Ocular Manifestation Of Systemic Ds

Question 1

Grading of hypertensive retinopathy

Answer 1

1: tortuous of retinal artery, silver wiring
2: grade 1 + AV napping/ AV nicking
3: Grade 2 + flamed shape haemorrhage + cotton wool exudates
4: Grade 3 + papilloedema (blurry margin of the optic disc)

Question 2

Mx of hypertensive retinopathy

Answer 2

• control BP
• lifestyle modification

Question 3

Spectrum of thyroid ophthalmopathy

Answer 3

• eyelid retraction
• exophthalmos (proptosis)
• extraocular muscle dysfunction
• corneal exposure
• conjunctival erythema
• optic n dysfunction

Question 4

Sight threatening condition

Answer 4

• exposure keratitis
• glaucoma
• optic neuropathy

Question 5

Treatment of thyroid eye ds

Answer 5

• topical lubricant
• systemic steroid: IV methylprednisolone, oral prednisolone
• steroid sparing agent: azathioprine
• radiotherapy
• surgical decompression

Question 6

Symptoms and signs of multiple sclerosis

Answer 6

Symptoms
- acute visual loss (optic neuritis)
- double vision
- eye pain

Signs
- optic disc swelling
- optic atrophy
- normal appearance optic disc (in retrobulbar optic neuritis)
- RAPD positive
- central scotoma
- colour vision

Question 7

Investigation of multiple sclerosis

Answer 7

ON is diagnosed by symptoms and clinical examination
- MRI: for prognosis

Question 8

Treatment of multiple sclerosis

Answer 8

• steroid: IV methylprednisolone for 3 days then 1mg/kg of prednisolone for 11 days
• plasma exchange and IV immunoglobulin therapy

Question 9

Symptoms of myastenia gravis

Answer 9

• bilateral ptosis
• limited eye movement dt ophthalmoplegia
• diplopia
• apnea and choking if affect respiratory and pharyngeal muscles

Question 10

Investigation of MG

Answer 10

• edrophonium (tensilon test)
• repetitive nerve stimulation (RNS) testing

Question 11

Mx of MG

Answer 11

Medical tx
- acetylcholinesterase inhibitor
- pyridostigmine (mestinon)

Surgical tx
- thyromectomy

Question 12

Episcleritis vs Scleritis
Symptoms
Physical examination
Mx

Answer 12

Symptoms
- episcleritis: mild pain, eye redness
- scleritis: severe pain, pain with eye movement

Physical examination
- episcleritis: blanch with phenylephrine eyedrop
- scleritis: DOES NOT blanch with phenylephrine eyedrop, may reveal nodules, scleral thinning, tender during touch

Mx
- episcleritis: self limiting, topical NSAID/steroid
- scleritis: local and systemic corticosteroid

Question 13

Ocular manifestation