Ophthalmology Flashcards by Siobhan Carlin

Acute angle closure glacoma pathophysiology

Inc IOP due to imapirment of aqueous flow due to:
Long sighted (hypermetropia)
Pupillary dilation
Lens growth with age
TCA’s or anticholinergics

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Acute angle closure glaucoma presentation

Pain
Red eye
Dec visual acuity
Halos
Semi dilated non reacting pupil

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Acute angle closure glaucoma Ix

Tolometry
Gonioscopy

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Acute angle closure glaucoma Mx

Urgent review
Laser iridotomy
Eye drops
* Muscarinic agonist inc outflow (e.g. pilocarpine) - small pupil
* BB (timolol)
* Alpha 2 agonist (apraclondine)
IV acetazolmide

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Anterior uveitis associated with and presentation

Associated with
- HLA B27 - reactive arthritis, ank spondilitis, IBD

Presentation
- Pain
- Red
- Blurred vision
- Photophobia
- Small and irreg pupil
- Ciliary flush
- Lacrimation

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Anterior uveitis Mx

Urgent review
Cycloplegics (e.g. atropine, cyclopentolate)
Steroid eye drops

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Herpes simplex keratitis presentation

Pain
Red
Dec visual acuity
Photphobia
Dendtitic ulcer (looks like branching linear epithelial defect)

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Herpes simplex keratitis Mx

Urgent
TOP aciclovir

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Scleritis assoc with, presentation and Mx

Assoc with
- Autoimmune e.g. RA

Presentation
- Severe pain (episcleritis is not painful)
- Red eye

Mx
- Same day assessment by ophthalmologist
- PO NSAIDs
- ?steroids/immunosupressive drugs

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Endophthalmitis presentation

Red
Pain
Visual loss
Following intraocular surgery

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Age related macular degeneration RF and different types

RF:
Smoking
Age
FHx
CV disease RF - HTN, DM, dyslipidaemia

Diff types:
Dry aka atrophic - druslens, most common
Wet aka exudative - choroidal neovascularisation –> leakage of serous fluid and blood, worst prognosis

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Age related macular degeneration Presentation

Dec visual acuity (gradual in dry and sub acute in wet, may fluctuate)
Loss central vision
Worse at night
Photopsia (perception of flickering or flashing lights)

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Age related macular degeneration Ix

Fundoscopy (see either red patch or druslen)
Slit lamp
Fluorescein angiography
Optical coherence tomography

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Age related macular degeneration Mx

For dry manage with Zn and anti-oxidant vitamins A, C, E - NOT IN SMOKERS
For wet manage with VEGF (e.g. bevacizumab), laser photocoagulation

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Primary open angle glaucoma RF and presentation

RF
- Age
- FHx
- CVD e.g. HTN, DM
- Steroids
- Myopia
- Afro-caribean ethnicty

Presentation
- Dec visual acuity
- Tunnel vision

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Primary open angle glaucoma Ix

Fundoscopy - optic disc cupping (>0.7), optic disc pallor, optic notching, disc haemorrhage, bayonetting of vessels
Slit lamp
Tonometry
Gonioscopy
Corneal thickness

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Primary open angle glaucoma Mx

Laser trabeculoplasty (>24)
Eyedrops
- Inc outflow = Prostaglandin analgue eyedrops (e.g. latanoprost) and Muscarinic receptor agonist (e.g. pilocarpine)
- Dec production = BB eyedrops (e.g. timolol) and Carbonic anhydrase inhibitors (e.g. dorzolamide)
- Both = Sympahomietic eye drops (e.g. brimonidine)

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Diabetic retinopathy diff types

Non prolifertaive
- Microanuerysm
- Blot haemorrhages
- Hard exudates
- Cotton wool spots

Proliferative
- Neovascularisation

Maculopathy
- Hard exudate
- Based on location
- T2DM

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Diabetic retinopathy Mx

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Non proliferative
- Observation
- ?Laser photocoagulation

Proliferative
- Photocoagulation (will notice 50% reduction in eye sight)
- VEGF
- ?Vitreoretinal surgery

Maculopathy
- VEGF

Hypertensive retinopathy classification

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Stage 1 = Arteriolar narrowing and tortuosity
Stage 2 = AV nipping
Stage 3 = cotton wool exudates, flame and blot harm
Stage 4 = papilloedema

Papilloedema signs and is on right = lesion on

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Signs
- Venous engorgement: usually the first sign
- Loss of venous pulsation: although many normal patients do not have normal pulsation
- Blurring of the optic disc margin
- Elevation of optic disc
- Loss of the optic cup
- Paton’s lines: concentric/radial retinal lines cascading from the optic disc

Papilloedema on right = lesion on left

Papilloedema causes

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SoL
Malignant hypertension
Idiopathic intracranial hypertension
Hydrocephalus
Hypercapnia
HypoPT
HypoCa
Vitamin A toxicity

Central retinal a. occlusion causes and presentation

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Causes
- Thromboembolism
- Arteritis

Presentation
- Painless
- Relative afferent pupillary defect

Central retinal a. occlusion Ix and Mx

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Ix
- Fundoscopy shows cherry red spot

Mx
- Arteritis = steroids
- Inatrarterial thrombolysis

Central retinal vein occlusion RF and presentation

RF - Age - CVD e.g. HTN and DM - Glaucoma - Polycythaemia Presentation - Painless - Sudden loss visual acuity

Central retinal vein occlusion Ix and Mx

Ix Fundoscopy - stormy sunset of retinal haemorhages Mx Conservtively Macular oedema = VEGF Neovascularisation = photocoagulation

In retinal vein occlusions what area corresponds to the temporal field?

The temporal field corresponds to the nasal retina

Optic neuritis causes and presentation

Causes - MS - Sypilis - DM Presentation - Pain - Dec acuity unilateral - Poor discrimination colours - Central scotoma - Relative afferent pupillary defect

Optic neuritis Ix and Mx

Ix - MRI Mx - High dose steroids

Lebers optic atrophy presentation

30 YO Central scotoma → loss of colour vision → rapid onset of significant visual impairment Mitochondrial disease

Retinitis pigmentosa presentation and Ix

Presentation - Night blindness - Tunnel vision Ix - Fundoscopy - black bone spicule-shaped pigmentation in the peripheral retina, mottling of the retinal pigment epithelium

Viterous haemorrhage causes and presentation

Causes - Bleeding disorders - Anticoag - DM Presentation - Sudden visual loss - Dark spots

Posterior viterous detachment presentation, Ix and Mx

Presentation - Dark curtain descending Ix - Fundoscopy = Weiss ring Mx - Nil - R/V within 24 hrs incase retinal tear/detachment

Retinal detachment presentation

Dense shadow that starts peripherally progresses towards central vision Straight lines appeared curved Relative afferent pupillary defect

Herpes Zoster opthalmicus, pathophysiology, resentation and Mx

Pathophysiology - Reactivation VZV to opthalamic division of trigeminal nerve Presentation - Vesicular rash around eye - Hutchinson's sign - rash on tip or side of nose (predicts ocular invovement in future) Mx - Ocular involvements = URGENT - PO antiviral for 7-10days

Orbital cellulitis Ix

Argyll-Robertson pupil causes and presentation

Causes: - DM - Syphilis Presentation - Small irreg pupil - Accom reflex +ve, pupillary reflex -ve ie light

Holmes-Adie pupil Presentation (x3) Holmes-Aide syndrome (x1)

Presentation - Dilated pupil - Once constricted then stay small - Poor accomodation Holmes-Aide syndrome + absent lower limb reflexes

Horners syndrome central, pre ganglionic and post ganglionic

Central = S's (Anhidrosis of the face, arm and trunk) - Stroke - Syringomyelia - Multiple sclerosis - Tumour - Encephalitis Pre = T's excluding tumour (Anhidrosis of the face) Pancoast's tumour Thyroidectomy Trauma Cervical rib Post = C's excluding cervical rib (No anhidrosis) Carotid artery dissection Carotid aneurysm Cavernous sinus thrombosis Cluster headache

Horners syndrome presentation and Ix

Presentation Miosis Ptosis Anhidrosis Enophthalmos Ix Apraclonidine drops = pupil dilation in affected eye and constriction in normal eye

Keratitis - what is it, presentation and Mx

What is it? - Inflammation of cornea Presentation - Gritty sensation Mx - TOP abx

Congenital lacrimal duct obstruction presentation and Mx

Presentation - Eye watering - May have associated infection Mx - Nil

Dacrocystitis: what is it, presentation and Mx

What is it? - Infection of the lacrimal sac Presentation - Watery eye - Swelling and erythema of inner eye Mx - ABx

RA ocular and iatrogenic manifestations

25% Ocular manifestations - Keratoconjunctivitis sicca (most common) - Episcleritis (erythema) - Scleritis (erythema and pain) - Corneal ulceration - Keratitis Iatrogenic - Steroid induced ctaracts - Hydroxychoroquine retinopathy

What are the features of eye disease in thyroid disease and the what do they worse with

Features - Exophthalmos - Conjunctival oedema - Optic disc swelling - Ophthalmoplegia - Inability to close the eyelids may lead to sore, dry eyes Worsen with - Radioiodine - Smoking

What are the complications to thyroid eye disease and what is the strongest indicator for an urgent ophthalmology review

Complications - Exposure keratopathy (dry and irritated) - Optic neuropathy - dec in visual acuity - Strabismus and diplopia Strongest indicator of the need for urgent ophthalmology review - Change of intensity or quality of colour vision

How do you manage thyroid eye disease

Methypred

Ophthalmology Flashcards

(47 cards)