Opthamology

Question 1

What is blepharitis?

Answer 1

inflammation of the eyelid margins. It may due to either meibomian gland dysfunction (common, posterior blepharitis) or seborrhoeic dermatitis/staphylococcal infection (less common, anterior blepharitis

Question 2

What is lantoprost?

Answer 2

Prostaglandin analog used in glaucoma. It works by increasing uveoscleral outflow

Question 3

Symptoms of carotid artery dissection?

Answer 3

localised headache, neck pain and Horner’s syndrome

Question 4

When distinguishing between cause of horners what are the different lesions and what relation do they have to anhidrosis?

Answer 4

Central lesion- anhidrosis of the face, arm and trunk
Pre-ganglionic- Anhidrosis of the face
Post-ganglionic- No anhidrosis

Question 5

What is Adie’s tonic pupil?

Answer 5

cause of ciliary ganglion dysfunction. This would cause a dilated pupil and the anisocoria would be greater in bright light.

Question 6

Adverse effects of prostaglandin analogues?

Answer 6

brown pigmentation of the iris, increased eyelash length

Question 7

Risk factors for retinal detachment?

Answer 7

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 8

What is tabes dorsalis?

Answer 8

slow degeneration of the nerve cells and nerve fibers that carry sensory information to the brain.

Question 9

What is scleritis?

Answer 9

full-thickness inflammation of the sclera. It generally has a non-infective cause and typically causes a red, painful eye

Question 10

Features of scleritis?

Answer 10

red eye
classically painful (in comparison to episcleritis), but sometimes only mild pain/discomfort is present
watering and photophobia are common
gradual decrease in vision

Question 11

Management of infective conjunctivitis

Answer 11

Topical antibiotic therapy- Chlorampenicol

Question 12

Central retinal vein occlusion vs branch retinal vein occlusion?

Answer 12

Branch- Confined to limited area of retina
Central- Severe retinal haemorrhages throughout

Question 13

Features of central retinal vein occlusiom?

Answer 13

sudden, painless reduction or loss of visual acuity, usually unilaterally
fundoscopy: widespread hyperaemia and severe retinal haemorrhages - ‘stormy sunset’

Question 14

What is the mode of action of beta blockers?

Answer 14

Reduces aqueous production

Question 15

Risk factors for retinal detachment?

Answer 15

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 16

What is Argyll-Robertson pupil?

Answer 16

Bilaterally small pupils that accommodate but don’t react to bright light. Causes include neurosyphilis and diabetes mellitus
Mneumonic: Accommodation Reflex Present (ARP) but Pupillary Reflex Absent (PRA)

Question 17

The most common causes of a sudden painless loss of vision are as follows:

Answer 17

ischaemic/vascular (e.g. thrombosis, embolism, temporal arteritis etc). This includes recognised syndromes e.g. occlusion of central retinal vein and occlusion of central retinal artery
vitreous haemorrhage
retinal detachment
retinal migraine

Question 18

Features of optic neuritis?

Answer 18

unilateral decrease in visual acuity over hours or days
poor discrimination of colours, ‘red desaturation’
pain worse on eye movement
relative afferent pupillary defect
central scotoma

Question 19

Presentation of orbital cellulitis?

Answer 19

Redness and swelling around the eye
Severe ocular pain
Visual disturbance
Proptosis
Ophthalmoplegia/pain with eye movements
Eyelid oedema and ptosis
Drowsiness +/- Nausea/vomiting in meningeal involvement (Rare)

Question 20

In acute angle-closure glaucoma (AACG) there is a rise in IOP secondary to an impairment of aqueous outflow. Factors predisposing to AACG include:

Answer 20

hypermetropia (long-sightedness)
pupillary dilatation
lens growth associated with age

Question 21

What does intravenous acetazolamide do?

Answer 21

reduces aqueous secretions

Question 22

What is laser peripheral iridotomy

Answer 22

Creates a tiny hole in the peripheral iris → aqueous humour flowing to the angle

Question 23

What is central scotoma?

Answer 23

area of depressed vision that corresponds with the point of fixation and interferes with central vision. It suggests a lesion between the optic nerve head and the chiasm

Question 24

What is Hutchison’s sign?

Answer 24

rash on the tip or side of the nose. Indicates nasociliary involvement and is a strong risk factor for ocular involvement

Question 25

What is a memobian cyst?

Answer 25

Retention cyst of the Meibomian gland. It presents as a firm painless lump in the eyelid. The majority of cases resolve spontaneously but some require surgical drainage

Question 26

most common cause of bacterial keratitis in contact lens wearers?

Answer 26

Pseudomonas aeruginosa

Question 27

What are some complications following cataract surgery?

Answer 27

Posterior capsule opacification: thickening of the lens capsule Retinal detachment Posterior capsule rupture Endophthalmitis: inflammation of aqueous and/or vitreous humour

Question 28

What is Holmes-Adie?

Answer 28

benign condition most commonly seen in women. It is one of the differentials of a dilated pupil.

Question 29

What is Holmes-Adie syndrome?

Answer 29

association of Holmes-Adie pupil with absent ankle/knee reflexes

Question 30

What is ambylopia?

Answer 30

Lazy eye

Question 31

Complications of scleritis?

Answer 31

glaucoma Cataracts Raised intraocular pressure Retinal detachment Uveitis Perforation of the globe

Question 32

What is drusen?

Answer 32

Yellow round spots in Bruch's membrane

Question 33

What does a posterior vitrous detachment look like?

Answer 33

Flashes of light (photopsia) - in the peripheral field of vision Floaters, often on the temporal side of the central vision

Question 34

What does retinal detachment look like?

Answer 34

Dense shadow that starts peripherally progresses towards the central vision A veil or curtain over the field of vision Straight lines appear curved Central visual loss

Question 35

What does a vitreous haemorrhage look like?

Answer 35

Large bleeds cause sudden visual loss Moderate bleeds may be described as numerous dark spots Small bleeds may cause floaters

Question 36

What are featues of a central retinal artery occlusion?

Answer 36

sudden, painless unilateral visual loss relative afferent pupillary defect 'cherry red' spot on a pale retina

Question 37

Signs of acute angle closure glaucoma?

Answer 37

severe pain (may be ocular or headache) decreased visual acuity, patient sees haloes semi-dilated pupil hazy cornea

Question 38

Signs of anterior uveitis?

Answer 38

acute onset pain blurred vision and photophobia small, fixed oval pupil, ciliary flush

Question 39

What is scleritis?

Answer 39

severe pain (may be worse on movement) and tenderness may be underlying autoimmune disease e.g. rheumatoid arthritis

Question 40

What is conjunctivitis?

Answer 40

purulent discharge if bacterial, clear discharge if viral

Question 41

What is dry macular degeneration characterised by?

Answer 41

drusen - yellow round spots in Bruch's membrane

Question 42

Difference between the vessels in scleritis and episcleritis?

Answer 42

In episcleritis, the injected vessels are mobile when gentle pressure is applied on the sclera. In scleritis, vessels are deeper, hence do not move

Question 43

Causes of papilloedema

Answer 43

space-occupying lesion: neoplastic, vascular malignant hypertension idiopathic intracranial hypertension hydrocephalus hypercapnia

Question 44

Investigations for age related macular degeneration?

Answer 44

slit-lamp microscopy is the initial investigation of choice, to identify any pigmentary, exudative or haemorrhagic changes affecting the retina which may identify the presence of ARMD. This is usually accompanied by colour fundus photography to provide a baseline against which changes can be identified over time. fluorescein angiography is utilised if neovascular ARMD is suspected, as this can guide intervention with anti-VEGF therapy. This may be complemented with indocyanine green angiography to visualise any changes in the choroidal circulation. ocular coherence tomography is used to visualise the retina in three dimensions because it can reveal areas of disease which aren't visible using microscopy alone.

Question 45

Mangement of anterior uveitits?

Answer 45

urgent review by ophthalmology cycloplegics (dilates the pupil which helps to relieve pain and photophobia) e.g. Atropine, cyclopentolate steroid eye drops

Question 46

Screening for positive FH of glaucoma?

Answer 46

From age 40

Question 47

treatment of dry ARMD

Answer 47

ombination of zinc with anti-oxidant vitamins A,C and E reduced progression of the disease by around one third. Patients with more extensive drusen seemed to benefit most from the intervention. Treatment is therefore recommended in patients with at least moderate category dry ARMD

Question 48

Features of acute angle-closure glaucoma?

Answer 48

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 haloes around lights semi-dilated non-reacting pupil corneal oedema results in dull or hazy cornea systemic upset may be seen, such as nausea and vomiting and even abdominal pain

Question 49

What do cotton wool spots represent?

Answer 49

Areas of retinal infarction

Question 50

Optic neuritis symptoms mneumonic?

Answer 50

Central scotoma Reduced red vision Acuity (reduced) Painful eye movement

Question 51

What is retinitis pigmentosa?

Answer 51

primarily affects the peripheral retina resulting in tunnel vision

Question 52

Features of retinitis pigmentosa?

Answer 52

night blindness is often the initial sign tunnel vision due to loss of the peripheral retina (occasionally referred to as funnel vision)

Question 53

Which is more acute wet or dry AMD?

Answer 53

Wet

Question 54

Signs and symptoms of anterior uveitis?

Answer 54

acute onset pain blurred vision and photophobia small, fixed oval pupil, ciliary flush

Question 55

What is dorzolamid?

Answer 55

Carbonic anhydrase inhibitor which reduces aqueous production

Question 56

What is endolamphtisi?

Answer 56

typically red eye, pain and visual loss following intraocular surgery

Question 57

What is amaurosis fugax

Answer 57

ischaemic optic neuropathy is due to occlusion of the short posterior ciliary arteries, causing damage to the optic nerve

Question 58

POAG may present insidiously and for this reason is often detected during routine optometry appointments. Features may include

Answer 58

peripheral visual field loss - nasal scotomas progressing to 'tunnel vision' decreased visual acuity optic disc cupping

Question 59

Diagnostic invesigation for optic neuritis?

Answer 59

MRI of the brain and orbits with gadolinium contrast is diagnostic in most cases

Question 60

Investigations for acute angle closure glaucoma?

Answer 60

tonometry to assess for elevated IOP gonioscopy (literally looking, oscopy, at the angle, gonio): a special lens for the slit lamp that allows visualisation of the angle

Question 61

What is gonioscopy?

Answer 61

special lens on the slit lamp which allows visualisation of the anterior chamber angle. This can highlight any blockages that may have resulted in this increasing rise in pressure

Question 62

Keith Wagner classification of hypertensive retinopathy?

Answer 62

Question 63

Absolute contraindications to laproscopy?

Answer 63

haemodynamic instability/shock raised intracranial pressure acute intestinal obstruction with dilated bowel loops (e.g. > 4 cm) uncorrected coagulopathy

Question 64

What does a venous duplex US show?

Answer 64

demonstrate retrograde venous flow

Question 65

Symptoms of posterior vitreous detachment?

Answer 65

The sudden appearance of floaters (occasionally a ring of floaters temporal to central vision) Flashes of light in vision Blurred vision Cobweb across vision The appearance of a dark curtain descending down vision (means that there is also retinal detachment)