Ophthalmology Flashcards

Question

How does acetazolamide work

Answer 1

Carbonic anhydrase inhibitor that reduces the production of aqueous humour.

Answer 2

Laser iridotomy This involves making a hole in the iris using a laser, which allows the aqueous humour to flow directly from the posterior chamber to the anterior chamber. This relieves the pressure pushing the iris forward against the cornea and opens the pathway for the aqueous humour to drain.

Answer 3

Progressive condition affecting the macula. It is the most common cause of blindness in the UK. It is often unilateral but may be bilateral.

Answer 4

- Wet (neovascular), accounting for 10% of cases - Dry (non-neovascular), accounting for 90% of cases

Answer 5

The macula is in the centre of the retina. It generates high-definition colour vision in the central visual field. It has four layers: - Choroid layer (at the base), which contains the blood vessels that supply the macula - Bruch’s membrane - Retinal pigment epithelium - Photoreceptors (towards the surface)

Answer 6

Important finding with AMD. They are yellowish deposits of proteins and lipids between the retinal pigment epithelium and Bruch’s membrane. A few small drusen can be normal in older patients. Frequent and larger drusen can be an early sign of macular degeneration.

Answer 7

- Atrophy of the retinal pigment epithelium - Degeneration of the photoreceptors

Answer 8

- New vessels develop from the choroid layer and grow into the retina (neovascularisation). - These vessels can leak fluid or blood, causing oedema and faster vision loss. - A key chemical that stimulates the development of new vessels is vascular endothelial growth factor (VEGF). This is the target of medications to treat wet AMD.

Answer 9

- older age - smoking - FH - CVD - obesity - poor diet

Answer 10

Visual changes associated with AMD tend to be unilateral, with: - Gradual loss of central vision - Reduced visual acuity - Crooked or wavy appearance to straight lines (metamorphopsia) - Worsening ability to read small text Wet AMD presents more acutely than dry AMD. Vision loss can develop within days and progress to complete vision loss within 2-3 years. It often progresses to bilateral disease.

Answer 11

- Glaucoma is associated with peripheral vision loss and halos around lights. - AMD is associated with central vision loss and a wavy appearance to straight lines.

Answer 12

- Reduced visual acuity using a Snellen chart - Scotoma (an enlarged central area of vision loss) - Amsler grid test can be used to assess for the distortion of straight lines seen in AMD - Drusen may be seen during fundoscopy - Fluorescein angiography involves giving a fluorescein contrast and photographing the retina to assess the blood supply, showing oedema and neovascularisation in wet AMD.

Answer 13

Dry AMD: Monitor and reduce the risk of progression by: - Avoiding smoking - Controlling BP - Vitamin supplementation Wet AMD: - Anti-VEGF medications (e.g., ranibizumab, aflibercept and bevacizumab) block VEGF and slow the development of new vessels. They are injected directly into the vitreous chamber of the eye (intravitreal), usually about once a month.

Answer 14

damage to the retinal blood vessels due to prolonged high blood sugar levels

Answer 15

- cotton wool spots - microaneurysms - hard exudates - blot haemorrhages - neovascularisation

Answer 16

- background - pre-proliferative - proliferative

Answer 17

- Exudates within the macula - Macular oedema

Answer 18

proliferative diabetic retinopathy is the development of new blood vessels (neovascularisation).

Answer 19

- Vision loss - Retinal detachment - Vitreous haemorrhage (bleeding into the vitreous humour) - Rubeosis iridis (new blood vessel formation in the iris) – this can lead to neovascular glaucoma - Optic neuropathy - Cataracts

Answer 20

Non-proliferative diabetic retinopathy: close monitoring and careful diabetic control. Proliferative diabetic retinopathy: - Pan-retinal photocoagulation (PRP) – extensive laser treatment across the retina to suppress new vessels - Anti-VEGF medications by intravitreal injection - Surgery (e.g., vitrectomy) may be required in severe disease An intravitreal implant containing dexamethasone is an option for macular oedema.

Answer 21

damage to the small blood vessels in the retina relating to hypertension Can happen due to chronic or malignant hypertension

Answer 22

- Silver/copper wiring (walls of the arterioles become thickened and sclerosed and reflect more light on examination) - Arteriovenous nipping (AV nipping) (arterioles cause compression of the veins where they cross due to sclerosis and hardening of the arterioles) - Cotton wool spots (ischaemia and infarction in the retina, causing damage to nerve fibres) - Hard exudates (damaged vessels leaking lipids onto the retina) - Retinal haemorrhages (damaged vessels rupturing and releasing blood in the retina. Dot and blot haemorrhages occur deeper, in the inner nuclear layer or outer plexiform layer. Flame haemorrhages occur in the nerve fiber layer) - Papilloedema (ischaemia to the optic nerve, resulting in optic nerve swelling)

Answer 23

Stage 1: Mild narrowing of the arterioles Stage 2: Focal constriction of blood vessels and AV nicking Stage 3: Cotton-wool patches, exudates and haemorrhages Stage 4: Papilloedema

Answer 24

Progressively opaque eye lens, which reduces the light entering the eye and visual acuity.

Answer 25

negative neonate red light reflex

Answer 26

- increasing age - smoking - diabetes - alcohol - steroids - hypocalcaemia

Answer 27

- asymmetrical - Slow reduction in visual acuity - Progressive blurring of the vision - Colours becoming more faded, brown or yellow - Starbursts can appear around lights, particularly at night

Answer 28

cataract surgery

Answer 29

endophthalmitis: inflammation of inner eye contents caused by infection. Can lead to vision loss. Treat with intravitreal antibiotics

Answer 30

circular muscles stimulated by parasympathetic nervous system using ACh

Answer 31

dilator muscles stimulated by sympathetic nervous system using adrenaline

Answer 32

- Trauma to the sphincter muscles in the iris (e.g., during cataract surgery) - Anterior uveitis can cause adhesions in the iris - Acute angle-closure glaucoma can cause ischaemic damage to the muscles of the iris and an abnormal pupil shape, usually a vertical oval - Rubeosis iridis (neovascularisation in the iris) can distort the shape of the iris and pupil. This is usually associated with poorly controlled diabetes and diabetic retinopathy - Coloboma is a congenital malformation that can cause a hole in the iris and an irregular shape. - Tadpole pupil involves muscle spasm in part of the dilator muscle of the iris, causing a misshapen pupil. It is a temporary condition and may be associated with migraines and Horner syndrome.

Answer 33

- Congenital - Stimulants (e.g., cocaine) - Anticholinergics (e.g., oxybutynin) - Trauma - Third nerve palsy - Holmes-Adie syndrome - Raised intracranial pressure - Acute angle-closure glaucoma

Answer 34

- Horner syndrome - Cluster headaches - Argyll-Robertson pupil (neurosyphilis) - Opiates - Nicotine - Pilocarpine

Answer 35

oculomotor nerve (CN3) - Ptosis (drooping upper eyelid) - Dilated non-reactive pupil - Divergent strabismus (squint) in the affected eye, with a “down and out” position of the affected eye

Answer 36

- Oculomotor nerve. - Supplies all the extraocular muscles except the lateral rectus and superior oblique. Therefore, when the oculomotor nerve stops working, most of the extraocular muscles stop working, and the lateral rectus and superior oblique (which are still working) pull the eye downward and outward. The oculomotor nerve also supplies the levator palpebrae superioris, which is responsible for lifting the upper eyelid. Therefore, a third nerve palsy causes ptosis (drooping of the upper eyelid).

Answer 37

idiopathic If pupil not effected (parasympathetic fibres spared): - diabetes - hypertension - ischaemia full third nerve palsy (CN3 compression): - trauma - Tumour - Cavernous sinus thrombosis - Posterior communicating artery aneurysm - Raised ICP

Answer 38

ptosis miosis anhidrosis can also have enopthalmos due to sympathetic fibres affected

Answer 39

4 Ss, 4 Ts and 4 Cs mnemonic. S for Sentral, T for Torso (pre-ganglionic) and C for Cervical (post-ganglionic). Central lesions (anhidrosis of arm, trunk and face): S – Stroke, Multiple Sclerosis, Swelling (tumours), Syringomyelia (cyst in the spinal cord) Pre-ganglionic lesions (anhidrosis of face): T – Tumour (Pancoast tumour) T – Trauma T – Thyroidectomy T – Top rib (a cervical rib growing above the first rib and clavicle) Post-ganglionic lesions (no anhidrosis): C – Carotid aneurysm C – Carotid artery dissection C – Cavernous sinus thrombosis C – Cluster headache

Answer 40

Heterochromia (different iris colour on affected side)

Answer 41

cocaine eye drops (dilates in normal, no reaction in horner's) low dose adrenalin eye drops (dilates in horner's)

Answer 42

- damage to post-ganglionic parasympathetic fibres - unknown cause - Dilated - Sluggish to react to light - Responsive to accommodation (the pupils constrict well when focusing on a near object) - Slow to dilate following constriction (“tonic” pupil)

Answer 43

- in neurosyphylis - Constricted pupil that accommodates when focusing on a near object but does not react to light. - Irregularly shaped

Answer 44

inflammation of the eyelid margins

Answer 45

gritty, itchy, dry sensation in the eyes. It can be associated with dysfunction of the Meibomian glands, which are responsible for secreting meibum (oil) onto the surface of the eye. It can lead to styes and chalazions.

Answer 46

Warm compresses and gentle cleaning of the eyelid margins to remove debris (e.g., using a cotton bud and baby shampoo)

Answer 47

infection of the glands of Zeis (sebaceous glands at base of eyelashes) or glands of Moll (sweat glands at base of eyelashes)

Answer 48

infection of the Meibomian glands. They are deeper, tend to be more painful and may point inwards towards the eyeball underneath the eyelid.

Answer 49

Hot compress Analgesia Topical antibiotics if assoc with conjunctivitis

Answer 50

- Meibomian gland blocked and swells. It is often called a Meibomian cyst. It presents with a swelling in the eyelid that is typically not tender (however, it can be tender and red). - Mx: warm compresses and gentle massage towards the eyelashes (to encourage drainage). Rarely, surgical drainage may be required.

Answer 51

- Eyelid turns inwards with the lashes pressed against the eye. - Pain and can cause corneal damage and ulceration - Mx: tape eyelid down and then surgical mx. Use lubricating eye drops when lid taped down

Answer 52

- Eyelid turns outwards, exposing the inner aspect (usually lower) - Most don't need treatment - Can use lubricating eye drops or maybe surgery

Answer 53

- Inward growth of the eyelashes - Results in pain and can cause corneal damage and ulceration. - Mx: remove the affected eyelashes. Recurrent cases may require electrolysis, cryotherapy or laser treatment to prevent them from regrowing

Answer 54

eyelid and skin infection in front of the orbital septum (in front of the eye). It presents with swollen, red, hot skin around the eyelid and eye. Must be differentiated from orbital cellulitis

Answer 55

systemic abx (oral/IV)

Answer 56

infection around the eyeball involving the tissues behind the orbital septum. Symptoms include : - pain with eye movement - reduced eye movements - vision changes - abnormal pupil reactions - proptosis (bulging forward of the eyeball).

Answer 57

Emergency admission under ophthalmology Intravenous antibiotics Surgical drainage if an abscess forms

Answer 58

inflammation of the conjunctiva. Bacterial, viral or allergic unilateral/bilateral

Answer 59

- Red, bloodshot eye - Itchy or gritty sensation - Discharge - Not painful - Bacterial= purulent discharge, morning stuck, highly contagious - Viral= clear discharge, pre-auricular LNs, viral sx, contagious

Answer 60

- Acute angle-closure glaucoma - Anterior uveitis - Scleritis - Corneal abrasions or ulceration - Keratitis - Foreign body - Traumatic or chemical injury

Answer 61

- conjunctivitis - Episcleritis - Subconjunctival haemorrhage

Answer 62

- hygiene measures - chloramphenicol or fusidic acid for bacterial if necessary - In neonates caused by gonococcal infection -> emergency

Answer 63

contact with contact allergens - swelling of the conjunctival sac, eyelid itching and watery discharge - Mx antihistamines or topical mast cell stabilisers for chronic

Answer 64

inflammation of the anterior uvea

Answer 65

uvea consists of iris, ciliary body and choroid

Answer 66

autoimmune process usually causes it, but it can be due to infection, trauma, ischaemia or malignancy.

Answer 67

- Seronegative spondyloarthropathies (e.g., ankylosing spondylitis, psoriatic arthritis and reactive arthritis) - Inflammatory bowel disease - Sarcoidosis - Behçet’s disease

Answer 68

- Painful red eye (typically a dull, aching pain) - Reduced visual acuity - Photophobia (due to ciliary muscle spasm) - Excessive lacrimation (tear production)

Answer 69

- Ciliary flush (a ring of red spreading from the cornea outwards) - Miosis (a constricted pupil due to sphincter muscle contraction) - Abnormally shaped pupil due to posterior synechiae (adhesions) pulling the iris into abnormal shapes - Hypopyon (inflammatory cells collected as a white fluid in the anterior chamber)

Answer 70

- Steroids (eye drops, oral or intravenous) - Cycloplegics (e.g., cyclopentolate or atropine eye drops) Cycloplegics dilate the pupil and reduce pain associated with ciliary spasm. Cycloplegic refers to paralysing the ciliary muscles. Cyclopentolate and atropine are antimuscarinic drugs that reduce the action of the iris sphincter muscles and ciliary muscles. DMARDs and anti-TNF for recurrent cases

Answer 71

Benign and self-limiting inflammation of the episclera, the outermost layer of the sclera, just below the conjunctiva.

Answer 72

relatively common > young/middle aged adults Associated with inflammatory conditions like: - RA - IBD - SLE

Answer 73

acute onset unilateral features - Localised or diffuse redness (often a patch of redness in the lateral sclera) - No pain (or mild pain) - Dilated episcleral vessels - normal visual acuity NO photophobia or discharge -->scleritis

Answer 74

photophobia and discharge

Answer 75

Apply phenylephrine eye drops. It will cause blanching of the episcleral vessels, causing the redness to disappear. It will not affect scleral vessels and will not impact the redness in scleritis.

Answer 76

self-limiting (1-2 weeks) analgesia and lubricating eye drops steroid eye drops for severe cases

Answer 77

inflammation of the sclera (white of eye)

Answer 78

necrotising scleritis which can lead to sclera perforation

Answer 79

most- idiopathic underlying systemic inflammatory condition less common- staph A/pseudomonas F>M

Answer 80

RA vasculitis (particularly granulomatosis with polyangiitis)

Answer 81

Scleritis usually presents with a more gradual onset. It can be unilateral or bilateral. Features include: - Red, inflamed sclera (localised or diffuse) - Congested vessels - Severe pain (typically a boring pain) - Pain with eye movement - Photophobia - Epiphora (excessive tear production) - Reduced visual acuity - Tenderness to palpation of the eye

Answer 82

- Refer for urgent assessment - Assess for an underlying systemic condition (e.g., rheumatoid arthritis or vasculitis). Management in secondary care: - NSAIDs (oral) - Steroids (topical or systemic) - Immunosuppression appropriate to the underlying systemic condition (e.g., methotrexate in rheumatoid arthritis) - Antimicrobial treatment for infectious scleritis.

Answer 83

Scratches or damage to the cornea. They cause a red, painful eye and photophobia

Answer 84

- Damaged contact lenses (assoc with pseudomonas infection) - Fingernails - Foreign bodies (e.g., metal fragments) - Tree branches - Makeup brushes - Entropion (inward turning eyelid) - Chemical abrasions (e.g., from acid) can cause severe damage and vision loss, requiring immediate extensive irrigation.

Answer 85

Painful red eye Photophobia Foreign body sensation Epiphora (excessive tear production) Blurred vision

Answer 86

A fluorescein stain can be applied to the eye. This is a yellow-orange colour and collects in abrasions or ulcers, highlighting them, particularly when viewed under cobalt blue light.

Answer 87

Mild, uncomplicated abrasions may be managed in primary care where there is appropriate experience and skill. Uncomplicated corneal abrasions usually heal over 2-3 days. More complicated cases require assessment and management by ophthalmology. Management options include: - Removing foreign bodies - Simple analgesia (e.g., paracetamol) - Lubricating eye drops - Antibiotic eye drops (e.g., chloramphenicol) - Close follow-up Lubricating eye drops vary in their viscosity: - Hypromellose drops are the least viscous (the effects last around 10 minutes) - Polyvinyl alcohol drops are the middle viscous choice - Carbomer drops are the most viscous (the effects last about 30-60 minutes)

Answer 88

inflammation of the cornea. most common cause of keratitis. Can be primary or recurrent. Recurrent is in trigeminal ganglion and can lie latent

Answer 89

- Viral infection (e.g., herpes simplex) - Bacterial infection (e.g., Pseudomonas or Staphylococcus) - Fungal infection (e.g., Candida or Aspergillus) - Contact lens-induced acute red eye (CLARE) - Exposure keratitis, caused by inadequate eyelid coverage (e.g., ectropion)

Answer 90

Usually affects only the epithelial layer of the cornea. Inflammation of the stroma (the layer between the epithelium and endothelium) is called stromal keratitis. This is associated with complications such as stromal necrosis, vascularisation and scarring and can lead to corneal blindness.

Answer 91

Primary infection- mild symptoms of blepharoconjunctivitis (inflammation of the eyelid margins and conjunctiva). Recurrent infection may present with: - Painful red eye - Photophobia - Vesicles (fluid-filled blisters) - Foreign body sensation - Watery discharge - Reduced visual acuity

Answer 92

Slit lamp examination. Fluorescein staining shows a dendritic corneal ulcer. Dendritic describes the branching appearance of the ulcer. Corneal scrapings can be used for viral testing.

Answer 93

Refer for urgent assessment Specialist management involves topical or oral antivirals (e.g., aciclovir or ganciclovir). Corneal transplant is an option to treat permanent scarring and vision loss after keratitis.

Answer 94

Small blood vessel within the conjunctiva ruptures, releasing blood into the space between the sclera and the conjunctiva. They often appear after episodes of strenuous activity, such as heavy coughing, weight lifting or straining when constipated. They can also be caused by trauma to the eye.

Answer 95

- most idiopathic - Hypertension - Bleeding disorders (e.g., thrombocytopenia) - Whooping cough - Medications (e.g., antiplatelets, DOACs or warfarin) - Non-accidental injury

Answer 96

patch of bright red blood underneath the conjunctiva. It covers the white of the eye painless, does not affect vision.

Answer 97

Dagnosis based on a history and examination. Underlying causes should be considered, for example: - Check BP - Checking INR in patients taking warfarin Self-limiting (2 weeks). Lubricating eye drops may be helpful if there is mild irritation

Answer 98

When the vitreous body comes away from the retina. It is common in older age.

Answer 99

Painless condition It may be completely asymptomatic. The key symptoms are: Floaters Flashing lights Blurred vision Would see some red vision in the eye due to haemorrhage

Answer 100

No treatment is necessary. Over time, the symptoms will improve as the brain adjusts. Can predispose patients to develop retinal tears and retinal detachment. These conditions can present similarly with flashes, floaters and vision loss. It is essential to exclude a retinal tear or retinal detachment with a thorough assessment of the retina, usually by an optometrist or ophthalmologist.

Answer 101

Involves the neurosensory layer of the retina (containing photoreceptors and nerves) separating from the retinal pigment epithelium (the base layer attached to the choroid). This is usually due to a retinal tear, allowing vitreous fluid to get under the neurosensory retina and fill the space between the layers The neurosensory retina relies on the blood vessels of the choroid for its blood supply. Therefore, retinal detachment can disrupt the blood supply and cause permanent damage to the photoreceptors, making it sight-threatening.

Answer 102

- Lattice degeneration (thinning of the retina) - Posterior vitreous detachment - Trauma - Diabetic retinopathy - Retinal malignancy - Family history - myopia

Answer 103

- Painless - Peripheral vision loss (often sudden and described as a shadow coming across the vision) - Blurred or distorted vision - Flashes and floaters (?one quadrant)w

Answer 104

Create adhesions between the retina and the choroid: - Laser therapy - Cryotherapy Aim to reattach the retina and reduce any traction/pressure that may cause it to detach again. The options for reattaching the retina are vitrectomy, scleral buckle or pneumatic retinopexy. - Vitrectomy= keyhole surgery removing the vitreous fluid, fixing the tear, and then inserting gas/oil to hold the retina in place. - Scleral buckling= a silicone “buckle” to put pressure on the sclera from outside, squashing the eye inwards to reconnect the layers of the retina. - Pneumatic retinopexy= injecting a gas bubble into the vitreous body and positioning the patient so the gas bubble presses the separated layer back into place.

Answer 105

When a blood clot forms in the retinal veins, blocking the drainage of blood from the retina. The thrombus may form in the central retinal vein or branch retinal veins. Central blockage affects whole retina

Answer 106

ischaemic or non-ischaemic. Retinal ischaemia leads to the release of vascular endothelial growth factor (VEGF), resulting in new blood vessel development (neovascularisation).

Answer 107

Blockage of a retinal vein causes venous congestion in the retina. Increased pressure in the retinal veins results in fluid and blood leaking into the retina, causing macular oedema and retinal haemorrhages. This results in retinal damage and vision loss.

Answer 108

- Hypertension - High cholesterol - Diabetes - Smoking - High plasma viscosity (e.g., myeloma) - Myeloproliferative disorders - Inflammatory conditions (e.g., SLE)

Answer 109

- painless blurred vision or vision loss. - In branch retinal vein occlusion, the vision loss corresponds to the affected area of the retina. - When it involves the branch draining the macula, central vision is lost.

Answer 110

Dilated tortuous retinal veins Flame and blot haemorrhages Retinal oedema Cotton wool spots Hard exudates "stormy thunder" appearance

Answer 111

Refer Aim to treat macular oedema and prevent neovascularisation: - Anti-VEGF therapies (e.g., ranibizumab and aflibercept) - Dexamethasone intravitreal implant (to treat macular oedema) - Laser photocoagulation (to treat new vessels)

Answer 112

obstruction to blood flow through the central retinal artery. The central retinal artery is a branch of the ophthalmic artery, which is a branch of the internal carotid artery.

Answer 113

atherosclerosis- most common GCA

Answer 114

CVD RFs (smoking, hypertension, diabetes and raised cholesterol) GCA RFs (white ethnicity, older age, female and polymyalgia rheumatica)

Answer 115

- sudden painless loss of vision - “curtain coming down” over the vision - relative afferent pupillary defect - Fundoscopy will show a pale retina with a cherry red spot

Answer 116

vision-threatening emergency, refer immediately. Giant cell arteritis is a potentially reversible cause. Testing includes an ESR blood test and temporal artery biopsy. Treatment is with high-dose systemic steroids. Immediate management options attempt to dislodge/resolve the blockage. There is no consensus, guidelines or solid evidence base for these options: Ocular massage (massaging the eye) Anterior chamber paracentesis (removing fluid from the anterior chamber to reduce the intraocular pressure) Inhaled carbogen (5% carbon dioxide and 95% oxygen) (to dilate the artery) Sublingual isosorbide dinitrate (to dilate the artery) Oral pentoxifylline (to dilate the artery) Intravenous acetazolamide (to reduce the intraocular pressure) Intravenous mannitol (to reduce the intraocular pressure) Topical timolol (to reduce the intraocular pressure)

Answer 117

artery is blocked so no hemorrhage is possible. Branch retinal vein has occlusion on a low pressure system so can escape and bleed

Answer 118

central affect whole vision branch only corresponds to part of retina effected

Answer 119

genetic condition causing degeneration of the photoreceptors in the retina, particularly the rods

Answer 120

many different genetic causes. Some causes involve isolated retinitis pigmentosa, while others result in systemic diseases associated with the condition. They vary in age at presentation and prognosis

Answer 121

Varies depending on the underlying cause. In most cases, the symptoms start in childhood. Rods degenerate more than the cones. Rods are responsible for night vision and peripheral vision. Therefore, there is: - Night blindness (often the first symptom) - Peripheral vision loss (before the central vision is affected) Fundoscopy shows pigmentation described as “bone-spicule” pigmentation. Spicule describes the sharp, pointed appearance. Bone-spicule refers to the similarity to the networking appearance of the bone matrix. The pigmentation is most concentrated around the mid-peripheral area of the retina. There can be a narrowing of the arterioles and a waxy or pale appearance to the optic disc.

Answer 122

Several genetic, systemic diseases involve retinitis pigmentosa. Some examples are: - Usher syndrome also causes hearing loss - Bassen-Kornzweig syndrome also causes progressive neurological impairments - Refsum disease also causes peripheral neuropathy, hearing and ichthyosis (scaly skin)

Answer 123

- Referral to an ophthalmologist - Genetic counselling - Vision aids - Sunglasses to protect the retina from accelerated damage - Driving limitations and informing the DVLA

Answer 124

- Ischaemic/vascular (e.g. thrombosis, embolism, temporal arteritis etc). e.g. occlusion of central retinal vein and occlusion of central retinal artery - vitreous haemorrhage - retinal detachment - retinal migraine

Answer 125

- space-occupying lesion: neoplastic, vascular - malignant hypertension - idiopathic intracranial hypertension - hydrocephalus - hypercapnia

Answer 126

- papilloedema - glaucoma - retinitis pigmentosa - choroidoretinitis - optic atrophy secondary to tabes dorsalis - hysteria

Answer 127

inflammation of the optic nerve

Answer 128

- multiple sclerosis: most common - diabetes - syphilis

Answer 129

- unilateral decrease in visual acuity over hours or days - poor discrimination of colours, 'red desaturation' - pain worse on eye movement - RAPD - central scotoma

Answer 130

- acute onset of eye pain and marked loss of vision, along with the presence of relative afferent pupillary defect (RAPD) on swinging flashlight test = optic neuritis. - The absence of optic disc swelling on fundoscopy = a retrobulbar lesion

Answer 131

MRI of the brain and orbits with gadolinium contrast is diagnostic

Answer 132

high-dose steroids recovery usually takes 4-6 weeks

Answer 133

MRI: if > 3 white-matter lesions, 5-year risk of developing multiple sclerosis is 50%

Answer 134

posterior vitreous detachment (retinal detachment possible but less common)

Answer 135

sudden loss of vision due to ischaemia, often due to thromboembolic disease in carotid

Answer 136

- Like retinal detachment, altitudinal field defects are commonly seen "curtain coming down" - temporary loss of vision

Answer 137

constricted pupil, headache and blurred vision

Answer 138

horizontal= peripheral problem pendular nystagmus, gait abnormality = cerebellar problem

Answer 139

- caused by reactivation of the varicella-zoster virus in the ophthalmic division of the trigeminal nerve. - Ocular involvement occurs in 50% of patients and some of these can experience a range of complications. - However, in the majority of cases there is complete resolution with no sequelae.