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Flashcards in Opthamology Deck (43):

What is this condition, its causes, symptoms and treatments


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)


What is this condition, its causes, symptoms and treatments


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 


What is this condition, its causes, symptoms and treatments


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


What is this condition, its causes, symptoms and treatments


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


What is this condition, its causes, symptoms and treatments

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 


What is this condition, its causes, symptoms and treatments

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


What is this condition, its causes, symptoms and treatments

Subconjuctival Hemorrhage

Localised sharply circumscribed, no pain, no visual loss

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


What is this condition, its causes, symptoms and treatments


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


What is this condition, its causes, symptoms and treatments

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 


What is this condition, its causes, symptoms and treatments

Viral conjuctivitis

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

no vision loss

Rx- strict hygiene, cool compress, lubricants


What is this condition, its causes, symptoms and treatments


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



What is this condition, its causes, symptoms and treatments

Allergic Conjuctivitis

Hx of atropy, asthma, eczema, hayfever

Rx- cool compresses, ocular lubricant, antihistamines


What is this condition, its causes, symptoms and treatments

Bacterial conjuctivitis

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

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


What is this condition, its causes, symptoms and treatments

Acute angle-closure glaucoma

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

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


What is this condition, its causes, symptoms and treatments


Pain, photophobia, red eye

smaller or irregular pupil

Rx- urgent opthalmologist referral, steriods 


List some of the features you can see

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


What causes Haemorrhages in the retina

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


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 


What causes maculopathy in the eye

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


What causes Neovascularisation in the eye

Growth of abnormal vessels and fibrous tissue due to retinal ischemia 


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 


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 


Differentials for chronic vision loss in white eye

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


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 


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 


Differentials for painless red eye

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


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 


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 


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



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


What structures is the anterior chamber located between

Cornea and iris


What structures is the posterior chamber located between

Lens and iris 


Which muscle makes the upper eyelid more moveable

Levator Palpebrae Superioris 


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 


Dilation of pupil 

Radial muscles contract 

Sympathetic innervation 


Constriction of pupil

Circular muscles contract 



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 


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 


Examination of eye injury

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


Investigations in eye trauma

  • Tonometry
  • Fluorescien staining
  • Imaging - CT or MRI 


Urgent consideration for red painful eye 

Angle closure glaucoma 


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