Opthal

Question 1

eye pain, semi dilated, non-reacting pupil
Decreased visual acuity
Haloes around eyes, corneal oedema

Answer 1

Acute angle closure glaucoma (=rise in IOP secondary to an impairment of aqueous outflow)

Tonometry -> inc IOP
Tx - pilocarpine eye drops, BB - definitive = surg

Question 2

Tx options for age related macular degen

Answer 2

Dry - anti-oxidant vitamins can slow progression

Wet - VEGR

Question 3

Acute onset eye pain
Pupil small and irregular
Red eye, photophobia, blurred vision, lacrimation

Answer 3

Anterior Uveitis (Inflammation of the anterior portion of the uvea)

Tx - urgent opthal rv, Atropine (dilated pupil to relieve pain), steroid eye drops

Question 4

Anterior Uveitis associated conditions

Answer 4

HLA-B27

Ank spont
Reactive Arth
UC/CD
Behcets
Sarcoidosis

Question 5

Small irreg pupils
No response to light but repose to accommodate

Answer 5

Argyll-Robertson pupil (ARP)
Accommodation Reflex Present (ARP) but Pupillary Reflex Absent (PRA)

Causes - DM, Syphilis

Question 6

Bilat inflam of eye lids, grittiness/discomfort, eyelid margins red and swollen

Answer 6

Blepharitis

Mx - hot compress, lid hygiene

Question 7

Gradual onset reduced vision, faded colour vision, light appear brighter (glare), halos around lights

Answer 7

Cataracts (F>M, inc with age)

Tx - surgery

Question 8

Sudden painless unilat loss of vision, RAPD, red spot on pale retina

Answer 8

Centra retinal artery occlusion

Question 9

Sudden painless unilat loss of vision, widespread hyperaemia, severe retinal haemorrhages

Answer 9

Central retinal vein occlusion

Question 10

Blurred unilateral vision, scotomas (blind spots), floaters

Opthal - areas of retinal whitening, retinal spots

Answer 10

Chorioretinitis

Opthalmoscope = pizza pie finding

Causes:
inf; toxoplasmosis, CMV (in immunocomp), syphilis, TB
AI; Sarcoid, Behcets, SLE

Question 11

Classification for diabetic retinopathy

Answer 11

Non-proliferativeDR;
- Mild = 1 or more microaneurism
- Mod - microA, blot haemorrhages, hard exudates, cotton wool spots
- Severe = Blot H and MicroA in all 4 quadrants

ProliferativeDR (more common in T1DM)
- retinal neovascularisation

Question 12

Episcleritis vs SCcleritis

Answer 12

Epi = not painfull
Asso w/ IBD, RA

Scleritis = Painfull
Asso w/ RA, SLE, Sarcoid, Granulomatosis w/ polyangitis

Use phenylphrine drops to differentiate - if eye redness improves after drops -> episcleritis

Question 13

red, painful, watery eye
Photophiobia, dec visual acuity
Flourescein staining shows branching ulcer

Answer 13

Herpes simples keratitis

Topical aciclovir and immediate referral to opthal

Question 14

Vesicular, burning rash around eye
On tip of nose

Answer 14

Herpes Zoster Opthalmicus
Rash on tip of nose = Hutchinsons sign

Tx - PO antiviral Tx for 7-10 days

Question 15

Unilateral dilated slow reacting pupil
abesnt knee/ankle reflexes

Answer 15

Holmes-Adie pupil

Question 16

Classification and staging for hypertensive retinopathy

Answer 16

Keith-Wagener classification:
I - Arteriolar narrowing and tortuosity
Increased light reflex - silver wiring

II - Arteriovenous nipping

III - Cotton-wool exudates
Flame and blot haemorrhages ( ‘macular star’ )

IV- Papilloedema

Question 17

red eye pain in contact lens wearer, gritty sensation, photophobia

Answer 17

Keratitis (commonly staph a/pseudonomas / environmental factors

Question 18

Unilateral eye pain, worse on movement
Decrease in visual acuity
Poor colour discrimination
RAPD
Central scotoma

Answer 18

Optic neuritis

Causes; MS, DM, Syphilis
Ix - MRI brain with contrast
Tx - steroids

Question 19

Peripheral visual field loss - nasal scotomas progressing to tunnel vision
Decreased visual acuity
Optic disk cupping

Answer 19

Primary open angle Glaucoma

Fundoscopy - optic disk cupping, optic disk pallow, bayoneting of vessels

Question 20

Mx for POAg

Answer 20

aim of treatment - lower intra-ocular pressure to prevent progressive loss of visual field

1- offer 360deg Selective laser trabeculoplasty

2 - Prostaglandin analogue eye drops (latanoprost)

3 - Beta blocker eye drops (timolol), Carbonic anhydrase inhib eye drops(dorzolamide), Sympathomimetic eye drops (brominodine)

Question 21

Finding on swinging light test - both eyes appear to dilate when light shone in affected eye

Answer 21

RAPD (Marcus-Gunn pupil)

Causes of RAPD - retinal detachment, optic neuritis (MS)

Question 22

pt presenting with tunnel vision and night blindness

Answer 22

Retinitis pigmentosa

Question 23

Occular manifestations of RA

Answer 23

Keratoconjunctivitis sicca (most common)
Episcleritis, scleritis
Corneal ulcers
Keratitis

Question 24

Sudden loss of vision
Flashes of light in peripheral field of vision
Floaters

Answer 24

Posterior vitreous detachment

Question 25

Painless flashes in vision, floaters, visual field loss and decreased visual acuity Normally wears glasses

Answer 25

Retinal detachment More common in short sighted people (myopes)

Question 26

Sudden vison loss, many dark spots or floaters preceding Hx of DM or bleeding disorder

Answer 26

Vitreous haemorrhage No pain, due to bleeding from new vessels Tx = treatment of new vessels - normally with photocoag

Question 27

Eye exam - cotton wool spots with cluster haemorrhages

Answer 27

Proliferative retinopathy

Question 28

Repetitive visual hallucinations, normally when lights are dim, person aware they are hallucinating

Answer 28

Charles Bonnet Syndrome - common in macular degeneration