Differential diagnosis of blurred vision

Question 1

Acute conditions causing blurred, painful red eye:

Answer 1

Corneal ulcer
Uveitis
AACG

Question 2

Acute conditions causing blurred, painless white eye:

Answer 2

CRAO
CRVO
Age related macula degeneration (wet)
AIOP/non-AIOP
Retinal detachment

Question 3

Chronic conditions causing blurred vision:

Answer 3

Diabetic retinopathy
Diabetic maculopathy
Glaucoma
Cataract
Age related macula degeneration (dry)

Question 4

Important risk factor for corneal ulcer:

Answer 4

Contact with the cornea e.g. contact lens/trauma/FB

Question 5

Symptoms of corneal ulcer:

Answer 5

Unilateral acute pain
Red eye
FB sensation
Decreased VA
Photophobia
Watering

Question 6

Management of corneal ulcer:

Answer 6

Corneal scrapings for cultures and g stain

Hourly topical abx: ofloxacin

Question 7

Signs of corneal ulcer:

Answer 7

White corneal infiltrate
Diffuse conjunctival injection
Mucopurulent discharge
Hypopyon
Anterior chamber cells (slit-lamp)
Progressive ulceration

Question 8

Complications of corneal ulcer if untreated:

Answer 8

Corneal perforation

Endopthalmitis

Question 9

Signs of anterior uveitis:

Answer 9

Circum-corneal injection
Keratic precipitates
Watery discharge
Possible constricted/distorted pupil
Hypopyon
(present in AI conditions and infections like herpes zoster)

Question 10

Symptoms of anterior uveitis:

Answer 10

Uni/bilateral red painful eye
Normal to mildly reduced VA
Photophobia
Tearing
Attack is several days to 6 weeks

Question 11

Complications of anterior uveitis:

Answer 11

Posterior syenchiae
Secondary glaucoma
Secondary cataract

Question 12

Treatment of anterior uveitis:

Answer 12

Topical steroids and cycloplegia

Question 13

Symptoms of AACG:

Answer 13

Unilateral loss of vision (6/36 or worse)
Halos
Red and painful eye
N+V

Question 14

Signs of AACG:

Answer 14

Reduced VA
Corneal oedema
Raised IOP
Oval unreactive pupil
Hypermetropia
Previous intermittent symptoms

Question 15

Signs of age-related macula degeneration (wet):

Answer 15

Grey/green lesion consisting of new blood vessels (choroidal neovascularisation)
Yellow exudates
Retinal haemorrhage

Question 16

Treatment of age-related macula degeneration (wet):

Answer 16

Regular intravitreal injections of anti-VEGF

Lifestyle advice + smoking cessation

Question 17

Associations of diabetic retinopathy:

Answer 17

CN palsies III, IV and VI

pupil usually spared in diabetic CN III palsy

Question 18

Signs of diabetic retinopathy:

Answer 18

Aneurysms
Dot and blot haemorrhages
Hard exudates (lipid) and cotton wool spots (soft exudate)
Retinal and macular oedema
Diplopia
New vessels in disc and retina and iris rubeosis

Question 19

What causes sight loss in diabetic retinopathy?

Answer 19

Macular oedema
Macular ischaemia
Vitreous haemorrhage
Tractional retinal detachment
Cataract (do red reflex)

Question 20

Treatment of diabetic retinopathy:

Answer 20

Focal macular laser to reduce macular oedema
PRP to treat new vessel formation
Intravitreal anti-VEGF injections (e.g. ranbizumab)
Vitrectomy

Question 21

What is the purpose of a vitrectomy in diabetic retinopathy?

Answer 21

Remove vitreous haemorrhage

Relieve tractional retinal detachment

Question 22

Presentation of glaucoma:

Answer 22

Disc cupping and nerve head damage
Loss of peripheral VF
Increased IOP (>21mmHg)

Question 23

What is normal tension glaucoma?

Answer 23

Optic nerve cupping and VF loss despite normal IOP

Question 24

Classic VF defect in glaucoma?

Answer 24

Arcuate scotoma - defect progressing from the disc, around the macula with preserved central vision

Question 25

First line treatment in glaucoma:

Answer 25

Reduce aqueous humour production with beta blocker, carbonic anhydrase inhibitor or alpha agonist drops

Question 26

Glaucoma treatment to increase aqueous outflow:

Answer 26

Prostaglandin analogues

Question 27

Surgery in glaucoma:

Answer 27

Laser open trabecular meshwork/new route

Question 28

Cataract causes which ammetropia?

Answer 28

Myopia

and glare

Question 29

Key exams in cataract:

Answer 29

Decreased red reflex
Difficult view of fundus
Decreased VA

Question 30

RFs for cataract:

Answer 30

Smoking, UV exposure, age
Congenital/birth trauma/maternal rubella or toxoplasmosis
Diabetes
Trauma
Corticosteroids
Eye disorders e.g. uveitis

Question 31

Different cataract presentations:

Answer 31

Nuclear (dark yellow, age)
Posterior sub-scapular
Cortical (spokes, water clefts/vacuoles)

Question 32

Treatment of cataract:

Answer 32

Surgical removal of lens and insertion of an artificial intraocular lens

Question 33

What is the leading cause of blindness in the western world?

Answer 33

Age-related macula degeneration (dry)

Question 34

Characteristics of dry AMD?

Answer 34

Progressive atrophy of macula retinal pigment epithelium cells causing gradual loss of central vision and reduction in VA
Peripheral vision is retained

Question 35

Signs of dry AMD:

Answer 35

Drusen - tiny yellow accumulations under near-retina from the photoreceptors
Mottled appearance of macula
Marked central atrophy (if advanced)

Question 36

Investigations for dry AMD:

Answer 36

Dilated fundus exam

Question 37

Investigation for wet AMD:

Answer 37

Fluorescein angiography

Question 38

Prognosis for dry AMD:

Answer 38

Slow deterioration in vision as there is no treatment

May progress to wet