Ophthalmology

Question 1

red eye differentials (5)

Answer 1

• Acute angle closure glaucoma
• Infective endophthalmitis
  -Orbital cellulitis
• Trauma
  -ITIS ( conjunctivitis and scleritis etc)

Question 2

dendritic ulcers + red , painful eye with photophobia and reduced visual acuity

Answer 2

Herpes simplex Keratitis
(refer for same say Opth Assessment )
- anti viral drops (acyclovir) and steroid eye drops

Question 3

sudden painless visual loss (7)

Answer 3

• CRVO
  -CRAO
  -Ischemic optic neuropathy (stroke)
  -GCA
  -Retinal detachment
• vitreous haemorrhage
  -Optic neuritis

Question 4

Acute angle closure glaucoma cause?
features ?
treatment ?

Answer 4

• increased intraocular pressure
• iris is pressed forward blocking the outfox through trabecular meshwork
  + red painful eye
  +head ache
  + nausea and vomtiting
  +hazy cornea
  + FIXED MID DILATED PUPIL

treatment :
acetazolamide ( reduces fluid production in ciliary body )
- Pilocarpine to pull iris away from trabecular meshwork
- topical antihypertensives and steroids
-DEFINITIVE treatment is laser iridiotomy

Question 5

treatment for Acute angle closure glaucoma ?

Answer 5

• lie patient on their back with pillow
• give pilocarpine eye drops( pulls iris away from trabecular meshwork=
• Acetazolamide 500mg orally
  -analgesia and antiemetics

Question 6

what 4 diagnoses should be ruled out in a painful red eye ?

Answer 6

1. acute angle closure glaucoma
2. Anterior uveitis
3. Scleritis
4. Corneal ulcers

Question 7

central retinal artery occlusion signs ?

Answer 7

cherry red spot and pale retina
- usually due to embolus from heart or carotids
- transient = amouris fugax (temporary blockage = retinal TIA)
- work with stroke clinic

Question 8

CRVO causes, signs and treatment

Answer 8

due to local thrombosis
associated with HTN , DM, older age and hypercoagubiltiy
signs: disk and retinal haemorrhage, macular oedema
HTN is the most common cause

treatment : VEGF and retinal laser

Question 9

treatment of CRAO AND CRVO

Answer 9

CRAO - aggressive treatment within 100min = lower the IOP, Vasodilators
CRVO - VEGF and retinal lasers

Question 10

vitreous haemorrhage
signs , symptoms and treatment

Answer 10

secondary to trauma or secondary to diabetic, HTN retinopathy etc

Symptoms :
- painless loss of vision in one eye
- blurry vision
- starts of as floaters and Blobs in eye

DO USS to check for tear

clears up in 6-8 weeks

Question 11

retinal detachment risk factors and signs

Answer 11

• myopia and trauma
• black curtain over the eyes
  signs :
  + RAPD
  + Visible detachment on fundoscopy
  + central scotoma
  +straight lines appear curved

Question 12

Signs of Dry AMD

Answer 12

+ DRUSEN
+ centra vision loss, GRADUALLY
+visual fluctuation
+myopia
+ lines appear curved - Amsler Grid

Question 13

treatment for Dry AMD

Answer 13

NO CURE
vitamin C,E
antioxidants and smoking cessation

Question 14

WET AMD signs and treatment

Answer 14

+ neovascualrisation
+central scotoma
+retinal haemorrhages
+ new onset to be able to see close by but not far away
+ straight lines are wavy = Amsler grid
+ SUDDEN VISION CHANGE

ANTI - VEGF injections

Question 15

signs of anterior uveitis

Answer 15

+ irregular pupil
+painful eye movement
+increased lacrimation
+Hutchinsons sign
+ Associated with HLA B27

Question 16

Cataracts symptoms

Answer 16

-Blurry haze
-Haloes
-hard to drive at night
- hazy lense ( clouding of sense due to ppt of proteins )

treatment = surgery

Question 17

Chronic glaucoma risk factors

Answer 17

• age
• afro / carribbean
• myopia
• raised IOP

Question 18

treatment for chronic open angle glaucoma

Answer 18

+PG drops ie : latanoprost increases outflow of the aqueous fluid
+ B- blockers = timolol to reduce production of Aqu fluids
+ surgery = trabeculectomy

( all work to reduce IOP )

Question 19

myopia is a risk factor for

Answer 19

retinal detachment
open angle glaucoma
cataracts

Question 20

hypermetropia ( long sightedness)
is a risk factor for ?

Answer 20

ACUTE CLOSED ANGLE GLAUCOMA

Question 21

diabetic retinopathy

Answer 21

+ cotton wool spots( occluded capillaries )
+blot haemorrhages
+ pale retina
+ vitreous haemorrhage
+ retinal detachments
+ glaucoma

pre proliferative = no new vessels
proliferative = new vessels nd cotton wool spots

treatment :
- optimise diabetic control
- laser Photocoagulation for proliferative
-

Question 22

grades of HTN retinopathy

Answer 22

grade 1- narrowing of the arteries
grade 2 + AV nipping
grade 3 + retinal haemorrhages and hard exudates and cotton wool spots
grade 4 + optics nerve oedema

Question 23

management of HTN retinopathy

Answer 23

laser Photocoagulation for neovascularisation

VEGF for new blood vessels too

Question 24

optic neuritis signs and diagnosis

Answer 24

• visual loss
• periocular pain
• red green desaturation
• MS (associated)

give high dose steroids
MRI FOR DIAGNOSIS

Question 25

Horners syndrome ?

Answer 25

Ptosis
Miosis
Anhidrosis ( on affected side of the face)

Question 26

Wilsons disease

Answer 26

• Brownish gold rings around the cornea = Kayser -Fleischer rings
• accumulation of copper in various organs
  + neurological and psychiatric symptoms

Question 27

Holmes AdLE pupil

Answer 27

+ DiLAted pupil , females and absent leg reflex
+ pupil is dilated and worse in bright light = problem with parasympathetic innervation

Question 28

Argll-Robertson pupil

Answer 28

due to neurosyphilis or DM
+ small , irregular pupil , irresponsive to light
+ bilateral small pupils
+ accommodate but don’t respond to light