OPTHALMOLOGY

Question 1

Focused history

Answer 1

HPC: SQITARS

Specific: Visual loss, discomfort, double vision, photopsia
(flashing light), localizable abnormal visual sensation (retinal
pathology).

PMHx: thyroid disease, thalassemia, HTN, DM

SHx- smoking

Fhx - vision problems

Question 2

Focused examination

Answer 2

General inspection - swelling, redness, discharge, abnormal eyelid position

Pupils - size and symmetry

Pupil reflexes - direct and consensual, swinging light test

Eye movements - move in H pattern

Snellen chart - VA

Pinhole or occluder - improves it indicates refractive component to poor acuity

Ishihara colour charts - wearing reading glasses, cover one eye and read plates - colour vision

Visual fields - sit opposite, pt cover one eye, you cover opposite pt to focus on bridge of nose is any part of face distorted or missing and use white neurotip to assess visual fields - start peripherally and move centrally

Blind spot - put red neurotip exactly between eyes and move slowly laterally until blind spot noted, find its borders

Question 3

causes of decreased acuity

Answer 3

Decreased acuity: (refractive errors, amblyopia, cataract,
corneal scarring, age-related macular degeneration, optic
neuritis).
Ishihara colour

Question 4

visual field test findings and causes

Answer 4

Monocular: anterior ischemic optic neuropathy, central
retinal artery occlusion, total retinal detachment.

Bitemporal hemianopia: pituitary adenoma,
craniopharyngioma.

Homonymous: stroke, tumour, abscess.
Scotoma: MS, diabetic neuropathy.

Question 5

general inspection of eye findings and causes

Answer 5

General inspection of eye: swelling (cellulitis), redness,
discharge, prominence, abnormal eyelid position (Horner’s
syndrome, oculomotor nerve palsy

Question 6

pupil inspection findings and causes

Answer 6

Pupil inspection: size, symmetry (large = oculomotor nerve
palsy, small = Horner’s syndrome), shape (congenital,
uveitis), colour (congenital Horner’s).

Question 7

pupil reflexes, findings and causes

Answer 7

Pupil reflexes: direct (retina, optic nerve) and consensual
(oculomotor nerve), swinging light test – affected pupil will
dilate (retinal vessel occlusion, optic neuritis, glaucoma,
compression, ischaemic optic neuropathy), accommodation
reflex (focus far away then close)

Question 8

eye movements and muscles tested

Answer 8

move in a H pattern. Superior rectus
(oculomotor) = up. Inferior rectus (oculomotor) = down.
Medial rectus (oculomotor) = in. Lateral rectus (abducens) =
out. Superior oblique (trochlear) = down, out, medial
rotation. Inferior oblique (oculomotor) = up, in, lateral rotation

Question 9

further investigations

Answer 9

Further investigations: fundoscopy, Amsler chart (central
vision loss), cranial nerves, BP, blood glucose, retinal
photography.

Question 10

acute glaucoma

Answer 10

Acute angle glaucoma: severe pain, blurring, worse in dark
room, hard, red eye, haloes around lights, nausea and
vomiting.

IV acetazolamide, combination of eye drops, laser
peripheral iridotomy

Question 11

chronic glaucoma

Answer 11

Chronic glaucoma: blurring, peripheral visual field loss. Slit
lamp, applanation tonometry, central corneal thickness,
gonioscopy.

Latanoprost (prostaglandin analogue) drops,
dorzolamide (carbonic anhydrase inhibitor) drops,
trabeculotomy, trabeculoplasty

Question 12

cataracts

Answer 12

blurring of vision, reduced night vision.
Ophthalmoscopy, slit lamp.

Glasses, surgery (phacoemulsion
and prosthetic lens)

Question 13

diabetic retinopathy

Answer 13

Diabetic retinopathy: blurring, visual loss.

HbA1c, optical
coherence tomography, fluorescein angiography.

Lifestyle,
BP control, glycaemic control, photocoagulation, anti-VEGF
intravitreal injections

Question 14

age related macular degeneration

Answer 14

Age related macular degeneration: visual loss, blurring,
difficulties in dark, flashing lights.

Slit lamp, Fluorescein
angiography, ocular coherence tomography. Lifestyle, antiVEGF injections, laser photocoagulation

Question 15

scleritis

Answer 15

Scleritis: red eye, boring pain, reduced vision, deep nonmobile vessels involved. Oral prednisolone

Question 16

episcleritis

Answer 16

Episcleritis: red eye, not painful, mobile vessels involved.
Phenylephrine drops differentiate from scleritis. Artificial
tears

Question 17

orbital cellulitis

Answer 17

Orbital cellulitis: redness around eye, severe eye pain with
movement, visual disturbance, proptosis. FBC, contrast CT,
blood culture. IV antibiotics

Question 18

peri orbital cellulitis

Answer 18

Periorbital cellulitis: redness around eye. FBC, swab and
culture discharge, contrast CT. Oral co-amoxiclav

Question 19

anterior uveitis

Answer 19

Anterior uveitis: red eye, pain, irregular pupil, blurring,
hypopyon. Cycloplegics (dilate pupil) e.g. atropine, steroid
eye drops

Question 20

retinal detachement

Answer 20

Retinal detachment: sudden painless dense shadow/curtain
over vision. Slit lamp, USS, indirect ophthalmoscopy.
Vitrectomy, pneumatic retinopexy, scleral buckle

Question 21

retinal artery occlusion

Answer 21

Retinal artery occlusion: sudden painless vision loss. CT
head, doppler carotid, ECG, echo, FBC, coagulation. Aspirin
300mg, ocular massage, oxygen, IV acetazalomide and
mannitol

Question 22

retinal vein occlusion

Answer 22

Retinal vein occlusion: sudden painless vision loss. BP, FBC,
glucose, ESR, fundal photography, optical coherence
tomography, fundus fluorescein angiography. Prevention

Question 23

conjunctivitis

Answer 23

Conjunctivitis: bacterial (purulent), viral (serous), allergic
(bilateral, itchy, eyelids swollen). Swab and culture.
Chloramphenicol drops or ointment, topical fusidic acid