Ophthalmology Problems

Question 1

Brain

Answer 1

Compensates for loss of central vision by providing peripheries

Question 2

Basics of anatomy

External

Answer 2

Cornea
Iris
Lens
Ciliary body

Vitreous
Retina
Optic nerve

Brow
Lids and lashes
Tear ducts and lacrimal glands
Orbit
Nerves and blood supply

Question 3

Extra-Ocular muscles

Obliques allow for

Answer 3

Superior rectus
Inferior rectus
Lateral rectus
Medial rectus

Superior oblique
Inferior oblique

Torsion and rotation

Question 4

What do you see on back of eye

Macula

Answer 4

Centre of vision - dark spot q

Optic nerve

Retinal vessels

Retina

Question 5

Eye and the brain

Answer 5

Eye is camera, brain is processor

Optic nerve is nerve of sight

Retina converts light into electrical impulses that travel down the optic nerve to the brain for processing

Problem in brain can affect visual processing and also give rise to visual disturbances

Question 6

Visual pathway

2 pathways

Mechanism

Answer 6

Lesion in any part of visual pathway gives particular visual field defect

Nasal and temporal

Nasal field of vision hits temporal retina

Temporal visual field hits nasal retina

Superior falls on inferior retina

Crossover (decussation) at optic chasm therefore R side represented on the L side

Question 7

Incidents which may cause loss of fields of vision

Answer 7

Stroke - cerebral artery - both fields on one side

Pituitary tumour - bitemporal hemianopia

Question 8

Causes of visual disturbance

Answer 8

Pathological processes affecting eye or affecting brain structures involved in visual processing

Question 9

Symptoms of visual disturbance

Answer 9

Loss of vision 
Flashing lights and floaters 
Droopy lids 
Visual field defects - central, peripheral, both 
Headaches
Pupil size inequalities 
Diplopia

Question 10

Causes of visual disturbance

Eyes

Brain causes

Systemic

Answer 10

Cataract 
Macular degeneration 
Glaucoma 
Retinal detachment 
Eye infections 

Stroke
Inflammations
Migraine
Papilloedema - optic nerve swelling

Diabetes and diabetic retinopathy
Vessel occlusions and atherosclerosis
Giant cell arteritis
Accelerated hypertension

Question 11

Red eye causes

Answer 11

Conjunctivitis - allergic, bacterial or viral
Burst blood vessel - subconjunctival haemorrhage
Viral e.g adenovirus
Vision normal
Watery means viral
Purulent discharge suggests bacterial
Treatment involves lubricant drops and antibiotic drops

Question 12

Ulcer or abrasion?

Answer 12

Corneal abrasion
Painful
Due to trauma
Heals within 2-3 days

Ulcer
Very painful
Related to contact lens wear
Urgent referral to ophthalmologist

Question 13

Subconjunctival haemorrhage

Answer 13

Can look worrying 
Spontaneous or traumatic 
on anticoagulants? Clotting problems? 
Check BP
Two weeks to resolve

Question 14

Anterior uveitis

Uvea

Answer 14

Iris, ciliary body and choroid 
iris sticks to anterior surface of lens 
Inflammation within front of the eye
Pain light sensitivity 
Vision can be decreased 
Irregular pupil 
Can be linked to ankylosing spondylitis 
Needs referral 
Can get collection of pus at base of eye

Question 15

Angle closure glaucoma

Causes

Answer 15

Fixed mid eye pupil
Halo in light
Corneal oedema
Angle between iris and cornea (fluid drainage through pupil behind cornea)

High pressure in the eye, must be lowered before optic nerve undergoes irreversible damage –> BLINDNESS
Often older
Very painful red eye with decreased vision
Accompanied by nausea and vomiting
Need urgent referral to ophthalmology

Question 16

Scleritis

Answer 16

Inflammation of sclera - tough outer coat of eye
Normal vision
Deep red inflammation, violet or bluish line
Intense pain, wakes patient from sleep
Requires referral

Question 17

Vision loss - causes

Answer 17

Cataracts
Corneal ulcer –> scar
Retinal issues
Bleed into vitreous humour

Question 18

Cataract

Answer 18

Clouding opacity of lens
Due to ageing
Occurs earlier in diabetic, trauma and steroids
Results in gradual loss of vision

Question 19

Macular degeneration

Two types

Answer 19

Age related change at macula which is central part of vision

Wet and Dry

Can be dry with deposits called DRUSEN found in macular region

Can be ‘wet’ (neovascular) with new blood vessel growth at the macular area and leakage of fluid
Patients complain of loss of central vision or distortion

Question 20

Visual loss - Retinal detachment

Answer 20

More susceptible with thinner retina
Patients see a shadow in peripheral vision typically preceded by flashing lights and floaters

Retina becomes detached from wall of the eye - jelly becomes more liquid with age and fluid can get beneath tear and lift retina off

Can progress to permanent irreversible vision loss

Question 21

Visual loss - CRAO

Answer 21

Central retinal artery occlusion
Central retinal artery is blocked by an embolus
Prognosis is poor as they are end vessels

Sudden irreversible loss vision
Parasenthesis - reduction of pressure

Commonly caused by embolus due to atherosclerosis
Rarely associated with giant cell arteritis (consider if headache is symptom)
URGENT REFERRAL

Question 22

Visual loss - diabetes

Associated with

Treatment

Answer 22

Retinopathy causes vision loss due to microvascular changes e.g vessels become leaky and

• retinal oedema - significant if macula affected
• vessels can shut down –> retinal ischaemia and new blood vessel growth –> bleed and cause vision loss

Worsening diabetic eye disease associated with poor diabetes control

Healthy tissue is lasered to prevent future damage

Question 23

Visual loss - glaucoma - open angle chronic glaucoma

Answer 23

Painless with elevated eye pressure over a prolonged period
Patients asymptomatic until late stage - gradual field loss
Optic nerve undergoes progressive nerve damage resulting in cupped appearance

Question 24

Visual problems and headache

Migraines

Giant cell arteritis

Papilloedema

Answer 24

Zig-zag lights, field defects, aura

severe headache, scalp pain, jaw pain , can cause strokes and bilateral blindness

raised intracranial pressure can cause optic nerve swelling and visual disturbance