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Opthalmology Flashcards

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1
Q

Afferent Defect of Pupils

A

 No direct response but intact consensual response
 Cannot initiate consensual response in contralateral eye.
 Dilatation on moving light from normal to abnormal eye

Total CN2 Lesion

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2
Q

Relative Afferent Pupillary Defect

A

Features

  • minor constriction to direct light
  • dilated on moving light from normal to abn eye
  • marcus gunn pupil

Causes

  • optic neuritis
  • optic atrophy
  • retinal disease
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3
Q

Efferent Defect

A

Dilated Pupil does not react to light

  • initial consensual response in contralateral pupil
  • opthalmoplegia + ptosis

Cause

3rd nerve palsy
 The pupil is often spared in a vascular lesion (e.g.
DM) as pupillary fibres run in the periphery.

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4
Q

DDx of fixed dilated pupil

A

Mydriatics (tropicamide etc)
Iris trauma
Acute glaucoma
CN3 compression (tumour, coning)

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5
Q

Holmes-Adie Pupil

A

Features
 Young woman sudden blurring of near vision
 Initially unilateral and then bilateral pupil dilatation
 Dilated pupil has no response to light + sluggish
response to accommodation.
 A “tonic” pupil

Ix
 Iris shows spontaneous wormy movements on slit-lamp
examination (Iris streaming)

Cause - damage to postganglionic parasympathetic fibres
idiopathic - may have viral origin

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6
Q

Holmes Adie syndrome

A

Tonic Pupil
absent knee/ankle jerks
low blood pressure

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7
Q

Horner Syndrome

A 
PEAS
Ptosis
Enopthalmos
Anhydrosis
Small pupil

Causes
- Central - MS, Wallenberg’s Lateral Medullary Syndrome

  • Pre-ganglionic (neck)
     Pancoast’s tumour: T1 nerve root lesion
     Trauma: CVA insertion or CEA

Post-ganglionic
Cavernous sinus thrombosis
 Usually 2ndary to spreading facial infection via the ophthalmic veins
 CN 3, 4, 5, 6 palsies

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8
Q

Argyll Robertson Pupil

A

Features

  • small, irregular pupils
  • accommodate but doesn’t react to light
  • atrophied + depigmented iris

Cause

  • DM
  • Quaternary syphilis
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9
Q

Optic atrophy/neuropathy

Features

A 
 ↓ acuity
 ↓colour vision (esp. red)
 Central scotoma
 Pale optic disc
 RAPD
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10
Q

Optic Atrophy/neuropathy

Causes

A

CAC VISION
- commonest MS + glaucoma

Congenital 
 Leber’s hereditary optic neuropathy 
 HMSN / CMT
 Friedrich’s ataxia
 DIDMOAD
 Retinitis pigmentosa

Alcohol + other toxins
 Ethambutol
 Lead
 B12 deficiency

Compression
 Neoplasia: optic glioma, pituitary adenoma
 Glaucoma
 Paget’s

Vascular: DM, GCA or thromboembolic

Inflammatory: optic neuritis –MS, Devic’s, DM

Sarcoid / other granulomatous

Infection: herpes zoster, TB, syphilis

Oedema: papilloedema

Neoplastic infiltration: lymphoma, leukaemia

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11
Q

Red eye History

A

Vision

  • blurred
  • distorted
  • diplopia
  • field defect/scotoma
  • floaters, flashes

Sensation

  • irritation
  • pain
  • itching
  • photophobia
  • FB

Appearance

  • red ?distribution
  • lump
  • puffy lids
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12
Q

Red eye key examination questions

A

Inspect from anterior to posterior

is acuity affected?

is the globe painful?

Pupil size + reactivity

Cornea - intact, cloudy? Use fluorescein

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13
Q

Sign of serious disease

A

Photophobia
Poor vision
Corneal fluorescein staining
Abnormal pupil

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14
Q

Acute closed angle glaucoma

A

Blocked drainage of aqueous from anterior chamber via canal of schlemm

Pupil dilatation worsens with blockage)

IOP rises from 15-20 to over 60mmHg

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15
Q

Acute closed angle glaucoma

RF

A 
Hypermetropia - long sitedness
Shallow ant. chamber
Female
FH
↑age

Drugs
 Anti-cholinergics
 Sympathomimetics
 TCAs
 Anti-histamines
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16
Q

Acute closed angle glaucoma

Sx
O/E
Ix

A

Sx

  • prodrome - rainbow haloes around lights at night
  • severe pain w n/v
  • decrease acuity + blurred vision

O/E

  • Cloudy cornea w circumcorneal infection
  • Fixed dilated irregular pupils
  • ^IOP - eye feels hard

Ix
- Tonometry (^^IOP - usually 40+)

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17
Q

Acute closed angle glaucoma

Acute Mx

subsequent Mx

A

Acute Mx - refer to cardiologist
 Pilocarpine 2-4% drops stat: miosis opens blockage
 Topical β-B (e.g. timolol): ↓ aqueous formation
 Acetazolamide 500mg IV stat: ↓ aqueous formation
 Analgesia and antiemetics

Subsequent Mx
- Bilateral YAG peripheral iridotomy once IOP decreses medically

YAG is Yttrium-Aluminum Garnet

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18
Q

Anterior Uveitis/Acute Iritis

A

 Uvea is pigmented part of eye and included: iris, ciliary
body and choroid.
 Iris + ciliary body = anterior uvea
 Iris inflammation involves ciliary body too.

Sx

  • acute pain + photophobia
  • blurred vision
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19
Q

Anterior Uveitis/Acute Iritis

O/E

A 
 Small pupil initially, irregular later
 Circumcorneal injection
 Hypopyon: pus in anterior chamber
 White (keratic) precipitates on back of cornea
 Talbots test: ↑pain on convergence
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20
Q

Anterior uveitis/acute iritis Associations

A

 Seronegative arthritis: AS, psoriatic, Reiter’s
 Still’s / JIA
 IBD
 Sarcoidosis
 Behcet’s
 Infections: TB, leprosy, syphilis, HSV, CMV, toxo

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21
Q

Anterior uveitis/acute iritis

Mx

A

 Refer to ophthalmologist
 Prednisolone drops
 Cyclopentolate drops: dilates pupil and prevents
adhesions between iris and lens (synechiae)

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22
Q

Episcleritis

A

inflammation below conjunctiva in episclera

Presents
 Localised reddening: can be moved over sclera
 Painless / mild discomfort
 Acuity preserved

Causes
 Usually idiopathic
 May complicate RA or SLE

Rx: Topical or systemic NSAIDs

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23
Q

Scleritis

A

vasculitis of sclera

Presents

  • severe pain, worse on eye movement
  • generalised scleral inflammation (vessels won’t move over sclera)
  • conjunctival oedema (chemosis

Causes

  • Wegener’s
  • RA
  • SLE
  • Vasculitis

Mx

  • refer to specialist
  • most need corticosteroids or immunosuppressants

Complications - scleromalacia (thinning) > globe perforation

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24
Q

Conjunctivitis Presents

A
  • Often bilateral ¯c purulent discharge
     Bacterial: sticky (staph, strep, Haemophilus)
    Viral: watery

Discomfort
Conjunctival injection
 Vessels may be moved over the sclera

Acuity, pupil responses and cornea are unaffected.

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25
Conjunctivitis Causes/Rx
Causes  Viral: adenovirus  Bacterial: staphs, chlamydia, gonococcus  Allergic Rx  Bacterial: chloramphenicol 0.5% ointment  Allergic: anti-histamine drops: e.g. emedastine
26
Corneal Abrasion
 Epithelial breech w/o keratitis  Cause: trauma Symptoms  Pain  Photophobia  Blurred vision Ix  Slit lamp: fluorescein stains defect green Rx  Chloramphenicol ointment for infection prophylaxis
27
Corneal Ulcer + Keratitis (Causes)
Causes: bacterial, herpetic, fungal, protozoa, vasculitic (RA)  Dendritic ulcer = Herpes simplex  Acanthamoeba: protazoal infection affecting contact lens wearers swimming in pools.
28
Corneal Ulcer + Keratitis (Presentation + RF)
Pain photophobia Conjunctival hyperaemia (XS blood vessels) decreased acuity white corneal opacity RF - contact lense wearers
29
Corneal Ulcer + Keratitis (Ix + Rx + complications)
Ix - green w fluorescin on slit lamp Rx - refer immediately to specialist  Take smears and cultures  Abx drops, oral/topical aciclovir  Cycloplegics/mydriatics ease photophobia  Steroids may worsen symptoms: professionals only Complications - scarring + visual loss
30
Opthalmic Shingles
Pain in CNV1 dermatome precedes blistering rash 40% → keratitis, iritis Hutchinson’s sign  Nose-tip zoster due to involvement of nasociliary branch.  ↑ chance of globe involvement as nasociliarry nerve also supplies globe Opthalmic involvement - Keratitis + corneal ulceration (fluorescin stains) - +/- iritis
31
Sudden Loss of vision Key Questions
 Headache associated: GCA  Eye movements hurt: optic neuritis  Lights / flashes preceding visual loss: detached retina  Like curtain descending: TIA, GCA  Poorly controlled DM: vitreous bleed from new vessels
32
Anterior Ischaemic Optic Neuropathy (AION)
optic nerve damaged if posterior cilliary arteries blocked (inflammation or atheroma) Pale swollen optic disc Causes - Arteritic AION - giant cell arteritis - Non-arteritic AION - HTN, DM, hyperlipidaemia, smoking
33
Optic neuritis Sx + Signs
Sx - unilateral loss of acuity over hrs - days - ↓ colour discrimination (dyschromatopsia) - eye movements may hurt ``` Signs  ↓ acuity  ↓ colour vision  Enlarged blind-spot  Optic disc may be: normal, swollen, blurred  Afferent defect ```
34
Optic neuritis Causes + Rx
``` Causes  Multiple sclerosis (45-80% over 15yrs)  DM  Drugs: ethambutol, chloamphenicol  Vitamin deficiency  Infection: zoster, Lyme disease ``` Rx  High-dose methyl-pred IV for 72h  Then oral pred for 11/7
35
Vitreous Haemorrhage
Source  New vessels: DM  Retinal tears / detachment / trauma Presentation  Small bleeds → small black dots / ring floaters  Large bleed can obscure vision → no red reflex, retina can’t be visualised Ix  May use B scan US to identify cause Mx  VH undergoes spontaneous absorption  Vitrectomy may be performed in dense VH
36
Central Retinal Artery Occlusion
Presents - Dramatic unilateral vision loss in seconds - Afferent pupil defect (may precede retinal changes) - Pale retina w cherry-red macula Causes - GCA - Thromboembolism: clot, infective, tumour ``` Rx - if seen w/i 6h aim is to ^retinal blood flow by decreasing IOP >occular massage > Surgical removal of aqueous > antihypertensives (local + systemic) ```
37
Central Retinal Vein Occlusion
Commoner than arterial occlusion Causes: arteriosclerosis, ↑BP, DM, polycythaemia Pres: sudden unilat visual loss w RAPD (relative afferent pupillary defect) Fundus: Stormy Sunset Appearance  Tortuous dilated vessels  Haemorrhages  Cotton wool spots Complications  Glaucoma  Neovascularisation Prognosis: possible improvement for 6mo-1yr
38
Branch Retinal Vein Occlusion
Presents - unilateral visual loss Fundus - segmental fundal changes Comps - retinal ischaemia > VEGF release + neovascularisation Rx - laser photocoagulation
39
Retinal Detachment
Holes/tears in retina allow fluid to separate sensory retina from retinal pigmented epithelium May be 2ndary to cataract surgery, trauma, DM ``` Presentation 4 Fs - Floaters - numerous acute onset spider web - Flashes - Field loss - Fall in acuity painless ``` Fundus - grey, opalescent retina, ballooning forwards
40
Retinal detachment Rx
Urgent surgery | Vitrectomy + gas tamponade w laser coagulation to secure retina
41
Causes of transient visual loss
 Vascular: TIA, migraine  MS  Subacute glaucoma  Papilloedema
42
Gradual Visual Loss Causes
``` Common  Diabetic retinopathy  ARMD  Cataracts  Open-angle Glaucoma ``` Rarer  Genetic retinal disease: retinitis pigmentosa  Hypertension  Optic atrophy
43
Age Related Macular Degeneration
Commonest cause of blindness 60+ RF - smoking, age, genetics Presentation - elderly, central visual loss Dry and Wet Ix Optical Coherence Tomography - high resolution images of retina
44
Dry AMD
Geographic Atrophy Drusen - fluffy white spots around macula Degeneration of macula Slow visual decline over 1-2 years
45
Wet AMD
Subretinal Neovascularisation Abberrant vessels grow into retina from choroid + haemorrhage Rapid visual decline (sudden/days/weeks) w distortion Fundoscopy - macular haemorrhage > scarring Amsler grid detects distortion
46
Mx of Wet AMD
Photodynamic therapy Intravitreal VEGF inhibitor - Bevacizumab (Avastin) - Ranibizumab (Lucentis) Antioxidant vitamins (C,E) + zinc may help early AMD
47
Tobacco-Alcohol Amblyopia
Due to toxic effects of cyanide radicals when combined with thiamine deficiency. Pres: Optic atrophy, loss of red/green discrimination, scotomata Rx: vitamins may help
48
Chronic Simple (open-angle) Glaucoma Pathogenesis
Pathogenesis depends on susceptibility of pt retina + optic nerve to ^IOP damage IOP >21mmHg > decreased bloow flor + damage to optic nerve > optic disc atrophy (pale) + cupping
49
Chronic Simple (open-angle) Glaucoma Presentation
Peripheral Visual field defect (superior nasal first) Central field intact - acuity maintained until late > presentation delayed until optic N damage is irreversible
50
Chronic Simple (open-angle) Glaucoma Screen if high risk (RF)
``` >35y Afrocaribbean FH Drugs - steroids Co-morbidities - DM, HTN, Migraines Myopia ```
51
Chronic Simple (open-angle) Glaucoma Ix Mx
Ix - Tonometry - IOP 21+ mmHg - Fundoscopy - cupping of optic disc - visual field assessment - peripheral loss
52
Chronic Simple (open-angle) Glaucoma Mx
Lifelong follow/up Eye-drops to lower IOP to baseline 1st line: β-blockers  Timolol, betaxolol  ↓ aqueous production  Caution in asthma, heart failure Prostaglandin analogues  Latanoprost, travoprost  ↑ uveoscleral outflow α-agonists  Brimonidine, apraclonidine  ↓ aqueous production and ↑ uveoscleral outflow Carbonic anhydrase inhibitors  Dorzolamide drops, acetazolamide PO Miotics  Pilocarpine Non-medical options - laster trabeculoplasty - Surgery (trabeculectomy) if drugs fail > new channel allows aqueous to flow into conjunctival bleb
53
Commonest Causes of Blindness Worldwide
```  Trachoma  Cataracts  Glaucoma  Keratomalacia: vitamin A deficiency  Onchocerciasis  Diabetic Retinopathy ```
54
The eye in DM
DM is leading cause of blindness up to 60yrs  30% have ocular problems @ presentation  BP < 130/80 and normoglycaemia → ↓ diabetic retinopathy
55
Eye in DM pathogenesis
Cataract - DM accelerates formation of cataract - Lens absorbs glucose, converted to sorbitol by aldose reductase Retinopathy - Microangiopathy > occlusion - Occlusoin > ischaemia > new vessel formation in retina  Bleed → vitreous haemorrhage  Carry fibrous tissue w them → retinal detachment - occlusoin also > cotton wool spots (ischaemia) - vascular leakage > oedema + lipid exudates - rupture of microaneurysms > blot haemorrhages
56
Eye in DM fundoscopy findings
Background Retinopathy: Leakage  Dots: microaneurysms  Blot haemorrhages  Hard exudates: yellow lipid patches ``` Pre-proliferative Retinopathy: Ischaemia  Cotton-wool spots (infarcts)  Venous beading  Dark Haemorrhages  Intra-retinal microvascular abnormalities ``` Proliferative Retinopathy  New vessels  Pre-retinal or vitreous haemorrhage  Retinal detachment Maculopathy  Caused by macular oedema  ↓ acuity may be only sign  Hard exudates w/i one disc width of macula
57
Eye in DM Ix Mx
Ix - fluorescein angiography Mx - good BP and glycaemic control - Rx concurrent disease (HTN, dyslipidaemia, renal disease, smoking, anaemia - Laser photocoagulation  Maculopathy: focal or grid  Proliferative disease: pan-retinal (macula spared)
58
CN palsies in DM (eye)
CNIII and CNVI palsies may occur in diabetic CNIII palsy, pupil may be spared as nerve fibres run peripherally + receive blood from pial vessels
59
Cataracts Presentation
 Increasing myopia  Blurred vision → gradual visual loss  Dazzling in sunshine / bright lights  Monocular diplopia
60
Cataracts causes
``` ↑Age: 75% of >65s DM Steroids Congenital Idiopathic  Infection: rubella  Metabolic: Wilson’s, galactosaemia  Myotonic dystrophy ```
61
Cataracts Ix
Visual acuity dilated fundoscopy tonometry blood glucose to exclude dM
62
Cataracts Mx
Conservative - glasses - mydriatic drops + sunglasses may give relief Surgery - consider if Sx affect lifestyle or driving - day case under local - phacoemulsion + lens implants -1% risk serious complications  Anterior uveitis / iritis  VH  Retinal detachment  Secondary glaucoma  Endophthalmitis (→ blindness in 0.1%) - post-op capsule thickening common - post-op eye irritation common + requires drops
63
Retina
outer pigmented layer in contact w choroid inner sensory layer in contact w vitreous at centre - fovea
64
Optic disc
Colour - pale pink, paler optic atrophy Contour - margins blurred in papilloedema + optic neuritis Cup - physiological cup lies centrally + should occupy 1/3 of disc diameter - Cup widening + deepening in glaucoma
65
Retinitis Pigmentosa
Most prevalent inherited degeneration of macula Presentation  Night blindness  ↓↓ visual fields → tunnel vision  Most are registrable blind (<3/60) by mid 30s Fundoscopy - Pale optic disc - optic atrophy - peripheral retina pigmentation - spares macula ``` assw Friedrich's ataxia Refsum's disease Kearns-Sayre Syndrome Usher's syndrome ```
66
Retinoblastoma
commonest intraocular tumour in children - AD mutation in RB gene - can be non-hereditary - pt typically have 1 mutant allele in every retinal cell, if other allele mutates > TB Assw osteosarcoma, rhabdomyosarcoma Signs - stabismus (eyes not aligned properly - leukocoria (white pupil) - no red reflex Rx - depends on size - chemo, radio, enuclreation
67
Stye or hordeolum externum
abscess/infection in lash follicle which points outwards Rx - local abx - fusidic acid
68
Chalazion or hordeolum internum
abscess of meibomian glands which point inwards onto conjunctiva - sebacious glands of eyelid
69
Blepharitis
common inflammation of eyelid Causes - seborrhoeic dematitis, staph Features - red eyes - gritty/itchy sensation - scales on lashes - oft assw rosacea Rx - clean cursts w warm soaks - may need fusidic acid drops
70
Entropion
lid inversion > corneal irritation | degeneration of lower lif fascia
71
Ectropion
lower lid eversion > watering + exposure keratitis assw ageing + facial nerve palsy
72
Ptosis
True ptosis is intrinsic Levator Palpebrae Superioris msucle weakness Bilateral - congen, senile, MG, Myotonic dystrophy Unilateral - 3rd nerve palsy - Horner's syndrome - Mechanical - xanthelasma , trauma
73
Lagopthalmos
difficulty in lid closure over globe may > exposure keratitis Causes - exopthalmos, facial palsy, injury Rx - lubricate eyes w liquid paraffin ointment - Temporary tarsorrhaphy may be needed if cornreal ulcer develops
74
Pinguecula
yellow vascular nodules either side of cornea
75
Pterygium
 Similar to pinguecula but grows over the cornea → ↓ vision.  Benign growth of conjunctiva  Assoc. c¯ dusty, wind-blown life-styles, sun exposure
76
Orbital Cellulitis
infection spreads locally (from paranasal sinuses, eyelid or external eye) - staph, pneumococcus, GAS Presentation - usually child w inflammation of orbit + lif swelling - pain and decreased ROM of eye movement - exopthalmos - systemic signs - fever - +/- tenderness over sinuses Rx - IV Abx - cefuroxime (20mg/kg/8h IV) Complication - local extension > meningitis and cavernous sinus thrombosis - blindness due to opitc N pressure
77
Carotico-Cavernous fistula
May follow carotid aneurysm rupture w reflux of blood into cavernous sinus. Causes: spontaneous, trauma ``` Presentation  Engorgement of eye vessels  Lid and conjunctival oedema,  Pulsatile exophthalmos  Eye bruit ``` Rx - oral antivirals - famciclovir, aciclovir
78
Exopthalmos/Proptosis
protrusion of one or both eyes Common cause - Grave's (retroorbital inflam + lymphocyte inflammation > swelling) - orbital cellulitis - trauma ``` Other causes - idiopathic (orbital inflammatory disease) - vasculitis - wegener's - carotico-cavernous fistula - Neoplasm  Lymphoma  Optic glioma: assoc. c¯ NF-1  Capillary haemangioma  Mets ```
79
Myopia
short sightedness - eye too long - distant objects focused too far forward Causes - genetic - XS close work in early decades Solution - concave lenses
80
Astigmatism
cornea or lens not same degree of curvature in horizontal + vertical planes - image of object is distorted longitudinally or vertically Solution - correcting lenses
81
Hypermetropia: long-sightedness
eye too short - when eye relaxed + not accommodating, objects focussed behind retina - contraction of ciliary muscles to focus image > tiredness of gaze + possibly convergent squint in children Solution - convex lenses - convex lenses
82
Presbyopia
w age lens becomes stiff + less easy to deform start 40 completed by 60 use convex lenses
83
Esotropia
convergent squint  Commonest type in children  May be idiopathic or due to hypermetropia
84
Exotorpia
divergent squint  Older children  Often intermittent
85
Non-paralytic Squint
Diagnosis - Corneal reflection - should fall centrally + symmetrically on each cornea - Cover test - movement of uncovered eye to take up fixation demonstrates manifest squint Management of 3Os - optical - correct refractive errors - orthoptic - patching good eye encourages use of squinting eye - Operations - resection and recession of rectus muscles - help alignment + cosmesis
86
Paralytic Squint
Diplopia most on looking in direction of pull of paralysed muscle eye won't fixate on covering cover each eye in turn - whichever sees outer image is malfunctioning
87
CNIII Paralytic Squint
Ptosis (Levator palpebrae superioris) Fixed dilated pupil (no parasympathetic) Eye looking down and out Causes - Medical - DM, MS, infarction - Surgical - ^ICP, cavernous sinus thrombosis, posterior communicating artery aneurysm
88
CNIV Paralytic Squint
Diplopia esp on going downstairs - head tilt Test - can't depress in adduction Causes - peripheral - DM, trauma, compression - Central - MS, vascular, SOL
89
CNVI
eye medially deviated and cannot abduct - diplopia in horizontal plane Cause - peripheral - DM, compression, trauma - Central - MS, vascular, SOL Rx- botulinum toxin - can eliminate need for surgery
90
Eye trauma if unable to open injured eye -
instill LA
91
Foreign Bodies
XR orbit if metal FB suspected - fluorescein may show cornreal abrasions ``` Mx - Chloramphenicol drop 0.5% prevent infection > usually coagulase negative staph - eye patch - cycloplegic drops may decrease pain ```
92
Intra-ocular haemorrhage
blood in anterior chamber = hyphaemia small amounts clear spontaneously - some may need evacuation complicated by corneal staining + glaucoma (pain) keep IOP low + monitor
93
Orbital Blowout Fracture
Blunt injury > sudden ^ IOP w herniation of orbital contents into maxillary sinus Presents - Opthalmoplegia + Diplopia - tethering of inferior rectur + inferior oblique - Loss of sensation to lower lid skin - infraorbital nerve injury - Ipsilateral epistaxis - damage to anterior ethmoidal artery - decreased acuity - irregular pupil reacting slowly to light Mx - Reduction and muscle relesae necessary
94
Chemical Injury to eye
Alkaline solutions are particularly damaging Mx  Copious irrigation  Specialist referral
95
Floaters (eye)
small dark spots in visual field Sudden showers of floaters can be due to blood or retinal detachment Causes - Retinal detachment - VH - diabetic retinopathy/HTN - Old retinal branch vein occlusion - snresis (degenerative opacities in vitreous)
96
Flashes (Photopsia)
either intraocular or intracerebral pathology Headache N/V migraine Flashes and floaters - retinal detachment
97
Haloes (eye)
usually diffractive phenomena may be caused by hazy ocular media - cataract, corneal oedema, acute glaucoma Haloes + eye pain - acute glaucoma jagged haloes which change shape - usually migraine
98
Seasonal Allergic Conjunctivitis
50% allergic eye disease small papillae on tarsal conjunctivae Rx - antzoline - antihistamine drops - cromoglycate - inhibits mast cell degranulation
99
Perennial allergic conjunctivitis
Sx all year w seasonal exacerbations small papillae on tarsal conjunctivae Rx - olopatadine (antihistamine + mast cell stabiliser)
100
Giant Papillary Conjunctivitis
Iatroenic FBs - contact lenses, prostheses sutures | giant papillae on tarsal conjunctivae
101
Mx or Allergic eye disorders
1 Remove allergen responsible where possible 2 General measures - cold compress - artificial tears - oral antihistamines - loratadine 10mg/d PO 3 eye drops - antihistamines - antazoline , azelastine - mast cell stabilisers - cromoglycate, lodoxamide - steroids - dexamethasone (beware inducing glaucoma) - NSAIDs - diclofenac
102
Trachoma
Caused by Chlamydia trachomatis spread by flies inflammatory reaction under lids > scarring > lid distortion > entropion > eyelashes scratch cornea > ulceration > blindness Rx - tetracycline 1% ointment +/- PO Prevention - good sanitation, face washing
103
Onchocerciasis (river blindness)
Caused by microfilariae of nematode Onchocerca volvulus - spread by flies - fly biets > microfillariae infection > invade eye > inflammation > fibrosis > corneal opacities + synechiae Rx - Ivermectin
104
Xeropthalmia + Keratomalacia
Vit A deficiency Presents - night blindness + dry conjunctivae (xerosis) - corneal ulceration + perforation Rx - vit A/palmitate reverses early corneal changes
105
hypertensive retinopathy
Keith-Wagener Classification 1. Tortuosity and silver wiring 2. AV nipping 3. Flame haemorrhages and soft / cotton wool spots 4. Papilloedema  Grades 3 and 4 = malignant hypertension
106
Granulomatous Disorders (eye signs)
TB, sarcoid, toxo, leprosy, brucella Uveitis (ant/post) and choroidoretinitis
107
Systemic inflammatory disease (eye signs)
Conjunctivitis: SLE, reactive arthritis, IBD Scleritis / episcleritis: RA, vasculitis, SLE, IBD Iritis : ank spond, IBD, sarcoid Retinopathy: dermatomyositis
108
Keratoconjunctivitis Sicca/Sjogren's
↓ tear production (Schirmer’s: <5mm in 5min) Dry eyes and dry mouth 1O or 2O: SLE, RA, sarcoid Rx: artificial tears or saliva
109
Vascular occlusion of eye
Emboli - amaurosis fugax : GCA, carotid atheroemboli Microemboli > roth spots - infective endocarditis > boat shaped haemorrhage w pale centres
110
Metabolic eye signs wilson's grave's hpt
 Kayser-Fleischer Rings: Wilson’s  Exophthalmos: Graves’  Corneal calcification: HPT
111
HIV/AIDs eye signs
CMV retinitis (pizza pie fundus + flames) HIV retinopathy - cotton wool spots
112
Mydriatics
Indication - eye examination, prevention of synechiae in ant uveitis/iritis Caution - may > acute glaucoma if shallow anterior chamber ``` Anti-Muscarinics -Tropicamide  Duration: 3h -Cyclopentolate  Duration: 24h  Preferred for paediatric use -Pupil dilatation + loss of light reflex -Cycloplegia (ciliary paralysis) → blurred vision ``` Sympathomimetics  Para-hydroxyamphetamine, phenylephrine  May be used w tropicamide  Don’t affect the light reflex or accommodation
113
Miotics
constrict pupils Use - acute closed angle glaucoma Muscarinic agonist - Pilocarpine
114
Chronic Open-Angle Glaucoma Rx
1st line: β-blockers  Timolol, betaxolol  ↓ aqueous production  Caution in asthma, heart failure Prostaglandin Analogues  Latanoprost, travoprost  ↑ uveoscleral outflow α-agonists  Brimonidine, apraclonidine  ↓ aqueous production and ↑ uveoscleral outflow Carbonic anhydrase inhibitors  Dorzolamide drops, acetazolamide PO Miotics  Pilocarpine
115
eye lubricants
hypomellose | antazoline
116
Anaesthetic used to permit examination of painful eye
Tetracaine |  Anaesthetic used to permit examination of a painful eye
117
Topical Anti-histamine
Emedastine | Antazoline

D3 (14 decks)

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