Opthalmology Flashcards
define glaucoma?
refers to a number of disorders where there is a progressive optic neuropathy and raised intraocular pressure is typically a key factor
which condition is characterised by a normal angle between the iris and cornea. It is divided into primary and secondary forms?
open angle glaucoma
commonest form of glaucoma?
primary open angle glaucoma
which condition is characterised by a closing or narrowing of the angle between the iris and cornea. Again may be split into primary and secondary forms?
angle-closure glaucoma
pathology closed angle glaucoma??
The closure of the anterior chamber angle (cornea-iris. due to lens being pushed against the iris) results in reduced drainage of the aqueous humour and rising IOP rapidly - cupping
pressure builds up particularly in posterior chamber
threshold above which IOPs are said to be raised?
21mmHg
what are the boundaries of the anterior chamber of the eye?
cornea - iris
what are the boundaries of the posterior chamber of the eye?
iris - lens `
boundaries of the vitreous chamber?
lens-back of the eye
anterior chamber filled with??
aqueous humor
posterior chamber filled with ??
vitreous humor
what does the cilliary epithelium do in the eye?
produces the aqueous humor
provides structural support
what is the normal pathway of the aqueous humor in the eye?
produced by the cilliary epithelium into post chamber flows to anterior chamber through trabecular meshwork canal of schemm aqueous veins (part of the episcleral venous system)
pathology open angle glaucoma?
angle between cornea and iris ‘open’ - slow clogging of trabecular meshwork over time
-> gradual increase in pressure on Optic nerve - cupping
-> outer rim atrophy - decrease in peripheral vision
THEN central vision loss as pressure increases
symptoms of closed angle glaucoma?
eye pain, redness, blurred vision, headaches, nausea, visual halos
what does tonometry assess?
introccular pressure
what will optic nerve imaging and direct observation show in closed angle glaucoma?
‘cupping’
medications for glaucoma?
to lower pressure by decreasing aqueous humor production - 1. BBs,
carbonic anhydrase inhibitors (dorzolamide)
to increase outflow of humor - prostaglandin analogues also 1.
to do both: alpha adrenergic agonists
treatments (non-pharm) for glaucoma:
trabeculoplasty - OA
laser iridotomy - CA
causes of ectropion:
muscle weakness
bell’s palsy - facial paralysis
trauma/previous surgery
eyelid growths
watery eyes, excessive dryness of eyes - gritty and sandy
easy irritated eyes - burning sensation and redness
photophobia:
ectropion
ectropion mx:
surgical definitive
what causes stye?
saureus
can be described in questions as an eyelid abscess
differentiate between stye and chalazion?
styes are typically tender to palpate
what respiratory abnormality may be the cause of papilloedema?
hypercapnia
commonest cause of unilateral red eye?
conjunctivitis
Contact lens wearers who present with a red painful eye mx?
always refer to opthalm to assess and rule out microbial keratitis
define keratitis?
inflammation of the cornea
aims of angle-closure glaucoma tx?
reduce aqueous humor secretion
induce pupillary constriction (to make pupil smaller and create more space for outflow)
74-year-old woman presents to the emergency department with a sudden loss of vision in her left eye, which occurred three hours ago and lasted for approximately 3 minutes. She describes the episode as a ‘black-out’ of her vision in that eye, with no associated pain or nausea, and denies any other symptoms. PMH: vasculopath - dx?
Amaurosis fugax
what is amaurosis fugax?
painless, transient monocular blindness together with the description of a ‘black curtain coming down’ is characteristic of amaurosis fugax
You perform a cover test to gather further information. Which one of the following findings would be consistent with a right esotropia?
on covering the left eye the right eye moves laterally to take up fixation
man presents with a ‘droopy eyelid’ on the right side. You also notice that his right pupil appears smaller than the left: indicates??
horner’s syndrome
59-year-old man complains of dry, sore eyes for the past six months. There has been no change in his vision and he doesn’t wear contact lens. The only past history of note is hypothyroidism. dx?
blepharitis
can be associated with seborrheoic dematitis
what is blepharitis?
inflammation of the eyelid margins
what can lead to fungal infections, which in turn can cause corneal ulcers?
steroid eye drops
Blunt ocular trauma with associated hyphema indicates?
high risk of glaucoma as raised ICP
man who presents to eye casualty with sudden onset loss of vision in his left eye. He is not experiencing any pain and has a past medical history of diet-controlled type 2 diabetes mellitus and hypertension. Slit-lamp examination reveals red blood cells in the anterior vitreous. dx?
vitreous haemorrhage
especially consider in diabetics
what disease is characterised by drusen - yellow round spots in Bruch’s membrane?
dry age related macular degeneration
what disease is characterised by choroidal neovascularisation.?
wet age related macular degeneration
sudden painless loss of vision, severe retinal haemorrhages on fundoscopy - dx?
CRVO
3 risk factors for CRVO?
increasing age
glaucoma
polycythaemia
pale retina on fundoscopy indicates ?
CRAO
features include afferent pupillary defect, ‘cherry red’ spot on a pale retina
CRAO
name some risk factors for vitreous haemorrhage:
Diabetes Trauma Anticoagulants Coagulation disorders Severe short sightedness
55-year-old lady presenting with red-tinged vision along with dark spots. These are typical features of ?
vitreous haemorrhage
Peripheral curtain over vision + spider webs + flashing lights in vision think??
retinal detachment
unilateral black shadow at the top of her right vision. She has also been experiencing flashing lights in spindly shapes, this came on suddenly a few hours ago. dx?
retinal detachment
28-year-old male with controlled ulcerative colitis (UC) presents to the clinic with an acute painful right eye. There is decreased vision and redness around the right eye. This is the first time presenting with these symptoms. smaller pupil in right eye.
Slit light examination shows inflammatory cells and an aqueous flare in the anterior chamber. dx?
anterior uveitis
also hypopyon (pus in anterior chamber)
tx anterior uveitis?
steroid eye drops with mydriatic eye drops
what is a suitable screening test for childhood squints?
corneal light reflection test
sudden vision loss. painless loss of red reflex cannot see retina poorly controlled DM dx?
vitreous haemorrhage
red hue to vision
6-yom to ED: swelling around his right eye. This has been present or the past 2 days and during this time he has been feverish and lethargic. He denies any loss of vision or trauma to the eye.
38.2ºC. right-sided proptosis, and all eye movements are reduced and painful in the affected eye. Fundoscopy is normal, visual acuity is 6/6 in the left and 6/12 in the right eye.
What is the most likely diagnosis?
orbital cellulitis
ceftriaxone
differentiating periorbital/orbital cellulitis?
reduced visual acuity, proptosis, ophthalmoplegia/pain with eye movements are NOT consistent with periorbital (preseptal) cellulitis
CT with contrast
Absence of painful movements, diplopia and visual impairment indicates periorbital
common causes of orbital cellulitis?
strep, staph, hib
severe pain: may be ocular or headache
decreased visual acuity
symptoms worse with mydriasis (e.g. watching TV in a dark room)
hard, red-eye (corneal injection)
haloes around lights at night
semi-dilated non-reacting pupil (fixed, dilated)
corneal oedema results in dull or hazy cornea
systemic upset may be seen, such as nausea and vomiting and even abdominal pain
dx?
acute angle-closure glaucoma
NICE guidelines say that any patient with life/sight-threatening causes of red eye should be…..?
referred to opthalm for same day assessment
2 methods for measuring IOP?
non-contact tonometry
goldmann’s applanation
when to start tx open angle glaucoma and first line tx?
started when IOP >24mmHg
1st line: PG analogue eye drops: latanoprost.
SE: eyelash growth, eyelid pigmentation, iris pigmentation.
2nd line: BB (timolol; reduce production aq humour). Carbonic anhydrase inhibitors (dorzolamide).
Surgery: trabeculotomy: create a new channel under sclera.
which medications can cause acute angle closure glaucoma?
adrenergic (adrenaline), anticholinergics (oxybutynin), TCA
if delay in ambulance for closed angle glaucoma pt, what mx can help in interim?
Lie patient on their back without a pillow
**Give pilocarpine eye drops (2% for blue, 4% for brown eyes) – acts on muscarinic receptos in the sphincter muscles and causes constriction of the pupil (headache, blurred vision).
+ ciliary muscle contraction – opens up the pathyway for the flow of aqeuus humour
**Give acetazolamide 500 mg orally(reduce production aqeuos humour)
Given analgesia and an antiemetic if required
which chemical stimulates the development of new vessels in wet age related macular degeneration?
VEG-F
Vascular endothelial growth factor
Gradual worseningcentral visual field loss
-Reducedvisual acuity
Crooked or wavy appearance to straight lines
refers to ???
ARMD
what is a Scotoma?
central patch of vision loss
how is AMD diagnosed?
slit-lamp exam by opthalmologist
optical coherence tomography
fluorescein angiography
dry AMD mx?
lifestyle factors to slow progression
smoking, BP, vitamins
wet AMD mx?
anti-VEGF drugs
ranibizumab,bevacizumabandpegaptanib
monthly injections into vitreous chamber
start <3/12 to be effective
fundoscopy changes: cotton wool spots, neurovascularisation, blot haemorrhages, hard exudates, microaneurysms - dx?
diabetic retinopathy
how is diabetic retinopathy classified?
proliferative or non-proliferative depending on whether new vessels have developed
cx of diabetic retinopathy:
Retinal detachment
Vitreous haemorrhage(bleeding in to the vitreous humour)
Rebeosis iridis(new blood vessel formation in the iris)
Optic neuropathy
Cataracts
mx diabetic retinopathy:
Laser photocoagulation
Anti-VEGFmedications -ranibizumab/bevacizumab
Vitreoretinal surgery(keyhole) may be required in severe disease
fundoscopy changes:
cotton wool spots, retinal haemorrhages, papilloedema, arteriovenous nipping, hard exudates, silver wiring - dx?
hypertensive retinopathy
mx: hypertensive retinopathy:
Management is focused on controlling the blood pressure and other risk factors such as smoking and blood lipid levels.
what is the role of the lens in physiology?
to focus light on the retina
which part of the eye anatomy contracts and relaxes to focus the lens?
cilliary body
how are congenital cataracts screened for?
red light reflex - new born assessment
“Starbursts” can appear around lights, particularly at night time
asymmetrical, generalised slow reduction in vision, blurriness
colour changes -> brown/yellows
dx?
cataracts
ix for cataracts?
loss of red light reflex
lens can appear grey or white when testing red reflex
tx cataracts:
Cataract surgery involves drilling and breaking the lens into pieces, removing the pieces and then implanting anartificial lensinto the eye. This is usually done as a day case under local anaesthetic. It usually gives good results.
regardless of acuity!
rare but serious cx of cataracts surgery:
Endophthalmitis - inflammationof the inner contents of the eye, usually caused by infection. It can be treated withintravitrealantibiotics
can cause loss of vision
mx blepharitis?
hot compress
eye hygeine
lubricating eye drops - hypromellose, polyvinyl alc(1), carbomer
Hordeolum externum is?
infection of glands of zeiss (sebaceous) and moll (sweat)
stye
Hordeolum internum is?
stye
infection of theMeibomian glands. They are deeper, tend to be more painful and may point inwards towards the eyeball underneath the eyelid.
tx stye:
hot compress
analgesia
top abx if association with conjunctivitis
what is a chalazion?
blockage of meibomian glands
typically non-tender swelling eyelid
mx chalazion?
hot compress and analgesia. Consider topic antibiotics (i.e. chloramphenicol) if acutely inflamed
rarely surgical drainage
what is entropion?
eyelid turns inwards with the lashes against the eyeball -> pain, corneal damage, ulceration
what eyelid disorder is sensitive to wind and can present with excessive tearing and itching?
entropion
tx entropion?
Taping the eyelid down to prevent it turning inwards. Prevent the eye drying out by using regular lubricating eye drops.
Definitive management = surgical intervention
what is an ectropion?
eyelid turns outwards
with inner eyelid exposed (mostly bottom eyelid).-> exposure keratopathy
red irritated eye, inability to close eye, dry eye, itching. eyelashes turned outwards.
dx?
ectropion
mx ectropion?
Mild cases - nil
Regular lubricating eye drops - protect the surface of the eye.
severe - surgery to correct the defect
what is trichiasis?
inward growth of eyelashes -> pain, corneal damage, ulceration
mx trichiasis?
specialist is to remove the eyelash (epilation). Recurrent cases may require electrolysis, cryotherapy or laser treatment
where is the infection in periorbital cellulitis?
orbital septum - in front of the eye
swelling, redness, hot skin around eyelids and eye - dx?
periorbital cellulitis
mx periorbital cellulitis?
Hot compresses and analgesia.
Topical antibiotics (i.e. chloramphenicol).
Conservative management fails then surgical drainage may be required
where is the infection in orbital cellulitis?
behind orbital septum - around the eyeball
pain on eye movement, reduced eye movements, changes in vision, abnormal pupil reactions and forward movement of the eyeball (proptosis) - indicate?
orbital cellulitis
mx orbital cellulitis?
This is a medical emergency that requires admission and IV antibiotics. They may require surgical drainage if an abscess forms.
what is the conjunctiva?
thin layer that covers the inside of the eyelid and the sclera of the eye
3 main types of conjunctivitis?
bacterial, viral, allergic
Unilateral or bilateral, Red eyes, Bloodshot, Itchy or gritty sensation, Discharge from the eye
painless. acuity intact. dx?
conjunctivitis
purulent dischargeand an inflamed conjunctiva. It is typically worse in the morning when the eyes may be stuck together. It usually starts in one eye and then can spread to the other. It is highly contagious - which type of conjuctivitis?
bacterial
clear discharge. It is often associated with other symptoms of a infection such as dry cough, sore throat and blocked nose. You may find tenderpreauricularlymph nodes (in front of the ears). It is also contagious - which type of conjunctivitis?
viral
significant watery discharge and itch - which type of conjunctivitis?
allergic
painless red eye ddx (3):
Conjunctivitis
Episcleritis
Subconjunctival Haemorrhage
painful red eye ddx (5):
Glaucoma Anterior uveitis Scleritis Corneal abrasions or ulceration Keratitis Foreign body Traumatic or chemical injury
mx conjunctivitis?
self-limiting 1-2 weeks
hygiene, avoid contact lenses,
?Bacterial conjunctivitis abx considered: Chloramphenicolandfuscidic acideye drops
why do patients under 1 month old need urgent opthalm review if conjunctivitis?
neonatal conjunctivitiscan be associatedgonococcal infectionand can cause loss of sight and more severe complications such as pneumonia.
allergic conjunctivitis mx:
- Antihistamines(oral or topical) can be used to reduce symptoms. Azelsiitne
- Topicalmast-cell stabiliserscan be used in patients with chronic seasonal symptoms.
what does the uvea refer to?
iris,ciliary bodyandchoroid.
also referred to as iritis
pathology anterior uveitis?
flooding of anterior chamber with neutrophils, m0s and lymphocytes, autoimmuneprocess but can be due toinfection,trauma,ischaemiaormalignancy.
floatersin the patient’s vision - think ?
anterior uveitis
which eye condition is associated with HLA B27 conditions such as anky spond, IBD< RA?
anterior uveitis
Dull, aching, painful red eye
Ciliary flush(a ring of red spreading from the cornea outwards)
Reduced visual acuity
Floaters and flashes
miosis, photophobia, lacrimation, posterior synechiae, hyponion
dx?
ant uveitis
ix: anterior uveitis?
Clinical dx. Slit lamp: IOP pressures etc + FBC, ESR< CRP
mx anterior uveitis?
- Steroids(oral, top or iv)
- Cycloplegic-mydriaticmedications such ascyclopentolateoratropineeye drops. These dilate the pupil and reduce pain
- Immunosuppressants- DMARDSandTNF inhibitors
- Laser therapy, cryotherapy or surgery (vitrectomy) in severe
Cycloplegicmeans
paralysing the ciliary muscles
Mydriaticmeans
dilating the pupils
what is episcleritis?
benign and self-limitinginflammationof theepisclera,the outermost layer of the sclera
which conditions is episcleritis associated with ?
inflammatory disorders such asrheumatoid arthritisandinflammatory bowel disease.
acute onset unilateral symptoms: Typically not painful but there can be mild pain Segmental redness (rather than diffuse). There is usually a patch of redness in the lateral sclera. Foreign body sensation Dilated episcleral vessels photophobia Watering of eye No discharge dx?
episcleritis
tx episcleritis:
self limiting and will recover in 1-4 weeks.
Lubricating eye drops can help symptoms.
Simpleanalgesia,cold compressesandsafety-net adviceare appropriate.
severe cases - systemicNSAIDs(e.g. naproxen) or topical steroid eye drops.
what is scleritis?
inflammationof the full thickness of thesclera.
most severe type of scleritis is called??
necrotising scleritis -> perforation of sclera
associations of scleritis?
50% people present w/ RA, IBD, SLE< sarcoid, GPA
50 % are bilateral Severe pain**** Pain with eye movement Photophobia Eye watering Reduced visual acuity Abnormal pupil reaction to light Tenderness to palpation of the eye describes which eye condition?
scleritis
what is differentiator between scleritis and necrotising scleritis?
necrotising - no pain, visual impairment
mx scleritits?
urgent opthalm underlying condition nsaids steroids immunosuppression
causes of corneal abrasions:
Contact lenses Foreign bodies Finger nails Eyelashes Entropion (inward turning eyelid)
which infection should be suspected in contact lens wearers with corneal abrasions?
pseudomonas
History of contact lenses or foreign body Painful red eye Foreign body sensation Watering eye Blurring vision Photophobia dx/
corneal abrasion
ix corneal abrasion?
fluorescein stain
slit lamp for more significant ones
mx corneal abrasion?
same day referral opthalm
analgesia (e.g. paracetamol)
Lubricating eye drops can improve symptoms
Antibiotic eye drops (i.e. chloramphenicol)
Bring the patient back after 1 week to check it has healed
what do cyclophenolate eye drops do?
dilate the pupil - improves sx like photophobia
how long do uncomplicated corneal abrasions take to heal?
2-3 days
what is keratitis?
inflammation of the cornea - can cause ulcers
commonest cause of keratitis?
viral infection with HSV commonest
which bacteria can cause keratitis?
pseudomonas or saureus
which fungi cause karatitis?
candida or aspergillus
what does CLARE stand for?
contact lens acute red eye
Painful red eye Photophobia Vesicles around the eye Foreign body sensation Watering eye Reduced visual acuity. This can vary from subtle to significant. Diagnosis?
keratitis
what will fluorescein stain show if HSV causing keratitis?
dendritic ulcer
how is keratitis dx?
slit lamp opthalm
how can pathogen be isolated in keratitis?
swab or scraping of cornea viral culture, pcr
mx keratitis?
opthalm same day referral
Aciclovir (topical or oral)
Ganciclovir eye gel
Topical steroids may be used alongside antivirals to treat stromal keratitis
what may be required to treat stromal keratitis?
corneal transplant
what happens in retinal detachment?
retina detaches from choroid underneath
vitreous fluid fills the space
painless Peripheral vision loss. This is often sudden and like a shadow coming across the vision. Blurred or distorted vision Flashesandfloaters dx?
retinal detachment
mx of retinal tear?
opthalm - sight threat. aim to reattach the retina
aims to create adhesions between the retina and the choroid to prevent detachment:
Laser therapy
Cryotherapy
surgery to reattach**
surgery to repair retinal detachment:
Vitrectomy
Scleral buckling
Pneumatic retinopexy
what causes CRVO or CRAO?
thrombus formation in vessels
role and anatomical position of retinal vein?
runs through optic nerve and drains blood from the retina
retinal vein occlusion pathology:
pooling of blood in the retina. This results in leakage of fluid and blood causingmacular oedemaandretinal haemorrhages. This results in damage to the tissue in the retina and loss of vision. It also leads to the release ofVEGF, which stimulates the development of new blood vessels (neovascularisation).
sudden painless loss of vision - think?
crvo
Fundoscopy examination is diagnostic of retinal vein occlusion. It give characteristic findings:
(3)
Flame and blot haemorrhages
Optic disc oedema
Macula oedema
other ix for retinal vein occlusion - 4
FBCfor leukaemia
ESRfor inflammatory disorders
Blood pressurefor hypertension
Serum glucosefor diabetes
mx retinal vein occlusion:
Laser photocoagulation
Intravitreal steroids (e.g. a dexamethasone intravitreal implant)
Anti-VEGF therapies (e.g. ranibizumab, aflibercept or bevacizumab)
refer immediately
vascular anatomy of Central retinal artery?
branch of the opthalmic artery which is a branch of the ICA
causes of CRAO?
atherosclerosis. It can also be caused bygiant cell arteritis, wherevasculitis
sudden painless loss of vision.
There will be arelative afferent pupillary defect - dx?
crao
fundoscopy for CRAO?
pale retina
-cherry-red spot
other ix for CRAO?
GCA ix - ESR, temporal artery biopsy
mx crao:
opthalm refer immediately
GCA - prednisolone 60mg
primary prevention: RFs = CV RFs (smoking, HTN, CAD, chol)
Secondary prevention M/CVA e.g. aspirin
?anterior chamber paracentesis (if <24 hours)
bright red blood. No visual changes. resolves within 1-2/52)????
subconjunctival haemorrhage - caused by increased BP, cough, exertion
Night blindness + peripheral to central visual loss - dx?
retinitis pigmentosa
Colour vision (‘red desaturation’) is affected in?
optic neuritis
59-M-> ED blurred vision in his left eye, progressively worsening over the past 24 hours. He has never had trouble with his eyesight before and is alarmed at the symptoms he is experiencing. Denies headache but reports pain on movement of his left eye. Colour red appears less vibrant than usual. He is normally fit and well. Underlying cause of his visual disturbance?
MS
Optic neuritis
high dose steroids
angle closure glaucome gold standard ix?
gonioscopy
give to angle closure glaucoma patients in emergency?
top timolol, top pilocarpine and IV acetazolamide
Bilateral grittiness -
blepharitis
A 68-M with T2DM worsening eye sight. Mydriatic drops are applied and fundoscopy reveals pre-proliferative diabetic retinopathy. A referral to ophthalmology is made. Later in the evening whilst driving home he develops pain in his left eye associated with decreased visual acuity. What is the most likely diagnosis?
acute angle closure glaucome
due to the mydriatic drops being applied
what is Hutchinson’s sign: and what is the opthalmology relevance?
vesicles extending to the tip of the nose. This is strongly associated with ocular involvement in shingles - opthalm assessment same day
risk factors for cataracts:
hypocalcaemia DM downs syndrome uveitis long-term steroid use sm, alc
hypermetropia sign seen in ? (long sightedness)
acute angle closure glaucoma
myopia seen in ? (short sightedness)
primary open angle glaucome
49-F known MS -> GP. Partner has noticed a change in the appearance of her eyes over the past few weeks. Has a ptosis on the left side associated with a small left pupil. Fundoscopy is nomal. dx?
horner’s syndrome
Ptosis + dilated pupil = third nerve palsy;
ptosis + constricted pupil = Horner’s
Keith-Wagener stages of hypertensive retinopathy:
I Arteriolar narrowing and tortuosity Increased light reflex - silver wiring II Arteriovenous nipping III Cotton-wool exudates, Flame and blot haemorrhages IV Papilloedema
72-F vesicular rash around her left eye. The left eye is red and there is a degree of photophobia. A presumptive diagnosis of herpes zoster ophthalmicus is made and an urgent referral to ophthalmology is made.
What treatment is she most likely to be given?
Oral aciclovir
HZO - trigeminal distribution
cx - ant uveitis
Tortuosity and silver wiring are features of Grade _ hypertensive retinopathy?
(also which classification system)?
1
Keith-Wagener
miosis + ptosis + enophthalmos +/- anhydrosis?
horner’s syndrome
A 42-year-old man is diagnosed with syphilis following months of ill health. On examination he is noted to have bilateral small pupils which accommodate but do not respond to light. dx?
argyll-robinson pupil
(also DM)
Accommodation Reflex Present (ARP) but Pupillary Reflex Absent (PRA)
In diabetic retinopathy, cotton wool spots represent areas of??
retinal infarction
26F GP practice with a painful lump on the edge of her left eyelid. Otherwise well, no PMH. Small pus-filled abscess in the area. Her visual field not affected. Dx, tx?
stye hot compress (+removal of debris)
sudden painless loss of vision, severe retinal haemorrhages on fundoscopy. also relative afferent pupillary defect noted. dx?
CRVO
“flare haemorrhages, cotton wool spots”
Red eye - glaucoma or uveitis?
glaucoma: severe pain, haloes, ‘semi-dilated’ pupil
uveitis: small, fixed oval pupil, ciliary flush
Key side effects of prostaglandin analogues (latanoprost) include:
increased eyelash length, iris pigmentation and periocular pigmentation
3F ->GP 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
eg of 3 combination drops given in acute angle closure glaucome as first line?
top timolol
top dorzolamide
top brimonidine
A 35-year-old male presents to his GP with a 4-day history of sudden onset dull pain in the orbital region, eye redness, lacrimation and photophobia. On examination, he has an irregular, constricted pupil.
dx, mx?
anterior uveitis
steroid and cycloplegic eye drops
Horner’s syndrome - anhydrosis determines site of lesion:
head, arm, trunk = central lesion: stroke, syringomyelia
just face = pre-ganglionic lesion: Pancoast’s, cervical rib
absent = post-ganglionic lesion: carotid artery
what is useful to identify refractive errors as the cause of blurred vision?
pinhole occluder
if horner’s syndrome and ?pancoast - what question will assist in dx?
smoking hx
A mother brings her 8-week-old child in for review. Since birth his right eye has been watering. His symptoms have got worse over the past few days after he picked up a mild viral illness. Clinical examination is unremarkable. What is the most appropriate action?
teach nasolacrimal duct massage
duct obstruction likely
An obese 22-year-old female presents to her GP with a 2-week history of daily headaches. Her headaches are bilateral across her forehead, constant throughout the day and worse on bending over. They are not associated with an aura. On fundoscopy, blurring of the optic disc is observed. dx?
idiopathic intracranial HTN
RAPD which pupil?
marcus-gunn
Those with a positive family history of glaucoma should be screened?
annually from age 40
Pain out of proportion of clinical presentation, contact lens and recent freshwater swimming is classical of ?
acanthamoebic keratitis
Following an uneventful pregnancy, a 19-year-old woman delivers a male child vaginally. At assessment one week later the child is noted to have purulent discharge and crusting of the eyelids. What is the next step in the management of the child?
swabs urgently
A 79-year-old gentleman presents with a 3 months history of a red swollen left upper eyelid. He remembers initially developing a bump on the eyelid which was uncomfortable but then got bigger forming a hard lump. He reports no pain currently and has not noted any problems with his vision and the eye itself appears healthy. dx?
chalazion
no pain
meibomian cyst
Anisocoria worse in bright light implies a problem with the??
dilated pupil - ciliary ganglion
papilloedema on fundoscopy?
blurring of optic disc margin on fundoscopy
In episcleritis, the injected vessels are ?
mobile when pressed gently with cotton wool
in scleritis fixed deeper - do not move
