1
Q
What are cataracts?
A
- opacification/clouding of the lens
- prevents light from reaching back of eye
- most common cause of blindness worldwide
2
Q
What is the epidemiology of cataracts?
A
- incidence increases with age - mostly over 65
- more common in women
3
Q
What are risk factors for cataracts?
A
- diabetes
- steroid use
- smoking
- trauma
- UV exposure
4
Q
Nuclear cataracts:
- what
- epidemiology
- symptoms
A
- caused by sclerosis of lens nucleus
- common in old age
- symptoms: myopia, dull colours
- e.g. patients previously needed reading glasses, no longer require
5
Q
What are the three parts of the lens relevant to cataracts?
A
- lens nucleus: middle aspect
- lens cortex: outer aspect
- lens capsule: membrane surrounding lens
6
Q
What are cortical cataracts? What is seen on ophthalmoscopy?
A
- opacification of lens cortex
- vision unaffected
- look like wheel spokes around edge of lens on ophthalmoscopy
7
Q
What are posterior subscapular cataracts?
- cause, symptoms
A
- opacifications of posterior aspect of lens
- affect younger patients/steroid use
- pts complain of glare when looking at light
- progress rapidly
8
Q
What are symptoms of cataracts?
A
- progressive blurring of vision
- glare/halos when looking at lights
- colours appear dull
9
Q
What is seen on examination of cataracts?
A
- reduced red reflex
- clouded lens
10
Q
What are dot opacities?
A
- early, localised marker of lens change
- precede cataracts
- also seen in diabetics and myotonic dystrophy
- can classify cataract type based on location
11
Q
What investigations are done for cataracts?
A
- ophthalmoscopy
- slit lamp examination
12
Q
What is the conservative management of cataracts?
A
- refrain from surgery until lifestyle affected
- if age related, prescribe stronger glasses or use brighter lighting
- control risk factors
13
Q
What is the surgical management of cataracts?
A
- phacoemulsification with an intraocular lens implant
- opacified lens broken down using USS, fragments aspirated
- new lens implanted
- ocular biometry to choose replacement lens
14
Q
What are complications of cataracts surgery?
A
- posterior capsule opacification
- endophthalmitis
- retinal detachment
- posterior capsule rupture
15
Q
What is posterior capsule opacification?
A
- patients present months to years later complaining cataracts returning
- treated with capsulotomy
- hole made for light to pass through
16
Q
What is endophthalmitis?
A
- infection of aqueous or vitreous humour
- can result in permanent blindness
17
Q
What are the common causes of endophthalmitis? exogenous, endogenous and bacteria
A
- exogenous: surgery or injection
- endogenous: endocarditis
- bacteria: Staph or Strep
18
Q
How does endophthalmitis present?
A
- severe pain
- rapidly progressive visual loss
- photophobia
- floaters if injection/surgery <6 weeks ago
19
Q
What may be seen on examination of endophthalmitis?
A
- Diffuse conjunctival injection
- Corneal haze, limited view of the pupil and iris
- Hypopyon
- Relative afferent pupillary defect
20
Q
How is endophthalmitis managed?
A
- ophthalmic emergency
- surgical intervention
- sampling of vitreous fluid followed by injection of intravitreal abx
- Patients admitted for topical and systemic therapy with close monitoring.
21
Q
What is age related macular degeneration (ARMD)?
A
- degeneration of central retina (macula)
- degeneration of retinal photoreceptors
- results in formation of drusen
22
Q
What are risk factors for ARMD?
A
- age (3x inc for pts over 75)
- smoking
- FHx
- htn, dyslipidaemia, diabetes
- ethnicity
23
Q
What is dry ARMD?
A
- atrophic
- non-exudative and non-neovascular
- drusen in Bruch’s membrane
- changes to retinal pigmentary epithelium
- slow visual deterioration
24
Q
What is wet ARMD?
A
- formation of choroidal neovascular membrane made up of new blood vessels
- leakage of shroud fluid and blood > rapid vision loss
- rapid progression
25
Which hormone causes wet ARMD?
- vascular endothelial growth factor
26
What are the symptoms of ARMD?
- progressive, central visual loss
- difficulty with dark adaptation
- fluctuations in vision
- photopsia and glare
27
What is seen on examination of ARMD?
- central metamorphopsia on Amsler grid
- central scotoma on visual field assessment
28
What is seen on fundoscopy in ARMD?
- demarcated red patches: sub retinal fluid leakage
- drusen
- choroidal neovascular membrane
29
How can suspected neovascular ARMD be investigated?
- fluorescein angiography: guides anti-VEGF therapy
- can be complemented with indocyanine green angiography to visualise deeper choroidal vessels
30
What is the initial investigation for ARMD?
- slit-lamp microscopy
- identifies pigmentary, exudative or haemorrhagic changes
- accompanied by colour fundus photography
31
What is OCT?
- ocular coherence tomography
- high res 3D imaging of retina
- assesses thickness of layers and presence of fluid
32
How is dry ARMD treated?
- low vision refractory aids
- AREDS2: vitamins if early
33
What vitamins comprise the AREDS2 formula for early dry ARMD?
- zinc
- vitamins A, C, E
34
Which risk factors should be controlled for treatment of ARMD?
- smoking
- ocular sun exposure
- CV health and diet
35
How can wet ARMD be treated?
- intravitreal anti-VEGF therapy
- given monthly for 3 mo
- stabilises or improves visual loss
36
What are examples of intravitreal anti-VEGF medications?
- aflibercept
- ranibizumab
- bevacizumab
- pegaptanib
37
Can people with ARMD drive?
- if their visual acuity is 6/12 or better
- failure to meet this: patient inform DVLA and stop driving
38
What are other non medical management strategies for ARMD?
- register with national centre for the blind
- regular eyesight testing
- OT
- psychology
39
What are possible complications of intravitreal injections?
- chemosis (oedema)
- scleral injection (bloodshot)
- Endophthalmitis and infection
40
What is acute angle-closure glaucoma?
- acute rise in intraocular pressure
- narrowing of anterior chamber angle of eye (between iris and cornea)
- causes optic nerve damage and sight loss
41
What is the pathophysiology of AACG?
- rise in IOP 2º to impaired aqueous outflow
- occurs in anatomically predisposed individuals
- reduced drainage mediated by pupillary block: iris and lens in contact causing iris to bow forward > inc IOP
- *iris blocks trabecular meshwork so aqueous humour can't drain*
42
What ophthalmic factors are predisposing to AACG?
- hypermetropia/short eyeball
- pupillary dilatation
- lens growth
- shallow anterior chamber
43
What are risk factors for AACG?
- age (60s-70s)
- female
- east asian
- FHx
- anatomical
44
What are the causes of pupil mid-dilation? (precipitates pupillary block, can lead to AACG)
- caused by dark room
- medications: anticholinergics, antidepressants, pupil dilators
45
What are symptoms of AACG?
- develops over hours to days
- unilateral severe eye pain or headache
- n+v
- dec visual acuity or loss
- rainbow haloes around bright lights
46
What are signs of AACG on examination?
- red, hard eye
- diffuse, hazy cornea
- fixed, non-reactive, mid-dilated pupil
- hard eye on palpation
47
How is AACG investigated?
- gonioscopy
- tonometry
48
What is tonometry? What is the value in AACG?
- measures IOP
- is >30mmHg in AACG
49
What is gonioscopy?
- gold standard for AACG
- lens for slit lamp
- allows visualisation of angle between iris and cornea
50
What is conservative management of AACG?
- oral analgesics
- antiemetics
- lie patient on back
51
What is acute medical management of AACG?
- acetazolamide
- timolol: β blocker
- topical steroids: reduce inflammation
- brimonidine: α 2 agonist
- (pilocarpine eye drops - in textbook less in practice)
52
What is brimonidine and how does it work?
- α 2 agonist
- reduces aqueous humour production and increases outflow
53
Patients taking which medications should avoid brimonidine?
- Monoamine oxidase inhibitors (MAOIs)
- tricyclic antidepressants
54
What is timolol and how does it work?
- β blocker
- reduces aqueous humour production
55
What is definitive management of AACG?
- bilateral laser peripheral iridotomy
- laser hole through peripheral iris allows aqueous drainage
- decreases intraocular pressure
- bilateral because other eye can be affected
56
What is blepharitis?
- inflammation of eyelid margins
57
What causes blepharitis?
Give a cause
Give a derm condition it is more common in
- Meibomian gland dysfunction: secrete oil to prevent tear film evaporation, so blockage > dry eye
- seborrhoeic dermatitis/staph infection
- more common with rosacea
58
What are features of blepharitis?
- bilateral
- gritty, itchy, dry eye
- sticky
- red margins
- swollen eyelid if staph
59
What can blepharitis lead to?
- styes and chalazions
- secondary conjunctivitis
60
What is the management of blepharitis?
- soften lid margin with hot compress 2x day
- lid hygiene: cotton buds and baby shampoo
- artificial tears if needed
61
What is central retinal artery occlusion (CRAO)?
- sudden occlusion of artery supplying inner retina
- leads to hypoperfusion, hypoxic damage, retinal cell death and visual loss
62
What are the 2 categories of aetiology of CRAO?
- embolism/thrombosis (atherosclerosis)
- arteritis (vasculitic)
63
What are features of CRAO?
- sudden, painless unilateral visual loss
- relative afferent pupillary defect
- cherry red spot on pale retina
64
How to differentiate CRAO and BRAO?
- pale area of retina in BRAO
- whole retina pale in CRAO
65
What ophthalmic investigations could be used to confirm CRAO?
- fluroscein angiography
- OCT
66
What other investigations can be done for CRAO if an embolic cause is suspected?
- carotid duplex USS (may have carotid bruit)
- ECG for AF/paroxysmal
- Echo
67
What bloods can be done for CRAO?
- ESR/CRP - temporal/GCA
- FBC
- coagulation studies
- HbA1c and lipids
- vasculitic screen
68
What is the aim of CRAO management?
- optical emergency
- re-perfuse ischaemic tissue
- urgent referral
69
What are immediate management options for CRAO?
- ocular massage
- inc blood oxygen and dilate retinal arteries: administer sublingual isosorbide dinitrate
- reduce IOP: IV acetazolamide and mannitol; anterior chamber paracentesis
70
What is a treatment option for CRAO for patients presenting within 24h?
- intra-arterial fibrinolysis: local injection of urokinase or thrombolysis with tPA (alteplase)
- evidence is mixed
71
What is primary open angle glaucoma?
- most common type
- optic neuropathy with raised IOP
72
What is normal IOP?
10-21mmHg
73
What is the pathophysiology of POAG?
- gradual inc in resistance to flow through trabecular meshwork into Canal of Schlemm
- inc IOP leads to retinal cell ganglion death
- loss of nerve axons leads to optic disc cupping
- this leads to visual loss
74
What are risk factors for POAG?
- myopia
- age over 65
- FHx
- Afro caribbean
- htn
- T2DM
75
What are the features of POAG?
- insidious onset
- peripheral visual field loss (superior > inferior) > central
- dec visual acuity
76
What is seen on fundoscopy in POAG?
- optic disc cupping
- optic disc pallor
- vessel bayonetting: breaks as they disappear into the cup, reappearing in base
- cup notching
- disc haemorrhages
77
Why might there be optic disc pallor in POAG?
- optic nerve atrophy
- death of nerve fibres gives pale disc
78
What cup to disc ratio is seen in POAG?
- >0.7
- normal is 0.4-0.7
- loss of disc substance widens and deepens cup
79
How is POAG picked up and referred?
- found by optometrist in routine check
- referred to ophthalmology
80
What is the gold standard investigation for POAG?
- measuring IOP
- with Goldman applanation tonometer
- measures pressure needed to indent cornea over surface area
- non-contact less accurate
81
What other investigations may be done for POAG?
- perimetry: visual field assessment
- slit lamp with pupil dilatation: optic nerve assessment
- central corneal thickness
82
What is seen on gonioscopy in POAG?
- open angle
- trabecular meshwork visible
- measures peripheral anterior chamber
83
Which investigations do nice guidelines state diagnose chronic open angle glaucoma?
- automated perimetry: visual fields
- slit lamp w/ pupil dilatation: optic nerve
- applanation tonometry: IOP
- gonioscopy
- central corneal thickness
84
What is the aim of POAG treatment?
- reduce IOP
- prevents progression of optic nerve damage
- preserve sight
85
What is the first line treatment of POAG?
- 360º selective laser trabeculoplasty
- if IOP ≥24mmHg
- causes rebuilding of meshwork
- can delay need for eye drops
- may need 2nd procedure later date
86
What is the second line treatment for POAG and give an example?
- prostaglandin analogue eyedrops
- latanoprost
87
How do PGA eyedrops work?
- increase uveoscleral outflow
- OD administration
- side effects: brown iris pigmentation
- increased eyelash length
- eyelid pigmentation
88
What are 3rd line treatments for POAG?
- β blocker eye drops
- carbonic anhydrase inhibitor eyedrops
- sympathomimetic eyedrops
89
What is the surgical intervention given in POAG?
- trabeculectomy surgery
- creating channel in sclera to drain aqueous humour
90
How do carbonic anhydrase inhibitors work?
- reduce aqueous production
91
What are side effects of pilocarpine?
- constricted pupils
- headache
- blurred vision
92
What is the method of pilocarpine?
- muscarinic receptor agonist
93
When do drivers with glaucoma need to notify the DVLA?
- both eyes: group 1: private car drivers
- one eye: group 2: e.g. lorry drivers
94
What are features of allergic conjunctivitis?
- bilateral erythema and swelling
- watery eyes
- itch
- swollen eyelids
- seasonal (pollen) or perennial (dust)
- Hx of atopy
95
How is allergic conjunctivitis managed?
- topical antihistamines
- topical mast-cell stabilisers: sodium cromoglicate
96
What is conjunctivitis?
- inflammation of conjunctiva
- covers outer globe and inner surface of eyelids
97
What may be seen on examination in allergic conjunctivitis?
- papillae
- cobblestone appearance
98
What type of hypersensitivity reaction causes allergic conjunctivitis?
- type I
- eosinophilic
99
What is the aetiology of viral conjunctivitis?
- adenovirus (MC)
- herpes virus
100
What are the features of viral conjunctivitis?
- bilateral
- profuse watery discharge
- associated with URTI
- can cause tender preauricular lymphadenopathy
101
What is pharyngoconjunctival fever?
- patients present with pharyngitis, conjunctivitis and fever
102
What is epidemic keratoconjunctivitis?
- severe
- corneal involvement
- photophobia
103
What is the management of viral conjunctivitis?
- self-limiting
- wash hands and avoid sharing towels
104
What are causative organisms of bacterial conjunctivitis?
- Staphylococcus
- Streptococcus
- Haemophilus
- Chlamydia
- gonorrhoea
105
In which group would gonorrhoea cause conjunctivitis?
- neonates
- exudative
- ophthalmia neonatorum
- infection from birth canal
106
Which bacteria cause reactive arthritis?
- Chlamydia
- gonorrhoea
107
What are the risk factors for infective conjunctivitis?
- contaminated skin
- objects
- unprotected sexual intercourse (bacterial)
108
What are the features of bacterial conjunctivitis?
- unilateral but can be bilateral
- sticky, purulent discharge
- eyes stick together on waking
109
What is the management of bacterial conjunctivitis?
- antibiotic drops:
chloramphenicol
- given 2-3hrly initially
110
How is infective conjunctivitis managed in pregnant women?
- BD fusidic acid
111
How is infective conjunctivitis managed in contact lens users?
- topical fluoresceins to check for corneal staining
- contact lenses not to be worn
- treat with quinolone or gentamicin
- risk of pseudomonas
112
What treatment is given for bacterial conjunctivitis if secondary to chlamydia or gonorrhoea?
- azithromycin
113
What complications may occur from gonorrhoea causing conjunctivitis?
- keratitis
- endophthalmitis
- either can lead to reduced vision or blindness
114
What is uveitis?
- inflammation of the uveal tract
- comprises iris, ciliary body and choroid
115
What is anterior uveitis?
- inflammation of iris and ciliary body
- presents as painful, photophobic red eye
116
What is the aetiology of anterior uveitis?
- majority idiopathic
- associated with HLA-B27
- AI diseases
- infection
- trauma
117
What are risk factors for uveitis?
- age over 20
- previous history
- HLA-B27 positive
118
What conditions is anterior uveitis associated with?
- ankylosing spondylitis
- reactive arthritis
- IBD
- Bechet's
- sarcoidosis
119
Over what timeframe do uveitis symptoms develop?
- hours to several days
120
What causes unilateral vs bilateral uveitis?
- unilateral: idiopathic or herpetic (can progress to bilateral)
- bilateral: systemic
121
What symptoms occur with anterior uveitis?
- pain (may inc w/ use)
- red eye
- photophobia
- lacrimation
- blurred vision
- small, irregular pupil
- impaired visual acuity
122
What is hypopyon?
- pus and inflammatory cells in anterior chamber
- causes visible fluid level
123
What systemic symptoms may occur with anterior uveitis?
- joint pain
- back pain
- IBD flare
124
How many chronic/intermediate/posterior uveitis differ?
- painless and decreased vision
125
What may be seen via pen torch examination in uveitis?
- ciliary injection: dilated conjunctival vessels
- irregular pupil
- cloudy cornea
- hypopyon
126
What may be seen on slit lamp examination of anterior uveitis?
- ciliary flush: red ring spreading outwards
- flare: foggy appearance of anterior chamber
- inflammatory cells in anterior chamber
- posterior synechiae: adhesions distorting pupil shape
127
How is anterior uveitis managed?
- r/v by ophthalmology
- cycloplegics
- topical steroid drops
- treat underlying cause (may need systemic steroids or immunosuppressants)
128
What do cycloplegics do and give an example?
- dilate pupils to relieve pain and photophobia
- cyclopentolate
129
What is the prognosis of anterior uveitis?
- self-limiting
- commonly reoccurs in young pts aged 18-35
130
What is scleritis?
- full-thickness scleral inflammation
- non-infective
131
What are risk factors for scleritis?
- RA
- SLE
- sarcoidosis
- granulomatosis with polyangiitis
132
What are the features of scleritis?
- red sclera
- dull, boring pain
- pain with eye movement
- watering and photophobia
- gradual decrease in vision
133
Why is there pain with eye movement in scleritis?
- extraocular muscles insert into sclera
- so movement will cause pain
134
What may be seen on examination in scleritis?
- eye is deep pink with violet hue
- dilated superficial bright red blood vessels
- tenderness to palpation
135
What is the management of scleritis?
- treat underlying cause: may need high-dose steroids or immunosuppressants
- oral NSAIDs
136
How do peri-orbital and orbital cellulitis differ?
- peri-orbital: anterior to orbital septum
- orbital: posterior to septum
137
What is orbital cellulitis?
- infection of muscle and fat within orbit
- does not involve globe
138
What is the epidemiology of orbital cellulitis?
- more common in children
139
What is the aetiology of orbital cellulitis?
- infection from acute bacterial sinusitis
- commonly from paranasal sinuses/URTI
- may progress from periorbital cellulitis
140
What are the features of orbital cellulitis?
- erythema and swelling around eye
- blurred vision
- painful eye movements
- change in colour vision
- proptosis
- eyelid oedema and ptosis
141
How can orbital and periorbital cellulitis be differentiatied?
- orbital cellulitis: reduced visual acuity, proptosis, painful eye movements
- none of these in periorbital
142
What bloods are done in orbital cellulitis?
- FBC: WCC elevated
- CRP elevated
- cultures, MC&S: Strep, Staph, HiB
143
What imaging is done in orbital cellulitis?
- CT with contrast: inflammation deep to septum, sinusitis
144
What 3 criteria mean imaging is indicated in orbital cellulitis?
- clinical examination not possible
- red flags
- failure to improve after 36-48h Abx
145
What is the management of orbital cellulitis?
- IV Abx for 7-10 days
146
What is the management if orbital collection is seen on imaging?
- evacuation of orbital pus
- drainage of paranasal sinus pus
147
What is periorbital cellulitis?
- infection of soft tissues
- incl eyelids, skin and subcut tissue in face
- less serious than orbital
148
What is the aetiology of periorbital cellulitis?
- superficial injury:
- insec bite, chalazion, conjunctivitis
149
What are the most frequent causative organisms of periorbital cellulitis?
- Staph aureus, Staph epidermidis, streptococci, anaerobic
150
What is the epidemiology of periorbital cellulitis?
- children
- median age is 21 mo
- more common in winter due to more RTIs
151
What are features of periorbital cellulitis?
- pain, redness, swelling of eyelid
152
What is seen on examination of periorbital cellulitis?
- erythema and oedema of eyelid
- partial or complete ptosis of eye
- systemically well
- no pain on eye movement
153
What investigations are done for periorbital cellulitis?
- bloods
- swab
- contrast CT
154
What is the management of periorbital cellulitis?
- oral co-amox
- clindamycin if allergic
155
In what condition may uveitis be silent?
- Juvenile idiopathic arthritis
- particularly oligoarticular
- may present without red eye, photophobia
156
What may cause a subconjunctival haemorrhage?
- trauma
- significant rise in intraocular pressure
- eye rubbing
157
What are risk factors for subconjunctival haemorrhage?
- hypertension
- anticoagulation/antiplatelets
158
What are features of subconjunctival haemorrhage?
- asymptomatic
- may have gritty eye
- stops at limbus (junction between cornea and conjunctiva)
159
How is subconjunctival haemorrhage managed?
- lubricants if gritty eye
- will resolve over a few weeks
-
160
What is squint? What are the 2 types?
- misalignment of the visual axes
- can be concomitant or paralytic
- if uncorrected can lead to ambylopia (one eye favoured)
161
What is concomitant squint?
- imbalance in extraocular muscles
- convergent more common than divergent
162
What is paralytic squint?
- rarer
- paralysis of extraocular muscles
163
What is the corneal light reflex test for squint? (Hirschberg test)
- hold light source 30cm from pt face
- see if light reflects symmetrically on pupils
164
What is the cover test for squint?
- ask child to focus on object
- cover one eye and observe movement of uncovered eye
- there should be no shift in fixation of the eye
165
What is a stye?
- external hordeolum
- staph infection of eyelash follicle
- infection of glands of Zeis (sebaceous glands) or Moll (sweat glands)
166
What is hordeolum internum?
- infection of Meibomian glands
- deeper and more painful than stye
- point inwards towards eyeball
167
How is a stye treated?
- hot compresses
- analgesia
- topical abx (chloramphenicol) if severe/recurrent
168
What is a chalazion?
- granulomatous inflammatory lesion of obstructed Meibomian gland
- non-infectious
169
What is the appearance of a chalazion?
- painLESS red eyelid cyst
- if infected > internal hordeolum
170
How is a chalazion treated?
- warm compress
- gentle massage
- if persistent: incision and curettage
171
What is entropion? What are the symptoms?
- inward turning of eyelid
- presses lashes against eye
- causes pain
- can cause corneal damage and ulceration
172
How is entropion managed?
- taping eyelid and eye drops
- surgical correction
173
What is ectropion?
- outward turning of eyelid
- usually affects bottom lid
- eyeball exposed > can lead to exposure keratopathy
174
What is trichiasis?
- eyelashes grow inwards
- causes corneal ulceration
175
How is trichiasis managed?
- remove affected eyelashes
- laser treatment to prevent regrowth
176
What is the pathophysiology of diabetic retinopathy?
- hyperglycaemia > inc blood flow
- precipitates damage
- microaneurysms
- retinal ischaemia
177
What are the 3 categories of diabetic retinopathy?
- non-proliferative
- proliferative
- maculopathy
178
What is mild/background NP diabetic retinopathy?
- ≥1 microaneurysm
179
What is moderate NPDR?
- microaneurysms
- blot haemorrhages
- hard exudates
- retinal ischaemia: venous beading, intraretinal microvascular abnormalities
180
What is severe NPDR? 4-2-1 rule
- blot haemorrhages in 4 quadrants
- venous beading in 2
- IRMA in 1
181
What are the signs on examination of proliferative diabetic retinopathy?
- neovascularisation
- fibrous tissue anterior to retinal disc
- vitreous haemorrhage
- retinal detachment
182
What are the symptoms of maculopathy in diabetes?
- blurred vision when reading
- difficulty recognising faces
- check visual acuity
183
What are intravitreal vascular endothelial growth factor inhibitors used to treat? Give an example, and a CI.
- maculopathy
- proliferative retinopathy
- ranibizumab
- CI if stroke or MI in past 3mo
184
What is the mechanism of photocoagulation for diabetic retinopathy?
- primary intervention for proliferative DR
- creates burns in retina
- destroys photoreceptors > dec O2 demand > delays DR progression
185
What are 3 key complications of panretinal photocoagulation?
- reduced quality of night vision
- restricted peripheral vision
- macular oedema
186
How often are individuals screened for diabetic retinopathy?
- annually
187
What is keratitis?
- inflammation of cornea
- urgent
188
What are the bacterial and viral causes of keratitis?
- Staph aureus
- Pseudomonas aeruginosa (contact lens)
- viral: herpes simplex
189
What are the features of keratitis?
- painful red eye
- photophobia
- gritty sensation
- hypopyon
190
How is keratitis managed?
- contact lens: same day referral to rule out microbial keratitis
- stop using contact lens
- topical fluoroquinolone
- cyclopentolate pain relief
191
How does herpes simplex keratitis present?
- red painful eye
- photophobia
- epiphora (watery eye)
- dec visual acuity
- dendritic corneal ulcer
192
How is herpes simplex keratitis managed?
- topical aciclovir
193
What history should be taken from contact lens wearers in keratitis?
- type of contact lens: daily, monthly
- duration of wear per day
- slept, showered, or swam with lenses in
194
What are the features of optic neuritis?
- unilateral decrease in visual acuity over hrs or days
- poor colour discrimination
- pain worse on eye movement
- RAPD
- central scotoma
195
What is relative afferent pupillary defect? How is it identified?
- affected AND normal eye dilate when light shone on affected
- identified by swinging light test
196
What are the causes of RAPD?
- retinal detachment
- optic neuritis
197
What is retinal detachment?
- layers of retina separate
- neurosensory retina separates from retinal pigment epithelium
198
What are risk factors for retinal detachment?
- diabetes
- high myopia
- age
- previous cataract surgery
- eye trauma
199
What is the presentation of retinal detachment?
- sudden painless visual loss: shadow/curtain
- shadow/curtain progressing from centre to periphery
- new onset flashing lights and floaters
- cobwebs in peripheral vision
200
What is seen on examination of retinal detachment?
- RAPD
- red reflex los
- reduced visual acuity
- tobacco dust sign on slit lamp (Shafer's sign)
201
How is retinal detachment managed preventatively?
- tear treated with laser photocoagulation
202
What are the 3 surgical techniques used to manage retinal detachment?
- vitrectomy
- pneumatic retinopexy
- scleral buckle
203
How to differentiate between homonymous quadrantinopias?
- superior: lesion of inferior optic radiation in temporal lobe
- inferior: lesion of superior radiation in parietal lobe
- PITS: parietal - inferior; temporal - superior
204
How can you differentiate between the cause of a superior and inferior bitemporal hemianopia?
- upper quadrant defect: inferior chiasmal compression (pituitary tumour)
- lower defect: superior compression: craniopharyngioma
205
How does visual loss differ with pre and post chiasmal lesions?
- prechiasmal lesions: ipsilateral monocular defect
- postchiasmal lesions: homonymous defects of contralateral side
206
What visual field loss would a lateral optic chiasm lesion cause?
- ipsilateral monocular nasal hemianopia
207
What visual field loss would an optic tract lesion cause? What are causes of this?
- contralateral homonymous hemianopia
- MCA stroke
- tumour
208
What visual field loss would an optic radiation lesion cause?
- contralateral homonymous quadrantinopia
209
What visual field loss would an occipital cortex lesion cause? What are causes of this?
- contralateral homonymous hemianopia with macular sparing
- PCA stroke
- trauma
210
Which loops are affected in upper quadrantinopia vs lower?
- Upper: Meyer's (temporal)
- lower: parietal
211
What are the features of corneal abrasion?
- eye pain
- lacrimation
- photophobia
- foreign body sensation
- decreased visual acuity
212
How is corneal abrasion investigated?
- fluorescein staining
- yellow stained abrasion visible with cobalt blue filter
213
How is corneal abrasion managed?
- topical abx
214
What is vitreous haemorrhage?
- bleeding into vitreous humour
215
What are the causes of vitreous haemorrhage?
- proliferative diabetic retinopathy
- posterior vitreous detachment
- ocular trauma
216
How does vitreous haemorrhage present?
- painless visual loss or haze
- red hue in vision
- floaters/shadows/dark spots
- dec visual acuity
217
How is vitreous haemorrhage investigated?
- obscured fundal view
- absent red reflex if severe
218
How is vitreous haemorrhage managed?
- observation, avoid heavy lifting, red flags
- laser therapy
- surgical if not clearing
219
What is posterior vitreous detachment?
- separation of vitreous membrane from retina
220
What is the epidemiology of posterior vitreous detachment?
- over 65s
- females
221
What are the features of posterior vitreous detachment?
- sudden appearance of floaters
- flashes of light
- blurred vision
- cobwebs
222
What is seen on ophthalmoscopy in posterior vitreous detachment?
- Weiss ring
- ring shaped floater due to detachment around optic nerve
223
How is posterior vitreous detachment managed?
- symptoms improve over 6mo
- if associated retinal tear or detachment this needs surgery
224
What are risk factors for subconjunctival haemorrhage?
- trauma
- contact lens use
- idiopathic
- valsalva manoeuvre
- htn and bleeding disorder
225
What are symptoms and signs of subconjunctival haemorrhage?
- unilateral red eye
- flat, red patch on conjunctiva
- normal vision
226
How is subconjunctival haemorrhage managed?
- self limiting, resolves in 2-3 weeks
227
What are 4 features of optic nerve dysfunction?
- decrease in visual acuity
- decrease in colour vision
- RAPD
- painful eye movement
228
What is CRVO?
- thrombus forms in retinal veins and obstructs venous draining from the retina
229
What is BRVO vs CRVO based on location?
- BRVO: obstruction in one of the four main retinal veins
- CRVO: obstruction of the main retinal vein
230
What are risk factors for CRVO?
- atherosclerosis: htn, cvd, diabetes, obesity, age
- hypercoaguable: glaucoma, myeloma, sickle cell, smoking
231
Why does ischaemic CRVO have a poorer prognosis than non-ischaemic?
- retinal non-perfusion
- capillary closure
- retinal hypoxia
- increased risk of neovascularisation
232
What is the presentation of CRVO?
- sudden painless unilateral visual loss
233
How does BRVO present?
- partial visual field defect
- metamorphopsia (distorted wavy vision)
234
What is seen on fundoscopy of CRVO?
- stormy sunset appearance (retinal haemorrhages)
- dot and blot haemorrhages
- cotton wool spots
- tortuous retinal veins
- retinal oedema
235
How can CRVO be investigated with imaging?
- fluorescein angiography
- OCT
236
How is CRVO managed?
- refer to ophthalmology
- if neovascularisation: pan-retinal photocoagulation
- macular oedema/vessel leakage: anti-VEGF (ranibizumab)
237
When are anti-VEGF agents contraindicated in CRVO treatment and what can be used instead?
- pregnancy
- stroke/MI within past 3 months
- use corticosteroids
238
What are the key criteria for papilloedema?
- blurred optic disc margins
- in the CONTEXT of raised ICP
- BILATERAL
239
What is episcleritis?
- acute onset inflammation in the episclera
- superficial layer lying between under teh conjunctiva and above the sclera
240
What are the features of episcleritis?
- red eye
- painless but may have mild irritation
- watering and mild photophobia
241
How can episcleritis and scleritis be differentiated?
- phenylephrine drops
- blanches conjunctival and episcleral vessels
- if redness improves after phenylephrine, can diagnose episcleritis
242
How is episcleritis managed?
- oral NSAIDs
- lubricating eye drops
243
What is anisocoria?
- pupils are unequal sizes
244
What is mydriasis? Give one differential
- dilated pupil
- disruption to parasympathetic innervation
- surgical 3rd nerve palsy
245
What is miosis? Give 2 differentials
- constricted pupil
- disruption to sympathetic innervation to the eye
- Horner syndrome
- Argyll Robertson pupil
246
In a CN3 palsy, what position is the eye and why?
- down and out
- pulled by SR4 and LR6 which pull the eye downwards (4) and outwards (6)
247
How do you differentiate between a surgical and medical cause of CN3 palsy? By dilated/normal pupil
- surgical: dilated pupil as something is pressing on the vessel from the outside in e.g. post communicating artery aneurysm/ADPKD
- medical: normal pupil, htn or diabetes
248
What is seen on examination of an Argyll Robertson pupil
- pupils constrict during accommodation
- don't react to light
249
What is the difference between papillitis and papilloedema?
- optic disc swelling
- papillitis is not bilateral or caused by raised ICP
250
Give 4 causes of anterior uveitis
- Seronegative spondyloarthropathies: ankylosing spondylitis, psoriasis
- Behcet's
- sarcoidosis
- IBD
MLA
flashcards
Decks in class (28)
# Cards
-
Renal148
-
Respiratory161
-
CV264
-
Derm109
-
Endocrinology271
-
Oncology72
-
Rheumatology226
-
3a Neuro228
-
3a Obstetrics247
-
GI303
-
Ophthalmology250
-
ENT102
-
Gynaecology286
-
Paeds resp117
-
Paeds GI130
-
Sexual Health105
-
Paeds endo26
-
Paeds cardio59
-
Haematology158
-
Ortho90
-
Anaesthesia + surgery4
-
Paeds neuro52
-
Paeds derm41
-
Paeds infectious68
-
Psychiatry269
-
Paeds MSK69
-
Paeds renal5
-
Paeds Genetics38
