Ophthalmology - Neuropathy and Retinopathy

Question 1

what is open angle glaucoma?

Answer 1

progressive optic neuropathy

death of retinal ganglion cells

Question 2

features of open angle glaucoma?

Answer 2

NONE
incidental finding
may have field loss

Question 3

features of open angle glaucoma on ophthalmoscopy?

Answer 3

cupped disc

visual field defect

Question 4

Tx for open angle glaucoma? e.g of drugs?

Answer 4

prostaglandin analogue (latanoprost)
B blocker (timolol)
carbonic anhydrase inhibitors (acetazolamide)
miotics (pilocarpine)

surgery (trabeculoplasty)

Question 5

who gets open angle glaucoma screening?

Answer 5

> 35yrs with FHx
diabetes
hyperthyroid disease

Question 6

what is GCA?

Answer 6

granulomatous disease or large to medium vessels

results in infarction of the anterior optic nerve

Question 7

what vessels are affected in GCA?

Answer 7

branches of the external carotid

Question 8

features of GCA?

Answer 8

headache
jaw claudication
painless loss of eyesight 
tender temporal artery
scalp tenderness

Question 9

what disease is associated with GCA?

Answer 9

polymyalgia rheumatica

Question 10

Ix for GCA? results?

Answer 10

opthalmoscopy (pale and swollen disc)
temporal artery biopsy
ESR, PV, CRP (raised)

Question 11

Tx for GCA?

Answer 11

methylpred IV 50mg-1g to save other eye

Question 12

risk factors for optic neuritis?

Answer 12

30-50yrs
MS
female

Question 13

features of optic neuritis?

Answer 13

pain on eye movement
visual loss
colour vision loss
central scotoma
RAPD
gradual recovery

Question 14

pathology behind optic neuritis?

Answer 14

demyelinating disease of the optic nerve

Question 15

Ix for optic neuritis?

Answer 15

MRI
CSF (oligoclonal bands for MS)
NMO antibody

Question 16

features of diabetic retinopathy?

Answer 16

visual loss
floaters
rubeosis iridis (new vessels on the iris)

Question 17

pathology behind diabetic retinopathy?

Answer 17

hyperglycaemia leads to microaneurysms and leakage
ischaemia occurs
oedema/vitreous haemorrhage cause vision loss

Question 18

stages of retinopathy and how regularly are they then screened?

Answer 18

none, 12 months

mild, 12 months

moderate (non proliferative), 6 months:
≥4 blot haemorrhages

severe (non proliferative), refer:
≥4 per quadrant
microaneurysms

proliferative, urgent referral:
new vessels on the disc

Question 19

stages of maculopathy?

Answer 19

none
observable (screen in 6)
referable
significant

Question 20

what changes are seen on ophthalmoscopy for non proliferative diabetic retinopathy?

Answer 20

microaneurysms
dot/blot haemorrhages
hard exudate
cotton wool patches

Question 21

what changes are seen on ophthalmoscopy for proliferative diabetic retinopathy?

Answer 21

new vessels on disc and periphery

Question 22

Tx for diabetic retinopathy?

Answer 22

control diabetes
laser for proliferative
anti VEGF
surgery