Ophthalmology

Question 1

Best drops for dilation (ophthalmoscopy)

Answer 1

Tropicamide 1%

short-acting

Question 2

What should pts be warned about re: pupil dilatation?

Answer 2

Avoid driving - vision may be blurry

Seek urgent help if any pain/ see haloes - acute angle closure glaucoma

Question 3

How do you test red reflex?

Answer 3

About 50 cm away (reflection from retina)

Question 4

Why might red reflex be absent?

Answer 4

Opacity between cornea and retina, usually cataracts

Question 5

What is green light on ophthalmoscope used for?

Answer 5

Enhances blood vessels and microaneurysms

Question 6

What are the red flags for red eye?

Answer 6

Pain

Visual loss

Question 7

Which eyedrops for bacterial conjunctivitis?

Answer 7

Chloramphenicol

Question 8

How to identify scleritis and episcleritis?

Answer 8

Redness more localised

(Scleritis more painful - wakes pt from sleep) needs opthalmological input

Question 9

How is corneal abrasion seen?

Answer 9

fluorescein

OPTHALMOLOGICAL EMERGENCY

Question 10

What does eye look like in acute angle glaucoma?

Answer 10

Inflamed and tender.
Cornea hazy
Pupil is semi-dilated and fixed

Question 11

Urgent mx acute angle glaucoma if unable to get to hospital

Answer 11

IV acetazolamide
Pilocarpine 4% to constrict pupil

(Once pressure is brought down, iridotomy or iridectomy performed to restore normal aqueous flow)

Question 12

Iridotomy vs iridectomy

Answer 12

with laser vs surgically

Question 13

What should be excluded if bacterial conjunctivitis doesnt improve?

Answer 13

Chlamydia (Reite’s)

Question 14

Which eye pathologies are more common in those with severe myopia?

Answer 14

Retinal detachment
Macular degeneration
Primary open angle glaucoma

Question 15

Which eye pathologies are more common in those with severe hypermetropia?

Answer 15

Closed angle glaucoma

Question 16

What is astigmatism?

Answer 16

Cornea has uneven curvature (like rugby ball)

Can be caused by pathology (eg cyst) distorting eye

Question 17

What is a chalzion?

Answer 17

Meibomian cyst: granuloma of the lipid-secreting meibomian glands that lie in the lid

Warm compresses and chloramphenicol
Or if big, incision

Question 18

Most common eyelid bump

Answer 18

Chalzion

Question 19

How is a stye different to chalzion?

Answer 19

Infection of lash follicle - may have a head of pus at last margin

Red, tender swelling

Question 20

Blistering around eye

Answer 20

Herpes zoster ophthalmicus

Question 21

Important cause of proptosis not to miss

Answer 21

Orbital cellulitis (infection from adjacent paranasal sinuses)
(esp children - can cause visual loss in hours)

Question 22

Mx enoptropion

Answer 22

Temporary: tape down eye + chloramphenicol

Then surgery

Common cause of blindness from corneal abrasion

Question 23

What is ectropion?

Answer 23

Eyelid everts, problem with tears draining

Question 24

What is Schirmer’s test?

Answer 24

Paper to measure tear production

Question 25

Signs of a blowout fracture

Answer 25

``` Swollen eye Subconjunctival haemorrhage Restricted vertical movements Loss of sensation Ipsilateral nose bleed ```

Question 26

Most common cause of acute onset of floaters

Answer 26

Vitreous detachmment

Question 27

Why does vitreous detachment need urgent referral?

Answer 27

floaters suggests traction on retina - could detach/ tear

Question 28

Causes of acute floaters

Answer 28

Vitreous hemorrhage Vitreous detachmment Retinal detachment

Question 29

How does non-proliferative diabetic retinopathy present on fundoscopy?

Answer 29

microaneurysms dot haemorrhages hard yellow exudates

Question 30

How does proliferative diabetic retinopathy present on fundoscopy?

Answer 30

New vessels | needs urgent referral for treatment

Question 31

What are the types of glaucoma?

Answer 31

Primary open angle: gradual | Primary closed angle: acute

Question 32

Classic appearance of glaucoma on fundoscopy

Answer 32

Cupping

Question 33

differentiate between episcleritis and scleritis

Answer 33

Apply phenylephrine drops to differentiate between episcleritis and scleritis (vessels blanch with episcleritis).

Question 34

what does fundoscopy show for retinal artery occlusion

Answer 34

pale retina w/ cherry spot

Question 35

what to prescribe for closed angle

Answer 35

``` Prostaglandin analogues (latanoprost), B2 antagonists (timolol), alpha agonists (brimonidine) ```

Question 36

conjunctivitis rx

Answer 36

Leave | or chloramphenicol

Question 37

urgent gp rx closed angle

Answer 37

Consider pilocarpine 4% drops every 5 mins and acetazolamide

Question 38

stages of hypertensive retinopathy

Answer 38

silver wiring AV nipping haemorrhages/ exudates papilloedema

Question 39

stages of diabetic retinopathy

Answer 39

background (blot and dot haemorrhages) pre-prolferative (cotton wool spots) neovascularisation