Ophtalmology

Question 1

What are cataracts?

Answer 1

Opacification of the lens of the eye

Question 2

Summarise the epidemiology of cataracts

Answer 2

Major cause of treatable blindness worldwide

Question 3

Explain the aetiology of cataracts

Answer 3

Most are idiopathic (age-related)

Secondary causes:
Local: previous eye trauma, uveitis
Systemic: DM, metabolic (Wilson’s), skin disease (scleroderma), drugs (steroids)
Congenital: congenital rubella syndrome

Question 4

What are the presenting symptoms of cataracts

Answer 4

Gradual onset painless loss of vision
Glare from bright light
Vision worsens in bright light
Monocular diplopia w haloes around lights

Question 5

What are the signs O/E of cataracts

Answer 5

Loss of red reflex
Hazy lens appearance
Reduced visual acuity

Question 6

How are cataracts investigated?

Answer 6

Usually unnecessary

Question 7

What is conjunctivitis?

Answer 7

Inflammation of the conjunctiva

Question 8

Summarise the epidemiology of conjunctivitis

Answer 8

Worldwide
Affects any age group
No gender, ethnic of social preponderance

Question 9

Explain the aetiology of conjunctivitis

Answer 9

Infectious: viral, bacterial

Non-infections:

• allergic
• mechanical/irritative/toxic
• immune-mediated
• neoplastic

Question 10

What are the risk factors for conjunctivitis?

Answer 10

Exposure to infected person
Infection in one eye - spread to other eye
Environmental irritants
Allergen exposure
Camps, swimming pools, military bases
Asian/Mediterranean young male
Atopy
Contact lens use
Ocular prosthesis
Mechanical irritation

Question 11

What are the presenting symptoms of conjunctivitis?

Answer 11

Red eye (generalised, bilateral)

Irritation, discomfort, grittiness

Discharge:
watery = viral
ropy, mucoid = allergic
purulent = bacterial

Itching = allergic

Eyelids stuck together in morning = bacterial + viral

Photophobia (suggests corneal involvement)
Visual acuity usually unaltered

Question 12

What are the signs O/E of conjunctivitis?

Answer 12

Conjunctival follicles (round collections of lymphocytes appearing as small dome-shaped nodules) - viral

Conjunctival injection (ie bloodshot eyes)

Dilated conjunctival vessels

Conjunctival chemosis (swelling)

Conjunctival papillae

Question 13

How is conjunctivitis investigated?

Answer 13

Rapid adenovirus immunoassay: +ve in adenovirus infection

• tear fluid sample
• 10 mins

Cell culture

Gram stain

Question 14

What is glaucoma?

Answer 14

Optic neuropathy with typical field defect usually associated with ocular hypertension (intra-ocular pressure > 21 mmHg

Question 15

What is unilateral conjunctivitis more likely to be caused by?

Answer 15

Bacterial infection

Question 16

Summarise the epidemiology of glaucoma

Answer 16

Prevalence:
1% in over 40s
10% in over 80s

3rd most common cause of blindness worldwide

Question 17

What are the presenting symptoms of glaucoma?

Answer 17

ACAG:

• painful red eye
• vomiting
• impaired vision

POAG:

• usually asymptomatic
• peripheral visual field loss

Congenital:

• buphthalmos
• watering
• cloudy cornea

Question 18

What are the signs O/E of glaucoma?

Answer 18

ACAG:

• red eye
• hazy cornea
• loss of red reflex
• fixed and dilated pupil
• eye is tender and hard on palpation
• cupped optic disc
• visual field defect
• moderately raised intra-ocular pressure

POAG:

• optic disc may be cupped
• usually no signs

Question 19

How is glaucoma investigated?

Answer 19

1. Goldmann Applanation Tonometry
   - standard method of measuring IOP
   - normal IOP = 15 mmHg
2. Pachymetry
   - use US/optical scanning to measure central corneal thickness
   - CCT < 590mm = higher risk of glaucoma
3. Fundoscopy - detects pathologically cupped optic disc
4. Gonioscopy - assess iridocorneal angle
5. Perimetry - visual field testing

Question 20

What is uveitis?

Answer 20

Inflammation of one or all parts of the uvea, the vascular area between the retina and sclera of the eye

Anterior uvea = iris + ciliary body

Posterior uvea = choroid + retina + retinal vasculature

Question 21

Summarise the epidemiology of uveitis

Answer 21

Uveitis associated with spondyloarhritis is 2x common in males

Question 22

Explain the aetiology of uveitis

Answer 22

• Infection, eg herpes simplex
• Manifestation of systemic inflammatory conditions, eg RA, ankylosing spondylitis, IBD, sarcoidosis, Behcet’s disease
• Sympathetic ophthalmia

Question 23

What are the risk factors for uveitis?

Answer 23

Inflammatory diseases of joints, bowel, or skin
HLA-B27 positive
Ocular trauma

Question 24

What are the presenting symptoms of uveitis?

Answer 24

Pain due to inflammation
Pain during accommodation
Blurred vision
Tearing
Photophobia
Floaters
Eye redness wo discharge

Rarely associated w tubulointerstitial nephritis - flank pain, haematuria, proteinuria

Question 25

What are the signs O/E of uveitis?

Answer 25

Reduced visual acuity
Ciliary flush
Hypopyon - exudate and inflammatory cells in inferior angle of anterior chamber
Small irregular pupil due to adhesion of iris to lens
Slit lamp - keratic precipiates

Question 26

How is uveitis investigated?

Answer 26

Ix for associated systemic conditions

Eg spondyloarthritides - sacroiliac joint XR, HLA-typing

Question 27

What is sympathetic ophthalmia?

Answer 27

Inflammation of contralateral eye weeks/months after penetrating injury due to recognition of eye antigens in CL eye by T-cells that were activated by injury to opposite eye