Opthal 2

Question 1

What does the uveal tract consist of + functions of each

Answer 1

1. Iris: controls amount of light entering lens via caring size aperture. Can dilate via SNS dilator pupillae. Can constrict via PSNS sphincter pupillae
2. Ciliary body: helps aq humour production and attachment of lens via suspensory ligaments
3. Choroid: allows passage of bv/nerves, removes waste products from retina, supplies nutrients to outer half retina, absorbs light passing through retina

Question 2

Iritis:

• Definition
• Risk factors
• Causes
• Symptoms
• Signs
• Investigations
• Management
• Complications

Answer 2

Iritis:

• Definition: inflammation of the iris
• Risk factors: hlab27, immunodef, >20, previous
• Causes: hlab27 cond inc JIA, sympathetic ophthalmia, infections toxoplasmosis, leukaemia/lymphoma, bisphosphonates
• Symptoms: acute red painful eye, reduced acuity, epiphora, photophobia
• Signs: ciliary injection, hypopyon, cloudy + hazy cornea, post synchiae
• Investigations: slit lamp (flare + cells diagnostic)
• Management: topical steroids + cycloplegics (atropine + cyclopentolate are antimusc), oral steroids if severe
• Complications

Question 3

Uveitis:

• Definition
• Symptoms
• Signs
• Management
• Complications

Question 4

Conjunctivitis:

• Definition
• Risk factors
• Causative organisms for bacterial + viral
• Symptoms
• Signs
• Management

Question 5

Layers of eyeball

Answer 5

1. Outer part - sclera + cornea (provides attachment for extra ocular muscles)
2. Middle - uveal tract
3. Inner - retina

Question 6

Scleritis:

• Definition
• Causes
• Symptoms
• Signs
• Management
• Complications

Answer 6

Scleritis:

• Definition: inflammation of sclera
• Causes: vasculitis, ra, idiopathic, pseudo infection
• Symptoms: severe dull pain wakes up at night worse with movement, epiphora, photophobia
• Signs: reduced acuity, tender when palpating
• Management: oral nsaids, steroids, immunosupp if underlying or abx
• Complications:: corneal scarring, cataracts, glaucoma

Question 7

Episcleritis:

• Definition
• Risk factors
• Symptoms
• Investigations
• Management

Answer 7

Episcleritis:

• Definition : inflammation episclera
• Risk factors: ibd, ra, young
• Symptoms: mild pain, localised dilated episcleral vessels
• Investigations: phenylephrine drops dilates vessels in episclera
• Management: self limiting, lubricating drops, steroids if severe

Question 8

• Functions of cornea
• Layers of cornea

Answer 8

1. Maintain transparency
2. Ocular protection
3. Refracts incoming light

Layers:
1. Epithelium non keratinised sq layer
2. Bowmans - any trauma below this level leads to cornea scarring
3. Stroma coll 1 fibres held by keratinocytes
4. Descemets
5. Endothelium maintains hydration, doesn’t regenerate

Question 9

Keratitis:

• Definition
• Risk factors
• Causes
• Symptoms
• Investigations
• Management

Answer 9

Keratitis:

• Definition: inflammation of cornea
• Risk factors: contact lens, trauma, dry, immunocomp
• Causes: bacterial (pseudo, staph, strep), viral (hsv - dendritic ulcer), fungi (aspergillus),
• Symptoms: red, pain, foreign body, epiphora, reduced acuity, hypopyon
• Investigations: slit lamp, fluoroscein, corneal scrapings for viral pcr
• Management: urgent assessment, no steroids if viral, no contact lens, abx, cycloplegics for pain

Question 10

Function of aqueous humour

Answer 10

Supply nutrients to cornea
Maintain adequate pressure in eye (11-21mmhg)

Can reduce IOP via alpha2 rec reducing production + inc uveoscleral outflow
Can increase IOP via beta2 rec by inc sq production

Question 11

Primary open angle glaucoma:

• Definition
• Risk factors
• Symptoms
• Investigations
• Management + side effects of medications
• Risk factors for secondary open angle glaucoma

Answer 11

Primary open angle glaucoma:

• Definition: gradual increase in resistance of trabecular meshwork
• Risk factors: myopia, fx, age, inc iop
• Symptoms: peripheral loss (tunnel vision), headaches, halos
• Investigations: non contact tonometry, GAT gold standard, gonioscopy
• Management + side effects of medications: First line is laser trabeculoplasty if iop >24mmhg. 2nd line latanoprost, brimidone, timolol. If not then trabeculectomy

Question 12

Acute angle closure glaucoma:

• Definition
• Risk factors
• Symptoms
• Signs
• Investigations
• Management: immediate, definitive
• Complications

Answer 12

Acute angle closure glaucoma:

• Definition: sudden bulging of iris seals off drainage in trabecular meshwork preventing aq humour production which can lead to optic nerve head changes
• Risk factors: hypermetropia, age, fx, inc iop, na/anticholinergics
• Symptoms: sudden pain worse in dark lights, halos, n+v, headaches
• Signs: reduced acuity, fixed dilated pupil, hazy cornea
• Investigations: fundoscopy/slit lamp, GAT gold standard, gonioscopy
• Management: immediate, definitive
  Immediate: lie down, pilocarpine, acetazolamide, timolol, brimidone, antiemetics/analgesia
  Definitive: laser iridotomy
• Complications: sight loss, central retinal vein occlusion