Ophthalmology Flashcards
A 54 year old man is noted to have papilloedema on examination. Which of the following may be responsible?
(A) Vitamin D Toxicity (B) Hypercapnia (C) Hyperkalaemia (D) Hypercalcaemia (E) Hypoglycaemia
(B) Hypercapnia
Hyperventilation to induce hypocapnia may be used in the emergency setting to reduce intracranial pressure.
Causes of papilloedema
- Space occupying lesion (neoplastic, vascular)
- malignant hypertension
- idiopathic intracranial hypertension
- hydrocephalus
- hypercapnia
The following features may be observed on fundoscopy of a patient with papilloedema:
- venous engorgement (usually the first sign)
- loss of venous pulsation (although many normal patients do not have normal pulsation)
- blurring of the optic disc margin
- elevation of the optic disc
- loss of the optic cup
- Paton’s lines: concentric/radial retinal lines cascading from the optic cup.
A 43 year old man with a history of chronic back pain presents to his GP complaining of pain in his left eye and photophobia. On examination the pupil is small, oval shaped and associated with ciliary congestion. What is the most likely diagnosis?
(A) Anterior Uveitis (B) Conjunctivitis (C) Scleritis (D) Meningitis (E) Acute Angle Closure Glaucoma
(A) Anterior Uveitis
Red eye - glaucoma or Uveitis?
Glaucoma - severe pain, haloes, ‘semi-dilated’ pupil
Uveitis - small, fixed oval pupil, ciliary flush
His chronic back pain may be HLA-B27 related, which is associated with anterior Uveitis.
Which of the following is not a recognised cause of tunnel vision?
(A) Papilloedema (B) Choroidoretinitis (C) Macular degeneration (D) Glaucoma (E) Retinitis pigmentosa
(C) Macular degeneration
Causes of tunnel vision include: Papilloedema Glaucoma Retinitis pigmentosa Choroidoretinitis Optic atrophy secondary to tabes dorsalis Hysteria
A 68 year old man was diagnosed with glaucoma and commenced on treatment. He returned in one month for review, his eye pressures had improved but he complains his eyelashes have increased in length. What medicine is likely to have caused his eyelashes to grow in length?
(A) Brinzolamide (B) Timolol (C) Dorzolamide (D) Brimonidine (E) Latanoprost
(E) Latanoprost
Key side effects of prostaglandin analogues include increased eyelash length, iris pigmentation and periocular pigmentation.
Prostaglandin analogues are the first line treatment for primary open angle glaucoma. They act by increasing uveoscleral outflow.
A 79 year old man presents with a 3 month history of a red swollen left upper eyelid. He remembers initially developing a bump on the lower eyelid which was uncomfortable but then got bigger forming a hard lump. He reports no pain currently and has not noted any problems with his vision. The eye itself appears healthy. What is the most likely diagnosis?
(A) Hordeolum externa (external stye) (B) Hordeolum interna (internal stye) (C) Chalazion (Meibomian cyst) (D) Blepharitis (E) Ectropion
(C) Chalazion
A meibomian cyst presents as a firm, painless lump in the eyelid.
These occur when the meibomian gland becomes blocked, forming a cyst and often occur following an internal stye (hordeolum internum). Patients will describe a firm, painless lump in the eyelid. Cysts can resolve spontaneously but may require topical antibiotics if they become infected.
The prolonged history here and absence of pain point away from either internal or external stye.
Blepharitis and ectropion would not cause a lump in the eyelid.
Which of the following is least associated with the development of optic atrophy?
(A) Ataxic telangiectasia (B) Longstanding papilloedema (C) Multiple sclerosis (D) Glaucoma (E) Retinitis pigmentosa
(A) Ataxic telangiectasia
Optic atrophy is seen as a pale, well demarcated disc on fundoscopy. It is usually bilateral and causes a gradual loss of vision (strictly speaking optic atrophy is a descriptive term and it is the optic neuropathy that results in visual loss).
A 64 year old woman with Type 2 Diabetes Mellitus presents as she has started to bump into things since the morning. Her medications include metformin, simvastatin and aspirin. Over the previous two days she had noticed numerous ‘dark spots’ over the vision in her right eye. Examination reveals she has no vision in her right eye. The red reflex is difficult to elicit on the right side and you are unable to visualise the retina on the right side during fundoscopy. Examination of the left funds reveals disease consistent with pre-proliferate every diabetic retinopathy. What is the most likely diagnosis?
(A) Occlusion of the central retinal vein (B) Vitreous Haemorrhage (C) Proliferative Retinopathy (D) Cataract (E) Retinal Detachment
(B) Vitreous Haemorrhage
The history of diabetes, aspirin use, complete loss of vision in the affected eye and inability to visualise the retina point towards a diagnosis of vitreous haemorrhage.
Causes of Vitreous haemorrhage include diabetes and bleeding disorders. Features may include sudden visual loss and dark spots.
A mother brings her 8 week old child in for review. Since birth his right eye has been watering. His symptoms have worsened over the past few days after he picked up a mild viral illness. Clinical examination is unremarkable. What is the most appropriate action?
(A) Refer urgently to ophthalmology
(B) Teach nasolacrimal duct massage
(C) Perform a depression screen on the mother
(D) Advise mother to clean the inner eyelids and use warm compresses
(E) Refer routinely to ophthalmology
(B) Teach nasolacrimal duct massage
Nasolacrimal duct obstruction is the most common cause of a persistent water eye in an infant. It is caused by an imperforate membrane, usually at the lower end of the lacrimal duct. Around 1 in 10 infants have symptoms at around one month of age.
Management:
(I) Teach parents to massage the lacrimal duct
(II) Symptoms resolve in 95% by the age of one year. Unresolved cases should be referred to an ophthalmologist for consideration of probing, which is done under a light general anaesthetic.
