ophthalmology

Question 1

Herpes Zoster Ophthalmicus Mx

Answer 1

oral antiviral (aciclovir)

Question 2

acute angle closure glaucoma Fx

Answer 2

optic neuropathy due to raise intraocular pressure
severe pain - occular, headache
decreased visual acuity
red eye
haloes around lights
semi dilated non reacting pupil

Question 3

acute angle closure glaucoma Mx

Answer 3

urgent ophthalmology
1st - eye drops
Pilocarpine (muscarinic antagonist increase outflow)
Timolol (B blcoker reduce aqueous production)
Apraclonidine/ Brimonodine (alpha agonist - reduce aqueous production and increase uveoscleral outflow )
Latanoprost (prostaglandin analogue, increase uveoscleral outflow)
+ IV Acetazolamide
Definitive - laser peripheral iridotomy

Question 4

Ischaemic/ Vascular loss of vision Causes

Answer 4

Amaurosis fugax - curtain coming down
large artery - thrombosis, embolis, dissection
small artery - anterior ischaemic optic neuropathy, temporal arteritis, hypoperfusion
TIA

Question 5

central retinal vein occlusion Fx

Answer 5

older people
fundoscopy - severe retinal haemorrhages (flames, blot haemorrhage)
Fx - sudden painless loss of vision
causes - glaucoma, polycythemia, hypertension

Question 6

central retinal artery occlusion Fx

Answer 6

causes - thromboembolism (atherosclerosis) or arteritis (temporal arteritis)
afferent pupillary defect, “cherry red” spot on retina

Question 7

vitreous haemorrhage Fx

Answer 7

Causes - diabetes, bleeding disorder, anticoagulant
Fx - sudden loss of vision (large), dark spots (moderate), floaters (small haemorrhage)

Question 8

retinal detachment Fx

Answer 8

dense shadow starts peripherally moves towards centre
central vision loss, painless
preceded by floaters

Question 9

posterior vitreous detachment Fx

Answer 9

flashes of light
floaters in peripheral

Question 10

Red eye DDx (6)

Answer 10

acute angle closure glaucoma - severe pain, decrease vision, DILATED fixed pupil
anterior uveitis - pain, decrease vision, SMALL fixed pupil
scleritis - pain
conjunctivitis - discharge
subconjunctival haemorrhage - Hx coughing/ trauma
endophthalmitis - post intraocular surgery

Question 11

Stye (hordeolum) Fx

Answer 11

Hordeolum externa (external) - infection (usually staph) of Zeis (sebum) or Moll (sweat) glands
Hordeolum interna (internal) - infection of Meibomian glands

Question 12

Dry eye syndrome

Answer 12

dry, gritty, sore BOTH eyes
if sticky eyelids, red eye lids - Meibomian gland dysfunction
commonly no abnormality on examination
Punctate fluorescein staining of the cornea is common

Question 13

relative afferent pupillary defect causes

Answer 13

retina: detachment, artery occlusion
optic nerve: neuritis (eg Multiple sclerosis)

Question 14

lens dislocation

Answer 14

painless, loss of vision
upwards: marfans
downwards: homocystinuria
ehlers danlos

Question 15

macular degeneration causes

Answer 15

degeneration of retinal photoreceptors resulting in formation of drusen
older people, smoking, family Hx, cardiovascular disease

Question 16

Wet vs dry macular degeneration

Answer 16

Dry: 90% cases, Drusen - yellow spots in Bruch’s membrane
Wet: choroidal neovascularisation, worse prognosis

Question 17

Macular degeneration Fx

Answer 17

reduced visual acuity (particularly near field objects) - gradual loss (day), subacute (wet)
worse night vision
flashing lights
visual hallucinations - Charles-Bonnet syndrome

Question 18

Macular degeneration Ix

Answer 18

1st - slit lamp
2nd - fluorescin angiography
3rd - ocular coherence

Question 19

blepharitis Mx

Answer 19

1st - hot compress + mechanical removal of debris (lid hygiene)
2nd - artificial tears

Question 20

Orbital compartment syndrome

Answer 20

secondary to retrobulbar haemorrhage (eye trauma)
Fx - eye pain, proptosis, rock hard eye lids, RAPD
Mx - emergency/ urgent canthotomy (done by ophthalmology)

Question 21

Argyl Robertson pupil

Answer 21

Fx - small, irregular pupil, Accommodation reflex present (ARP), Pupilary reflex absent (PRA)
C - diabetes, syphillis

Question 22

Horners syndrome Fx

Answer 22

miosis (small pupil)
ptosis (droopy eyelid)
enophthalmos (sunken eye)
anhidrosis (loss of sweating on ipsilateral side)

Question 23

Horners syndrome causes
1. Anhidrosis face, arm trunk (central lesion)
2. Anhidrosis face (pre-ganglion)
3. No anhidrosis (post-ganglion)

Answer 23

1. stroke, syringomyelia, MS, encephalitis
2. Pancoast Tumour, thyroidectomy, trauma, cervical rib
3. carotid artery dissection/ aneurysm, cavernous sinus thrombosis, cluster headache

Question 24

Keratitis Fx

Answer 24

red eye, photophobia, gritty sensation

Question 25

keratitis Mx

Answer 25

stop using contact lens
topic Abx (quinolones)
cyclopentolate for analgesia

Question 26

retinitis pigmentosa Fx

Answer 26

night blindness, tunnel vision

Question 27

hypertensive retinopathy classification

Answer 27

I Arteriolar narrowing and tortuosity, Increased light reflex - silver wiring
II Arteriovenous nipping
III Cotton-wool exudates, Flame and blot haemorrhages, These may collect around the fovea resulting in a ‘macular star’
IV Papilloedema

Question 28

corneal abrasion Ix + Mx

Answer 28

Ix - fluorescein uptake (shows yellow stain abrasion)
Mx - topical antibiotic (eg chloramphenicol)

Question 29

conjunctivities Mx

Answer 29

1st - watch and wait
2nd - topical chloramphenicol (unless pregnant, then topical fusidin)

Question 30

Corneal abrasion Mx

Answer 30

Ix - Fluorescin stains abrasion GREEN
Mx - Chloramphenicol (abx eye drops)

Question 31

Wet/ age related macular degeneration retinal changes

Answer 31

choroidal neovascularisation

Question 32

hypertensive retinopathy retinal change

Answer 32

AV nicking

Question 33

optic neuritis Fx

Answer 33

painful eye movement
visual loss (sub acute)
loss of colour vision