Ophthalmology Flashcards
A middle-aged woman presents to the pharmacy suffering from a red left eye. The redness appeared quite quickly, and she has no other symptoms. Based on this information, what is the most likely diagnosis?
a. bacterial conjunctivitis
b. allergic conjunctivitis
c. episcleritis
d. subconjunctival haemorrhage
e. keratitis
d. subconjunctival haemorrhage
bacterial and allergic conjunctivitis are bilateral; the other three are unilateral, but keratitis is painful. This leaves a choice between episcleritis and subconjunctival haemorrhage. Given that symptoms appeared quickly, d is the most likely.
A man in his late 40s presents to the pharmacy suffering from a red right eye. The redness appeared a day or so ago, and he says the feeling is uncomfortable. He says he has not noticed any discharge, but mentions his eye is watering more than usual. Based on this information, what is the most likely diagnosis?
a. scleritis
b. uveitis
c. keratitis
d. viral conjunctivitis
e. glaucoma
d. viral conjunctivitis
all options, other than d, will present with true eye pain rather than discomfort
A woman in her late 30s presents with a red left eye. She says the eye has been red for a little while (at least 2 weeks), but that it has not been bothering her; however, she would like to get rid of the redness before attending a work party. What is the most likely diagnosing?
a. allergic conjunctivitis
b. episcleritis
c. scleritis
d. blepharitis
e. subconjunctival haemorrhage
b. episcleritis
Because the eye is not causing any discomfort, then the options listed that are plausible are episcleritis an subconjunctival haemorrhage. Based on duration b is more likely than e.
Red eye is a common presenting symptom. Based solely on epidemiology, which of the conditions listed below is least likely to be seen in a community pharmacy?
a. viral conjunctivitis
b. scleritis
c. glaucoma
d. subconjunctival haemorrhage
e. episcleritis
c. glaucoma
sinister causes of red eye are relatively uncommon. Options a, d and e are likely to be seen routinely by community pharmacists. This leaves a choice between b and c as the right answer. Scelritis is rare but an acute presentation of glaucoma constitutes the most unusual case that a pharmacist would see.
Mr Simmonds, a 54 year old, presents with a red right eye. He has had the symptoms for a week or so. He is complaining of photophobia and takes methotrexate for rheumatoid arthritis. What is the most likely diagnosis?
a. scleritis
b. episcleritis
c. uveitis
d. glaucoma
e. keratitis
c. uveitis
Photophobia is a symptom of few ocular conditions seen by a pharmacist. From the list, this only occurs in uveitis and keratitis. However, there is an association with keratitis and autoimmune disease. Therefore, uveitis is most likely in this case.
Priya Patel, a 27 year old woman, presents with bilateral red eye of 3 days’ duration. She complains also of slight discharge. Visual examination reveals nothing untoward. Your differential diagnosis is conjunctivitis. Which of the following symptoms help(s) differentiate allergic conjunctivitis from bacterial and viral conjunctivitis?
a. she also has nasal congestion
b. redness is distributed throughout the conjunctiva
c. she complains of itching eyes
d. discharge is mucopurulent
e. symptoms were sudden in onset
c. she complains of itching eyes
Nasal congestion is not associated with allergic conjunctivitis but could be seen in viral; redness distribution can be helpful but generalized redness is associated with bacterial and viral causes; discharge can suggest bacterial conjunctivitis but is not useful for confirming allergic conjunctivitis; sudden-onset conjunctivitis is more useful in bacterial and viral causes.
A patient presents with the following symptoms. There is a bright red patch in the eye, which appeared overnight. There is no recent history of trauma to the eye. There is no pain or discomfort and no discharge from the eye. Vision is normal, and there is no evidence of photophobia. What is the most likely diagnosis for this set of symptoms?
a. subconjunctival haemorrhage
b. uveitis
c. episcleritis
d. keratitis
e. viral conjunctivitis
a. subconjunctival haemorrhage
painless red eye, from the options listed, can only be subconjunctival haemorrhage or episcleritis. Because this was sudden in onset, the cause is likely to be option a
A middle-aged woman presents with a history of a red left eye for the last 24 hours. Which of the following symptoms should alert you to potential sinister pathology?
a. discomfort in the eye
b. generalized scleral redness
c. irregular pupil
d. redness located in the fornix
e. mucopurulent discharge
c. irregular pupil
all acute self-limiting causes of red eye will have normal pupil reactions and shape. therefore, option c is the correct answer.
A mother of a young girl (8 years old) asks you to look at her daughter’s sore left eye. On examination, you notice that her eyelid is slightly swollen, and her eye is a little red and tender to the touch. What is the most likely diagnosis?
a. blepharitis
b. bacterial conjunctivitis
c. stye
d. chalazion
e. entropion
c. stye
the most likely condition in this age group is either bacterial conjunctivitis or stye. Because she has local pain associated with her eyelid, stye is the most likely condition based on the symptoms listed.
Mr Singh, a 76 year old man, asks to speak with the pharmacist. He has a sore right eye. He says that his eye is watering and irritated. The symptoms have been present for quite some time. Eye examination is normal. Based on this information, what is the most likely diagnosis?
a. blepharitis
b. conjunctivitis
c. dry eye syndrome
d. entropion
e. stye
c. dry eye syndrome
entropion, blepharitis and dry eye syndrome can all cause excessive tearing. However, an eye examination would generally show other symptoms of redness and skin flaking in blepharitis. As eye examination is normal this tends to rule out entropion. Dry eye syndrome seems the most likely diagnosis. Supporting this is that Mr Singh’s age also fits with this diagnosis .
Mr Bradley comes into your pharmacy to ask about treatment for an infected eye. For OTC treatment of acute bacterial conjunctivitis, which one of the following regimens should be recommended for chloramphenicol eye drops, 0.5%?
a. apply one drop four times a day. duration of treatment is 7 days
b. apply one drop every 2 hours for 2 days and then four times a day thereafter. Duration of treatment is 5 days
c. apply two drops four times a day. duration of treatment is 5 days.
d. apply one drop every 4 hours for 3 days and then four times a day. duration of treatment is 7 days.
e. apply one drop every 4 hours for 2 days and then four times a day. duration of treatment is 5 days.
b. Apply one drop every 2 hours for 2 days and then four times a day thereafter. Duration of treatment is 5 days.
The dosing schedule is in accordance with product license for chloramphenicol
Mrs Sykes, a 52 year old woman, presents with a bright red left eye that she noticed the previous day. Which of the symptom clusters would you most likely think warrants referral to an optician?
a. slight eye discomfort but no discharge, with vision unaffected
b. slight pain with little discharge and vision unaffected
c. slight pain with little discharge and blurred vision due to tearing
d. slight pain with mucopurulent discharge and vision unaffected
e. moderate pain with slight discharge and vision unaffected
b. slight pain with little discharge and vision unaffected.
True eye pain should be referred for further evaluation but pain is subjective. Slight eye pain is, in most cases, manageable in the pharmacy. In this case, only option e warrants referral.
Mr X presents one evening to the pharmacy with symptoms of blurred vision and eye pain. Which one of the following is the most likely diagnosis?
a. episcleritis
b. glaucoma
c. keratitis
d. uveitis
e. viral conjunctivitis
c. keratitis
viral conjunctivitis an episcleritis can be discounted because neither are painful or cause blurred vision. All others will cause pain but keratitis and uveitis are least associated with blurred vision compared to glaucoma, which also occurs frequently in the evening
Mrs Beattie, a 65 year old woman, asks to speak with the pharmacist. She says that both her eyes are sore and feel itchy and watery. The symptoms have been present for quite some time. Eye examination is normal. Based on the information, what is the most likely diagnosis?
a. blepharitis
b. dry eye syndrome
c. conjunctivitis
d. stye
e. entropion
b. dry eye syndrome
Bilateral presentation will rule out stye and entropion. No signs of conjunctival redness would also rule out conjunctivitis. The description could be either blepharitis or dry eye syndrome. Because the eye examination is normal, this points to b more than a because one would expect to see skin debris and/or lash deformities in blepharitis.
Mrs Jenkins asks for your advice. She tells you that she was gardening 2 days ago when a branch went into her right eye. Since then, she has experienced severe pain, with watery discharge. On inspecting her eye, you see redness around the iris and small pupil. Which of the following conditions is this most likely to be?
a. subconjunctival haemorrhage
b. uveitis
c. keratitis
d. viral conjunctivitis
e. episcleritis
c. keratitis
Subconjunctival haemorrhage and episcleritis are painless; viral conjunctivitis causes discomfort not pain. This leaves uveitis and keratitis as an option, both of which cause pain. Pupil changes occur in both, but uveitis shows an irregular shaped pupil compared to a small pupil in keratitis.
Which condition shows redness greatest in the fornices?
a. allergic conjunctivitis
b. bacterial conjunctivitis
c. viral conjunctivitis
d. subconjunctival haemorrhage
e. episcleritis
a. allergic conjunctivitis
allergic conjunctivitis shows redness in the fornices because pollen is washed into the corner of the eyes, causing local direct irritation; bacterial and viral can show generalized redness; subconjunctival haemorrhage and episcleritis show segmental redness.
Which condition is bilateral and discomfort is described as itching?
a. allergic conjunctivitis
b. bacterial conjunctivitis
c. viral conjunctivitis
d. subconjunctival haemorrhage
e. episcleritis
a. allergic conjunctivitis
bilateral involvement is associated with options a, b and c, the three forms of conjunctivitis commonly seen in the community pharmacy. Bacterial and viral are described as discomfort rather than itching.
Which condition is usually sudden in onset, unilateral and painless?
a. allergic conjunctivitis
b. bacterial conjunctivitis
c. viral conjunctivitis
d. subconjunctival haemorrhage
e. episcleritis
d. subconjunctival haemorrhage
Only d and e should be considered. Both tend to be painless but subconjunctival haemorrhage is associated with an abrupt onset.
Which condition affects women more than men?
a. allergic conjunctivitis
b. bacterial conjunctivitis
c. viral conjunctivitis
d. subconjunctival haemorrhage
e. episcleritis
e. episcleritis
all forms of conjunctivitis and subconjunctival haemorrhage show no gender differences
Which condition is associated with other symptoms such as cough?
a. allergic conjunctivitis
b. bacterial conjunctivitis
c. viral conjunctivitis
d. subconjunctival haemorrhage
e. episcleritis
c. viral conjunctivitis
b, d and e have no other associated symptoms. a and c can show other symptoms; allergic conjunctivitis can have nasal symptoms but not cough
Which symptom is most closely associated with a stye?
a. painful upper eyelid
b. painless lump on the upper eyelid
c. unilateral swollen eyelid
d. burning of lid margins
e. in-turning eyelid
f. out-turning eyelid
g. pain and swelling over the lacrimal sac
a. painful upper eyelid
Styes tend to cause localized pain. Given the options, b and d-g can be excluded, leaving painful upper eyelid and unilateral swollen eyelid as possible viable options. Based on the information given, a is a better fit than c.
Which symptom is most closely associated with orbital cellulitis?
a. painful upper eyelid
b. painless lump on the upper eyelid
c. unilateral swollen eyelid
d. burning of lid margins
e. in-turning eyelid
f. out-turning eyelid
g. pain and swelling over the lacrimal sac
c. unilateral swollen eyelid
orbital cellulitis causes swelling and, based on this symptom, only c is a viable option
Which symptom is most closely associated with blepharitis?
a. painful upper eyelid
b. painless lump on the upper eyelid
c. unilateral swollen eyelid
d. burning of lid margins
e. in-turning eyelid
f. out-turning eyelid
g. pain and swelling over the lacrimal sac
d. burning of lid margins
blepharitis involves the lid margins rather than the eyelids themselves. Based on this, the only viable option is d.
Which symptom is most closely associated with carcinoma?
a. painful upper eyelid
b. painless lump on the upper eyelid
c. unilateral swollen eyelid
d. burning of lid margins
e. in-turning eyelid
f. out-turning eyelid
g. pain and swelling over the lacrimal sac
b. painless lump on the upper eyelid
Carcinomas affecting the eyes/eyelids tend to be slow-growing, insidious and painless. This means that options a, c, d and g can be excluded. Options e and f can also be excluded because they are a consequence of eyelid pathology but not tumour growth.
