Opthal

Question 1

“Severe Pain
↓ Acuity
Worse in Dark (Mydriasis)
Haloes around light
Semi - Dilated Non - Reactive Pupil
N + V + Abdo Pain

Hypermetropia (Long SIghted)”

Answer 1

Acute angle closure glaucoma

Question 2

Investigations for AACG

Answer 2

“Tonometry (raised pressure)
Gonioscopy (see the angle)”

Question 3

Management for AACG

Answer 3

“Initial:
Muscarinic: Pilocarpine
Beta - Blocker: Timolol
Alpha - 2 Agonist: Apraclonidine
Intravenous Acetazolamide

Definitive:
Peripheral Laser Iridotomy”

Question 4

“Peripheral visual field loss
↓ Acuity
optic cupping
Myopia (Short Sighted)”

Answer 4

Primary open angle glaucoma

Question 5

risk factors for POAG

Answer 5

increasing age
affects < 1’5 in individuals under 55 years of age
but up to 10% over the age of 80 years
genetics
first degree relatives of an open-angle glaucoma patient have a 16% chance of developing the disease
Afro Caribbean ethnicity
myopia
hypertension
diabetes mellitus
corticosteroids

Question 6

fundoscopy signs of POG

Answer 6

Optic cupping
optic disc pallor
bayonetting of vessels

Question 7

investigations POAG

Answer 7

Fundoscopy (Optic Disc Cupping)
Slit Lamp Examination
Tonometry
Gonioscopy

Question 8

Treatment for POAG

Answer 8

Latanoprost

Question 9

“Acute onset
Pupil small +/- irregular
Photophobia
Red eye
Tearing
Hypopyon”

Answer 9

Anterior Uevitis

Question 10

Associated conditions with Anterior uveitis

Answer 10

ankylosing spondylitis
reactive arthritis
ulcerative colitis, Crohn’s disease
Behcet’s disease
sarcoidosis: bilateral disease may be seen

Question 11

Investigations for anterior uveitis

Answer 11

“Goniocopy
Tonometry
Slit-lamp investigation
Full eye exam”

Question 12

Management for Anterior Uveitis

Answer 12

urgent review by ophthalmology
cycloplegics (dilates the pupil which helps to relieve pain and photophobia) e.g. Atropine, cyclopentolate
steroid eye drops

Question 13

acute or subacute onset of:
painless visual loss or haze (commonest)
red hue in the vision
floaters or shadows/dark spots in the vision

Answer 13

Vitreous Haemorrhage

Question 14

Investigations for vitreous haemorrhage

Answer 14

dilated fundoscopy: may show haemorrhage in the vitreous cavity
slit-lamp examination: red blood cells in the anterior vitreous
ultrasound: useful to rule out retinal tear/detachment and if haemorrhage obscures the retina
fluorescein angiography: to identify neovascularization
orbital CT: used if open globe injury

Question 15

“Gradual worsening central vision loss.
Reduced visual acuity.
Crooked/wavy appearance to straight lines.

Wet AMD: more acute - vision loss over days “

Answer 15

Macular degeneration

Question 16

unilateral decrease in visual acuity over hours or days
poor discrimination of colours, ‘red desaturation’
pain worse on eye movement
relative afferent pupillary defect
central scotoma

Answer 16

Optic neuritis

Question 17

Causes of optic neuritis

Answer 17

multiple sclerosis: the commonest associated disease
diabetes
syphilis

Question 18

Investigations for optic neuritis

Answer 18

Investigation
MRI of the brain and orbits with gadolinium contrast is diagnostic in most cases

Question 19

Management of optic neuritis

Answer 19

Management
high-dose steroids
recovery usually takes 4-6 weeks

Question 20

Risk factors for macular degeneration

Answer 20

75<
smoking
family history ischaemic cardiovascular disease, such as hypertension, dyslipidaemia and diabetes mellitus.

Question 21

What is dry macular degeneration

Answer 21

90% of cases
also known as atrophic
characterised by drusen - yellow round spots in Bruch’s membrane

Question 22

What is wet macular degeneration

Answer 22

10% of cases
also known as exudative or neovascular macular degeneration
characterised by choroidal neovascularisation
leakage of serous fluid and blood can subsequently result in a rapid loss of vision
carries the worst prognosis

Question 23

Investigations and findings of AMD

Answer 23

“Fundoscopy:
Drusen.

Amsler Grid Testing:
Distortion of Straight Line.

Snellens Chart:
Reduced Acuity.
Scotoma (central patch of vision loss).
Slit Lamp Microscopy.”

Question 24

Treatment for AMD

Answer 24

“Dry:
Avoid Smoking
Control BP
Vitamin Supplementation (zinc, A, C and E).

Wet:
Monthly Intra - vitreal Anti-VEGF “