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Opthamology Flashcards

(61 cards)

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1
Q

How are Snellen charts interpreted?

A
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2
Q

Name some causes of papilloedema

A
  • Intracranial Space-Occupying Lesion
  • Encephalitis
  • Optic neuritis
  • Benign intracranial hypertension
  • Malignant hypertension
  • Ischaemic optic neuropathy
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3
Q

Label this retina

A
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4
Q

Label this eye

A
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5
Q

Name some causes of ptosis

A

Neurological:

  • Oculomotor nerve palsy (dilated pupil)
  • Horner’s syndrome (constricted pupil)

Muscular/mechanical:

  • Old age (changes in levator muscle)
  • Myasthenia gravis
  • Muscular dystrophy
  • Myopathy (Grave’s)
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6
Q

What is a stye?

A
  • External stye = infection of lash follicle or associated sweat/sebum gland
    • Points outwards
    • Staph aureus
  • Internal stye = abscess of a meibomian gland
    • Points inwards

Both treated with oral or topical antibiotics

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7
Q

What is a Meibomian cyst/Chalazion?

A

Blockage of the Meibomian gland, which can become infected

Treat with topical antibiotics or refer to opthalmology if recurrent (incision/curettage)

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8
Q

What is blepharitis? How does it present?

A

Chronic, low-grade inflammation of the Meibomian glands and lid margins

  • Red eyelid margins
  • Irritable, burning, dry, red eyes
  • Scales on eyelashes
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9
Q

How is blepharitis managed?

A
  • Warmth - apply hot, moist flannel to open up glands
  • Massage - press on the eyelids with a cotton bud to release the Meibomian gland secretions
  • Clean
  • Treat dry eyes with tear supplements
  • Topical antibiotics
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10
Q

What are the red flag signs of red eye?

A
  • Decrease in visual acuity
  • Pain deep in the eye (not surface)
  • Absent or sluggish pupil response
  • Corneal damage on fluorescin staining
  • History of trauma
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11
Q

How does conjunctivitis present?

A
  • Uni/bilateral red eye
  • Surface irritation
  • Eye discharge
  • Sticking of the eyelids
    • Especially on waking up
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12
Q

How is conjunctivitis managed?

A
  • Conservative
    • Bath eye with boiled, cooled water BD
    • Avoid contact lens use
    • Simple hygiene measures (hand washing)
  • If symptoms not improved in 3-5d = topical chloramphenicol qds for 5 days
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13
Q

What is keratitis? How does it present?

A

Inflammation of the cornea

  • Very painful eye
  • Blurred vision
  • Photophobia
  • Profuse watering
  • Decrease visual acuity
  • Conjunctivitis
  • Creamy-white, disc-shaped lesion
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14
Q

What is epicleritis and scleritis? What’s the difference?

A

Episcleritis = inflammation of the thin layer of vascular tissue overlying the sclera

  • Minimal tenderness
  • Usually unilateral
  • No discharge

Scleritis = inflammation of the sclera

  • Painful, red eye
  • Uni or bilateral
  • May blur vision and decrease acuity
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15
Q

How is epicleritis and scleritis treated?

A

Episcleritis:

  • NSAID
  • Opthalmology - steroids

Scleritis:

  • Steroids
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16
Q

How does iritis/anterior uveitis present?

A
  • Acute pain
    • Increases as eyes converge/pupils constrict
  • photophobia
  • Blurred vision
  • Decreased visual acuity
  • Circumcorneal redness
  • Small or irregular pupil
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17
Q

What are the major causes of blindness in the UK?

A

Elderly:

  • Macular degeneration
  • Glaucoma
  • Cataracts

Younger:

  • Diabetic retinopathy
  • Uveitis
  • Inherited retinal disease
  • Retinovascular disease
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18
Q

What are the different types of glaucoma?

A
  • Open angle/chronic (majority) = drainage of the aqueous fluid is slowed by a clogging causing increased intra-ocular pressure over a long period of time
    • Angle between iris and cornea is ‘open’ and wide
  • Closed angle/acute (emergency) = drainage becomes suddenly blocked causing a sudden rise in intra-ocular pressure which leads to loss of vision
    • Angle between iris and cornea is ‘closed’
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19
Q

Describe how to assess the eye

A
  • Visual acuity records macular (central) vision
    • Snellen chart at 6m
  • Colour vision assessment - ishihara chart
  • Examination
    • Eyelids - symmetrical, position, skin changes
    • Eye surface - use fluorescin stain if indication of corneal damage
    • Note redness
  • Opthalmoscopy
  • Visual fields (peripheral vision)
  • Eye movements (9 positions of gaze)
  • Pupils
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20
Q

Describe how to carry out fundoscopy

A
  • Darken the room
  • Check red reflex
  • Examine disc
    • Place hand on patients forehead
    • Use your right eye for patients right eye
    • Shape, colour and size of cup
  • Follow vessels to periphery
  • Examine macula by asking patient to look directly into the light
  • Examine peripheral retina by asking patient to look up and down
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21
Q

How is a squint managed? (eso/exotropia)

A

3 O’s:

  • Optical - assess refractive state
    • Exclude abnormality
    • Glasses to correct refractive error
  • Orthoptic - patching good eye
  • Operations - resection and recession of rectus muscles
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22
Q

What is refraction? Different types?

A

Disorders of size and shape of eye

  • Myopia (short sight) = eyeball too long → focus on close objects
    • Need concave spectacles or LASIK
  • Hypermetropia (long sight) = eyeball too short → focus on distant objects
    • Need convex spectacles
  • Astigmatism = cornea or lens don’t have the same degree of curvature in horizontal and vertical planes → distorted image longitudinally/vertically
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23
Q

What is acute/closed angle glaucoma?

A

Blocked flow of aqueous from anterior chamber via canal of Schlemm (imbalance between drainage and production of aqueous)

  • Intraocular pressure >/= 30mmHg (normal 15-20)
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24
Q

Symptoms of acute glaucoma

A
  • Reduced vision
    • Preceded by blurred vision or halos around lights
  • Painful, red eye
  • Corneal oedema
  • Fixed mid-dilated and oval-shaped pupil
  • Associated headache and nausea
  • Worse at night (pupil dilatation)
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25
How is acute glaucoma managed?
* Send to eye unit immediately for gonioscopy (view iridocorneal angle) * Pilocarpine 2-4% drops/2 hours * Miosis opens blocked channels * Acetazolamide 500mg IV stat * Decreases aqueous formation * Mannitol 2% IV infusion * Topical steroids + beta blockers * Peripheral iridectomy
26
How is corneal abrasion identified and managed?
* Identify - fluorescin drops + blue light = green lesions * Manage = chloramphenicol drops
27
How are corneal ulcers managed?
* Take appropriate smears and cultures * Chloramphenicol (G +ve) alternated with ofloxacin (G -ve) * Adapt after cultures * Admit if diabetes or immunosuppression * Add steroid drops after recovery starts
28
What questions to ask with sudden painless loss of vision? What differentials do they suggest?
HELLP * Headache associated? If \> 50 years do ESR → giant cell arteritis * Eye movements hurt? → optic neuritis * Lights/flashes preceding → Detached retina * Like a curtain descending → amaurosis fugax (emboli/GCA) * Poorly controlled diabetes? Check acuity, pupil reaction anf fundi
29
What is optic neuropathy? Name some causes
Optic nerve damaged if posterior ciliary arteries are blocked by inflammation or atheroma * Arteritic = giant cell arteritis * Non-arteritic * Hypertension * Hyperlipidaemia * Diabetes * Smoking
30
What is vitreous haemorrhage
Haemorrhage from new retinal vessels (diabetes, central retinal vein occlusion) retinal tears, retinal detachment or trauma * Vitreous floaters = black dots/ring-like forms * Large bleed obscures red reflex and retina * B-scan ultrasound to identify cause
31
Name some symptoms of optic neuritis?
* Unilateral loss of acuity over hours or days * Colour vision affected * Eye movements hurt * Afferent defect in pupil (no direct constriction) * May have swollen optic disc
32
Name some causes of optic neuritis?
Disc swelling due to inflammation of the myelin sheath of the optic nerve * Multiple sclerosis * Syphilis * Diabetes * Vit deficiency (B12, D)
33
How is optic neuritis managed?
* Methylprednisolone for 72 hours * Then prednisolone for 11 days
34
Name some causes of transient visual loss
* TIA * MS * Subacute glaucoma * Papilloedema * Migraine * Vascular
35
Name some symptoms of central retinal artery occlusion
* Unilateral visual loss in seconds * Acuity reduced to finger counting * Afferent pupil defect (no direct contraction) * Retina = white with cherry red spot at macula
36
Name some causes of central retinal artery occlusion
Mainly thromboembolic * Hypertension * Smoking * Diabetes * Hyperlipidaemia
37
How is central retinal artery occlusion managed?
If \< 6 hours * Ocular massage * Surgical removal of aqueous * Antihypertensives
38
Name some causes of central retinal vein occlusion
* Arteriosclerosis * Hypertension * Diabetes * Polycythaemia * Glaucoma
39
Name some causes of gradual loss of vision
* Cataracts * Macular degeneration * Glaucoma * Diabetic retinopathy * Hypertension * Optic atrophy
40
Name some risk factors for age-related macular degenerations (AMD)
* Genetics * Smoking * Age * White * CVS disease * Hypertension * Hyperopia
41
How does AMD present?
* Elderly patients with deteriorating **central** vision * Can't see clock face * Can't see faces * Problems seeing straight lines - blurry or curved * Dimming of vision * Fundoscopy * Drusen = undigested cellular debris from degeneration of RPE (retinal pigmented epithelium) - small amounts normal * Pigment * +/- macular bleeding
42
How is AMD investigated?
* Visual acuity test * Fundoscopy/slit lamp exam * Amsler grid (straight lines appear wavy) * Fluorescin angiography - view leaking vessels * Optical coherence tomography
43
How is AMD managed?
* Antioxidants/vitamins (green leaf veg etc) * Intravitrael VEGF inhibitor * Laser photocoagulation * Intravitreal steroids (traimcinolone)
44
How can cataracts present?
* Blurred vision * Reduced colour sensitivty * Loss of stereoptosis - affects distance judgement * Gradual loss of vision * Changing refraction * Dazzle in sunlight * Monocular diplopia
45
How is cataracts managed?
* Convervative * Sunglasses * Mydriatic drops * Surgery = lens extraction via phacoemulsion (US energy) and insertion of intraocular lens * Antibiotic and anti-inflammatory drops for 3-6 weeks post-op * Change glasses
46
Name some complications of cataracts surgery
* Posterior capsule thickening + opacification * Treat with YAG laser * Astigmatism more noticeable * Endopthalmitis * Eye irritation * Vitreous haemorrhage * Anterior uveitis * Retinal detachment
47
What are the risk factors for cataracts?
* Genetics * DM * Steroid use * High myopia * Trauma * Down's syndrome
48
What pathology can the optic disc show?
3 Cs: * Colour (normally pale pink) - pale in optic atrophy * Contour * Oval in astigmatism * Large in myopia * Blurred margins in papilloedema and optic neuritis * Cup \*normamly 1/3 of disc diamter) - wider/deeper in glaucoma
49
What is retinal detachment? How does it present?
Fluid separates the sensory retina from the retinal pigment epithelium. 4 Fs: * Floaters * Flashes * Field loss * Fall in acuity * Curtain falling over vision
50
Name some causes of retinal detachment
* Retinal tear * Melanoma * Diabetes * Surgery * Trauma * Myopia
51
Name risk factors for developing diabetic retinopathy
* Duration of DM * Hyperglycaemia * Hypertension * Hyperlipidaemia * Nephropathy * Pregnancy
52
Describe the fundoscopy of diabetic retinopathy
* Microangiopathy → occlusion → ischaemia and **new vessel formation** * New vessels bleed → vitreous haemorrhage * Ischaemic nerve fibres → **cotton wool spots** * **Microaneuryms** → **flame haemorrhages** * **Hard exudate** (lipid-filled macrophages)
53
How is diabetic retinopathy managed?
* Primary prevention * Glycaemic control * BP control * Lipid lowering * Medical * Anti-VEGF injections * Intravitreal steroids (triamcinolone) * Surgical * Photocoagulation by laser * Vitreo-retinal surgery
54
Signs of hypertensive retinopathy
* AV nipping and crossover * Hard exudate * Macula oedema * Cotton wool spots * Flame haemorrhages
55
What is chronic/open angle glaucoma? Criteria for diagnosis
Optic neuropathy → death of retinal ganglion cells and optic nerve axons * 3 or more field locations are outside noraml limits * Nasal and superior 1st * Large cup-to-disc ration (\> 1/3) * Intra-ocular pressure **may** be \> 21 * Central field intact (good acuity)
56
How is chronic glaucoma screened for? Who?
Humphrey visual fields * \>35 with positive family history * Afro-Caribbean * Myopia * Diabetic/thyroid eye disease
57
How is chronic glaucoma investigated?
* Intra-ocular pressure * Cup/disc ratio on fundoscopy * Visual fields (humphrey) * Gonioscopy (view iridocorneal angle) * Optical coherence tomography * Central corneal thickness (normal 555 micrometers)
58
Describe the drug management of chronic glaucoma
* Prostaglandin analogues (latanoprost) * Inc uveosacral outflow * Beta blockers (timolol) * Dec production of aqueous * Carbonic anydrase inhibitors (dorzolamide) * Alpha-adrenergic agonists (brimonidine) * Miotics (pilocarpine)
59
Describe the surgical management of chronic glaucoma
* Trabeculectomy * Early failure, hypotony (low IOP) infection, bleb leakage * Selective laser trabeculoplasty * Glaucoma tube surgery * Laser peripheral iridotomy
60
Name some symptoms of chronic glaucoma
Late stage * Blurred vision * Parts of page missing * Tunnel vision * Loss of central fixation * Haloes (rainbow) around lights * Headache
61
What is amaurosis fugax?
Temporary loss of vision in 1 eye with complete recovery after seconds to minutes * Thrombotic embolus in retinal, opthalmic or ciliary artery from carotid atheromatous plaque

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