Questions Flashcards
Causes of red eye
Painful:
Anterior Uveitis
Keratitis
Acute closed angle glaucoma
Not painful:
Subconjunctival haemorrhage
Painful red eye with blurring of vision, small pupil and photophobia
Anterior uveitis
Treatment for glaucoma
Treatment is essentially medical and based on parasympathomimetic and beta-blocker eye drops
Carbonic anhydrase inhibitor drugs are also used
Opthalmic manifestations of rheumatoid disease
Keratoconjunctivitis sicca
Episcleritis
Scleritis
Which disease may present with anterior uveitis
Sarcoidosis
Behcets
Ankylosing spondylitis
Recurrent anterior uveitis is the most commonly disabling complication of Behcets
Main opthalmic presentation of myotonic dystrophy
Cataracts
Ocular manifestations of hypocalcemia
Cataracts
Papilloedema
Which disease are “sunflower cataracts” seen in
Seen in Wilson’s disease
-do not disable vision
What lifestyle choice may exacerbate Grave’s opthalmopathy
Smoking!!
Nerve supply to the lateral rectus
CNVI
abducent nerve
Nerve supply to the superior oblique muscle
CNIV
trochlear nerve
Nerve supply to the levator palpebrae superioris
CNIII and the cervical sympathetic nerves, and hence paralysis may be due to to lesions of either
How may infections reach intracranial structures?
Via the superior opthalmic vein
The opthalmic artery is an anastamoses between which arteries?
The external carotid (via the facial artery) and the internal carotid artery (from which it arises)
The opthalmic artery branch to the retina is an end artery
Where does the superior opthalmic vein drain?
Into the cavernous sinus
What is Weber’s syndrome?
This refers to infarction of one half of the midbrain and results in:
Ipsilateral oculomotor nerve palsy
Contralateral hemiplegia and
Paralysis of upward gaze
Blood supply to the macular region of the visual cortex
Supplied with blood from the middle and posterior cerebral arteries
(e.g. an infarction to the posterior cerebral artery would cause a homonymous hemianopia with macular sparing)
What is an altitudinal field defect
A visual field defect in which either the upper or lower half of the field is selectively affected
An elderly patient with a history of hypertension and glaucoma presents with decreasing visual acuity and peripheral visual field loss. Fundoscopy reveals optic disc cupping - primary open-angle glaucoma
Primary open angle glaucoma
A woman with a history of rheumatoid arthritis presents with severe, constant pain in her right eye. On examination the right eye is red and there is a degree of photophobia. Visual acuity is normal - scleritis
Scleritis
Difference between scleritis and episcleritis?
Scleritis is very very painful, episcleritis is “fine, not too bad”
Which conditions are associated with scleritis?
Rheumatoid arthritis and connective tissue disease
How does pilocarpine work?
Muscarinic receptor agonist
What is epiphora
Excessive watering of the eye
Drug used to treat glaucoma and how does it work
Pilocarpine
Acts on the ciliary muscle and causes it to contract, this opens the trabecular meshwork and allows excess fluid to drain
Also stiumlates parasympathetic nervous system and causes pupil to constrict (miotic)
A woman is noted to have a unilateral mydriatic pupil which is minimally reactive to light
Holmes-Adie pupil
What is Holmes-Adie syndrome
Holmes-Adie syndrome (HAS) is a neurological disorder affecting the pupil of the eye and the autonomic nervous system. It is characterized by one eye with a pupil that is larger than normal and constricts slowly in bright light (tonic pupil), along with the absence of deep tendon reflexes, usually in the Achilles tendon.
a patient presents with a ‘droopy eyelid’. On examination they have unilateral miosis, ptosis and narrow palpebral aperture giving the appearance of enophthalmos
Horner’s syndrome
An elderly man presents an acute, painful red eye associated with decreased visual acuity. His symptoms are worse in the dark. On examination he has a semi-dilated non-reacting pupil
Acute angle closure glaucoma
- you may also feel sick and vomit
- often see haloes around lights
Which eye condition is worse in the dark and why
Acute angle closure glaucoma
(people with glaucoma prefer bright lights because it makes the pupil constrict and pull the iris away from drainage channels = allows fluid to drain)
An elderly patient with a history of atrial fibrillation presents with a sudden painless loss of vision in one eye. Fundoscopy reveals a ‘cherry red’ spot on a pale retina
Central retinal artery occlusion
An elderly patient with a history of hypertension and glaucoma presents with decreasing visual acuity and peripheral visual field loss. Fundoscopy reveals optic disc cupping
Primary open angle glaucoma
an elderly patient with a history of chronic glaucoma and hypertension presents with a sudden painless loss of vision in one eye. Fundoscopy reveals multiple flame-shaped haemorrhages and optic disc oedema
Central retinal vein occlusion
an elderly man with a long history of diabetes presents with sudden visual loss in one eye. For the past few days he had been experiencing floaters and ‘cobwebs’. Visual acuity is reduced to sensing light
Vitreous haemorrhage
an elderly female smoker presents with reduced visual acuity, complaining of ‘blurred’ vision. On examination there is a central scotoma and fundoscopy reveals multiple drusen
Macular degeneration
a 30-year-old man presents with visual problems. His vision is much worse in the dark and he has now started to lose peripheral vision. He has a family history of similar problems
Retinitis pigmentosa
an elderly short-sighted man presents with a floater on the temporal field of vision. Visual acuity is normal for the patient
Vitreous detachment
A man who has a history of syphilis presents with bilateral small, irregular pupils which respond to accomodation but not to light
Argyll robertson pupil
An elderly man presents an acute, painful red eye associated with decreased visual acuity. His symptoms are worse in the dark. On examination he has a semi-dilated non-reacting pupil
Acute angle closure glaucoma
An elderly patient with a history of chronic glaucoma and hypertension presents with a sudden painless loss of vision in one eye. Fundoscopy reveals multiple flame-shaped haemorrhages and optic disc oedema
central retinal vein occlusion
A woman with a history of rheumatoid arthritis presents after developing a red right eye. There is no pain, discharge or photophobia although the eye is tearing. Visual acuity is normal
Episcleritis
Which heart condition is associated with central retinal artery occlusion?
AF - cause can throw off clots
A young man presents with an acute, painful red eye associated with photophobia and blurred vision. On examination the pupil is small and irregular
Anterior uveitis
Smoking is a massive risk factor for which condition?
Macular degeneration
