Ophthalmology

Question 1

What is the presentation of acute closed-angle glaucoma?

Answer 1

• Intraocular pressure >30mmHg
• Pupil fixed and dilated
• Patient generally unwell with N&V
• Headache and painful red eye preceded by blurred vision or haloes around lights at night (25%)

Question 2

What is the cause of acute closed-angle glaucoma?

Answer 2

Where the angle of anterior chamber narrows acutely causing a sudden rise in intraocular pressure

Question 3

What is the difference between primary and secondary acute closed-angle glaucoma?

Answer 3

Primary occurs in patients with anatomical predisposition, secondary is as a result of a pathological process

Question 4

Why are carbonic anhydrase inhibitors used to treat acute closed-angled glaucoma?

Answer 4

They decrease aqueous humour formation

Question 5

What is the treatment for acute closed-angle glaucoma?

Answer 5

Carbonic anhydrase inhibitors in combination with beta-blockers and alpha-2 agonists e.g. topical dorzolamide/brinzolamide with timolol ophthalmic and brimonidine ophthalmic

Question 6

What is glaucoma?

Answer 6

A progressive optic neuropathy with characteristic changes in the optic nerve head and corresponding loss of visual field

Question 7

What are the risk factors for glaucoma?

Answer 7

• Increased IOP
• Black ethnicity
• Family history
• Increased age
• Low diastolic perfusion pressure

Question 8

Why are regular eye tests important when thinking about glaucoma?

Answer 8

Because glaucoma is asymptomatic until the advanced stages where loss of vision is irreversible

Question 9

What is the first-line treatment for primary open-angle glaucoma?

Answer 9

• Prostaglandin analogues e.g. latanoprost
• Beta blocker e.g. timolol
• Carbonic anhydrase inhibitors e.g. brinzolamide
• Alpha-2 adrenergic agonists e.g. apraclonidine

Question 10

What is the treatment for primary open-angle glaucoma when eye drops are not complied with/contra-indicated?

Answer 10

Laser trabeculoplasty

Question 11

What are the visual field defects seen in primary open-angle glaucoma?

Answer 11

Tends to be bilateral, but not always symmetrical

Question 12

What is congenital glaucoma?

Answer 12

Also known as childhood glaucoma, is the incorrect development of the eye’s drainage system before birth

Question 13

What are the signs and symptoms of congenital glaucoma?

Answer 13

• Photophobia
• Corneal opacification (hazy gray cornea)
• Enlarged eye and cornea
• Epiphora (overflow of tears)
• Vision loss

Question 14

What is neovascular glaucoma?

Answer 14

A type of secondary glaucoma where the angle is blocked by new blood vessels

Question 15

What is the cause of neovascular glaucoma?

Answer 15

Usually ischaemic retina driving new vessel formation

Question 16

What is the treatment for neovascular glaucoma?

Answer 16

• Treat underlying cause (e.g. ischaemic retina)

- Reduce IOP

Question 17

What is keratoconjunctivitis sicca and what is it also known as?

Answer 17

A multifactorial ocular surface disease characterised by a loss of homeostasis of the tear film due to tear film hyperosmolarity and instability, ocular surface inflammation and damage, and neurosensory abnormality. This results in ocular discomfort, dryness, and visual disturbance.

Also known as dry eyes

Question 18

What is the most common eye complication seen in RA patients?

Answer 18

Keratoconjunctivitis sicca (dry eyes)