Clinical Ophthalmology Flashcards

24 sample cards from the Ophthalmology deck

Sampled from the end of the deck, so these are different cards from the ones shown on the syllabus page.

1. What are the categories of regular astigmatism based on focal line positions relative to the retina?

   Simple (one focal line on retina, other in front or behind), compound (both in front = myopic, or both behind = hypermetropic), and mixed (one in front and one behind the retina).

2. What is presbyopia and its underlying cause?

   Presbyopia is the age-related loss of accommodation (typically from ~40 years) due to increasing lens sclerosis/hardening and reduced ciliary muscle efficiency, causing difficulty with near vision; corrected with convex reading lenses.

3. How does accommodative amplitude change with age, and roughly what near add is needed at 60?

   Amplitude of accommodation declines steadily (~$14\ \text{D}$ at 10 years to <$2\ \text{D}$ by 60). By age 60 a near add of about $+2.50\ \text{to}\ +3.00\ \text{D}$ is typically required.

4. What is the clinical triad of the accommodation (near) reflex?

   1) Accommodation (lens thickening via ciliary contraction), 2) Convergence of the eyes (medial recti), 3) Miosis (pupillary constriction).

5. Compare the discharge and key features of bacterial, viral and allergic conjunctivitis.

   Bacterial: purulent/mucopurulent discharge, sticky lids. Viral: watery discharge, follicles, preauricular lymphadenopathy, often bilateral/contagious. Allergic: watery/stringy discharge, marked itching, papillae, associated atopy.

6. What is the typical management of acute bacterial conjunctivitis?

   Often self-limiting; topical broad-spectrum antibiotics (e.g., chloramphenicol or fluoroquinolone drops), lid hygiene, and strict hygiene measures to prevent spread. Avoid steroids unless indicated.

7. What is ophthalmia neonatorum and its two most important causes by timing?

   Conjunctivitis in the first month of life. Gonococcal (Neisseria gonorrhoeae): hyperacute, days 1–5, sight-threatening. Chlamydial: days 5–14, most common; both acquired during vaginal delivery.

8. What is a pterygium and how does it differ from a pinguecula?

   Pterygium is a triangular fibrovascular conjunctival growth that crosses the limbus onto the cornea (can affect vision/astigmatism). Pinguecula is a yellowish conjunctival degeneration that does NOT cross the limbus onto the cornea. Both are UV/sun-related.

9. What is keratitis and what are its major causative categories?

   Keratitis is inflammation of the cornea. Causes: bacterial, viral (herpes simplex/zoster), fungal, protozoal (Acanthamoeba, esp. contact-lens wearers), and non-infectious (exposure, autoimmune).

10. What is the classic corneal sign of herpes simplex epithelial keratitis, and which drug is avoided?

    A branching dendritic ulcer that stains with fluorescein. Treat with topical antivirals (e.g., acyclovir/ganciclovir); topical corticosteroids are avoided in active epithelial disease as they worsen it.

11. Define a corneal ulcer and its cardinal clinical features.

    A corneal ulcer is an epithelial defect with underlying stromal inflammation/necrosis. Features: pain, photophobia, lacrimation, redness (ciliary injection), reduced vision, a fluorescein-staining defect, and possibly a hypopyon.

12. What is a hypopyon and what does it signify in corneal ulcer?

    A hypopyon is a layer of inflammatory cells (sterile pus) in the inferior anterior chamber forming a horizontal fluid level; it indicates severe intraocular inflammation, often accompanying a serious corneal ulcer.

13. What is the first-line investigation for an infective corneal ulcer before treatment?

    Corneal scraping for Gram stain, KOH/Giemsa smear, and culture (bacterial, fungal, Acanthamoeba) to identify the organism and guide targeted antimicrobial therapy.

14. What are corneal dystrophies and their general characteristics?

    Corneal dystrophies are inherited, usually bilateral and symmetrical, progressive, non-inflammatory corneal opacities not related to environmental/systemic causes, classified by the corneal layer involved (epithelial, stromal, endothelial).

15. Name the corneal dystrophy affecting the endothelium and its main consequence.

    Fuchs endothelial dystrophy: progressive endothelial cell loss with guttae, leading to corneal oedema, stromal/epithelial swelling, and reduced vision; may require endothelial keratoplasty (DSEK/DMEK).

16. Define cataract and its most common type/cause.

    Cataract is any opacity of the crystalline lens or its capsule. The most common cause is age-related (senile) cataract; morphological types include nuclear, cortical, and posterior subcapsular.

17. List common causes of cataract besides ageing.

    Diabetes mellitus, corticosteroid use, trauma, intraocular inflammation (uveitis), congenital (e.g., rubella, galactosemia), radiation, and metabolic disorders.

18. What is the definitive treatment of cataract and the most common surgical technique?

    Surgical removal of the opaque lens with intraocular lens (IOL) implantation. Phacoemulsification (ultrasonic fragmentation and aspiration through a small incision) is the most common modern technique.

19. What is the difference between a subluxated and a luxated (dislocated) lens?

    Subluxation: partial displacement with the lens still within the pupillary area, some zonules intact. Luxation (complete dislocation): total displacement into the anterior chamber or vitreous with all zonules broken.

20. Name systemic conditions classically associated with ectopia lentis (lens dislocation) and their typical direction.

    Marfan syndrome (usually superotemporal), homocystinuria (usually inferonasal), and Weill-Marchesani syndrome; also trauma (most common overall cause).

21. What defines primary open-angle glaucoma (POAG)?

    A chronic, progressive optic neuropathy with an open, normal-appearing anterior chamber angle, characterised by increased cup-to-disc ratio, retinal nerve fibre loss, and corresponding visual field defects, usually (not always) with raised intraocular pressure.

22. What is the normal range of intraocular pressure and the level often taken as significant in glaucoma?

    Normal IOP is about $10\ \text{to}\ 21\ \text{mmHg}$ (mean $\approx 15\ \text{mmHg}$). Pressures consistently above $21\ \text{mmHg}$ are considered raised, though normal-tension glaucoma can occur within the normal range.

23. What is the characteristic visual field defect pattern in POAG?

    Early: paracentral scotomas and nasal step; progression to arcuate (Bjerrum) scotomas, then tunnel vision with sparing of central acuity until late; the peripheral field is affected first.

24. What are the main classes of medical therapy to lower IOP in POAG and their mechanisms?

    Prostaglandin analogues (increase uveoscleral outflow, first-line), beta-blockers and carbonic anhydrase inhibitors and alpha-2 agonists (reduce aqueous production), and pilocarpine (increases trabecular outflow). Laser trabeculoplasty or trabeculectomy if medication fails.

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