Opthalmology Cases Flashcards
(22 cards)
What are some risk facctcorts for age related macular degeneration
Increasing age >75
Smoking
Family history
HTN, diabetes etc
Features and signs of age related macular degeneration
Reduction of visual acuity (gradual in dy) (subacute in wet)
Reduced vision at night
Fluctuation in visual disturbance
Glare around objects/ flickering or flashing lights
Hallucinations -Charles bonnet syndrome
Amsler grid: Distortion of line perception
Fundoscopy: drusen
What investigations are done in age related macular degeneration.
Amsler grid: distortion of line perception
Fundoscopy: drusen
Slit lamp- identify pigmentary, exudative or haemorrhagic changes
Fluoresce in angiography - if neovascularisation is suspected (in wet)
Optical coherence tomography- used to visualise retina in 3 dimensions
How is age related macular degeneration managed
Dry- Zinc with anti-oxidant vitimans - A,C,E
WET: anti-VEGF agents - 4 weekly injections
Laser photocoagulation - risk of acute vision loss
What are the stages of hypertensive retinopathy
1: arteriolar narrowing and tortuosit, increased light reflex- silver wiring
2: ateriovenous nipping
3: cotton- wool exudates, flame and blot haemorrhages (may collect around fovea giving a macular star)
4: papiloedema
What are the stages of non proliferative diabetic retinopathy
Mild: 1 microaneurys
Moderate: microanurysms, bot haemorrhages, hard exudates (lipid deposits that leak out of damaged vessels), cotton wool spots (areas of retinal infarction)
Severe: blot haemorrhages and microanuerysms in 4 quadrants, venous beading (wall as of veins are no longer straight)
What are the key features of proliferative diabetic retinopathy (more common in type II)
Retinal neovascularisation- may lead to vitreous haemorrhage ( stormy sunset)
Fibrous tissue forming in front of retinal disc
What is the management for divetic retinopathy
Optimise glyceamic control, blood pressure, hyperlipideamia
Regular review by ophthalmology
Non-proliferative:
regular observation, panretinal laser photocoagulation if severe
Proliferative:
If change in visual acuity- anti vegf injections
Consider panretinal laser photocoagulation in proliferative or severe non-proliferative
If severe or vitreous haemorrhage- consider viteoetinal surgery
Features of acute angle-closure glaucoma
Features include:
Severe pain : ocular or headache
Decrease visual acuity
Symptoms worsen in dark
Hard, red eye
Haloes around lights
Semi dilated non-reacting pupil
Corneal oedema (dull or hazy cornea)
Systemic upset- nausea , vomiting even abdo pain
What are some factors predisposing to acute angle-closure glaucoma
Long sightedness- hypermetropia
Pupillary dilation
Lens growth associated with age
Investigations for AACG
Tonomotry- asses IOP
Goinoscopy- looks at angle
What is the manamagement for AACG
Combination of eye drops: direct parasympthetic (pilocarpine), beta blocker (timolol), alpha 2 agonist
IV acetazolamide - reduces aqueous secretions
Diffinitive: laser peripheral iridotomy - hole in peripheral iris
Open angle glaucoma features
Peripheral visual field loss - NASA’s scotoms (tunnel vision)
Decreased visual acuity
Optic cupping
Fundoscopy: optic disc cupping (optic disc widens and deepens),
Optic disc pallor (indicating optic atrophy)
Bayoneting of vessels (vessels have breaks as they disappear into deep cupping and reappear at the base)
Investigations for AOAG
Visual field testing
Slit lamp:
Tonomotry
Gonioscopy
What is the management for AOAG
360 selective laser trabeculoplasty if IOP >24 mmHg may need another at later date
Prostaglandin analogue eye drops - 2nd line
3rd line: beta blocker eye drops, carbonic anhydrase inhibitor eye drops, sympathomimetic eyedrops
In refractory cases:
Surgery- trabeculotomy
What are some common causes of vitreous haemorrhage
Proliferative diabetic retinopathy
Posterior vitreous detachment
Ocular trauma - most common cause in children and young adults
What are the features of vitreous haemorrhage
Painless sudden vision r haze
Red hue in vision
Floaters or shadows/dark spots in vision
Signs: decreased visual acuity depending on size of haemorrhage
Visual field defect if severe haemorrhage
Investigations for vitreous haemorrhage
Fundoscopy : haemorrhage
Slit-lamp: red blood cells in anterior vitreous
USS: rule out retinal tear/detachment
Fluorescein angiography- identify neovascularisation
Orbital CT- if open globe injury
Management of vitreous haemorrhage
Urgert Opthalmoscopy referral
Manage underlying causes e,g, glycaemic control
Consider viteroretineal surgery if haemorrhage does not clear spontaneously
What are some causes of optic neuritis
MS
Syphillis
Diabetes
Features and investigation of optic neuritis
Unilateral decrease in visual acuity over hours or days
Poor discrimination of colours- red desaturation
Pain on eye movement
Relative afferent pupillary defect
Central scotoma
MRI of brain and orbits with gandalonium contrast is diagnostic
What is the management of optic neuritis
High dose steroids
4-6 weeks recover
