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Flashcards in Opthamology Deck (43):
1

What is this condition, its causes, symptoms and treatments

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Blepharitis

Non specific generalised inflammation of the eyelids

Causes = staph aureus, seborrheric dermatitis, rosacea, contact allery

Symptoms- itch, watery or dry, light sensitivity

Treatment - daily lid hygiene, lubrication, warn wet compress, treat cause (seb derm, rosacea)

2

What is this condition, its causes, symptoms and treatments

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Ectropion

Lid turning outwards with exposure of the conjunctival sac

Causes- aging, scaring, facial nerve palsy - stroke or Bell's palsy 

Symptoms - irritation, gritty, burning, excess tear

Rx- topical lubrication, possible surgical intervention 

3

What is this condition, its causes, symptoms and treatments

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Entropion

Lid turning inwards with eyelashes abrading the cornea

Causes- trachoma, aging and scarring

Symptoms - redness and pain, light sensitivity, tearing, decreased vision when cornea scaring

Rx- check condition of cornea with fluorescein, lubricate, tape lid back from cornea, definitive mangement with surgery

4

What is this condition, its causes, symptoms and treatments

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Pterygium

Raised, yellowish fleshy lesion at the limbus-collagen degeneration and fibrovascular proliferation

Causes - UV light, chronic irritation, genetics

Rx- Lubrication and sunglasses, surgery if over cornea

5

What is this condition, its causes, symptoms and treatments

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Herpes Simplex Keratitis

Dendritic branching ulcer on the cornea - need a stain

Ask about history of previous red eye or cold sores

Rx- Topical or oral acyclovir, opthamologist referal 

6

What is this condition, its causes, symptoms and treatments

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Corneal Ulcer

associated with hx of contact lens wear

epithelial defect with opacified base

Bacterial or acanthamoeba

Rx- urgent opthalmologist referral for investigation and antibiotcs

7

What is this condition, its causes, symptoms and treatments

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Subconjuctival Hemorrhage

Localised sharply circumscribed, no pain, no visual loss

Rx- Check BP, check INR if on warfrin, will resolve spontaneously

8

What is this condition, its causes, symptoms and treatments

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Chalazion

Localised eyelif inflammation, minimal ocular involvement

Causes- cyst in tarsal plate, blocked eyelid

Symptoms - not painful but red

Rx- Topical antibiotics (minimal evidence), warm compress, occasionally surgery

9

What is this condition, its causes, symptoms and treatments

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Herpes Zoster Ophthalmicus

Vesicular rash, may have dendritic corneal ulceration

Opthalmic branch of trigeminal nerve

ask about chicken pox history

Rx- oral antivirals, urgent referral if corneal ulceration 

10

What is this condition, its causes, symptoms and treatments

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Viral conjuctivitis

URTI history, gritty eye, watery discharge, begins with one eye spreads to another

no vision loss

Rx- strict hygiene, cool compress, lubricants

11

What is this condition, its causes, symptoms and treatments

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Adenovirus

looks like ordinary viral conjuctivitis then progresses to chemosis, photo phobia, reduced vision

Be wary - can cause keratoconjuctivitis with pseudomembranes

Urgent ophthalmologist referal for steriods drops

 

12

What is this condition, its causes, symptoms and treatments

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Allergic Conjuctivitis

Hx of atropy, asthma, eczema, hayfever

Rx- cool compresses, ocular lubricant, antihistamines

13

What is this condition, its causes, symptoms and treatments

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Bacterial conjuctivitis

Red eye, purulent discharge, no visual loss, no corneal involvement

Rx- Strict hygiene, refular cleaning with warm water, topical antibiotics 

14

What is this condition, its causes, symptoms and treatments

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Acute angle-closure glaucoma

Red eye, hazy cornea, fixed semi dilated pupil, nausea, visionloss

Rx- urgent opthalmologist referral, IV acetazolamide, pilocarpaine, topical beta blocker 

15

What is this condition, its causes, symptoms and treatments

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Iritis 

Pain, photophobia, red eye

smaller or irregular pupil

Rx- urgent opthalmologist referral, steriods 

16

List some of the features you can see

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  1. Haemorrhages
  2. Exudate
  3. Muculopathy
  4. New Vessels 
  5. Can also get - cotton wool spots (soft exudate)

17

What causes Haemorrhages in the retina

Retinal infarct caused by partial arteriolar occlusion, or complete occlusion and then reperfusion

18

What causes Exudates in the eye

Localised infarcts in RNFL (retinal nerve fiber layer) --> obstructed axoplasmic flow in nerve axons --> swelling and atrophy of fibers 

19

What causes maculopathy in the eye

Accumulation of intraretinal fluid due to capillary leak in the macular region 

20

What causes Neovascularisation in the eye

Growth of abnormal vessels and fibrous tissue due to retinal ischemia 

21

What is the mangement of a diabetic eye

  1. Urgent ophthalmology referal 
  2. laser therapy for maculopathy and new vessels
  3. anti VEGF for maculopathy
  4. Blood Glu and pressure control
  5. No smoking or driving 

22

Differentials for acute vision loss in non-inflammed eye

  1. Retinal Detachment
  2. Retinal artery or vein occlusion
  3. Migraine 
  4. Hyperglycemia
  5. Amauroxis fugax 
  6. Anterior ischemic optic neuropathy- temporal gaint cell arthritis
  7. Optic Neuritis - MS 

23

Differentials for chronic vision loss in white eye

  1. Macular degeneration 
  2. Refractive errors
  3. Cataracts 
  4. Diabetic retinopathy
  5. Open angle glaucoma

24

Red flags in vision loss 

  • Sudden vision loss  
  • Vision loss with temporal arteritis symptoms - jaw claudication (pain with chewing), temporal tenderness 
  • Raised intraocular pressure – ie pain with tender globe and hazy cornea, nausea and fixed dilated pupil 
  • Pain on eye movement in younger patients 30-50 – optic neuritis 
  • History of new flashes and floaters 

25

Examinations to be done in vision loss

  1. Visual acuity 
  2. Visual fields
  3. Red reflex
  4. pupil reflex
  5. Fundoscopy
  6. Blood pressure
  7. BGL 

26

Differentials for painless red eye

  1. Chalazion/stye
  2. Subconjuctival haemorrhage
  3. Pteyrium 
  4. Eyelid disorders 

27

Differentials of painful red eye

  1. Conjuctivitis (allergic, bacterial, viral)
  2. Keratitis
  3. Corneal trauma
  4. Keratoconucticitis sicca dry eyes
  5. episcleritis
  6. scleritis
  7. Acute angle closure glaucoma 
  8. endophthalmitis
  9. uveitis 

28

Emergency conditions causing red eye 

  1. Angle closure glaucoma 
  2. Ketaritis 
  3. Ruptured globe/penetrating eye injury
  4. Blunt trauma
  5. Corneal abrasion 
  6. Gonococcal conjuctivitis 
  7. Orbital fracture 

29

What should your uncorrected vision in better eye be better than to drive

6/12

30

What is true about visual field in regards to driving unconditionally

 Binocular with a  horizontal extent of at least 110 degrees within 10 degrees above or below the horizontal midline,

If there is significant field loss/ scotoma within a central radius of 20 degrees of foveal fixation

31

What structures is the anterior chamber located between

Cornea and iris

32

What structures is the posterior chamber located between

Lens and iris 

33

Which muscle makes the upper eyelid more moveable

Levator Palpebrae Superioris 

34

Flow of lacrimal fluid 

From excretory lacrimal ducts to conjuctiva of upper eyelid to medially over anterior chamber to two openings called lacrima puncta to lacrimal canals (superior and inferior) to lacrimal sac to nasolacrimal duct to nasal cavity 

35

Dilation of pupil 

Radial muscles contract 

Sympathetic innervation 

36

Constriction of pupil

Circular muscles contract 

Parasympathetic 

37

Red flags in eye trauma

  1. History suggestive of penetrating injury - hammering metal on metal
  2. Distorted pupil
  3. Poor vision
  4. Alkali or strong acid burn 

38

What features of the history are important in ophthalmic eye trauma

  • Mechanism of eye injury
  • Associated symptoms - diplopia, pain w/ movement, nausea, bleeding from nose or mouth, facial numbness = Orbital fracture 
  • Past history - esp occular cataracts
  • Mediation 
  • Time of last meal
  • Tetanus 

39

Examination of eye injury

  • Visual acuity
  • Corneal exam with opthalmoscope and slit lamp 
  • Red reflex
  • Pupil reflex
  • Eye movement 
  • Fundoscopy 

40

Investigations in eye trauma

  • Tonometry
  • Fluorescien staining
  • Imaging - CT or MRI 

41

Urgent consideration for red painful eye 

Angle closure glaucoma 

42

Medications that aggrevate closed angle glaucoma

Medications blocking ACh

  1. Depression - SSRI (fluoxetine, paraoxetine), TCA (amitryptilne, imipramine)
  2. Asthma and COPD ipratroprium bromide, tiotropium bromide 
  3. incontinence - tolterodine, oxybutynin
  4. Muscle spasm- orpheadrine, trihexyphenidyl 
  5. Nausea - prometazine 

Ephedrine containging mediations

Sulfonamide containing drugs 

  1. Topiramate, acetazolamide, quinine, tetracycline, trimethoprim/sulfanethoxazole

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