last day Ophthal

Question 1

Assessment of glaucoma

Answer 1

corneal thickness
gonioscopy
tonometry
visual fields/acuity
fundoscopy
FHx

Question 2

Management of ARMD

Answer 2

counselling on condition - driving, maintenance of peripheral vision
optimise cataracts, DM, other ocular issues
low vision aids
register as low sight
antioxidant can slow progression but as yet no definitive cure
If suddenly worsens need to seek help - wet ARMD can give

Question 3

Retinal vein occlusion Ix/Mx

Answer 3

Clotting, FBC, U&Es, review of other eye, lipid and glucose
fundoscopy
can give prophylactic low dose aspirin
can lead to macular oedema and neovascularisation so follow up with OCT and laser/anti-VEGF

Question 4

acute glaucoma management

Answer 4

refer to ophthalmology
systemic acetazolamide/beta blocker if not CI
antiemetics/analgesia as required
check for pupil block if so then pilocarpine
laser iridiotomy

Question 5

corneal abrasion management

Answer 5

refer to ophthalmology
analgesia/antiemetics
LA drops and dilating drops
Chlormaphenicol eye drops
Visualise cornea with fluourescien
occlusive padding
review daily until resolved

Question 6

common eye signs in NAI

Answer 6

periorbital bruising
lens dislocation
retinal detachment
should document findings clearly, contact child protection team, get senior help, ask accompanying adults what relation they have to child

Question 7

intraocular foreign body management and compications

Answer 7

plain XR/ocular Us/CT
significant risk of endophthalmitis so antibiotics and red flag symptoms
repair any corneal perforation
remove foreign body - risk of sidirosis
Risk of: corneal scarring - astigmatism, cataract, retinal detachment, glaucoma, and sympathetic ophthalmitis

Question 8

sudden visual loss in kids

Answer 8

congenital cataract, retinoblastoma, toxocaria, persistent hyperplastic primary vitreous

Question 9

adult onset strabismus

Answer 9

neurological causes include palsies of the eye movement nerves secondary to increased ICP, haemorrhage or infarct causing INO
muscular causes: trauma of muscles, MG
ocular - intraocular tumours, orbital wall fractures, thyroid eye disease
6th nerve may be due to IC aneurysm

Question 10

internuclear ophthalmoplegia

Answer 10

is a failure of convergent gaze, failure of adduction of the affected eye when gaze is diverted medially to the affected eye, the unaffected eye abducts with nystagmus

Question 11

How does thyroid eye disease lead to visual loss

Answer 11

EOM inflitration with autoantibodies which leads to inflammation and ophthalmoplegia
this can also cause compression of the optic nerve causing optic nerve atrophy - visual loss
exophthalmos leads to corneal exposure which can cause ulceration -> scarring/astigmatism

Question 12

6th nerve palsy mx

Answer 12

eye patching, prisms, exclude intracranial pathology such aneurysm and stroke
spontenous recovery over 6m

Question 13

Myasthenia Gravis

Answer 13

Test for with a tensilon test which gives IV cholinesterase inhibitor increased availability of acetylcholine at the neuromuscular junctions

Question 14

management of dry eyes

Answer 14

shirmers test to confirm
increase room humidity, side guards for spectacles, artifical eye lubricant - whatever the atient prefers remember ointments may blur vision, punctal plugs
fluourescein corneal examination, may see punctate erosions

Question 15

atopic keratoconjunctivitis

Answer 15

can cause corneal ulceration and scarring, keratoconus, scarring can lead to reduced vision and astigmatism, can lead to glaucoma and cataract
treat with mast cell stabilisers, allergen avoidance, topical antihistamines, topical steroids if severe

Question 16

lower motor neuron causes of facial palsy

Answer 16

Bells
Trauma
infection - ramsey hunt, otitis media
malignancy - parotid tumour, acoustic neuroma
Systemic - MS

Question 17

3rd nerve palsy

Answer 17

medial, superior and inferior rectus muscles
down and outward position
Pupil dilated
mild ptosis
affected eye unable to adduct

Question 18

thyroid eye disease scoring

Answer 18

clinical activity score based on pain, sings (chemosis, conjunctiva, redness, swelling of eyelids), acuity, proptosis, eye movements

Question 19

optic neuritis

Answer 19

presents with eye pain, worse on movement and enlarged blind spot
investigate with - visual acuity, colour testing, RAPD, blind spot, cranial nerves - eye movement and peripheral fields, fundoscopy (optic disc may be normal), corneal examination
MRI head and orbit for demyelinating lesiosn
Manage - discuss with neuro SpR, ?IV methylprednisolone, 10-25% develop MS, ask MS questions such as gait disturbance GU disturbance, intermittent weakness

Question 20

Horners Syndrome causes and Ix

Answer 20

Brainstem: CVA, trauma
Spinal cord: trauma, syringomyelia, tumour
Preganglionic: pancoast tumour, tumour, carotid artery dissection, thyroid issues
Postganglionic: otitis media, herpes zoster
4% cocaine eye drops

Question 21

Myasthenia gravis investigaion and management

Answer 21

Upward eye test, fatiguability of arms
IV tensilon test
single muscle EMG
rule out thymoma with CT chest 
discuss with neuro, pyridostigmine (long acting anticholinesterase, consider immunosuppresion, counselling r.e: choking/cv arrest

Question 22

Treatment of GCA

Answer 22

IV steroids with steroid counselling
TAB within a week
refer to rheumatology
if long term steroids may need bone protection

Question 23

pituitary adenoma investigation

Answer 23

bloods for prolactin, GH, TSH
joint care with head and neck surgeons
MRI head

Question 24

causes of strabismus

Answer 24

idiopathic
refractive error
Cerebral palsy;
Down syndrome;
Hydrocephalus;
Brain tumors;
Prematurity.

Question 25

treatment of childhood strabismus

Answer 25

correct any refractive error
patching of eye to prevent ambylopia
opthroptic management
surgery to EOMs - recession most common