Ophthalmology conditions

Question 1

What are cataracts?

Answer 1

Opacification of the lens of the eye

Question 2

What causes cataracts?

Answer 2

Most are idiopathic (age-related)

Question 3

What are the secondary causes of cataracts?

Answer 3

Local previous disease (eye traume, uveitis)
Systemic: Diabetes, Metabolic (e.g. Wilson’s), skin disease (e.g. scleroderma), drugs (e.g. steroids)
Congenital: Congenital rubella syndrome

Question 4

What are the symptoms for cataracts?

Answer 4

Gradual-onset painless loss of vision
Glare from bright light
Vision may worsen in bright light
Some may experience monocular diplopia with haloes around light
Some may begin ti be able to read without glasses

Question 5

Why could cataracts make it so that old people can then read without glasses?

Answer 5

A sclerotic cataract may increase the lens’ converging power

Question 6

What are the signs of cataracts?

Answer 6

Loss of red reflex
Hazy lens appearance
Reduced visual acuity

Question 7

What investigations are done for cataracts?

Answer 7

Usually unnecessary

Question 8

What is conjunctivitis?

Answer 8

Inflammaiton of the conjunctiva

Question 9

What is it called when the cornea becomes involved in conjunctivitis?

Answer 9

Keratoconjunctivitis

Question 10

What is it called when the eye lid becomes involved in conjunctivitis?

Answer 10

Blepharoconjunctivitis

Question 11

What are the 2 categories that cause conjunctivitis?

Answer 11

Infectious

Non-infectious

Question 12

What causes infectious conjunctivitis?

Answer 12

Viruses
Bacteria
- S. aureus
- Strep. pneumonia
- H. influenzae

Question 13

What are the risk factors for conjunctivitis?

Answer 13

Contact with an infected person
Uniocular conjunctivitis
Allergens/irritants
Contact lenses
Atopy
Floppy eyelid syndrome

Question 14

What are the symptoms of conjunctivitis?

Answer 14

Red eye
Irritation, discomfort and grittiness/stickiness
Discharge
- Purulent (bacterial cause)
- Water (viral cause)
- Mucoid (allergic cause)
Photophobia (corneal involvement)

Question 15

What are the signs of conjunctivitis?

Answer 15

Blood shot eyes
Dilated conjunctival vessels
Conjunctival chemosis (swelling)
Conjunctival follicles (round lymphocytes visible on eye lid)
Conjunctival papillae (Allergy)

Question 16

What are the investigations of conjunctivitis?

Answer 16

Diagnosis from examination / history

Question 17

What is Glaucoma?

Answer 17

Optic neuropathy with typical field defect, usually associated with ocular hypertension >21 mmHg

Question 18

What are the 2 main categories of glaucoma?

Answer 18

Open angle glaucoma

Closed angle glaucoma

Question 19

What is open angle glaucoma?

Answer 19

Angle between iris and cornea is open but drainage is blocked, potentially due to blood or inflammatory cells

Question 20

What is closed angle glaucoma?

Answer 20

Angle between iris and cornea is closed and the lens is pushed forwards.
This causes ocular hypertension which compresses/stretches the retinal nerve fibres causing visual disturbances

Question 21

What are the primary causes of glaucoma?

Answer 21

Acute Closed-angle glaucoma (ACAG)
Chronic closed angle glaucoma (CCAG)
Primary open-angle glaucoma (POAC)

Question 22

What are the secondary causes of glaucoma?

Answer 22

Trauma
Uveitis
Steroids
Rubeosis iridis (formation o fnew blood vessels on the surface of the iris)
Buphthalmos (Enlargement of eye ball congenitally)

Question 23

What are the risk factors for open angle glaucoma?

Answer 23

> 50 years old
Family history
Afro-carribean ethnicity

Question 24

What are the risk factors for closed angle glaucoma?

Answer 24

Female
Hyperopia (smaller anterior chamber)
Inuit/asian ethnicity

Question 25

What are the symptoms of Acute Closed Angle Glaucoma?

Answer 25

Painful red eye Vomiting Impaired vision Haloes seen around lights

Question 26

What are the signs of acute closed angle glaucoma?

Answer 26

``` Red eye Hazy cornea Loss of red reflex Fixed and dilated pupil Eye is tender and hard on palpation Cupper optic disdc Visual field defect Moderated raised intra-ocular pressure ```

Question 27

What are the symptoms of Primary open-angle glaucoma?

Answer 27

Asymptomatic | Peripheral visual field loss

Question 28

What are the signs of primary open-angle glaucoma?

Answer 28

Potential disc cupping

Question 29

What are the symptoms of congenital Glaucoma?

Answer 29

Buphthalmos Watering Cloudy cornea

Question 30

What investigations are done for glaucoma?

Answer 30

Goldmann applanation tonometry to measure intra-ocular pressure (>21) Slit-lamp biomicroscopy (ACAG shows shallow anterior chamber) Gonioscopy (ACAG shows invisible trabecular meshwork) Automatic static perimetry to test visual field (scotomas - visual field loss) Pachymetry to measure central corneal thickness (CCT<590mm)

Question 31

What is Uveitis?

Answer 31

Inflammation of the iris and ciliary body

Question 32

What causes uveitis?

Answer 32

May be caused by infection (e.g. Herpes simplex) May be a manifestation of systemic conditions (e.g. Reactive arthritis, Ankylosing spondylitis, IBD, sarcoidosis, behcet's disease) Sympathetic ophthalmia

Question 33

What is sympathetic ophthalmia?

Answer 33

Inflammation of the contralateral eye weeks/months after penetrating injury

Question 34

What causes sympathetic ophthalmia?

Answer 34

Recognition of eye antigens in the contralateral eye by T-cells that were activated by the initial penetrating injury to the eye

Question 35

What are the risk factors for Uveitis?

Answer 35

Inflammation of Joints/Bowel/Skin HLA-B27 positive Ocular trauma

Question 36

What are the symptoms of Uveitis?

Answer 36

Pain due to inflammation/during accomodation Photophobia Red eyes Blurred vision Lacrimation Rarely associated with tubulointerstitial nephritis (flank pain, haematuria, proteinuria)

Question 37

What are the signs of Uveitis?

Answer 37

Reduced visual acuity Ciliary flush Hypopyon (exudate and inflammatory cells in the inferior angle of the anterior chamber) Small irregular pupil due to adhesions of the iris to the lens Fundoscopy (exclude detachment) Signs of complications (Increased IOP, cataract) Signs of underlying aetiology

Question 38

What are the investigations for Uveitis?

Answer 38

Investigations for associated systemic conditions