Ophthalmology

Question 1

DDX for gradual loss of vision (4)

Answer 1

Chronic Open-Angle Glaucoma
Age-related Macular Degeneration
Diabetic Retinopathy
Cataracts

Question 2

Main riskfactors for ARMD?

Answer 2

Age & Smoking

Others include: diet, FHX and hypertension

Question 3

Management for DRY and WET ARMD

Answer 3

Dry = No cure so management revolves around lifestyle changes (smoking cessation) and low visual aids.

Wet = caused by choroidal neovascularisation
- give Anti-VEGF injection (intravitreal) such as bevacizumab & ranibizumab

Question 4

AMSLER grid for wet ARMD

Answer 4

distortion at central field

Question 5

Risk factors for Cataracts:

Answer 5

Age
Diabetes
Steroids
Myotonic Dystrophy
Down's syndrome
Vitrectomy Surgery
Trauma

Question 6

Management for cataracts

Answer 6

Day-case surgery: phaecoemulsification with lens implant

Question 7

Investigation for cataracts

Answer 7

Opacification on slit-lamp

Question 8

Management for ACUTE CLOSED ANGLE GLAUCOMA

Answer 8

STAT = acetazolamide (IV/PO) with Beta-blockers or pilocarpine

Question 9

Causes of Relative Afferent Pupillary Defect

Answer 9

Retinal Occlussion (Artery and Ischaemic Venous)
Optic neuritis
Optic atropathy

Question 10

Causes of FIXED DILATED pupils

Answer 10

Acute Closed Angle Glaucoma
Mydriatics (tropicamide)
CN3 compression from coning or tumour

Question 11

What is horner syndrome

Answer 11

Ptosis (drooping of upper eyelids)
Enopthalmos
Anhydrosis (no sweat)
Small pupils

Question 12

Causes of Horner’s Syndrome

Answer 12

Central: Multiple Sclerosis

Pre-ganglionic: Pancoast tumour or trauma (CVA insertion or CEA)

Post-ganglionic:

• cavernous sinus thrombosis
• infection spreading via opthalmic vein
• CN 3 4 5 6 palsies

Question 13

Features of Optic Atrophy/Neuritis

Answer 13

RAPD
Loss of acuity
Loss of colour vision (red)
Pale optic disc
Central scotoma

Question 14

Causes of optic neuritis/artophy

CAC VISION

Answer 14

MS & Glaucoma = commonest

• Congenital
• Alcohol, lead and B12 deficiency
• Compression: glaucoma, neoplasia (optic glioma, pituitary adenoma) & Paget’s
• Vascular: DM, GCA or thromboembolic
• Inflammation: MS, DM, Devic’s
• Sarcoid
• Infection: HSV, TB, syphillis
• Oedema: papilloedema
• Neoplastic infiltration: leukaemia, lymphoma

Question 15

Red eye
Pupils fixed and dilated
Painful
Loss of vision + blurry 
Rainbow Haloes around lights at night

O/E: cloudy cornea, eye feels hard

Answer 15

Acute Angle Closure Glaucoma

Give acetazolamide (IV/PO) asap

Question 16

Red eye
SMALL PUPILS
Painful
PHOTOPHOBIA
Blurry vision

O/E: pus in anterior chamber, white precipitates on back of cornea, pain on convergence on Talbot test

Answer 16

Anterior Uveitis/Acute iritis

Question 17

What is anterior UVEITIS associated with?

Answer 17

Seronegative: Ank spond, psoriatic arthritis, Reiters

Juvenile Idiopathic Arthritis
IBD
Sarcoidosis
Behcets
Infections: TB, leprosy, syphillis, HSV, CMV, Toxo

Question 18

Episcleritis features are?

Answer 18

Painless
Red eye
No changes to visual acuity

Question 19

Scleritis features are?

Answer 19

Painful
Purplish eye
Conjunctival oedema

Question 20

Conditions associated with scleritis?

Answer 20

Rheumatoid Arthritis
Systemic Lupus Erythromatus
Wegner’s
Vasculitis

Question 21

Features of corneal abrasion?

Answer 21

Painful eye
Blurred vision
PHOTOPHOBIA

Question 22

Examination for corneal abrasion?

Management if confirmed?

Answer 22

Slit lamp: Fluorescein stain defect green

Chloramphenicol ointment for infection prophylaxis