Common Conditions of the Eye 2

Question 1

What is the two pathologies of the cornea

Answer 1

Inflammatory
- corneal ulcers

Non inflammatory
- dystrophies

Question 2

What is the aetiology of corneal ulcers

Answer 2

Infectious

Trauma

Corneal degeneration

Dystrophy

Question 3

Why is it important to have aggressive management in dealing with infectious corneal ulcers

Answer 3

Prevent the spreading of infection

as if spreads below bowman capsule the healing process will involve scar tissue formation

Question 4

What is the cause of dystrophies of the cornea

Answer 4

Due to opacifying
Genetics
Accumulation of lipids

Question 5

What is the clinical presentation of corneal dystrophy

Answer 5

Happens in first to fourth decade

Decreased vision - bilateral

starts in one layer of the cornea and spreads to other

Question 6

What is cataract

Answer 6

Lens opacification occurring with old age

Question 7

What is the 3 pathologies that lead to cataract

Answer 7

New fibres formed from Basement membrane compact around old fibres - opaque

No blood supply dependant on nutrition from diffusion

absorbs harmful UV rays to protect the retina

Question 8

What is the name of childhood cataract

Answer 8

sutural and zonular - formed due to the opacification of certain zones on the lens in utero

Question 9

What is a differential diagnosis to cataract

Answer 9

Nuclear sclerosis

cloudy appearance but doesn’t affect vision

Question 10

Why is it necessary to manage cataract

Answer 10

as if left untreated will result in loss of vision

Question 11

How is cataract managed

Answer 11

Surgery(day case) small incision to open lens capsule  cataractous lens removed by emulsification (phacoemulsification)
then Intra ocular lens is placed in the posterior chamber capsular bag

Question 12

What is the two types of glaucoma

Answer 12

Open angle

Closed angle

Question 13

What is the clinical presentation of glaucoma

Answer 13

Bilateral

Asymptomatic for a long period of time

Picked up on routine eye exam

Question 14

What is glaucoma

Answer 14

Raised intraocular pressure resulting in field of vision loss

Question 15

What is the pathology of open angle glaucoma

Answer 15

Trabecular meshwork isn’t working leading to the increase of intraocular pressure this causes damage to nerve fibres on surface of retina, nerve fibres eventually die out/lost resulting in blindness

Question 16

What is the appearance on the ophthalmoscopy for glaucoma

Answer 16

optic disc appears unhealthy, pale and cupped

Question 17

What is the triad of signs that lead to the diagnosis of glaucoma

Answer 17

Raised IOP
Visual field defects
Optic disc changes on ophthalmoscopy

Question 18

What is the management for increased IOP

Answer 18

Eye drops to decrease IOP
- Prostaglandin analogues
- Beta-blockers
- Carbonic anhydrase inhibitors
Laser trabeculoplasty
Trabeculectomy surgery

Question 19

What is the symptoms of angle closure glaucoma

Answer 19

Sudden onset, painful,
vision lost/ blurred
headaches (often confused with migraine

Question 20

What is seen on examination of closed angle glaucoma

Answer 20

Red eye,

Cornea often opaque

Question 21

Why is the cornea obliwue in closed angle glaucoma

Answer 21

Raised IOP drive fluid into cornea

Question 22

What affect does angle closed glaucoma have on the pupil and iris anterior chamber

Answer 22

Pupil Mid-dilated

iris is pushed forwards so the anterior chamber is shallow

Question 23

What is the pathology of closed angle glaucoma leading to increased intraocular pressure

Answer 23

Predisposed eye as aqueous produced doesn’t freely go from posterior chamber exit through the pupil

Pupil is mid dilated causing periphery of iris to crowd and obstruct outflow

so aqueous humour fail to reach trabecular mesh work/AC

Then the iris sticks to pupillary boarder and balloons anteriorly obstructing angle

This raises the intraocular pressure driving aq humour into the cornea

Question 24

What are the two methods an acute episode of glaucoma (closed angle0 is managed

Answer 24

Decrease IOP

Iridotomy - laser

Question 25

What treatment is used to decrease IOP

Answer 25

IV infusion with or without oral therapy – carbonic anhydrase inhibitors (acetazolamide)

Analgesics,

antiemetics

Constrictor eye drops – pilocarpine

Beta-blocker drops - timolol

Steroid eye drops (dexamethasone)

Question 26

How does Iridotomy work to treat acute glaucoma

Answer 26

A laser in bothers to bypass blockage

Question 27

What type of glaucoma presents as an emergency

Answer 27

Angle closure glaucoma

Question 28

What is Uvetits

Answer 28

Inflation of the uvea - vascular layer of the eyeball leading to leakage of blood vessels

Question 29

What is the three types of uveitis and their locations

Answer 29

Anterior uveitis – iris with or without ciliary body inflammed

Intermediate uveitis – ciliary body inflammed

Posterior uveitis – choroid inflammed

Question 30

What is the aetiology of uveitis

Answer 30

Isolated illness

Non-infectious autoimmune causes eg HLA B27

Infectious causes e.g. TB

Associated with systemic diseases – eg: ankylosing spondylosis

Question 31

The presence of HLA-B27 predisposes to what type of uveitis

Answer 31

anterior uveitis

Question 32

What is the pathophysiology of anterior uveitis

Answer 32

Leaks plasma and white blood cells into aqueous humour

Question 33

What is the clinical appearance of anterior uveitis

Answer 33

eye is red
painful
Visual loss

Question 34

Where might cells settle in anterior uveitis from the anterior chamber

Answer 34

Cells in the anterior chamber settle inferiorly - hypopyon

Question 35

What can be seen on examination of anterior uveitis

Answer 35

Hazy anterior chamber and cells deposit at the back of the cornea

Question 36

What can been seen on examination of intermediate uveitis

Answer 36

The ciliary body is inflamed and leaks cells and proteins

This leads to a hazy vitreous

Question 37

What is the symptom of intermediate uveitis

Answer 37

Patient complains of floaters or hazy vision

Question 38

What is the pathophysiology of posterior uveitis and what symptoms does this cause

Answer 38

inflammation frequently spreads to the retina causing blurred vision