Opthalmology Flashcards
(181 cards)
1
Q
Name 4 conditions where you can get flashers and floaters
A
- Retinal tear
- Retinal detachment
- Posterior vitreous detachment
- Vitreous haemorrhage
2
Q
What condition is typically described as a “curtain coming down over my vision”?
A
Amaurosis fugax
3
Q
What is an entropion?
A
In-turning of lide
4
Q
What are the complications of an entropion?
A
The eyelashes can –> keratitis, permanent corneal scarring, reduced vision
5
Q
What are the treatment options for entropion?
A
Topical Abx, taper down lid, surgery
6
Q
What is ectropian? What are the treatment options?
A
Eversion of lower lid. Lubricate to prevent drying due to exposure, surgery
7
Q
Name some causes of ptosis
A
CN III palsy Horner’s syndrome, dystrophy, MG, ageing, lid lumps, oedema
8
Q
What 2 organisms are normally the cause of blepharitis?
A
Staph or epidermidis
9
Q
What are the treatment options for blepharitis?
A
- Wash with sodium bicarbonate
- Warm compresses
- Lubricants
- Abx drops/ointments
- Low dose oral doxycycline
- Topical anti-inflammatory
10
Q
What is a Chalazion? How does it look initially and how does it change over time?
A
A Meibomian cyst = granuloma of lipid secreting Meibomian glands in the lid. A lump. Initially, an erythematous oedematous lid w/ discrete tender area then a hard lump/
11
Q
What treatment options are available for a Chalazion?
A
Hot compresses. Abx drops. Most resolve by themselves. Some require surgery.
12
Q
What is the treatment for bacterial conjunctivitis?
A
Chloramphenicol hourly for 24 hours then QDS for a week
13
Q
What is the most common cause of viral conjunctivitis?
A
Adenovirus
14
Q
What might have happened to a patient with viral conjunctivitis who later goes on to become photophobic and have a loss of vision?
A
Corneal opacities may have formed
15
Q
What is bacterial keratitis and in whom is it most common in?
A
Infection of the cornea. Contact lenses wearers @ risk.
16
Q
List as many symptoms of bacterial keratitis as you can
A
- Red, sticky
- Pain
- Reduced vision
- Photophobia
- Purulent discharge
- White fluffy corneal abscesses
17
Q
List 4 complications of bacterial keratitis
A
- Endopthalmitis
- Corneal perforation
- Permanent corneal scarring
- Visual loss
18
Q
How should you manage a patient with suspected bacterial keratitis?
A
- Admit
- Scrape cornea
- Urgent gram stain and culture
- Antibiotic drops (hourly day and night)
- Topical steroids 48hrs to reduce scarring
- Isolate
19
Q
What is the typical causative agent in viral conjunctivitis?
A
Herpes simplex type 1
20
Q
How does viral keratitis present?
A
- Unilateral red eye
- Pain
- Photophobia
- Reduced vision
- Branching dendritic ulcer staining with fluorescein
21
Q
Name 3 complications of viral keratitis
A
1) Corneal scarring
2) Disciform keratitis
3) Corneal perforation
22
Q
Which medication is contraindicated in viral keratitis and why?
A
Topical steroids are contraindicated as it will worsen dendritic disease
23
Q
If a person with a history of viral keratitis presents with red eye - what is the likely cause?
A
Ulcer has recurred - needs to be assessed by an ophthalmologist
24
Q
What treatment should you give to someone with viral keratitis?
What else should you do regarding their pupil size?
A
1) Antiviral ointment e.g. Aciclovir
2) Dilate pupil to relieve pain
25
How might a corneal foreign body present?
| If you suspect penetration of the globe is suspected, which 2 imaging modalities can you use?
A red, watery eye.
CT and B-scan US.
26
What is the treatment for someone with a corneal foreign body?
Remove, instil topical antibiotic and pad eye, topical antibiotic gel for 1 week
27
How would someone with a corneal abrasion react to light?
Photophobic :(
28
What investigation can you do with someone with a suspected corneal abrasion?
Loss of epithelium stains green with fluorescein drops using a blue torch
29
What are the 2 treatments for someone with suspected corneal abrasion? What is their prognosis?
Dilate the pupil to prevent ciliary spasm and use antibiotic drops for 1 week.
It usually heals within 48 hours.
30
Which eye condition is AS associated with?
Acute anterior uveitis (iritis)
31
How does acute anterior uveitis (iritis) present in terms of symptoms?
Unilateral red eye, pain, blurred vision, photophobia.
32
What may you find on examination of someone with acute anterior uveitis (iritis)?
- Conjunctival injection
- Keratic precipitates
- Flare (albumin leakage from iris vessels)
- Hypopyon (if severe)
- Miosis and posterior synechiae
33
What are posterior synechiae?
Adhesions between iris and lens
34
What is a complication of acute anterior uveitis (iritis) and how what else can this lead onto?
360 degrees posterior synechiae --> blockage of aqueous humour circulation --> iris bombe and high IOP.
35
What is iris bombe?
Apposition of iris to the lens or anterior vitreous - prevents aqueous from flowing from the posterior to anterior chamber --> pressure in the posterior chamber rises --> anterior bowing of the peripheral iris & obstruction of the trabecular meshwork.
36
What are the chronic consequences of someone with acute anterior uveitis (iritis)?
Can cause secondary cataract +/- macular oedema which leads to reduced vision.
37
What are the 3 treatments that should be given/done to someone with acute anterior uveitis (iritis)?
1) Dilate pupil (prevent ciliary spasm)
2) Break PS
3) Intensive topical steroids (subconjunctival injection if severe)
38
Name 4 risk factors for primary open angle glaucoma
1) Family history
2) High myopia
3) Retinal vein occlusion
4) DM
39
What 5 things may you find on examination of someone with primary open angle glaucoma?
1) Cupped optic discs (C:D ratio >0.5)
2) Pallor
3) Nasal shift of vessels
4) Haemorrhages
5) Asymmetry of C:D ratio
40
How would vision loss progress in someone with primary open angle glaucoma?
Vision loss if advanced
| Then... Nasal --> Arcuate scotoma --> tunnel vision
41
What would you see on gonioscopy of someone with primary open angle glaucoma?
Open drainage angle
42
What is a complication of primary open angle glaucoma?
Central vein occlusion
43
Broadly speaking, what are the 4 treatments available for someone with open angle glaucoma?
1) Topical ocular hypotensives
2) Systemic hypotensives
3) Drainage surgery - trabeculectomy +/- antimetabolite
4) Insertion of drainage device
44
List 4 classes of drugs that can be used as topical ocular hypotensives
1) Prostaglandin analogue
2) B blockers
3) Carbonic anhydrase inhibitor
4) Sympathomimetic
45
Give an example of a Prostaglandin analogue that is used as a topical ocular hypotensive
Latanoprost
46
Give an example of a B blocker that is used as a topical ocular hypotensive
Timolol
47
Give an example of a Carbonic anhydrase inhibitor that is used as a topical ocular hypotensive
Dorzolamide
48
Give an example of a Sympathomimetic that is used as a topical ocular hypotensive
Brimonidine
49
What is a primary cause of acute angle closure glaucoma?
Hypermetropia (smaller eye with narrower drainage angle)
50
What is a secondary cause of acute angle closure glaucoma?
Cataract
51
How would acute angle closure glaucoma affect someone's vision? (2 symptoms)
It would decrease their vision and they would see haloes around lights
52
Other than vision being affected, what other symptoms would acute angle closure glaucoma cause?
```
Severe eye pain
Headache
N&V
Abdo pain
Red eye
```
53
How would the pupil look like in someone with acute angle closure glaucoma?
Mid-dilated oval pupil.
54
Broadly, how do you manage acute angle closure glaucoma? How do you want their pupil to be?
- Admit
- Systemic ocular hypotensives
- Topical pilocarpine drops (to constrict pupil)
- IOP reducing drops
- Laser iridectomy (in both eyes!)
55
What eye pathology may occur in someone with AF?
Amaurosis fugax
56
What eye pathology may occur in someone with Carotid dissection?
Horner's syndrome
57
What eye pathology may occur in someone with hypertension?
Vessel occlusion
58
What eye pathology may occur in someone with IE?
Roth spots in retina
59
What eye pathology may occur in someone with Acne rosacea?
Blepharokeratoconjunctivitis/ marginal keratitis
60
What eye pathology may occur in someone with Psoriasis?
Anterior uveitis
61
What eye pathology may occur in someone with IBD?
Uveitis
62
What eye pathology may occur in someone whose mother had an STI when giving birth to them?
Ophthalmia neonatorum
63
What eye pathology may occur in someone with Syphilis?
Uveitis
64
What eye pathology may occur in someone with Behcets?
Uveitis
65
What eye pathology may occur in someone with sarcoidosis?
Uveitis
66
What eye pathology may occur in someone with Juvenile idiopathic arthritis?
Uveitis
67
What eye pathology may occur in someone with SLE?
Uveitis/ scleritis
68
What eye pathologies may occur in someone with RA?
Scleritis, corneal melt, dry eye
69
What eye pathologies may occur in someone who has taken an a blocker?
Poor pupillary dilatation
| Intra-operative floppy iris syndrome
70
What eye pathologies may occur in someone who has taken steroids?
Cataract
| Glaucoma
71
What eye pathology may occur in someone who has taken Tamoxifen?
Retinopathy
72
What eye pathology may occur in someone who has taken Hydroxychloroquine?
Maculopathy
73
Give me 5 differential diagnoses of painful loss of vision
1) Optic neuritis
2) Keratitis
3) Angle closure glaucoma
4) Uveitis
5) Scleritis
74
Give me 5 differential diagnoses of gradual painless loss of vision
1) Dry age related macular degeneration
2) Cataract
3) Primary open angle glaucoma
4) Diabetic maculopathy
5) Papilledema
75
Give me 4 differential diagnoses of recent painless loss of vision
1) Cataract
2) Retinal detachment
3) Wet age related macular degeneration
4) Dry age related macular degeneration
76
Give me 4 differential diagnoses of sudden painless loss of vision?
1) Vitreous haemorrhage
2) Retinal detachment
3) Wet age related macular degeneration
4) Vascular occlusion:
- Retina: venous or arterial
- Optic nerve head: Anterior ischaemic optic neuropathy
77
Give me 10 differential diagnoses of red eye
1) Viral keratitis
2) Marginal keratitis
3) Acute anterior uveitis (iritis)
4) Angle closure glaucoma
5) Blepharitis
6) Bacterial conjunctivitis
7) Viral conjunctivitis
8) Bacterial keratitis
9) Episcleritis
10) Scleritis
78
Name the 3 types of cataract. Which is most common?
1) Nuclear sclerosis (most common)
2) Cortical
3) Posterior subscapular
79
Give 5 causes of cataract. Which is the most common cause?
```
Ageing (commonest cause)
Intraocular inflammation
DM
Systemic steroids
Congenital
```
80
What does the surgery for cataract entail?
Phakoemulsification and posterior chamber intraocular lens implant.
81
Why might a 'dropped nucleus' occur in cataract surgery?
If there is rupture of the posterior lens capsule in surgery -> vitreous loss -> 'dropped nucleus'
82
What 2 medications must you give to someone post cataract surgery?
Topical steroids and antibiotics.
83
What is the commonest cause for Central Retinal Vein Occlusion?
Atherosclerosis
84
What is the commonest cause for Branch Retinal Vein occlusion?
Hypertension
85
How painful are retinal vein occlusions? How quickly do they affect vision?
They are painless.
| They result in a sudden drop in visual acuity in one eye.
86
What would you see on examination of someone with Central Retinal Vein Occlusion?
A swollen disc and retina (esp macular area), marked venous engorgement. Haemorrhages and cotton wool spots.
87
When would you see RAPD in someone with Central Retinal Vein Occlusion?
If there is extensive retinal haemorrhage.
88
What 2 treatments should be given to someone with Central Retinal Vein Occlusion?
Panretinal photocoagulation for ischaemic CRVO (cauterizing blood vessels)
Intravitreal anti-VEGF injections for macular oedema
89
Out of all of the occlusions that could happen to blood vessels in the eye, which one is an emergency?
Central retinal artery occlusion!
90
Name 3 causes of retinal artery occlusion
Atheroma
Embolus (usually from carotid bifurcation)
Arteritis (GCA)
91
How painful is Retinal artery occlusion? How quickly does vision loss occur?
It is painless.
| Visual loss occurs suddenly.
92
What would you find on examination in someone with retinal artery occlusion?
Pale retina with cherry red spot at the macula. Segmentation of blood in vessels.
93
What treatments should be given to someone with retinal artery occlusion presenting within 8-12 hours?
```
Decrease IOP to aid perfusion
Drain aqueous surgically
Get patient to rebreathe into bag (increased CO2 dilates vessels so the embolus can pass through)
Massage the eye (to dislodge embolus)
IV acetazolamide
```
94
What is the prognosis like in retinal artery occlusion?
| What treatment is available for patients presenting after 12 hours?
Treatment is ineffective at restoring vision :(
No immediate treatment after 12 hours :(
95
What biochemical test should you order to rule out an important cause in retinal artery occlusion?
Measure ESR for GCA
96
Name 3 complications of retinal artery occlusion
- Optic atrophy
- Ocular neovascularisation
- Neovascular glaucoma
97
Which vessels are occluded in Anterior Ischaemic Optic Neuropathy?
Short posterior ciliary arteries are occluded. These supply the optic head.
98
Name 4 causes of Anterior Ischaemic Optic Neuropathy
```
1) GCA (arteric cause)
Non-arteric causes:
2) HTN
3) Atherosclerosis
4) Small crowded optic disc
```
99
How painful is Anterior Ischaemic Optic Neuropathy? How quickly does it affect vision?
It is painless
| It causes sudden loss of vision
100
What would you see on examination of someone with Anterior Ischaemic Optic Neuropathy?
Pale, swollen optic disc with surrounding nerve fibre haemorrhages and cotton wool spots if arteritic.
101
Which condition must you exclude in someone presenting with Anterior Ischaemic Optic Neuropathy?
GCA!
102
What is the treatment for chemical injuries to the eyes?
Wash out copiously with saline until the pH is neutral.
103
Out of acids and alkalis, which are most toxic to the eyes?
Alkalis
104
What is a hyphaema?
What view does it give on ophthalmoscopy?
What also gives the same view?
Hyphaema = blood in the anterior chamber
It gives a black opthalmoscopic view
Vitreous haemorrhage
105
What is traumatic mydriasis?
Irregular, poorly reacting pupil due to blunt trauma
106
What is Iridodialysis?
Peripheral tear of a section of the iris root
107
Name 2 metals that are chemically toxic to the retina
Copper and iron
108
In penetrating injuries, which imaging modality is essential?
CT scan
109
What harm can vegetable material (gardening/ farming) do to the eye?
Can lead to intraocular infection
110
What 2 things should you measure in someone with a suspected penetrating injury?
Visual acuity and intra-ocular pressure
111
What must you never ever ever do to an eye which you suspect might be perforated?
Press on it as the intraocular contents may be extruded!!
112
Name 4 symptoms of GCA
Night sweats, weight loss, scalp tenderness, jaw claudication
113
Which rheumatological condition is linked with GCA?
Polymyalgia rheumatica
114
Why might a patient with GCA get double vision?
Due to cranial nerve III/ IV/ VI palsies
115
How would you describe the temporal artery in someone with GCA?
Thickened, non-pulsatile and tender
116
Why might someone with diabetic retinopathy get a sudden loss of vision?
Due to vitreous haemorrhage
117
In terms of retinopathy staging, what does R1 mean?
Background retinopathy
118
In terms of retinopathy staging, what does R2 mean?
Pre-proliferative retinopathy
119
In terms of retinopathy staging, what does R3 mean?
Proliferative
120
What would you find on examination of someone with background retinopathy?
Microaneurysms, haemorrhages, exudates
121
What would you find on examination of someone with pre-proliferative retinopathy?
Venous beading, looping of vessels
122
What would you find on examination of someone with proliferative retinopathy?
Fine new vessels +/- venous haemorrhage
123
What would you find on examination of someone with end stage retinopathy?
Fibrosis, tractional retinal detachment
124
What is the treatment for background retinopathy?
Observe (focal laser if threatening fovea)
125
What is the treatment for pre-proliferative retinopathy?
Careful observation by an ophthalmologist
126
What is the treatment for proliferative retinopathy?
Urgent panretinal laser photo-coagulation (long-standing haemorrhage will require vitreoretinal surgery)
127
What is the treatment for end stage retinopathy?
Vitreoretinal surgery
128
In which type of diabetes is proliferative retinopathy more common in?
T1DM
129
In which type of diabetes is maculopathy more common in?
T2DM
130
Which part of the vision is affected in maculopathy?
Distortion of central vision with difficulty reading
131
What is the treatment for macular oedema in maculopathy?
Intravitreal anti-VEGF injections
132
What is retinal detachment?
The separation of sensory retina from retinal pigment epithelium
133
What changes in vision would someone with retinal detachment report and where would this occur?
Flashes, floaters, field loss (inverse and opposite direction to detachment)
134
On examination, how would the retina look in someone with retinal detachment?
Grey, corrugated appearance of retina ballooning forward into vitreous.
135
What are the 2 surgical options for someone with retinal detachment?
What in injected into the vitreous cavity to tamponade the retina during these surgeries?
- Cryotherapy to seal tear and suturing into sclera a silicone buckle to relieve (external)
- Pars plana vitrectomy (internal - removes vitreous jelly and lasers to seal)
Air is injected
136
How does age related macular degeneration tend to present in terms of eyes affected and vision changes?
Bilateral loss of central vision in old (central scotoma)
137
Why might someone with age related macular degeneration have a sudden deterioration in their vision?
If there is a haemorrhage as seen in the wet type.
138
What is the first symptom someone with age related macular degeneration tends to experience?
Distortion of vision
139
Which type of age related macular degeneration is most common?
Dry age related macular degeneration
140
Which precursor is seen in dry age related macular degeneration and how would you describe it?
Drusen (soft-type - small yellowish macular lesion).
141
What is the classic lesion seen in dry AMD?
Geographic atrophy
142
Which form of age related macular degeneration is responsible for the most blindness in the disease?
Wet AMD
143
What imaging would you use in someone with wet AMD and what would you expect to see?
Fundus fluorescein angiography - would see choroidal neovascularisation
144
What effect does choroidal revascularisation have on the retina in someone with wet AMD?
These new blood vessels penetrate into the retina in the macular region and bleed. This eventually causes macular scarring which can result in profound loss of central vision (disciform scar)
145
What are the treatments/ advice you can give to someone with dry AMD?
No treatment :(
Advice: stop smoking
Low vision aids to help reading.
V high doses of antioxidants and zinc to decrease relative risk of it progressing to advanced AMD
146
What is the treatment for wet AMD? Give some examples
Anti-VEGF intravitreal injections e.g. Ranibizumab, Bevacizumab, Aflibercept
147
Define strabismus. What is it colloquially known as? What are the 2 types?
```
= Misalignment of the eyes
'Squint'
Either paralytic (=incomitant) or non-paralytic (=comitant).
```
148
What are the 2 different ways eyes can be in strabismus?
1) Convergent (esotropia/esophonia)
| 2) Divergent (exotriopia/ exophonia)
149
What does esoTROPIA mean?
A convergent squint which is always present
150
What does exoPHORIA mean?
A squint is intermittently present
151
What is a complication of strabismus in a child?
Amyblyopia
152
What is amyblopia?
| Name 2 causes
A reduction in vision which persists after removal of any obstacle to clear vision to DEVELOPING visual system.
Causes include strabismus and refractive errors.
153
Which age group is at risk of amyblopia?
At risk of amyblyopia if there is any reduction of visual stimulation in the first 6-8 years of life
154
What is the treatment for amyblopia? Only when does the treatment work?
Occlusion treatment: patch the good eye after management of the underlying cause
155
What causes paralytic strabismus?
When might the patient experience diplopia?
Which age group is able to suppress the diplopia?
Where is the limitation of movement?
Cranial nerve palsy.
Diplopia when eyes move into the direction of the palsied muscle or when 1 eye is covered.
A young child is able to suppress diplopia
There is a limitation of movement towards direction of the palsied muscle.
156
What is the most common type of strabismus in a child?
| What happens to ocular movements in this type?
Non-paralytic strabismus
| Ocular movements are full
157
Name 4 causes of non-paralytic strabismus
- High refractive errors
- poor vision
- retinoblastoma
- neurodevelopmental delay
158
What examination can you carry out on someone with non-paralytic strabismus?
Perform a cover test with a target (not a light) at near (33cm) and distance (6m)
159
What are the treatments for non-paralytic strabismus in a child?
Correct any amblyopia first
Refractive correction
Surgery
160
What are the treatments for non-paralytic strabismus in an adult?
Refractive correction
Botulinum toxin
Surgery
161
What is a positive scotoma?
Patient sees a grey/black area
162
What is a negative scotoma?
Patient sees a gap in their visual field
163
Name 2 causes of a central scotoma
Optic nerve lesion (ischaemic, compressive, demyelination), macular lesion
164
What visual defect can a pituitary space occupying lesion cause?
Bitemporal hemianopia
165
What visual defect can an issue with the retrochiasmal pathways (vascular, compressive) cause?
Homonymous hemianopia
166
What does Perimetry measure and put simply, how does it work?
Measures patient's field of vision.
| Confrontation to white and red targets (easy, quick and accurate
167
What are the 2 types of Perimetry?
- Manual perimetry: Goldmann perimetry (kinetic)
| - Automated perimetry: e.g. Humphrey visual field (static)
168
Which type of diplopia disappears when 1 eye is closed?
Binocular diplopia
169
Which eye(s) is affected in supranuclear disorders and why?
Both eyes as the lesion is central to the cranial nerve nucleus
170
Why does internuclear ophthalmoplegia occur?
Due to lesion in the medial longitudinal fasciculus
171
What 2 things do the medial longitudinal fasciculus connect?
The 6th cranial nerve nucleus to the contralateral medial rectus muscle.
172
How does internuclear ophthalmoplegia present?
Prevents eye adducting when the contralateral eye abducts and the abducting eye develops nystagmus.
173
Name 4 causes of nystagmus
Sensory deprivation before 6 years old
Cerebellar disease
Alcohol
Congenital (decreased vision, no oscillopsia)
174
Generally speaking, what are the 2 causes of a positive RAPD?
Decreased optic nerve function or gross retinal disease
175
What is another term for a Holmes-Adie pupil? How does this present? How does it change over time?
AKA tonic pupil
1 or both pupils abnormally dilated with delayed constriction to light. Large pupil initially then smaller pupil years later.
176
How do Argyll-Robertson pupils present?
| Name 2 conditions they may be seen in
Small pupils. can accommodate but don't respond to light.
| May be seen in syphilis and diabetes.
177
What eye disease can B12 deficiency, tobacco/ alcohol amblyopia and methanol poisoning lead to?
What would you find on examination?
Optic atrophy - optic disc pallor
178
Name 4 causes of papilloedema
- Obstruction of CSF flow in ventricular system by congenital or acquired lesions (e.g. brain tumour)
- Obstruction of CSF absorption by arachnoid villi (e.g. blood, protein, inflammatory debris)
- Obstruction of cerebral venous drainage system
- Idiopathic intracranial hypertension (IIH)
179
Name 3 symptoms a patient with papilloedema may experience
| When might vision become affected?
- Headache with diurnal variation and postural features
- Pulsatile tinnitus
- Transient visual obscurations
- Normal vision unless optic atrophy
180
Name 6 signs you may see in someone with papilledema on examination of their eyes
What would happen to their visual fields?
- Blurring of both optic disc margins
- Loss of spontaneous venous pulsations
- Elevation of optic disc with obscuration of vessels
- Hyperaemia and venous engorgement
- Haemorrhages and cotton-wool spots
- Visual fields full although blind spot enlarged in more advanced cases
181
What are the 4 treatments available for those with IIH?
- weight loss
- carbonic anhydrase inhibitors
- lumboperitoneal shunt or optic nerve sheath fenestration may prevent loss of vision
