neuropathy (35%)
- often unilateral

optic neuritis (31%)
- norm unilateral

raised intracranial pressure (14%)
- bilateral
- called papilloedema

- temporal arteritis
- thyroid eye disease
- congenital
- retinal vein occlusion
- malignant hypertension
- glaucoma
- infiltration/inflammtion (lymphoma, sarcoidosis)
- uraemia

41

optic disc swelling:
- main finding on neuro exam?
- most obvious sign on fundoscopy?

- enlarged blind spot
(may also have opthalmoplegia + reduced VA)

- BLURRED DISC MARGINS

42

amblyopia:
- what is it?
- causes? 3
- treatment? 2

lazy eye
- brain uses one eye over the other due to some difficulty with the lazy eye

- a squint
- difference in glasses prescription between the eyes
- obstacle blocking the eye (cataracts or ptosis)

- correct glasses prescription
- patch the good eye at a young age to force bad eye to work harder

43

squints:
- technical name?
- name for inward squint?
- name for outward squint?
- commonest cause?
- commonest cause in adults?
- treatment?

strabismus

inward = ESOtropia
outward = EXOtropia

- congenital (leads to amblyopia to avoid double vision)

- cranial nerve palsy secondary to compression etc
- nb get double vision

- treat underlying cause (if acquired)
- correct with surgery on ophthalmic muscles