Mx – no cure, chronic intermittent condition: 1. Self-care (eyelid hygiene and warm press), no eye make-up 2. Eyelid measures are ineffective: o Anterior blepharitis -> Topical antibiotic – Chloramphenicol o Posterior blepharitis + meibomian gland dysfunction & rosacea -> oral antibiotics 3. Refer to ophthalmology if severe

- Reduced acuity, progressive blurring, change of colour vision - Loss of red reflex - ‘Halos’ around lights - Gradual visual loss

Opthamology Flashcards by Hamish Halliday

What is glaucoma?

Glaucoma is optic nerve damage due to rise in intraocular pressure due to block of aqueous

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What is the normal intra-ocular pressure?

Normal IOP is 10-21mmHg

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What happens in acute angle-closure glaucoma?

Iris bulges forward and seals off trabecular meshwork

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What happens in chronic open-angle glaucoma?

There is increased resistance of trabecular meshwork

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What is the Px of acute angle closure glaucoma?

Acute painful red eye

Blurred vision
Headaches, N&V
Seeing halos around lights
o Hazy oedematous cornea
Evening symptoms

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What is the Px and Ix of chronic open-angle glaucoma?

Is often asymptomatic

Ix:
- Visual field defects
Peripheral vision closes until tunnel vision

Fundoscopy -> Cupped optic disc
Optic cup > 0.5 x optic disc
Measure IOP (> 24mmHg)
o Non-contact tonometry = puff of air at cornea
o Goldmann applanation tonometry

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Mx of acute angle-closure glaucoma?

->Refer to ophthalmologist

Emergency mx:
- Patient lie flat with head not supported to relieve pressure
- Pilocarpine eye drops
o 2% in blue eyes
o 4% in brown eyes
- Acetazolamide 500mg orally
- Analgesia + anti-emetic

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Mx of chronic open-angle glaucoma?

If >24 mmHg:
- Laser trabeculoplasty (SLT)

Not suitable for SLT ->
1. Prostaglandin analogue
2. B-blocker
3. Carbonic anhydrase inhibitor
Advanced COAG -> glaucoma surgery + mitomycin-C (MMC)

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What is blepharitis?

Inflamed eyelids

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What are the different types of blepharitis?

Anterior - staphylococcal or seborrheic

Posterior - meibomian

Can also be mixed

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Mx of blepharitis?

Mx – no cure, chronic intermittent condition:
1. Self-care (eyelid hygiene and warm press), no eye make-up

Eyelid measures are ineffective:
o Anterior blepharitis -> Topical antibiotic – Chloramphenicol
o Posterior blepharitis + meibomian gland dysfunction & rosacea -> oral antibiotics
Refer to ophthalmology if severe

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What is a chalazion?

Meibomian gland blockage -> non-tender eyelid swelling

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What is an entropion and mx?

Eyelids turn inwards with the lashes against the eyeball
-> corneal damage + ulceration

Mx:
Tape eyelid down + lubricating drops

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What is an ectropion?

Eyelid turns outwards with inner aspect of eyelid exposed
-> exposure keratopathy

Mx:
Lubricating drops

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What is trichiasis and mx?

Inward growth of eyelashes -> corneal damage + ulceration

Mx - Epilation, laser mx

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Who gets cataracts?

Rx – elderly, smoking, alcohol, diabetes, steroids, hypocalcaemia
- Can also occur in children (congenital)

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Px of cataracts?

Reduced acuity, progressive blurring, change of colour vision
Loss of red reflex
‘Halos’ around lights
Gradual visual loss

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Px of central retinal artery and vein occlusion?

Both - Sudden, painless unilateral loss of vision, RAPD

Amaurosis fugax – branch retinal artery occlusion
o “Black curtains coming down” – lasts a few minutes

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What would be seen on fundoscopy of central retinal artery occlusion and central retinal vein occlusion?

Artery occlusion (light) - pale retina (due to lack of blood flow & oedema) with a cherry-red spot

Vein occlusion (dark) - Flame and blot haemorrhages, optic disc oedema, macular oedema

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Mx of central retinal artery occlusion?

Refer to ophthalmology - immediate mx:
o Ocular massage
o Increase blood oxygen content and dilate renal arteries -> Sublingual isosorbide dinitrate and inhaled carbogen
o Reduce ocular pressure ->IV acetazolamide and mannitol

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Mx of central retinal vein occlusion?

Study These Flashcards

Mx – treat macular oedema + prevent neovascularisation
- Laser photocoagulation
- Intravitreal steroids
- Anti-VEGF

Difference in px between peri-orbital and orbital cellulitis?

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Painful eye movements, blurred vision and altered colour vision in orbital cellulitis

Peri-orbital cellulitis - Eyelid and skin infection in front of the orbital septum
Orbital cellulitis - Infection around the eyeball that involves tissues behind the orbital septum

Chlamydia and gonorrhoea conjunctivitis px:

Study These Flashcards

Chlamydia conjunctivitis:
- Chronic low-grade irritation and mucous discharge, often unilateral
- Follicles “grains of rice” on lower eyelid

Gonorrhoea conjunctivitis:
- Rapid with copious discharge, eyelid swelling & tender lymphadenopathy

Rx of different conjunctivitis?

Study These Flashcards

Bacterial -> Keratitis

Viral -> Keratoconjunctivitis

Gonorrhoea -> Corneal ulceration

Mx of bacterial conjunctivitis?

Self-limiting If severe -> chloramphenicol drops or fusidic acid

Mx of contact lens conjunctivitis?

Contact lens conjunctivitis -> stop contacts + antibiotics against gm -ve (gentamicin or levofloxacin)

Px of allergic conjunctivitis?

Bilateral ocular itching +/- watery discharge, conjunctival redness & swelling - Hx of rhinitis, asthma urticaria, eczema

Mx of allergic conjunctivitis?

Mx: 1. Avoidance of allergens, eye care 2. Topical antihistamine or mast cell stabiliser / topical antihistamine 3. Adjuvant – Topical ocular diclofenac

What is uveitis?

Inflammation of the uveal tract (iris, ciliary body and choroid)

Uveitis px:

Red painful eye, blurred vision, eye watering, photophobia - Deep aching pain - 20-50 years - Can be acute or chronic - Hypopyon – exudate in front of iris

Types of uveitis?

Anterior uveitis – anterior segment of eye (iris & ciliary body) inflammation (90% of cases) Intermediate uveitis – vitreous inflammation Posterior uveitis – retina and choroid inflammation Panuveitis – inflammation in the anterior chamber, vitreous and retina or choroid

Causes of uveitis?

Autoimmune (HLA-B27) [ankylosing spondylitis] Infective – herpes simplex, hzv, cytomegalovirus, toxoplasmosis Traumatic, neoplasia (rare)

Non-infectious uveitis mx:

Corticosteroids to reduce inflammation Mydriatic to paralyse ciliary body (cyclopentolate or atropine)

Difference in px between episcleritis and scleritis?

Episcleritis - normal vision, 50% are bilateral Scleritis - reduced visual acuity + severe pain

Mx of episcleritis?

Lubricant + NSAIDs

Mx of scleritis?

Emergency as life threatening Oral NSAIDs + steroids

Ix for keratitis?

Fluorescein Viral -> dendritic corneal ulcer Bacterial - > corneal ulcer + hypopyon

Mx for keratitis?

Viral -> refer to ophthalmology, acyclovir Bacterial -> topical antibiotics (oxaflocin)

Px of keratitis?

Inflammation of the cornea Px - Painful red eye, photophobia, vesicles around eye, foreign body sensation, watery eye, acute visual loss

Px of optic neuritis?

- Partial or total unilateral visual loss over a few days - Pain behind eye, worse on movement - Poor colour discrimination - Pale and swollen optic disc on fundoscopy - RAPD, central scotoma

Mx of optic neuritis?

High dose oral steroids (IV methylprednisolone)

Px of age-related macular degeneration?

- Gradual worsening central visual field loss (scotoma) - Reduced visual acuity - Distortion of vision where straight lines appear wavy (metamorphopsia)

Fundoscopy of age-related macular degeneration?

Drusen - Yellow deposits under the retina made of lipids

Types of age-related macular degeneration?

- Dry (90% – gradual) – drusen + macular atrophy - Wet (10% – subacute) – new vessels growing -> leakage of fluid and blood -> oedema

Mx of wet age-related macular degeneration?

Intra-vitreal anti-VEGF (ranibizumab)

Fundoscopy of diabetic retinopathy?

- Microaneurysms -> Blot haemorrhages - Exudate (cotton wool spots) - New blood vessel growth - Oedema

How is diabetic retinopathy classed?

Is it proliferative? (is there new vessel growth?) Is there maculopathy? (is the macula thickened?)

Complications of diabetic retinopathy?

- Retinal detachment - Vitreous haemorrhage - Optic neuropathy - Glaucoma - Cataracts

Px of retinal detachment?

Sudden onset, painless progressive visual field loss, floaters, recurrent flashes, and progressive visual loss

Mx of diabetic retinopathy?

Laser photocoagulation Anti-VEGF (ranibizumab) Vitreoretinal surgery

Keith Wagner classification of hypertensive retinopathy?

Stage: I Arteriolar narrowing II Arteriovenous nipping III Retinal haemorrhages, exudates, cotton wool spots IV Papilloedema

Visual field loss types:

Optic nerve defect – Monocular vision loss Optic chiasm defect – bitemporal hemianopia Optic tract defect or occipital cortex (macula spared) – Homonymous hemianopia

Opthamology Flashcards

(52 cards)