Ophthalmology - presentations

Question 1

How is red eyes assessed?

Answer 1

history of symptoms and onset
- pain
- visual loss - serious
- gritty - conjunctivitits, dry eyes, foreign body
- itching - allergic, blepharitis

examination of both eyes
- visual acuity with snellen
- evidence of trauma, discharge, swelling
- pattern on redness
- perform fluorescein examination
- assess pupils, RAPD?
- BP

Question 2

what are some red flags for a red eye?

Answer 2

• reduced visual acuity
• severe pain, headache, photophobia
• significant ciliary injection, fluorescein staining
• unequal pupils and abnormal reactions
• pain on pupillary constriction, loss of red eye, corneal haze, hyphaema or hypopyon (blood and pus in anterior chamber)

Question 3

what are some differentials for a painful red eye?

Answer 3

acute angle-closure glaucoma
anterior uveitis
scleritis
corneal ulcerations
keratitis
foreign body
trauma or chemical injury
endophthalmitis

Question 4

what are some differentials for a painless red eye?

Answer 4

conjunctivitis
episcleritis
subconjuctival haemorrhage
dry eye
episcleritis

Question 5

what is anisocoria?

Answer 5

difference in pupil size

• physiological is ≤2mm and difference same in all light levels

Question 6

what is the pupillary high reflex anatomy?

Answer 6

light activates retinal ganglion cells → axons through optic nerve → chiasm → optic tract → synapse at EWN → efferent parasympathetic fibres travel with CN3 → cilairy ganglion

iris contains 2 muscles - constricting sphincter innervated by parasympathetic and dilating by sympathetic (which starts at ipsilateral hypothalamus)

Question 7

what is the significance of anisocoria in dark or light?

Answer 7

• greater anisocoria in dark → impaired dilation in small pupil (sympathetic dysfunction)
• greater anisocoria in light → impaired constriction in large pupil (parasympathetic dysfunction)

Question 8

what are some differentials for a large pupil?

Answer 8

• Adie’s tonic pupil
  
  • post viral denervation of the sphincter pupillae and ciliary muscle
• dilator drops
• 3rd nerve palsy
• traumatic mydriasis

Question 9

what are some differentials of a small pupil?

Answer 9

• horners syndrome
• pilocarpine drops
• uveitis

Question 10

what is your understanding of positive or negative phenomenon in terms of vision loss?

Answer 10

• positive - brightness, shimmering, hallucinations → migraine aura, seizure
• negative - blackness, greyness, shade-obscuring vision → TIA, stroke

Question 11

how do you assess visual loss?

Answer 11

• visual acuity and colour vision
  
  • snellen, pinhole, fingers, movement
  • ishihara, red saturation
• swing test for RAPD
• visual fields
• ophthalmoscopy

Question 12

what are some differentials for acute loss of vision?

Answer 12

amaurosis fugax
central venous occlusion
central arterial occlusion
vitreous haemorrhage
retinal detachment
optic neuritis
GCA