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Flashcards in Ophthalmology Conditions Deck (55)
1

how does blepharitis present?

gritty eyes
bilateral

2

anterior ve posterior blepharitis?

anterior = usually a bacterial infection (Staph)
dandruff in eyelashes
posterior = meibomian gland dysfunction, glands become blocked so tear film becomes unstable

3

how is blepharitis managed?

primarily targeted at lid hygiene
warm compress
artificial tears for comfort

4

bacterial conjunctivitis?

thick sticky discharge
red eye
usually unilateral but progresses to bilateral
papillae

5

what usually causes bacterial conjunctivitis?

staph aureus
strep pneumonia
h. influenzae (esp children)

6

how is bacterial conjunctivitis managed?

usually self limiting
chloramphenicol drop if severe or persistent

7

how does viral conjunctivitis present?

watery discharge
may have had a recent cold/URTI
follicles on lids

8

what usually causes viral conjunctivitis?

adenovirus

9

how is viral conjunctivitis managed?

self limiting but very contagious
good lid hygiene

10

how does chlamydial conjunctivitis present?

on-going red eye (2 or more weeks)
rice grain follicles on lids
unresponsive to previous treatment

11

how is chlamydial conjunctivitis managed?

oxytetracycline

12

what condition may present with blue/green discolouration in the eye?

keratitis

13

how does keratitis present?

pain
usually unilateral
redness
photophobia
reduced vision
epiphora

14

characteristic feature of bacterial keratitis? how is this managed?

hypopyon
required debridement and admission for hourly drops of fluroquinolones
requires corneal scrape to determine antibiotic sensitivities

15

what usually causes viral keratitis and how does this present?

adenoviral
herpes simplex = terminal end bulbs
herpes zoster = involvement of ophthalmic division of the trigeminal nerve (unilateral vesicular rash, Hutchinson's sign)

16

how is viral keratitis managed?

HSV = acyclovir
HZ = ocular lubricants and systemic pain relief

17

main risk factor for keratitis?

contact lens wearer

18

how does anterior uveitis present?

pain
circumlimbal redness
reduced vision (especially accommodation)
photophobia (can be recurring)

19

what are the 5 types of anterior uveitis?

autoimmune
infective (HSV, HZ)
malignancy
trauma
idiopathic

20

which autoimmune conditions are associated with anterior uveitis?

reiters (reactive arthritis)
UC
ankylosing spondylitis
sarcoidosis

21

what is reiters syndrome?

reactive arthritis with triad
- uveitis
- urethritis
- arthritis

22

signs of anterior uveitis on investigation?

cells and flare in anterior chamber seen on slit lamp investigation
keratic precipitates
hypopyon
synechiae (misshapen pupil)

23

how is anterior uveitis managed?

topical steroids (prednisolone acetate) and cyclopentolate

24

how does cataract present?

gradual deterioration (over several years) in vision
glare
painless
opacity in the lens

25

what can cause cataract?

most are age related
congenital
traumatic
drug induced

26

how is cataract managed?

surgery
lens replacement

27

what is glaucoma?

group of diseases characterised by progressive neuropathy resulting in characteristic visual field defects due to damage to individual bundles of nerve fibres in the optic nerve head)

28

what increases risk of angle closure glaucoma?

+ve family history
Chinese ethnicity
shallow anterior compartment
hypermetropic eye prescription

29

how does angle colure glaucoma present?

sudden pain
nausea
vomiting
often in the evening
pupil mid-dilated
redness
cells and flare
very high intraocular pressure (40+ mmHg)

30

how is angle closure glaucoma managed?

pilocarpine and acetazolamide
peripheral iridotomy

31

what are the important 3 Cs in assessing glaucoma?

contour
colour
cup
(when looking at the optic disc)

32

what are the 3 classifications of diabetic retinopathy?

no retinopathy
non-proliferative (mild, mod, severe)
proliferative

33

describe the 3 stages of diabetic retinopathy

background retinopathy = microaneurysms, microhaemorrhages, hard exudates
pre-proliferative = cotton wool spots, dot and blot haemorrhages, abnormalities in venous calibre
proliferative = new vessel formation on fundus, can have rubeosis iridis (new vessels on the irido-corneal angle)

34

how is diabetic retinopathy managed?

optimise medical management of diabetes
lasers (sacrifice peripheral retina to maintain central vision)
surgery (vitrectomy) - to prevent traction on new blood vessels causing haemorrhage

35

dry vs wet macular degeneration?

dry = most common, no treatment but less severe than wet, drusen visible on examination
wet = sudden loss of central vision, distortion of straight lines, haemorrhage and exudates

36

risk factors for ARMD?

female
Caucasian
age
smoking

37

treatment for wet ARMD?

anti VEGF injections

38

how does retinal detachment present?

sudden reduced vision like veil/curtain coming down
flashing lights
floaters
painless
may have history of trauma
may have RAPD
detachment is often visible on examinaiton

39

how is retinal detachment treated?

emergency surgery

40

how does central retinal artery occlusion present?

sudden painless loss of vision
RAPD
may have carotid artery disease
cherry red spot
rarely recovers

41

how does branch retinal vein occlusion?

may be asymptomatic or be aware of a blind spot
often history of uncontrolled hypertension

42

how does central retinal vein occlusion present?

visual loss

43

how is central retinal vein occlusion managed?

anti VEGF
address risk factors

44

what is amaurosis fugax?

transient central retinal artery occlusion
transient complete loss of vision
short duration (few mins) followed by a full recovery

45

how does giant cell arteritis present?

headache
jaw claudication
scalp tenderness
malaise
can affect the eyes
- arteritic ischaemic optic neuropathy (AION)
- non-arteritic ischaemic optic neuropathy (NAION)

46

how does AION present?

sudden visual loss (severe)
pale, swollen optic disc

47

how is AION managed?

irreversible but emergency treatment with steroids to prevent bilateral vision loss

48

how does NAION present?

hyperaemic
swelling
altitudinal visual field defect
atherosclerosis

49

how is NAION managed?

treat the cause

50

what is papilloedema and how does it present?

optic disc swelling secondary to raised ICP
nausea
vomiting
headaches
transient visual loss
enlarged blind spot
may have CN VI palsy due to raised ICP
usually in young females with high BMI

51

how is papilloedema managed?

identify cause (usually benign intracranial hypertension)
best treatment = weight loss
acetazolamide also an option

52

what condition is the patient likely to have is they have optic neuritis?

multiple sclerosis

53

how does 4th nerve palsy present?

will struggle to focus down and in (think walking downstairs while reading)

54

how will a 6th nerve palsy present?

poor abduction of eye

55

common story in sub-conjunctival haemorrhage?

red eye
noticed it waking up this morning
no pain
normal vision