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Ophthalmology Flashcards

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1
Q

OPEN ANGLE GLAUCOMA

What is glaucoma in general?

A
  • Optic neuropathies associated with raised intraocular pressure (IOP)
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2
Q

OPEN ANGLE GLAUCOMA

What is the pathophysiology of primary open angle glaucoma?

A
  • Gradual increased resistance to aqueous humour outflow through the trabecular meshwork leading to increased IOP
  • The iris is CLEAR of the meshwork
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3
Q

OPEN ANGLE GLAUCOMA

What are some risk factors for primary open angle glaucoma?

A
  • Increasing age + FHx
  • Black ethnic origin
  • Myopia
  • HTN + DM
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4
Q

OPEN ANGLE GLAUCOMA

What is the clinical presentation?

A
  • Insidious onset + may be Dx via routine screening at optometrist
  • Peripheral vision loss = tunnel vision
  • Halos around lights (esp. at night)
  • Decreased visual acuity
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5
Q

OPEN ANGLE GLAUCOMA
How is primary open angle glaucoma investigated?
What is gold standard?

A
  • Visual field assessment for peripheral vision loss
  • Fundoscopy
  • Measuring IOP (non-contact tonometry vs. GOLD STANDARD Goldmann applanation tonometry)
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6
Q

OPEN ANGLE GLAUCOMA

What might fundoscopy reveal in primary open angle glaucoma?

A
  • Optic disc cupping = cup:disc >0.7 (0.4–0.7) as IOP makes optic cup widen + deepen
  • Optic disc pallor = optic atrophy
  • Bayonetting of vessels = sharp kink as pass over edge of cup
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7
Q

OPEN ANGLE GLAUCOMA
What is the difference between the two methods of measuring IOP?
What is normal IOP and when is it treated?

A
  • Non-contact = screening, estimates IOP by shooting air at cornea
  • Goldmann applanation = device on slit lamp directly applies various pressures to cornea
  • Normal 10–21mmHg, treat when ≥24mmHg
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8
Q

OPEN ANGLE GLAUCOMA
What is the first line management of primary open angle glaucoma?
What is the mechanism of action?
What are some side effects?

A
  • Prostaglandin analogue eye drops = latanoprost
  • Increases uveoscleral outflow
  • Eyelash growth + brown iris pigmentation
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9
Q

OPEN ANGLE GLAUCOMA

In terms of second line management of primary open angle glaucoma, how can the drugs be categoried?

A
  • Drugs that reduce aqueous humour production = beta-blockers (timolol) and carbonic anhydrase inhibitors (dorzolamide)
  • Drugs that increase uveoscleral outflow = muscarinic receptor agonist/miotic (pilocarpine)
  • Drugs that do both = sympathomimetics/alpha-2-agonists (brimonidine)
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10
Q

OPEN ANGLE GLAUCOMA
What conditions would you avoid timolol in?
When would you avoid using brimonidine and what is an adverse effect?

A
  • Asthma + heart block

- Avoid if MAOI/TCA, can cause ocular hyperaemia

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11
Q

OPEN ANGLE GLAUCOMA
What is the mechanism of action of pilocarpine?
What is are some side effects?

A
  • Rapid miosis + contraction of ciliary muscles open trabecular meshwork so increased aqueous humour outflow
  • Miosis, headache + blurred vision
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12
Q

OPEN ANGLE GLAUCOMA

If medical management fails in primary open angle glaucoma, what option may be trialled?

A
  • Trabeculectomy = bleb creates new channel for aqueous humour to drain from anterior chamber
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13
Q

ACUTE ANGLE CLOSURE GLAUCOMA

What is the pathophysiology of acute angle closure glaucoma?

A
  • Iris bulges forward + seals off the trabecular meshwork from the anterior chamber preventing drainage of aqueous humour = acute raised IOP
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14
Q

ACUTE ANGLE CLOSURE GLAUCOMA
What are some risk factors of acute angle closure glaucoma?
What medications can precipitate it?

A
  • Hypermetropia, female, Eastern Asian, FHx, cataracts

- Adrenergics (noradrenaline), anticholinergics = both cause mydriasis

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15
Q

ACUTE ANGLE CLOSURE GLAUCOMA

What symptoms may a patient experience in acute angle closure glaucoma?

A
  • Acute, severely painful red eye
  • Blurred vision
  • Halos around lights
  • Headache
  • N+V
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16
Q

ACUTE ANGLE CLOSURE GLAUCOMA

What are some signs of acute angle closure glaucoma on examination?

A
  • Dull/hazy cornea due to corneal oedema
  • Semi-dilated non-reacting pupil
  • Firm eyeball on palpation
  • Decreased visual acuity
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17
Q

ACUTE ANGLE CLOSURE GLAUCOMA

How do you manage someone with acute angle closure glaucoma initially?

A
  • EMERGENCY = same-day ophthalmologist assessment
  • Combination of eye drops = pilocarpine, timolol, brimonidine
  • IV acetazolamide
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18
Q

ACUTE ANGLE CLOSURE GLAUCOMA

What is the definitive management of acute angle closure glaucoma?

A
  • Laser peripheral iridotomy = hole in peripheral iris allows aqueous humour to flow posterior > anterior chamber which relieves pressure pushing iris against cornea
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19
Q

AGE-RELATED MACULAR DEGENERATION
What are the two types of age-related macular degeneration (AMD)?
What is the epidemiology?

A
  • Dry (90%) and wet (10%)

- Most common cause of blindness in the UK

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20
Q

AGE-RELATED MACULAR DEGENERATION

What is the pathophysiology of dry AMD?

A
  • Drusen in Dry
  • Caused by atrophy of the retinal pigment epithelium + retinal photoreceptor degeneration > protein/lipid deposits (drusen)
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21
Q

AGE-RELATED MACULAR DEGENERATION

What is the pathophysiology of wet AMD?

A
  • Choroidal neovascularisation into retina where leakage of serous fluid + blood can lead to rapid loss of vision
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22
Q

AGE-RELATED MACULAR DEGENERATION
What is the biggest risk factor of AMD?
What are some other risk factors?

A
  • Advancing age

- Smoking, FHx, CVD risk factors

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23
Q

AGE-RELATED MACULAR DEGENERATION
What is the clinical presentation of AMD?
How may this differ in wet AMD?

A
  • Gradual worsening CENTRAL visual loss = central scotoma
  • Reduced visual acuity, esp. low lighting + near field objects
  • Fluctuations in visual disturbance which vary day-to-day
  • Crooked/wavy appearance of straight lines
  • Wet = ACUTE vision loss
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24
Q

AGE-RELATED MACULAR DEGENERATION

What are some tests you would do when examining someone with suspected AMD?

A
  • Snellen chart = reduced visual acuity
  • Amsler grid test = assess distortion of straight lines
  • Fundoscopy
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25
AGE-RELATED MACULAR DEGENERATION What would you see on fundoscopy for dry AMD? What would you see on fundoscopy for wet AMD?
- Drusen in macular area | - Demarcated red patches = intra-retinal or sub-retinal fluid leakage or haemorrhage
26
AGE-RELATED MACULAR DEGENERATION What is the first line specialist investigation in AMD? What investigation is mandatory for diagnosis + follow-up? What other investigation is there and when would you use it?
- Slit-lamp microscopy - Optical coherence tomography = X-sectional view of layers of retina - Fluorescein angiography = if ?neovascularisation, detects leakage
27
AGE-RELATED MACULAR DEGENERATION How do you manage AMD in general? What is the management of dry AMD?
- Urgent referral to ophthalmology | - Avoid smoking, control BP, vitamin supplementation (zinc + vitamins A/C/E)
28
AGE-RELATED MACULAR DEGENERATION | What is the definitive management of wet AMD?
- Anti-vascular endothelial growth factor (VEGF) medications (ranibizumab, bevacizumab) 4/52 intravitreous injection
29
AGE-RELATED MACULAR DEGENERATION What treatment may be considered in AMD if there is neovascularisation? What is an important risk of this treatment?
- Laser photocoagulation to slow progression of AMD | - Risk of acute visual loss after treatment
30
CATARACTS What is the pathophysiology of cataracts? What is the epidemiology?
- Gradual lens opacification reducing visual acuity by reducing the light that reaches the retina - Leading cause of curable blindness worldwide, more common in women
31
CATARACTS What is the most common cause of cataracts? What are some risk factors and what type of cataracts do they relate to?
- Normal ageing process (nuclear type) - CVD = smoking, alcohol, DM (dot opacities type) - Steroids (Subcapsular type) - Hypocalcaemia
32
CATARACTS | What is the clinical presentation of cataracts?
- Asymmetrical gradual reduction in visual acuity + progressive blurring - Glare + halos around lights, esp. at night - Faded colour vision = colours more brown/yellow
33
CATARACTS | What investigations would you do in cataracts?
- Fundoscopy = loss of red reflex (grey/white) but normal fundus + optic nerve - Slit-lamp examination reveals visible cataract
34
CATARACTS What is the initial management of cataracts? What is the definitive management of cataracts?
- Prescribing stronger lenses, encourage bright lights | - Cataract surgery = replace lens with artificial one (only effective treatment)
35
CATARACTS | Before referring someone for cataracts surgery, what factors should be considered?
- Impact on vision + QOL - If they're uni or bilateral - Risk/benefits - Patient choice
36
CATARACTS | What are some complications of cataract surgery?
- Endophthalmitis - Posterior capsule opacification = thickening of lens capsule - Retinal detachment - Posterior capsule rupture
37
CATARACTS What is endophthalmitis? What can it progress to? How is it managed?
- Rare but serious inflammation of inner eye contents often 2º to infection - Can progress to vision or even eye loss - Intravitreal Abx
38
CRAO | What is the pathophysiology of central retinal artery occlusion (CRAO)?
- Occlusion > reduced central retinal artery blood flow which supplies the retina
39
CRAO What is the most common cause of CRAO? What are some other causes? What are some risk factors?
- Atheroscelrosis - Emboli or vasculitis (GCA) - CVD = smoking, HTN, alcohol, DM, obesity
40
CRAO | What is the clinical presentation and examination findings in CRAO?
- Sudden painless monocular loss of vision - RAPD due to ischaemic retina not sensing input - Fundoscopy = pale retina (reduced perfusion) + cherry red spot at macula
41
CRAO | What is the management of CRAO?
- Immediate ophthalmologist assessment | - Long-term = optimise CVD risk factors
42
CRVO What is the pathophysiology of central retinal vein occlusion (CRVO)? What is a potential consequence of this?
- Thrombus blocks drainage of blood from retinal veins causing pooling of blood in retina + so macular oedema + retinal haemorrhages - May lead to release of VEGF > neovascularisation
43
CRVO | What are some risk factors of CRVO?
- CVD = smoking, alcohol, HTN, DM, obesity | - Thrombophilias = polycythaemia
44
CRVO | What is the clinical presentation of CRVO?
- Sudden painless monocular loss of vision - RAPD - Fundoscopy = widespread flame haemorrhages "stormy sunset" + optic disc swelling
45
CRVO What is a key differential of CRVO? What is it?
- Branch retinal vein occlusion | - Vein in distal retinal venous system is occluded so more limited area of fundus affected
46
CRVO | How does branch retinal vein occlusion present?
- Blurring of vision or field defect rather than total loss | - Flame haemorrhages in region of occlusion on fundoscopy
47
CRVO | What is the management of CRVO?
- Immediate ophthalmologist assessment - Majority conservative - Macular oedema = intravitreal anti-VEGF (ranibizumab) - Retinal neovascularisation = laser photocoagulation
48
AION What is anterior ischaemic optic neuropathy (AION)? What are the two types?
- Optic nerve damage due to lack of blood supply | - Arteritic (most commonly GCA) or non-arteritic
49
AION | What is the clinical presentation and exam findings of AION?
- Sudden onset monocular vision loss - RAPD - Fundoscopy = optic disc swelling (acute phase) + pale (chronic phase)
50
AION | What is the management of AION?
- Immediate ophthalmology assessment - Always check FBC, CRP/ESR, ?temporal artery biopsy if GCA - GCA = high dose steroids to prevent vision loss
51
POSTERIOR VITREOUS DETACHMENT What is the pathophysiology of posterior vitreous detachment? What is a consequence of this?
- Vitreous gel separates from the retina due to natural changes to the vitreous fluid of the eye with ageing (less firm + able to maintain shape) - Predisposes to retinal tears or detachment
52
POSTERIOR VITREOUS DETACHMENT What is the clinical presentation of posterior vitreous detachment? What are some risk factors?
- Can be asymptomatic, more common in F - Sudden onset flashes + floaters - Painless blurred vision - Age, highly myopic pts
53
POSTERIOR VITREOUS DETACHMENT | What is a key investigation in posterior vitreous detachment and what may it show?
- Ophthalmoscopy = Weiss ring | - Detachment of vitreous membrane around the optic nerve to form a ring-shaped floater
54
POSTERIOR VITREOUS DETACHMENT | What is the management of posterior vitreous detachment?
- Ophthalmology assessment within 24h > rule out retinal tear or detachment - Improves without treatment over 6m - Surgery if associated retinal tear or detachment
55
RETINAL DETACHMENT | What is the pathophysiology of retinal detachment?
- Retina separates from choroid underneath usually due to retinal tear allowing vitreous fluid to get under retina + fill space between retina/choroid - Outer retina relies on choroidal vessels for blood supply > emergency
56
RETINAL DETACHMENT What are the two main causes of retinal detachment? What are some risk factors?
- Retinal tear - Vitreous collapse (with age) > posterior vitreous detachment - Age, eye trauma, FHx
57
RETINAL DETACHMENT | What is the clinical presentation of retinal detachment?
- New onset flashes + floaters - Painless blurred vision - Peripheral>central vision loss "sudden + like a shadow coming across vision"
58
RETINAL DETACHMENT | What is the management of retinal detachment?
- Immediate ophthalmology referral - Retinal tears = laser therapy or cryotherapy > create adhesions between retina/choroid to prevent detachment - Retinal detachment = vitrectomy > surgery to reattach retina
59
VITREOUS HAEMORRHAGE What is a vitreous haemorrhage? What are some causes?
- Bleeding from retinal vessels into vitreous gel | - Proliferative diabetic retinopathy in 50%, ocular trauma (#1 paeds/young adults), retinal tear/detachment
60
VITREOUS HAEMORRHAGE | What is the clinical presentation of vitreous haemorrhage?
- Painless monocular vision loss - Red hue in vision - Blurred vision with floaters or black dots - NO RAPD, absent red reflex
61
VITREOUS HAEMORRHAGE | What investigations would you do in vitreous haemorrhage?
- Fundoscopy - Slit lamp examination - USS eye to rule out retinal tear/detachment
62
VITREOUS HAEMORRHAGE | What is the management of vitreous haemorrhage?
- Clears spontaneously within 6–8w - ?Vitrectomy - Laser photocoagulation in proliferative diabetic retinopathy
63
CONJUNCTIVITIS | What is conjunctivitis?
- Inflammation of the conjunctiva either allergic, viral or bacterial
64
CONJUNCTIVITIS What are the causes of conjunctivitis that is... i) allergic? ii) viral? iii) bacterial?
i) Seasonal (pollen) or perennial (dust mite, detergents) ii) HSV, adenovirus iii) H. influenzae, staph. aureus, strep pneumoniae
65
CONJUNCTIVITIS | What is the clinical presentation of allergic conjunctivitis?
- BILATERAL conjunctival erythema | - Allergic Sx = nasal congestion, sneezing, eyelid swelling, itch
66
CONJUNCTIVITIS | How can you differentiate the clinical presentation of infective conjunctivitis?
- Bacterial = PURULENT discharge, eyes stuck together in morning - Viral = SEROUS discharge, recent URTI, pre-auricular lymphadenopathy
67
CONJUNCTIVITIS | What is the management of allergic conjunctivitis?
- First line = avoid allergens, topical/systemic antihistamines - Second line = topical mast-cell stabilisers to prevent histamine release
68
CONJUNCTIVITIS | What is the management of infective conjunctivitis?
- Often self-limiting, no contact lenses, avoid sharing towels - Topical chloramphenicol if bacterial - Topical fusidic acid is alternative in pregnant women
69
EPISCLERITIS What is episcleritis? What conditions is it associated with?
- Inflammation of outermost layer of sclera, just underneath the conjunctiva - Inflammatory disorders = rheumatoid arthritis, IBD
70
EPISCLERITIS | What is the clinical presentation of episcleritis?
- Painless red eye (may be mild pain) - Episcleral injected vessels are MOBILE with gentle scleral pressure - Watering of eye
71
EPISCLERITIS | What investigation can be done to confirm the diagnosis and differentiate it from the main differential?
- Phenylephrine drops blanch conjunctival + episcleral but NOT scleral vessels - Eye redness improves after drops = episcleritis
72
EPISCLERITIS | What is the management of episcleritis?
- Conservative with analgesia, cold compresses + safety netting - Artificial tears may be used
73
SCLERITIS What is scleritis? What is the most serious type and why?
- Inflammation of the full thickness of the sclera | - Necrotising scleritis = visual impairment but NO pain, risk of scleral perforation
74
SCLERITIS | What is scleritis associated with?
- 50% systemically unwell with rheum conditions such as RA, SLE, granulomatosis with polyangiitis + IBD
75
SCLERITIS | What is the clinical presentation of scleritis?
- PAINFUL red eye with NO response to phenylephrine drops - Injected vessels are NOT mobile with scleral pressure as deeper - Reduced visual acuity
76
SCLERITIS | What is the management of scleritis?
- Same day ophthalmology referral - NSAIDs (topical/systemic) - Steroids (topical/systemic)
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ANTERIOR UVEITIS | What is anterior uveitis?
- Inflammation in the anterior part of the uvea (iris + ciliary body)
78
ANTERIOR UVEITIS | What are the causes of acute and chronic anterior uveitis?
- Acute (HLA B27) = ankylosing spondylitis, reactive arthritis, psoriatic arthritis, IBD - Chronic = sarcoidosis, infections (TB, syphilis, herpes)
79
ANTERIOR UVEITIS | What is the clinical presentation of anterior uveitis?
- Unilateral painful red eye + ophthalmoplegia - Photophobia (ciliary muscle spasm) - Abnormal pupil shape (posterior synechiae/adhesions) - Ciliary flush (red ring spreading from cornea outwards) - Hypopyon (pus collection in anterior chamber = yellow fluid with a level) - Floaters + flashers
80
ANTERIOR UVEITIS | What is the management of anterior uveitis?
- Same day ophthalmology referral - Cycloplegic-mydriatic eye drops = cyclopentolate, atropine (antimuscarinics) - Steroid eye drops
81
ANTERIOR UVEITIS | How do cycloplegic-mydriatic eye drops help in anterior uveitis?
- Paralyses ciliary body + causes mydriasis to reduce pain associated with ciliary muscle spasm
82
KERATITIS What is keratitis? What are the two main types?
- Inflammation of the cornea | - Herpes keratitis + bacterial keratitis
83
KERATITIS What causes herpes keratitis? What often precipitates bacterial keratitis?
- Reactivation of HSV1 which lies dormant in trigeminal ganglion - Often precipitated by minor trauma due to corneal abrasion or contact lens use
84
KERATITIS | What is the main cause of bacterial keratitis and how may this differ?
- Usually Staph. aureus | - Pseudomonas aeruginosa or amoebic (acanthamoebic keratitis, contaminated water) in contact lens wearers
85
KERATITIS | What is the clinical presentation of keratitis?
- Red eye with pain + photophobia - Foreign body/gritty sensation - Bacterial = may have hypopyon - Reduced visual acuity (may have corneal opacification)
86
KERATITIS | What is a pathognomonic sign of herpes keratitis?
- Dendritic ulcers seen on slit lamp with fluorescein
87
KERATITIS | What are some complications of keratitis?
- Corneal scarring > blindness (#1 form of corneal blindness in developed world) - Endophthalmitis - Perforation
88
KERATITIS | What is the management of keratitis?
- Contact lens wearers with red eye = same day ophthalmology slit-lamp to rule out microbial keratitis - Bacterial = topical Abx - HSV = topical aciclovir as untreated > corneal scarring (?transplant)
89
CORNEAL ABRASIONS | What is a corneal abrasion and what causes it?
- Damage to corneal epithelium often 2º to trauma to the eye (contact lenses, foreign body, entropion) or occupational (sheet metal working)
90
CORNEAL ABRASIONS What is the clinical presentation of a corneal abrasion? How would you investigate this?
- Painful red eye, foreign body sensation, watering eye - May develop corneal ulcer (deeper breach in corneal epithelium) - Fluorescein stain applied to eye = stain collects in abrasion highlighting it
91
CORNEAL ABRASIONS | What is the management of corneal abrasions?
- Same day ophthalmology referral for slit lamp exam | - Uncomplicated = simple analgesia, lubricating eye drops, follow-up in 24h
92
SUBCONJUNCTIVAL HAEMORRHAGE | What is a subconjunctival haemorrhage?
- Small blood vessels within conjunctiva ruptures + releases blood into the space between the sclera + conjunctiva
93
SUBCONJUNCTIVAL HAEMORRHAGE | What causes a subconjunctival haemorrhage?
- Often after episodes of strenuous activity or trauma - Whooping cough - Sneezing - HTN - NAI - Bleeding disorders + anticoagulants
94
SUBCONJUNCTIVAL HAEMORRHAGE What is the clinical presentation of subconjunctival haemorrhage? What is the management?
- Painless patch of bright red blood | - Spontaneous recovery in about 2w
95
PERIORBITAL/ORBITAL CELLULITIS What is periorbital cellulitis? What is orbital cellulitis?
- Infection of soft tissues anterior to orbital septum (eyelids, skin, subcut tissues) but NOT contents of orbit - Infection affecting fat + muscles posterior to orbital septum within the orbit but NOT involving globe
96
PERIORBITAL/ORBITAL CELLULITIS What usually causes periorbital cellulitis? What usually causes orbital cellulitis?
- Spread from superficial tissue injury (chalazion, insect bite) - Spreading infection from URTI or sinusitis
97
PERIORBITAL/ORBITAL CELLULITIS What are some common bacterial causes of periorbital cellulitis? What are some common bacterial causes of orbital cellulitis? What are some risk factors for orbital cellulitis?
- Staph aureus, staph epidermidis, streptococci - Staph aureus, HiB, streptococci - Paeds, previous sinusitis, no HiB vaccine, periorbital cellulitis
98
PERIORBITAL/ORBITAL CELLULITIS What is the clinical presentation of periorbital cellulitis? How is this differentiated from orbital cellulitis?
- Symptoms = acute onset red, swollen + painful eye, fever | - Signs = erythema + oedema of eyelids, ptosis due to swelling (signs differentiate from orbital cellulitis)
99
PERIORBITAL/ORBITAL CELLULITIS What is the clinical presentation of orbital cellulitis? What are some potential major complications of orbital cellulitis?
- Symptoms = acute onset red, swollen + painful eye, fever - Signs = ophthalmoplegia, proptosis, decreased acuity, RAPD - Cavernous sinus thrombosis or intracranial infection
100
PERIORBITAL/ORBITAL CELLULITIS | What are some investigations you would do in periorbital and orbital cellulitis?
- Bloods = FBC (raised WCC), CRP raised, blood cultures + swab MC&S - Contrast CT orbits, sinuses + brain scan to look for inflammation of orbital tissues deep to septum to Dx
101
PERIORBITAL/ORBITAL CELLULITIS What is the management of pre-orbital cellulitis? What is the management of orbital cellulitis?
- Urgent ophthalmology referral, PO/IV Abx, ?admit if paeds | - Ophthalmology emergency > admit for IV Abx
102
BLEPHARITIS What is blepharitis? What are some causes?
- Inflammation of the eyelid margins - Meibomian gland dysfunction (common, posterior) - Seborrhoeic dermatitis/staph infection (less common, anterior) - Rosacea
103
BLEPHARITIS What is the usual function of the Meibomian gland? What occurs in dysfunction?
- Secrete oil onto eye surface to prevent rapid evaporation of tear film - Drying + irritation
104
BLEPHARITIS | What is the clinical presentation of blepharitis?
- Bilateral grittiness + dryness - Eyelid margins red + itchy - Swollen eyelids in staph blepharitis - Styes + chalazions more common
105
BLEPHARITIS | What is the management of blepharitis?
- Hot compress BD to soften lid margin - Lid hygiene to mechanically remove debris = cotton wool buds dipped in cooled boiled water or baby shampoo - Lubricating eye drops for symptomatic control
106
EYELID DISORDERS – STYE | What is the classification of styes?
- Hordeolum externum = infection of glands of Zeis (sebum producing) or glands of Moll (sweat glands) at base of eyelashes, usually staphyloccal - Hordeolum internum = infection of Meibomian glands, may result in chalazion
107
EYELID DISORDERS – STYE How do styes present? How are they managed?
- Tender red lump along eyelid ± pus - Hot compresses + analgesia - ?Topical chloramphenicol if associated with conjunctivitis
108
EYELID DISORDERS – CHALAZION What is a chalazion? What can cause it?
- Meibomian gland becomes blocked and swells > Meibomian cyst - Hordeolum internum
109
EYELID DISORDERS – CHALAZION How do chalazions present? How are they managed?
- Firm, non-tender swelling in eyelid (often upper) - Hot compresses + analgesia - ?Topical chloramphenicol if acutely inflamed - Few require surgical drainage
110
EYELID DISORDERS – ENTROPION What is entropion? How does this present?
- Eyelid turns inwards with lashes against the eyeball | - Pain which can lead to corneal damage (abrasions) + ulceration
111
EYELID DISORDERS – ENTROPION | What is the initial management of entropion?
- Same-day ophthalmology referral if risk to sight | - Taping eyelid down to prevent inwards turning (with lubricating eye drops to prevent eye drying out)
112
EYELID DISORDERS – ENTROPION | What is the definitive management of entropion?
- Surgical intervention
113
EYELID DISORDERS – ECTROPION What is ectropion? What is a consequence of this?
- Eyelid turns outwards with inner aspect of eyelid exposed (often bottom lid) - Exposure keratopathy as eyeball exposed + not adequately lubricated + protected
114
EYELID DISORDERS – ECTROPION | What is the management of ectropion?
- Same-day ophthalmology referral if risk to sight - Mild = may only need regular lubricating eye drops - Significant cases = surgery
115
EYELID DISORDERS – TRICHIASIS | What is trichiasis?
- Inward growth of eyelashes > pain + can lead to corneal damage (abrasion)/ulceration
116
EYELID DISORDERS – TRICHIASIS | What is the management of trichiasis?
- Same-day ophthalmology referral if risk to sight - Eyelash removal (epilation) - Recurrent cases = electrolysis, cryotherapy or laser treatment to prevent lash regrowth
117
HERPES ZOSTER OPHTHALMICUS | What is herpes zoster ophthalmicus?
- Reactivation of the varicella zoster virus in the area supplied by the ophthalmic division of the trigeminal nerve
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HERPES ZOSTER OPHTHALMICUS What is the clinical presentation of herpes zoster ophthalmicus? What is an important sign?
- Painful red eye - Vesicular rash around eye ± actual eye involvement - Hutchinson's sign = rash on tip/side of nose > nasociliary involvement + strong indicator for ocular involvement
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HERPES ZOSTER OPHTHALMICUS | What are some potential complications of herpes zoster ophthalmicus?
- Ocular involvement = conjunctivitis, keratitis, episcleritis, anterior uveitis - Post-herpetic neuralgia
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HERPES ZOSTER OPHTHALMICUS | What is the management of herpes zoster ophthalmicus?
- Ocular involvement = same day ophthalmology review - PO aciclovir 7–10d started within 72h (IV if severe or immunocompromised) - Do NOT Rx top steroids without ophthalmology guidance
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HORNER'S SYNDROME What are the three main causes of Horner's syndrome? How can they be differentiated by clinical presentation?
- Central lesions (S–entral) = anhidrosis of face, arm + trunk - Pre-ganglionic lesions (T–orso) = anihydrosis of the face - Post-ganglionic lesions (C-ervical) = no anhidrosis
122
HORNER'S SYNDROME What are some causes of... i) central Horner's syndrome? ii) pre-ganglionic Horner's syndrome? iii) post-ganglionic Horner's syndrome?
i) Stroke, Syringomelia, multiple Sclerosis ii) pancoast Tumour, Thyroidectomy, Trauma iii) Carotid artery dissection + aneurysm, Cavernous sinus thrombosis, Cluster headache
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HORNER'S SYNDROME What is the classic clinical presentation of Horner's syndrome? What other features may be present?
- Triad = miosis, ptosis + unilateral anihidrosis - Enophthalmos (sunken eye) - Heterochromia (difference in iris colour) in congenital Horner's
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HORNER'S SYNDROME What test can be used in Horner's syndrome to confirm? What happens?
- Apraclonidine (alpha adrenergic agonist) drops - Pupillary dilation in Horner's (hypersensitive) but mild miosis in normal pupil as down-regulates noradrenaline release
125
HYPERTENSIVE RETINOPATHY What is hypertensive retinopathy? What classification is used?
- Damage to small blood vessels in the retina due to systemic HTN - Keith-Wagener classification
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HYPERTENSIVE RETINOPATHY | What are the various stages of hypertensive retinopathy?
- I = arteriolar narrowing + tortuosity, increased light reflex (silver wiring as arterioles sclerosed) - II = arteriovenous nipping (compression of veins where sclerosed arterioles cross) - III = cotton-wool spots, hard exudates + retinal haemorrhages - IV = papilloedema (ischaemia to optic nerve > oedema + blurred margins)
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RETINITIS PIGMENTOSA | What is retinitis pigmentosa?
- Congenital inherited condition with degeneration of rods + cones in retina - Often rods degenerate more than cones > night blindness
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RETINITIS PIGMENTOSA What is the clinical presentation of retinitis pigmentosa? When does it normally present and who in?
- Peripheral vision lost first = tunnel vision - Night blindness may be first Sx - Sx start in childhood in those with positive FHx
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RETINITIS PIGMENTOSA | What might you see on fundoscopy in retinitis pigmentosa?
- Black "bone-spicule" pigmentation in peripheral retina - Optic disc pallor - Retinal vessel narrowing
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RETINITIS PIGMENTOSA | What is the management of retinitis pigmentosa?
- Ophthalmology referral for assessment + diagnosis | - Vision aids + sunglasses to protect retina from accelerated damage
FINALS
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