Ophthalmology Passmed Flashcards
What is the approach for any patient who presents with new-onset flashes or floaters?
should be referred urgently for assessment by an ophthalmologist within 24 hours
could be caused by retinal detachment
A 70-year-old man is investigated for blurred vision. Fundoscopy reveals drusen, retinal epithelial and macular neovascularisation. A diagnosis of age related macular degeneration is suspected.
What is the most appropriate next investigation?
Fluorescein angiography
a diagnostic procedure that uses a fluorescent dye and a camera to capture images of blood flow in the retina and choroid
NICE guidelines recommend fluorescein angiography for patients with suspected wet AMD to confirm diagnosis and guide treatment
Peripheral curtain over vision + spider webs + flashing lights in vision =
think retinal detachment!
SPOT DIAGNOSIS :
A 35-year-old male presents to the emergency with an acute onset painless red eye. On examination, his fundoscopy is normal and there is no RAPD. He has a past medical history of constipation.
Subconjunctival haemorrhage
SPOT DIAGNOSIS:
A 77-year-old male presents to the Emergency Department with an exquisitely painful red eye and reduced vision in his right eye. He has a past medical history of rheumatoid arthritis and cataracts, for which he had an operation 5 days ago.
Endophthalmitis
SPOT DIAGNOSIS:
A 65-year-old female presents to the emergency department with a painful red eye. It came on suddenly this morning and is associated with photophobia and reduced vision. On examination, she has a small pupil and ciliary flush.
Anterior uveitis
Sudden painless vision loss preceded by dark spots in vision in diabetic patient =
think vitreous haemorrhage
important differential for sudden visual loss in diabetics
Localised headache, neck pain, and neurological signs (e.g. Horner’s) =
think Carotid artery dissection
long history of diabetes mellitus in an elderly patient along with long standing unilateral blurry vision and halos surrounding light sources =
think cataract
acute closed angle glaucoma also causes halos around lights but would be acute onset and associated with pain
primary open angle glaucoma is associated with peripheral visual field loss more than progressive blurring
Contact lens wearers who present with a red painful eye =
Refer urgently to eye casualty to exclude microbial keratitis as this is sight-threatening
A 1 week old neonate is noted to have purulent discharge and crusting of the eyelids. What is the next step in the management of the child?
Take urgent swabs of the discharge for microbiological investigation
Although minor conjunctivitis with encrusting of the eyelids is common and often benign, a purulent discharge may indicate the presence of a serious infection (for example, with chlamydia or gonococcus)
A patient is examined 3 days after cataract surgery.
OE:
left eye is hyperaemic with hypopyon
eye movements are painful and visual acuity is severely reduced
What is your top differential?
Post-operative endophthalmitis
a rare but serious complication of cataract surgery which needs urgent treatment
First-line treatment for primary open angle glaucoma in a patient with a history of heart block?
Latanoprost
Treatment for primary open angle glaucoma that causes pupillary constriction, blurred vision and headaches?
Pilocarpine
Treatment for primary open angle glaucoma that has an adverse effect of hyperaemia?
Sympathomimetics e.g. brimonidine
Sudden painless loss of vision, severe retinal haemorrhages on fundoscopy =
think Central Retinal Vein Occlusion
Dense shadow in the vision starting peripherally and progressing centrally, painless visual loss =
think retinal detachment
What is the mx for any child under the age of 4 years with suspected squint?
immediate referral to opthalmology
A 67-year-old woman presents for review. She has recently been diagnosed with dry ARMD.
What is the most effective intervention to slow the progression of this condition?
stop smoking
A 71-year-old female with dry ARMD is reviewed. Unfortunately her eyesight has deteriorated over the past 6 months. She has never smoked and is taking antioxidant supplements.
What is the most appropriate next step?
Explain no other medical therapies currently available
What is the easiest way to distinguish between scleritis and episcleritis?
Scleritis is painful, episcleritis is not painful
A 48-year-old woman with RA presents with a several-day history of painful, watering red eye and blurred vision. She is myopic and has a family history of glaucoma. You diagnose scleritis.
What complication is she at risk of?
Perforation of the globe
Definitive treatment for acute angle-closure glaucoma?
Laser peripheral iridotomy
Which refractive errors are the 2 types of glaucoma associated with?
Acute angle closure glaucoma is associated with hypermetropia (long-sightedness), where as primary open-angle glaucoma is associated with myopia (short-sightedness)
my way to think about it: in hypermetropia, the eyeball is smaller and fatter so easier for pressures to build up
