opthamology

Question 1

How do you differentiate posterior vitreous detachment, retinal detachement and vitreous haemorrhage?

Answer 1

Posterior vitreous detachment:
Flashes of light (photopsia) - in the peripheral field of vision. Floaters, often on the temporal side of the central vision. Fundoscopy shows Weiss ring appearance, occasional haemorrhage

Retinal detachment: Same sx as vitreous detachment (flashers and floaters), 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.
Fundoscopy shows retinal tear, ‘tobacco dust’ in the anterior chamber

Vitreous haemorrhage: Large bleeds cause sudden visual loss. Moderate bleeds may be described as numerous dark spots. Small bleeds may cause floaters. Vitreous haemorrhage occurs when blood leaks into the vitreous humour from damaged blood vessels in conditions such as diabetic retinopathy or retinal tears.

Question 2

How do you differentiate central retinal vein occlusion from central retinal arterial occlusion?

Answer 2

Both cause sudden painless visual loss

Retinal vein: more common, with age, can be caused by glaucoma, hypertension, polycythaemia. optic disc swelling, and multiple flame-shaped and blot haemorrhages may be seen.
occurs when there is a blockage in the central retinal vein, leading to impaired venous drainage from the retina. This results in increased pressure within the blood vessels, causing them to leak blood and fluid into the surrounding tissues.

Retinal arterial: Cherry spot on pale retina on fundoscopy, afferent pupillary defect,

Question 3

When blood vessel is affected in ischaemic optic neuropathy?

Answer 3

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

Question 4

Anterior uveitis vs acute closed angle glacuoma signs and sx?

Answer 4

Acute closed-angle glaucoma: sudden onset of unilateral eye pain and visual loss. The condition is quite often associated with a headache. On examination, findings consistent with glaucoma include an erythematous globe with a fixed and dilated pupil with a hazy cornea.

Anterior uveitis: painful red eye with photophobia. Visual loss is more variable and can include reduced visual acuity, blurred vision, or reduced peripheral fields. In contrast to a fixed and dilated pupil, anterior uveitis is associated with a constricted pupil. Patients with a history of HLA-B27 positivity or autoimmune conditions are more likely to develop anterior uveitis.

Question 5

What is keratitis?

Answer 5

This is the microbial invasion of the cornea causing eye redness, pain, photophobia, increased lacrimation, and eyelid oedema. Risk factors for keratitis include ocular trauma and contact lens use. It is an ophthalmological emergency and should be treated promptly with topical antibiotic eye drops (or oral antibiotics in some cases).

Question 6

What is retinitis pigmentosa?

Answer 6

Retinitis pigmentosa is a group of inherited retinal disorders characterized by progressive degeneration of the retina, leading to night blindness and peripheral vision loss (tunnel vision)

Question 7

What does fundoscopy for diabetic retinopathy show?

Answer 7

Usually slow onset visual loss. Fundoscopy shows microaneurysms, dot and blot haemorrhages, hard exudates, and cotton wool spots

Question 8

What is Argyll-Robertson pupil

Answer 8

small, irregular pupils
no response to light but there is a response to accommodate
Associated with neurosyphilis but most common cause in UK is DM

Question 9

What is a stye vs chalazion vs blepharitis?

Answer 9

stye: infection of the glands of the eyelids

A chalazion (Meibomian cyst) is a 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

blepharitis: inflammation of the eyelid margins typically leading to a red eye

Question 10

How do you manage a stye?

Answer 10

management includes hot compresses and analgesia. CKS only recommend topical antibiotics if there is an associated conjunctivitis

Question 11

What is an adie pupil?

Answer 11

Tonically dilated pupil, slowly reactive to light with more definite accommodation response. Caused by damage to parasympathetic innervation of the eye due to viral or bacterial infection. Commonly seen in females, accompanied by absent knee or ankle jerks.

Question 12

What is a marcus-gunn pupil?

Answer 12

Relative afferent pupillary defect, seen during the swinging light examination of pupil response. The pupils constrict less and therefore appear to dilate when a light is swung from unaffected to affected eye. Most commonly caused by damage to the optic nerve or severe retinal disease.

Question 13

What is horners syndrome?

Answer 13

Miosis (pupillary constriction), ptosis (droopy eyelid), apparent enophthalmos (inset eyeball), with or without anhidrosis (decreased sweating) occurring on one side. Caused by damage to the sympathetic trunk on the same side as the symptoms, due to trauma, compression, infection, ischaemia or many others.

Question 14

What is hutchinsons sign?

Answer 14

Unilaterally dilated pupil which is unresponsive to light. A result of compression of the occulomotor nerve of the same side, by an intracranial mass (e.g. tumour, haematoma)

Question 15

What is a closed open-angle glaucoma ? How does it present? RF? findings on exam? mx?

Answer 15

Glaucoma = raised intraocular pressure
Open angle = peripheral iris is NOT covering trabecular meshwork –> aqueous humor can drain

RF: age, fhx, myopia, HTN, DM, steroids

Presentation: insidious, peripoheral visual field loss (nasal scotoma), decreased acuity

Fundoscopy:
1. Optic disc cupping - cup-to-disc ratio >0.7 (normal = 0.4-0.7), occurs as loss of disc substance makes optic cup widen and deepen
2. Optic disc pallor - indicating optic atrophy
3. Bayonetting of vessels - vessels have breaks as they disappear into the deep cup and re-appear at the base
4. Additional features - Cup notching (usually inferior where vessels enter disc), Disc haemorrhages

Mx: refer opthamology.

Question 16

How does dry vs wet age related macular degeneration present?

Answer 16

BOTH: blurred central vision and poor vision at night. Patients often complain that straight lines become curved.

Dry: drusen on opthalmoscopy, comes on gradual
wet: faster, choroidal neovascularisation on opthalmoscopy

anti-VGEF injections for wet ARMD - urgent referral to opthamology needed

Question 17

How does hypertensive retinopathy present?

Answer 17

Hypertensive retinopathy is often asymptomatic but can present with reduced acuity. The fact that this patient has no past medical history makes hypertensive retinopathy unlikely. Hypertensive retinopathy has a characteristic appearance on ophthalmoscopy, and there will be signs of arteriovenous nipping and copper wiring signs. Furthermore, hypertensive retinopathy is not associated with cup-to-disc ratio changes.

Question 18

How do cataracts present?

Answer 18

Cataracts are often asymptomatic if they aren’t in the visual axis. If they do present with symptoms it is generally a loss of vision with problems such as haloes due to light scattering. A peripheral cataract can easily be visualised on slit lamp examination, and there would be no optic disc involvement.