Opthalmology

Question 1

What are the differentials for painless loss of vision

Answer 1

Ischaemia/thrombosis - thrombosis, emboli, temporal arteritis (including central retinal vein occlusion or central artery occlusion)
Vitreous haemorrhage
Retinal detachment
Retinal migraine

Question 2

What is Amaurosis fugax and what is it a sign of?

Answer 2

A temporary loss of vision in one or both eyes due to lack of blood flow to the retina

Sign of ischaemia/vascular problem of the eye
Wide list of differentials such as thrombus, GCA, AION

Question 3

What is an anterior ischaemic optic neuropathy and what is its classical presentation?

Answer 3

Sudden loss of vision due to an interruption of blood flow to the front (anterior) of the optic nerve, also known as the optic head

Presentation- loss of vision, usually upon waking up in the morning

Question 4

What are the fundoscopy findings of an anterior ischaemic optic neuropathy?

Answer 4

If it is arteritic then pallid swelling of the optic disc and a peripapillary cotton-wool spot

Non-arteritic- hyperemic swelling of the optic disc with flamed shaped peripapillary haemorrhage

Question 5

What is and what are the Symptoms of optic neuritis?

Answer 5

Inflammation of the optic nerve

Features - subacute loss of vision, unilateral loss of acuity, colour vision affected (red appears less red). RAPD. Pain worse on eye movement

Question 6

What condition is optic neuritis associated with?

Answer 6

Multiple sclerosis

Question 7

Fundoscopy findings of central retinal artery occlusion

Answer 7

Cheery spot on pale retina

Question 8

A cherry spot on fundoscopy is associated with what condition?

Answer 8

Central retinal artery occlusion

Question 9

Management of central retinal artery occlusion

Answer 9

If seen within 100 mins of onset - try to increase retinal blood flow
Emergency treatment aims to reduce intraocular pressure
Surgery

Question 10

Fundoscopy findings or central retinal vein occlusion

Answer 10

Severe retinal haemorrhages

Question 11

Features of virtuous haemorrhage

Answer 11

Sudden painless loss of vision
Virteous floaters
Small black dot of tiny ring like forms

Question 12

Painless visual loss or haze, red hue in vision and floaters is the typical presentation of what?

Answer 12

Virteous haemorrhage

Question 13

Floaters, flashes, field loss, fall in acuity is the typical presentation of what?

Answer 13

Retinal detachment

Question 14

What is the classical presentation of retinal detachment?

Answer 14

Floaters, flashes, field loss, fall in acuity

Painless, may be like a curtain falling as the lowe half of the retina detaches upwards

Question 15

What are the fundoscopy findings of retinal detachment?

Answer 15

Grey, opalescent retina, ballooning forward

Question 16

Red eye differentials

Answer 16

Acute angle closure glaucoma
Anterior uveitis 
Scleritis 
Conjunctivitis 
Subconjunctival haemorrhage 
Endophthalmitis

Question 17

Presentation of acute angle closure glaucoma

Answer 17

Severe pain (ocular or headache)
Decreased visual acuity, patient sees haloes
Semi-dilated pupil
Hazy cornea

Question 18

Anterior uveitis presentation

Answer 18

Acute onset
Pain
Blurred vision and photophobia
Small, fixed, oval pupil

Question 19

Scleritis presentation

Answer 19

Severe pain (may be worse on movement) and tenderness
May be underlying autoimmune disease (RA)

Question 20

Conjunctivitis presentation

Answer 20

Purulent discharge if bacterial, clear discharge if viral

Question 21

Man with ankylosing spondylitis presents with red eye, acute onset, small and irregular pupil, photophobia and blurred vision probably has what?

Answer 21

Anterior uveitis

Question 22

What conditions is anterior uveitis associated with?

Answer 22

HLA-B27 conditions

Ank spond.
Reactive arthritis 
U.C / crohns
Bachets
Sarcoidosis

Question 23

Management of anterior uveitis

Answer 23

Urgent review by opth
Cycloplegics - dilates pupils - atropine
Steroid eye drops

Question 24

What is glaucoma?

Answer 24

Optic neuropathies associated with raised intraocular pressure

Classified based on whether the peripheral iris is covering the trebcular Methwold which is important in the drainage of aqueous humour from the anterior chamber of the eye. In open-angle = iris is clear of the mesh work

Question 25

Presentation of acute closure glaucoma

Answer 25

Painful red eye
Headaches
N+V
Haloes around light, burning and blurred vision 
Dilated pupil

Question 26

Ophthalmoscopy findings of glaucoma

Answer 26

Cupping of the optic disc

Mid dilated pupil

Question 27

Management of acute glaucoma

Answer 27

Referral to opthalmology
Reduce IOP - topical agents (muscarinic agonist - pilocarpine +/- B blocker - timolol)
Laser peripheral iridotomy

Question 28

Management of chronic glaucoma

Answer 28

Topical treatment - prostaglandin analogues (latanorprost), b-blockers (timolol) a2-agonists (brimonidine)
Combine eye drops
Laser trabeculoplasty if medical management insufficient