Ophthalmology

Question 1

Peripheral vision loss (sudden shadow), blurred/distorted vision, flashes/floaters

Answer 1

Retinal detachment

Question 2

Sudden painless loss of vision. FUndoscopy shows flame + blot haemorrhages, optic disc oedema, macular oedema

Answer 2

Retinal vein occlusion

Question 3

Sudden, painless loss vision. Cherry red spot + pale retina (hazy white fog). Relative afferent pupillary defect

Answer 3

Central retinal artery occlusion

Question 4

Generalized reduction in visual acuity + starbursts around lights + halos
DM can cause

Answer 4

Cataracts

Question 5

Central loss + crooked/wavy appearance of straight lines.

Answer 5

Macular degeneration

-Dry = drusen (most common)
-Wet - choroidal neovasculrisation. (fatser visual loss, v rare)

Question 6

Glaucoma, acte vs chronic for associations

Answer 6

acute = as with hypermetropia - long sited

Open - myopia ass -short sited

Question 7

Peripheral loss of vision + halos around light

Severe pain
Cupping optic disc
Semi dilated pupil

Dx and mx

Answer 7

Glaucoma

Dx - ophthalmologist - slit lamp, tonometry, gonioscopy.
Aim - reduce aqueous secretion + induce pupillary constriction
SUrgery is definitive but after IOP reduced

1.Prostaglandin analogue
2.BB, Cabronic anhydrase inhibitor, sympathomimetic eyedrop

ACute:
Combo eye drops - direct parasympathomimetic (pilocarpine etc), BB, alpha-2 agonist
+
iV Acetylzolamide

Definitive is laser peripheral iridtomy

Question 8

Small fixed oval pupil, ciliary flush, blurred vision + photophobia
Acutely painful, decreased visual acuity

Answer 8

uveitis

Question 9

Unilat decrease in visual acuity, poor discrimination colours (red desaturation), pain worse on eye movement, relative aff pupillary defect, central scotoma.

Answer 9

optic neuritis

Question 10

Severe pain, exacerbated by movements, tender, may be underlying autoimmune
With phenylephrine, redness doesn’t blanch

Answer 10

Scleritis

Same day referral to ophthalmology (oral NSIDAs-> top steroids)

Question 11

difference with episcleritis vs scleritis

Answer 11

In episcleritis - vessels blanch and move with cotton bud and doesn’t usually cause pain

Question 12

Dendritic corneal ulcer

Answer 12

Herpes keratitis

Question 13

Corneal ulcer- focal circular/oval shaped
(Pseudomonas aeruginosa in contact lens weares)

Answer 13

Bacterial keratitis

Question 14

Hypertensive retinopathy stages

Answer 14

I - AV narrowing + tortuosity, increased light reflex + silver wiring
II- Arteriovenous nipping
III - Cotton wool exudates, flame + blot haemorrhages (macular star)
IV - Papilloedema

Question 15

Tx for non proliferative and proliferative diabetic retinopathy

Answer 15

Non-p = observe and if severe then pan retinal laser photocoagulation

Proliferative = VEGF + pan retinal laser photocoagulation

Question 16

Allergic conjunctivitis tx

Answer 16

1.Topical/systemic antihistamines
2.Topicla mast cell stabilisers

Question 17

Red eye, pain + visual loss after eye surgery

Answer 17

Endothalmitis

Question 18

Pianless, transient monocular blindness (black curtain coming down)

CVD FRS

Answer 18

Amaurosis fugal

Question 19

3rd nerve palsy vS horners syndrome

Answer 19

3rd nerve palsy = Ptosis, dilated non reactive pupil
DIvergent strabismus (squint)

Horners = Ptosis and constricted (meiosis) pupil
Enophthalmos +/- anhidrosis

Question 20

WHta is a relative aff pupillary defect

Answer 20

Affected and normal eye appears to dilate when light is shone on affected eye
Causes - retinal detachment, optic neuritis.

Question 21

Periorbital vs orbital cellulitis and mx

Answer 21

Periorbital = Hot, redness, swelling

Orbital = pain on eye movement, change in vision + proptosis

CT with contrast
Orbital - admit to hospital for iV Abx

Question 22

dx, mx

Answer 22

herpes zoster opthalm..

VSV in ophthalmic division trigemnial nerve. (Shingles)
Vesicular rash around eye, hutchingsons sign (rash on top or side nose - nasociliary involvement and strong RF for ocular involvement)

Oral antiretroviral tx 7-10days, topical steroids if secondary inflammation of eye
Ocular Involvement - urgent ophthalmology review

most recover

Question 23

Bilateral grittiness and discomfort, particularly around eyelid margins. Eyes may be sticky in morning,eyelid margins can be red. Styes/chalazions common.

dx, mx

Answer 23

blepharitis

1.Hot compress twice a day
2.Lid hygiene (remove debris with cotton bud)
Artificial tears

Question 24

PG analogues in glaucoma - moa, s.e

Answer 24

Prostaglandin analogues
lantroprost
increases uveoscleral outflow
OD
A/E include brown pigmentation of iris, increased eyelash length

Question 25

BB in glaucome - MOA

Answer 25

timolol - reduces aqueous production - avoid in asthmatic and pts with heart block

Question 26

Sympathomimetics in Glaucoma

Answer 26

brimonidine, a2 adrenoreceptor agonist - reduced aqueous production and increases outflow
Avoid if taking MAOI or TCA
A/E - hyperaemia

Question 27

Carbonic hydrase inhibitors in glaucoma

Answer 27

(Dorzolamide) - reduce aqueous production
Systemic absorption may cause sulphonamide like reactions

Question 28

Miotics in glaucoma - moa, a/e

Answer 28

pilocarpine (muscarinic receptor agonist) - increases uveoscleral outflow
a/e - constricted pupil, headache, blurred vision

Question 29

Anterior uveitis mx

Answer 29

Steroid and cycleplegic eye drops

Question 30

Argyll-RObertson pupil

Answer 30

Seen in neurosyphilis
Pupil accommodates but doesnt reaction
Small irregular pupils. No response to light but will accommodate
Causes - DM, syphilis

Question 31

Tonically dilated pupil, slowly reactive to light with more definitive accommodation response.
Caused by damage to parasympathetic innervation of eye due to viral or bacterial infection
Commonly in females, accompanied by absent knee or ankle jerks

Answer 31

adie pupil

Question 32

Relative aff pupillary defect seen during swinging light exam of pupil response
Pupils construct less and therefore appear to dilate when a light is swung from unaffected to affected eye
Most commonly caused by damage to optic nerve or severe retinal disease

Answer 32

Marcus gunn pupil

Question 33

Unilateral dilated pupil which is unresponsive to light. Result of compression of occulomotor nerve of same side, by intracranial mass (tumour, haematoma)

Answer 33

Hutchinson’s