Ophthalmology

Question 1

Amaurosis fugax

Answer 1

Sudden, painless loss of vision
Can be large artery disease, small artery occlusive disease (e.g. temporal arteritis), venous disease or hypoperfusion
May represent a form of TIA
Often described as curtain coming down over vision

Question 2

Central retinal vein occlusion

Answer 2

Sudden painless loss of vision
Caused by glaucoma, polycythaemia, hypertension
Optic disc swelling, multiple flame and blot haemorrhages

Question 3

Central retinal artery occlusion

Answer 3

Sudden painless loss of vision
Due to thromboembolism or arteritis
Afferent pupillary defect, cherry red spot on pale retina

Question 4

Vitreous haemorrhage

Answer 4

Causes - diabetes, bleeding disorders, anticoagulants
Sudden painless loss of vision or have dark spots/floaters if smaller bleeds

Question 5

Retinal detachment

Answer 5

Sudden painless loss of vision
May have flashes or floaters preceding
Dense shadow starting peripherally and progresses towards centre of vision
Veil/curtain over vision
Straight lines appear curved

Question 6

Posterior vitreous detachment

Answer 6

Flashes of light in peripheral vision
Floaters - often temporal side of central vision

Question 7

Acute angle-closure glaucoma presentation

Answer 7

Unilateral eye pain and visual loss
Headache
Red eye
Fixed and dilated pupil with hazy cornea

Question 8

Anterior uveitis presentation

Answer 8

Painful red eye with photophobia
Variable vision loss
Constricted pupil
More common with HLA-B27 or autoimmune conditions

Question 9

Keratitis presentation

Answer 9

Infection of the cornea
Painful red eye
Photophobia
Watery eye
Eyelid oedema
Risk factors - contact lenses, trauma
(Emergency)

Question 10

Scleritis

Answer 10

Associated with women and systemic autoimmune disease
Painful red eye
Blurred vision
Photophobia
Watery eye

Question 11

Risk factors for acute angle closure glaucoma

Answer 11

Hypermetropia (long-sightedness)
Pupillary dilatation
Lens growth associated with age

Question 12

Acute angle closure glaucoma management

Answer 12

Emergency - refer to ophthal
Direct parasympathomimetic eye drops e.g. pilocarpine
Beta blocker eye drops e.g. timolol
Alpha 2 agonist eye drops e.g. apraclonidine
IV acetazolamide

Definitive management - laser peripheral iridotomy

Question 13

Retinitis pigmentosa

Answer 13

Inherited
Night blindness and tunnel vision

Question 14

Vitelliform macular dystrophy

Answer 14

Accumulation of yellow deposits on macula
Distortion or loss of central vision

Question 15

Diabetic retinopathy fundoscopy findings

Answer 15

Microaneurysms
Dot and blot haemorrhages
Hard exudates
Cotton wool spots

Question 16

Pituitary tumour visual defect

Answer 16

Bitemporal hemianopia, upper quadrant defect more than lower

Question 17

Homonymous quadrantanopias cause

Answer 17

PITS - parietal-inferior, temporal-superior
Lesion in parietal lobe causes inferior homonymous quadrantanopia
Lesion in the temporal lobe causes superior homonymous quadrantanopia

Question 18

Dry macular degeneration

Answer 18

90% of ARMD
Drusen - yellow spots on macula

Question 19

Wet macular degeneration

Answer 19

10% of ARMD
Choroidal neovascularisation
Leakage of serous fluid and blood - can cause rapid loos of vision
Worse prognosis

Question 20

ARMD presentation

Answer 20

Reduction of visual acuity - especially near field objects
Difficulty seeing in the dark
Fluctuating visual disturbance
Photopsia (perception of flickering or flashing lights) and glare around objects
Charles-Bonnet syndrome - visual hallucinations
Distortion of line perception

Question 21

Management of ARMD

Answer 21

Dry:
- Zinc with vitamin A C and E to reduce progression

Wet:
- Anti-VGEF injections
- Laser photocoagulation
- Photodynamic therapy