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Year 2 - Ophthalmology > Week 2 > Flashcards

Flashcards in Week 2 Deck (24):
1

What is Seidel's Test?

After adding fluoroscein to an injured eye, the fluid can be visualised becoming more and more diluted as it flows out at the site of injury 

2

Lipid-soluble drugs penetrate the ____

Water-soluble drugs penetrate the ____

Name a drug used in ophthalmology that has both hydrophilic and lipophilic properties and therefore can penetrate the cornea easily

Lipid soluble penetrate the epithelium (which is lipophilic and hydrophobic)

Water soluble penetrate the stroma (which is lipophobic and hydrophilic)

Chloramphenicol has both hydrophilic and lipophilic properties 

3

What anti-inflammatory agents are used in ophthalmology?

Steroids

NSAIDs

Anti-histamines 

Mast cell stabilisers 

4

What are some of the side effects of steroids, both locally (in the eye) and systemically?

Local

  • Cataracts
  • Glaucoma
  • Exacerbation of viral infection (e.g. in Herpes zoster)

Systemic 

  • Gastric ulcers 
  • Immunosuppression 
  • Osteoporosis
  • Weight gain 
  • Diabetes 
  • loads more... 

5

Order these topical steroids from weakest to strongest...

- Betamethasone

- FML

- Dexamethasone/Prednisolone

Predsol

FML

Predsol

Betamethasone 

Dexamethasone/Prednisolone 

6

How would a patient with glaucoma present in terms of visual defect?

What treatments can be given?

Patients with glaucoma initially lose peripheral vision, then in the later stages central vision is affected

Treatments aim to "turn off the tap or open the drain" i.e. relieve pressure 

Prostanoids e.g. Latanoprost

Beta-blockers e.g. timolol 

Carbonic Anhydrase Inhibitors e.g. Dorzolamide (topical) or Acetazolamide (systemic)

Alpha2 adrenergic agonists e.g. Brimonidine

Parasympathomimetic e.g. pilocarpine

7

What is one of the main issues with regards to medication for glaucoma? What is a potential solution?

Compliance is the issue!

Can be solved with intravitreal injection - delivers effective conc. of drug to site but many drugs are toxic to the retina 

Can also be done to treat Endophthalmitis and deliver steroids/anti-VEGF

8

What is endophthalmitis?

Inflammation of the interior eye, usually due to bacterial infection 

Possible complication of surgeries to the eye, including procedures for glaucoma. Potentially sight-threatening and antibiotics need to be given ASAP

9

What is the difference between wet and dry age-related macular degeneration?

Dry - most common form, slow and gradual progression of blurry vision, painless. "Drusen" (yellow spots) may be seen on fundoscopy

Wet - sudden onset of vision loss, caused by the development of new blood vessels. "Scotoma" (dark spots) may be seen on fundoscopy

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10

What are the 3 C's that have to be mentioned when inspecting the back of the eye on fundoscopy?

Cup size (disc to cup ratio is 0.2-0.6)

Colour 

Contour 

11

List some causes of sudden onset visual loss

Vascular causes

  • occlusion of retinal circulation/optic head circulation
  • abnormal blood vessels e.g. diabetes retinopathy, wet ARMD), retinal tear 

Vitreous haemorrhage 

Closed-angle glaucoma 

 

12

What arteries supply the eye?

Central retinal artery - supplies the inner 2/3rds of the retina (outer 1/3rd is supplied by the choroid)

Posterior ciliary arteries - mainly supply the optic head 

13

What are some of the signs and symptoms of Central Retinal Artery Occlusion (CRAO)

What causes CRAO?

Signs

  • RAPD (relative afferent pupil defect)
  • Pale, oedematous retina, thread-like vessels 

Symptoms 

  • Sudden visual loss
  • Profound i.e. can't count fingers 
  • Painless 

CRAO is a type of stroke, most commonly caused by carotid artery disease but also less commonly caused by emboli from the heart 

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14

CRAO - treatment 

If presenting within 24 hours - try ocular massage in an attempt to convert from CRAO to BRAO

Vascular management - establish the source of the embolus via carotid doppler and assess and manage risk factors  

15

What is amaurosis fugax?

(HINT - this translates to "fleeting darkness") 

How is it managed?

Transient CRAO - temporary, painless visual loss

Described as being like "a curtain coming down" over the vision 

Lasts ~5 mins with full recovery 

Management - urgent referral to Stroke Clinic and give Aspirin

16

What are some of the signs and symptoms of Central Retinal Vein Occlusion (CRVO)?

How would it appear on fundoscopy?

Signs

  • Retinal haemorrhages 
  • Dilated, tortuous veins 
  • Disc and macular swelling 

Symptoms

  • Sudden visual loss
  • Moderate to severe, anywhere between 6/9 to perception of light 

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17

Arterial occlusions in the eye are due to stasis/emboli

Venous occlusions in the eye are due to stasis/emboli

Arterial = emboli

Venous = stasis 

18

What is occlusion of the posterior ciliary arteries also known as? 

What are the two types of this occlusion, and what commonly causes each?

How does this condition present on fundoscopy?

Also known as Ischaemic Optic Neuropathy 

Types 

Arteritic (50%), caused by inflammation (e.g. GCA)

Non-arteritic (50%), caused by atherosclerosis

On fundoscopy a pale, swollen disc is seen 

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19

What are some of the important symptoms to be aware of for Giant Cell Arteritis?

Headache

Jaw claudication 

Scalp tenderness 

Amaurosis fugax 

Malaise 

Very high ESR, PV and CRP

Tender/enlarged scalp arteries 

20

What are some of the signs and symptoms of Vitreous haemorrhage?

How might it present on fundoscopy?

Symptoms

  • Loss of vision
  • Floaters

Signs

  • Loss of red reflex 
  • May see haemorrhage of fundoscopy  

 

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21

If a patient presented with sudden onset of flashes and floaters and a painless loss of vision, what might be the cause?

Which group more commonly gets this condition?

Could be retinal detachment

More common in Myopes (short-sighted individuals)

22

How is closed-angle glaucoma brought about?

Aqueous humour encounters increased resistance through the iris/lens channel

Increased pressure = iris bows forward and obstructs the trabecular meshwork

 

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23

How will a patient with closed-angle glaucoma present, and how do they need to be managed?

Presentation

  • painful, red eye 
  • visual loss 
  • headache 
  • nausea and vomiting 

Management

  • requires urgent drops/oral medication to lower IOP and prevent patient from going blind 
  • follow up with laser iridotomy to unblock trabecular meshwork 

24

List some of the causes of gradual visual loss

Cataracts 

Dry ARMD

Refractive error 

Glaucoma (open-angle)

Diabetic retinopathy