Ophthalmology

Question 1

How are bacterial and viral conjunctivitis differentiated?

Answer 1

• bacterial is more often unilateral with a thick, purulent discharge
• viral is more often bilateral with a watery discharge, itchiness, and preauricular adenopathy; it is more easy transmissible

Question 2

What does the differential for red eye include?

Answer 2

• conjunctivitis
• uveitis
• glaucoma
• abrasion

Question 3

Describe the pathophysiology, presentation, diagnosis, and treatment for uveitis.

Answer 3

• it is an inflammation of the middle layer of tissue in the wall of the eye, including the iris
• presents with red eye, pain, photophobia, and minimal discharge, often in those with a history of autoimmune disease
• diagnosis is made by slit lamp examination
• treat with topical steroids

Question 4

Describe the presentation, diagnosis, and treatment for corneal abrasion.

Answer 4

• presents with red eye and a feeling of grittiness or foreign body sensation
• diagnosis is made with fluorescein stain
• there is no specific therapy

Question 5

Describe the presentation, diagnosis, and treatment of chronic glaucoma.

Answer 5

• presents with slowly progressive bilateral loss of peripheral vision
• diagnosis is made with tonometry
• treat with prostaglandin analogues, topical beta blockers, topical carbonic anhydrase inhibitors, alpha2-agonsits, and pilocarpine

Question 6

Describe the presentation, diagnosis, and treatment of acute glaucoma.

Answer 6

• presents with sudden onset of an extreme eye pain and a red, hard eye with a non-reactive pupil
• exam shows a cup-to-disc ratio grater than 0.3 and the diagnosis is confirmed with tonometry
• treat with acetazolamide, mannitol, pilocarpine, and topical beta-blockers

Question 7

Describe the presentation, diagnosis, and treatment of herpes keratitis.

Answer 7

• it is an infection of the cornea
• presenting with a red, swollen, painful eye
• diagnosis is made with fluorescein staining showing a dendritic pattern
• treat with oral acyclovir and avoid steroids which are contraindicated

Question 8

Describe the fundoscopic findings and treatment of diabetic retinopathy.

Answer 8

• fundoscopy reveals microaneurysms, hemorrhages, exudates, and retinal edema
• this is followed by cotton wool spots and later neovascularization
• nonproliferation retinopathy is best managed with glucose control while proliferative retinopathy requires VEGF inhibitors or photocoagulation

Question 9

Describe the presentation and treatment of retinal artery occlusion.

Answer 9

• presents with sudden onset of monocular vision loss
• the retina will appear pale with a dark macula
• treat with 100% oxygen, ocular massage, acetazolamide, anterior chamber paracentesis, and thrombolytics

Question 10

Describe the presentation of retinal vein occlusion.

Answer 10

presents with sudden onset monocular vision loss and diffuse retinal hemorrhages present on fundoscopy

Question 11

What are the risk factors for retinal detachment?

Answer 11

• trauma
• extreme myopia
• diabetic retinopathy

Question 12

Describe the presentation and treatment of macular degeneration.

Answer 12

• presents with progressive, bilateral loss of central vision
• may be dry or wet, which is characterized by neovascularization behind Bruch membrane
• dry is best treated with vitamins and anti-oxidants while wet requires VEGF inhibitors like ranibizumab and bevacizumab or laser photocoagulation