Abnormal VS Normal

Question 1

Primary open-angle glaucoma management

Answer 1

Routine referral

Question 2

Primary open-angle glaucoma signs

Answer 2

Loss of ISNT rule
Disc asymmetry >0.2
Vertical enlargement of cup
large disc>0.7
Focal narrowing or notching of NRR
Visible lamina cribosa pores
Pallor
Saucerisation
Baring of circumlinear vessels
Bayonetting
Collaterals
Disc haemorrhages
Peripapillary atrophy
RNFL thinning
Flame shaped haemorrhage at disc rim

Question 3

Primary open-angle glaucoma risk factors

Answer 3

Ocular hypertension
older age
family history in first degree realtive
people of west african descent including african-caribbean (onset at younger age)
thinning corneal thickness
high myopia>4D
diabetes
systemic hypertension and other vascular risk factors

Question 4

Primary open-angle glaucoma DDX

Answer 4

ocular hypertension
tilted optic disc
physiological cupping
disc drusens
anterior ischaermic optic neuropathy (AION)
secondary glaucoma
optic atrophy
any condition with glaucoma like VF defect

Question 5

Ocular hypertension signs

Answer 5

IOP>21
normal VF
no ONH damage
no other pathology to expalin high IOP
open drainage angle of gonioscopy with normal appearance
asymptomatic

Question 6

Ocular hypertension Risk factors

Answer 6

High blood pressure
Race (Afro-Caribbean)
Ageing

Question 7

Ocular hypertension DDX

Answer 7

POAG
PACG
Secondary ACG

Question 8

Normal tension glaucoma signs/symptoms

Answer 8

IOP>21
VF defect (paracentral scotoma)
Abnormal ONH (glaucomatous optic neuropathy)
peripheral vasospasm
symptoms: migraine/asymptomatic

Question 9

Normal tension glaucoma DDX

Answer 9

POAG
intermittent ACG
secondary OAG
Ischaemic optic neuropathy

Question 10

Normal tension glaucoma risk factors

Answer 10

hypotension
thinner corneas
glaucomatous optic neuropathy
gender (female x2 risk than men)

Question 11

Acute angle closure glaucoma DDX

Answer 11

Red eye: acute conjunctivitis, uveitis, keratitis, trauma
High IOP: inflammation, neovascular glaucoma, secondary angle closure glaucoma

Question 12

Acute angle closure glaucoma risk factors

Answer 12

positive family history of ACG
hyperopia/short axial length
ethnicity (Chinese)
age (over 40)

Question 13

Optic neuritis signs

Answer 13

rapid loss of vision in one eye
retro-orbital ocular pain
visual loss is made worse by heat or exercise

Question 14

optic neuritis symptoms

Answer 14

RAPD
VA loss mild to severe
central scotoma
severely impaired colour vision
normal fundus/blurred disc margins
swollen veins

Question 15

Optic neuritis management

Answer 15

urgent referral

Question 16

optic neuritis risk factors

Answer 16

young age
women 3x more than men
multiple sclerosis
viral infection
tuberculosis
syphilis (STI)

Question 17

Optic neuritis DDX

Answer 17

arteritic anterior ischaemic optic neuropathy
non arteritic anterior ischaemic optic neuropathy
papilloedema

Question 18

Papilloedema signs (mechanical)

Answer 18

elevation of ONH
blurring of optic disc margins
filling of the physiological cup
oedema of peripapillary RNFL
retinal or choroidal folds

Question 19

Papilloedema signs (vascular)

Answer 19

hyperaemia of the disc
loss of spontaneous venous pulsation and venous congestion
papillary/peripapillary haemorrhages
hard exudates
cotton wool spots
enlarged blind spot
diplopia (6th CN palsy)

Question 20

Papilloedema management

Answer 20

urgent referral

Question 21

papilloedema symptoms

Answer 21

severe headache
nausea
explosive vomitting
normal vision/sudden blanking of vision lasting seconds
brain tumours
meningitis
hydrocephalus
pseudo-tumour cerebri

Question 22

papilloedema DDX

Answer 22

Optic disc drusens
malignant hypertensive
anterior ischaemic optic neuropathy
optic neuritis
central retinal vein occlusion
pseudopapilloedema

Question 23

hypertensive retinopathy signs

Answer 23

focal arteriolar narrowing
arteriosclerotic changes
nerve fibre haemorrhages (flame-shaped)
cotton wool spots
disc oedema
macular star of exudates

Question 24

hypertensive retinopathy DDX

Answer 24

diabetic retinopathy
central retinal vein occlusion
radiation retinopathy