Ophthalmology

Question 1

What are the risk factors for ARMD?

Answer 1

Female, smoking, hypertension, cataract surgery

Question 2

What are the clinical features of ARMD?

Answer 2

Blurred/loss of central vision
Absent foveal reflex
Yellow drusen
Areas of hypo and hyper pigmentation

Question 3

What are the clinical features of wet AMD?

Answer 3

Fluid/bloods develops in retina
Sudden loss of central vision
Needs urgent referral and anti-VEGF

Question 4

What is glaucoma?

Answer 4

Damage to optic nerve due to increased ocular pressure
Visual field defect
Cupping of optic disc

Question 5

What is the normal flow of aqueous humour?

Answer 5

Ciliary process
Posterior chamber
Anterior chamber
Trabecular meshwork, Schlemm’s canal, episcleral veins

Question 6

What are some risk factors for primary open angle glaucoma?

Answer 6

Age, male, race, FH, short-sighted (myopia), DM, tight collar and tie

Question 7

What is the treatment of primary open angle glaucoma?

Answer 7

Medical - prostaglandin analogues e.g. latanoprost
Laser trabeculoplasty
Trabeculectomy

Question 8

What are the clinical features of closed angle glaucoma?

Answer 8

May be preceded by subacute episodes - headaches, coloured haloes around lights 
Photophobic and painful eye
Watering and loss of vision 
May be systemically unwell 
Dilated pupil, cloudy cornea, red eye

Question 9

Which eye drops should be cautioned in glaucoma?

Answer 9

Tropicamide and phenylephrine

Increase pupil size - narrows drainage angle

Question 10

What are the clinical features of central retinal artery occlusion?

Answer 10

Sudden painless loss of vision
Cherry red spot, pale retina
Exclude GCA

Question 11

What are the clinical features of central retinal venous occlusion?

Answer 11

Acute monocular loss of portion of visual field

Intraretinal haemorrhage and lipids, dilated retinal veins

Question 12

What investigations should be done in orbital cellulitis?

Answer 12

Orbit MRI/CT
Conjunctival swab
FBC 
Blood cultures
Pulse, BP, temperature, visual acuity - hourly

Question 13

What are the clinical features of infective endophthalmitis?

Answer 13

Usually follows eye surgery
Increasingly painful eye and reduced visual acuity
Red eye, hypopyon, corneal oedema and infection
Give intra-vitreal antibiotics

Question 14

What are the clinical features of herpes eye infections?

Answer 14

Mild fever, malaise, URTI
Dendritic ulcer on fluorescein and cobalt blue
HSV1

Question 15

What are the clinical features of an abducens palsy?

Answer 15

Lateral rectus palsy - can abduct one eye

Usually due to microvascular infarct

Question 16

What are the red flags for an abducens palsy?

Answer 16

Under 35, other palsies, papilloedema

Question 17

What are the clinical features of an oculomotor palsy?

Answer 17

Ptosis, eye turned down and out
Microvascular infarct or berry aneurysm
Pupil dilated - think aneurysm, urgent neuroimaging

Question 18

Which drops should be used to dilated pupils in children?

Answer 18

Cyclopentolate

Question 19

When should babies be screened for ROP?

Answer 19

Babies born under 31 weeks should be screened at 4-7 weeks postnatally

Question 20

What conditions are associated with congenital cataracts?

Answer 20

Cytomegalovirus, varicella, rubella

Down’s, Edward’s

Question 21

What is the treatment of congenital cataracts?

Answer 21

Bilateral dense - surgery at 4-6 weeks
Bilateral partial - may not need surgery
Unilateral dense - urgent surgery and aggressive anti-amblyopia therapy