Part 2 Flashcards
(86 cards)
1
Q
Fungal corneal ulcer
A
- Presents w: hazy cornea, ring shaped dry ulcer with feathery margins
- Ring called: immunological ring of wiesley
- Most specific feature: fungal hyphae surrounding the ulcer- satellite lesions
- Hypopyon- fixed and unsterile
- MCC- aspergillus
- DOC- 5% Natamycin drops
2
Q
Viral keratitis
A
-Viral corneal ulcer. Also called Acute epithelial keratitis.
- Foreign body sensation, Lacrimation, Photophobia, Pain-mild to moderate, Decreased vision, Corneal sensitivity is reduced.
-2% Flouroscien stain will stay green in blue light.
-Dentritic ulcer, club shaped ends
-MCC- HSV type 1 and 2
-DOC- 3% acyclovir ointment
3
Q
Viral keratitis Rx
A
1- 3% acyclovir ointment
2- triflourothymidine 1% drops
3- debridement
4- topical antibiotics
5- 1% atropine (cycloplegic) for pain relief
6- oral acyclovir in immunocompromised
4
Q
Herpes zoster ophthalmicus
A
-Follows Hutchinson’s rule- if tip of nose has vesicles, there will be ocular involvement (nasocilliary nerve)
-Ophthalmic dev of trigeminal nerve.
-DOC- oral acyclovir.
5
Q
Acanthamoeba keratitis
A
- Acanthamoeba is fresh water protozoan
- H/O- bathing in dirty pond, contact lens user.
- most painful ulcer
•Dendritic ulcer -> ring ulcer
• Involves the adjoining limbus causing limbitis
• Radial keratoneuritis. - mc organism for contact lens- pseudomonas
- Dx by biopsy and corneal scraping
- Rx-
Debridement
amoebicides- polyhexamethylene and chlorhexidine
Antifungal
Amino glycoside
Antibiotic and pain relief
Keratoplasty in unresponsive.6-12 months.
6
Q
Lagophthalmos
A
- Inability of the eye to close
- Due to palsy of CN7
- orbicularis oculi muscle paralysis
Can lead exposure keratitis
7
Q
Keratoconus
A
- conical elevation of cornea anteriorly
- Common in Young females
- Mc complain- repeated change of glass numbers
- can lead to astigmatism
- Munson sign - notching of lower lid on downward gaze.
- Fe deposits- fleisher ring
- vertical stress lines on descemets membrane Vogt’s striae
Rx- C3R
Corneal collagen crosslinkage with riboflavin drops (vit B2)
8
Q
Esthesiometry
A
Done to check corneal sensations
9
Q
Keratometry
A
Done to check corneal curvature
10
Q
Corneal thickness checked by?
A
Pachymetry
Central- 520 micron
11
Q
Rate of aqueous, humour production
A
2 to 3 microlitre/minute
12
Q
Most important mechanism for equals humour production?
A
Secretion
13
Q
Drainage mechanism of aqueous humour
A
Conventional trabecular outflow
Unconventional Uveoscleral outflow
14
Q
What is gonioscopy used for?
A
To check angle between the cornea and iris
If angle is closed, it can lead to angle-closure glaucoma/ congestive glaucoma
15
Q
Normal intraocular pressure
A
16 to 21 mmHg
16
Q
Aqueous humour fluctuation for glaucoma diagnosis
A
8 mmHg
17
Q
Tonomertry
A
To check IOP
1- Schiotz- indentation tonometer
2- Goldman applanation tonometer (good std)
3- portable- tonopen
18
Q
Glaucoma signs and symptoms
A
Triad- ROV
Raised intraocular pressure
Visual field defect
Optic nerve defects
IOP can be raised by increased aqueous humour production or decreased aqueous humour drainage.
H1N1 LAB3
Haemorrhagous
Notching
Laminar dot sign
Asymmetry
And Bayoneting of blood vessels: If blood vessels bend or kink sharply when they pass over the edge of the cup.
19
Q
Glaucoma examination
A
Visible part of retina= fundus
Fundus exam to see retina- by ophthalmoscope.
Optic cup is inside the optic disc
Distance bw that is the cup disc ratio CDR
Normal CDR is 0.3
In glaucoma, there is:
Vertically oval cup
Enlarged CDR- more than 0.7
Tonometry - Raised intraocular pressure
ii. Fundoscopy - Characteristic optic disc head changes
(glaucomatous cupping)
ill. Imaging (OCT) - Retinal nerve fibre layer damage iv. Perimetry - Visual field defects V.
Gonioscopy - An open anterior chamber angle
20
Q
Visual field examination done by?
A
Perimetry
21
Q
Visual field defect in glaucoma
A
- Constriction of visual field
- Nasal visual field is lost
First change noticed = paracentral, winged shaped scotoma —
Leading to a sickle shaped scotoma —
Arcuate scotoma —
Ring/ annular shaped scotoma
Wo StAR
causing tunnel vision
22
Q
Acute angle closure glaucoma
A
Sudden rise of interocular pressure— rocky, hard, eyeball
Sudden painful loss of vision
1- Hazy cornea,
2- redness,
3- vertically, oval, fixed, non reactive, mid dilated pupil
Pain, nausea, headache at affected side of face.
First drug- IV MANNITOL
glycerol + tab acetazolamide
DOC- pilocarpine
23
Q
Open Angle glaucoma DOC
A
Latanoprost
Prostaglandin analog
24
Q
Only safe drugs for glaucoma in pregnancy
A
Alpha 2 agonists
Apraclinidine
25
Prostaglandin side-effects
-Conjunctival hyperaemia
-Eyelash elongation and darkening
-Peri ocular skin hyperpigmentation
-Iris hyperpigmentation
-Cystoid macular oedema
-Myalgia and skin rash
26
Mannitol dose for PACG
Dose 1g/kg body weight or 5 ml/kg body weight of a 20% solution in water
given intravenously over 30-60 minutes with peak action within 30 minutes.
**Use isosorbide in diabetic pts instead**
27
PACG RX
IOP > 50mmHg
1- Bright light and supine position
2- mannitol
3- acetazolamide 500mg iv followed by 250 mg 6 hourly orally.
4- Analgesics: For relief of pain.
5- Antiemetics: For control of vomiting.
Peripheral iridotomy
Trabaculotomy
28
Surgical rx for PACG
Angle-closure is due to synechiae formation between the iris and cornea
**If synechiae is less than 180° - peripheral irodotomy by Nd YAG laser**
**If Closure is more than 180° - trabeculectomy**
29
Glaucoma in children
If at birth- congenital glaucoma
If between 1 to 3 years, - infantile glaucoma
If after 3 years - juvenile glaucoma
30
Most common type of glaucoma in children
Infantile glaucoma
31
Congenital glaucoma
Due to trabecular dysgenesis
Triad- BPL
**B - blepharospasm
P - photophobia
L- lacrimation**
- **Buohthalmos** - bulls eye appearance
- horizontal stress lines on the descmets membrane of cornea- **Haab’s stria**
RXOC- trabeculectomy + trabeculotomy
32
Which side is optic disc present on?
Nasal side
33
Centre of macula
Fovea centralis
1.5mm size
3mm temporal to optic disc
34
Cones are responsible for?
Color and day vision
35
Rods are responsible for?
Night and dim vision
36
Maximum number of cones located at?
Fovia centralis
Causing **sharpest image formation**
37
What is responsible for central vision?
Macula lutea
38
Central retinal artery branches of?
Ophthalmic artery— internal carotid artery
39
Types of retinal detachment
1- Rhegmatogenous retinal detachment
2- Tractional retinal detachment
3- Exudative retinal detachment
40
Rhegmatogenous retinal detachment
Due to a tear between the neural and pigment layers of retina
**horse shoe shaped tear**
Common in myopes, where axial length is increased, so tears occur.
41
Tractional retinal detachment
Due to Neovascularisation- (neo angiogenesis) causing traction of the retina
Seen in diabetic retinopathy and Eales disease and CRVO and ROP.
Hazy cornea and neovessels seen
42
Exudative retinal detachment
Due to some malignancy or infection, causing collection of pus
**shifting fluid sign**
43
Hyperoleon
After pars plana vitrectomy, (usually done for retinal detachment or haemorrhage) silicon oil is inserted.
If oil comes from the posterior sentiment into the anterior segment, it’s called this sign
44
Vitreous haemorrhage
**Boat shaped subhyaloid** haemorrhage
**MCC- trauma**
45
Most common cause of sudden painless loss of vision?
Vitreous haemorrhage
46
Young adult male presents with hx of **recurrent vitreous haemorrhage**
Dx?
Eale’s disease
Periphlebitis or inflammation of veins
47
FFA
- fundus flourisein angiography
- dye inserted from the antecubital vein
- Ischaemic part will appear black
- Dye will leak out in haemorrhages
48
Rx for VH or eale’s disease
Intravitreal steroid injections
Anti VEGF mabs
( beva cizumab and rani bizumab)
Wait for 1 month for blood to be absorbed
If not
PPV- pars plana vitrectomy
49
Diabetic retinopathy
Two types
1- nonproliferative diabetic retinopathy
2- Proliferative diabetic retinopathy
1- Most important risk factor- **duration of diabetes**
2- Poor HbA1c control
50
Nonproliferative, diabetic retinopathy
Earliest feature- **microaneurysms**
**Most specific features- dot blot haemorrhage**
-Flame shape haemorrhage
-Dot blot haemorrhages
-Hard exudates (yellow)
-Soft exudates (large) **cotton wool spot**
51
Most common cause of decreased version in diabetic retinopathy
Cystoid Macular oedema
52
Most common cause of decreased vision in diabetes
Snowflake cataract
53
Beta blocker’s contraindicated in treatment for glaucoma for pts with?
Asthma
54
Rx for proliferative diabetic retinopathy
Pan retinal photo coagulation
Done by nd yag laser
55
Ischaemic CRVO
-Venous occlusion mostly due to compression by the retinal artery
- causes increased pressure leading to **flame shaped** haemorrhages
- **splashed tomato appearance**
56
Segmental BRVO
-Segmental branch retinal vein occlusion
- only a specific segment affected
- splashed tomato here also
57
CRAO
- due to embolism or plaque
- **retinal whitening** due to ischemia
- **Cherry red spot** of the choroid
- segmental blood flow causing **tram track/ cattle track appearance**
58
Dry ARMD
-atrophy of Retinal pig epi, photo receptors, choriocappilary
- MCC of decreased vision in worldwide blindness.
- **gradual central vision loss**
- Distorted vision difficulty reading
- Bilateral
- Asymmetrical
Hard drussen
Soft drussen
Focal hyperpigmentation
Dx- FFA and fundus exam
Rx-
amsler grid testing to check for wet type conversion
Htn control
Vit c e beta carotene
Vision aid
59
Prolonged use of hydrochloroquines and chloroquine causes?
Bullseye maculopathy
60
Retinitis pigmentosa
- Idiopathic degeneration of rods and cones
- More commonly rods
- Night vision affected
- Mc symptom- **night blindness** nactylopia
- Mc pattern of inheritance- **autosomal recessive**
**Signs- BAP
B- bony specules (pigmentations)
A- attenuated blood vessels
P- pale optic disc**
Rx- vit A
61
Roth spots
- Haemorrhages with white centres
- Characteristic of **infective endocarditis**
MCC- staph aureus
62
Retinoblastoma
- most common primary intraoccular **malignant** tumour in **children**
- Rb gene mutation located on the 13q14 chromosome
- autosomal dominant
- triretinal = **bilateral retinoblastoma + pineal gland tumour**
- mc Mets route through optic nerve
- presenting complain- leukocoria, converging squint
- Most pathognomic feature- **mass + calcification**
- intraoccular calcification
- Dx: ultrasound B scan
(B scan for posterior segment pathology
A scan for axial length)
Indirect ophthalmoscopy
Tonometry, slit lamp, CT. MRI
- flexner winterstiner Roettes on biopsy if done.
63
Retinoblastoma Rx
- Small tumours - <3mm wide x 2mm thick:
Laser photocoagulation
Transpupillary thermotherapy
Cryotherapy
-Medium tumours - 12mm wide × 3mm thick:
Brachytherapy
Primary chemotherapy
External beam radiotherapy
- Unilateral tumour with advanced disease: Enucleation of the eye
- Very large tumours: Chemotherapy followed by enucleation of the eye
- Extraocular extension - Metastasis: Adjuvant chemotherapy
External beam radiotherapy
Metastatic disease -chemotherapy
64
Axial prptosis
- protrusion of eye ball forward from the centre
- MCC in adults- **thyroid ophthalmology**
- MCC in children- **orbital cellulitis**
- to check degree of proptosis: **hertels exophalmometer** is used
- **more than 21mm** is considered proptosis
65
Thyroid ophthalmopathy
- first muscle affected- **inferior rectus**
-signs -
1 lid retraction causing **darilympal sign**
2 Lid lag von **graffes sign**
3 Starting look **kochers sign**
66
Cavernous sinus thrombosis
- Venous sinus that Drains all ophthalmic veins and Al veins of the cranial fossa
- pooling of blood leads to proptosis
- Loss of abduction- lateral rectus (LR6)
- first nerve affected- CN 6
- 3,4,5 nerve also affected
- The classic presentation is rapid onset of fever, severe headache 50-90%, malaise, nausea and vomiting.
- Delirium due to meningitis and septic emboli to various parts of body.
Diagnosis: CBC, ESR, C-reactive protein, Blood cultures, Lumber puncture to rule out meningitis
Imaging:
CT-Scan with contrast
MRI
CT venogram, MRI venogram
Rx. reatment
- Broad spectrum antibiotics iv
- Analgesic and antiinflammatory drugs
Surgical drainage may be required in certain cases.
67
Sympathetic ophthalmitis due to which type of trauma?
Penetrating trauma
68
congenital ptosis
Present since birth
Third Cranial nerve palsy
Lavator palpebrae superioris muscle palsy
69
Stye/ hordeolum externum
- Acute painful suppurative inflammation of **zeis** and **moll**
Small name small glands
-MCC **staph aureus**
Rx.
Hot compress
Antibiotic drops
Anti inflammatory drugs
Or I/D if v large
70
Chalazion
- Also called tarsal cyst
- chronic **painless,** nonsuppurative, inflammation of **meibomian gland**
*CHRONIC IS PAINLESS ALWAYS*
RxOC- incision and curettage by chalazion clamp
Steroid injections
Systemic antibiotics
Warm compress and anti inflammatory for conservative
Fate:
- Spontaneous complete resolution
- Liquify to form a thin fibrous sac- chalazion cyst.
- Get fibrosed into a hard nodule.
- Calcify- hard nodule.
- Get infected and suppurate.
- Burst and present as fleshy mass
71
Hordeolum internum
Acute painful, suppurative infection of miebomian glands
72
Symblepharon
Adhesion of the bulbar conjunctiva, and the palpebral conjunctiva of the same side
Same side- s
73
Ankyloblepharon
Adhesion of upper and lower eyelid
Amne samne- Ankylo
74
Ectropion
Outward turning of eyelid
75
Entropion
Inward turning of eyelid
76
Trichiasis
Inward directed eyelashes
77
Districhiasis
Extra row of eyelashes
78
Madarosis
Loss of eyelashes
79
Most common cancer of eyelid?
Basal cell carcinoma/ rodent ulcer
Most common site- lower lid
80
Most common cause of leukocoria?
Retinoblastoma
Also, congenital cataract
81
Acute dacryocystitis
Inflammation of lacrimal sac
NLD-
18-24mm
Opens into inf meatus
Thru valve of hasner
DOB direction
- Seen in **females** commonly
- MCC **staph aureus**
- **painful suppurative**
Sx- DCR **dacryocystorhinostomy** into the middle meatus
82
Congenital dacryocystitis Rx
Rx-
Topical antibiotics
Till 1 year- crigglers sac massage
1-4 years- probing and syringing and catheter dilation
After 4- external DCR surgery. Thru the skin approach
Types:
With silicon tube
Without tube
(External)
Endolaser (internal)
83
Schirmers test
For keratocunjunctivitis sicca
Whatman filter paper used
Side 5x35
Noted after 5 minutes
In normal eye: less than 10 mm is considered dry
W anaesthesia: less than 6mm
84
Dry eye/ keratocunjunctivitis sicca
Insufficient tear production to maintain tear film
Types-
- Pure Keratoconjunctivitis sicca: Lacrimal glands alone are involved.
- Primary Sjogren syndrome: autoimmune (dry mouth also)
- Sec. Sjogren (RA SLE)
- Non sjogren (trauma infection tumour)
**Dryness irritation burning foreign body sensation photophobia, corneal filaments**
Tests:
**flouriscein stain, rose Bengal stain, lissamine stain**
Tear film break up time: less than 10 secs
Rx.
Artificial tears (methylcellulose)
Autologous serums
Mucolytic agents
Topical retinoids
Anti inflammatory drops
Contact lens to stop evaporation.
Plugs and transplant of limbal system
85
Primary open angle glaucoma
bilateral optic neuropathy, often asymmetrical
i. IOP > 21 mm Hg
ii. Glaucomatous optic disc changes ii. Glaucomatous visual field defects iv. Open and normal appearing angle
MC of all glaucoma
Black people
Elderly, myopia, contraceptive pill
Due to loss of trabeculocytes
Symptoms
painless, slowly progressive loss of vision usually bilateral with insidious onset.
a. Night blindness
Sudden loss of vision in one eye with gross visual damage in the other eye.
headache and frequent change of presbyopic glasses.
86
Medicines for glaucoma
**Increase flow:**
Prostaglandins
Alpha 2 agonists
Cholinergics
Adrenergics
Rhokinase inhibitors
**Decrease production:**
Beta blockers
Alpha 2 agonists
Carbonic anhydrase inhibitors
