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
HZO management =
urgent ophthalmological review and 7-10 days of oral antivirals
Which organism should be suspected in contact lens associated keratitis?
Pseudomonas aeruginosa
which investigation is the gold-standard for confirming the diagnosis of optic neuritis?
MRI of the brain and orbits with gadolinium contrast
What vitamin supplementation is useful for patients with dry ARMD?
High-dose beta-carotene and vitamins C and E
Contact lens and recent freshwater swimming + new eye pain =
acanthamoebic keratitis
A 62-year-old man presents to his GP with sudden visual loss in his right eye. He is otherwise asymptomatic.
Which one of the following conditions is LEAST likely to be responsible?
Ischaemic optic neuropathy
Occlusion of central retinal vein
Occlusion of central retinal artery
Optic neuritis
Vitreous haemorrhage
Optic neuritis
due to patient demographic
Treatment for herpes simplex keratitis =
topical aciclovir
Those with a positive family history of glaucoma should recieve what?
screening annually from 40 years
A 58-year-old male presents with a painful right eye. He also has some tearing of the eye and a reduced vision. On examination you identify a corneal ulcer.
Which medication is most likely to have resulted in this developing?
Steroid eye drops
can lead to fungal infections, which in turn can cause corneal ulcers
What is the strongest risk factor for developing subcapsular cataracts?
steroid use
night blindness + tunnel vision + fam hx =
think retinitis pigmentosa
Congenital tear (lacrimal) duct obstruction is a cause of recurrent watery or sticky eye in neonates. How is it managed?
Usually self resolves in 1 year
A patient receives mydriatic drops in eye casualty. Later in the evening he develops pain in his left eye associated with decreased visual acuity. What is the most likely diagnosis?
Acute angle closure glaucoma
Mydriatic drops are a known precipitant of acute angle closure glaucoma
most common underlying cause of a vitreous haemorrhage =
Proliferative diabetic retinopathy
Anisocoria worse in bright light =
problem is with the dilated pupil
Flashes + floaters are most commonly caused by what?
posterior vitreous detachment
Hyphema =
urgent specialist assessment by ophthalmology
