Sample Qs Flashcards
(24 cards)
What investigation for a lid laceration?
All stab injuries should have orbital and head CR to investigate for fractures, FBs and pneumocranium
What should you examine for in lid laceration?
Depth, length, tissue viability
Tissue viability
Lid position
Orbicularis funciton
Lagophthalmos
Intercanthal distance
Canalicular involvement
Nasolacrimal drainage
Associated injury of globe or orbit
What management for lid laceration?
Corneal lubrication
Tetanus prophylaxis
Surgical repair
Management for simple superficial lid laceration not involving lid margin?
Full thickenss with tissue loss?
Interrupted 6-0 sutures parallel to lid margin
Absorbable - vicryl for children
Prolene (non-absorbable may be used)
Small defect (0-25% tissue loss) - clean and close with interrupted sutures 6-0 vicryl one layer to tarsus and one layer to skin
Large defect (25-60%) - lateral canthotomy/cantholysis, Tenzel or McGregor flat
Very large (>60%)
Hughes tasroconjunctival flat and skin graft for LL
Cutler Beard flap for UL
What is management for canalicular laceration?
Splint opened duct with silicone tubing e.g. Mini Monoka stent and place 6-0 vicryl orbiculiaris sutures
For lower lids reattach the lower limb of medial canthal tendon to posterior lacrimal crest
Close muscle and skin with 6-0 vcryle
Leave tubues in for 3 monthW
When to remove skin sutures
5-7 days
What is a tetanus prone wound
Heavily contaminated / devitalised wound
uncertain of vaccination status clear wound - what do you give? Dirty wound?
Clean - tetanus vaccina and completion of course by GP
Dirty - Vaccine Ig and completion of course by GP
What is retinal dialysis? Where does it occur? How long is progression
Full thickenss circumferential break at the ora serrata, commonly supero-nasal
Usually from blunt trauma
Not related to PVD so progression to RD is slow
Irregular tear may occur at equator
Progression to RD is slow (months)
Where is the ora serrata? Where is the pars plana
Ora serrata is the boundary between the retina and the ciliary body. It marks the end of the photosensitive area of the retina
The pars plana is the flat part of the ciliary body between the ora serrata and and the ciliary processes
What are commotio retinae
Grey white retinal opacity associated with photoreceptor outer segment fragmentation and intracellular oedema (glial and axonal elements)
Most cases resolve with visual recovery - remainder may experience reintla atrophy or macular hole
What is likely if retinal dialysis is symptomatic
Macula has detached
What is mucormycosis? How does it stain?
Aggressive Rapid progressing funcatl infection caused by Mucor Spp or Rhizopus
Immunosuppressed disease in patients who are acidotic such aas DKA, malignancy, therapeutic, HIV
Fungal septic necrosis and infarction of tissues of nasopharynx and orbit
Black crusty material in nasopharynx - CN palsy
Orbital inflammation
Stains showing non-septate branching hyphae
Managed with IV antifungals e.g. high dose aphoterocin
debridement with ENT
Disfference between aspergillosis and mucormycosis
Aspergillosis slow devleopment of orbital inflammation
Aspergillosis has septate hyphae
What is a carotid cavernous fistula? Direct vs indirect?
What is seen on MRI scan?
Anastomoses between arterial and venous circulation
High flow system arising from direct communication between intracavernous ICA and the cavernous sinus
Indirect (dural shunt) - low flow system arising from dural arteries (branches of ICA and ECA) with cavernous sinus
Features
Pulsatile proptosis with bruit, orbital oedema, injected chemotic conj, ophahtlmopareiss III VI, retinal vein engorgement, RAPD, disc swelling
Dural shunt may eb asymptomatic, episclera venous engorgement
Imaging: B Scan, CR, MRI shows dilated superior ophthalmic vein
Management:
Cathter emdolisation in high flow
Low flow thrombose spontaneously in 40%
What are orbital varices?
Congenital venous enlargements may be present form childhood
Unilateral
Medial orbit
Intermittent proptosis/visible varix worse with increasing venous pressure (valsave, coughing, head down)
CT/MRI shows multiple ill defined irregular masses
What is phacomorphic glaucoma?
Large intumescent (fluid filled) lens causes anterior bowing of iris with secondary angle closure
Acute or chronic angle closure, high IOP, shallow AC, semi dilated pupil
Distinguished from PACG by presence of ipsilateral swollen cataract and contralateral open angle with deep AC
What is phacolytic glaucoma
Hypermature cataract loses solumble lens proteins through intact anterior capsule causing trabecular obstruction and secondary OPEN angle glaucoma
High IOP, Deep AC
Lens protein may form pseudohypopyon, open angles, hypermature cataract
What is Fuch’s heterochromic uveitis? What is seen on examination
Mild chronic anterior uveitis
Iris heterochromia
Cataract (cortical/PSC)
May be complicated by glaucoma
Young adults,
Unilateral
White stellate KPs over corneal endothelium, iris atrophy, transillumination, heterochromia - affected eye is bluer
Associated with rubella
OE:
Open angle, twig like neovascularisation of angle (NVA)
What is Posner-Schlossman uveitits
Recurrent unilateral painless high IOP in white eye
Young men
Blurring of vision
White eye, occasional cells, no synechiae, open angle
Treat inflammation, topical or systemic lower IOP
What is normal CCT
540–560 microns
Average: ~550 µm
Thin cornea: <500 µm
Thick cornea: >580 µm
Thin cornea = underestimated IOP + risk factor for POAG
Thick cornea = overestimated IOP
CG85 management for POAG
Where’s INO
Medial longitudinal fasciculus
Ipsilateral loss of adduction and overshoot of contralateral eye (ataxic nystagmus)
