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Opthalmology Flashcards

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1
Q

What is Blepharitis?

A

Inflammation of the rims of eyelids

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2
Q

Aetiology of Blepharitis

A

Chronic staphylococcal infection + Meibomian gland dysfunction

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3
Q

Presentation of Blepharitis

A

Gradual onset gritty/dry eye, crusting on lashes, red conjunctivae, red rimmed thickened lid margins, blocked/oozing Meibomian glands

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4
Q

Management of Blepharitis

A

Eyelid hygiene, massage, hot compresses

Topical Chloramphenicol

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5
Q

What is a Chalazion?

A

Granuloma of Meibomian gland

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6
Q

Presentation of Chalazion

A

Eyelid swellng/lump, tender red eye, watery eye, heaviness of eyelid

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7
Q

Management of Chalazion

A

Warm compresses, Chloramphenicol, Surgical incision

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8
Q

What is a stye?

A

Infection of the lash follicle

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9
Q

What is the most common tumour of the eyelid?

A

Basal Cell Carcinoma

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10
Q

Which muscles does the 3rd cranial nerve (oculomotor) supply?

A 
Levator palpebrae superioris, Superior rectus, Inferior rectus, Medial rectus, Inferior oblique
Constrictor pupillae (constricts pupil)
Ciliary muscles (adapts to short range vision)
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11
Q

Causes of 3rd nerve palsy

A

Raised ICP- compressed against temporal bone

Posterior communicating artery aneurysm, Cavernous sinus infection/trauma, Diabetes, MS, MG

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12
Q

Presentation of 3rd nerve palsy

A

Ptosis, eye down & out, unable to elevate, depress or adduct eye, fixed dilated pupil

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13
Q

Management of 3rd nerve palsy

A

Treat the cause

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14
Q

Aetiology of Retinal Tear/Detachment

A

Neurosensory layer detaches from epithelium

Most preceded by posterior vitreous detachment

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15
Q

Risk factors for Retinal Tear/Detachment

A

Myopia, FH, previous Hx, age, lattice degeneration, Marfan’s, diabetic retinopathy, maculopathy

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16
Q

Presentation of Retinal Tear/Detachment

A

New onset floaters/flashes, sudden onset painless progressive visual loss, RAPD, altered red reflex

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17
Q

Management of Retinal Tear/Detachment

A

Urgent referral
Cryotherapy/Photocoagulation for tears
Surgery for detachment
Topical Abx + steroids

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18
Q

Aetiology of Diabetic Retinopathy

A

Microvascular occlusion –> Retinal ischaaemia –> Arteriovenous shunts + neovascularisation
Leakage –> intraretinal haemorrhages + oedema
Visual loss due to macular oedema, foveal ischaemia and foveal haemorrhage

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19
Q

Presentation of Diabetic Retinopathy

A

Gradual reduction in central vision

Haemorrhages cause sudden onset dark painless floaters

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20
Q

Features of Background Diabetic Retinopathy

A

Microaneurysms, Blot haemorrhages, Hard exudates

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21
Q

Features of Pre-proliferative Diabetic Retinopathy

A

Cotton wool spots, >3 blot haemorrhages, venous beading/looping, dark cluster haemorrhages

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22
Q

Features of Mild vs Moderate vs Severe Non-proliferative Diabetic Retinopathy

A

Mild: 1 or more microaneurysms
Moderate: microaneurysms, blot haemorrhages, hard exudates, cotton wool spots, venous beading/looping
Severe: blot haemorrhage + microaneurysms in 4 quadrant, venous beading in at least 2 quadrants, intraretinal microvascular abnormalities in 1 quadrant

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23
Q

Features of Proliferative Diabetic Retinopathy

A

Retinal neovascularisation, fibrous tissue forming anterior to retinal disc

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24
Q

How often are diabetics screened for Diabetic Retinopathy?

A

Annually

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25
Management of Diabetic Retinopathy
Glycaemic + BP control Smoking cessation Laser treatment, intravitreal steroids, anti-VEGF, vitrectomy for bleed
26
What is Diabetic maculopathy?
Grouped exudate within the macula | Any exudate or retinal thickening within 1 disc diameter of the foveola
27
Management of diabetic maculopathy
Laser | Intravitreal triamcinolone
28
What is the arterial supply to the eye?
Opthalmic artery from internal carotid
29
What s the venous supply of the eye?
Superior and inferior opthalmic veins- drain into cavernous sinus
30
Differentials of a red eye
``` Keratitis Scleritis Uveitis Endopthalmitis Acute glaucoma ```
31
Causes of blue sclera
Rheumatoid arthritis | Marfan's syndrome
32
Causes of proptosis/exopthalmos
Eye forwards- thyroid disease | Eye downwards- lacrimal gland tumour
33
Causes of purulent eye discharge
Infection, allergy
34
Causes of bloody eye discharge
Severe infection | Tumour
35
Cause of sudden visual loss
Vascular/inflammatory eg retinal vein occlusion
36
Causes of transient visual loss
Vascular cause- GCA/retinal emboli
37
Causes of central visual loss
Macular or optic nerve disease
38
Causes of peripheral visual loss
Glaucoma, CVA, retinitis pigmentosa
39
Causes of colour vision loss
Optic neuritis, cataract, drug toxicity
40
Cause of poor night vision
Retinitis pigmentosa
41
Causes of loss of red reflex
Cataracts, Retinoblastoma
42
What is Amaurosis fugax?
Transient and painless loss of vision in one eye - transient retinal ischaemia
43
What are the most common causative organisms for infectious conjunctivitis?
Adenovirus, Herpes, Staph, Strep, Moraxella, Chlamydia, Gonorrhoea
44
Management of infectious conjunctivitis
Topical antibiotics- Chloramphenicol
45
What are red flags of a red eye?
Impaired vision, pain/photophobia, lack of ocular discharge
46
What is uveitis?
Inflammation of the uveal tract (iris + ciliary body + choroid) Anterior (iritis) or Posterior
47
Causes of Uveitis
Autoimmune disease eg Sarcoidosis, infections, infiltrative (neoplastic), trauma, ischaemic, immunosuppression
48
How do you determine if Uveitis is granulomatous or not?
Whether or not there are keratic precipitates
49
Presentation of Anterior Uveitis
Unilateral painful red eye, photophobia, pain worse when reading, blurred vision, tear production, headache
50
Presentation of Intermediate Uveitis
Painless floaters, reduced vision
51
Presentation of Posterior Uveitis
Gradual visual loss, bilateral blurred vision and floaters
52
Management of Uveitis
``` Cytoplegic-mydriatic drugs- 1% Atropine- relieves pain and prevents adhesions Corticosteroids Immunosuppressors- Ciclosporin Laser phototherapy, Cryotherapy Vitrectomy ```
53
What is Glaucoma?
Damage to the optic nerve head with progressive loss of retinal ganglion cells and their axons
54
Aetiology of open angle glaucoma
Flow is reduced through trabecular meshwork (absorbs aqueous humour) --> painless chronic degenerative obstruction
55
Aetiology of closed angle glaucoma
Iridocorneal angle closed by forward displacement of the foot of iris against the cornea --> aqueous humour cannot flow from posterior to anterior angle --> rapid and painful build up
56
Risk factors for Glaucoma
Raised IOP, myopia, diabetes, FH, Female, prolonged steroid use, uveitis, hypertension, trauma Mydriatic drops can be a precipitant of closed-angle
57
Investigation in Glaucoma
Gonioscopy- measure angle between cornea + iris
58
How is Glaucoma screened for?
Annual screening from age 40 if family history
59
Presentation of open-angle glaucoma
Majority asymptomatic Chronic progressive bilateral peripheral visual loss then tunnel vision Intraocular pressure 11-21
60
Management of Glaucoma
1. Increase uveoscleral outflow- Prostaglandin analogues- Latanoprost 2. Reduce aqueous production- B Blockers- Timolol 3. Trabeculectomy/Laser surgery DVLA!
61
Presentation of closed-angle glaucoma
Severe and rapid pain, blurred vision, coloured haloes, N&V, red eye Hard globe- raised IOP
62
What is the world's leading cause of blindness?
Cataracts
63
Risk factors for cataracts
Age, smoking, diabetes mellitus, systemic corticosteroids, uveitis, UV exposure, malnutrition Paeds: Rubella, metabolic, trauma
64
Presentation of cararacts
Gradual painless loss of vision, diplopia, glare, haloes, defects in red reflex
65
Management of cataracts
Surgery- lens extraction + replacement Phacoemulsification DVLA
66
What is Age-related Macular Degeneration?
Ageing changes without any other obvious precipitating cause in the macula age > 55
67
Risk factors for Age-related Macular Degeneration
Smoking, age, FH, hypertension, aspirin use, exposure to sunlight, previous cataract surgery, alcohol, obesity, hyperopia, CV disease
68
Pathophysiology of Age-related Macular Degeneration
Dry- Drusen- collection of lipid + proteins beneath retinal pigment epithelium + within Bruck's membrane Atrophy of light-sensitive cells, neovascular AMD
69
Presentation of Age-related Macular Degeneration
Can be asymptomatic Painless deterioration and blurring of central vision Metamorphosia- straight lines blurry Scotoma- grey/black patch over central vision Light glare, loss of contrast Photopsia- flashing/flickering lights Visual hallucinations- Charles Bonnet
70
Management of Age-related Macular Degeneration
1 week referral Wet- VEGF- Ranibizumab, Photocoagulation/Photodynamic therapy Dry- vit A/C/E or zinc
71
Differentials of dry eye
Hyposecretive- Sjogren's, lymphoma, sarcoidosis, lacrimal gland obstruction, CNVII damage, anticholinergics, beta blockers, SSRIs, diuretics, antihistamines Evaporative- Blepharitis, Parkinson's, thyroid eye disease, vitamin A deficiency, contact lenses
72
Risk factors for dry eyes
Female, old age, HRT, contact lenses
73
Investigations for dry eyes
Tear break-up time with fluorescein | Schirmer's test- filter paper wetting in 5mins < 5mm
74
Causes of Papilloedema
SOL eg neoplasia, infection, haemorrhage, idiopathic intracranial hypertension, hydrocephalus
75
Causes of Horner's syndrome
Central- MS, stroke Pre-ganglionic- Pancoast tumour Post-ganglionic- Carotid artery disseciton
76
What does papilloedema signify?
Raised intracranial pressure
77
Presentation of Horner's syndrome
Ptosis, Meiosis (contricted pupil), anhidrosis, pseudo-enopthalmos
78
Key difference between Horner's syndrome and 3rd nerve palsy in terms of presentation
Horner's: constricted pupil | 3rd nerve palsy: dilated pupil
79
Features of hypertensive retinopathy
Arterial narrowing- 'copper wiring' Arteriovenous nipping Vascular leakage Haemorrhage + exudates Macular star- thin white streaks around macula Disc swelling, cotton wool spots, blot (flame) haemorrhages
80
Management of hypertensive retinopathy
Manage the hypertension
81
Presentation of Retinitis pigmentosa
Night blindness + tunnel vision
82
Fundoscopy findings in Retinitis pigmentosa
Black bone spicule-shaped pigmentation in peripheral retina, mottling of retinal pigment epithelium

Finals Revision (13 decks)

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