Ophthal

Question 1

Mx of blepharitis

Answer 1

Good eye lid hygiene (warm towel, massage to get oils out, then clean wthbaby shampoo on cotton wool)
Can give chloramphenicol if purulent

Question 2

Presention of anterior uveitis (aka iritis)

Answer 2

Acute onset
Pain
Blurred vision
photophobia (often intense)
Small fixed oval pupil, ciliary flush

May also have ank spond, RA, Crohn’s, Behçet’s…

Question 3

Management of pt with acute ophthalmic pain, intense photophobia, blurred vision. On examination, small oval fixed pupil

Answer 3

Likely Ant uveitis

Urgent ophthal referral
Give cycloplegics (dilates so relieve pain) eg atropine
Steroid eye drops

Question 4

Thyroid eye disease…when do you need urgent ophthalmology referral

Answer 4

Globe subluxation (!!!!)
Sudden change / deterioration in vision /colour vision
Cornea visible with eye lid closed
Corneal opacity

Question 5

Thyroid eye disease management

Answer 5

Found in about 30% if Graves’ disease patients
Quit smoking!!
Sometimes worsened by radio iodine (~15%)
Lubricant,steroids, beta blockers

Question 6

What is a hypopyon??

Answer 6

Leukocytic exudate seen in anterior chamber of eye, usually with redness of conjuctiva
Classically anterior uveitis
(Consider keratitis if reactive pupil and Hx of contact lens use)

Question 7

Features of retinal detachment

Answer 7

Dense shadow that starts peripherally progresses towards the central vision
A veil or curtain over the field of vision
Straight lines appear curved
Central visual loss

Flashes of light and floaters are more likely vitreous detachment
Loss of red reflex is more vitreous haemorrhage

Question 8

Nerve supply of extra ocular muscles

Answer 8

Occulomotor does all but SO4LR6

Question 9

Ddx of unilateral mydriasis (dilation)

Answer 9

Holmes Adie syndrome (more common in women, once constricted it is sluggish. Assx with absent ankle/knee reflexes)
Traumatic iridoplegia

Question 10

Central Retinal vein occlusion presentation and findings

Answer 10

Sudden painless loss of vision, severe retinal haemorrhages on fundoscopy

Question 11

Management of optic neuritis

Answer 11

High dose methylpred for 72 hours, then prednisolone 1mg/kg/d for 11 days

Question 12

Temporal arteritis management

Answer 12

ESR above 47,
Prednisolone 80mg / day.
Temporal artery biopsy within one week
Gradually reduce steroids as ESR reduces… One year or so

Question 13

painful red eye with decreased acuity. On examination hazy steamy cornea. Management

Answer 13

Acute angle glaucoma… Constrict pupil (pilocarpine) and acetazolamide to reduce IOP

Question 14

What is blocked in acute angle glaucoma

Answer 14

Canal of Schlemm takes fluid out of anterior chamber. Pupil dilation worsens this.

Question 15

Management of chronic open angle glaucoma

Answer 15

Beta blocker like timolol

Question 16

Management of allergic conjuctivitis

Answer 16

Antihistamine like antazoline