Opthalmology

Question 1

Monocular transient vision loss DDx (1 most common)

Answer 1

1. Amaurosis Fugax (embolic Cx, carotid artery - think AF, eCG, carotid USS)
   [‘curtain over eye’, normal neuro/ocular exam, refer urgently neuro/opthal]

-Acute angle closure glaucoma
-Retinal vascular occlusion
-Retinal vasospasm
-Dry eyes
-Tear film instability

Question 2

Binocular transient vision loss DDx (1 most common)

Answer 2

1. Migraine

-Occipital lobe dysfunction
-Vertebrobasilar embolism (a/w cerebellar signs)
-Dissecting aneurysm
-Orthostatic hypotension

Question 3

Blepharitis non-pharm Rx (3)

Answer 3

-Eyelid hygiene with warm compress
-Eyelid firm massage
-Scrubbing inside of eyelid

Question 4

Dx?

Answer 4

Marginal keratitis

Inflammatory condition of peripheral cornea

Complication of ocular rosacea

Question 5

Diagnosis?

Painless, bilateral loss of central vision (reading, driving, recognising faces)
○ Drusen = debris beneath retinal epithelium
○ Wet = neovascularisation
Anti-VEGF for Wet
Annual optom review & self-exam for change in central vision - Amsler grid testing

Answer 5

Age-Related Macular Degeneration

Question 6

Flashes and floaters DDx

Answer 6

Flashes:
-Vitreous traction
-Retinal tear
-Optic neuropathy

Floaters:
-Posterior vitreous detachment
-Vitreous haemorrhage
-Retinal detachment (“curtain coming down on vision”)

Flashes + Floaters:
-PVD, retinal tear, retinal detachment
Posterior uveitis

Other:
-Migraine aura, postural hypotension, GCA

Acute onset –> refer opthal sem-urgent (1 week)
Acute + LOV/field loss/curtain sensation –> same day

Question 7

Unilateral red eye DDx (6)

Answer 7

○ Acute angle closure glaucoma
○ Acute anterior uveitis (Ank spond, sarcoid)
○ Corneal foreign body
○ Viral/bacterial conjunctivitis
○ Corneal ulcer
○ Marginal keratitis (a/w dry eye syndrome - limbal opacities)

Question 8

Timeframe for visual acuity/milestones in newborns/infants

Answer 8

• 6 weeks - 2 months –> start to fix and focus
  
  • 3 months –> tracking objects
  • By age 4-5 mths - eye alignment should be stable w/ no intermittent/constant deviation

Rx
* Refer opthal if true strabismus
* Glasses to help control convergent deviation

Question 9

Anterior uveitis clin. features (7)
Rx (1)
Difference between keratitis?

Answer 9

-Photophobia
-Deep ache/pain around eyes
-Red eye
-Floaters
-Visual acuity loss
-Irregular pupil shape (synechiae)
-Turbidity/inflammatory cells in aqueous humour

Refer opthal urgent 1-2 days - needs slit lamp

Keratitis - more likely foreign body/gritty sensation, more likely vision loss. Hx of contact wear/trauma

Question 10

Diagnoses?

Answer 10

-From top left clockwise:
-Cyst of Moll (translucent)
-Cyst of Zeis
-Epidermal inclusion cyst
-Molluscum

Question 11

Microbial keratitis RFs (3)
Management steps (2)

Answer 11

○ Contact lens wear (esp. overnight wear)
○ Ocular surface diseases (e.g blepharitis, dry eyes)
○ Foreign body risk occupations

	Refer emergently - life threatening
	Stop contact lens wear

Question 12

Leukocoria DDx (5)
Management step (1)

Answer 12

-Retinoblastoma (most common intraocularneoplasm childhood, unilateral)
-Congenital cataracts
-Retinal detachment
-Retinopathy of prematurity
-Coat’s disease (retinal telangiectasia) - unilateral, boys >girls

Refer all to opthalmology

Question 13

Anterior uveitis assoc. conditions (6)

Answer 13

ank spond
psoriatic arthritis
IBD
sarcoidosis
syphilis
Behcet disease

Question 14

Traumatic eye injury immediate management steps (5)

Answer 14

• Urgent referral to eye hospital
  ○ Protect eye with clear shield
  ○ Don’t apply pressure or examine further, don’t remove foreign body
  ○ Update tetanus
  ○ Avoid coughing/blowing nose

Question 15

Trachoma Rx (2 steps)

Answer 15

Rx. Oral azithrmoycin 20mg/kg, up to 1g stat dose
* Treat household contacts