Ophthalmology

Question 1

Glaucoma - medical managment

Answer 1

Open-angle
1st line
- Prostaglandin analogues e.g.
latanoprost
2nd line
- Beta-blockers e.g. timolol
Adjuncts
- Carbonic anhydrase inhibitors e.g. dorzolamide
- Alpha agonists e.g. brimonidine

Closed-angle
- Chronic = surgery
- Acute:
- IV acetazolamide
- Miotics e.g. pilocarpine
- Laser iridoplasty

Question 2

CMV retinitis

Answer 2

Occurs in 25% of untreated AIDS

Features:
- Subacute (1-2 weeks)
- Progressive visual blurring
- Visual floaters

Investigations:
- Ophthalmoscopy
- ‘pizza pie’ appearance - white retinal
discolouration + haemorrhages
- Serology
- Include screening for toxoplasma

Question 3

Consequences of blunt ocular trauma

Answer 3

Subconjunctival haemorrhage
Corneal abrasion
Traumatic pupillary mydriasis
Hyphaema
Vitreous haemorrhage
Commotio retinae
Choroidal rupture
Retinal detachment

Question 4

Hyphaema

Answer 4

Occurs when bleeding from iris vessels fills the anterior chamber with blood which settles to form a layer

Described according to how far up the anterior chamber the level is

Risk of increased IOP due to blockage of the trabecular network

Management:
- Strict rest - risk of secondary bleed
- If small may self-resolve
- If large, risk of raised IOP
- IV acetazolamide

Question 5

Diabetic retinopathy

Answer 5

A microvascular complication of diabetes
- A leading cause of sight loss in adults
- Proliferative more common in T1DM,
maculopathy more common in T2DM

Features:
- Background retinopathy
- Micro-aneurysms
- Blot haemorrhages
- Exudates

• Pre-proliferative
  - Changes severe and widespread
  - Venous changes
  - Large, deep haemorrhage
  - Cotton-wool spots
• Proliferative:
  - Neo-vascularisation in retina and iris
  - Vitreous haemorrhage
• Maculopathy:
  - Retinopathy within macula with leakage of
  blood and exudate
  - May present as blurred vision

Management:
- Background:
- Tight BM control
- Annual screening
- Pre-proliferative
- Ophthalmology referral for 4-6 monthly
observation
- Proliferative
- Pan-retinal photocoagulation (laser therapy)
- Intra-vitreal injection of anti-VEGF or steroids
- Vitrectomy
- Maculopathy
- Intra-vitreal steroids

Complications:
- Sight loss
- Vitreal haemorrhage
- Sudden onset flashers/floaters and painless
vision loss