1
Q
risk factors for cataracts
A
DRATS-MUD Dm Rtx Atopy Trauma Steroids Myotonic dystrophy Uveitis Downs
2
Q
MCC reversible blindness
A
cataracts
3
Q
PC cataracts
A
painless gradual decrease VA glare halos around lights at night dimness decrease colour intensity- CLOUD/ BLURRY VISION monocular diplopia
4
Q
3 types of cataracts
A
- cortical
- nuclear sclerosis
- posterior subcapsular
5
Q
cortical cataracts associated with
A
DM and aging
6
Q
nuclear sclerosis a/w
A
aging
7
Q
NB extra facts for nuclear sclerosis
A
brunescent-yellowish
SECOND SIGHT PHENOMENA
8
Q
posterior subcapsular=
A
FROSTED GLASs; posterior adjacent to the capsule
a/w DRATS-intraocular inflammation
9
Q
diagnostic tests for cataracts
A
- VA
- Opthalmoscope- red reflex
- Slit lamp
10
Q
name of surgery for cataracts
A
phacoemulsification: sutureless 3mm incision AND place intraocular lens
11
Q
complications of cataracts surgery
A
RARE C-GERD Cystoid macular edema Glaucoma Endopthalmitis Retinal detachment Dislocated IOL
12
Q
decrease aqueous production drugs
A
AB-D-P
Alpha agonists- AD, brimonidine
Betablockers- timolol
Diuretics
13
Q
increase aqueous outflow drugs
A
Cholinomimetics- pilocarpine, carbachol
PG’s- latanoprost
14
Q
BOTH: decrease aqueous production
increase aqueous outflow
A
ALPHA AGONISTS
15
Q
definition of glaucoma
A
- optic nerve damage
- visual field defect
- +/- IOP
16
Q
optic nerve head damage in glaucoma
A
loss of ganglion cells and axons, thus loss of neuroretinal rim–> ENLARGEMENT of optic disc= cupping
17
Q
EXTRA: spectrum of optic nerve damage
A
- pallor and cupping of optic disc: small paracentral scotoma
- concentric enlargement: arcuate defect
- superior expandion: arcuate defect
- advanced total cupping: temporal central island
18
Q
different types of glaucoma
A
- POAG
- Low tension glaucoma
- Ocular HTN
- Chronic closed angle glaucoma
- secondary glaucoma- rubeotic
19
Q
rubeotic glaucoma
A
neovascularisation secondary to DM
20
Q
low tension glaucoma
A
glaucomatous disc with normal IOP
21
Q
who is at risk for low tension glaucoma
A
- women>60
- secondary vasc insuff
22
Q
ocular HTN
A
normal disc with increase IOP
23
Q
chronic closed angle glaucoma diagnosis based off of….
A
appearance of drainage angle
trabecular meshwork covered by lens
similar glaucomatous disc with increased IOP
24
Q
risk factors for POAG
A
- increase IOP
- increase age
FEMD
family hx
ethnicity- afrocarribean
myopia
DM
25
diagnosis of glaucoma
1. VA-- advanced
2. Pupil rxn- RAPD with asym optic n damage
3. gonioscopy- angle- open or closed
3. Goldmann tonometry-- applanation
5. fundosocpy-- cupping
6. Humphrey visual fields
26
monitoring disease progression in glaucoma
- Fundoscopy
| - Humphrey vf
27
treatment of glaucoma
PG or Betablocker-- individually then together, then CA inhibitor, then
Trabeculectomy
28
risk factors to becoming blind with glaucoma
severity at presentation
LE
rate of progression
29
dry ARMD
RPE atrophy-- coalescence of depigmented RPE= clump of focal hypo/hyperpigmentation
30
bruch membrane
area separating inner choroidal vessels from RPE
31
drusen
white deposits/lipofuscin between RPE and photoreceptors
32
wet ARMD secondary to
- inflammation
- submacular haemorrhage
- macular edema/exudate
33
END STAGE ARMD
GEOgraphical atrophy
SCARRING
IRREVERSIBLE loss of central vision
34
risk factors for ARMD
- female
- increasing age
- smoker
- caucasian
- blue eyes
- family history
35
PC ARMD
- metamorphopsia
- central scotoma
- reading difficulties
36
2 types of wet
occult
| classic
37
classic wet ARMD
well defined leakage
38
occult wet ARMD
mottled or ill-defined leakage
39
dx ARMD
1. VA/VF
2. Amsler grid
3. OCT
4. Fluorescin angio
40
dry ARMD tx
low vision magnifying aids
| social services
41
wet ARMD
intravitreal VEG-F-- 3 months, then maintenance
- 2/3= stabilize
- 1/3= improve
42
exogenous antioxidant vitamins
- vits C, E
- Beta-carotene
- Zn
43
macular pigments
- lutein
| - zeaxathin
44
risk factors for DM retinopathy
- CV risk factors
- duration
- ethnicity-- black
- anaemia
- puberty
- prego
45
microvascular pathophysiology for DM
capillary leakage--> ischaemia--> vascular occlusion
parasite loss
endothelial damage
46
neuroretinal pathophysiology for DM
impaired neurotransmission--> apoptosis
47
late PC of DM
DECREASE VA= LATE
- macular edema= mcc vision loss
- VH
- retinal tractional detachment
48
clinical findings for DM retinopathy
1. VA
2. anterior segment (3)
3. dilated fundal exam (3)
49
anterior segment findings DM retinopathy
- IRIS NEOVASC
- glaucoma- rubeotic- increase IOP
- cataracts- lens
50
dilated fundal exam DM retinopathy
- DM retinopathy
- vascular occlusions
- AION
51
dx of DM retinopathy
EXACT SAME AS ARMD (still do amsler in case of metamophopsia)
52
tx of DM retinopathy
1. systemic- cv rf's
2. screening- annual, vital
3. laser tx
4. surgery= vitrectomy
5. intravitreal Veg-F
53
laser tx indicated for...
1. maculopathy
| 2. proliferative
54
maculopathy benefit from laser tx
- closes leaky vessels
- stimulates RPE pump
- decreases edema
- stabilizes vision
55
proliferative benefit from laser tx
- destroys ischaemic retina
| - decreases angiogenic GFs
56
focal/ grid laser tx....
MACULOPATHY
x central field
x burn spread--> foveal burn/blind spot
57
panretinal photocoagulation
x cannot drive
x peripheral field
x night vision
x painfull
58
sx in DM indications
VITRECTOMY
- persistent VH
- tractional RD
59
intravitreal veg-f for maculopathy
- decrease edema
| - increase vision
60
intravitreal veg-f for retinopathy
- regress new vessels
| - clear VH
61
combined laser and intravitreal tx DM
- DIABETIC MACULAR EDEMA-- diffuse OR focal
| - PROLIF.D.R.-- with VH or DME
62
background DR
microaneurysms
dot and blot haemorrhages
retinal edema
hard exudates
63
micro aneurysms are secondary to....
proliferation of pericytes
64
preproliferative DR
```
cotton wool spots
intra-retinal microvascular abnormalities
venous changes
extensive RHs
arterial changes
```
65
cotton wool spots
secondary to impaired axonal transport--> ischaemia
| TEMPORARY
66
intra-retinal microvascular abnormalities
arteriolar-venular shunts
| capillary occlusion adjacent
67
venous changes
sausaging/beading
| omega sign
68
arterial changes
attenuation of vessels
69
proliferative DR
ischemia--> VEGF--> neovasc- NVD/NVE--> RH--> traction vitreous= RD--> fibrosis
70
advanced diabetic eye
rubeotic glaucoma
persistent VH
tractional RD-- fibrotic bands
71
maculopathy Diabetes
macular edema= variable visual impairment
| macular ischaemia= SEVERE visual impairment
72
maculopath in DM can be
mixed
diffuse
focal
ischaemic
73
differential for leucocoria
1. cataracts
2. coloboma
3. toxicariasis
4. coloboma
RETINA
5. ROP
6. retinal dysplasia
7. retinal detachment
8. COATS DISEASE
9. primary persistent vitreous
10. corneal opacity
74
COATS DISEASE
exudative retinal telangiectasias
75
3 parts of uvea
1. iris
2. ciliary body
3. choroid
76
anterior uveitis
iritis
77
posterior uveitis
choroiditis
78
uveitis
- RA
- JIA
- sarcoidosis
- HLA--B27
79
keratoconus
abnormal conical shape of cornea--> astigmatism
80
cause of keratoconus
MCC= SPORADIC
- downs
- contacts
atrophy
81
keratoconus a/w
breaks in
- bowmans membrane
- descemet membrane
82
munsons sign
bulging of lower eyelid when looking downwards with a keratoconus
83
risk factors for retinal vein occlusion
atherosclerosis
HTN
DM
glaucoma
84
fundoscopy retinal vein occlusion
blood and thunder; diffuse all 4 quads
venous engorgement
optic disc swollen
macular edema
85
tx retinal vein occlusion
intra-lesional anti-veg-F
| - laser
86
risk factors for retinal artery occlusion
EMBOLI
THROMBUS
GCA
87
timing for retinal artery occlusion
2hours
88
fundoscopy for retinal artery occlusion
```
cherry red macula
paleretina
boxcarring-- narrowing arterioles
cotton wool spots
hollenhorst plaques
```
89
tx for retinal artery occlusion
globe massage
| acute angle closure tx
90
tx keratoconus
contact lens
| CORNEAL TRANSPLANT
91
most common site for tear for RD
SUPEROTEMPORAL RETINA
92
risk factors for RD
- age
- myopia
- DM
- trauma
93
photopsia---
tears in vessel--> blood drop into vitreous=
| HAZY VISION
94
3 types of retinal detachment
1. rhegmatogenous
2. tractional
3. exudative
95
rhegmatogenous RD
hole in the neurosensory retina= MC
96
tractional RD
pull neurosensory away from RPE
97
exudative
damage RPE--> subretinal fluid
98
2 similar treatments for rhegmatogenous and tractional RD
SCLERAL BUCKLE sx
| VITRECTOMY
99
additional tx for rhegmat. RD
- cryotx
- laser tx
- pneumatic retinopexy
100
additional tx for tractional RD
- membrane removal
- intraocular gas
- silicone oil
101
inflammation difference between chalazion and hordoleum
```
chalazion= granulomatous
hordoleum= acute inflammation
```
102
other name for chalazion=
meibomian cyst
103
other name for hordoleum=
stye
104
cysts of zeis and moll
zeis= modified sweat gland
moll= modified sebaceous gland of external eyelid
SMALL WHITISH OPAQUE CHRONIC PAINLESS NODULES
105
TX cysts of zeis and moll
simple incision
106
tx molluscum contagiosum
shave excision
107
trichiasis secondary to
blepharitis
SJS
trauma/ burns
108
tx trichiasis
lubricant
electrolysis
eyelash pluck cryotx
109
blepharitis two types
1. staph-- ulcerative and dry scales
| 2. seborrheic-- NO ulcers, greasy scales
110
toothpaste sign
blepharitis-- discharge with pressure
111
tx blepharitis
warm compresses and baby shampoo
antibiotics
short course steroids
112
entropion diagnosis
forced lid closure-- lid rolls inwards
113
causes of entropion
1. involution=MC
2. cictricial
3. spastic
4. congenital
114
involution as cause of entropion
= MC, AGING--> laxity
115
causes of cicatricial entropion
```
SC-SHOTT
SJS
Chemical burns
Surgery
Herpes zoster
Ocular pemphigoid
Trauma
Trachoma
```
116
ocular pemphigoid-->
cictricial entropion:
| older patients with chronic ulcers and adhesions
117
spastic entropion-->
orbicularis oculi irritation
118
causes of ectropion
1. involution
2. cicatricial
3. mechanical
4. paralytic
5. congenital
119
mechanical cause of ectropion
WEIGHT of tumor/ edema/ fat on the eyelid
120
paralytic cause of ectropion
CN7
121
diagnosis of ectropion
SNAPBACK TEST-- pull eye inferiorly-- lid remains away from globe
122
treatment of entropion and ectropion
LUBE
| SURGERY
123
causes of ptosis
MCC= age related dehiscence
congenital
acquired
124
acquired causes of ptosis
neurogenic- CN3, Horners
aponeurotic- rupture LPS
myogenic- mg, myotonic dystrophy
mechanical- inflam/tumor/vascular
125
lagopthalmos
incomplete closure of eyelids--> CN7 palsy
126
bells phenomeon
tighten eyes shut--> globes don't go up anymore
| = LAGOPHTHALMOS positive
127
treatment of lagopthalmos
lubricants
tape eyelids
lateral tarsorrhaphy
128
causes of blepharospasm
PARKINSONS
idiopathic
PYOGENIC
129
benign tumors of eyelid
- papilloma
- seborrheic keratosis
- keratocanthoma
- naevi
- capillary haemangioma
- xanthelasma
130
malignant tumors of eyelid
- BCC
- SCC
- melanoma
- meibomian cell ca
131
pre-auricular lad-- eye lid tumor
SCC
132
symptoms of thyroid eye disease
- red/ irritated/ discomfort
- wide eye staring
- diplopia
- decrased vision
133
signs of thyroid eye disease
```
FULLNESS
conjunctival hyperemia
conjunctival edema= chemosis
lid retraction
lid lag
resisted eye movement
optic neuropathy
```
134
dx thyroid eye disease
thyroid-- TFTS, TPO
| CT ORBIT-- enlarged extraocular muscles-- XS soft tissue and normal tendon
135
dx optic neuropathy secondary to thyroid eye disease
- VA/VF
- fundoscopy
- pupils
- colour vision
136
tx optic neuropathy secondary to thyroid eye disease
orbital decompression
strabismus sx
lid retraction sx
137
tx thyroid eye disease
- lubricants
- NSAIDs
- prisms-- diplopia
- steroids
- immunosup
- radiotherapy
- surgery
138
lens for esotropia and exotropia
convex
139
different types of squints
esotropia
exotropia
hypertropia
hypotropia
140
different types of ambylopia
strabismic
stimulus deprivation-- patho. obstacle
anisometropic-- unequal refractive errors
ametropic-- bilateral high refractive errors
141
window to correct lazy eye=
8 years old
142
orbital tumors MCC=
```
LYMPHOMA
rhabdomyosarcoma
capillary haemangioma
carcinoma of lacrimal duct
optic nerve glioma
optic nerve meningioma
mets
```
143
amaurosis fugax is secondary to...
arterial embolism
| GCA
144
non-arteritic anterior ischaemic neuropathy
sudden painless monocular MILD-MOD vision loss
RAPD
altitudinal field loss
145
risk factor for N-AION
HYPERTENSION
146
ESR for NON-AION
NORMAL ESR
147
signs of GCA
- scalp tenderness
- tender nodular NON-pulsatile temporal artery
- RAPD
- swollen optic disc and pale
148
dx GCA
FBC
ESR, CRP
Biopsy
149
vitrehous haemorrhage has no...
NO red reflex
| NO view of retina
150
vitreous haemorrhage causes
MCC= DM
- retinal vein occlusion
- trauma
151
PC optic neuritis
sudden LOV
PAIN on movement
dull ache
152
signs of optic neuritis
RAPD
pale swollen optic disc
early= colour desaturation
papillitis or retrobulbar
153
3 big causes optic neuritis
MS
idio
viral
154
syneresis
CHRONIC flashes and floaters
155
MCC flashes and floaters=
posterior vitreous detachment= 70%
ASYMPT.
NO retinal tear
NO RD
156
other causes for flashes and floaters
- PVD
- migraine
- VH
- posterior uveitis
157
retrobulbar optic neuritis
NORMAL optic disc
158
treatment of GCA
IV methylprednisolone
60-80mg prednisone
----> 5-10mg prednisone; 1-2years
159
neurologic causes of diplopia
```
CN3,4,6
SHTT MD.
Stroke
HTN
Tumor
Trauma
MS
DM
```
160
mechanical causes of diplopia
- thyroid eye disease
- orbital cellulitis
- blow out fracture
- lymphoma
161
distorted vision causes
ARMD
macular hole
retinal vein occlusion
162
tx of conjuncitivitis
chloramphenicol-- drops every day for 2-3wks
| Sodium chromoglycate- qds +/- olapatadine
163
episcleritis
localized or diffuse redness
| SPARING**** palpebral conjunctiva
164
tx episcleritis
RESOLVE SPONTANEOUSLY
| ---> oral NSAIDs or topical steroids
165
iritis PC
PAINFUL eye, increasing in severity
photophobia
circumcorneal redness
constricted pupil
166
tx iritis
INTENSIVE steroids and mydriatic--> cyclophentolate
167
marginal keratitis
= peripheral corneal ulcer
168
tx marginal keratitis
steroid/ Abx combo
169
tx herpes simplex keratitis
3% acyclovir 5x/day for 2-3wks
170
infective keratitis-- bacterial:
ofloxacin OR
| vancomycin + ceftazidime
