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Opthalmology Flashcards

1
Q

What are the features of an afferent pupillary defect?

A

No direct response but in tact consensual response
No contralateral consensual response
Dilation on moving light from normal to abnormal eye

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2
Q

What are the causes of a Marcus Gunn pupil?

A

Optic neuritis
Optic atrophy
Retinal disease

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3
Q

What are the features of an efferent pupilliary defect?

A

Dilated pupil which does not react to light
Initiates consensual response in contralateral eye
Opthalmoplegia
Ptosis

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4
Q

What is the cause of an efferent pupillary defect?

A

3rd nerve palsy

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5
Q

What are the differentials for a fixed dilated pupil?

A

Mydriatics e/g/ tropicamide
Iris trauma
Acute glaucoma
CN3 compression

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6
Q

What are the features of Horner’s syndrome?

A

PEAS

Ptosis
Enopthalmos
Anhydrosis
Small pupil

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7
Q

What are the causes of Horner’s syndrome?

A

Central, pre-gang, post-gang

Central - MS, LMS

Pre-gang - Pancoast’s tumour (T1), trauma due to CVA insertion

Post-gang - Cav sinus thrombosis, CN3,4,5,6 palsies

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8
Q

What are Argyll Robertson pupils and what causes them?

A

Small irregular pupils which accomodate but dont react to light.

DM
Quaternary syphillis

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9
Q

What are the features of optic atrophy/neuropathy?

A

Reduced acuity and colour vision
Central scotoma
Pale optic disc
RAPD

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10
Q

What are the causs of optic atrophy/neuropathy?

A

CAC VISION
n.b. MS and glaucoma commonest

Congenital - CMT, Leber’s Hereditary optic neuropathy, retinitis pigmentosa

Alcohol etc. - Lead, B12 def

Compression - Neoplasia, glaucoma, Pagets

Vascular - DM, GCS, VTE

Inflamm - MS

Sarcoid

Infection - Zoster, syphillis, TB

Oedema - papilloedema

Neoplastic infiltrates (lymphoma/leukaemia)

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11
Q

What might be the history findings of red eye?

A

Vision - blurred, diplopia, scotoma, floaters, flashes

Sensation - irritation, pain, itching, photophobia, FB

Apperaance - red +- lump

Discharge - watery, sticky, stringy

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12
Q

What are the signs of serious disease in a patient with red eye?

A

Photophobia
Visual impairment
Corneal fluorescein staining
Abnormal pupil

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13
Q

What are the key examination questions in red eye?

A

Is acuity affected?
Is the globe painful?
Are the pupils equal and reactive?
Are the cornea in tact or cloudy?

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14
Q

Comment on each of the following in acute glaucoma:

Pain
Photophobia
Acuity
Cornea
Pupil
IOP
A 
Pain +++
Photophobia nil
Acuity reduced
Cornea hazy/cloudy
Pupil large
IOP raised
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15
Q

Comment on each of the following in anterior uveitis:

Pain
Photophobia
Acuity
Cornea
Pupil
IOP
A 
Pain ++
Photophobia ++
Acuity reduced
Cornea normal
Pupil small
IOP normal
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16
Q

Comment on each of the following in conjunctivitis:

Pain
Photophobia
Acuity
Cornea
Pupil
IOP
A 
Pain +/-
Photophobia +
Acuity normal
Cornea normal
Pupil normal
IOP normal
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17
Q

What is the pathology and thus of acute closed angle glaucoma?

A

Blocked drainage of aqueous humor from anterior to posterior chamber via the canal of Schlem
Pupil dilatation worsens the blockage
IOP rises from 15-20 ->60

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18
Q

What are the risk factors for acute closed angle glaucoma

A 
Hypermetropia (long sightedness)
Shallow ant chamber
Female
FH
Old age
Drugs - anticholinergics, TCAs, anti-histamines
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19
Q

What are the symptoms of acute glaucoma?

A

Severe pain with N/V

Reduced acuity with blurred vision

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20
Q

What are the examination findings of acute glaucoma>

A

Cloudy cornea with circumcorneal injection
Fixed, dilated, irregular pupil
Raised IOP makes eye feel hard

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21
Q

What is the acute management of acute glaucoma?

A

Pilocarpine drops - miosis opens blockage
Topical beta blockade (timolol) - reduces aqueous formation
Acetazolamide 500mg IV state - reduces aqueous formation
Analgesia
Antiemetics

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22
Q

What is the pathophysiology of anterior uveitis?

A

Uvea includes iris, ciliary body and choroid (vascular layer)
These structuresbecome inflamed in ant uveitis

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23
Q

What are the symptoms of anterior uveitis?

A

Acute pain and photophobia

Blurred vision

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24
Q

What are the examination findings of anterior uveitis?

A

Amall pupil initially ->irregular later on
Circumcorneal injection
Hypopyon - pus in ant chamber

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25
What is Tablot's test and when is it positive?
Assesses pain on convergence and is seen in anterior uveiitis
26
What are the associations with ant uveitis?
``` Seronegative arthropathies - AnkSpon, psoriatic, Reiters Stills disease IBD Sarcoid Bechets Various infections ```
27
What is the management of anterior uveitis?
Prednisolone drops | Cyclopentolate drops dilate the pupil and prevent adhesions forming between iris and lens
28
How does episcleritis present and what causes it?
Localised reddening which can be moved over the sclera Painless/mild discomfort Acuity is preserved Usually idiopathic
29
How do you treat episcleritis?
Topical or systemic NSAIDs
30
How might scleritis present?
Severe pain worse on movement Generalised scleral inflammation (vessels wont move unlik episcleritis) Conjunctival oedema (chemosis)
31
What are the common causes of scleritis?
GwP RA SLE Vasculitides
32
How is scleritis managed, and what is an important complication to note?
Corticosteroids or immunosuppressants Scleromalacia (thinning) may precede globe perforation
33
What are the presenting features ofconjunctivitis?
Often bilateral with purulent discharge Discomfort Conjunctival injection (vessels may be moved over sclera) Acuity responses and cornea are unaffected
34
What are the causes of conjunctivitis?
Adenovirus Bacterial - staph, chlamydia, gonogoccal ALlergic
35
What is the treatment for conjunctivitis?
Chloramphenicol ointment if bacterial | Antihistamine drops if allergic
36
HOw would you investigate a corneal abrasion?
Under a slit lamp with fluorescein stain which marks the defect green
37
What would you give for a corneal abrasion?
Chloramphenicol prophylaxis
38
What are the features of corneal abrasion?
Pain Photophobia Blurring
39
What are the causes of corneal inflammation?
Bacterial, herpes, fungi, RA
40
What are the features of corneal inflammation?
``` Pain Photophobia COnjunctival hyperaemia Reduced acuity White corneal opacity ```
41
What is the main risk factor for corneal inflammation?
Contact lenses
42
How would you investigate corneal inflammation?
Slit lamp and fluorescein
43
What is the management of corneal inflammation
``` Immediate referral Smears and cultures Abx/aciclovir drops Mydriatics ease photophobia Steroids worsen symptoms ```
44
What is the presentation of opthalmic shingles?
Pain in CNV1 distribution precedes a blistering rash 40% develop keratitis, ant uveitis Hutchinson's sign - nose tip zoster due to nasociliary involvement
45
What are the key questions to ask in the event of sudden loss of vision?
HELLP Headache? - GCA Eye movement pain? - optic neuritis Lights
46
What are the clinical features of optic neuritis?
``` Unilateral acuity loss over hours-days Dyschromatoplasia Painful eye movements Enlarged blind spot Afferent defect ```
47
What are the causes of optic neuritis?
``` MS DM Ethambutol, chloramphenicol Vit def Zoster/Lyme disease ```
48
What is the treatment of optic neuritis?
IV methyle pred for 72 hrs then oral pred for 11 days
49
What are the common sources of vitreous haemorrhages?
Neovascularisation in DM | Retinal tear/detacment/trauma
50
WHat is the resolution of vitreous haemorrhage?
Usually undergoes spontaneous resolution
51
WHat is the presentation of central retinal artery occlusion?
Dramatic unilateral visual loss in seconds Afferent pupil defect Pale retina with cherry red macula
52
What are the causes of central retinal artery occlusion?
GCA | Thromboembolism
53
What is the teratment of central retinal artery occlusion?
Ocular massage Surgical aqueous removal Antihypertensives
54
What are causes of retinal vein occlusion?
Arteriosclerosis, HTN, DM, polycythaemia
55
What is the presentation of retinal vein occlusion?
Sudden unilateral vision loss associated with RAPD in the case of central retinal vein occlusion
56
What are the fundoscopic findings in central retinal vein occlusion?
Central - Stormy sunset appearance with tortuous dilated vessels Haemorrhages Cotton wool spots
57
What are the complications of central retinal vein occlusion?
Glaucoma | Neuovascularisation due to VEGF release
58
What are the causes of retinal detachment?
SUrgery Trauma DM
59
What are the clinical features of retinal detachment?
4Fs Floaters Flashes Field loss Fall in acuity
60
What are the fundoscopic features of retina detachment?
Grey opalescent retina with ballooning
61
What is the management of retinal detachment?
Urgent surgery with vitrectomy and gas tamponade c laser coagulation to secure the retina
62
What are the causes of transient visual loss?
Vascular - TIA, mibgraine MS Subacute glaucoma Papilloedema
63
What are the causes of gradual visual loss?
``` Common DM ARMD Cataracts Open angle glaucoma ``` Rarer Retinitis pigmentosa HTN Optic atrophy
64
WHat are the commonest causes of blindness in those over and under 60?
Under 60 - DM retinopathy | Over 60 - ARMD
65
What are the risk factors for ARMD?
Age Smoking Genes
66
What is the primary presenting feature of ARMD?
Central visual loss
67
What is the difference between dry and wet ARMD?
Dry presents with fluffy white spots around the macula with degeneration, which may progress to Wet ARMD with neovascularisation, haemorrage and rapid visual decline
68
What is the management of wet ARMD?
Photodynamic therapy VEGF inhibitors Antioxidants and vitamins
69
What is the typical presentation of open angle glaucoma?
Peripheral visual field defect begining superonasally and working inferotemporally
70
What are the risk factors for OA glaucoma?
``` >35 A-C FH Steroids DM HTN Myopia ```
71
How would you investigate open angle glaucoma, and what would be seen on fundoscopy?
Tonometry - IOP>21mmHg Fundoscopy shows cupping of the optic disc Peripheral loss on visual field assessment
72
What is the management of OA glaucoma?
``` Life long folow up Drops to lower IOP B blockers - timolol Prostaglandin analogues - Latanoprost A-agonists - Brimonide Carbonic anhydrase inhibitors - acetazolomide Miotics - pilocarpine ``` Non medical Laser trabeculoplasty
73
Why does DM cause cataracts?
THe lens absorbs glucose which is converted to sorbitol by aldose reductase
74
WHat is the pathogenesis of diabetic retinopathy?
Small vessel disease causes occlusion which leads to ischaemia and neovascularisation which may bleed and result in vitreous haemorrhage with oedema and lipid exudates Occlusion also causes cotton wool spots as a sign of ischaemia Microaneurysms may rupture and cause blot haemorrhages
75
What is the screening programme for diabetic retinopathy?
All diabetics should be screened annually with fundus photogaphy. Those with macular degeneration, proliferative and pre-proliferative retinopathy should be referred
76
How else can you investigate DM retinopathy?
Fluorescein angiography
77
WHat is the management of DMR?
Good BP and glycaemic control Treat concurrent illnesses Stop smoking Laser photocoagulation (Focal/grid for maculopathy, pan-retinal with macular sparing for proliferative disease
78
What are the fundoscopic findings of each stage of DM retinopathy?
Background - leakage Dots - microaneurysms Blot haemorrhages Hard exudates - yellow lipid patches ``` Pre-proliferative - ischaemia Cotton wool infarcts Venous beading Dark haemorrhages Microvascular abnormalities ``` Proliferative - Neovascularisation Vitreous haemorrhage Retinal detachment Maculopathy - macular oedema Inaccuity amy be only sign Hard exudates within one disc width of the macula
79
What is the typical presentation of cataracts?
Myopia Blurred vision Dazzling sunshine Monoocular diplopia
80
What are the causes of cataracts?
``` Age DM Steroids Idiopathic Congenital rubella Myotonic dystrophy ```
81
What is the management of cataracts?
Conservative Glasses and mydriatic drops Surgical Phacoemulsification with lens implant
82
What are the complications of phacoemulsification surgery?
``` Ant uveitis Vhaemorrhage Ret detachment Glaucoma Capsule thickening Irritation ```
83
What are the various inheritance methods of retinitis pigmentosa?
Mostly AR AD best XLR worst
84
What is the typical presentation of retinitis pigmentosa?
Night blindness | Tunnel vision
85
What are the fundoscopic findings of ret pig?
Pale optic disc- (atrophy) | Peripheral pigmentation with macular sparing
86
Give a syndrome which is assocaited with ret pig
Friedrich's ataxia
87
WHat are the findings of a retinoblastoma?
Strabismus | White pupil with no red reflex
88
What is the difference between a stye and a chalazion?
A stye is an abscess/infection in a lash follicle which points outwards, whereas a chalazion is the same but pointing inwards
89
What is blepharitis and what are its features?
Chronic inflammation of the eyelid Red eyes Gritty/itching Scales on lashes Often w. rosacea
90
What causes blepharitis and how is it treated?
Seborrheic dermatitis and staph Clean crusts with warm soaks +-fusidic acid drops
91
What are en- and ectropia?
Entropion is lid inversion leading to corneal irritation Ectropion is lower lid eversion leading to watering and exposure keratitis
92
What are the causes of ptosis?
``` Bilateral Congenital Senile Myasthenia Myotonic dystrophy ``` Unilateral 3rd nerve palsy Horner;s Xanthalesma. trauma
93
What is pterygium?
A benign overgowth of the conjunctiva leading to yellow bascular nodules over the cornea
94
What are the causes of expothalmos?
Common Graves (esp in smokers) Orbital cellulitis Trauma ``` Rarer Idiopathic GwP Neoplasm Carotid cavernous fistula ```
95
What are myopia and hypermetropia and their treatments?
Hypermetropia= long sightedness Eye is too short so give convex lenses Myopia = short sightedness Eye is too long so give concave lenses
96
What are eso and exotropia?
Esotropia is a convergent squint | Exotropia is a digergent squint
97
What is the difference between a non-paralytic and paralytic strabismus?
Non paralytic is when the strabismus occurs in all directions, while parlytic squint diplopia is present and most notable on looking towards the pull of the paralysed muscle
98
What are the causes of the various paralytic squint?
CN3 Medical - DM, MS, infarction Surgical - raised ICP, CS thrombosis, posterior communicating artery aneurysm CN4 Peripheral - DM, trauma, compression Central - MS, vascular, SOL CN6 as for CN4
99
How would you manage an ocular foreign body?
Chloramphenicol prophylaxis Eye patch Cyclogenic drops for pain relief (tropicamide
100
What is -and the presentation of -an orbital blow out fracture?
Blunt injury causes sudden rise in IOP as orbital contents herniate into the maxillary sinus ``` Opthalmoplegia Diplopia Loss of sensation to lower lid skin Ipsilateral epistaxis Poor light response ```
101
What causes floaters?
Ret detachment FH DM HTN
102
What is the commonest cause of flashes/photopsia?
posterior detachment
103
What is the pathophysiology of a trachoma?
Caused by Chlamydia trachomatis spread by flies. results in inflammation -> scarring -> lid distortion -> Entropion -> corneal irritation.....blindness
104
What is the management of trachoma?
Tetracycline 1% ointment
105
What are the eye signs in hypertensive retinopathy?
``` Tortuosity Silver wiring AV nipping Flame haemorrhages Cotton wool spots Papilloedema ```
106
What are the eye signs in HIV patients?
CMV retinitis - pizza pie fundus with flames | HIV retinopathy - cotton wool spots
107
What are the different types of mydriatics commonly used?
Anti-muscarinics e.g. Tropicamide | Sympathomimetics e.g. Phenylephrine
108
What are the different types of miotics commonly used and why would you use one?
Pilocarpine - muscarinic agonist | Used for acute glaucoma

Scott's Notes (21 decks)

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