OCULAR CONDITIONS

Question 1

AMD RISK FACTORS

Answer 1

age (>50)
smoking
female
caucasians
UV exposure
family history
poor diet

Question 2

WHERE DOES DRY AMD BEGIN?

Answer 2

Bruch’s membrane

Question 3

BRUCH’S MEMBRANE ROLE

Answer 3

it is located between RPE and vascular choroid

RPE layer allows waste products from photoreceptors to move through Bruch’s membrane where they are cleared away by choroidal BVs

Question 4

BLEPHARITIS TYPES

Answer 4

staphylococcal - crusting at anterior lid margin

seborrhoeic - oily/ greasy deposits on lid margin

demodex - cylindrical dandruff (collarettes), type of mite

meibomian gland dysfunction - blocked oil glands

Question 5

AC cells convection current

Answer 5

cells move upwards at back of eye and downwards at front of eye

warmer at back of eye

Question 6

keratic precipitates

Answer 6

inflammatory deposits

large mutton fat - more suspicious px has granulomatous uveitis and has underlying systemic cause

small fine KPs - more likely idiopathic

Question 7

ANTERIOR CHAMBER CELLS GRADING

Answer 7

grade 0 = no cells
grade 0.5+ = 1-5 cells
grade 1+ = 6-15 cells
grade 2+ = 16-25 cells
grade 3+ = 26-50 cells
grade 4+ = >50 cells

Question 8

ANTERIOR CHAMBER FLARE GRADING

Answer 8

grade 0 = no flare
grade 1 = faint flare
grade 2 = mod flare (iris + lens clear)
grade 3 = marked flare (iris + lens hazy)
grade 4 = intense flare (fibrin or plastic aqueous)

Question 9

recurrent vs chronic anterior uveitis

Answer 9

recurrent = repeated episodes separated by periods of inactivity without treatment or 3+ months

chronic = persistent uveitis characterised by prompt relapse (<3/12) after discontinuation of therapy

Question 10

ANTERIOR UVEITIS AETIOLOGY

Answer 10

• autoimmune (systemic disease)
• prior infections (HS, HZ)
• idiopathic
• external injury/ infection
• intraocular surgery

Question 11

SYSTEMIC CONDITIONS ASSOCIATED WITH ANTERIOR UVEITIS

Answer 11

ankylosing spondylitis
juvenile idiopathic arthritis
inflammatory bowel disease
sarcoidosis

Question 12

non-granulomatous vs granulomatous anterior uveitis

Answer 12

non-granulomatous = acute onset, fine KPs, more likely idiopathic

granulomatous = chronic condition, large ‘mutton fat’ KP + iris nodules, more likely associated with systemic conditions

Question 13

IRIS NODULES

Answer 13

iris nodules represent accumulations of inflammatory cells

Koeppe - found at pupillary border
Busacca - further from pupil, systemic causes

Question 14

ANTERIOR UVEITIS MANAGEMENT

Answer 14

instil cyclopentolate 1% drops to relieve pain + prevent posterior synechiae

emergency referral for topical steroids - prednisolone 1% every hour + cyclo 3x daily; px reviewed in 24 hours

Question 15

KERATOCONUS

Answer 15

non inflammatory progressive ectasia of cornea causing an irregular thinned corneal shape

Question 16

keratoconus risk factors

Answer 16

asian ethnicity, family history, collagen/ connective tissue disorders, atopy, eye rubbing

Question 17

dry AMD management

Answer 17

no treatment - aim is to slow down progression
advise on nutritional supplements
stop smoking
leafy green veg
amsler - self monitoring

Question 18

wet AMD treatment

Answer 18

urgent referral for intravitreal anti VEGF injections if VA better than 6/60

laser photocoagulation
photodynamic therapy

Question 19

ANTI VEGF injections

Answer 19

these inhibit activation of VEGF receptors to inhibit new vessel growth

Ranibizumab (Lucentis), Aflibercept (Eylea)

3 doses injected every 4 weeks

Question 20

AMAUROSIS FUGAX

Answer 20

temporary loss of vision in one or both eyes due to lack of blood flow to retina

Question 21

OXIDATIVE STRESS

Answer 21

imbalance of free radicals and antioxidants in the body

Question 22

DR PATHOGENESIS

Answer 22

high blood sugar -> oxidative stress, inflammation, hypoxia -> VEGF production -> promotes growth of new leaky BVs

Question 23

why is VEGF stimulated?

Answer 23

oxygen deprivation