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47 Cards in this Set
- Front
- Back
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Diabetic Retinopathy |
Most common cause of blindness in 35-65 year olds Hyperglycaemia - increased retinal blood flow and abnormal metabolism in vessel walls Exudates, microaneurysms, neovascularisation |
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Mild Non-proliferative diabetic retinopathy |
>= 1 microaneurysm |
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Moderate Non-proliferative diabetic retinopathy |
Microaneurysm Hard exudates Blot haemorrhages Cotton wool spots, venous beading/looping, intraretinal microvascular abnormalities less severe than sever NPDR |
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Severe Non-proliferative diabetic retinopathy |
Blot haemorrhages and microaneurysms in 4 quadrants Venous beading in >=2 quadrants Intraretinal microvascular abnormalities in >=1 quadrant |
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Proliferative retinopathy |
Retinal neovascularisation - vitreous haemorrhage Fibrous tissue forming anterior to retinal disc Blind in 5 years Requires referral for panretinal photocoagulation - laser therapy |
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Primary Open Angle Glaucoma |
Optic neuropathy due in the majority of people to raised IOP. Chronic simple glaucoma 2 % of those > 40 years Risk factors - fhx, black, myopia (short sightedness), hypertension, diabetes Features - peripheral visual field loss, decreased visual acuity, optic disc cupping |
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Acute angle closure glaucoma features |
Severe pain - ocular or headache Decreased visual acuity - patient sees haloes Semi-dilated pupil Hazy cornea Unilateral peripheral visual field loss |
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Anterior uveitis |
Acute onset, Pain, Blurred vision and photophobia, Small, fixed oval pupil, ciliary flush, lacrimation. Ankylosing spondylitis, reactive arthritis, IBD, Behcet's Mx - urgent referral, atropine + cyclopentolate (dilates pupils), steroid eye drops. |
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Scleritis |
Severe pain - worse on movement and tenderness Underlying autoimmune disease |
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Macular degeneration risk factors |
Age > 60 years Smoking Fhx White High cumulative sunlight exposure Female |
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Early age related macular degeneration |
Non-exudative Drusen Alterations to retinal pigment epithelium |
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Late age related macular degeneration |
neovascularisation Exudative |
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Age related macular degeneration |
Reduced visual acuity - central vision is lost first Central scotomas Drusen, pigmentary changes Mx - stop smoking, beta-carotine, vitamins E + C, zinc Dry - no medical treatments Wet - photocoagulation, photodynamic therapy, anti-growth factor and MAB treatment |
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Retinoblastoma |
Most common occular malignancy in children Average age - 18 months - 10 % hereditary Absence of red-reflex, white pupil, strabismus, visual problems Mx - enucleation, chemo, radiotherapy, photocoagulation > 90 % survive to adulthood |
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Sudden painless loss of vision |
Ischaemic optic neuropathy Occlusion of central retinal vein Occlusion of central retinal artery Vitreous haemorrhage Retinal detachment |
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Central retinal vein occlusion |
Increasing age More common than retinal artery occlusion Causes - glaucoma, polycythaemia, hypertension Fundoscopy - retinal haemorrhages - pizza. |
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Central retinal artery occlusion |
Due to thromboembolism or temporal arteritis Afferent pupilary defect Cherry red spot on a pale retina |
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Posterior vitreous detachment |
Flashes of light in the peripheral field of vision Floaters - often on the temporal side of central vision |
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Retinal detachment |
Flashes of light in the peripheral field of visionFloaters - often on the temporal side of central vision Dense shadow that progresses towards the central vision Veil/curtain over vision Central visual loss Straight lines - curved |
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Vitreous haemorrhage |
Diabetes, bleeding disorders Large - sudden visual loss Moderate - numerous dark spots Small - floaters |
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Horners Syndrome |
Miosis - small pupil Ptosis - drooping eye lid Enophthalmos - sunken eye anhydrosis - loss of sweating on 1 side Heterochromia - difference of eye colour - seen in congenital Horners Syndrome. |
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Retinitis Pigmentosa |
Features - night blindness, funnel vision, fundoscopy - black pigmentation in peripheral retina |
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Hordeolum externum |
Infection - staphylococcal of the glands of zeis (sebum producing) or glands of moll (sweat glands). Mx - hot compress and analgesia - abxs only required if causing conjunctivitis |
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Hordeolum internum |
Infection of the meibomium glands - may leave a residual chalazion - meibomium cyst |
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Chalazion |
Retention cyst of meibomium gland Firm, painless lump in the eyelid Mx - majority spontaneously resolve - some require surgical drainage |
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Papiloedema |
Fundoscopy - venous engorgement, loss of venous pulsation, blurring of optic disc margin, elevation of optic disc, loss of the optic cup. Causes - space-occupying lesion, malignant hypertension, ideopathic intrancranial hypertension, hydrocephalus, hypercapnia |
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Optic neuritis |
Causes - MS, diabetes, syphilis Features - unilateral gradual loss of visual acuity, poor discrimination of colours, pain on eye movement, afferent pupillary defect, central scotoma Mx - high dose steroids - 4-6 weeks MRI > 3 white matter lesions - chance of MS in next 5 years - 50 %. |
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Acute Angle Closure Glaucoma |
Risk factors - hypermetropia (long sightedness - eye balls are smaller), pupil dilation, lens growth associated with age Mx - urgent referral, acetazolamide, pilocarpine. |
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Cataracts risk factors |
Age, UV light Systemic - Down's, DM, hypocalcaemia, steroids, congenital rubella, galactosaemia, myotonic dystrophy Ocular - trauma, uveitis, high myopia, topical steroids |
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Dacryocystitis |
Infection of the lacrimal sac Watering eye, swelling and erythema at inner canthus of the eye Mx - systemic antibiotics - if signs of orbital cellulitis - IV antibiotics |
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Normal IOP |
10-21 mmHg |
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Latanoprost |
Prostaglandin analogue Increases uveoscleral outflow Causes brown pigmentation of the iris Once daily application Used first line if history of asthma |
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Timolol |
Beta blocker Reduces aqueous production Avoid in asthmatics and those with heart block |
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Brimonidine |
Sympathomimetic Reduces aqueous production and increases outflow Avoid if taking MAOIs or TCAs Causes hyperaemia |
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Dorzolamide |
Carbonic anhydrase inhibitor Reduces aqueous production Systemic absorption may cause sulphonamide-like reactions |
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Pilocarpine |
Miotics Muscarinic receptor antagonist Increases uveoscleral outflow Causes constricted pupils, headache and reduced vision. |
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Holmes-Adie Syndrome |
Pupil dilation - won't constrict to light Benign. Seen in women. Unilateral in 80 %. If pupil constricts - remains small for a long time Absent ankle/knee reflexes |
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Temporal Arteritis |
Large vessel vasculitis - PMR > 60 years, onset < 1 month, headache, jaw claudication, ischaemic optic neuropathy - visual disturbance, tender temporal artery, aching and stiffness in proximal limb muscles, lethargy, depression, night sweats, low-grade fever, anorexia, night sweats. |
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Temporal Arteritis Mx |
Ix - ESR > 50, raised CRP, biopsy - skip lesions, normal creatinine kinase and EMG. Tx - high dose prednisolone and opthamology referral. |
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Blepharitis |
Inflammation of eyelid margins Causes - meibomian gland dysfunction, seborrhoeic dermatitis, staph infection, rosacea. Bilateral, gritty dry eyes, sticky, red eyelid margins, styes, chalazions, seoncdary conjunctivitis. Mx - hot compresses, cooled boiled water and baby shampoo/sodium bicarb, artificial tears. |
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Emergency reduction of raised ICP |
Hyperventilation - hypocapnia - reducing ICP and papilloedema. |
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Mydriasis |
Pupil dilation Causes - Argyll-Robertson syndrome, 3rd nerve palsy, atropine, tropicamide, cocaine, amphetamines, TCAs, congenital, phaeochromocytoma. |
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Classification Hypertensive Retinopathy |
I - Anteriolar narrowing and tortuosity, increased light reflex, silver wiring. II - AV nipping III - Cotton-wool exudates, flame and blot haemorrhages IV - Papilloedema |
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Bitemporal Hemianopia |
Lesion of optic chiasm Upper quadrant defect>lower quadrant defect - inferior chiasm - pituitary source Lower quadrant defect>upper quadrant defect - superior chiasm - craniophayngioma |
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Argyll-Robertson Pupil |
Accomodation reflex present but no response to light. Small, irregular pupils. Causes - DM, syphilis |
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Afferent pupillary defect |
Marcus-Gunn Pupil Lesion anterior to the optic chiasm - optic nerve or retina. Optic nerve - optic neuritis - MS. Retina - detachment |
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Tunnel vision causes |
Glaucoma Retinitis pigmentosa Papilloedema Coroidoretinitis Hysteria |
