Ophthalmology randomised Flashcards by Siobhan Carlin

Optic neuritis causes and presentation

Causes
- MS
- Sypilis
- DM

Presentation
- Pain
- Dec acuity unilateral
- Poor discrimination colours
- Central scotoma
- Relative afferent pupillary defect

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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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Lebers optic atrophy presentation

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

Mitochondrial disease

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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

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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

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Optic neuritis Ix and Mx

Ix
- MRI

Mx
- High dose steroids

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Hypertensive retinopathy classification

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

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Papilloedema causes

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

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Central retinal vein occlusion RF and presentation

RF
- Age
- CVD e.g. HTN and DM
- Glaucoma
- Polycythaemia

Presentation
- Painless
- Sudden loss visual acuity

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Keratitis - what is it, presentation and Mx

What is it?
- Inflammation of cornea

Presentation
- Gritty sensation

Mx
- TOP abx

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Diabetic retinopathy Mx

Non proliferative
- Observation
- ?Laser photocoagulation

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

Maculopathy
- VEGF

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Endophthalmitis presentation

Red
Pain
Visual loss
Following intraocular surgery

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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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Age related macular degeneration Ix

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

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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

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Acute angle closure glaucoma Ix

Tolometry
Gonioscopy

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Central retinal a. occlusion causes and presentation

Causes
- Thromboembolism
- Arteritis

Presentation
- Painless
- Relative afferent pupillary defect

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Holmes-Adie pupil

Presentation
Holmes-Aide syndrome

Presentation
- Dilated pupil
- Once constricted then stay small
- Poor accomodation

Holmes-Aide syndrome
+ absent lower limb reflexes

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Age related macular degeneration Mx

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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

Diabetic retinopathy diff types

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

Proliferative
- Neovascularisation

Maculopathy
- Hard exudate
- Based on location
- T2DM

Acute angle closure glaucoma presentation

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

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

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The temporal field corresponds to the nasal retina

Horners syndrome presentation and Ix

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Presentation
Miosis
Ptosis
Anhidrosis
Enophthalmos

Ix
Apraclonidine drops = pupil dilation in affected eye and constriction in normal eye

Acute angle closure glaucoma Mx

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

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

Herpes simplex keratitis Mx

Urgent TOP aciclovir

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

Retinal detachment presentation

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

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)

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

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

Papilloedema signs and is on right = lesion on

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

Orbital cellulitis Ix

Argyll-Robertson pupil causes and presentation

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

Central retinal vein occlusion Ix and Mx

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

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

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

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

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

Congenital lacrimal duct obstruction presentation and Mx

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

Viterous haemorrhage causes and presentation

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

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

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

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

Anterior uveitis Mx

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

Central retinal a. occlusion Ix and Mx

Ix - Fundoscopy shows cherry red spot Mx - Arteritis = steroids - Inatrarterial thrombolysis

How do you manage thyroid eye disease

Methylpred

Ophthalmology randomised Flashcards

(47 cards)