Opthalmology

Question 1

An 82-year-old woman presents to her GP complaining of losing vision in her peripheries for 4 months and generally worse visual acuity. She now describes having ‘tunnel vision’. She has a past medical history of hypertension and type 2 diabetes mellitus and wears prescription glasses for her short-sightedness. Fundoscopy reveals optic disc cupping and hemorrhages.

What is the most likely diagnosis?

Answer 1

Primary open angle glaucoma

Question 2

A 62-year-old woman presents to the ophthalmology clinic with a sudden onset of a painful, red right eye, associated with blurred vision, headache, and seeing halos around lights. On examination, the right eye demonstrates a mid-dilated, non-reactive pupil, and increased intraocular pressure.

What is the most appropriate definitive treatment for this patient’s condition?

Answer 2

Laser peripheral iridotomy is the definitive treatment for acute angle-closure glaucoma

Question 3

A 74-year-old retired artist attends the GP with a long-standing painless loss of vision. She complains of a gradual loss of vision affecting reading as she is finding the words on the page more difficult to see. She also complains that straight lines in her paintings are starting to appear wonky and this is also picked up with Amsler grid testing.

What is the most likely diagnosis?

Answer 3

Amsler grid testing (to check for distortion of line perception) may be useful in testing patients with suspected age related macular degeneration

Question 4

Wet macular degeneration is characterised by

Answer 4

choroidal neovascularisation

Question 5

retinal detachment definition

Answer 5

Retinal detachment occurs when the neurosensory tissue that lines the back of the eye comes away from its underlying pigment epithelium. It is a reversible cause of visual loss, provided it is recognised and treated before the macula is affected

Question 6

risk factors for retinal detachment

Answer 6

diabetes mellitus
* occurs as a result of breaks in the retina due to traction by the vitreous humour
* these tears may proceed to detachment if left untreated

myopia
age
previous surgery for cataracts (accelerates posterior vitreous detachment)
eye trauma e.g. boxing

Question 7

retinal detachment features

Answer 7

Question 8

management of retinal detachment

Answer 8

any patients with new onset flashes and floaters should be referred urgently (<24 hours) to an ophthalmologist for assessment with a slit lamp and indirect ophthalmoscopy for pigment cells and vitreous haemorrhage