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59 Cards in this Set
- Front
- Back
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Corneal ulcer
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Presents w/ red eye, pain, photophobia, and sense of foreign body.
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Signs of corneal ulcer
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Corneal opacity, corneal stain with fluoroscein
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Anterior uveitis
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Pain, photophobia, blurred vision. Treat with topical steroids and cycloplegic/mydriatic drops.
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Scleritis
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Severe inflammation of the sclera that can result in necrosis. Associated with rheumatoid conditions. Presents with severe pain and tenderness. Treat with steroids.
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Signs of acute angle glaucoma
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Red eye, mid-dilated oval pupil
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Conjunctivitis treatment
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Bacterial = chloramphenicol
Chlamydial = Tetracycline |
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Homonymous quadrananopias
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Parietal = inferior
Temporal = superior |
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Bitemporal hemianopia
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Chiasmal lesion
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Homonymous hemianopia
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Optic tract lesion
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Homonymous hemianopia with macular sparing
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occipital cortex or optic radiation
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4 stages of hypertensive retinopathy
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1. Arteriolar narrowing, increased light reflex (silver wiring)
2. Arteriovenous nipping 3. Cotton wool spots, flame hamorrhages 4. Papilloedema |
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Mild, moderate, and severe NPDR
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Mild = 1 or more microaneurysm
Moderate = microaneurysms, blot haemorrhages, hard exudates, cotton woll spots Severe = Blot haemorrhages and microaneurysms in 4 quadrants, venous beading in at least 2 quadrants, IRMA in at least 1 quadrant |
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Causes of optic neuritis
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MS, diabetes, syphilis
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Features of optic neuritis
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Unilateral decrease in visual acuity, red desaturation, pain worse on eye movement, relative afferent pupillary defect, central scotoma
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Management and prognosis of optic neuritis
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High dose steroids. Recovery in 4-6 weeks.
If more than 3 white matter lesions on MRI, 5 year risk of developing MS is 50% |
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Features of papilloedema on fundoscopy
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Venous engorgement, loss of venous pulsation, blurring of optic disc margin, elevation of optic disc, Paton's lines (concentric lines cascading from optic disc)
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Causes of papilloedema
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Neoplasm, malignant HTN, raised ICP, hydrocephalus, hypercapnia
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Acute migraine management
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Oral triptan and NSAID/paracetamol. If young (12-17) consider a nasal triptan rather than an oral. If not tolerated, offer metoclopramide.
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Migraine prophylaxis
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Topiramate or propanolol. If these fail, acupuncture or riboflavin. Women with menstrual migraine = frovatriptan or zolmitriptan.
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Features of Horner's
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Miosis (small pupil), ptosis, enophthalmos, anhydrosis
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Treatment for allergic conjunctivitis
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Artificial tears, cool compress, antihistamines
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Treatment for bacterial conjunctivitis
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Azithromycin or erythromycin
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Treatment for chlamydial conjunctivitis
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Azithromycin or erythromycin or doxycycline
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Treatment for viral conjunctivitis
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Typically self limiting, however if treatment is indicated use epinastine or azelastine.
Adjunct with topical corticosteroids (loteprednol or prednisolone) and ganciclovir |
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Causal agents of corneal ulceration (bacterial, viral, fungal, protozoal, vasculitic)
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Bacterial - pseudomonas
Herpetic - simplex, zoster Fungal - candida, aspergillus Protozoal - acanthamoeba Vasculitic - RA |
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Treatment for corneal ulceration
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If a simple abrasion - chloramphenicol. Otherwise, refer.
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Treatment for bacterial corneal ulceration
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Gentamicin + cefazolin/vancomycin eye drops, atropine or hyoscine for symptom relief. Oral analgesia.
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Treatment for herpetic corneal ulceration
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Trifluridine, ganciclovir or aciclovir. Atropine or hyoscine for symptom relief. Oral analgesia.
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Treatment for fungal corneal ulceration
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Natamycin. Atropine or hyoscine for symptom relief. Oral analgesia.
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Definition of anterior uvea
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Iris and ciliary body
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Definition of posterior uvea
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Choroid, retina, renal vasculature
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Symptoms of anterior uveitis
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Painless visual loss
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Examination signs - uveitis
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Reduced visual acuity, inflammation of eye in anterior disease (look for keratic precipitates on the corneal endothelium or adhesions between lens and iris), may see raised IOP and macular oedema
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Uveitis examination
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Talbot's test positive (pupils constrict and pain increases on convergence)
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Uveitis management
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Topical and, if required, oral prednisolone
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Cause of acute angle glaucoma
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Blocked drainage of aqueous from anterior chamber via canal of Schlemm. Classically presents at night as pupil dilatation worsens condition.
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Symptoms of acute angle glaucoma
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Severe pain, n&v, decreased vision, halos around lights
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Signs of acute angle glaucoma
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Red eye. Fixed, dilated pupil. Corneal haze.
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Acute angle glaucoma management
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Dorzolamide or acetazolamide. Timolol. Pilocarpine.
Chronic? Consider laser peripheral iridotomy |
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Visual defects in open angle glaucoma
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Sausage shaped defects near blind spot (scotomata), which may coalesce to form big defects. Nasal and superior fields are lost first.
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Signs on examination in open angle glaucoma
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Pallor of optic disc. Widening and deepening of optic cup (cup to disc ratio >0.4).
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Open angle glaucoma tests
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Tonometry
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Management of open angle glaucoma
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Prostaglandin analogues, beta blockers, acetazolamide, pilocarpine.
If eye drops fail, laser trabeculoplasty. |
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4 major causes of blindness worldwide
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Cataract, vitamin A deficiency, trachoma, onchocerciasis
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What should your first thought be with cataracts?
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Check BM to exclude DM!
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Pathogenesis of cataracts in DM
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Lens takes up glucose, which is converted by aldolase reductase into sorbitol
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Pathogenesis of glaucoma in DM
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Blocked drainage of aqueous fluid by new blood vessels
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What are cotton wool spots?
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Ischaemic nerve fibres
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What causes flame shaped haemorrhages?
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Rupture of microaneurysms at the nerve fibre level
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Symptoms of retinal artery occlusion
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Rapid visual loss. Acuity is typically finger counting or worse
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Signs of retinal artery occlusion on examination
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Retina appears white with a cherry spot at the macula
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Management of retinal artery occlusion
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Ocular massage, surgical removal of aqueous from the anterior chamber, systemic or topical antihypertensive treatment
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Which is more common, retinal vein or retinal artery occlusion?
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Vein
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Fundoscopy of retinal vein occlusion
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Tortuous, dilated vessels. Optic nerve swelling/oedema. Retinal haemorrhages in all quadrants.
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Signs and symptoms of thyroid eye disease
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Red, painful eye. Double vision. Reduced acuity. Proptosis, chemosis. Retraction of upper lid. Lid lag.
Restricted eye movements, typically due to inferior rectus lesion. Mechanical limitation of the eye in upgaze. Involvement of medial rectus can causes limitation of abduction. CAN MIMIC SIXTH NERVE PALSY. |
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Treatment of thyroid eye disease
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Steroids, radiotherapy, surgical orbital decompression.
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What is a squint?
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Abnormality of coordinated movement of the eyes
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What is exotropia?
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A divergent squint - one eye turned out
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What is esotropia?
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A convergent squint - one eye turned in
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