AMC Flashcards > Ophthalmology > Flashcards

Ophthalmology Flashcards

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1
Q

Cataracts: risk factors

A
  • Ageing / Senility
  • Corticosteroid therapy
  • Diabetes
  • Hypoparathyroidism
  • Dystrophia myotonia
  • Trauma (may be delayed)
  • Ocular disease (e.g. glaucoma)
  • Smoking
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2
Q

Cataracts features

A

– Reading Difficulty
– Difficulty in recognising faces
– Problem with driving especially at night
– Difficulty with television viewing
– Reduce ability to see in bright light (glaring)
– May see haloes around light

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3
Q

Traumatic cataract features

A
  • under 45 years of age
  • injury to the lens by foreign body or direct impact
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4
Q

Cataracts management

A
  • Intraocular lens
    -phaecoemulsification to replace intraocular lens
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5
Q

Hyphaema causes

A

Trauma (squash ball, rugby)
- Blood clotting disturbances
- Medications (anticoagulants)
- Neovascularisation (diabetic retinopathy, previous eye surgery0
- melanoma or retinoblastoma
- abnormal vasculature

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6
Q

Hyphaemia features

A
  • presence of blood in the anterior chamber
  • ## impaired visual acuity
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7
Q

Hyphaemia management

A
  • Urgent referral to the ophthalmologist
  • bed rest with the head elevated 30 to 45° with eye shield
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8
Q

Unilateral cataract features

A

– A progressive blurring of vision.
– Glare, especially in bright light or when driving at night
– Monocular double vision

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9
Q

Nasolacrimal duct obstruction features

A
  • Clear eye discharge & crusting of the eyelashes
  • No redness or irritation
  • 6 to 20% of newborns
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10
Q

Nasolacrimal duct obstruction management

A
  • resolves spontaneously
  • requires antibiotics only when
    complicated conjunctivitis or dacryocystitis
  • Ophthalmologic consultation if persists past 12 months of age or earlier if complicated by recurrent infection
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11
Q

Diabetic retinopathy screening

A

2 yearly by either optometrist or ophthalmologist unless:

  • Aboriginal and Torrens Islanders
  • Non-English-speaking backgrounds
  • Visual loss
  • Poor diabetic control
  • hypertension
    -hyperlipidaemia
  • anaemia
  • renal disease
    -long duration of diabetes
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12
Q

Diabetic retinopathy predictors

A
  1. Non-English-speaking backgrounds
  2. Duration of diabetes
  3. Control of diabetes
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13
Q

Diabetic retinopathy screening in diabetic pregnant women

A

1st trimester

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14
Q

Diabetic retinopathy screening in children

A

Puberty

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15
Q

Diabetic retinopathy screening in gestational diabetes

A

diabetes persists after pregnancy

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16
Q

Diabetic retinopathy screening in Non proliferative diabetic retinopathy

A

Screen every 3–6 months

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17
Q

Diabetic retinopathy risk factors

A

-Poor glycemic control.
-Longer duration diabetes.
-Poor lipid or blood pressure control.
-Aboriginal and Torrens Islanders

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18
Q

Diabetic retinopathy management

A

Prophylactic photocoagulation

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19
Q

Base orbital fracture features

A
  • Damage to infraorbital nerve failing to “push” the eyeball up
    1. Diplopia when gazing upwards
    2. enophthalmos (eye receding into the orbit)
    3. Numbness (cheek, upper lip, or upper gingiva)
  • Blurry vision
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20
Q

Superior orbital fracture features

A
  • vertical diplopia when gazing downwards
  • no numbness
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21
Q

Zygomatic fracture features

A
  • horizontal diplopia
  • Mallar flattening
    -difficulty in opening mouth
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22
Q

Hyphaemia complications

A
  • recurrent bleeding
  • glaucoma
  • blood staining of the cornea
  • all leading to permanent vision loss
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23
Q

Nasal bone fracture features

A
  • horizontal diplopia
  • cerebrospinal fluid leakage
  • epistaxis
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24
Q

Glaucoma risk factors

A

-The family history of glaucoma.
-Myopia.
-Diabetes Mellitus.
– Migraine.
– History of trauma to the eyes
– Abnormal blood pressure

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25
Tripod fracture features
- vertical/horizontal/oblique diplopia - difficulty in mastication
26
Open angle glaucoma treatment
- STAMP -Supine Position - Timolol topical (carteolol) - Acetazolamide IV - Mannitol -Pilocarpine topical
27
Long term treatment of acute closed-angle glaucoma
Laser iridotomy
28
Long term treatment of chronic open-angle glaucoma
Laser trabeculectomy
29
Difference between hypermetropia & presbyopia
Age 40 and is completed at 60
30
Contraindication to timolol
– severe hypotension – chronic obstructive airways disease – Moderate to severe asthma – uncontrolled cardiac failure – bradycardia or second or third-degree atrioventricular block
31
Eye corticosteroid side- effects
– **Microbial keratitis** – Corneal thinning – Delayed corneal healing – Corneal perforation – Cataract formation – Raised intraocular pressure – Glaucomatous optic neuropathy
32
Acute closed angle glaucoma features
- rapidly increased IOP - pain - nausea - blurred vision - eye redness - hazy cornea -pupils partially or fully dilated and unresponsive to light (anisocoria) - NO photophobia
33
Indications for referral of Ophthalmologist
– Penetrating eye injury or intraocular foreign body – Incomplete removal or practitioner uncertainty – Persisting foreign body symptoms – Persisting rust ring – Persisting vision loss – Keratitis – Endophthalmitis – Paediatric or uncooperative patients that may require examination under anaesthesia
34
Features of retinal detachment
- Hx of trauma, diabetic retinopathy, myopia and cataract surgery - sudden onset of floaters, flashes and field defects - painless loss of vision - dark shadow (curtain closing) of affected eye
35
Features of Posterior Vitreous detachment
- Age >70 years (66%) -**Vision acuity preserved**
36
Unilateral exophthalmos features
- most common **Graves’s disease (Thyrotoxicosis)** - orbital pseudotumor - orbital cellulitis - cavernous sinus - thrombosis - retrobulbar - retro-orbital tumours - Congenital glaucoma Nasopharyngeal tumours
37
Retinal artery occlusion fundoscopic features
- Cherry red spot - Retinal whitening
38
Chronic simple glaucoma fundoscopic features
- increased ratio of the optic cup to the optic disc - retinal vessels seem to be cut/ broken upon entering optic disk
39
external hordeolum (stye) pathogen
Staphylococcus aureus
40
external hordeolum (stye)
Warm compresses
41
Strabismus cut-off point
- 5 to 6 months to align by itself - Correcting strabismus before 4-6 years
42
dacryocystitis management
- flucloxacillin - amoxicillin - clavulanate - cephalexin
43
Macular degeneration features
- blurry centre of her vision - distortion of objects (straight lines wavy)
44
Types of age related macular degeneration
Dry - **slow progression** - 90% of AMD cases - drusen, pigmentation and sometimes haemorrhages at macula Wet - **rapid deterioration** - abnormal vessels grow from the choroid into the neurosensory retina &leak macula - rapid deterioration
45
Hypertensive retinopathy features
- papilloedema - straightening of the vessels - thickened opacified vessel walls - arteriovenous nicking
46
Bacterial conjuctivitis treatment
Chloramphenicol
47
inflammation of meibomian glands
Internal hordeolum
48
Features of viral conjunctivitis
- adenovirus - **watery** eyes - uni or bilateral affection - contact lenses - usually painless - vision preserved
49
Features of allergic conjunctivitis
- can be watery - bilateral -history of contact hypersensitivity (changing contact lenses), hay fever - usually painless - vision preserved
50
Features of keratitis
- herpes simplex/zoster infection - **circumcorneal dendritic ulceration** - eye pain and redness - grittiness (foreign body) -photophobia - lacrimation - vision and pupillary reflex **normal**
51
Features of acute uveitis (iritis)
- eye pain and redness - **visual acuity may be decreased** - photophobia - hypopyon (white cells precipitating in anterior chamber) -irregular constricted pupil (reflex abnormal) -history of prior surgery (phacoemulsification) - also associated with seronegative arthropathies (ankylosing spondylitis, RA, IBD)
52
53
Traumatic cataract features
- under **45 years** of age - injury to the lens by foreign body or direct impact
54
Conditions that require urgent referral to Ophthalmologist
- Significant eye trauma, burns, embedded foreign body in cornea, intraocular foreign body - Hyphaemia (>3mm)/hypopyon - Corneal ulcer - Severe conjunctivitis - Uveitis/ acute iritis - Behcet syndrome - acute glaucoma - giant cell arteritis - acute dacryocystitis - endophthalmitis - herpes zoster ophthalmicus
55
features of retinal artery occlusion
unilateral + sudden onset of significant vision loss - preceded by transient monocular blindness
56
Types of retina artery occlusion
attach pics
57
Hypopyon
sign not diagnosis indicates uveitis
58
Management of subconjunctival haemorrhage
- red discolouration NOT crossing the limbus = warm compress - red discoloration CROSSING the limbus = find underlying cause (Orbit CT) - AVOID NSAID's
59
Management of episcleritis
- Hypromellose (artificial tears) 4-6 times/day - Topical NSAID's diclofenac NOTE: Topical steroids (prednisolone) if all above not helping
60
Difference between subconjunctival haemorrhage & episcleritis
Subconjunctival haemorrhage: - micro tears in the sclera that cause haemorrhages, eyes appears dark red due to the accumulation of blood, but could also turn blue/purple/yellow after - no discomfort with the exception of trauma Episcleritis: - Patchy pinkish/redness of the eye usually found in the corner - no discharge, itchiness - mild discomfort -
61
Difference between episcleritis & scleritis
- If a patient's eye redness improves after phenylephrine instillation = episcleritis - scleritis is painful
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