OPTHAL 1

Question 1

sudden vision loss

Answer 1

vascular
retinal detachment 
ARMD wet
closed angle glaucoma 
optic neuritis 
stroke

Question 2

central retinal artery occlusion visual acuity

causes

Answer 2

<6 over 60

carotid artery disease
embolic: calcific heart valves, vegetations, thrombus
GCA

Question 3

ix for CRAO
bilateral. age
treatment within 12-24h

Answer 3

RAPD. pale oedematous retina. cherry red spot (choroid). thread like vessels

1-2% bilateral. over 60s

ocular massage, paper bag breathing, IV diamond - move emboli to branch, anterior chamber paracentesis
establish source of embolism

Question 4

branch RA occlusion is what
symp
management

Answer 4

one or multiple branch affected
only part of vision lost
assess

Question 5

amaurosis - fugax is what 
symptoms 
examination 
cause
managemetn

Answer 5

transient retinal artery occlusion
transient painless vision loss. unilateral - like curtain coming down. lasts around 5 mins with full recovery
nothing abnormal on examination
atherosclerosis. idiopathic. infections
immediate referral to TIA clinic. aspirin

Question 6

CRVO cause 
what should you determine 
symptoms 
ix and on examination 
if no signs of ischaemia 
signs of iscaeqhmia and no neovasculirisation
signs of neovasculisiation

Answer 6

virchows triad: atherosclerosis, stasis, htn

determine degree of ischaemia

sudden loss of vision. painless

retinal flame haem (stormy sunset) and blot haem. swollen disc. tortured dilated vessels. cotton wool spots. neovasculirisation if longstanding.

review 3 monthly

review in 4-5 weekly

argon laser pan retinal photocoag. anti VEGF

Question 7

ischaemic optic neuropathy is what
symptoms
the two types

Answer 7

occlusion of optic nerve head circulation - posterior ciliary arteries become occluded leading to occlusion of optic nerve head

sudden profound vision loss and very swollen disc. altitudinal defect

arrterritic 50%

non arrteritic 50%

Question 8

arteritic
symptoms
ix
treatment

Answer 8

GCA. in over 50s
scalp tenderness, jaw claudication, assoc with PMR

increased PV/CRP/ESR. temporal artery biopsy

IV methylpred. then high dose PO pred

Question 9

non arteritic in who
assoc with what
symptoms
management

Answer 9

45-65yo
hypermetropes, smokers, night time hypotension
swollen optic disc. mod severe loss
no active treatment

Question 10

optic/retrobulbar neuritis where and is what 
symptoms 
ix
cause
treatment

Answer 10

unilateral. progressive over das

variable loss of central vision. washed out colours. central scrotoma. pain on movement behind eye

decreased visual acuity, RAPD, enlarged blind spot, optic disc sweetness (not in retro)

demyelination. MS

gradual recovery over days- weeks. IV steroids can hasten but affect final visual acuity. B interferon may work. oral steroids - worse outcome

Question 11

haemorrhage is usually what 
2 types 
symp
ix
management

Answer 11

often vitrous haemorrhage

bleeding from normal vessels - associated with retinal tears
bleeding from abnormal vessels associated with retinal ischaemia and new vessel formation (RVO, DMR)

sudden loss. floaters

loss of red reflex

underlying cause. intervitrectomy if not responding

Question 12

retinal detachment cause 
symptoms 
what is the emergency 
ix
management

Answer 12

myopia, age, tear, also trauma

painless loss, persistent flashing lights in peripheral vision, bursts of new floaters, dark shadows in peripheral vision which increase in size, curtain coming down

macula still on - emergency to stop it coming off

maybe RAPD, DM, tear on opthalmascope

if retinal tear - laser to prevent detachment 
if detached (surgery): scleral buckle, vitrectomy/laser or cryotherapy/bubble of gas to act as internal tamponade

Question 13

ARMD
symptoms of wet ARMD
ix/on examination
management

Answer 13

commonest cause of blindness in over 65s in western world

sudden reduction loss of central vision. distortion - metamorphosis. fluffy oedematous macular due to leaking. new blood vessels under retina

haemorrhage. exudate. ocular coherence tomography: can see fluid distorting retinal pigment epithelium
fundus fluorescent angiography: inject dye and watch it go through circulation shows hydrofluorescence leakage

Anti VEGF ranibizumab (lucentis)

Question 14

anti VEGF

Answer 14

monoclonal ABs also used in DMR
intravitreal injection
inhibit groth factor: aborrted growth or new vessels. shrinkage of new vascular membrane. decreased fluid leakage/blood into tissues

Question 15

gradual vision loss often what

CARDGIAN

Answer 15

bilateral 
cataracts 
ARMD dry
refractive error
DMR
inherited disease
glaucoma open 
access to eye clinic 
non urgent

Question 16

cataracts is what
causes and which is the most commonest
what are the types (3)
management

Answer 16

clouding lens

age related - commonest
trauma, DM, congenital, steroids, intra uterine infections like rubella, CMV, toxoplasmosis

nuclear sclerotic which is the commonest. cortical. post sub capsular - DM, quick to progress

phacoemulsion with intraocular lens transplant. chloramphenicol and pred drops for 4w after

Question 17

dry ARMD is what
symptom
management

Answer 17

wear and tear of retinal pigment epithelium: drusen, RPE hypo/hyperpigemantaion

progressive decrease in central VA

low visual aids. diet/smoking. amsler grid - metamorphosis. blind registration

Question 18

refractive error myopia
hypermetropia
astigmatism
prebyopia

Answer 18

short sight. increased risk of tear and retinal detachment

long sighted. increased risk of closed angle glaucoma

irregular corneal curvature

loss of vision with ageing

Question 19

glaucoma is what 
pathology 
symptom 
ix
normal IOP is what 
visual acuity

Answer 19

progressive optic nerve damage due to increased IOP and visual field loss

blockage to aqueous outflow leading to increased IOP. visual acuity preserved unless v severe

peripheral vision loss

increased IOP. disc cupping - doughnut. field defects. IOP - tonometry. fields - perimetry

normal IOP 10-21

as long as macular preserved VA normal

myopics also have disc cupping

Question 20

open angle glaucoma in who 
symp
risk factors 
management 1
2
3
4
5
surgery and risk

Answer 20

75% in over 75s. picked up on screening.
asymp
age, FA, increased OAP, afrocrribean

prostaglandins - xalatan, makes iris more leaky. one drop a night. hyperpigemtn lashes and iris

add on beta blocker - timoptol, laevobutanol. decreased aq solution to avoid systemic. side effects hold tear ducts for a few mins

add on carbonic anhydrase. acetozolamide PO/IV for high IOP v effective only short term due to SE of tingling, renal calculi
dorzolamide(drops) - no systemic SE local irritation

sympathemetics - adrenaline, propine, alphagran. increased outflow. dilate pupil. local irritation. CVS side effects. awful lethargy. get allergic to in the long term. long term decreases value to surgery

parasympathememetics - pilocarpine. increased outflow. local SE - contraction, night blindness, colour vision affected, bad headaches which wear off

surgery - trabeculectomy - increased progression of cataracts

Question 21

secondary open angle glaucoma

Answer 21

trauma, uveitis, lens protein, pseudoexfoliation

Question 22

acute closed angle glaucoma
cause
symptoms including level IOP
management

Answer 22

hypermetropes. low light triggers

mid dilated - stuck. N/V. gradual decrease in vision after a few hours. hazy cornea - oedematous leading to halo and coloured rings. unilateral.
IOP 50-80

reduce IOP medically. peripheral irotomy - do other eye prophylactically. steroid for 1w. monster risk of open angle glaucoma

Question 23

increased ICP leads to what

chronic swelling

Answer 23

papilloedema

atrophic and pale