2021

Question 1

Management of uveitis

Answer 1

Prednisolone drops, cylopentale dilating drops
Referral to rheum if appropriate
Consider CMV/sarcoid/VZV
Talk to consultant
Ophthal follow up
If panuveitis - then specific treatment for TB, syphilis, toxo. Likely loss of vision

Question 2

Management of endophthalmitis

Answer 2

tap and inject - culture/antibiotics, then oral tablets and drops, usually an hourly regime so may be difficult at home so admit
if systemic then systemic steroids
CT orbit

Question 3

Management of Retinal Detachment

Answer 3

check for history of trauma/fhx

referral to VR may need surgery

Question 4

management of refractive surprise

Answer 4

hospital incident reporting system
offer a second opinion
may need surgery - laser/IOL exchange/piggyback

Question 5

management of CRVO

Answer 5

risk facrots: age, DM, IOP, BP, COCP, clotting disorders, hypercholesterolaemia, smoking
Imaging: FFA/OCT
Follow up with ophthal
Red flags for vision
AntiVEGF if macular oedema
unlikely to get back to normal but may improve a bit

Question 6

management of CRAO

Answer 6

Risk factors
Aspirin
Neurology/TIA clinic
Imaging - ct head/carotid US
AntiVEGF 
Ocular massage/AC paracentesis
severe prognosis

Question 7

management of acute angle closure glaucoma

Answer 7

check current illness/trauma/surgery
Topical drops
PO acetazolamide, if vomiting IV
Laser iriodotomy once cornea clears

Question 8

management of chronic glaucoma

Answer 8

tonometry, gonioscopy, OCTs, VF
topical drops
review in 2 months then 3-4 months
laser and surgery
Follow up in eye clinic.

Question 9

management of optic neuritis

Answer 9

may or may not be due to MS
acuity/colour
speak to consultant likely will need an MRI scan
consider steroids if bilateral but only reduce time of symptoms
will likely get a bit worse before it gets better

Question 10

management of retinoblastoma

Answer 10

chemo, radio,
CT/MRI/US
admit

Question 11

management of sarcoidosis

Answer 11

uveitis/snow balls/cataract/glaucoma

steroid drops topically, may need systemic if bilateral

Question 12

management of neurofibromatosis

Answer 12

signs: cafe au lait spots, lisch nodules, neurofibromas, optic nerve gliomas
sometimes may need surgical removal
specialist centre in St Thomas/Manchester

Question 13

management of myasthenia gravis

Answer 13

can cause double vision, eyelid lagging, and difficulty with speech/chewing/limb weakness
take choking or breathlessness seriously
tensilon test
bloods for antibodies
acetylcholinesterase inhibitors - pyridostigmine
steroids
medical team - neuro, may want to do a CT

Question 14

management of ambylopia

Answer 14

acuity, cylopegic refraction, pupils, AC exam, fundus

Management with glassess/patch/surgery

Question 15

management of MS

Answer 15

neuro exam, exercise, vaccinations, spacitiy, physio

Question 16

management of vitreous haemorrhage

Answer 16

avoid strenuous exercise, keep head up 
US scan
wait for blood to settle may take 1 week
if DM then refer
may need VR surgery
ask about trauma
safety net
if new vessels then VEGF

Question 17

papilloedema

Answer 17

how much has your optician told you about this?
the nerves in the back of your eye appear swollen, these nerves are connected to your brain and are needed for vision. This may be for a variety of reasons one being an imbalance of fluid in your head or from something within your head causing increased pressure.

Question 18

management of TED

Answer 18

symptoms: eye pain, redness, pain on movement, proptosis, thyroid symptoms
bloods for TFTs and autoantibodies
MRI/CT orbit
orthoptic review
treatment with carbimazole

Question 19

management of ARMDs

Answer 19

counselling
refraction
amsler grid
smoking cessation
antioxidants
registration
red flags for wet ARMDs

Question 20

management of GCA

Answer 20

bloods for ESR, CRP, FBC
IV steroids then PO
discuss TAB
discuss with consultant
Refer to rheum
Follow up in eye clinic

Question 21

management of 3rd nerve palsy

Answer 21

causes: aneurysm, tumour, trauma, vasculitis
Ix: MRI/CT, vascular risk factors, Hess chart, visual fields

Question 22

management of sarcoidosis

Answer 22

uveitis, granulomas, snow balls

bloods, cxr, referral to resp, ongoing eye follow up