Practical Opthalmology Flashcards
(52 cards)
1
Q
What’s direct ophthalmoscope
A
Device that allows you to look into the back of the eye to look at the health of the retina, optic nerve, vasculature and vitreous humor with magnification of approximately 15 times
2
Q
How to set the light size in direct ophthalmoscope
A
- Large aperture is used for a dilated pupil after administering mydriatic drops
- Medium aperture is the standard for a non-dilated pupil in a dark room
- Small aperture is for a constricted pupil in a well-ligt room
3
Q
Cycloplegic drops
A
Atropine 2wks
Cyclopentolate 2d
Tropicamide 6h
4
Q
Type of light colours and shapes in direct ophthalmoscope
A
Slit
- Used to look at contour abnormalities of the cornea, lens or retina
Grid
- Used to approximate the relative distance between retinal lesions
Red free (green)
- Used to look closely at the vasculature
Blue
- Used to look for corneal abrasions or ulcers with fluorescein dye
5
Q
DDx of absent red reflex
A
- Corneal scar
- Optical media opacity
- Hyphema
- Vitreous haemorrhage
- Retinal detachment
6
Q
Direct ophthalmoscope characteristics
A
- Monocular view
- Field of view limited 15 degree
- Magnification 15 time
- Image virtual and erect
- Illumination less bright so less useful in hazy media
- Stereopsis (3D vision) absent
7
Q
Indirect ophthalmoscope characteristics
A
- Binocular view
- Field of view wider 35 degree
- Magnification 5 times
- Image real, inverted and reversed
- Illumination very bright so more useful in hazy media
- Stereopsis (3D vision ) present
- Not affected by patient refractive error so it is better use for retinal detachment , myopic patient, patient with cataract , retinal mass
8
Q
DDx of hypopion
A
Keratitis, Endophthalmitis, Behçet, Uveitis, Intraocular FB, TB, Masquerade
9
Q
Define pteregium + causes + indications for surgery
A
Triangular fibrovascular growth of bulbar conjunctiva extending onto the cornea
Chronic UV exposure, wind, and dust
→ inflammation → fibrovascular proliferation
- Visual axis involvement → Threatens vision
- Induced astigmatism
- Recurrent inflammation
- Cosmetic concern
10
Q
DDx of increased cup to disc ratio
A
- Glaucoma – especially open-angle (most common)
- Optic nerve atrophy
- Physiological large cup – normal variant
- Ischemic – Toxic/nutritional – Compressive optic neuropathy
- Trauma – optic nerve damage
11
Q
Evaluation of the Patient After Ocular Trauma by resident doctor
A
- قبل الضربة شلون كان يشوف لو لا وشوكت اخر وجبة اكلها
- شنو نوع الضربة وشوكت صارت وشلون
- شنو سووله بالطوارئ بعدما انضرب
12
Q
DDx of subconjunctival haemorrhage
A
- Trauma – most common (rubbing, foreign body, blunt injury)
- Valsalva maneuver – coughing, sneezing, vomiting, straining
- Hypertension
- Bleeding disorders – e.g., thrombocytopenia, hemophilia
- Anticoagulant or antiplatelet use – warfarin, aspirin, etc.
- Idiopathic – especially in elderly
- Conjunctivitis – especially viral (mild bleeding)
13
Q
DDx of hyphema
A
- Trauma – blunt or penetrating (most common)
- Post-surgical – especially after intraocular surgeries
- Neovascularization – from diabetic retinopathy, CRVO
- Intraocular tumors – retinoblastoma, melanoma
- Bleeding disorders – hemophilia, leukemia
- Anticoagulant use – warfarin, DOACs
- Iritis/Uveitis – severe inflammation may cause bleeding
- Juvenile xanthogranuloma – in infants
14
Q
Slit lamp can see up to …
The rest of the eye can be visualised by …
A
1/3 of vitreous
+ 90D lens or Cycloplegic agents
15
Q
DDx of sudden painful vision loss
A
- Acute angle-closure glaucoma
- Optic neuritis – often with MS
- Anterior ischemic optic neuropathy (AION) – especially arteritic (GCA)
- Endophthalmitis – post-op or trauma
- Severe cases keratitis – Anterior uveitis (iritis) – Scleritis
- Orbital cellulitis – proptosis, fever
- Chemical injury (alkali or acid burns) – Trauma (globe rupture, hyphema)
16
Q
DDx of sudden painless vision loss
A
- Central retinal artery occlusion (CRAO)
- Central retinal vein occlusion (CRVO)
- Retinal detachment
- Vitreous hemorrhage
- Non-arteritic anterior ischemic optic neuropathy (NA-AION)
- Cortical blindness – stroke, occipital lobe lesion
- Amaurosis fugax – transient ischemia (TIA)
17
Q
DDx for gradual (chronic) vision loss
A
- Cataract – most common cause worldwide
- Open-angle glaucoma – peripheral loss first
- Diabetic retinopathy – progressive vascular damage
- Age-related macular degeneration (AMD) – central vision loss
- Refractive errors – uncorrected myopia/hyperopia/astigmatism
- Optic atrophy – from chronic compression, MS, or ischemia8.
- Tumors – optic nerve or intraocular tumors (slow-growing)
18
Q
Causes of bilateral disc swelling
A
- Increased intracranial pressure (ICP):
• Idiopathic intracranial hypertension (IIH)
• Brain tumor / abscess
• Hydrocephalus
• Cerebral venous sinus thrombosis (CVST)
• Meningitis
⸻
- Hypertensive causes:
• Malignant hypertension
• Pre-eclampsia / eclampsia
⸻
- Inflammatory / Infectious:
• Optic neuritis (bilateral)
• Sarcoidosis
• Tuberculosis
• Syphilis
• Lyme disease
⸻
- Infiltrative / Neoplastic:
• Leukemia / lymphoma
• Optic nerve glioma / meningioma
⸻
- Toxic / Nutritional optic neuropathy:
• Methanol
• Ethambutol
• Vitamin B12 deficiency
⸻
- Pseudopapilledema:
• Optic disc drusen
• Hyperopia
• Crowded disc
19
Q
Causes of unilateral disc swelling
A
- Optic neuritis
• Demyelinating (e.g., MS)
• Infectious (e.g., viral)
⸻
- Anterior ischemic optic neuropathy (AION)
• Arteritic (Giant cell arteritis)
• Non-arteritic
⸻
- Compressive optic neuropathy
• Orbital tumor
• Optic nerve sheath meningioma
⸻
- Inflammatory / Infectious
• Sarcoidosis
• Syphilis
• Tuberculosis
• Cat scratch disease (neuroretinitis)
⸻
- Infiltrative / Neoplastic
• Lymphoma
• Leukemia
⸻
- Papillophlebitis (young adults, mild CRVO-like)
⸻
- Pseudopapilledema
• Optic disc drusen (can be unilateral)
⸻
- Traumatic optic neuropathy
20
Q
Questions to ask in patients with glaucoma
A
- Symptoms
- Surgical Hx (myopia is risk factor)
- Drug Hx (steroids)
- Family Hx
- Trauma Hx
21
Q
If IOP was high, what’s the next step?
A
Order CCT and perimetry
- Low corneal thickness ~> Falsely low IOP
- High corneal thickness ~> Falsely high IOP
22
Q
DDx of blurred vision after cataract surgery
A
Early causes (within days–weeks):
• Corneal edema (especially if surgery was prolonged)
• Residual refractive error
• Misalignment of IOL
• Retained lens fragments
⸻
Late causes (weeks–months):
• Posterior capsular opacification (PCO) → most common
• Cystoid macular edema (CME)
• Retinal detachment
• Endophthalmitis (serious, usually early but can be delayed)
• IOL decentration or dislocation
23
Q
DDx of leukocoria
A
- Retinoblastoma
- Congenital cataract
- Retinopathy of prematurity (ROP)
- Toxocariasis
- Coloboma
24
Q
If refractive error more than 10D, what to do?
A
Lens ~> Either phakik IOL or Clear lens extraction
25
What do you think about raised IOP without nerve damage
Occular hypertension
High corneal thickness
26
Examination of vision consists of
- VA ~> Snellen chart
- VF ~> Perimetry or confrontation test
- Colour ~> Ishihara plates
- Refraction ~> Retinoscopy or automated refractometry
- Mobility and nystagmus ~> H test
- Alignment ~> Light reflex
27
Magnification of slit lamp up to
Magnification normally 10x—16x
28
Why we stain cornea with fluorescein
Fluorescein staining cornea & detect any epithelial defect which stained green when exposed to blue light
29
When we examine optic disc we look for
Size , shape, margin , color & cup
30
What’s Electrophysiologic testing (ERC, EOG)
- Electrophysiologic testing: assess integrity of neural pathway from retina to cortex (example ERC, EOG)
31
What’s B scan and what makes it special
- Ultrasonic: using high frequency give less penetration but good resolution, evaluate globe or orbit
32
Topical eye anaesthesia vs LA
- Topical anesthetic: like , tetracaine , benoxinate , proparacaine
For tonometry, removal of foreign body or structures
- Local anesthetic (injection) as lidocaine (xylocaine)
For surgery such as cataract extraction
33
Topical vasoconstrictors
Ophtazoline
34
Causes of cataract
Age related (senile)
Trauma
Congenital
Drug induced = steroid/cytotoxic
Associated with ocular pathology like uveitis
Associated with systemic disease like DM, hypoparathyroidism
35
Normal aite of the eyelid and causes of ptosis
Normal site of eyelids
- Upper eyelid covers 1/6 from sclera
- Palpebral fissure = 9mm
Causes
o Neurogenic o Myogenic o Traumatic o Aponeurotic o Mechanical
36
Rubbing lashes vs Trichiasis
Rubbing lashes
When one or more lashes become misdirected and rub against the cornea or bulbar conjunctiva
Trichiasis
If they are larger than four maldirected lashes and rub against the cornea or bulbar conjunctiva
37
What’s scotoma
- Visual field defect is called scotoma
Relative scotoma
The target can be seen but only when it is made brighter or larger
(that is, reduced sensitivity)
Absolute scotoma
No response to a stimulus regardless of brightness or size
(definitive absence of processing from this area).
38
Mydriasis vs Miosis
Mydriasis
• Pharmacological (mydriatics) • Acute congestive glaucoma
• Optic atrophy • Retinal central artery occlusion
• Third nerve palsy (central) • Irritation of cervical sympathetics
Miosis
• Pharmacological (Miotics) • Acute iritis • Chronic iritis
• Horner syndrome • Irritation of the third nerve in pontine haemorrhage
39
Bupthalmos
1. The cornea is enlarged
2. Corneal edema
3. Bluish sclera
4. Deep AC
40
Schirmer test
It measures the amount of tears (quantity) to determines whether the eye produces enough tears to keep it moist or not
More than 10 mm of moisture on filter paper is normal & below this dry eye
41
Pachymeter
Used to measure the thickness of the eye's cornea
42
Specular microscopy
A noninvasive photographic technique that allows you to visualize and analyze the corneal endothelium
43
Any patient with Dendritic Ulcer, giving him medication containing steroids is contraindicated
Because it will grow to form what's called Geographical Ulcer
44
Signs of keratoconus
- Oil doplet reflex seen by direct ophthalmoscopy
- Scissor reflex seen by retinoscopy
- Vogt lines:- fine vertical deep stria seen by slit lamp
- Fleischer ring :- epithelial iron deposition at base of cone
- Munson signs :- bulging of lower lid in down gaze
45
Indications for contact lenses use
1- Optical indication to improve visual acuity when spectacles fail to do that
— Irregular astigmatism as in keratoconus or after corneal graft
— Anisometropia as binocular vision cannot achieved by spectacles due to
ansiokonia as occur after cataract extraction without intraocular lens IOL
— Superficial corneal irregularities
2- Promotion of epithelial healing
— Persistent epithelial defect
— Recurrent erosion syndrome as in corneal dystrophy or after trauma
3- Pain relief as in
— Bullous keratopathy by protect exposed corneal nerves
— Wet filamentary keratitis as in case of brain stroke
— Trichiasis to protect cornea from aberrant lashes
4- Other uses of C.L
— Prevent symplepharon as in cicatrizing conjunctivitis
— Preserve corneal integrity as in corneal graft dehiscence
46
Complications of contact lenses
A- Mechanical damage to corneal tissue causing acute or chronic keratopathy
B- Immunological (allergic) keratitis
C- Toxic keratitis caused by hyper sensitivity from preservative such thiomerasl
d- Infective bacterial keratitis or acntheameba
E- Giant papillary conjunctivitis as in poor fitted C.L
47
Types of contact lenses
- Hard contact lenses
Either impermeable to oxygen & always for daily use
Or gas preamble which can be used for longer period
- Soft contact lenses
Cosmetic
Therapeutic such as bandage which use for protection of corneal epithelium
48
Conjunctival discharge
- Watery discharge occur in acute viral or acute allergic conjunctivitis
- Mucoid discharge chronic allergic conjunctivitis and dry eye
- Mucopurulent discharge in acute bacterial or chlamydial infection
- Purulent discharge typical of gonococcal infection
49
Follicular vs Papillary conjunctival reactions
Follicular reaction
- Lymphatic and seen as multiple discrete yellowish slightly elevated lesions. it caused by viral conjunctivitis ,chlamydial conjunctivitis & drugs toxicity
Papillary reaction
- Develops only in palpebral & limbal bulbar conjunctiva, seen as elevated red dots represent hyperplastic epithelium with fibrovascular core
- Caused by
Chronic blepharitis, Acute bacterial conjunctivitis
Allergic conjunctivitis and Contact lens wear
50
True vs pseudomembranes in conjunctivitis
Pseudo-membrane
- Coagulated exudates & may easily peeled leaving epithelium intact
True membrane
- Infiltration of conjunctival epithelium & attempting to remove may lead to tearing & bleeding
- Caused by
Severe adenoviral conjunctivitis, Gonococcal conjunctivitis , Steven-Jonson
51
Lymphadenopathy + Conjunctive caused by
Viral, chlamydial & gonnococcal infection
52
What’s pseudoproptosis and pseudo-enopthalmos
Pseudoproptos due to facial asymmetry, enlargement of the globe
(e.g. high myopia or buphthalmos), lid retraction or contralateral enophthalmos
Pseudoenophthalmos may be caused by a small or shrunken eye (microphthalmos or phthisis bulbi), by ptosis, or by contralateral proptosis or pseudoproptosis
