Eyes

Question 1

Conjunctivitis

Answer 1

A: Bacterial, viral, chlamydia, allergic, toxic/drops.

S: Red eye, purulent or watery discharge, itchy, gritty sticky.

D: If severe/recurrent then conjunctival swab.

T: Topical antibiotics if bacterial.

Question 2

Subconjunictival haemorrhage

Answer 2

A: Blood under conjunctiva from trauma, valsalva, HTN, bleeding disorders, anitocoagulants, idiopathic or orbital mass.

S: Blood under conjunctiva, red eye.

D: If other orbital signs, CT head. If recurrent, check for coagulopathy.

T: Nil.

Question 3

Episcleritis

Answer 3

A: Usually idiopathic, common in young adults.

S: inflammation, engorged vessels, painful red eye.

D: -

T: Usually self-limiting, topical steroids for comfort.

Question 4

Scleritis

Answer 4

A: Often associated with systemic connective tissue disease, rheumatoid arthritis.

S: inflammation, engorged vessels, severe eye pain, red eye, may have reduced vision.

D: -

T: Oral NSAIDs/steroids.

Question 5

Keratitis

Answer 5

A: Corneal inflammation: viral (herpes), bacterial, fungal, acanthamoeba.

S: Ulcer/epithelial defect (check for dendrite in herpes simplex infection), corneal opacity, discharge, hypopynon, painful red eye, maybe a skin rash (with herpes zoster).

D: corneal scrape

T: Topical antibiotics/anti-fungals/antivirals

Question 6

Acute angle closure glaucoma

Answer 6

A: Angle closure due between iris and trabecular meshwork which impairs aqueous outflow.
Often due to pupil block.

S: Raised IOP, closed angle, conjuncitval infection, fixed mid-dilated pupil, hazy cornea, painful red eye, blurred vision, nausea, vomiting, headache.

D: Check IOP, gonioscopy

T: Urgent opthalmology referral, laser iridotomy.

Question 7

uveitis (acute iritis)

Answer 7

A: Inflammation of uveal tract (iris, cilliary body, choroid). Often idiopathic, can be associated with systemic disease, infection or trauma.

S: Keratitic precipitates, floaters, blurred vision, conjuncitval infection, painful red photophobic eye.
Signs include keratitic precipitates, dilated ciliary vessels and cells in anterior chamber

Anterior = pain/redness and photophobia, but may also get floaters, blurred vision. (most common)
Intermediate = floaters and blurred vision
Posterior = vision problems
D: -

T: Topical steroids and mydriatics.

Question 8

Central retinal artery occlusion

Answer 8

A: Occlusion leads to hypoxia of retina. Usually atherosclerotic but can be embolic or inflammatory.

S: White, swollen retina, cherry red spots at macula, RAPD. Causes sudden, unilateral, painless vision loss.

D: -

T: Occular massage, reduce IOP, rule out GCA.

Question 9

Central retinal vein occlusion

Answer 9

A: Diabetes, HTN, hypercholesterolaemia, glaucoma.

S: Retinal haemorrhages, tortuous veins, optic disc swelling, cotton wool spots.
Painless loss of vision in one eye.

D: B scan if no retinal view.

T: Reduce IOP, photocoagulation if neurovascularisation.

Question 10

Giant cell (temporal) arteritis

Answer 10

A: Arterial inflammation and ischaemia of optic nerve head.

S: RAPD, swollen pale disc, thick, tender, non-pulsatile temporal artery.
Sudden vision loss, scalp tenderness, headache, jaw claudication.

D: Temporal artery biopsy.

T: High dose steroids.

Question 11

Vitrous haemorrhage

Answer 11

A: Diabetic retinopathy, posterior vitreous detachment, retinal tear/detachment, retinal vein occlusion, trauma, cancer.

S: Blood within vitreous, obscured fundal view, sudden, painless loss of vision.

D: B scan if no retinal view.

T: May require surgical removal of blood (vitrectomy)

Question 12

Posterior vitreous dettachment

Answer 12

A: Ageing process, may occur earlier in myopia, trauma, inflammation, connective tissue disease.

S: Weiss ring, visible posterior hyaloid face. Flashes of light, floaters.

D: -

T: Monitor and warn of symptoms of retinal detachment (a complication)

Question 13

Retinal detachment

Answer 13

A: Retinal tears, traction, accumulated fluid in subretinal space.

S: Elevation of retina from pigment epithelium, anterior pigmented cells, vitreous hemorrhage, tears in retina.
Flashes of light, floaters, black curtain/shadow moving across vision, visual loss.

D: B scan

T: Surgical repair

Question 14

Optic neuritis

Answer 14

A: Inflammation of optic nerve, most common cause is demyelination.

S: Reduced visual acuity, reduced colour vision, field loss, retrobulbar pain.

D: Consider MRI, LP.

T: IV steroids.

Question 15

Cataract

Answer 15

A: Opacity of lens from age, sunlight, alcohol, dehydration, corticosteroid use, diabetes.

S: Opacity of lens, reduced vision, glares.

D: -

T: Surgical (phacoemulsification and intraocular lens insertion)

Question 16

Chronic open-angle glaucome

Answer 16

A: Optic neuropathy, visual field loss, raised ICP, trauma, uveitis, congenital, idioptathic.

S: Usually asymptomatic. Disc cupping, raised IOP, visual field defect, tunnel vision occurs late.

D: Visual field test.

T: Topical drops (eg prostagladin agonists, beta-blockers).

Question 17

CMV retinitis

Answer 17

A: Infection (cytomegalovirus) associated with HIV/immmunosupression

S: Retinal haemorrhage and whitish areas, floaters, visual reduction.

D: CD4 count,
.
T: HAART, antivirals (eg gangliclovir)

Question 18

Papilloedema

Answer 18

A: Optic disc swelling due to raised to ICP, can be from intracranial mass, or idiopathic intracranial HTN.

S: Swollen optic discs/blurred/elevated disc margins.
Reduced visual acuity, field defects, headache, nausea, vomiting.

D : -

T: Depends on cause. Weight loss is recommended for idiopathic intracranial HTN, masses may need surgery.

Question 19

Stye (external hordeolum)

Answer 19

A: Staphylococcal infection

S: Eyelid lump, tender

D: -

T: Eyelid epilation, warm compress, antibiotics

Question 20

Entropion/Extropion

Answer 20

A: Inversion/Eversion of eyelid

T: Botulinum toxin or surgery

Question 21

Keratoconjunctivitis sicca (dry eye)

Answer 21

A: Tear film dysfunction: deficient tear production

S: Irritation, redness, compensatory watering

D: Schirmer test shows reduced wetting

T: Artificial tears, lubricating ointment

Question 22

Orbital/Preseptal cellulitis

Answer 22

A: Streptococcus pneumoniae, staph aureus, strep pyogenes, haemophilus influenzae

S: Orbital: fever, pain, lid swelling/erythema, proptosis, restricted eye movement, diplopia and optic nerve dysfunction.
Preseptal: Same as above, but no proptosis, no restricted eye movements, no optic nerve dysfunction.

D: CT if suspected orbital/sinus disease

T: If orbital, start IV antibiotics - may need surgical drainage.
If septal and systemically unwell, oral antibiotics.
Antibiotics can be penicillins or cephalosporins - vancomycin if resistant

Question 23

Herpes zoster opthalmicus (eye shingles)

Answer 23

A: Varicella zoster virus reactivation

S: Rash and neuralgia involving opthalmic branch of trigeminal nerve. Hutchinson’s sign (skin lesions at the tip or side of the nose)

D: -

T: Systemic antivirals (aciclovir)