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Opthalmology Flashcards

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1
Q

define cartaracts

A

accumulation of protein in the lens resulting in opacification and vision loss

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2
Q

risk factors for cataracts

A

old age
diabetes
eye trauma
long term ocular steroid use

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3
Q

presentation of cataracts

A

decrease in acuity
painless, blurred or cloud vision
glare
change in colour vision

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4
Q

post operative complications of cataract surgery

A

endophthalmitis
uveitis
retinal detachment

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5
Q

types of AMD

A 
early/intermediate AMD (drusen deposits, near normal vision)
late AMD (loss of central vision)

2 forms of Late AMD
atrophic/dry and exutative/wet

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6
Q

risk factors for AMD

A

age
Fhx
previous cataract surgery
smoking, hypertension, CVD

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7
Q

fundoscopy findings in AMD

A

early - drusen, loss of retinal epithelium and photoreceptors
dry - thickening of bruch’s membrane, geographical atrophy
wet - subretinal haemorrhage, pigment epithelial detachment, retinal thickening, oedema, lipid exudates

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8
Q

management of AMD

A 
risk modification (cardiovascular risks, smoking, antioxidant and mineral supplements)
dry - no current effective treatment
wet - VEGF intravitreal injection (ranibizumab)
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9
Q

pharmacological treatment of open angle glaucoma

A

latanoprost (prostaglandin analogue - increases uveoscleral outflow)
timolol (beta blocker -decrease aqueous humour production)
brinzolamide (carbonic anhydrase inhibitor - decreases aqueous humour production)
brimonidine (a1 agonist - both)

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10
Q

surgical management of open angle glaucoma

A

trabeculectomy with mitomycin C
tube placement - ahmed valve
laser trabeculoplasty

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11
Q

fundoscopy findings in open angle glaucoma

A

thinning of the neurosensory rim
nerve fibre layer defect
optic disc rim notching and cupping
cup:disc ratio enlarged (>0.6) or asymmetrical (>0.2 between eyes)

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12
Q

presentation of angle closure glaucoma

A 
sudden onset severe painful, red eye
blurred vision
halos around lights
headache
N&V
pupil mid dilated and fixed
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13
Q

management of angle closure glaucoma

A 
topical pilocarpine (reduces IOP)
IV brinzolamide (carbonic anhydrase inhibitor)
YAG laser iridotomy (both eye - prophylactic in the second one)
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14
Q

what is rhegmatogenous RD

A

detachment due to a retinal discontinuity (break/tear)
Whereas, In the tractional form, RD is caused by proliferative membranes, either on the retinal surface or, less commonly, underneath it (sub-retinal strands). No retinal break is present, although it may subsequently develop (combined rhegmatogenous/tractional RD)

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15
Q

risk factors for retinal detachment

A

trauma
myopia
previous cataract surgery, laser refractive surgery
family history

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16
Q

presentation of retinal detachment

A

dense shadowing in peripheral vision moving to central vision
curtains coming down
straight lines appearing curved
floaters or flashing lights

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17
Q

management of retinal detachment

A

Complete detachment = Vitrectomy + Laser retinopexy/Cryopexy (to Seal any holes/breaks)

Haemorrhagic = retinotomy +/- Gas/Oil bubble injection (Tamponades the break)

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18
Q

bacterial causes of conjunctivitis

A

pneumococcus
s. aureus,
haemophilus influenzae

Neisseria gonorrhoea
chlamydia trachomatis

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19
Q

viral causes of conjunxtivitis

A

adenovirus
herpes simplex
epstein barr

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20
Q

presentation of viral conjunctivitis

A

bilateral
red, watery, itchy
follicles

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21
Q

presentation of bacterial conjunctivitis

A

unilateral/bilateral
red, sticky, discharge
papillae

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22
Q

common causative organisms in keratitis

A

bacterial: pseudomonas, s. aureus
viral: herpes simplex, herpes zoster
fungal: aspergillus

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23
Q

risk factors for keratitis

A

bacterial: CL user, dry eyes, lid disease
viral: Hx of HSV, HZV
fungal: trauma from vegetation, ocular corticosteroid use

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24
Q

findings of fluorescein staining in keratitis

A

bacterial: oval/round lesion
viral: dentritic (HSV)
fungal: feathery edges, satellite lesions

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25
investigations for keratitis
WCC, CRP cornel scrapings culture contact lens and solution culture fluorescein staining
26
management of keratitis
bacterial: antibiotics HSV: aciclovir fungal: anti fungal photophobia: cyclopentolate CL hygiene education avoid CL use - should avoid use until resolved
27
difference between a corneal abrasion and a corneal ulcer
abrasions only affect the epithelium | ulcers involve the stroma
28
how does central retinal artery occlusion present
sudden painless central vision loss decrease visual acuity RAPD
29
clinical features of CRAO
pale/swollen retina "cherry red spot" intraretinal haemorrhage
30
investigations for CRAO
fluoroscein angiogram - shows slow filling arterioles lipid panel, aPTT, INR, clotting ECHO
31
management of CRAO
TIA referral (carotid US/CT head, Aspirin/clopidogrel, no driving for a month)
32
risk factors for RVO
``` atherosclerosis systemic hypertension diabetes smoking CVD ```
33
how does RVO present
sudden painless vision loss
34
clinical findings of RVO
tortuous vessels disc swelling flame haemorrhages cotton wool spots
35
investigations for RVO
fluorescein angiogram optical coherence tomography electroretinography
36
management of RVO
address vascular risk (BP, lipids, DM, smoking) | for macular oedema - VEGF inhibitor, intra vitreal steroids
37
presentation of AION
``` NAION = reduced vision in one eye, often obscured by a 'shadow' affecting upper or lower half, painless AAION = + symptoms of temporal arteritis (jaw claudication, scalp tenderness, etc.) ```
38
investigations for aaion
ESR, CRP, temporal artery biopsy
39
management of AION
prednisolone
40
describe the 2 types of diabetic retinopathy
non proliferative early stage, leakage of blood vessels -> blurred vision proliferative advanced form, neovascularisation -> prone to rupture leading to haemorrhage, vision loss and retinal scarring
41
features of diabetic retinopathy on fundoscopy
``` microaneurysms blot/dot haemorrhages hard exudates cotton wool spots new vessels ```
42
R0 of diabetic retinopathy
no signs
43
R1 of diabetic retanopathy
mild - at least one dot haemorrhage/microaneurysm without hard exudates
44
R2 of diabetic retinopathy
moderate - 4 or more blot haemorrhages in one hemi field
45
R3 of diabetic retinopathy
severe: any of the following 4 or more blot haemorrhages in both hemi fields venous bleeding intraretinal microvascular abnomality
46
R4 of diabetic retinopathy
proliferative disease: new vessels, vitreous haemorrhage
47
investigations for diabetic retinopathy
photographs of fundus optical coherence tomography fluorescein angiography
48
management of diabetic retinopathy
glycaemic control mild = observe/VEGF inhibitor (ranibizumab) PDR = pan retinal photocoagulation laser diabetic macular oedema = intravitreal injections (corticosteroids, anti VEGF) vitreous haemorrhage = vitrectomy
49
ocular features of hypertension
``` anterior narrowing cotton wool spots retinal haemorrhages optic nerve swelling retinal ischaemia and neovascularisation ``` associated with RAO/RVO
50
how to distinguish between scleritis and episcleritis
episcleritis blanches with phenylephrine drops | scleritis does not
51
presentation of optic neuritis
painful vison loss pain on movement of eyes reduced colour vision RAPD
52
Management of optic neuritis
IV methylprednisolone (speeds up recovery but does not improve visual acuity)
53
features of thyroid eye disease
exophthalmos restricted movements lid retraction and swelling chemosis of conjunctiva
54
management of thyroid eye disease
smoking cessation artificial tears and lubrication systemic steroids if vison affected surgery (orbital decompression, eye muscle surgery, eyelid surgery)
55
how does cranial nerve III palsy present
adduction weakness (outwards and downwards) ptosis fixed dilated pupil vertical diplopia
56
how does 4th nerve palsy present
extorsion of the eye (inability to depress and adduct the eye simultaneously) head tilt to opposite side of lesion vertical/oblique diplopia
57
how does 6th nerve palsy present
esotropia (affected side's eye drifts towards the midline) | horizontal diplopia
58
define amblyopia
Strabismus in children may cause suppression (active process of the central nervous system by which the visual input of one eye is ignored) of the image created by the non-fixating eye, resulting in amblyopia (decreased vision in an anatomically normal eye caused by suppression) and irreversible loss of vision if not adequately treated
59
investigations for strabismus
cover test and prism cover test uncover test hirschberg test krimsky test
60
management of stribismus
correct any refractive errors cover the good eye in amblyopia extraocular muscle surgery treat any intracranial causes (stroke, masses etc)
61
causes of acute painless vision loss
``` CRAO CRVO AION retinal detachment wet ARMD vitreous/retinal haemorrhage (in diabetic retinopathy) ```
62
causes of gradual painless vision loss
cataract open angle glaucoma diabetic retinopathy dry ARMD
63
causes of an acute red eye
``` conjunctivitis corneal ulcer/abrasions uveitis/iritis acute angle closure glaucoma trauma ```
64
presentation of uveitis
``` anterior = photophobia, pain, reduced vision intermediate = reduced vision, floaters, photopsia posterior = reduced vision, scotoma, floaters, photopsia ```
65
signs of anterior uveitis
limbal injection hypopyon anterior chamber cells
66
signs of intermediate/posterior uveitis
vitreous haze snowballs multifocal choroiditis retinitis
67
management of uveitis
topical pred or dex systemic steroids if posterior mycophenolate can be considered

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