Fundoscopy

Question 1

What are 3 side effects to using dilating eye drops?

Answer 1

Temporary blurred vision
Temporarily more sensitive to light
Temporarily unable to drive

Question 2

What do you assess the eyelids and lashes for?

Answer 2

Lids: lumps (benign or malignant), oedema, cellulitis + entropion/ectropion.
Lashes: loss of lashes (malignant lesions) or trichiasis (inturning of lashes).

Question 3

What should you assess the cornea for?

Answer 3

Abrasion: redness, pain, watering + photophobia. Defects stain brightly with fluorescein drops + a cobalt blue light.
Ulcer: pain, watering, photophobia + a staining epithelial defect with associated haziness (infiltrate: may appear fluffy + irregular)

Question 4

What is diffuse conjunctival injection? What is it caused by?

Answer 4

Redness: dilated inflamed blood vessels across most of the conjunctiva
Bacterial, viral + allergic conjunctivitis.

Question 5

What is Circumciliary injection? What is it caused by?

Answer 5

Dilated inflamed blood vessels affecting the conjunctiva in a circular pattern around the cornea suggesting intraocular inflammation.
Keratitis, acute angle-closure glaucoma + uveitis.

Question 6

What are watery and purulent discharge from the eye associated with?

Answer 6

Watery: allergic conjunctivitis, viral conjunctivitis or normal physiological production (e.g. reaction to a corneal abrasion/foreign body).
Purulent: bacterial conjunctivitis.

Question 7

What is Hyphema? What is it the result of?

Answer 7

inferior settled layer of blood in the anterior chamber Trauma.

Question 8

What is Hypopyon? What usually causes it?

Answer 8

inferior settled layer of ‘pus’ in the anterior chamber. Severe corneal ulcers or endophthalmitis
Can occur secondary to anterior uveitis.

Question 9

What is Periorbital erythema and swelling a feature of?

Answer 9

Preseptal cellulitis (anterior to the orbital septum)
Orbital cellulitis (posterior to the orbital septum).

Question 10

What do you assess the pupil for?

Answer 10

Size: varies + depends on lighting conditions
Shape: abnormal shapes can be congenital or due to pathology. Peaked pupils in the context of trauma: globe injury.
Asymmetry in size: anisocoria May or may not be pathological

Question 11

Which pupil is abnormal:
If a pupil is more pronounced in bright light?
If pupil is more pronounced in dark?

Answer 11

Light: Large pupil= abnormal e.g. Oculomotor nerve palsy
Dark: small pupil= abnormal e.g. Horner’s syndrome

Question 12

What do you assess the lids for?

Answer 12

Position: ptosis: Horner’s syndrome (subtle) + oculomotor nerve palsy (partial to complete ptosis).
Margins: crusting + inflamed in blepharitis.

Question 13

List 4 causes of painless red eye

Answer 13

Conjunctivitis
Subconjunctival haemorrhage
Episcleritis
Dry eye

Question 14

List 6 causes of painful red eye

Answer 14

Scleritis
Uveitis
Corneal abrasion
Corneal ulcer
Acute angle-closure glaucoma (AACG)
Foreign bodies

Question 15

What does absence of the red reflex suggest in children and adults?

Answer 15

Adults: cataracts in lens blocking light, vitreous haemorrhage + retinal detachment.
Children: congenital cataracts, retinal detachment, vitreous haemorrhage + retinoblastoma.

Question 16

What may be seen in the anterior segment of the eye?

Answer 16

Fluorescein dye fluoresces yellow unde blue cobalt light filter if there is damage to corneal or conjunctival epithelium (e.g. an abrasion).
White opacities on the cornea suggest a corneal ulcer.

Question 17

Which 3 C’s are assessed when looking at the optic disc?

Answer 17

Contour: borders should be well defined
Colour: a healthy = orange-pink doughnut with a pale centre (well-perfused neuro-retinal tissue)
Cup: the pale centre of the orange-pink doughnut, due to absence of neuroretinal tissue. A cup-to-disc ratio of 0.3 is normal

Question 18

What do blurred borders of the optic disc suggest?

Answer 18

Optic disc swelling (papilloedema) secondary to raised intracranial pressure.

Question 19

What does a pale optic disc suggest?

Answer 19

Optic atrophy which can occur as a result of optic neuritis, advanced glaucoma + ischaemic vascular events.

Question 20

What does an increased cup to disc ratio suggest? When can this occur?

Answer 20

Reduced volume of healthy neuro-retinal tissue

Glaucoma.

Question 21

List 9 types of retinal pathology

Answer 21

Arteriolar narrowing
Arteriovenous nipping/nicking
Dot + blot haemorrhages
Flame haemorrhages
Cotton wool spots
Hard exudates 
Neovascularisation
Pan-retinal photocoagulation
Branch retinal vein occlusion

Question 22

Describe the appearance of the macula

Answer 22

Temporal to the optic nerve head
Yellow
Central part = “fovea” is darker than the rest of the macula

Question 23

List 3 types of macula pathology

Answer 23

Hard exudates
Drusen
Cherry-red spot