Ophthalmology

Question 1

History to take from a PT with impaired vision symptoms

Answer 1

Is it bluntly -central, peripheral
Distortion
Flushing lights
Areas of missed vision
Painful/painless
Speed of onset (gradual/sudden)
Other systematic symptoms

Question 2

Cataract

Answer 2

Lens does not age well- metabolism breaks down and lens becomes cloudy and not clear as before
Gradual, painless, hazy/misty vision, near/total blindness

Question 3

Age related macular degeneration

Answer 3

Age related problem
Only central vision is affected
Blurred, distorted

Dry type- gradual, slowly progressive, no specific treatment
Wet type- faster onset and progression, treatable

Question 4

Glaucoma

Answer 4

Condition of the optic nerve (optic neuropathy)
Gradual, progressive loss of axons from the nerve inside the eye
High BP is the risk factor

Chronic open angle- peripheral vision is affected first, central vision comes after, asymptomatic

Acute closed angle- red, painful eye, unreactive pupil, severe headache

Question 5

Retinal detachment

Answer 5

Flushing lights, floaters
Painless, no external features of the eye
Urgent surgery needed (gas bubble is inflated to avoid eye collapse)
Usually one eye affected (48 h)
No IHS- if NO or entonox- if gas bubble in the eye can be inflated again with the gases ( contraindications for 3 months after eye surgery)

Question 6

Giant cell arteritis

Answer 6

Vasculitis, medical emergency

Usually in 50+

Jaw/tongue claudication pain,
Tender scalp skin, headache, feeling rotten, losing weight, vision disturbance

If not treated - permanent vision loss (due to blood vessel blockage)

Question 7

Eye and diabetes

Answer 7

Retinopathy - vitreous haemorrhage, retinal detachment. Sugar causes damage to the vessels and can either haemorrhage or swell up/oedema leading to retinal ischaemia.
Body’s response to ischaemia is to make new vessels but because eye is so small, vessels are faulty (vessels itself do not affect the vision, the problem is when vessel break causing billed in vitrous causing vision disturbance) if those vessels constrict/scar they will cause retinal detachment

Maculopathy- retinal oedema/swelling. Retina will take up all the blood that has leaked and that will obstruct the macula and cause vision loss

Sugar blood is toxic to blood vessels

Question 8

Causes of red/sore eye

Answer 8

Mild: conjunctivitis, subconjunctival hemorrhage, dry eyes, episcleritis

Moderate: corneal abrasion, corneal foreign body, iritis, scleritis, facial nerve palsy

Severe: corneal ulcer, penetrating injury, chemical injury, acute glaucoma orbital cellulitis

Question 9

Conjunctivitis

Answer 9

Bacterial: sticky, purulent discharge, bilateral, sequential

Viral: watery, bilateral

Question 10

Subconjunctival hemorrhage

Answer 10

Asymptomatic but scary to pt
Can be linked with high blood pressure, anticoagulants

Question 11

Corneal ulcer

Answer 11

Risk in pt having contact lenses
Can lead to blindness
Pt will complain of photophobia
It required urgent treatment (24h)

Question 12

Peri orbital cellulitis

Answer 12

Inflammation of orbital septum (most useful and important barrier to intra-orbital infection)
Eye lid needs to be lifted to check the eye

Two types:

1. Preseptal cellulitis
   - hot, red, swollen, tender lids
   - white eye
   -vision unchanged
   -full range of eye movement
   -normally reactive pupils
2. Orbital cellulitis
   - hot,red, swollen, tender lids
   -red, infected eye
   -blurred, reduced vision
   -restricted eye movements
   -sluggish pupil, poorly or non reactive

Question 13

Orbital fracture symptoms and signs

Answer 13

Bruising
Pain
Double vision
Periorbital oedema

Question 14

Orbital compartment syndrome

Answer 14

Risk of permanent sight loss
Retrobulbar haemorrhage: severe pain, reduced vision, slow/unreactive pupil, restricted movement in all directions

Question 15

Chemical injury to the eye

Answer 15

Irrigation is the key (first irrigation then exam or history)
Aim is to prevent corneal scarring