Ophthalmology

Question 1

How does retinitis pigmentosa present?

Answer 1

Retinitis pigmentosa - night blindness + tunnel vision

Question 2

How does Horner’s syndrome present?

Answer 2

Horner’s syndrome, also known as oculosympathetic paresis, is a rare condition characterised by a triad of ptosis (drooping eyelid), miosis (constricted pupil), and anhidrosis (lack of sweating) on the affected side of the face.

Question 3

How does Argyll-Robertson pupil present?

Answer 3

bilateral small pupils that constrict when the patient focuses on a near object but do not react to direct or consensual light stimulation. They are often referred to as ‘prostitute’s pupils’ because they ‘accommodate but do not react’. It is seen primarily in patients with neurosyphilis, which does not fit with the presented case.

Question 4

How does sixth nerve palsy present?

Answer 4

A sixth cranial nerve palsy would present with horizontal double vision that increases when looking towards the affected side due to paralysis of the lateral rectus muscle, which abducts the eye.

Question 5

How does third nerve palsy present?

Answer 5

third nerve palsy is incorrect as it typically presents with drooping of the eyelid (ptosis), dilation of the pupil (mydriasis), upward and outward deviation of the eye (‘down & out’ appearance) and inability to move eye inward and downward due to paralysis of the medial rectus and inferior rectus muscles respectively.

Question 6

How does Holmes-Adie pupil present?

Answer 6

This condition presents with a unilateral dilated pupil that reacts poorly to light but shows slow constriction on accommodation. It may be associated with absent reflexes elsewhere in the body such as the ankle-jerk reflex. Holmes-Adie syndrome doesn’t cause ptosis which was observed in our patient.

Question 7

How does Herpes Zoster Ophthalmicus present?

Answer 7

This condition presents with a painful, blistering rash in the distribution of the ophthalmic division of the trigeminal nerve. It is caused by reactivation of latent varicella-zoster virus (the same virus that causes chickenpox) within the sensory ganglion. The patient’s age and presentation with a burning sensation around his right eye followed by an erythematous blistering rash are typical features of this condition.

Question 8

Where do you see drusen?

Answer 8

Drusen = Dry macular degeneration

Question 9

What is the biggest risk factor for macular degeneration?

Answer 9

Smoking

Question 10

How does fundoscopy differ in retinal central vein vs artery occlusion?

Answer 10

Artery - fundoscopic findings of a pale and opaque retina with a cherry-red spot are classic features of central retinal artery occlusion (CRAO)

Vein - diffuse retinal haemorrhages (‘blood and thunder’ appearance), venous dilation and tortuosity

Question 11

How does optic neuritis present?

Answer 11

Colour vision is affected in optic neuritis and typically there is periocular pain associated with eye movement. Visual field defects can also occur, most commonly in the form of a central scotoma. There is typically a relative afferent pupillary defect if the other eye is uninvolved.

Question 12

What is amsler grid testing?

Answer 12

Amsler grid testing (to check for distortion of line perception) may be useful in testing patients with suspected age related macular degeneration

Question 13

How do we treat herpes zoster ophthalmicus?

Answer 13

Oral steroids

Question 14

How does keratitis present?

Answer 14

red eye, photophobia and gritty sensation

Question 15

How do episcleritis and scleritis differ?

Answer 15

Episcleritis is typically asymptomatic or presents with a mild grittiness sensation, but scleritis usually presents with frank pain and tenderness.

Question 16

Where do you see bone-spicule pigmentation on fundoscopy?

Answer 16

Retinitis pigmentosa classically presents with black bone-spicule pigmentation on fundoscopy

Question 17

Which kind of eye drops can be used to differentiate scleritis and episcleritis?

Answer 17

Phenylephrine 10% eye drops can be used to distinguish between episcleritis and scleritis. It blanches the redness in episcleritis but doesn’t in scleritis.

Question 18

What is Hutchinson’s sign?

Answer 18

Seen in herpes zoster ophthalmicus, Hutchinson’s sign: rash on the tip or side of the nose. Indicates nasociliary involvement and is a strong risk factor for ocular involvement

Question 19

How does anterior uveitis present?

Answer 19

Anterior uveitis is characterised by symptoms of a painful red eye with photophobia. Visual loss is more variable and can include reduced visual acuity, blurred vision, or reduced peripheral fields. In contrast to a fixed and dilated pupil, anterior uveitis is associated with a constricted pupil. Patients with a history of HLA-B27 positivity or autoimmune conditions are more likely to develop anterior uveitis.

Question 20

What is chorioretinitis?

Answer 20

Chorioretinitis is an inflammatory condition affecting the choroid and retina of the eye. This dual inflammation can be precipitated by infectious or autoimmune aetiologies, leading to the potential for significant visual impairment if not promptly and effectively managed.

Question 21

Where would you see pizza pie appearance on fundoscopy?

Answer 21

When the moon hits your eye like a big pizza pie that’s chorioretinitis

Question 22

Why do you see an irregular pupil in anterior uveitis?

Answer 22

An irregular pupil is found in anterior uveitis because of the formation of posterior synechiae due to inflammation within the eye and they stick the iris to the anterior lens surface causing irregularity of the pupil.

Question 23

What is the definitive treatment for acute angle closure glaucoma?

Answer 23

Laser peripheral iridotomy is the definitive treatment for acute angle-closure glaucoma. Produces an extra pathway in the iris for aqueous to flow from the posterior chamber into the anterior chamber in order to be drained into the angle.

Question 24

How do we treat herpes simplex keratitis?

Answer 24

Topical aciclovir

Question 25

Where do you see a central scotoma?

Answer 25

Optic neuritis

Question 26

What is a hypopyon?

Answer 26

pus in the anterior chamber

Question 27

A 68-year-old man with a history of type 2 diabetes mellitus presents with worsening eye sight. Mydriatic drops are applied and fundoscopy reveals pre-proliferative diabetic retinopathy. A referral to ophthalmology is made. Later in the evening whilst driving home he develops pain in his left eye associated with decreased visual acuity. What is the most likely diagnosis?

Answer 27

Acute angle closure glaucoma

Question 28

Where would you see positive Chvostek and Trousseau signs

Answer 28

Hypocalcaemia

Question 29

Which ophthalmological condition is associated with hypocalcaemia

Answer 29

Cataracts

Question 30

How does herpes simplex keratitis present?

Answer 30

Features
red, painful eye
photophobia
epiphora
visual acuity may be decreased
fluorescein staining may show an epithelial ulcer

Question 31

What is the Keith-Wagener classification for hypertensive retinopathy?

Answer 31

First they start to twist and turn [silver wiring] (I), then they nip about the place [AV nipping] (II), afterwards they play with cotton wool and fire [cotton wool spots, flame and blot haemorrhages] (III), finally they swell up [papilloedema] (IV).

Question 32

What is Marcus-Gunn pupil?

Answer 32

Relative afferent pupillary defect, seen during the swinging light examination of pupil response. The pupils constrict less and therefore appear to dilate when a light is swung from unaffected to affected eye. Most commonly caused by damage to the optic nerve or severe retinal disease.

Question 33

What is a hordeolum externum?

Answer 33

A type of stye

Question 34

What is a chalazion?

Answer 34

A chalazion is also called meibomian cyst and is typically on the internal eyelid.