opthalmology Flashcards
(424 cards)
1
Q
amblyopia
A
reduced vision in a structually normal eye
2
Q
anirdia
A
absence of iris
3
Q
anterior chamber
A
aqueous chamber lying between cornea and iris
4
Q
aphakia
A
absence of lens
5
Q
aqueous humour
A
secretion of the ciliary body which flows through the pupil into the anterior chamber and largely leaves the eye via the drainage angle
6
Q
arcuate scotoma
-what and feature of?
A
an arc shaped blind spot running from the blind spot to the peripheral visual field
- position determined by course of damaged retinal nerve fibres
- feature of chronic glaucoma
7
Q
astigmatism
A
refractive error that prevents the light rays from coming to a single focus on the retina because of the irregular corneal curvature
- near and far sight are blurry
8
Q
blepharitis
A
inflammation of the eyelids, most commonly the lid margins
9
Q
blepharospasm
A
spasm which may be tonic or chronic, of the orbicularis oculi muscle (closes the eyelid)
10
Q
buphthalmos
A
the large eyeball in infantile glaucoma
11
Q
blind spot
A
each eye has a normal blind spot which corresponds to the optic nerve head
12
Q
blind spot
A
each eye has a normal blind spot which corresponds to the optic nerve head
13
Q
canal of schlemm
A
a circular drainage canal (a venous sinus) into which aqueous humour drains from the trabecular meshwork before discharging into the anterior ciliary veins
14
Q
canthus
A
the angle at either end of the eyelid aperture, specified as outer or inner
15
Q
cataract
A
opacity of the lens
16
Q
chemosis
A
conjunctival oedema and swelling
17
Q
choroid
A
thin, highly vascular membrane covering the posterior 5/6 of the eyeball between the retina and sclera
18
Q
conjunctiva
A
mucous membrane lining the inner surfaces of the eyelids and the anterior part of the sclera
19
Q
conjunctival concretion
A
cluster of small hard yellowish-white calcified matter mostly in the clear membrane on the inside of the eyelid
20
Q
convergence
A
movement of the eyes turning inwards towards each other
21
Q
cornea
A
the curved transparent anterior portion of the fibrous outer coat of the globe of the eye
22
Q
cyclodiode laser
A
trans- scleral diode laser photo-coagulation used to lower intra-ocular pressure in advanced glaucoma
23
Q
cyclodiode laser
A
trans- scleral diode laser photo-coagulation used to lower intra-ocular pressure in advanced glaucoma
24
Q
cycloplegic
A
a drug that temporarily puts the ciliary muscle at rest, paralyses accomodation and dilates the pupil
25
dacryocystitis
inflammation of the lacrimal sac
26
dacrocystorhinostomy
an operation to produce an alternative drainage route between the lacrimal sac and the nose
27
diabetic retinopathy
microvascular disease of the retina in diabetes
28
drainage angle
the zone in the anterior chamber through which the aqueous must pass to leave the eye
lies at the point of convergence of the iris with the cornea
29
diplopia
the condition in which a single object is seen as two rather than one
30
divergence
movement of the eyes turning outwards away from each other
31
ectropion
turning out of the eyelid
32
emmetropia
state of normal vision
33
endophthalmitits
this is an inflammation of the interior of the eye
- can be a complication of all intraocular surgeries and or procedures
- with the potential of loss of vision or even the eye itself
- eye looks cloudy and inflammed
34
enopthalmos
recession of the eye (globe) into the orbit
35
enotropion
a turning inward of the eyelid
36
enucleation
complete surgical removal of the eyeball
37
episclera
the free connective tissue between the sclera and the conjunctiva
38
episclera
the free connective tissue between the sclera and the conjunctiva
39
evisceration
removal of the eye's contents leaving the scleral shell and the extraocular muscle intact
-performed to reduce pain or improve aesthetics in a blind eye with endophalmitis
40
exenteration
removal of the entire contents of the orbit, including eyeball, lids and periostium
41
exopthalmos
abnormal protrusion of the eyeball -due to endocrine
42
fornix
the junction of the lid (palpebral) and globe (bulbar) conjunctivas. the pocket into which medication is instilled
43
fundus, ocular
the interior of the eye visible through the pupil with the use of an opthalmoscope
comprises of the retina, pars planna, retinal blood vessels and sometimes choroidal vessels
44
glaucoma
complex group of eye disorders having a common feature of optic nerve damage of a characteristic type affecting the optic nerve head
-assoc. with elevated or unstable intra-ocular pressures
45
goldman's applanation tonometer
a slit lamp mounted instrument which estimates the intraocular pressure by the force required to flatten a given corneal area
46
heterochromia
difference in colour of the two irises or of different parts of the same iris
47
hypermetropia
long sighted
48
hyphaema
haemorrhage into the anterior chamber
49
hypopyon
collection of white cells in the anterior chamber of the eye forming a fluid level
50
iris
the muscular and vascular diaphragm interposed between the cornea and the crystalline lens
51
keratic precipitates KP
fine cellular deposits at the back of the cornea
52
keratitis
inflammation of the cornea, which may or may not be assoc. with infection
53
limbus
junctional zone where the cornea joins the sclera
54
macula
the cone rich portion of the retina, used for fixation of gaze
55
meibomian cyst (tarsal cyst, chalazion)
a small localised swelling of the eyelid resulting from obstruction and retention of secretions of meibomian glands
-non malignant condition
56
miotics
drugs that constrict the pupil
| maybe used to treat glaucoma and accomodative strabismus
57
miosis
constriction of the pupil
58
mydriatics
drugs that dilate the pupil
| may be used to facilitate fundal examination, cataract and retinal surgery and to treat ocular inflammations
59
myopia
short sighted
term used to describe the optical status of the eye in which the images of distant objects are focused short (in front) of the retina.
The patient suffers from blurred distance vision
60
phaco
| phacoemulsificaiton
a procedure to removal the crystalline lens in cataract surgery that consists of emulsifying and aspirating the contents of the lens with the use of a low frequency ultrasonic needle inserted into the eye at the limbus (cataract surgery)
61
photophobia
abnormal sensitivity and discomfort to light
62
phthisical eye
a shrunken blind eye, which is undergoing severe degenerative changes.
Results in poor cosmetic appearance.
may also become painful and require enuculeation or appearance improved with fitting of a cosmetic shell
63
photopsia
flashing lights associated with migraine headaches, posterior vitreous detachment or retinal detachment
64
presbyopia (old sight)
physiologically blurred near vision, commonly evident soon after the age of 40
65
punctum
a tiny aperture in the margin of each eyelid, at the inner canthus almost level with the caruncle, that opens into the lacrimal duct
66
retina
light sensitive, innermost nervous tissue, layer of the eye which lies between the vitreous body and the choroid
- extends from the ora serrata to the optic disc and comprises ten layers
- The retina converts light into nerve impulses for transmission to visual and motor centres in the brain
67
sclera
tough white opaque portion of the fibrous outer coat of the eye
68
scotoma
an area of partial or complete blindness surrounded by a normal or relatively normal visual field
69
sjorgrens syndrome
a chronic connective tissue disease characterised by failure of lacrimal secretion and dryness of all mucous membranes
often assoc. to rheumatoid arthritis
70
hyperopia
long sighted
71
slit lamp
microscope for examining the eye under magnification and providing a slit like beam of light
72
strabismus squint
condition in which the lines of sight of the two eyes are not directed towards the same fixation point
73
synechia
adhesion of the iris to the cornea (anterior synechia)
| adhesion of the irirs to the lens (posterior)
74
temporal arteritis
sight threatening condition resulting from a systemic vasculitis
-dx based on CPR and ESR
give steroids!! sight threatening
75
tonometer
an instrument for the objective measurement of intra-ocular pressure
76
uveal tract
the major vascular comparment of the eye comprising iris, ciliary body and choroid
77
vitreous
gel of the eye, lying between the crystalline lens and the retina
78
keratoconus and rx
progressive thinning of the cornea
| treated with riboflavin and UVA light to cause new collagen cross linking
79
RX options for retinal detachment
--cryoptherapy with cold probe or
-photocoagulation with laser
-sceral bulking with silicone oil
pneumatic retinopexy with gas injections
vitrectomy - removed and replaced with gas or oil
80
cornea replacement
- complete= penetrating keratoplasty
| - partial= lamellar keratoplasty
81
macular hole repair Rx
vitrectomy- remove some of the vitreous gel to stop it pulling on the retina and a mix of gas/ air is inserted into the space
82
trichiasis
inward growing of eye lashes
83
red eye causes
1. allergic CJ
2. infectious conjunctivitis
3. iritis
4. scleritis
5. episcleritis
6. CN VII palsy
7. stromal keratitis
8. epithelial keratitis
9. acute angle closure glaucoma
84
Binocular diplopia causes and type of diplopia
```
Binocular Diplopia (improves when close one eye)
CN 3= vertical diplopia
CN IV= vertical diplopia
CN VI= horizontal diplopia
internuclear opthalmoplegia= horizontal
restrictive myopathy= thyroid- tight IR
```
85
monocular diplopia causes
cataracts does not improve when one eye closed
86
binocular visual loss causes
Chiasm lesion= bitemporal hemianopia
| post-chiasm lesion= homonymous hemianopia
87
monocular visual loss causes
```
refractive error (improves with pinhole)
retina detachment (RAPD)
optic nerve (RAPD)
vitreous haemorrhage
cataract
macula
```
88
epiphoria causes
```
red eye
ectropion (eyelid face outwards)
CN VII palsy
punctal stenosis
nasolacrimal duct stenosis (hard stop)
canalicular stenosis (soft stop)
```
89
CN VII palsy presentation
red eye
| inability to close eye
90
CNVI palsy
horizontal diplopia
loss of lateral rectus so eyes converge
loss of abduction
91
CN IV PALSY
superior oblique
vertical diplopia
eye faces upwards
92
CN IIII
```
all the rest
eye looks down and out due to LR and SO
vertical diplopia
unable to adduct
mydriasis -aniscoria
ptosis
```
93
Horner's syndrome
```
miosis
ptosis
anihydrosis
enopthalmos- sink
sympathetic NS
```
94
ocular causes of visual field defects
glaucoma- most common cause
macula degeneration- central scotoma
retinal detachment
optic neuritis- enlarged blind spot
95
neurological causes of visual field defects
space occupying lesion- pituitary, meningioma
aneurysm
stroke
trauma
96
orbital causes of visual field defects
optic nerve glioma
meningioma
hemangioma
97
vascular causes of visual field defects
branch retinal and central retinal
98
left optic nerve field defect
no light perception of left eye
99
chiasm field defect
bitemporal hemianopia
100
right optic tract field defect
incongrous left homonymous hemianopia
101
left lateral geniculate nucelus field defect
right homonymous quadruple sectoranopia
102
left temporal lobe field defect
right homonymous hemianopia upper quadrant
103
left parietal lobe field defect
right homonymous hemianopia lower quadrant
| PITS
104
left occipital lobe
right homonymous hemianopia- macula sparing
105
retinitis pigmentosa presentation
```
normal visual acuity
reduced visual field
pigmentation in the retina
usually initially loss of night vision
tunnel vision
```
106
what is retinitis pigmentosa
breakdown retina cells
genetic inhertied disorder
affects photoreceptors
peripheral retina loss
107
assoc. syndromes to retinitis pigmentosa
alport
refsum
usher
due to RPDR gene- autosomal dominant or x-linked
108
management of retinitis pigmentosa
no cure
Vit A supplements
complete blindness is rare but visual field loss will continue to be lost
109
causes of RAPD
optic neuropathy
| retinal pathology
110
how is an RAPD identified
swinging flashlight test
111
optic neuropathy fundoscopy
normal retinal appearance in optic neuropathy
depends on pathology
if optic papillitis (head of optic nerve) = presents with oedema around the optic disc
112
retinopathy fundoscopy
whitening of the retina- ischaemic
113
optic neuritis causes
MS
diabetes
syphilis
114
presentation of optic neuritis
- unilateral decrease in Visual acuity over hours
- poor discrimination- red desaturation
- pain worse on eye movement (infammation causes traction on inflammed meninges)
- RAPD
- central scotoma
115
treatment of optic neuritis
high dose steroids
| takes 4-6 weeks to recover
116
visual loss: macula pathology causes
- macular degeneration
| - diabetic maculopathy
117
macula degeneration fundoscopy features
```
drusden
RPE atrophy
choroidal neovascularisation
subretinal or sub RPE haemorrhage
RPE detachment
disciform scar at the macula
```
118
diabetic maculopathy signs
widespread haemorrhages
wide exudation
cisterna
119
causes of chiasmic field defect
pituitary adenoma
120
causes of homonymous hemianopia
stroke, trauma, tumour, infection
121
acute visual loss definition
rapid onset, <72 hours
usually monocular
may herald binocular disease
122
acute ocular vascular causes of visual loss
Central retinal vein occlusion
central retinal artery occlusion
branch retinal vein occlusion
branch retinal artery occlusion
123
acute neurologic vascular causes of visual loss
Arteritic anterior optic neuropathy- GCA
non-arteritic AION
optic neuritis
papillitis
124
acute systemic vascular cause of visual loss
CVD
Haematological
inflammatory and infection
125
where are binocular field defects located?
either chiasm or posterior visual pathway
126
acute non vascular causes of visual loss
traumatic
| non-traumatic causes: retinal detachment and vitreous haemorrhage
127
chronic causes of visual loss
- lifestyle: tobacco, alcohol
- macula degeneration ( painless)
- retinitis pigmentosa
- cataracts (painless)
- refractive error (painless)
- diabetic retinopathy
- chronic open angle glaucoma (painless)
- drugs
- papilloedema (IC HTN)
painful causes
- systemic eg sarcoidosis
- IC HTN- headache
- lesion: glaucoma, optic neuritis
- mechanical= thyroid eye disease
128
amaurosis fugax
- painless temporary loss of vision
- curtain descending
- vascular/ ischaemic cause
- can represent a TIA so give aspirin
129
painless causes of visual loss
```
CRAO
CRVO
BRVO
BRAO
proliferative diabetic retinopathy
glaucoma
retinal detachment
amaurosis fugax
```
130
painful causes of visual loss
optic neuritis
scleritis
keratitis
endophalmitis
131
definition of partial sight registration
when either the central vision ie visual acuity in the best eye is around 6/18 to 6/60 or at any level of central vision when a reasonably significant field defect is present
132
definition of blind sight registration
when either the central vision ie visual acuity in either eye is counting fingers or at any level of central vision when a significant field defect is present
133
investigations for visual loss 4
- confrontation visual fields
- measurement of visual acuity- snellen and pinhole
- swinging flashlight test- RAPD CHECK
- Fundoscopy
134
cherry red spot on fundoscopy suggests
central retinal artery occlusion
135
complete starry night on fundoscopy suggests
1. also known as blood and thunder
2. multiple flame haemorrhages and dialted veins
3. may or may not have cotton wool spots
4. chronically may only be small haemorrhages in periphery
central retinal vein occlusion
136
branch retinal artery occlusion fundoscopy signs
opaque retina on one half/ section and then normal retina on the other
137
branch retinal vein occlusion fundoscopy sign
areas of starry night sky
138
hx of abrupt, painless, significant loss of vision and a white eye is...
central retinal artery occlusion
139
hx of abrupt, painless, visual loss suggests
branch retinal artery occlusion
140
hx of painless loss of vision, often noted in am after rising from sleep
>50
gradual onset
suggest central retinal vein occlusion
141
causes of central retinal artery occlusion
linked to arteriosclerotic vascular disease, CVD, thrombus, temporal arteritis, hyperocaguable state
142
cause of branch retinal artery occlusion
often an emboli from the carotid artery
143
RF for branch retinal vein occlusion
1. talc IV drug abuser
2. fat from long bone #
3. problems with endocarditis or calcifications
4. vasculitis
144
examination findings for central retinal artery occlusion
vision: light perception or worse
field: massive visual field loss
pupil: large RAPD
Fundus: opaque retina with a cherry red spot, oedematous
145
examination findings for branch retinal artery occlusion
vision: variable- depends on the size and location
pupil: may have a RAPD depends on defect of the size
field: loss corresponds to occluded artery
Fundus: opaque retina adjacent to occluded artery with an embolus at proximal end of arteriole- often bifurcation
146
central retinal vein occlusion assoc.
assoc. too glaucoma and open angle glaucoma
147
central retinal vein examination findings
vision: variable
pupil: afferent defect
field: general depression
fundus: starry night sky - haemorrhages in all 4 quadrants
148
branch retinal vein examination findings
pupil\: variable
afferent defect variable
field variable
haemorrhages in one-two quadrants depending on vein
149
management of central retinal artery occlusion
if seen within 100 mins of onset
- massage the eyeball to lower the intra-ocular pressure (apply firm pressure with the eyelid closed for 5 seconds to acutely raise the intraocular pressure and then let go) sudden release of pressure can break the occluding material
- refer to opthalmology
- consider the source
150
why does CRAO produce a cherry red spot
opaque retina- due to ischaemia to the retina which produces oedema of ganglion cells and axons
cherry red spot since ganglion cells are absent in the macula so there is the normal macular red reflex from the underlying choroidal blood flow is accentuated as a cherry red spot
151
management of branch retinal artery occlusion
determine the source
| no specific ocular treatment
152
management central retinal vein occlusion
- refer the patient to an opthalmologist
- 40-70% will have open angle glaucoma
- 60% will develop neovascular glaucoma
- assess for systemic illness
153
branch retinal vein occlusion fundoscopy signs
1. flame haemorrhages adjacent to the dilated engorged occluded vein
2. occlusion site where retinal artery crosses the vein
3. superior branch veins are occluded more often
154
management branch retinal vein occlusion
opthalmic referral to treat possible
- macular oedema
- neovascular proliferation
155
acute vascular systemic defect causing visual loss presentation
again painless and acute visual loss
which is due to vascular occlusion, or leaking vessels
other assoc. symptoms of systemic disease eg arthralgia, fever and malaise
156
fundoscopy presentation for systemic visual loss 6
1. cotton wool spots (ischaemic micro-infarction of ganglion cells)
2. flame shaped haemorrhages
3. lipid exudates (due to serum extravasation through damaged vesels)
4. embolic plaques- platelet aggregation from damaged endothelium
5. calcific emboli from damaged cardiac valves
6. dot and blot haemorrhages- internal retinal elements confine these capillary haemorrhages to their characteristic round shape
157
cardiovascular causes of visual loss 6
1. hypertensive retinopathy
2. retinall arteriosclerosis
3. cardiac vascular disease
4. carotid atheromatous disease
5. hypotension leading to anterior ischaemic optic neuropathy
6. vasculitis
158
hypetensive retinopathy grading
1=arteriolar narrowing
2=focal narrowing and greater arteriole constriction
3=addition of flame haemorrhages, cotton wool spots and lipid exudates
4= grade 3 plus papilloedema, retinal oedema often assoc, with renal, CNS and cardiac involvement
159
retinal arteriosclerosis pathophysiology
- sclerosis causes widening of the arteriole's light reflex and causes arterial crossing changes including
- -> nicking or compressing of the AV
- -> distortion of the crossing angle from acute towards a right angle called banking
160
cardiac vascular disease pathophysiology for causing visual loss
-heart valve problems that may underlie acute visual loss are
--> endocarditis
--> rheumatic fever
-->mitral valve prolapse
--> calcific valvular disease
opthalmoscopy may show multiple emboli or embolic haemorrhages
161
cardiac atheromatous disease - pathophysiology visual loss 2
1. occlusive disease: caused by thrombosis which produces ocular ischaemia- retinal haemorrhages and cotton wool spots
2. eroding atheromatous plaque producing cholesterol and platelet emboli that can lead to retinal artery occlusions
162
endocrine causes of visual loss
1. diabetes mellitus
163
haematological causes of visual loss 5
1. leukaemia
2. anaemia
3. thrombocytopaenia
4. hyperviscosity states
5. hypercoaguable states
164
haematological pathophysiology
| visual loss
due to retinal haemorrhages or retinal oedema involving the macular area
165
inflammatory pathophysiology
| visual loss
- collagen vascular and infectious diseases
| - produce retinopathy of ischaemic infarcts (cotton wool spots), haemorrhages and exudates
166
inflammatory causes of visual loss 7
```
inflammatory
-lupus
-polyarteritis nodosa
-dermatomyositis
infectious
-AIDS
-disseminated HSV
-disseminated varciella
-cytomegalic viral retinitis
```
167
4 acute vascular neurologic causes of visual loss
1. AION arteritic ischaemic optic neuropathy
2. non-arteritic ischaemic optic neuropathy
3. papillitis and optic neuritis= inflammatory optic nerve
4. vascular occlusion in the CNS
168
GCA pathophysiology
hypo-perfusion or sometimes occlusion of the short posterior ciliary arteries causing ischaemia to the optic disc and the anterior optic nerve producing visual loss
169
GCA cause
- arteritis- (inflammation of artery walls) occlusive
| - arteriosclerosis -hypoperfusion and hypoxia
170
complications GCA
risk of binocular and permanent blindness
171
presentation of GCA
- Long prodrome of systemic symptoms before visual symptoms
- female over 50
- sudden monocular loss of vision
- visual loss may stutter- fluctuates for a day or two before permanent
- jaw claudication
- headache
- scalp tenderness
- malaise, arthralgia, weight loss, fever
- polymyalgia rheumatica
172
INX for GCA
- ESR!!!- >60- should treat high dose steroids
| - DO NOT WAIT FOR TEMPORAL ARTERY BIOPSY
173
temporal artery biopsy signs for GCA 3
- giant cells
- elastic fragments
- occlusion
174
examination findings for GCA
- vision: variable to no light perception
- pupil: afferent pupillary defect
- field: altitudinal field defect is common (usually loss of upper or lower half of field of vision)
fundus: pale, swollen optic disc, small splinter haemorrhages
175
non arteritic AION exam findings
normal ESR
| no arteritis on temporal artery biopsy
176
assoc, to non-AION
high BP
high lipids
smoking
177
ambylopia
lazy eye
| caused by strabismus
178
exotropia
In exotropia, when the fixating eye is covered, the outwardly deviated eye will move inward to fixate the viewed object..
179
esotropia
When the fixating eye is covered, the other eye will move outward from its inwardly deviated position to fixate the viewed object.
180
hypertopia
In hypertropia, when the fixating eye is covered, the upwardly deviated eye will move downward to fixate the viewed object.
181
presentation of non AION
painless
often noticed upon awakening
>50 years
182
examination findings for non AION
no difference to arteritic except the swollen nerve is usually NOT pale in non arteritis cases
183
visual field defect for vascular occlusion in the CNS
homonymous hemianopia or quadrantanopia as ischaemic or haemorrhage infarcts of the visual pathways and cortex
184
presentation of vascular occlusion in the CNS visual loss
- normal visual acuity
| - homonymous hemianopia or quadrant
185
optic neuritis main causes- inflammatory optic nerve disease
```
multiple sclerosis
diabetes
syphilis
vitamin deficiency
leber's
ischaemic due to thrombosis
```
186
presentation of optic neuritis
```
monocular visual loss
acute onset over hours or days
unilateral loss
affects colour vision
poor descrimination especially red
RAPD
central scotoma
dull retrobulbar eye ache which is aggravated with eye movement
```
187
examination findings for optic neuritis
vision: decreased in most cases- no light perception
pupil: RAPD, unless previous episode in other eye to balance it
Field: central scotoma and altitudinal field loss are common- ie often top half
Fundus: normal disc in many cases- can be some swelling or pale
raised ESR
188
management optic neuritis
high dose steroids
| takes 4-6 weeks to recover
189
location of optic neuritis
- retrobulbar neuritis= means in the posterior part of the optic nerve so wont see disc changes
- papillitis= means anterior so get papilloedema
190
what should not be given in optic neuritis
oral steroids as may lead to more reccurrences
| use IV??
191
papillitis vs papilledema
- vision
- pupil response
- optic disc
- haemorrhages
- cells in vitreous
- cause
papillitis
- reduced vision
- afferent defect
- swollen disc
- haemorrhages
- cells in vitreous
- inflammation
papilloedema
- normal vision
- normal pupil response
- swollen disc
- haemorrhages
- no cells in the vitreous
- caused by raised ICP
192
assoc. conditions to papillitis
- lupus
- sarcoidosis
- syphilis
193
retinal detachment presentation
4f's
- floating spots (floaters)
- flashing lights
- may detect a curtain or shade obscuring any part of field of vision
- fall in acuity
- central vision loss
- straight lines appear curved
- painless
- gradual over days
- fhx of myopia
- can be gradual over days
194
types of retinal detachment
1. rhegmatogenous retinal detachment
| 2. tractional retinal detachments
195
rhegmatogenous retinal detachment
- tear in the retina causes fluid to pass from the vitreous space into the subretinal space
- trauma
196
tractional retinal detachments
- pulling on the retina
- more common in myopic eyes
- cataracts for myopic eyes increases the risk
197
RF/ causes of retinal detachments 6
- age
- previous surgery for cataracts
- myopia
- eye trauma
- fhx
- phx of retinal break
198
examination findings for retinal detachment
- vision: normal to hand motions, if macular detached
-pupil: RAPD
loss of red reflex
decreased visual acuity
-field: any areas of visual field may be obscured, depending on which area of the retina is detached
-fundus: dilated exam show elevated waxy, gray appeararing retina, ballooning forward
199
management of patient presenting with flashing lights and floaters
refer to opthalmology immediately
200
retinal detachment management
- refer to opthalmology
- rest
- if detachment is superior then nurse flat
- if detachment is inferior then lie 30 degrees head up
- laser photocoagulation therapy
- surgery
201
surgery options for retinal detachment
- vitrectomy and gas tamponade scleral silicone implants
| - cryotherapy to secure retina
202
vitreous haemorrhage cause
vitreous haemorrhage is a separation of the posterior vitreous from the retina
- normal ageing degeneration
- retinal blood vessels may also tear in separation
203
- sudden visual loss
- dark spots
- painless
is. ..
vitreous haemorrhage
204
- acute visual loss
- painless
- flashing lights and floaters
- straight lines appeared curve
- central vision loss
- curtain over field of vision
retinal detachment
205
```
flashing light and floaters
painless
blurred vision
cobweb across vision
is..
```
posterior vitreous detachment
206
vitreous haemorrhage causes 6
1. diabetic retinopathy
2. retinal break
3. retinal detachment
4. posterior vitreous detachment
5. neovascularisation from retinal vein occlusions
6. anticoagulants
207
management vitreous haemorrhage
urgent referral to opthalmology
208
rf for vitreous detachment
- ageing
| - myopic eye
209
sign for vitreous detachment
weiss ring= floater on opthalmoscopy
210
management for vitreous detachment
wait 6 months
211
management for vitreous and retinal detachment
need surgery
212
red flags for visual loss 6
```
sudden onset
headache--? GCA
pain- glaucoma, keratitis, scleritis
pain on eye movement, optic neuritis, scleritis
distorition- macular
worse in morning- RVO, macular oedema
```
213
optic neuropathy meaning
damage to optic nerve of any cause
214
causes of optic neuropathy
- Ischaemic optic neuropathy= AION, PION, radiation
- optic neuritis
- compression from lesions thyroid
- infiltrative eg infection
- toxic
- trauma
- hereditary
215
drugs that cause Bull's eye maculopathy 2
- chloroquine
| - hydroxychloroquine
216
drugs that damage the RPE 3
- mellaril
- chloroquine
- plaquenil
217
drugs that damage optic nerve 3
ethambutol
chloramphenicol
quinine
218
what dose of chloroquine- aralen is toxic
>300 daily dose
219
monitoring on chloroquine for
<250
>250 daily
```
<250= annually
>250= 2-4 times yearly
```
220
hydroxychloroquine- plaquenil dose that is toxic and monitoring
>400 can be tolerated but check eye every 4 month
| <400check annually
221
ethambutol what damage does it cause 5
```
optic nerve
optic disc oedema
visual loss
colour defect
central field visual loss
```
222
toxic dose of ethambutol
>25
223
thyroid
| -2 eye signs specific to grave's
lid lag and lid retraction
224
eye disease in thyroid
- lid lag and retraction
- proptosis or exopthalmos
- secondary corneal exposure
- ocular motility restriction
- optic nerve compression
225
what is the big complication from thyroid eye disease
optic nerve compression
226
inx for thyroid eye disease
- examine thyroid, visual field, pupil, acuity, exopthalmometry
- thyroid levels
- CT and USS- check eye muscles
227
management during active phase for thyroid eye
- dry= artifical tears
- dark glasses
- corneal exposure-treat with tarsorrhaphy-suture lid close
- optic nerve compression: steroids, irradiation, surgical orbital decompression
228
management during inactive phase for thyroid eye disease
- eyelid lengthening to reduce lid retraction
- ocular muscle surgery to relieve diplopia
- orbital decompression to reduce proptosis
229
mechanisms of diabetes and poor vision 4
1. macrovascular- facial palsy and cornea exposure, occipital stroke - homonymous hemianopia
2.microvascular-temporary squint, retinopathy
maculopathy
3. premature lens opacities- cataracts
4.osmotic lens changes--> refractive errors with hypoglycaemic episodes
230
pathology of diabetic retinopathy 5 stages
1. no diabetic eye changes
2. background diabetic retinopathy
3. pre-proliferative dr
4. proliferative dr
5. vitrous haemorrhage or fraction retinal detachment
231
pathogenesis of retinopathy
1. leaky vessels- hard exudates, oedema
| 2. occlusion- ischaemia- cotton wool spots and neovascularisation
232
earliest detectable sign of DM retinopathy
loss of pericytes from retinal capillaries and breakdown of blood retinal barrier
233
diabetic maculopathy presenation
macular oedema
234
mild NDPR or background diabetic retinopathy
1. micro-aneurysms- dot haemorrhages- greater than or equal to 1
2. +/-blot haemorrhages- deeper haemorrhages
3. +/-hard exudates = protein leaks
235
moderate NDPR 4
1. cotton wool spots
2. venous beading
3. IRMA= dilated tortuous capillaries in retina
4. +mild changes
236
severe NDPR
1. blot haemorrhage and/or microaneurysms in all 4 quadrants
2. venous beading in greater than or equal to two quadrants
IRMA in greater than or equal to 1 quadrants
237
what are cotton wool spots
nerve fibre layer infarct
238
what are venous beading
congested veins
239
proliferative diabetic retinopathy
-neovascularisation
-fibrous tissue = NVD neovascularisation of the disc, neovascularisation elsewhere NVE
proliferation of extra retinal fibrovascular tissue occurs
240
management of proliferative DR
-urgent referral to opthamology
241
when would an emergency referral for diabetic retinopathy be needed 4
and what is the risk of this
```
1. rubeosis iridis= new vessels on iris
risk of glaucoma secondary
2. retinal traction and detachment
3.vitreous haemorrhage
4. pre-retinal haemorrhage
```
242
signs of diabetic maculopathy 3
1. macular oedema
2. hard exudates
3. microaneurysms or dot haemorrhages
243
presentation of diabetic maculopathy
1. loss of visual acuity
2. unlike PDR can be asymptomatic initially
3. affects central more than peripheral vision
244
INX for diabetic maculopathy
ocular coherence tomography OCT
1. OCT helps to identify cystoid macular oedema
2. funudus fluorescein angiography for ischaemia
245
treatment for diabetic maculopathy
-intravitreal anti VEGF injections
246
what is ranibiziumab, aflibercept, bevacizumab
Anti VEGF injections
247
what is clinically significant macular oedema CSMO
presence of retinal thickening with or without hard exudates within a radius of <1 disc diameter of the centre of the foeva
- sight threatening
248
eye screening for diabetic eye by age
0-30 years onset= first exam 5 years after onset, minimum follow up is annually
31+ years onset= first exam at time of dx, review annually
pregnancy onset= first exam during first trimester, and then every 3 months
249
eye screening for diabetic eye by severity and treatment
mild and mod= review every 4 months
| severe= fundus fluorscein check - treat with pan retinal laser coagulation
250
management for diabetic eye
1. eye follow up
2. laser photocoagulation for
- macular oedema
- proliferative DR- remove new vessels
3. diabetic control
4. vitrectomy
5. maculopathy give VEGF injections
- focal for hard exudates
- grid for CSMO
251
vitrectomy indications for diabetes
1. if pan retinal laser is not possible (vitreous haemorrhage blocks retinal view)
2. traction retinal detachment
3. no space left for laser
4. repeated PRLP fails to control neovascularisation
5. persistent vitreous haemorrhage after 3 months
252
macular degeneration vs glaucoma
macular degeneration= loss of central vision
| glaucoma= loss of peripheral vision
253
what is the leading cause of blindness in the >65 in the UK
age related macular degeneration
254
pathogenesis of ARMD
there is degeneration of retinal photoreceptors causing pigment, drusen in the macula
over time it progresses to retinal atrophy and central retinal degeneration causing central loss of vision
255
most common type of ARMD
dry atrophic type 80-90%
256
features of dry ARMD
```
slower progressive loss
cause is unknown
drusen and changes at macula
prevention best treatment
vitamins
no other treatment
```
257
features of wet/ exudative/ proliferative ARMD
10-20%
-pathological choroidal neovascular membranes CNVM develop under the retina
-choroidal neovascularisation
-the CNVM can leak fluid and blood causing a central disciform scar
-vision deteriorates rapidly and distortion is a key feature
-opthalmoscopy
fluid exudation, localised detachment of pigment
258
```
which of these are a feature of ARMD
- loss of night vision
-reduction in visual acuity
-peripheral vision loss
-central vision loss
-acute loss
-gradual loss
-blurry small words
-reduction of visual acuity- long sight
-fluctuating vision loss
-photopsia
-glare
straight lines appear curvy
```
1. older age
2. central vision loss
3. loss of night vision
5. gradual loss
6. blurry small words
7. reduction of visual acuity- especially short sight-fine detail
8. fluctuating
9. photopsia
10. glare
11. straight lines appear curvy -metamorphosia
259
elderly female presents with reduced visual acuity complaining of blurred vision, glare
on examination there is a central scotoma
macular degeneration
260
risk factors for macular degeneration 5
- increasing age
- smoking
- CVD
- FHX
- cataract surgery
261
what is used to monitor macular degeneration
Amsler grid
262
fundus presentation of atrophic macular degeneration
- drusen: small round deposits under the retina- in the macula bilaterally
- atrophy of the RPE
263
fundus presentation of wet macular degeneration
- all features of atrophic degeneration plus
- neovascular membrane under the retina which causes- neovascular proliferations leak
- subretinal haemorrhages
- serous detachments of macula and eventual
264
investigations for macular degeneration
- Fundoscopy
- slit lamp
- fluoroscein angiography for wet type if signs of neovascular- as can guide anti VEGF
- occular CT coherence tomography for monitoring
265
where are drusen found
in macular degeneration around the macula small yellow deposits
-lipoporteinaceous deposits
266
what can laser proliferation be used for in ARMD
if wet ARMD is detected early and caused by neovascular membrane outside the centre of the macula then new blood vessels can be destroyed by laser photocoagulation
267
wet ARMD management options 9
- needs prompt treatment to avoid visual loss
- arrange a fluoroscein angiogram at the outset and then 4-6 weekly reviews with a photograph and OCT
- anti-VEGF- intravitreal vascular endothelial growth factor inhibitors- monthly Bevacizumab, and ranibizumab
- laser photocoagulation
- photodynamic therapy PDT IV verteporfin
- intravitreal steroids triamcinolone
- visual aids
- diet rich in fruit and green veg
- vitamins and antioxidants
268
Dry ARMD management
- stop smoking
- antioxidant supplements
- no other treatment options
269
what do cones do
colour vision
| central vision
270
what do rods do
night vision
| peripheral vision
271
fhx cause of macular degeneraiton
complement factor H mutation
272
what is the most common cause of damage to the optic nerve
glaucoma
273
what is normal eye pressure
11 to 21
274
what is glaucoma
- increased eye pressure as meshwork is narrowed and get damage to optic nerve
- glaucoma is optic neuropathy with death of retinal ganglion cells and their optic nerve axons
275
two types of glaucoma
chronic open angle glaucoma
| acute angle closure glaucoma
276
risk factors for chronic open glaucoma
- increased IOP
- black
- FHX
- increased age
- HTN
- DM
- myopia
- steroids
277
diagnosis of COAG
-intraocular pressure measure using tonometry
>21 but not needed
-central corneal thickness measurements
-gonioscopy- peripheral anterior chamber depths
-visual field: central field is intact as forms an arcuate defect with central intact so presentation often delayed
-slit lamp and fundoscopy
278
symptoms of chronic open angle glaucoma
often asymptomatic until visual fields are impaired
peripheral visual field loss- nasal scotomas
-tunnel vision
-decreased visual acuity
279
fundoscopy presentation for COAG
1. optic disc cupping >0.7
2. optic disc pallor- atrophy
3. bayonetting of vessels
4. cup notching
5. disc haemorrhages
280
screen for COAG IF
>35 yrs and ?
- positive fhx
- african carribean
- myopic
- diabetic
- thyroid eye disease
281
follow up for COAG is
4-6 monthly
282
management for COAG
1. Prostaglandin analogues- lantoprost or travoprost- increase uveoscleral outflow
2. beta blockers eg timolol- decrease production of aqueous
3. alpha adrenergic agonists - brimonidine, apraclonidine
4. carbonic anhydrase inhibitors- acetazolamide, dorzolamide
5. miotics- pilocarpine
6. sympathomimetic- dipivefrine
7. fixed dose combination treatment
8. laser therapy trabeculoplasty
9. trabeculectomy
283
pathogenesis COAG
- cause unknown- but increased IOP- retinal ganglion cell death
In open-angle glaucoma, the angle in your eye where the iris meets the cornea is as wide and open as it should be, but the eye’s drainage canals become clogged over time, causing an increase in internal eye pressure and subsequent damage to the optic nerve. It is the most common type of glaucoma
284
optic disc cupping means
| and glaucoma changes
loss of disc substances making the disc look larger
- asymmetric cupping suggests glaucoma
- as damage progresses disc pales and cup widens and deepens so vessels appear to have breaks as disappear into cup -bayonetting
- disc vessels are also displaced nasally
- nasal and superior fields are lost first and temporal fields last
285
optic cup ratio definition for glaucoma
glaucoma is present when on field testing, 3 or more locations are outside normal limits and the cup to disc ratio is >0.7 (optic disc cupping)
286
pathogenesis acute angle closure glaucoma
blockage of the trabeculae meshwork duct occurs at the anterior chamber angle- therefore aqueous fluid cant drain so the pressure increases
-displacement of the lens and the iris obstructs the fluid outflow across the trabecular meshwork
Mechanisms that push the iris from behind including, most commonly, relative pupillary block (where accumulation of aqueous in the posterior chamber forces the peripheral iris anteriorly, causing anterior iris bowing, narrowing of the angle
Mechanisms that pull the iris into contact with the TM (e.g., contraction of inflammatory membrane as in uveitis, fibrovascular tissue as in iris neovascularisation
also with time friction can cause scar tissue between TM and iris
287
factors predisposing to AACG are
hypermetropia= long sightedness
pupillary dilatation
lens growth assoc. to age
288
A 64-year-old woman presents to the emergency department with severe pain around her right eye of 4-hour duration, accompanied by blurred vision in that eye. She is also nauseated. Examination shows a red right eye with oedematous cornea and a wide pupil that is unresponsive to light. Intra-ocular pressure is extremely elevated (60 mmHg), only in the right eye.
acute angle closure glaucoma
289
A 50-year-old man presents for a routine eye examination with no symptoms. He has elevated intra-ocular pressure of 25 mmHg in the right eye and 30 mmHg in the left eye. On dilated examination, the cup-to-disc ratio is 0.5 in the right eye and 0.8 in the left eye. Corneal thickness and gonioscopy are normal. Subsequent automated testing of visual fields demonstrates peripheral visual field loss greater in the left eye than in the right. Repeated automated visual field testing shows that the visual field defects are reproducible.
open angle glaucoma
290
A 75-year-old woman presents with new-onset distortion in one eye. Vision is 20/80 in the involved eye. has smoked 20 cigarettes a day for most of her life. blurred vision and difficult reading small print
AMD
291
A 65-year-old man presents with generally decreased vision and difficulty driving at night due to glare from oncoming headlights. He describes having trouble reading the small print on his television screen. He is healthy and has no history of any other eye problems. His best corrected visual acuity is noted to be 20/50 in the right eye and 20/40 in the left eye. On examination, a yellowish opacification of the lens in the left eye is noted.
cataracts
292
A 67-year-old man presents with a 2-day history of sudden visual loss in his right eye. He is slightly myopic and had successful cataract extraction with intraocular lens implantation 3 years earlier. He does not remember this eye ever having been injured. No pain was associated with the vision loss, and his blood pressure is normal with medication. The patient describes the loss of vision as a veil covering the visual field.
retinal detachment
293
A 65-year-old man with a history of hypertension and hypercholesterolaemia notices sudden, painless vision loss in his right eye. The vision loss is limited to the superonasal quadrant of his visual field. He first noticed the visual field loss approximately 6 weeks ago. For the past 2 weeks, however, he has started to have blurred vision centrally, making reading difficult.
CRVO
294
A 40-year-old man presents to the emergency department complaining of red eye without purulent discharge. He also has pain, photophobia, blurred vision, and tearing. On slit-lamp examination, the attending ophthalmologist notices a small irregular pupil, conjunctival injection around the corneal limbus, and WBCs in the anterior chamber.
uveitis
295
primary vs secondary glaucoma
```
primary= in a patient with anatomical predisposition- ie no known cause
secondary= due to a cause eg haemorrhage
```
296
presentaation of acute angle closure glaucoma
- mid dilated pupil
- n and v
- ciliary injection
- corneal oedema- rise in IOP
- steamy vision
- see halos and rainbows around light
- pain severe and achy
- cloudy eyes
- headache
- blurred vision
297
signs of acute angle closure glaucoma
- whole cornea is cloudy
-fixed mid dilated pupil
-not reacting to light
-red eye
-sore
IOP
visual field defect
optic disc cupping
298
when is AAC glaucoma worse
- dim light so in winter as the pupil dilates so pushes iris up
- anatomical= in small eyes -hypermetropia- increase risk as lens capsule keeps growing in life so lens gets bigger
299
management of AACG
```
refer to opathalmoloy
emergency
give
-beta blockers eg timolol
-carbonic anhydrase eg acetazolamide
-mitotic eye drops- pilocarpine
-prostaglandin analogues eg latanoprost
-sympathomimetics eg brimonidine- alpha 2 receptor agonist
```
- laser iridotomy-creation of opening in iris to allow aqueous humor to flow from posterior to anterior
- iridectomy surgical
300
complications of AACG
visual loss
CRVO CRAO
repeat episodes
301
lantoprost SE
-increased eyelash length
iris pigmentation
periocular pigmentation
302
pathology cataracts
- any opacity of the crystalline lens may be considered cataracts
- light scattering opacity in the lens
303
commonest cause of blindness in the world
cataracts
304
risk factors for cataracts
- usually ageing assoc.
- DM
- genetics in children
- smoking
- alcohol
- sunlight
- trauma
- radiotherapy
- HIV
- drugs eg steroids
- intraocular tumors
- trauma
- long term UV exposure
305
inx cataracts
- blood glucose
- hx and exam
- opthalmoscopy
- slit lamp exam
306
four types of cataracts
1. mature
2. nuclear sclerotic NS
3. posterior subcapsular
4. cortical spokes
307
most common type of cataracts
nuclear sclerotic
308
nuclear sclerotic cataracts
- usually characterised by darkening and hardening of the lens
- nucleus- central part of lens
- slow and insidious dimming of distance vision while good reading vision preserved
- hardening of nucleus increases refractive index - myopic refractive error shift
- common in old age
309
mature cataracts
when the entire lens is opacified nucleus and cortex
| - most dont reach this stage due to surgery
310
posterior subcapsular cataracts
- this type of cataract shows with aggregations of degenerated epithelial fibers beneath the posterior lens capsule commonly in the visual axis
- symptoms are glare especially in the sunlight and from ongoing headlights
- also reduced reading vision
- can be caused by high dose steroids
- recently created lens fibres break down eg after x-ray ,trauma, steroids
311
cortical spokes cataracts
- looks like bike spoke
- peripheral spokes against the red fundus reflex are commonly seen in this type of cataracts
- opacified cortical lens fibers
- otherwise few visual problems until spokes involve visual axis
312
ocular causes of cataracts
- trauma
- uveitis
- high myopia
- steroid eye drops
- intraocular trauma
313
systemic causes of cataracts
- diabetes and other metabolic
- systemic steroids, chlorpromazine
- x-radiation
- congenital rubella
- atopic dermatitis
- myotonic dystrophy
- down syndrome
314
symptoms and signs of cataracts
-painless loss of vision
-glare and halos-dazzle in sunlight
-can get monocular diplopia
-change in refraction
-altered colour perception
-decreased visual acuity- especially in bright lights
-difficulty driving at night
-dark silhouette against red reflex
loss of stereopsis affects distance judgements
315
management cataracts
- mydriatic drops
- shades
- stronger glasses/ light improvement
- if symptoms are restricting or unable to read number plate at 20m then offer surgery
- phacoemulsion and intraocular lens implant
- patient choice not based on visual acuity
316
complications of phacoemulsion
- posterior capsule opacification
- retinal detachment
- endophalmitis
- posterior capsule rupture
- iris prolapse
- cystoid macular oedema
- vitreous loss
317
prevention of cataracts
1. use sunglasses
2. oxidative stress decrease with antioxidants and caffeine
3. stop smoking
318
inx for cataracts
- examination- red reflex
- look for systemic cause in <60or if unilateral cataract
- biometry to enable accurate intraocular lens power calculation
319
red eye causes
bilateral
- allergic conjunctivitis- mostly itchy
- infective conjunctivitis- discharge
- keratoconjunctivitis sicca
unilateral
- CN VII palsy
- entropion
- trichiasis
- stromal keratitis
- epithelial keratitis
- episcleritis
- scleritis
- iritis
- acute angle closure glaucoma
320
5p's of red eye
```
pain
pus
pink
pupil
pressure
```
321
red eye bilateral
bilateral watery discharge
follicles
viral conjunctivitis
322
red eye bilateral
purulent discharge
gritty or burning
bacterial conjunctivitis
323
red eye bilateral
| predominantly itchy
allergic conjunctivitis
324
causes of a red eye
```
conjunctivitis
dry eyes
CN VII palsy
entropion or trichiasis
stromal keratitis
epithelial keratitis
acute angle closure glaucoma
iritis
scleritis
episcleritis
```
325
watery eye infant
| cause treatment
nasolacrimal duct obstruction
| rx: lacrimal duct massage
326
ciliary injection meaning
inflammation within the anterior segment of the eye
| injection most intense adjacent to the edge of the cornea-limbal area
327
diffuse injection meaning
denotes an inflammed surface conjunctiva- conjunctivitis - more around the outside of the eye
328
scletoral injection
episcleritis
329
ciliary injection with purulent discharge
indicates a corneal ulcer
330
>30
diffuse injection
mucoid crusting
reduced schrimer tear test
dry eyes
331
management of allergic conjunctivitis
```
avoid allergen
shower and was hair
sodium p.
opatanol-mast celll stabiliser
anti-histamine eg antazoline
-antihistamine drops eg emedastine
NSAID eg Ketorolac
avoid steroids
```
332
management of viral conjunctivitis
symptomatic relief
| artificial tears, decongestants
333
bacterial conjunctivitis rx
most settle no treatment
topical chloromycetin drops or chloramphenicol
ointment at night
-if fails take swabs for STI
topical fusidic acid for pregnant women
334
newborn baby purulent eye discharge
need to to consider chlamydia/ gonorrhoea
335
chlamydia eye presentation
bleeding
bacterial that doesnt go away
treat systemically
336
gonorrhoea eye presentation
purulent discharge
vision threatening
treat systemically IV
337
SE of topical steroids
secondary infections
delayed corneal epithelial wound healing
cataract formation
permanent rise in intraocular pressure- glaucoma
338
dry eyes
-diffuse inflammation
severe RA
crusting on eyelids
superficial punctate keratopathy SPK
339
inx dry eyes
schrimer tear test
| <10mm after 5 minutes
340
treatment dry eyes
artifical tears
long term ocular lubricants
viscotears and lacrilube
punctal occlusion
341
sub-conjunctival haemorrhage cause
spontaneous
| secondary to trauma
342
epithelial keratitis presentation
```
ciliary injection
no pus
aching pain
foreign body sensation
gritty sensation
smaller pupil
red eye
photophobia
```
343
risk factors keratitis
dry eyes
corneal graft
contact lens wearers
corneal ectasian
344
causes of keratitis
```
chronic HSV
infection
-HSV
actahamoeba
gram positive
gram negative rods
pseudomonas most common contact wearers
```
345
contact wearers keratitis pathology
-pseudomonas
-acathamoeba
inflammatory keratitis
-white dot in ulcer
pain
```
trauma
contact lens wearer abuse
severe dry eyes
complication from topical steroidal
exposure keratitis
```
346
inx keratitis
fluoroscein
347
management of keratitis by pathology
refer to opthalmology
-bacterial= antibiotics -topical quinolones
viral= topical oral antivirals
fungal= antimyoctics
also can give cyclopentolate to relieve
348
complications of ulcers
-hypophyon= pus in the ant chamber
visual loss
scarring
perforation
349
stromal keratitis
abscess
infection in stroma
urgen attention
350
uveitis presentation
```
-throbbing pain
ciliary injection
photophobia
smaller pupil
red eye
distorted pupil
no pus
severe and aching pain
```
351
anterior uveitis
irits
| anterior cyclitis
352
intermediate uveitis
vitreous
353
posterior uveitis
retina/ choroid
354
panuveitis
all of the uvea
355
anterior uveitis presentation
```
red eye
pain
kerato precipitates
photophobia
assoc. seronegative
```
356
intermediate/ posterior uveitis
painless
floaters
blurred vision
less common
357
management uveitis
refer to opthalmology
steroid eye drops
cyclopentolate to dilate
358
complications of uveitis
cataract
macular oedema
secondary glaucoma
359
scleritis presentation
```
often assoc. with ocular tenderness
deep boring pain
can be segmental or whole
scleral swelling
produces more injection
can be sight threatening
smaller pupil
```
360
risk factors scleritis
RA
361
inx scleritis
fluoroscein
| epinephrine- wont blanch vessels
362
management scleritis
urgent referral
| topical or oral steroids
363
scleromalacia perforans necrotising
severe form of sscleritis
blue black patches where sclera has thinned out
needs IV steroids
364
episcleritis presentation
```
inflammation more superficial episceleral tissue
self-limiting
segment in the red eye
no usually assoc. to pain
mild foreign body sensation
sector of engorged episcleral and assoc. conjunctival vessels- diffuse injection
no pus
itchy and burning sometimes
small pupil
high pressure
```
365
inx episcleritis
fluoroscein
| will blanch under epinephrine
366
management episcleritis
self limiting
| symptomatic treatment
367
blepharitis
inflammation of eyelid margins
bilateral grittiness
cause
-sebhorreic dermatitis
meibomian gland dysfunction
features
- bilatera
- gritty
- sticky
- red
- swollen- staph. bleph
- styes are more common
rx
hygiene
hot compress
368
herpes zoster opthalmicus is
describes the reactivation of the varicella zoster virus in the opthalmic division of the trigeminal nerve
369
features hzo
vesicular rash around the eye which may or may not involve the actual eye itself
photophobia
red eye
watery eye
Hutchinson's sign is rash on the tip or side of the nose- inidcates nasocilirary involvement and strong Rf
370
management hzo
refer to opthalmology
oral anti-viral aciclovir for 7 to 10 days
IV antivirials if severe
topical steroids may be used
371
complications of HZO
ocular- conjunctivitis, keratitis, ant uveitis
ptosis
post herpatic neuralgia
372
herpes simplex keratitis
```
most common cause of corneal blindness
also get conjunctivitis, keratitis
red eye
vesicles on kips
pain
epiphoira
ulceration
```
373
papilloedema causes
```
increased ICP
hydrocephalus
malignant HTN
hypercapnia
idiopathic intracranial hypertention
tumour trauma
```
374
signs of papilloedema
```
swollen optic disc
decreased blurring optic disc margin
cork screw blood vessels
blood vessel obscuration- blurry
disc haemorrhage
venous engorgment
elevated
loss optic cup
paton's line
```
375
myopic eye
short sighted
eye is bigger
so things from a distance dont meet behind the retina
376
causes myopia
```
simple myopia
degenerative myopia
-malignant or pathological
-gets worse over time
often with peri disc atrophy and RPE
```
377
hypermetropia
long sighted
eye is smaller
rays of light from a close object focus behind
378
presbyopia
impaired power of accomodation
379
astigmatism
where cornea is irregularly curved prevent light rays from being brought into common focus on the retina
380
eye trauma
```
foreign body
UV burns
hyphemia
perforating injury
blow out fractures
```
381
chemosis
swollen conjunctiva
| can be due to foreign material or ruptured globe
382
limitation on upper gaze suggests a
blow out fracture
383
subconjunctival haemorrhage
```
usually benign
can be due to HTN
normal va, clear cornea
round pupil
normal fundus and eye movements
```
384
corneal foreign body
normal visual acuity
stain with fluoroscein
normal fundus, eye movements
385
hyphema
```
reduced visual acuity
clear cornea
no stain
round pupil
abnormal RR-loss of red reflex
cant visualise fundus
full eye movements
blood in anterior chamber
```
386
penetrating injuries
```
reduced visual acuity
clear cornea
stains
peaked pupil
cant visualise fundus
full eye movements
```
387
orbital fracture
```
normal va
clear cornea
no stain
round pupil
abnormal eye movements
diplopia
```
388
corneal laceration
peaked pupil
penetrating corneal laceration into pupil
entire thickness
389
traumatic iridodialysis
sign of blunt trauma
| separation or tearing of the iris
390
canaliculus lid laceration
chronic tearing
391
orbital floor fracture
blunt trauma
orbital contents can herniate down
inferior rectus becomes trapped so trapped in upgaze
diplopia
392
acute alkali chemical keratoconjunctivitis
irrigate eye immediately
393
uv eye burn treatment
cyclopentolate
topical antibiotics
patching
394
complications hyphaema
lens dislocates
glaucoma
retinal detachment
395
peaked distorted pupil suggests
corneal laceration
| refer
396
styes are
swelling on the lids
infection in the oil gland in the eyelid
often staph aureus
397
horodeolum externum
outward
| lash follicles or sweat gland of moll and seis
398
horodeolum internum
abscess of meibomian glands and point inwards opening into the conjunctiva
less local reaction
leave a residual swelling called a chalazion
399
pinguecula
degenerative yellow vascular grey nodules on the conjuctiva either side of corneum
if inflammed can use ttopical steroids
400
entropion
```
lid inturning
irritates cornea
taping lower eyelids to cheek
or botox injections
surgery
```
401
ectropion
assoc.
old age
facial palsy
out turning eyelids
402
horner
miosis
ptosis
annihydrosis
403
third nerve
down and out
mydriasis
ptosis
404
causes of third nerve palsy
cavernous sinus lesions
superior orbital fissures
diabetes and HTN
PCA aneurusm
but vascular lesions spare the pupil eg diabetes and HTN in the nerve
405
other causes of a fixed dilated pupil
mydriatics
trauma
acute glaucoma
406
holmes adie pupil
tonically dilated pupil
accompanied by absent knee and ankle jerks
slow response to accomodation and light
idiopathic
loss of parasympathetic to the eye
benign-often women
slowly refractive to light with more definite accomodation
407
Horner causes
central lesions (anihydrosis face arms and trunk)
stroke
MS
tumour
pre-ganglionic anihydrosis only face
tumour- pancoast
thyroidectomy
trauma
post-ganglionic no anihydrosis
carotid artery aneurysm
cavervous sius thrombosis
carotid artery dissection
408
hutchinson's
unilateral dilated pupil unresponsive to light
| compression to occulomor nerve on same side by intracranial mass
409
argyll robertson
bilateral small pupils that accomodate but dont react to bright lights
neurosyphilis and DM
410
tropia and phoria
tropia- always present- cover test
| phoria- only seen on alternate cover test
411
conmitant strabismus
due to imbalance of extraocular muscles
inherited CNS problem
constant upon direction of gaze
412
non comitant strabismus
due to paralysis of nerve
depends upon direction of gaze
acquired nerve palsy
therefore may only be evident when patient attempts to use the weak muscle
413
ambylopia
lazy eye
failure to achieve normal visual acuity
reduction of corrected central visual acuity even though the eye appears structually normal
can be unilateral or bilateral
414
pathology ambylopia
50%
due to if one eye sees significantly worse (diplopia) - due to a refractive error= then the brain suppresses the image from the poorer seeing eye so a squint develops
the brain also begins to rely on the good eye
so vision of the bad eye is suppressed and neural connections diminish and fail to develop
415
ambloypia need to treat by
age 8
416
causes ambylopia
```
poor alignement
irregular shape eye
hypermetropia and myopia
opacifications of ocular media in one eye
signifcant asymmetric refractive index
retinoblastoma
```
417
management of strabismus and ambloypia
-refer children with squints to opthalmology
corneal light reflection test and other testsing
E game
eye patch the good eye so suppressed eye has to be used
418
binocular diplopia means
diplopia will go when each eye is covered separately
419
monocular diplopia means
diplopia will be present when each eye is covered separately
- cataracts
- cortical abnormality
420
horizontal diplopia
lateral rectus palsy
421
vertical diplopia causes
3rd nerve palsy - aniscoria, dilated pupil, down and out, ptosis
thyroid orbiopathy
cranial nerve 4
422
3rd nerve palsy causes
space occupying lesion- dilated pupil
| ischaemic cause- normal pupil as no effect on parasympathetic supply
423
signs of thyroid orbitopathy present
tightness of eye muscles
| lid and conjunctiva
424
causes 4th nerve palsy
trauma- blow out
diabetes
tumour
idiopathic
