Summary

Summary Ophthalmology overview for medical finals

1 purchase

Module
Ophthalmology (MBCHB)

Institution
University Of Leicester (LE)

An overview of key conditions in ophthalmology that you need to know for medical finals, and links to clinical science to aid understanding.

[Show more]

Preview 4 out of 48 pages

View example

Uploaded on November 1, 2021
Number of pages 48
Written in 2021/2022
Type Summary

£8.49

Add to cart

Save

100% satisfaction guarantee
Immediately available after payment
Both online and in PDF
No strings attached

1

Ophthalmology
History and examination......................................................................................................................... 2
Anatomy ................................................................................................................................................ 4
Presentations ......................................................................................................................................... 8
Vision loss ........................................................................................................................................................ 8
Abnormal pupil ................................................................................................................................................ 8
Colour Blindness ............................................................................................................................................ 10
Red Eye .......................................................................................................................................................... 10
Diplopia ......................................................................................................................................................... 12
Emergencies ................................................................................................................................................... 14
Chemical injuries ...................................................................................................................................................................... 15
Deterrant spray injuries ........................................................................................................................................................... 15
Penetrating injuries .................................................................................................................................................................. 15
Orbital blowout fracture .......................................................................................................................................................... 16
Cavernous sinus thrombosis .................................................................................................................................................... 16
Corneal abrasion ...................................................................................................................................................................... 17
Corneal ulcer (infective keratitis) ............................................................................................................................................. 17
Optic neuritis ............................................................................................................................................................................ 17

Cataracts .............................................................................................................................................. 18
Ectopia Lentis ....................................................................................................................................... 19
Hypertensive Retinopathy..................................................................................................................... 19
Diabetic Retinopathy ............................................................................................................................ 19
Conjunctivitis (Pink Eye) ........................................................................................................................ 21
Subconjunctival haemorrhage .............................................................................................................. 22
Iritis (Anterior Uveitis or Iridocyclitis) .................................................................................................... 22
Uveitis (Posterior Uveitis or Choroiditis) ................................................................................................ 23
Corneal Problems ................................................................................................................................. 24
Scleritis................................................................................................................................................. 26
Episcleritis ............................................................................................................................................ 27
Glaucoma ............................................................................................................................................. 28
Primary Open-angle Glaucoma ....................................................................................................................... 29
Closed-angle/Acute Angle-Closure Glaucoma (EMERGENCY) ........................................................................... 30
Periorbital/Pre-Septal Cellulitis ............................................................................................................. 31
Orbital/Post-Septal Cellulitis ................................................................................................................. 31
Eyelid Problems .................................................................................................................................... 32
Stye ............................................................................................................................................................... 32
Chalazion/Meibomian Cyst ............................................................................................................................. 33

, 2
Blepharitis ..................................................................................................................................................... 33
Abnormal Eyelid Position................................................................................................................................ 33
Retinal Vascular Occlusions .................................................................................................................. 35
Anterior ischaemic optic neuropathy .............................................................................................................. 35
Central Retinal Vein Occlusion ........................................................................................................................ 36
Central Retinal Artery Occlusion ..................................................................................................................... 36
Retinal Detachment .............................................................................................................................. 37
Cranial Nerve Palsies and the Eye ......................................................................................................... 40
Refraction and Refractive Errors ........................................................................................................... 41
Squint (Strabismus)............................................................................................................................... 43
Thyroid Eye Disease (Grave’s Orbitopathy) ............................................................................................ 45

History and examination
History:

• Onset
• Trauma?
• Location – unilateral, bilateral, sectoral
• Pain/discomfort (gritty, FB sensation, itch, deep ache)
o FB sensation – FB, conjunctivitis, blepharitis, abrasion or ulcer
o Gritty – corneal ulcer, corneal abrasion, FB
o Lid itching – blepharitis, stye, chalazion, eczema
o Aching in eyeball – scleritis or uveitis
o Pressure sensation with N+V – acute angle closure glaucoma
o Headache – migraine, meningitis, encephalitis, cluster headache,  ICP, GCA
o Eye pain – inside the eye or outside?
• Photosensitivity/photophobia
• Redness (one/both eyes, diffuse, perilimbal, sectoral, colour – bright or dark red, vessel dilation or
haemorrhage)
• Watering +/- discharge Photopsia –
• Change in vision (blurring, halos around lights, diplopia, photopsia) flashing lights
o Blurring – generalised or central?
▪ Generalised blurring – reduction in clarity of entire field of vision. Caused by refractive error,
cataracts (diffuse, painless loss of vision), medication SEs e.g. steroids
▪ Central blurring – pathology more likely to be in the macula or optic nerve. Caused by age
related macula degeneration, diabetic maculopathy, optic disc swelling
o Floaters (blob moves about), it’s in the vitreous humour e.g. posterior vitreous detachment, vitritis,
blood
o Scotoma (blob stays in one place) - it could mean retina detachment or vascular occlusion
o Photopsia – usually due to migraine (Sx go after aura ends) or pathology in vitreous or retina
(vitreous detachment, retinal tear or detachment)
o Diplopia – clarify what they mean by double vision. Ask when they cover one eye, if one image
disappears then they have monocular diplopia
▪ Monocular – double vision is present even if one eye is closed if you cover up the normal
eye. If you cover up the eye with double vision, only one image will show and double vision
will no longer be present. This is due to cataracts, corneal abrasion, eyelid cyst

, 3
▪ Binocular – double vision is only present when both eyes are open. This is due to pathology
In the nerves, NMJ or muscles
• Contact lens wear/ glasses (ask if they have glasses for reading/driving/TV etc)
• Previous ocular history
• PMH

Examination:

• Inspect face, eyelids and area around the eyes
o Inspect periocular region for abnormalities
o Ocular adnexa – area around the eye
• Conjunctiva – check for:
o Congestion – redness (diffuse)
o Subconjunctival haemorrhage
o Discolouration – yellowing (jaundice)
• Cornea – check for:
o Normal transparency
o Haze
o Oedema
o Cloudiness
• Anterior chamber – check for:
o Hyphema – blood in anterior chamber. Causes include clotting problems and trauma
• Iris – check against the other eye:
o Haemorrhage
• Pupil – check against the other eye:
o Size
o Shape
o Reaction – light reaction and accommodation reflex

Posterior segment requires gadgets to test for abnormalities.

Visual Acuity Tests – Snellen chart (uses score of 6/6), LogMAR chart (uses score of 0.1 per line with each letter
having value of 0.02, goes down from 1.0 [6/60] to 0.0 [6/6] with better visual acuity).
• 6/12 or 0.3 is minimum driving standard by DVLA
• Children:
o Keeler Preferential Looking Cards – 8wks-12mths, uses square-wave grating of different spatial
frequencies with examiner objectively observing patient’s eyes to see if look toward grating
o Cardiff Acuity Cards – 3-18mths, simple picture at top of bottom, check if eyes looking towards top
or bottom of card
o Kay Pictures – 2-4yrs, picture-based test +/- matching cards, recorded as LogMAR, 4 pics each line at
3m
o LogMAR Keeler Book – 4yrs+, letter-based +/- matching cards, test at 3m
o Testing Low Vision – counting fingers, hand movements, perception of light, no perception of light
(if cannot perceive light)

, 4
Other Visual Tests – Ishihara colour vision test

Supraorbital nerve,
artery and vein

Anatomy

Orbital cavity – made of 4 bony walls. Cavity is a pyramidal
shape with the apex facing anteriorly.

Blood vessels and nerves of orbit – main arterial supply is via
CNIII, CNIV, CNVI ophthalmic artery and its branches. Ophthalmic veins
(superior and inferior) drain venous blood into cavernous
Maxillary
nerve,
infra-
orbital
nerve/art
ery/vein,
zygomatic
nerve,
ganglionic
branches
from Infraorbital branch of
pterygop maxillary division - CNV
alatine
ganglion

sinus, pterygoid plexus and facial vein. General sensory
innervation from the eye is via ophthalmic division of
trigeminal (Va). Special sensory vision from retina is
transmitted via the optic nerve. Motor innervation to
muscles is via CN III, IV, VI.

Eyelid – consists of skin, subcutaneous tissue, tarsal plate and muscles (palpebral part of orbicularis oculi and levator
palpebrae superioris). Also consist of glands (Meibomian and sebaceous glands that are associated with lash follicle).
Meibomian glands secrete a lipid-rich substance onto edges of lid to prevent evaporation of tear film and tear
spillage.

The benefits of buying summaries with Stuvia:

Guaranteed quality through customer reviews

Stuvia customers have reviewed more than 700,000 summaries. This how you know that you are buying the best documents.

Quick and easy check-out

You can quickly pay through credit card for the summaries. There is no membership needed.

Focus on what matters

Your fellow students write the study notes themselves, which is why the documents are always reliable and up-to-date. This ensures you quickly get to the core!

Frequently asked questions

What do I get when I buy this document?

You get a PDF, available immediately after your purchase. The purchased document is accessible anytime, anywhere and indefinitely through your profile.

Satisfaction guarantee: how does it work?

Our satisfaction guarantee ensures that you always find a study document that suits you well. You fill out a form, and our customer service team takes care of the rest.

Who am I buying these notes from?

Stuvia is a marketplace, so you are not buying this document from us, but from seller charlottetomlinson1. Stuvia facilitates payment to the seller.

Will I be stuck with a subscription?

No, you only buy these notes for £8.49. You're not tied to anything after your purchase.

Can Stuvia be trusted?

4.6 stars on Google & Trustpilot (+1000 reviews)

66184 documents were sold in the last 30 days

Founded in 2010, the go-to place to buy revision notes and other study material for 15 years now

Start selling