Term
| common causes of red eye? |
|
Definition
conjunctivitis
blepharitis
corneal abrasion
foreign body
subconjunctival haemorrhage
keratitis, iritis, uveitis
glaucoma
chemical/radiation burn
episcleritis
scleritis |
|
|
Term
| features of acute angle closure glaucoma |
|
Definition
severely painful
nausea, vomiting, headache
haloes and photophobia
pt usually 50 or >
hazy cornea
decreased VA
fixed, semi-dilated or oval pupil
mx: refer immediately |
|
|
Term
|
Definition
|
|
Term
| diagnosis of acute angle closure glaucoma? |
|
Definition
you need 2 of the following
occular pain
nausea and vomiting
hx of intermittent blurring of vision with haloes and at least 3 of the following
IOP >21mmHg
conjunctival injection
corneal epithelial oedema
mid-dilated non reactive pupil
shallow chamber in the presence of occlusion |
|
|
Term
| mx of acute angle closure glaucoma |
|
Definition
lay pt supine
IV acetazolamide
topical agents used include:
beta blockers e.g. timolol, caution in asthma
prednisolone: 15mg every 15mins for 1 hour then hourly
pilocarpine: in pts with their real lens
phenylephrine: in pts who do not have their real lens. |
|
|
Term
| surgical mx of acute angle closure glaucoma |
|
Definition
peripheral iridotomy (PI)
surgical iridectomy when PI not available. This option is more invasive.
lensectomy: when a cataracts lens has swollen and caused the acute angle closure |
|
|
Term
| how is peripheral iridotomy performed? |
|
Definition
| 2 holes are made in each iris with a laser usually at 11o clock and 2 o clock to provide a passive for aqueous flow. the other eye is prophylactically treated as it is at risk of getting affected later. |
|
|
Term
| which 3 structures form the uvea? |
|
Definition
iris
ciliary body
choroid
superficial to the uvea is the sclera and beneath it is the retina |
|
|
Term
| what is inflamed in anterior uveitis? |
|
Definition
the iris.
it is also called iritis |
|
|
Term
| in severe uveitis you might see white clumps on the corneal endothelial surface. what are these? |
|
Definition
These are keratic precipitates.(KPs)
those which are larger and greasy looking are called mutton fat KPs |
|
|
Term
| which HLA is associated with uveitis? |
|
Definition
|
|
Term
|
Definition
inflammatory due to AI disease: HLA b27
infectious causes: lyme disease, syphylis
iatrogenic: surgery, trauma, medication e.g rifabutin (Abx)
ischemic causes due to poor circulation
trauma
neoplastic infiltration.
herpes infection.
HIV |
|
|
Term
| symptoms of anterior uveitis? |
|
Definition
red painful eye
photophobia; direct and consensual
pain worse when trying to read
onset can be few hours/days
there can be xs tear production and associated headache |
|
|
Term
| keratic precipitates are characteristic of which condition? |
|
Definition
|
|
Term
| iris atrophy is a diagnostic feature for uveitis due to? |
|
Definition
|
|
Term
| how is the severity of uveitis graded? |
|
Definition
by the number of cells seen in the aqueous humour. this is graded from 0-4
0 = no cells seen
4 = > 50 cells |
|
|
Term
| referral from primary care for a pt presenting with anterior uveitis? |
|
Definition
| refer to ophthalmologist within 24 hours |
|
|
Term
|
Definition
cycloplegic drugs e.g. cyclopentolate 1% used to paralyse cillary body. this relieves pain and prevents adhesions between iris and lens
topical steroids
if macular oedema reoccurs then immunosuppressors e.g. ciclosporin |
|
|
Term
| which is the only pt group that is currently screened for uveitis? |
|
Definition
| children with juvenile idiopathic arthritis. |
|
|
Term
| complications of anterior uveitis |
|
Definition
macular oedema
secondary cataract
posterior synechiae: can cause blockage of aqueous flow and lead to raised IOP |
|
|
Term
| symptoms of conjuctivitis |
|
Definition
red eye
irritation, grittiness and discomfort are typical
discharge
photophobia is not typical and VA should remain unaltered. |
|
|
Term
| typical hx of pt with conjunctivitis? |
|
Definition
close contact with another infected person
recent URTI
eyes glued together after sleep, mucopurulent discharge.
there may be pre auricular lymphadenopathy |
|
|
Term
| which virus causes most viral conjunctivitis? |
|
Definition
|
|
Term
| in conjunctivitis how can you differentiate between allergic, viral and bacterial forms from the hx? |
|
Definition
itching? allergic
reoccuring? viral
pre auricular lymph node? more likely viral or atypical bacteria: gonococcal/ chlamydia
absence of itching and absence of contact with infected person make bacterial more likely
purulent d/c: bacteria
watery d/c: viral |
|
|
Term
| conjunctival follicles are round collections of lymphocytes typically seen in what type of conjunctivitis? |
|
Definition
|
|
Term
| mx of simple bacterial conjunctivitis |
|
Definition
reassurance that condition is self limiting and resolves in 1-2 weeks. come back if it is going on for > 2 weeks.
remove contact lens until 24 hours after cleared infection
wipe away secretions using damp cotton wool
pts often resist conservative rx so a pragmatic approach is taken to rx with ABx.. treat if causing distress, absence from school/work or if pt wears contact lens but advice them they should not wear lens until 24 hours after infection has been cleared. |
|
|
Term
| what Abx of choice is given in conjunctivitis? |
|
Definition
chloramphenicol.
avoid in pregnancy, breast feeding, hx of myelosuppression or blood dyscrasias,
fusidic acid is an alternative for staph infections and in pregnancy. |
|
|
Term
| which group are at risk for eye infections by pseudomonas? |
|
Definition
|
|
Term
| what ix should you do in someone who presents with a foreign body in their eye? |
|
Definition
|
|
Term
| what is the first priority in evaluating a corneal injury? |
|
Definition
| it is to include/exclude a full thickness injury therefore a ruptured globe. |
|
|
Term
| what test is used to see if an injury is penetrating? |
|
Definition
Siedel's test
apply 10% fluorescing to the affected area and view using a Wood's light or cobalt blue light source. if aqueous fluid is leaking through this will be seen as a pale or clear liquid in a pool of dye. if this test is positive then rx for open globe injury |
|
|
Term
| what imaging modality is used for evaluating orbital fractures and intra orbital foreign bodies? |
|
Definition
|
|
Term
| corneal abrasion: mx and features |
|
Definition
analgesia with NSAIDs
patching is not recommended: may delay healing
topical Abx commonly prescribed to prevent bacterial superinfection |
|
|
Term
| chloramphenicol is an Abx used in eye infections. what type of people should not be given this Abx? What is the alternative |
|
Definition
pregnant
breastfeeding
myelosupression
hx of blood dyscrasia
intolerent to cholamphenicol
alternative: fusidic acid |
|
|
Term
| contact lens abrasions should be treated with what type of Abx? |
|
Definition
|
|
Term
causes of subconjunctival haemorrhage?
this is a benign self limiting condition when not associated with systemic illness |
|
Definition
valsalva manœuvre: coughing, straining
trauma
HTN
bleeding disorder
warfarin therapy
coronary heart disease |
|
|
Term
| ix in subconjunctival haemorrhage? |
|
Definition
check BP
discourage elective use of aspirin products or NSAIDs |
|
|
Term
blepharitis - inflammation of the eyelid
what is the mx? |
|
Definition
lid Hygiene
warm compress
lid massage
lid cleansing |
|
|
Term
| Ddx of non painful red eye acute? |
|
Definition
subconjuctival haemorrhage
episcleritis
conjunctivitis |
|
|
Term
| which type of glaucoma is associated with hypermetropia and which angle is associated with myopia?? |
|
Definition
hypermetropia = acute angle closure glaucoma
myopia = primary open angle glaucoma |
|
|
Term
| risk factors for primary open angle glaucoma |
|
Definition
advanced age
FHx
black ethnicity
myopia
HTN
diabetes melitus |
|
|
Term
| signs of Horner's syndrome on eye examination |
|
Definition
miosis - (constricted pupil)
ptosis
endopthalmos
+/- anhidrosis on that side of face |
|
|
Term
| common causes of sudden painless loss of vision? |
|
Definition
central retinal artery obstruction
central retinal vein obstruction
retinal detachment
vitreous haemorrhage
ischemic optic neuropathy (temporal arteritis or atherosclerosis) |
|
|
Term
| central retinal vein occlusion features |
|
Definition
this is more common than artery occlusion
the incidence increases with age
causes: glaucoma, polycythaemia and HTN
several retinal haemorrhages usually seen on fundoscopy |
|
|
Term
| central refinery artery occlusion, features |
|
Definition
due to thromboembolism or arteritis
cherry red spot
afferent pupillary defect |
|
|
Term
how to differentiate between
posterior vitreous detachment
retinal detachment
vitreous haemorrhage |
|
Definition
posterior vitreous detachment: flashes of light (photopsia) in peripheral vision. floaters often on temporal side of central vision
retinal detachment: dense shadow starting at periphery and proceeding to central vision. a veil/curtain over the field of vision. straight lines appear curved. central visual loss.
vitreous haemorrhage: large bleeds cause sudden visual loss, moderate bleeds may be described as numberous dark spots and small bleeds may be described as floaters. |
|
|
Term
| what is the common cause of blindness in the UK? |
|
Definition
age related macular degeneration.
there is degeneration of the central retina, this is called the macula |
|
|
Term
| what is dry macular degeneration characterised by? |
|
Definition
| drusen. these are yellow round spots in Bruch's membrane |
|
|
Term
| which type of macular degeneration is characterised by choroidal neovascularisation and leaking of serous fluid? |
|
Definition
|
|
Term
| risk factors for macular degeneration |
|
Definition
age > 60
FHx
smoking
more common in caucasians
high cumulative sun exposure
female sex |
|
|
Term
| features of macular degeneration |
|
Definition
central vision affected first
straight line appear wavy or crooked
there may be central scotomas |
|
|
Term
| ix and dx of macular degeneration |
|
Definition
OCT provides cross sectional view of macula
if neovascularisation is present then fluorescing angiography is performed |
|
|
Term
| NICE general mx for macular degenration |
|
Definition
refer to opthalmology within 1 week
encourage them to stop smoking
high dose beta carotene, zinc, vit C and E may help slow down visual loss for pts with established degeneration but avoid in current smokers as it may increase risk of lung cancer |
|
|
Term
| rx for dry and wet mac degeneration |
|
Definition
dry MD: currently no rx
wet MD: anti VEGF: intravitreal injections of ranizimubab or afibercept.
photocoagulation
photodynamic therapy |
|
|
Term
| what is the brand name for afibercept? |
|
Definition
|
|
Term
| what is the brand name for ranizimubab |
|
Definition
|
|
Term
| for pts with a history of asthma and glaucoma they cannot use beta blockers, what becomes first line in these situations? |
|
Definition
| prostaglandin analogue e.g. lantaprost |
|
|
Term
beta blockers e.g timolol
MOA
SE |
|
Definition
reduces aqueous production
avoid in asthmatics and pts with heart block |
|
|
Term
prostaglandin analogues e.g lantaprost
MOA
SE |
|
Definition
increases uveosceral outflow
SE: brown pigmentation of the iris
administered once daily |
|
|
Term
pilocarpine
what type of drug is it?
MOA
SE |
|
Definition
muscarinic receptor agonist
MOA: increases uveoscleral outflow
SE: constricted pupil, headache and blurred vision |
|
|
Term
what is dorzolamide?
MOA
SE |
|
Definition
its a carbonic anhydrase inhibitor
it reduces aqueous production
SE: systemic absorption may cause sulphonamide type reactions |
|
|
Term
give an example of an alpha 2 receptor agonist used in primary open angle glaucoma
MOA
SE |
|
Definition
reduces aqueous production AND increases outflow
SE: hyperaemia (xs of blood in vessels supplying organ or body)
avoid if taking MAOI or TCA antidepressants |
|
|
Term
| what surgery might be considered in glaucoma if drops are working? |
|
Definition
|
|
Term
|
Definition
raised ICP
space occupying lesions, neoplastic and vascular
malignant HTN
idiopathic intracranial HTN
hydrocephalus
hypercapnia
rare causes include: hypOparathyroid, hypOcalcemia and vit A toxicity |
|
|
Term
| classical symptoms of optic neuritis? |
|
Definition
visual loss; blind spot; central scotoma
eye pain: worse on eye movement
red desaturation
lethargy is a common non specific symptom |
|
|
Term
left homonymous hemianopia.
where is the lesion? |
|
Definition
|
|
Term
|
Definition
parietal -inferior
temporal- superior |
|
|
Term
| is there is macula sparing where is the lesion? |
|
Definition
|
|
Term
tunnel vision AKA bitemporal hemianopia,
where is the lesion? |
|
Definition
|
|
Term
| in bitemporal hemianopia you can have an upper quadrant defect or a lower quadrant defect. where are relative lesions for each? |
|
Definition
if upper quadrant defect is > lower quadrant defect this mean there is inferior chasmal compression most likely to be the pituitary
if the lower quadrant defect is more than the upper quadrant defect then this means there is superior chasmal compression commonly a craniopharyngioma, |
|
|
Term
|
Definition
blepharitis: inflammation of eyelid margins typically leading to red eye
stye: infection of glands of the eyelids
chalazion: meibomian cyst (rounded appearance and no yellow head)
entropion
ectropion |
|
|
Term
|
Definition
infection of glands of the eyelids
there are internal and external stye |
|
|
Term
| what is the latin name for external stye? |
|
Definition
hordeolum externum
this is usually a staphylococcal infection of the
glands of Zeis (sebum making)
OR
glands of Moll (sweat making) |
|
|
Term
| what is the Latin name for an internal stye? |
|
Definition
| hordeolum internum: this is an infection of the meibomian glands and it may leave a residual chalazion (Meibomian cyst) |
|
|
Term
|
Definition
hot compress and analgesia
Abx are only recommended if there is associated conjunctivitis. |
|
|
Term
a chalazion is AKA meibomian cysts
features of it? |
|
Definition
presents as firm painless lump in eyelid
majority of cases resolve spontaneously but some require surgical drainage |
|
|
Term
| ischemic optic neuropathy is one cause of painless loss of vision. which arteries are obstructed? |
|
Definition
| short posterior ciliary arteries. this causes damage to the optic nerve |
|
|
Term
| night blindness and tunnel vision what are you thinking? |
|
Definition
|
|
Term
| which part of the retina does retinitis pigmentosa affect? |
|
Definition
the peripheral retina.
this results in tunnel vision.
on fundoscopy there is black bone spicule shaped pigmentation in peripheral retina. |
|
|
Term
| 34 year old man with ankylosing spondylitis presents with painful red eye and mild photphobia. what are you thinking he has that is associated with ankylosing spondylitis? |
|
Definition
|
|
Term
| conditions associated with anterior uveitis? |
|
Definition
ankylosing spondilytis
reactive arthritis
ulcerative colitis, crohns disease
Behcets disease |
|
|
Term
|
Definition
urgent review by ophthalmologists
cycloplegics (dilate the pupil and this helps relieve pain and photophobia) e.g. atropine and cyclopentolate
steroid eye drops |
|
|
Term
| Horner's syndrome can be due to central, pre and post ganglionic lesions. in which one of these categories is anhidrosis of the face absent? |
|
Definition
in post ganglionic lesions.
these are remembered by all the Cs
carotid artery dissection
carotid aneurysm
cluster headache
cavernous sinus thrombosis |
|
|
Term
| mx of acute angle closure glaucoma? |
|
Definition
urgent referral
reduce aqueous secretions with acetazolamide
induce pupilary constriction with topical pilocarpine |
|
|
Term
ptosis and constricted pupil = Horner's syndrome
what about Ptosis and dilated pupil? |
|
Definition
|
|
Term
what is dacryocystitis?
features of it?
mx? |
|
Definition
inflammation of the lacrimal sac
features: watery eye (epiphora)
swelling and erythema at inner canthus of eye
mx: systemic Abx
IV Abx if there is periorbital cellulitis |
|
|
Term
| watery eye and swelling and erythema of the inner canthus of the eye? |
|
Definition
dacryocystitis
mx: systemic Abx |
|
|
Term
| Management of infective conjunctivitis |
|
Definition
it is normally self limiting that settles w/o rx within 1-2 weeks
when Abx are offered these are the common ones:-
Chloramphenicol: drops are given 2-3 hourly initially
Chloramphenicol ointment is given ads initially
Topical fusidic acid is an alternative and should be used for pregnant women. Treatment is twice daily
Contact lens should not be worn during an episode of conjunctivitis
Advice should be given not to share towels
School exclusion is not necessary |
|
|
Term
| in which 2 conditions might a hypopyon be seen? |
|
Definition
anteriour uveitis
keratitis
in keratitis the pupillary reaction is normal
where as in anterior uveitis it isn't. |
|
|
Term
| A 23-year-old female presents with recurrent headaches. Examination of her cranial nerves reveals the right pupil is 3 mm whilst the left pupil is 5 mm. The right pupil constricts to light but the left pupil is sluggish. Peripheral neurological examination is unremarkable apart from difficult to elicit knee and ankle reflexes. What is the most likely diagnosis? |
|
Definition
Holmes-Adie pupil
a benign condition most commonly seen in women. It is one of the differentials of a dilated pupil.
unilateral in 80% of cases
dilated pupil
once the pupil has constricted it remains small for an abnormally long time
slowly reactive to accommodation but very poorly (if at all) to light
Holmes-Adie syndrome:
association of Holmes-Adie pupil with absent ankle/knee reflexes |
|
|
Term
| features of central retinal vein occlusion |
|
Definition
| sudden painless loss of vision, severe retinal haemorrhages on fundoscopy |
|
|
Term
| Adverse effects include brown pigmentation of the iris |
|
Definition
|
|
Term
| First-line treatment in a patient with a history of heart block |
|
Definition
|
|
Term
| Causes pupillary constriction, blurred vision and headaches |
|
Definition
|
|
Term
| central field loss occurs from degeneration of the fovea. some examples? |
|
Definition
ARMD
optic neuropathy
macular holes
retinal artery occlusion |
|
|
Term
| examples of conditions where there is peripheral field loss? |
|
Definition
glaucoma
retinal detachment
retinitis pigmentosa
chorioretinitis
branch retinal artery occlusion |
|
|
Term
where would the visual loss be if it was a central retinal artery occlusion?
where would visual loss be reported if it was a branch retinal artery occlusion |
|
Definition
central retinal artery occlusion = central visual loss
branch retinal artery occlusion = peripheral visual loss. |
|
|
Term
| which test assesses the eyes greatest power of resolution? |
|
Definition
|
|
Term
| what does visual sensitivity measure? |
|
Definition
|
|
Term
| which grid testing assesses the central 10 degrees of visual field? |
|
Definition
|
|
Term
| where is the fovea located? |
|
Definition
within the macula.
together they are responsible for central vision |
|
|
Term
| what fundoscopy changes would you see in central retinal vein occlusion? |
|
Definition
it will look hyperaemic compared to retinal artery occlusion that looks pale
there are many haemorrhages and cotton wool spots. it will look like a storm |
|
|
Term
| which drug can cause a classical 'bull's eye maculopathy' affecting the centre of the field |
|
Definition
chloroquine
NB: vigabatrin causes field defects in 40% who take it |
|
|
Term
what must a person do with regards to driving if they are diagnosed with a visual loss.
what is the name of the specific test used to assess their vision? |
|
Definition
they should not drive until the visual defect has been formally assessed.
they should inform the DVLA.
the DVLA will organise a specific visual test called the ESTERMANN'S visual field test. this is carried out by one of their approved optometrists who will report back to them and tell them if you are ok to drive. |
|
|
Term
| features of absolute glaucoma: this is the end point of glaucoma |
|
Definition
no functioning vision
stony appearance to eye
loss of pupillary reflex
very painful |
|
|
Term
|
Definition
disease of the optic nerve
there is progressive loss of retinal ganglion cells and their axons. |
|
|
Term
| whats the word for short sightedness? |
|
Definition
myopia.
myopia is a risk factor for primary open angle glaucoma |
|
|
Term
| what is the normal cup:disc ratio ? |
|
Definition
|
|
Term
|
Definition
mild: early visual field defects
moderate: arcuate scotoma and thinning of neuroretinal rim (cupping)
severe: extensive visual field loss and marked thinning of the neuroretinal rim
end stage : only smaller residual visual field remains. cup:disc in the region of 0.9-1.0 |
|
|
Term
| since 2000 what type of glaucoma med is 1st choice. clue: not beta blocker |
|
Definition
|
|
Term
| what is the action of prostaglandin analogues? |
|
Definition
they increase aqueous outflow by uveoscleral route.
SE: browning of iris, lengthening of eyelashes
CI: active uveitis, pregnancy, breast feeding |
|
|
Term
| MOA of beta blockers in glaucoma |
|
Definition
they reduce aqueous secretion by blocking beta receptors on the ciliary bodies.
CI: bradycardia, heart block, asthma, COPD
SE: nightmares, depression, bradycardia, irritation, erythema, dry eyes. |
|
|
Term
| MOA carbonic anhydrase inhibitors |
|
Definition
they reduce aqueous secretion by ciliary body.
CI: breast feeding, renal/hepatic impairment, metabolic disturbance, sulfonamide sensitivity
SE: taste disturbance, dizziness, fatigue, sulphonamide related side effects. |
|
|
Term
| MOA of sympathomimetics in glaucoma |
|
Definition
they reduce aqueous secretion and increase outflow through trabecular meshwork.
CI: MAOIs, angle closure glaucoma.
SE- ocular : mydriasis, dry eye, smarting/redness of eye.
systemic SE:lethargy, hypotension |
|
|
Term
MOA of miotics
these can cause brown pain
systemic SE: sweating, GI disturbance and bradycardia |
|
Definition
they cause cilliary muscle to contract and this opens up drainage channels in trabecular meshwork.
CI: retinal holes and in situations like uveitis where ciliary contract is undesirable
occular SE: miosis, can affect driving due to blurred vision
those with dark iris need more. caution in heart disease, HTN, parkinson's disease and UTract obstruction |
|
|
Term
| when should laser and surgery be considered in glaucoma? |
|
Definition
| after lack of success with 2 different drops |
|
|
Term
| name of trabeculoplasty surgery used in glaucoma? |
|
Definition
argon laser trabeculopplasty (ALT)
selective laser trabeculoplasty (SLT) |
|
|
Term
| surgery used in angle CLOSURE glaucoma. what does it involve? |
|
Definition
| YAG laser iridotomy: a small hole is made in the iris to enhance flow |
|
|
Term
what is a relevant disability as opposed to an absolute disability?
give examples |
|
Definition
relevant disability: visual field DEFECT
absolute disability: reduced VISUAL ACUITY |
|
|
Term
what is the most common cause of gradual visual loss in the developed world?
what is the worldwide cause? |
|
Definition
macular degeneration
followed by diabetic retinopathy
worldwide it is chlamydial infection causing trachoma. |
|
|
Term
| causes of bilateral acute loss of vision? |
|
Definition
bilateral occipital lobe ischemia or infarction
bilateral occipital trauma
severe bilateral papilloedema
rapidly progressing chiasmal compression
bilateral optic nerve damage e.g. methyl alcohol poisoning |
|
|
Term
| which form officially registers someone as sight impaired? |
|
Definition
CVI certificate of vision impairment.
you need a consultants signature to be registered.
registration is voluntary but does entitle you to benefits and concessions. |
|
|
Term
| complications of those with visual problems |
|
Definition
social isolation
falls and accidents
restriction of activities and the need for supervision
education difficulties
reduced employment perspectives, |
|
|
Term
| what does distortion of straight lines indicate on an ambler grid? |
|
Definition
| serious macular pathology and warrants an urgent referral |
|
|
Term
| if visual acuity is improved using a pinhole what does this indicate? |
|
Definition
|
|
Term
painful loss of vision tend to have a more sinister pathology.
name some causes |
|
Definition
progressive neoplastic (choroidal melanoma) or inflammatory process (chorioretinitis)
systemic problem: sarcoidosis
optic nerve lesions: optic neuritis or neuroma
intracranial masses, HTN or pathology |
|
|
Term
| what does a driver need to be able to do in order to keep their license? |
|
Definition
read a number plate 20-20.5 metres
minimum VA 6/12
if they don't have this they should not drive and inform DVLA |
|
|
Term
| whats the procedure for cataracts and informing DVLA? |
|
Definition
| often safe to drive and don't need to tell them |
|
|
Term
| if you have a visual field defect do you have to notify the DVLA? |
|
Definition
| yes you do and then they will assess you |
|
|
Term
| if you have diplopia what do you need to do with regards to DVLA? |
|
Definition
do not drive, let them know.
if you are group one driver and diplopia is controlled by glasses of by a patch then you may get your license back.
if you are a group 2 driver then patching is not acceptable to get your license back and you will not be permitted to drive. |
|
|
Term
| if you are colourblind do you need to let DVLA know? |
|
Definition
| no you don't and you can continue to drive but if you have night blindness you need to let DVLA know. |
|
|
Term
you have blepharospasm and drive.. do you need to stop driving and tell DVLA?
what is blepahrospasm? |
|
Definition
uncontrollable and sometimes painful movements around the eye.
you need to stop driving and tell DVLA
they will get a specialist opinion before giving your license back |
|
|
Term
| what diameter AAA disqualifies someone from driving? |
|
Definition
> 6.5cm
you need to tell DVLA if your AAA is > 6cm |
|
|
Term
| what is the most common refractive error? |
|
Definition
myopia
it means near sighted where light falls in front of rather than on the retina.
distant objects appear blurry but near objects are fine
it is corrected by giving CONCAVE lens with negative focusing power. this lengthens the rays and makes it hit the the retina
severe myopia increases risk to glaucoma, cataracts and retinal detachment |
|
|
Term
| hyperopia is called far sightedness. give features and management of this condition |
|
Definition
when light falls behind the retina
close objects appear blurry but far objects are normal
managed by convex lens |
|
|
Term
| if you are short sighted where is the light falling in relation to the retina and how can you fix this? |
|
Definition
light is falling in front of the retina rather than on it.
you fix it by giving a concave lens |
|
|
Term
| if you are far sighted where is the light falling in relation to the retina and how can you fix it? |
|
Definition
light is falling behind the retina rather than on the retina
you fix it by giving convex lens |
|
|
Term
presbyopia. problem focussing on close or far objects?
what is the pathophysiology? |
|
Definition
there is progressing problem to focus on near objects.
the problem is due to hardening of the lens by decreased levels of alpha crystallin. this causes the eye to focus light behind rather than on the retina.
mx is with reading glasses that have a higher focusing power in the lower portion of the lens |
|
|
Term
pathophysiology of binocular double vision
how can you get rid of binocular double vision |
|
Definition
this occurs when the images produced by the 2 eyes do not absolutely match
if one eye is covered then the diplopia disappears |
|
|
Term
| what is the most common cause of binocular diplopia? |
|
Definition
| cranial nerve palsies e.g. abducent nerve palsy |
|
|
Term
| causes of monocular diplopia |
|
Definition
cornea and lens problems including cataracts
eye muscle problems: graves disease, MG
nerve problems: CN III, IV, VI. MS, GBS, DM |
|
|
Term
| which muscle may be trapped in an inferior orbital fracture that can cause diplopia? |
|
Definition
|
|
Term
| brain problems that can present with diplopia? |
|
Definition
migraine
raised ICP
strokes
aneurysms |
|
|
Term
| oblique eye muscles move the eye OUTWARDS as well as up and down. because they are on a pulley they move the eye the opposite way to which the name suggests. knowing this information which way does the superior oblique move the eyeball and which way does the infer oblique move the eyeball? |
|
Definition
superior oblique: Down and Out
inferior oblique: Up and Out
Superior oblique is AKA the Tramp's muscle |
|
|
Term
eye movements of the following muscles
superior oblique
inferior oblique
superior rectus
inferior rectus
medial rectus
lateral rectus
include nerve supply. |
|
Definition
superior rectus moves eye up.
in palsy the eyeball is looking down
CN: III
inferior rectus moves eye down
in a palsy the eye is looking up
CN: III
medial rectus moves eye medially
in palsy is it laterally resting
CN: III
lateral rectus moves eyeball laterally
in a palsy it is medially resting
CN: VI
Superior oblique moves eyeball down and out
in palsy it is resting up and in
CN: IV
inferior oblique moves eye up and out
in a palsy it is resting down and in
CN: III |
|
|
Term
| what are the 5 red flags in diplopia? |
|
Definition
pupil involvement with 3rd nerve palsy suggests posterior communicating artery aneurysm. the pupil reacts poorly
diplopia affecting 2 or more of lip, pupil and eye movement, Horner's syndrome due to carotid dissection or inflammatory neuropathy (GBSyndrome)
multiple cranial nerve palsies suggest intracranial or meningeal tumour
diplopia with weakness and fatigue suggests MG
Diplopia with new onset headache and scalp tenderness suggests GCA |
|
|
Term
| low vision aids can be optical or non optical give an example of an optical visual aid |
|
Definition
illuminated magnifiers
handheld magnifiers
flat magnifiers
for viewing faraway objects include binoculars |
|
|
Term
| low vision aids can be optical or non optical give an example of a NON optical visual aid |
|
Definition
anglepoise lamp
bold print books
liquid level indicators which beep to stop you burning yourself when using hot water. |
|
|
Term
| which system is used to standardise eye trauma terminology |
|
Definition
| The Birmingham Eye Trauma Terminology System |
|
|
Term
define
eye wall injury
open globe injury
closed globe injury |
|
Definition
eye wall injury: confined to cornea and sclera
closed globe injury: eye wound is not full thickness
open globe injury: full thickness eye wound |
|
|
Term
high velocity injury raises possibility of penetrating injury.
what do forceful injuries such as a punch cause? |
|
Definition
|
|
Term
| what should you not do in an OPEN globe (penetrating) injury? |
|
Definition
do not manipulate the eye
do not apply any pressure e.g. do not measure IOP
do not patch the eye |
|
|
Term
| example of urgent eye injuries that may rapidly lead to blindness? |
|
Definition
chemical burns
retrobulbar hemorrhage
open globe injuries |
|
|
Term
| serious/red flag symptoms in eye injuries |
|
Definition
reduced and progressive VA
pain that is not relieved by local anaesthetics
diplopia
flashes and new floaters and that can indicate retinal injury |
|
|
Term
| what does a tear shaped pupil and a positive SIedel's test both indicate? |
|
Definition
|
|
Term
| serious signs in eye injury |
|
Definition
deep lid laceration
subconjunctival haemorrhage
pupil, iris or fundal abnormalities
abnormalities of eye movements |
|
|
Term
| scan of choice to detect orbital trauma, fracture and intra ocular foreign body (IOFB) |
|
Definition
|
|
Term
| USS is good for evaluating the globe but when is it contra indicated? |
|
Definition
|
|
Term
| if a metallic foreign body was suspected which mode of investigation would be contra indicated? |
|
Definition
|
|
Term
| from acid and alkali injuries to the eyes, which one is better to have and what is the reason? |
|
Definition
acid create a barrier to the tissue protein and this forms a barrier for further tissue penetration. this is the reason why it is better to have an acid rather than an alkali burn.
alkali burns produce penetrating eye injuries more quickly than acids. |
|
|
Term
|
Definition
before anything do 3 I's
irrigate
irrigate
irrigate |
|
|
Term
|
Definition
|
|
Term
| mx of chemical burns to eyes |
|
Definition
| irrigate irrigate and irrigate until pH of eye is back to physiological pH this is 7.4 then examine |
|
|
Term
| how to irrigate following chemical eye injury? |
|
Definition
saline bags, giving set, towel
sit pt by sink
give anaesthetic drops into their eyes
explain what you are doing, remove their contacts if they are wearing them |
|
|
Term
| what volume of fluid may be needed to neutralise the pH in a severe chemical eye injury? |
|
Definition
|
|
Term
| how long should you irrigate an eye in a chemical injury? |
|
Definition
15-30 mins irrigate whilst you refer and take a history
check pH every 5 mins
if you need to install drops then install them every 5 mins as they will wash away too with irrigation
after irrigation check VA in both eyes. |
|
|
Term
| how are CS (tear) gas injuries treated? |
|
Definition
| by blowing cool air into the eyes |
|
|
Term
| summary mx of chemical eye injury |
|
Definition
irrigation using saline. you will need a lot of bags
you want to get the pH to normal. This is 7.4
in severe injuries especially with alkalis you may need up to 20l of fluid to get the pH back
You may have to give anaesthetic drops if the pt is in pain whilst you irrigate
you should give the drops and check pH every 5 mins.
explain what you are doing to the patient as this can be a distressing time.
whilst you are irrigating make a referal and take a history.
irrigate for 15-30 minutes, once finished check VA in both eyes and record.
also give broad spec Abx |
|
|
Term
| features of retrobulbar haemorrhage |
|
Definition
severe eye pain
progressive visual loss
progressive opthalmoplegia
proptosis
bleeding in orbital cavity compresses orbital structures. this causes ischema of the eye and optic nerve.
this is an eye emergency and surgery is needed to prevent visual loss. |
|
|
Term
what is the mx of retrobulbar haemorrhage?
what is the role of medical mx? |
|
Definition
surgical rx definitive: incision at LATERAL CANTHUS to relive high IOP
medical mx can buy time: IV mannitol, dexamethasone and acetazolamide. |
|
|
Term
|
Definition
do NOT touch, manipulate or prod eye
use a raised eye shield, if not available then make one from the bottom of a polystyrene cup
refer immediate and give Abx cover
make pt NBM
avoid any increase pressure to the eye: tell pt not to blow nose, cough, strain or bend over.
provide analgesia and anti emetics
rx as high tetanus risk wound |
|
|
Term
| why should you not attempt to remove a penetrating FB lodged in the eye yourself? |
|
Definition
it may cause prolapse of the eye contents
refer immediately
treat as open globe injury |
|
|
Term
miosis = small pupil
what is the word for a large pupil? |
|
Definition
|
|
Term
| what does a D shaped pupil indicate? |
|
Definition
| detachment of the iris from its root base. |
|
|
Term
signs of non accidental eye injuries in children
referal of these injuries is mandatory |
|
Definition
retinal haemorrhages
peri occular bruising or lid laceration
subconjunctival haemorrhage
unexplained lens dislocation or cataracts
unexplained corneal or conjunctival injuries particularly in the lower half of the eye.
consider when a child presents with injuries in the absence of trauma or medical explanation |
|
|
Term
| what can occur sometime later after a blunt trauma? |
|
Definition
retinal hemorrhage
this is why you should refer anyone with blunt trauma and a history of floaters. |
|
|
Term
| complications of open globe injury |
|
Definition
endopthalmitis
cataract
in terms of FB, the more posterior the FB is in the globe, the worse the prognosis |
|
|
Term
| signs and symptoms of orbital cellulitis |
|
Definition
eyelid oedema
erythema
proptosis, gaze restriction, diplopia
systemic signs: fever |
|
|
Term
| orbital cellulitis occurs when infection develops in which part of the orbit? |
|
Definition
|
|
Term
| mucormycosis is a rare cause of orbital cellulitis and it is usually fatal. factors such as DKA and neutropenia are present in those affected. what is commonly the presenting feature? |
|
Definition
| severe infection of the facial sinuses is the commonest presentation. |
|
|
Term
| when do orbital cellulitis and preseptal cellulitis most commonly occur? |
|
Definition
| in the winter months due to more infections of the sinuses from colds and influenza etc |
|
|
Term
| complications of orbital cellulitis |
|
Definition
meningitis
total loss of vision
cerebral abscess |
|
|
Term
|
Definition
| swelling/oedema of the conjunctiva |
|
|
Term
| what ix if you suspect orbital cellulitis? |
|
Definition
| CT sinus and orbit +/- brain |
|
|
Term
mx for preorbital cellulitis
and orbital cellulitis |
|
Definition
preorbital: mx: PO co-amoxiclav or IV ceftriaxone
orbital cellulitis: IV cefotaxime and flucox plus metronidazole if pt is > 10 years and has sinusitis |
|
|
Term
| fluorescin stain and what colour light is used to detect foreign bodies in the eye? |
|
Definition
| blue light AKA Wood's light |
|
|
Term
| In fluorescein angiography where is the dye injected by the ophthalmologist? |
|
Definition
|
|
Term
| if you wanted to see deeper patterns of circulation than fluorescein angiography was providing which dye test could you use? |
|
Definition
| ICG - indocyanine green angiography |
|
|
Term
| which test is used to see if there are ocular leaks from the cornea, sclera or conjunctiva following injury or surgery? |
|
Definition
Seidel test
fluorescein 10% dye injected. then use a cobalt blue light
the leak will appear green |
|
|
Term
| areas of retinal ischema with oedema are AKA? |
|
Definition
|
|
Term
stages of hypertensive eye disease
severe eye disease changes associated with SBP >220 or DBP >110 |
|
Definition
1: silver wiring
2: AV nipping
3: cotton wool spots and superficial haemorrhages
4: papilloedema |
|
|
Term
| complications of hypertensive retinopathy |
|
Definition
optic neuropathy
central vein or central artery occlusions |
|
|
Term
|
Definition
fatty deposits in retinal vessels remain when HTN is rx but retinopathy resolves.
eye changes develop within 48 hours of BP rising and resolve 2-10 weeks of it being lowered. |
|
|
Term
|
Definition
may be a sign of MS
there is pain in the eye made worse on moving
there are colour changes (dyschromatopsia) particularly red desaturation
RAPD
scotoma |
|
|
Term
rx for optic neuritis?
ix in optic neuritis? |
|
Definition
methylprednisolone 1g daily for 3 days
do MRI of brain to give information on likelihood of getting MS |
|
|
Term
| eye conditions associated with diabetes |
|
Definition
cataracts
rubeiosis iridis and glaucoma
diabetic retinopathy (DR)
occular motor nerve palsies |
|
|
Term
| after medically dilating the pupil for how long can the pt not drive? |
|
Definition
|
|
Term
| which agent is used to dilate the eye in diabetic eye exam? |
|
Definition
|
|
Term
| when should monitoring for DR begin in type 1 and 2 diabetes? |
|
Definition
| from 12 years of age annually |
|
|
Term
|
Definition
glycemic control ideally around 6.5%
BP control 140/80 or 130 if end organ damage
lipid control |
|
|
Term
how is macular oedema treated
how is retinopathy treated? |
|
Definition
macular oedema: focal laser rx
retinopathy: pan retinal photocoagulation |
|
|
Term
| in clinically significant macular oedema what rx is used as adjunct to focal laser therapy? |
|
Definition
intravitreal steroids e.g.
TRIAMCINOLONE |
|
|
Term
| complications of diabetic retinopathy |
|
Definition
visual loss secondary
macular oedema
macular ischemia
vitreous haemorrhage
tractional retinal detachment |
|
|
