Opthalmology Flashcards
1
Q
Which drugs used in the management of primary open angle glaucoma increase uveoscleral outflow?
A
- Prostaglandin analogues (e.g. latanoprost)
- Miotics (e.g. pilocarpine)
2
Q
Which drugs used in the management of primary open angle glaucoma reduce aqueous production?
A
- Beta-blockers (e.g. timolol, betaxolol)
- Carbonic anhydrase inhibitors (e.g. dorzolamide)
3
Q
Which drug type used in the management of primary open angle glaucoma reduces aqueous production and increases uveoscleral outflow?
A
Sympathomimetics (e.g. brimonidine, an alpha2-adrenoceptor agonist)
4
Q
What are the adverse effects of latanoprost?
A
- Brown pigmentation of the iris
- Increased eyelash length
5
Q
When would timolol be contraindicated?
A
Asthmatics and patients with heart block
6
Q
When would brimonidine be contraindicated?
A
Avoid if taking MAOI or tricyclic antidepressants
7
Q
What are the adverse effects of brimonidine?
A
Hyperaemia
8
Q
What are the adverse effects of dorzolamide?
A
Systemic absorption may cause sulphonamide-like reactions
9
Q
What are the adverse effects of pilocarpine?
A
Adverse effects included a constricted pupil, headache and blurred vision
10
Q
Describe the clinical features of Horner’s syndrome
A
- Miosis (small pupil)
- Ptosis
- Enophthalmos (sunken eye)
- Anhidrosis (loss of sweating one side)
11
Q
Describe the clinical features of an Argyll-Robertson pupil
A
- Typically presents with bilateral irregularly shaped pupils that constrict poorly to light but accommodate well to near vision
- Associated with neurosyphilis
12
Q
Describe the clinical features of a third nerve palsy
A
- Usually results in a dilated pupil and ptosis
- Also causes other ocular motor abnormalities such as diplopia (double vision) and inability to move the eye upward, downward or inward
13
Q
Describe the clinical features of a Holmes-Adie pupil
A
- Characterised by a large, irregularly shaped pupil that reacts slowly to light stimulation but constricts well upon accommodation
- This condition is more commonly seen in young women and can be associated with absent tendon reflexes
14
Q
Which of the following is NOT a cause of a mydriatic pupil?
* Third nerve palsy
* Atropine
* Holmes-Adie pupil
* Argyll-Robertson pupil
* Traumatic iridoplegia
A
Argyll-Robertson pupil
15
Q
What is the main risk of hyphema?
A
The main risk to sight comes from raised intraocular pressure which can develop due to the blockage of the angle and trabecular meshwork with erythrocytes
16
Q
Following ocular trauma, what opthalmic emergency should be assessed for?
A
Orbital compartment syndrome
17
Q
Describe the management of orbital compartment syndrome
A
Urgent lateral canthotomy (before diagnostic imaging) to decompress the orbit
18
Q
When should patients with a positive family history of glaucoma be screened?
A
Annually from 40 years
19
Q
Describe the management of herpes zoster ophthalmicus
A
Urgent ophthalmological review and 7-10 days of oral antivirals
20
Q
Name a screening test for childhood squints
A
The corneal light reflection test
21
Q
What is the first line management of bacterial conjunctivitis
A
Topical chloramphenicol
22
Q
In a patient with Horner’s syndrome, anhydrosis of the head, arm and trunk indicates a lesion at what level?
A
Central lesion: stroke, syringomyelia
23
Q
In a patient with Horner’s syndrome, anhydrosis of the just the face indicates a lesion at what level?
A
Pre-ganglionic lesion: Pancoast’s, cervical rib
24
Q
In a patient with Horner’s syndrome, no anhydrosis indicates a lesion at what level?
A
Post-ganglionic lesion: carotid artery
25
What is the most likely diagnosis associated with this fundoscopy?
Branch retinal vein occlusion
## Footnote
Fundoscopy shows severe retinal haemorrhages (red patches) confined to a limited area of the retina, making the diagnosis branch retinal vein occlusion
26
Why would a lumbar puncture be contraindicated in a patient with blurring of the optic disc margin on fundoscopy?
Papilloedema indicates raised intracranial pressure and thus would contraindicate an LP
27
A 3-year-old child is brought to surgery as her mother has noticed that she is 'cross-eyed'. The corneal light reflection test confirms this. What is the most appropriate management?
Refer to opthalmology
28
Name 2 examination findings associated with optic neuritis
* Relative afferent pupillary defect
* Central scotoma
29
List some of the causes of cataract formation
* Normal ageing process: most common cause
* Smoking
* Increased alcohol consumption
* Trauma
* Diabetes mellitus
* Long-term corticosteroids
* Radiation exposure
* Myotonic dystrophy
* Metabolic disorders: hypocalcaemia
30
Describe the clinical features of chronic open-angle glaucoma
* Peripheral vision defect
* Increased cup-to-disc ratio
* Tonometry can be normal
31
Name a common cause of suddenonset visual loss in diabetics
Vitreous haemorrhage
32
What is the most likely diagnosis associated with this fundoscopy?
Optic nerve tumour
## Footnote
Demonstrates papilloedema, characterised by the blurring of the optic disc edges and enlargement of the surrounding veins. There are small haemorrhages (patches of red) surrounding the optic disc which are also seen in papilloedema
33
Flashes + floaters are most commonly associated with what condition?
Posterior vitreous detachment
34
What is the gold-standard investigation for suspected optic neuritis?
Contrast MRI of the brain and orbits
35
What is the most appropriate management of orbital cellulitis?
Admission to hospital for IV antibiotics due to the risk of cavernous sinus thrombosis and intracranial spread
36
How would you differentiate between preseptal and orbital cellulitis?
Reduced visual acuity, proptosis, ophthalmoplegia/pain with eye movements are NOT consistent with preseptal cellulitis
37
What is the most appropriate management for proliferative diabetic retinopathy?
Intravitreal VEGF inhibitors + pan-retinal photocoagulation laser
38
A 24-year-old woman presents with visual disturbance. On examination, you swing the penlight from eye to eye quickly and note that the right pupil and left pupil dilate when light is shone into the right eye.
Where is the most likely site of the lesion?
Right retina or optic nerve
## Footnote
A relative afferent pupillary defect is when the affected and normal eye appears to dilate when light is shone on the affected eye
39
In diabetic retinopathy, what is the pathophysiology of cotton wool spots?
Pre-capillary arteriolar occlusion (retinal infarction)
40
Name a complication of scleritis
Perforation of the globe
41
List some of the potential causes of papilloedema
* Space-occupying lesion: neoplastic, vascular
* Malignant hypertension
* Idiopathic intracranial hypertension
* Hydrocephalus
* Hypercapnia
* Rare causes include hypoparathyroidism, hypocalcaemia, vitamin A toxicity
42
A 60-year old man presents with a one month history of worsening visual acuity. He describes blurring of the smaller words in the newspaper and has noticed that straight lines, such as those on the wallpaper in his lounge appear 'curvy'. He has also started to see a grey patch in his central field of vision. On examination his acuity is 20/30 bilaterally. Ophthalmoscopy demonstrates choroidal neovascularisation. What is the most likely diagnosis?
(Wet) age-related macular degeneration
43
Describe the findings associated with stage 1 hypertensive retinopathy
Arteriolar narrowing and tortuosity
Increased light reflex - silver wiring
44
Describe the findings associated with stage 2 hypertensive retinopathy
Arteriovenous nipping
45
Describe the findings associated with stage 3 hypertensive retinopathy
* Cotton-wool exudates
* Flame and blot haemorrhages; these may collect around the fovea resulting in a 'macular star'
46
Describe the findings associated with stage 4 hypertensive retinopathy
Papilloedema
47
Describe the clinical features of a Marcus-Gunn pupil
* Relative afferent pupillary defect, seen during the swinging light examination of pupil response
* The pupils constrict less and therefore appear to dilate when a light is swung from unaffected to affected eye
* Most commonly caused by damage to the optic nerve or severe retinal disease
48
Describe the clinical features of a Hutchinson's pupil
* Unilaterally dilated pupil which is unresponsive to light
* A result of compression of the occulomotor nerve of the same side, by an intracranial mass (e.g. tumour, haematoma)
49
Describe the management of herpes simplex keratitis (dendritic ulcer)
Topical aciclovir
50
What is the most likely diagnosis associated with this fundoscopy?
Central retinal artery occlusion
51
When anisocoria is greater in bright light, this means there is an issue with the **dilated/undilated** pupil and its inability to constrict
Dilated
52
Describe the first line management of acute angle-closure glaucoma
* Combination of eyedrops (pilocarpine, timolol, apraclonidine)
* Intravenous acetazolamide
53
What is the most likely diagnosis associated with this fundoscopy?
Proliferative retinopathy
54
A 34-year-old man with a history of ankylosing spondylitis presents with a painful right eye associated with mild photophobia. Cycloplegic drops have recently been given. What is the most likely diagnosis?
Anterior uveitis
55
What is the most common cause of bacterial keratitis in contact lense wearers?
Pseudomonas aeruginosa
56
What is the most likely diagnosis associated with this fundoscopy?
Papilloedema
57
Describe the clinical features of carotid artery dissection
* Localised headache
* Neck pain
* Neurological signs (e.g. Horner's)
58
An 83-year-old lady is complaining of poor vision, which has been gradually progressing for the last few years. On examination, there are obvious cataracts in both eyes, but best corrected visual acuity is only slightly reduced at 6/9. She has no past ocular history.
What is the most appropriate management?
Referral for cataract surgery
## Footnote
Cataract removal operations should never be rationed on the basis of visual acuity
59
A 56-year-old woman presents to the GP because she has been experiencing some visual changes. The doctor performs a fundoscopy (pictured). The only previous fundoscopy was three years ago and was normal.
What additional feature would you find on examination?
Hypertension
60
Describe the clinical features of post-operative endopthalmitis
Painful red eye and visual loss shortly after ocular surgery
61
A 73-year-old man complains of a sore right eye. What is the diagnosis?
Entropion
62
Define entropion
In-turning of the eyelids
63
Define ectropion
Out-turning of the eyelids
64
What two investigations should be performed in patients with suspected acute angle-closure glaucoma?
Tonometry and gonioscopy
65
Describe the clinical features of central retinal vein occlusion
* Sudden painless loss of vision
* Severe retinal haemorrhages on fundoscopy
66
A 67-year-old woman with a history of Addison's disease presents to the hospital with pain when chewing. This has been the case for the last 5 days. She has subsequently developed a headache in the last two days and feels her sight is slightly out of focus. Fundoscopy is shown.
Given the presentation and background, what is the most appropriate management?
IV methylprednisolone
## Footnote
Suggestive of temporal arteritis
67
Name a strong risk factor for subcapsular cataracts
Steroid use
68
How would you differentiate between macular degeneration and primary open-angle glaucoma?
* Macular degeneration is associated with central field loss
* Primary open-angle glaucoma is associated with peripheral field loss
69
What is the first line treatment for blepharitis?
Hot compresses and mechanical removal of lib debris
70
What test can be used to identify refractive errors as the cause of blurred vision?
Pin-hole occluder
## Footnote
If decreased visual acuity is caused by refractive error then pin-hole acuity will be better than unaided acuity
71
How would you differentiate between glaucoma or uveitis in a patient presenting with a red eye?
* Glaucoma: severe pain, haloes, 'semi-dilated' pupil
* Uveitis: small, fixed oval pupil, ciliary flush
72
What is the pathological basis for wet macular degeneration?
Choroidal neovascularisation
73
What is the first line management for a stye?
Analgesia + warm compresses
74
Describe the clinical presentation of anterior uveitis
Bilateral red, painful eyes around the corneal limbus, watering, blurry vision, and small, fixed, oval-shaped pupils
75
Describe the management of anterior uveitis
Anterior uveitis is most likely to be treated with a steroid + cycloplegic (mydriatic) drops
76
What complication can be associated with panretinal laser photocoagulation?
Descrease in night vision
77
Describe the clinical features of keratitis
Red eye, photophobia and gritty sensation
