Ophthalmology

Question 1

Conjunctivitis

Presentation

Answer 1

Red eye
Gritty irritation
Injection worse peripherally
Discharge (can be watery or purulent)
Follicles and papillae in fornix of the eye

Question 2

Does conjunctivitis affect both eyes?

Answer 2

It can do as it is easily transmitted but not always

Question 3

Does conjunctivitis cause altered visual acuity?

Answer 3

Tearing and discharge may make vision difficult but there is not a true reduction in visual acuity

Question 4

Viral causes of acute conjunctivitis

Answer 4

Adenovirus
Herpes
Molluscum contagiosum

Question 5

What associated symptom do you get with conjunctivitis caused by adenovirus?

Answer 5

Lymph node enlargement

Question 6

Bacterial causes of conjunctivitis

What uncommon cause can cause severe infection?

Answer 6

Staph.
Strep. pneumoniae
H. influenza
M. catarrhalis

Rare but severe - gonorrhoea (Neisseria gonorrhoeae)

Question 7

Chronic causes of conjunctivitis

Answer 7

Repeated infections:
Molluscum contagiosum
Chlamydia
Trachoma

Question 8

What symptom will tell you conjunctivitis is caused by bacteria or virus?

Answer 8

Bacterial conjunctivitis will usually present with the patient’s eyes being stuck upon waking up

Question 9

Treatment for conjunctivitis

Answer 9

Often self limiting
Cleaning the eyes with water can help
For bacterial cases, Chloramphenicol is the standard antibiotic
Fusidic acid can be given in pregnancy

Question 10

Anterior Uveitis (Iritis)
Symptoms

Answer 10

Central redness
Photophobia
Acute pain
Small pupil due to iris spasms
Inflammatory deposits (which can lead to hypopyon)

Question 11

Common causes of Iritis

Answer 11

Infectious: Varicella zoster, Herpes simplex, CMV, toxoplasmosis
Malignancy: Retinoblastoma, leukaemia, Non-Hodgkin’s
Autoimmune: Psoriatic arthritis, sarcoidosis

Question 12

Management of iritis

Answer 12

Steroids
Atropine to paralyse ciliary body
Systemic immunosuppression and antibiotics can be used in severe cases

Question 13

Episcleritis

Causes and symptoms

Answer 13

Non-infectious inflammation of episclera
Associated with collagen disorders or RA
Asymptomatic, or can cause mild pain

Question 14

Treatment of episcleritis

Answer 14

Self limiting

Steroids can be used if symptoms persist

Question 15

Scleritis

Presentation

Answer 15

Patient has deep, boring pain in the eye
Wakes them up at night
Lacrimation
Photophobia

Question 16

Scleritis

Causes

Answer 16

Herpes zoster

Collagen disorders, sarcoidosis, gout, IBD

Question 17

Scleritis

Treatment

Answer 17

Steroids (topical and then oral)

Question 18

Glaucoma

Cause

Answer 18

Blockage of trabecular meshwork, so aqueous humour can’t drain away and ocular pressure builds up
Presses on optic nerve and can cause vision loss

Question 19

Open angle glaucoma

Presentation

Answer 19

Visual loss
Fundoscopic changes: Increased cupping, optic disc atrophy, haemorrhage, rim changes
Increased ocular pressure

Question 20

What happens to cause angle closure in glaucoma?

Answer 20

Iris (pupil) catches on the lens while it is in mid-dilation

This is common in shock, TV in low light (any time when the pupil suddenly changes size)

Question 21

Treatment of Open angle glaucoma

Answer 21

Topical Beta blocker (Timolol) and Carbonic Anhydrase inhibitors to reduce aqueous production

Prostaglandin analogues to increase drainage

Question 22

Risk factors for Open angle glaucoma

Answer 22

Age
Family history
Nerve pinching
Being African American

Question 23

Risk factors for closed angle glaucoma

Answer 23

Hyperopic eyes (have a smaller anterior chamber)
Pupil dilation (including with antihistamines)

Question 24

Presentation of close angled glaucoma

Answer 24

Painful red eye
Nausea and vomiting
Seeing haloes in their vision (from water in the cornea)

Question 25

Treatment of closed angle glaucoma

Answer 25

EMERGENCY Pilocarpine to constrict pupil and open blockage Timolol and carbonic anhydrase inhibitors to reduce aqueous production Laser surgery (to make a hole through the iris) can be a definitive treatment

Question 26

Orbital cellulitis | Aetiology

Answer 26

Infection behind the orbital septum | Sight threatening emergency

Question 27

Causes of orbital cellulitis

Answer 27

Spread of infection from other sites (paranasal sinuses and dental infections) Direct innoculation in trauma (72hrs post injury)

Question 28

Pathogens in orbital cellulitis

Answer 28

Strep pneumonia/ pyogenes Staph aureus H. influenza (in kids) MRSA

Question 29

Orbital cellulitis | Presentation

Answer 29

``` Unilateral oedema, erythema, chemosis and pain Proptosis (anterior protrusion of eye) Ophthalmoplegia (paralysis of the eye) Reduced visual acuity RAPD ```

Question 30

Orbital cellulitis | Treatment

Answer 30

Emergency IV antibiotics (Cefotaxime and Flucloxacillin with metronidazole) Clindamycin and ciprofloxacin in penicillin allergy Surgery can be indiciated

Question 31

Giant cell arteritis | Definition

Answer 31

Chronic vasculitis, characterised by granulomatosis of blood vessels in the head, particularly branches of the carotid artery

Question 32

Clues to Giant cell arteritis

Answer 32

``` Unilateral headache Tenderness or thickening of temporal artery Scalp tenderness (brushing hair) Jaw claudication Vision loss Fever Distal swelling and pitting oedema ```

Question 33

Diagnosis of Giant cell arteritis

Answer 33

Temporal artery biopsy | Bloods: ESR, CRP, ALP, FBC (raised platelets)

Question 34

Treating Giant cell arteritis

Answer 34

Oral prednisolone | Aspirin and PPI long term

Question 35

Physiological changes in macular degeneration

Answer 35

Drusen Abnormalities in RPE Neovascularisation within the retina - causes scarring and bleeding

Question 36

Major risk factors for AMD

Answer 36

Smoking Family history Increasing age

Question 37

Presentation of AMD

Answer 37

Loss of central vision or scotoma Metamorphopsia (waving of lines) Reduced adaptation to light and dark

Question 38

Treatment of AMD

Answer 38

Anti-VEGF treatments | Holistic care, looking at functioning, driving and coping with vision loss

Question 39

Classic symptoms of Optic neuritis

Answer 39

Vision loss Eye pain (particularly on movement) Loss of colour vision

Question 40

Major risk in someone with vitreous detachment?

Answer 40

Progressing to retinal detachment

Question 41

Risk factors for retinal detachment?

Answer 41

Age Short sightedness FHx Previous history of detachment

Question 42

Presentation of retinal detachment

Answer 42

New onset floaters and flashes | Progressing to painless sudden vision loss