gradual visual loss

Question 1

generalised reduction in visual acuity with starburst around lights

Answer 1

cataracts

Question 2

peripheral loss of vision with halos around lights

Answer 2

glaucoma

Question 3

central loss of vision with crooked or wavy appearance to straight lines

Answer 3

macular degeneration

Question 4

what produces aqueous humour

Answer 4

ciliary body

Question 5

normal intraocular pressure

Answer 5

10-21

pressure is created by resistance to flow through trabecular meshwork into canal of schlemm

Question 6

what can cause cupping of the optic disc?

Answer 6

increased pressure
optic cup is made wider + deeper
optic cup > 0.5 the size of optic disc = abnormal

Question 7

investigations for glaucoma

Answer 7

goldmann applanation tanometry = gold standard
–> makes contact with cornea, applies diff pressures

non-contact tanometry
–> puff of air, used in screening

fundoscopy = disc cupping
peripheral field assessment

Question 8

open angled glaucoma

Answer 8

poor drainage of aqueous humour through trabecular meshwork, slow onset

RF = black, near-sightedness (myopia)

Question 9

presentation of open angled glaucoma

Answer 9

peripheral vision first - eventually tunnel vision
gradual onset fluctuating pain
headaches

halos appearing around lights
optic disc cupping

Question 10

criteria for beginning management of open angled glaucoma

Answer 10

pressure of 24 mmHG

Question 11

pharma management of open angled glaucoma

Answer 11

1st line = prostaglandin analogue (latanoprost)
–> increase outflow

others reduce aqueous production

• timolol (BB)
• carbonic anhydrase inhibitor

Question 12

closed angle glaucoma

Answer 12

when irisi bulges forward + seals off trabecular meshwork from anterior chamber preventing drainage

increased pressure pushes irish forward more + more

medical emergency

Question 13

medications that can predispose close angle glucoma

Answer 13

adrenergic - noradrenalin
anticholinergic - oxybutynin, solifenacin

tricyclic antidepressants - amitriptyline

Question 14

closed angle glucoma presentation

Answer 14

haxy cornea
fixed pupil size
blurred vision
headache, N+V
firm eyeball on palpation
decreased visual acuity

Question 15

initial management of closed angle glaucoma

Answer 15

pilocarpine - constrict pupils + contracts ciliary
–> opens pathway

acetazolamide - reduces production (carbonic anhydrase inhibitor)

Question 16

definitive management of close angle glaucoma

Answer 16

laser iridotomy

–> zap hole in iris

Question 17

papilloedema

Answer 17

bilateral dic swelling SECONDARY to raised intracranial pressure

(suspect space occupying lesion until proved otherwise)

Question 18

causes of papilloedema

Answer 18

space occupying lesion
malignant hypertension - always check BP

idiopathic intracranial hypertension - young females

Question 19

causes of increased cranial pressure

Answer 19

obstruction to CSF circulation - congenital malformation
overproduction of CSF - choroid plexus tumour

inadequate absorption - subarachnoid haemorrhage

Question 20

endophthalmitis

Answer 20

inflammation of inner ocntents of eye

Mx = intravitreal antibiotics injected

Question 21

classification of hypertensive retinopathy

Answer 21

Keith-Wagener
1 = mild narrowing
2 = focal constriction

3 = cotton wool, exudates, haemorrhages
4 = papillodema

Question 22

hypertensive retinopathy presentation

Answer 22

cotton wool spots
atriovenous nipping - art compress veins where they cross
exudates
haemorrhages

papilloedmea - ischaemia to optic nerve resulting in optic nerve swelling + blurring of optic disc margins

Question 23

types of macular degeneration

Answer 23

dry (90%) - gradual

wet (10%) - sudden, vascular proliferation

Question 24

macular degeneration of funducopy

Answer 24

drusen = yellw deposits of protein + lipids

Question 25

diagnosis of wet macular degeneration

Answer 25

optical coherence tomography
–> atrophy of retinal pigment epithelium, degeneration of photoreceptors

(shows cross section ofretina layers)

Question 26

age related macular degeneration presentation

Answer 26

central vision loss - scotoma (blind spots/distortions)
wavy appearance to straight lines

(wet more acute - loss of vision over days)

Question 27

fluorescein angiography

Answer 27

given fluorescin contrast + photgraph retina to look in detail at the blood supply to retina

–> shows any oedema + neovascularisation

(2nd line diagnosis for wet ARMD after OCT)

Question 28

management of wet ARMD

Answer 28

anti-VGEF meds
ranibizumab, bavacizumab

injected directly into vitreous chamber once a month
slow + reverse progression

Question 29

management of dry ARMD

Answer 29

lifestyle measures - smoking, bp, vitamin supplementation

social support
magnifiers

Question 30

stages of diabetic retinopathy

Answer 30

1. non proliferative
2. proliferative
3. diabetic maculopathy

Question 31

diabetic retinopathy on fundoscopy

Answer 31

hard exudates
microaneurysms
blot haemorrhages
neovascularisation
cotton wool spots

Question 32

what causes cotton wool spots

Answer 32

damage to nerve fibres

Question 33

pathophysio of diabetic retinopathy

Answer 33

hyperglycaemia leads to damage to retinal small vessels + endthelial cells
damage to wall leads to microaneurysms, venous beading

increased vascular permeability leads to leakage - blot haemmorhages + hard exudates

Question 34

management of diabetic retinopathy

Answer 34

yearly review

NP = observe, photocoag in severe

P = panretinal laser photpcoagulation, intravitreal VEGF inhibitors, vitereoretinal surgery in severe

maculopathy = intravitreal VEGF inhib if change in visual acuity

Question 35

difference between proliferative and non-proliferative diabetic retinopathy

Answer 35

prolif = retinal neovascularisation - may lead to virous haemorrhage

–> patient may complain of floaters or sever visual loss