Ophthalmology

Question 1

Glaucoma:

Answer 1

-Raised intra-ocular pressure in the eye
-Causes visual field defects eg. reduced peripheral vision
-2 types: Open and closed:

Open= gradual loss of vision, unlikely to notice it until fovea vision is affected.

Closed= intense eye pain, red eye, seeing halos around light, nausea, vomiting, mild dilated pupil on examination

Question 2

Differentiating between Episcleritis and Scleritis:

Answer 2

• Scleritis=painful, more serious condition requiring intervention
• Episcleritis=not painful, just erythema(redness) NB: E piscleritis
  E rythema

Question 3

Keratitis:

Answer 3

• Eye discharge

Question 4

Retinopathy:

Answer 4

• Can occur due to Hydroxychloroquine use in Rheumatoid Arthritis patients, therefore they need an annual eye check.
• Presents as painless reduction in visual acuity, not keeping with patient’s presentation.

Question 5

Herpes Zoster Ophthalmicus (HZO)-

Answer 5

Is the reactivation of varicella zoster virus in ophthalmic branch of Trigeminal nerve.
- Presents with: vesicular, burning rash around eye, Hutchinson’s sign(rash on side/tip of nose)
-Mx: Oral Antiviral treatment for 7-10 days.

Question 6

Conjunctivitis:

Answer 6

Presentation: sore red eyes, with sticky discharge

Can be Bacterial or Viral
- Viral= Serous discharge, recent URTI, Pre-auricular(in front of ears) lymph nodes
-Bacterial= Purulent(pus) discharge, eyes are often shut together in the morning.

If allergic cause: 1st line management= topical antihistamines, 2nd line: Topical mast cell stabilisers

Mx: Topical Antibiotics (Chloramphenicol) drops are given 2-3 times hourly initially
- should not use contact lens during infection

-School exclusion is NOT necessary

Question 7

Central retinal artery occlusion:

Answer 7

• Presents with Sudden loss of vision due to thromboembolism from a plaque.
  -Fundoscopy: shows= cherry red spot on a pale retina

Question 8

Diabetic retinopathy:

Answer 8

• history of diabetes, blurred vision
• Fundoscopy: Micro-aneurysms, cottonwool spots, hard exudates

Question 9

Anterior Uveitis:

Answer 9

• Presents with: acute red eye with vision loss, no halos, examination: small or normal sized pupil, not dilated

Question 10

Posterior Uveitis:

Answer 10

• usually PAINLESS
• blurry vision and floaters, does not cause a red eye

Question 11

Orbital Cellulitis:

Answer 11

• presents with pain and face swelling after a Upper Respiratory Tract Infection
• Mx: is a medical emergency and patients need to be admitted to hospital for IV antibiotics.

Question 12

Spot diagnosis: P eripheral visual field loss

Answer 12

• P rimary open-angle glaucoma
• common to have headaches due to not wearing glasses

Ddx: MaCular degeneration: is associated with Central visual field loss.
- NB: Sudden onset loss of vision+ painful red eye= Acute angle-closure glaucoma

Question 13

reactive arthritis associations?

Answer 13

• Can also be gastroenteritis. as well as STIs

Question 14

Potential complication of pan-retinal photocoagulation?

Answer 14

• A decrease in night vision

Question 15

Optic Neuritis features?

Answer 15

• Pain in eye movement
• RAPD and central scotoma
• Red desaturation: also general poor discrimination of

Question 16

Spot diagnosis? Haloes around light?

Answer 16

Acute angle glaucoma

Question 17

Presentation of Retinal detachment?

Answer 17

• Sudden, painless vision loss
• Floaters in the affected eye, often accompanied by flashes of light/curtain like shadow
• Fundoscopy: would reveal an elevated retina separated from the underlying choroid layer.

Question 18

CRAO: central retinal artery occlusion?

Answer 18

• On fundoscopy: would show a cherry red spot+pale and opaque retina

Question 19

CRVO: central retinal vein occlusion?

Answer 19

on fundoscopy: will show= diffuse retinal haemorrhages (blood and thunder appearance)

Question 20

Age related macular degeneration?

Answer 20

• Dry: can see Drusen in the eye
• Affects the central vision, and can lead to difficulty with tasks like reading and recognising faces.

Question 21

Orbital Cellulitis?

Answer 21

• Sudden onset unilateral swelling of eye
• with proptosis(exophthalmos) and reduced eye movements.
• Is a medical emergency: requiring hospital admission and urgent senior review
• Mx: admission to hospital for IV antibiotics.

Question 22

Spot Diagnosis of Bilateral Grittiness of the eye?

Answer 22

Blepharitis

Question 23

Proliferative diabetic retinopathy:

Answer 23

Can see neovascularisations (new blood vessels on fundoscopy)

Question 24

Top differential for red eye?

Answer 24

• Anterior Uveitis

Question 25

Definitive management: of diabetic proliferative retinopathy

Answer 25

Pan-retinal Photocoagulation

Question 26

definitive management in acute angle-closure glaucoma?

Answer 26

• Laser iridotomy (creates holes in iris= which will allow movement of aqueous humour from posterior to anterior chamber.

Question 27

2 types of macular degeneration and its prognosis?

Answer 27

• Dry: more common but less severe
• Wet: less common but more severe, characterised by: choroidal neovascularisation= leading to rapid and severe vision loss.

Question 28

Anterior Uveitis: mx?

Answer 28

• Treated with= Steroid + Cycloplegic (mydriatic) drops

Question 29

What condition shows Choroidal Neovascularisation?

Answer 29

• Age-related macular degeneration

Question 30

Acute closed angle glaucoma presentation?

Answer 30

• Pain
• Headache
• Red eye and classically ‘halos’ around objects

Question 31

Keratitis (pathogen that could cause it) ?

Answer 31

• Acanthamoeba
  = Condition classically presents with: pain out of proportion, contact lens wearing, recent fresh water swimming
• other features: red eye, pain and erythema, photophobia, foreign body, gritty sensation, may see hypopyon