Opthalmology

Question 1

List the causes of Marcus-Gunn Pupil?

Answer 1

Any lesion anterior to the optic chiasm (the optic nerve or retina)

Optic nerve- Optic neuritis
Retina- detachment

Question 2

What is the finding in Marcus-Gunn Pupil?

Answer 2

The affected and normal eye appear to dilate when light is shone in affected eye

Question 3

What is the afferent pathway of the pupillary light reflex?

Answer 3

Retina > Optic nerve > Lateral geniculate body > Midbrain

Question 4

What is the efferent pathway of the pupillary light reflex?

Answer 4

Edinger westphal nucleus (midbrain) > oculomotor nerve

Question 5

What is the most common cause of blindness in adults aged 35-65?

Answer 5

Diabetic retinopathy

Question 6

What is the pathophysiology of diabetic retinopathy?

Answer 6

Hyperglycaemia is thought to cause increased retinal blood flow and abnormal metabolism in the retinal vessel walls. This precipitates damage to endothelial cells and pericytes

Endothelial dysfunction causes the characteristic exudates.

Pericyte predisposes to the formation of microaneurysms.

Question 7

What are the 3 classifications of diabetic retinopathy?

Answer 7

1. Non-proliferative diabetic retinopathy
2. Proliferative diabetic retinopathy
3. Maculopathy

Question 8

List the features that may be seen in fundoscopy in non-proliferative diabetic retinopathy?

Answer 8

Microaneurysms
Blot haemorrhages
Hard exudates
Cotton wool spots (soft exudates)

Question 9

List the features that may be seen on fundoscopy in proliferative diabetic retinopathy?

Answer 9

Retinal neovascularisation
Fibrous tissue forming anterior to retinal disc

Question 10

What type of diabetic retinopathy is more common in T1DM?

Answer 10

Proliferative DR

Question 11

What type of diabetic retinopathy is more common in T2DM?

Answer 11

Maculopathy

Question 12

What is the mx for maculopathy?

Answer 12

• Optimise glycaemic control, blood pressure and hyperlipidemia
• Regular review by ophthalmology
• Change in visual acuity then intravitreal vascular endothelial growth factor (VEGF) inhibitors (RANIBIZUMAB)

Question 13

What is the mx for non-proliferative retinopathy?

Answer 13

• Optimise glycaemic control, blood pressure and hyperlipidemia
• Regular review by ophthalmology
• If severe/very severe consider panretinal laser photocoagulation

Question 14

What is the mx for proliferative retinopathy?

Answer 14

panretinal laser photocoagulation

intravitreal VEGF inhibitors

severe or vitreous haemorrhage: vitreoretinal surgery

Question 15

What is a potential complication of pan-retinal laser photocoagulation?

Answer 15

Decrease in night vision

Question 16

What is scleritis?

Answer 16

full-thickness inflammation of the sclera.

Question 17

List the RF of scleritis?

Answer 17

Rheumatoid arthritis: the most commonly associated condition

Systemic lupus erythematosus

Sarcoidosis

Granulomatosis with polyangiitis

Question 18

List the features of scleritis?

Answer 18

Painful red eye
watering
photophobia
gradual decrease in vision

Question 19

How is scleritis differentiated from episcleritis?

Answer 19

classically painful (in comparison to episcleritis)

Question 20

What is the mx of scleritis?

Answer 20

same-day assessment by an ophthalmologist

oral NSAIDs are typically used first-line

oral glucocorticoids may be used for more severe presentations

immunosuppressive drugs for resistant cases

Question 21

What is the 1st line mx for scleritis?

Answer 21

Oral NSAIDs

Question 22

List 3 differentials for painful acute vision loss?

Answer 22

Acute glaucoma
Optic neuritis
GCA

Question 23

List 3 differentials for painless acute vision loss?

Answer 23

Central retinal Artery Occlusion
Central retinal Vein occlusion
Retinal detachment
Vitreous haemorrhage
Retinal migraine

Question 24

List the RF of CRVO?

Answer 24

Increasing age
HTN
CVS
Glaucoma
Polycythaemia

Question 25

What will be seen on fundoscopy in CRVO?

Answer 25

Widespread uraemia Severe retinal haemorrhage (stormy sunset)

Question 26

How are the retinal haemorrhages described in CRVO?

Answer 26

'Stormy sunset'

Question 27

What is the tx for majority of CRVO cases?

Answer 27

Conservative mx

Question 28

What is tx for macular oedema?

Answer 28

Intravitreal anti VEGF

Question 29

What is tx for retinal neovascularisation?

Answer 29

Laser photocoagulation

Question 30

What is the cause of CRAO?

Answer 30

Occurs due to thromboembolism or arteritis

Question 31

What are the features of CRAO?

Answer 31

Sudden painless vision loss (unilateral) RAPD 'cherry spot' on pale retina

Question 32

What fundoscopy finding is present in CRAO?

Answer 32

'cherry spot' on pale retina

Question 33

What is mx for CRAO?

Answer 33

Treat underlying cause

Question 34

what is the mx for an acute presentation of CRAO?

Answer 34

Intra-arterial Thrombolysis

Question 35

What are the RF vitreous haemorrhage?

Answer 35

Diabetes Bleeding disorders Anticoagulants

Question 36

What are the features of Retinal detachment?

Answer 36

Sudden onset, painless and progressive visual field loss, described as a curtain or shadow progressing to the centre of the visual field from the periphery Straight lines appear curved +/- RAPD new onset floaters or flashes, as these indicate pigment cells entering the vitreous space or traction on the retina respectively

Question 37

List the RF for retinal detachment?

Answer 37

Diabetes Myopia Age Previous surgery for cataracts Eye trauma e.g. boxing

Question 38

What are the common causes for vitreous haemorrhage?

Answer 38

proliferative diabetic retinopathy (over 50%) posterior vitreous detachment ocular trauma: the most common cause in children and young adults

Question 39

At what rate is blood typically cleared from the retina?

Answer 39

approximate rate of 1% per day.

Question 40

What are the sx of vitreous haemorrhage?

Answer 40

painless visual loss or haze (commonest) red hue in the vision floaters or shadows/dark spots in the vision

Question 41

What is papilloedema?

Answer 41

Optic disc swelling, that is caused by increase in intracranial pressure

Question 42

List 3 causes of papilloedema?

Answer 42

Space occupying lesion Malignant HTN Idiopathic intracranial HTN Hydrocephalus Hypercapnia rare: Hypoparathyroidism, Vit A toxixity

Question 43

What signs/findings will be seen on fundoscopy in papilloedema?

Answer 43

Venous engorgement Loss of venous pulsation Blurring of optic disc margin Elevation of optic disc Loss of optic cup PATON'S LINE

Question 44

What is often the 1st sign seen on fundoscopy in papilloedema?

Answer 44

Venous engorgement

Question 45

What is ARMD?

Answer 45

Characterised by degeneration of retinal photoreceptors that result in the formation of Drusen

Question 46

What is the most common cause of blindness in the UK?

Answer 46

ARMD

Question 47

List the types of ARMD?

Answer 47

1. Dry ARMD 2. Wet ARMD

Question 48

What type of ARMD is most common?

Answer 48

Dry ARMD (90%)

Question 49

How is dry ARMD characterised?

Answer 49

Characterised by Drusen- yellow round spots in bruchs membrane

Question 50

Which type of ARMD is atrophic?

Answer 50

Dry

Question 51

Which type of ARMD is exudative or neovascular?

Answer 51

Wet ARMD

Question 52

Which type of ARMD is acute?

Answer 52

Wet

Question 53

How is wet ARMD characterised?

Answer 53

Characterised by choroidal neovascularisation

Question 54

What are the sx of ARMD?

Answer 54

Vision loss - Gradual- Dry ARMD - Subacute- Wet ARMD Poor vision at night Reduced visual acuity (struggles to see peoples faces) Glare Photopsia

Question 55

What is the mx of Dry ARMD?

Answer 55

Smoking cessation Zinc and Antioxidant Vit A

Question 56

What is the mx of Dry ARMD?

Answer 56

Anti VEGF injections (Monthly)