opthal

Question 1

Retinal vessel occlusion - ARTERY - 3 x types

Answer 1

CRAO
Branch retinal artery occlusion
Cilioretinal artery occlusion

Question 2

Retinal vessel occlusion - VENOUS - 2 x types

Answer 2

CRVO

Branch retinal vein occlusion

Question 3

CRAO sx (2) + fundoscopy findings

Answer 3

sudden painless TOTAL loss of vision + RAPD

F-globally pale retina + cherry red macula

Question 4

Branch retinal artery occlusion

Answer 4

sudden painless PARTIAL loss of vision
NO RAPD
F-focal ischaemic region corresponding to visual loss

Question 5

Cilioretinal artery occlusion

Answer 5

Painless CENTRAL vision loss

• 15-30% population
• equally if CRA present and CRAO occurs, central vision may be retained

Question 6

Retinal vessel occlusion -ARTERY -IX + MX

Answer 6

IX: CVS RF HX (echo, carotid dopplers), T.A. biopsy, ESR
MX: eyeball massage, carbogen therapy (inhale 5% CO2, 95% O2), haemodilution, vasodilators, decrease intraocular pressure

Question 7

Retinal vessel occlusion -VENOUS - IX + MX

Answer 7

Ix: fluorescein angiography (ischaemic vs non-ischaemic CRVO)
Mx (only ischaemic CRVO): pan-retinal photocoagulation

Question 8

CR VEIN O 2x types + sx

Answer 8

Ischaemic + Non-Ischaemic
Ischaemic - sudden painless TOTAL loss of vision (usu unilat) + RAPD
fundoscopy -widespread hyperemia, severe retinal H ‘stormy sunset’
Non-isch - SUBACUTE mild-mod loss of vision + NO RAPD

Question 9

BRVO sx

Answer 9

ASYMPT - unless involving macula

-cause = blockage of retinal veins at AV crossings

Question 10

endopthalmitis

Answer 10

red eye, pain and reduced vision following intraocular surgery

Question 11

anterior uveitis

Answer 11

acute onset
pain
blurred vision and photophobia
small, fixed oval pupil, ciliary flush

Question 12

hyp retinopathy stage I

Answer 12

arteriolar narrowing + tortuosity, incr light reflex, silver wiring

Question 13

hyp retinopathy stage II

Answer 13

AV nipping

Question 14

hyp retinopathy stage III

Answer 14

cotton wool exudates + flame + blot H

Question 15

hyp retinopathy stage IV

Answer 15

papilloedema

Question 16

RAPD/Marcus-Gunn pupil how is it found, what is finding + what is it caused by

Answer 16

• swinging light test –> affected + normal eye BOTH DILATE when light shone onto affected eye
• causes: retina detatchment, optic neuritis eg MS

Question 17

pathway of pupillary light reflex - afferent and efferent

Answer 17

afferent: retina → optic nerve → lateral geniculate body → midbrain
efferent: Edinger-Westphal nucleus (midbrain) → oculomotor nerve

Question 18

retinal detachment 4Fs

Answer 18

Floaters
Flashes
Field loss
Fall in acuity

-sudden painless loss of vision - char by dense shadow starting peripherally + progressing centrally

Question 19

horners - central lesions SSS

Answer 19

anhidrosis of FACE, ARM, TRUNK
Stroke
MS
Syringomyelia
Tumour
Encephalitis

Question 20

Horners - pre ganglionic TTT

Answer 20

Anhidrosis of FACE
pancoast Tumour
Thyroidectomy
Trauma
Cervical rib

Question 21

Horners - post ganglionic CCCC

Answer 21

no anhidrosis
Carotid artery dissection
Carotid aneurysm
Cavernous sinus thrombosis
Cluster headache

Question 22

immediate mx of AACG

Answer 22

combination of eye drops, for example:
-a direct parasympathomimetic (e.g. pilocarpine, causes contraction of the ciliary muscle → opening the trabecular meshwork → increased outflow of the aqueous humour)
a beta-blocker (e.g. timolol, decreases aqueous humour production)
-an alpha-2 agonist (e.g. apraclonidine, dual mechanism, decreasing aqueous humour production and increasing uveoscleral outflow)
-intravenous acetazolamide- reduces aqueous secretions

Question 23

definitive mx of AACG

Answer 23

laser peripheral iridotomy

-creates tiny hole in peripheral iris –> aqueos humour flowing to angle

Question 24

define + causes of tunnel vision

Answer 24

Tunnel vision is the concentric diminution of the visual fields
-Causes:
papilloedema
glaucoma
retinitis pigmentosa
choroidoretinitis
optic atrophy secondary to tabes dorsalis
hysteria

Question 25

papilloedema define

Answer 25

optic disc swelling caused by incr IOP - almost always BILATERAL

Question 26

papilloedemA on fundoscopy

Answer 26

- venous engorgement: usually the first sign - loss of venous pulsation: although many normal patients do not have normal pulsation - blurring of the optic disc margin - elevation of optic disc - loss of the optic cup - Paton's lines: concentric/radial retinal lines cascading from the optic disc

Question 27

causes of papilloedema

Answer 27

- space-occupying lesion: neoplastic, vascular - malignant hypertension - idiopathic intracranial hypertension - hydrocephalus - hypercapnia

Question 28

what is most common cause of blindness >60Y

Answer 28

ARMD - 90% Dry, 10% Wet

Question 29

ARMD key features

Answer 29

- Degeneration of the CENTRAL RETINA (MACULA) is the key feature with changes usually BILATERAL - ARMD is characterised by degeneration of retinal photoreceptors that results in the formation of DRUSEN which can be seen on fundoscopy and retinal photography - It is more common in -OLD - FEMALES

Question 30

ARMD RF

Answer 30

1. old age 2. smoking 3. FHx 4. CVD RF

Question 31

Blepharitis define + cause

Answer 31

= inflammation of the eyelid margins. - - It may due to either meibomian gland dysfunction (common, posterior blepharitis) or seborrhoeic dermatitis/staphylococcal infection (less common, anterior blepharitis) - Blepharitis is also more common in patients with rosacea

Question 32

Blepharitis features

Answer 32

``` BILATERAL GRITINESS + DISCOMFORT -eyes sticky in AM -eyelid margins red -styes + chalazions more common in pts with Bleph -secondary conj may occur ```

Question 33

Blepharitis Mx

Answer 33

1. softening of the lid margin using hot compresses twice a day 2. 'lid hygiene' - mechanical removal of the debris from lid margins 3. cotton wool buds dipped in a mixture of cooled boiled water and baby shampoo is often used 4. an alternative is sodium bicarbonate, a teaspoonful in a cup of cooled water that has recently been boiled 5. artificial tears may be given for symptom relief in people with dry eyes or an abnormal tear film

Question 34

classification of squints by where eye deviates toward on cover test

Answer 34

``` Squints may be classified as to where the eye deviates toward the nose: esotropia temporally: exotropia superiorly: hypertropia inferiorly: hypotropia ```

Question 35

3rd N P vs HS

Answer 35

Ptosis + dilated pupil = third nerve palsy | ptosis + constricted pupil = Horner's

Question 36

Optic Neuritis Sx CRAP

Answer 36

``` EYE MVMNTS HURT Central scotoma RAPD Acuity loss - central vision, colour vision Pain on mvmnt ```

Question 37

optic neuritis causes

Answer 37

MS DM Drugs- ethambutol, chloramphenicol Inf - VZV, Lyme

Question 38

Argyll-Robertson Pupil

Answer 38

Acommodation reflex present (ARP) but (PRA) pupillary reflex absent