Opthalmic history

Question 1

Management of conjunctivitis

Answer 1

Swabs - bacterial / viral / chlamydial

No contact lenses for 48hrs after resolution of sx

wash hands

avoid sharing towels

chloramphenicol eye drops QDS

Question 2

Presentation of anterior uveitis

Answer 2

red eye 
no discharge
pain on looking at bright lights 
blurry vision 
acute onset

Question 3

treatment for anterior uveitis

Answer 3

topical steroid drop (can’t drive)

cycloplegic drop - dilating for pain relief

Question 4

bacterial keratitis =

Answer 4

corneal ulcer caused by bacteria

Question 5

treatment of bacterial keratitis

Answer 5

topical broad spectrum abx

Question 6

presentation of acute closed angle glaucoma

Answer 6

red eye 
painful 
severe pain 
n&v 
halos round light
reduced visual acuity

Question 7

Acute treatment for ACAG

Answer 7

IV Acetazodlamide

Question 8

Dendritic ulcers usually caused by

Answer 8

HSV

Question 9

Presentation of dendritic ulcer

Answer 9

pain
burning
irritation
photophobia

Question 10

treatment of dendritic ucler

Answer 10

urgent review by opthalmology

acyclovir drops

Question 11

red eye differentials

Answer 11

conjunctivites
anterior uveitis
bacterial keratitis 
ACAG 
dendritic ulcer

Question 12

Central retinal artery occlusion presentation

Answer 12

sudden PAINLESS loss of vision

loss of reactivity in that pupil

cherry red spot and pale retina on fundoscopy

Question 13

What should be excluded if central retinal artery occlusion suspected?

Answer 13

GCA

Question 14

Retinal detachment more common in which type of vision?

Answer 14

myopia (short sighted)

Question 15

Presentation of retinal detachment

Answer 15

Painless loss of vision suddenly
Flashing lights and floaters proceed, then veil/ curtain across vision

VA may be normal if macula not affected

Question 16

GCA presentation

Answer 16

headache 
>50 
rapid onset 
headache
jaw claudication 
temporal tenderness 

PMR

May have normal VA - can have loss of pupil reactivity to light if eye affected

Question 17

Migraine presentation

Answer 17

unilateral headache 
may have an aura / prodromal symptoms 
photophobia 
nausea 
triggers? 

vision normal

Question 18

Optic neuritis presentation

Answer 18

unilateral decrease in VA
Colour vision loss
PAIN on eye movement

may have RAPD

Question 19

Presentation of benign intracranial HTN

Answer 19

Headache - ICP sx
Blurred vison
N&V

Question 20

Central retinal vein occlusion

Answer 20

Sudden PAINLESS loss of vision

Retinal haemorrhages on fundoscopy

Question 21

RF for vitreous haemorrhages

Answer 21

DM

Bleeding disorder

Question 22

Treatment in dry ARMD

Answer 22

Stop smoking
good diet and exercise

visual rehab and aids

Question 23

Which type of eye sights predisposes to glaucoma

Answer 23

myopia

Question 24

which part of the vision is lost in glaucoma

Answer 24

peripheral

Question 25

Conservative management of cateracts

Answer 25

stronger glasses/ contact lens, encourage use of brighter lighting – help optimise vision don’t slow down progression so surgery needed eventually

Question 26

Argyll Robertson pupil

Answer 26

o ARP – accommodation reflex present
o PRA – pupillary reflex absent

NO RESPONSE TO LIGHT

Question 27

Holmes – Adie pupil

Answer 27

usually unilateral dilated pupil
usually woman
slow to redilate after constriction
Associated with absent ankle/knee reflexes

Question 28

RAPD

Answer 28

o Found by swinging light test
o Caused by lesion anterior to optic chiasm i.e. optic nerve or retina

Retina detachment
Optic nerve: optic neuritis e.g. MS

Pathway of pupillary light reflex
 afferent: retina → optic nerve → lateral geniculate body → midbrain
 efferent: Edinger-Westphal nucleus (midbrain) → oculomotor nerve