Questions

Question 1

Causes of red eye

Answer 1

Painful:
Anterior Uveitis
Keratitis
Acute closed angle glaucoma

Not painful:
Subconjunctival haemorrhage

Question 2

Painful red eye with blurring of vision, small pupil and photophobia

Answer 2

Anterior uveitis

Question 3

Treatment for glaucoma

Answer 3

Treatment is essentially medical and based on parasympathomimetic and beta-blocker eye drops
Carbonic anhydrase inhibitor drugs are also used

Question 4

Opthalmic manifestations of rheumatoid disease

Answer 4

Keratoconjunctivitis sicca
Episcleritis
Scleritis

Question 5

Which disease may present with anterior uveitis

Answer 5

Sarcoidosis
Behcets
Ankylosing spondylitis

Recurrent anterior uveitis is the most commonly disabling complication of Behcets

Question 6

Main opthalmic presentation of myotonic dystrophy

Answer 6

Cataracts

Question 7

Ocular manifestations of hypocalcemia

Answer 7

Cataracts

Papilloedema

Question 8

Which disease are “sunflower cataracts” seen in

Answer 8

Seen in Wilson’s disease

-do not disable vision

Question 9

What lifestyle choice may exacerbate Grave’s opthalmopathy

Answer 9

Smoking!!

Question 10

Nerve supply to the lateral rectus

Answer 10

CNVI

abducent nerve

Question 11

Nerve supply to the superior oblique muscle

Answer 11

CNIV

trochlear nerve

Question 12

Nerve supply to the levator palpebrae superioris

Answer 12

CNIII and the cervical sympathetic nerves, and hence paralysis may be due to to lesions of either

Question 13

How may infections reach intracranial structures?

Answer 13

Via the superior opthalmic vein

Question 14

The opthalmic artery is an anastamoses between which arteries?

Answer 14

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

Question 15

Where does the superior opthalmic vein drain?

Answer 15

Into the cavernous sinus

Question 16

What is Weber’s syndrome?

Answer 16

This refers to infarction of one half of the midbrain and results in:
Ipsilateral oculomotor nerve palsy
Contralateral hemiplegia and
Paralysis of upward gaze

Question 17

Blood supply to the macular region of the visual cortex

Answer 17

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)

Question 18

What is an altitudinal field defect

Answer 18

A visual field defect in which either the upper or lower half of the field is selectively affected

Question 19

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

Answer 19

Primary open angle glaucoma

Question 20

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

Answer 20

Scleritis

Question 21

Difference between scleritis and episcleritis?

Answer 21

Scleritis is very very painful, episcleritis is “fine, not too bad”

Question 22

Which conditions are associated with scleritis?

Answer 22

Rheumatoid arthritis and connective tissue disease

Question 23

How does pilocarpine work?

Answer 23

Muscarinic receptor agonist

Question 24

What is epiphora

Answer 24

Excessive watering of the eye

Question 25

Drug used to treat glaucoma and how does it work

Answer 25

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)

Question 26

A woman is noted to have a unilateral mydriatic pupil which is minimally reactive to light

Answer 26

Holmes-Adie pupil

Question 27

What is Holmes-Adie syndrome

Answer 27

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.

Question 28

a patient presents with a ‘droopy eyelid’. On examination they have unilateral miosis, ptosis and narrow palpebral aperture giving the appearance of enophthalmos

Answer 28

Horner’s syndrome

Question 29

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

Answer 29

Acute angle closure glaucoma

• you may also feel sick and vomit
• often see haloes around lights

Question 30

Which eye condition is worse in the dark and why

Answer 30

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)

Question 31

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

Answer 31

Central retinal artery occlusion

Question 32

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

Answer 32

Primary open angle glaucoma

Question 33

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

Answer 33

Central retinal vein occlusion

Question 34

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

Answer 34

Vitreous haemorrhage

Question 35

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

Answer 35

Macular degeneration

Question 36

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

Answer 36

Retinitis pigmentosa

Question 37

an elderly short-sighted man presents with a floater on the temporal field of vision. Visual acuity is normal for the patient

Answer 37

Vitreous detachment

Question 38

A man who has a history of syphilis presents with bilateral small, irregular pupils which respond to accomodation but not to light

Answer 38

Argyll robertson pupil

Question 39

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

Answer 39

Acute angle closure glaucoma

Question 40

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

Answer 40

central retinal vein occlusion

Question 41

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

Answer 41

Episcleritis

Question 42

Which heart condition is associated with central retinal artery occlusion?

Answer 42

AF - cause can throw off clots

Question 43

A young man presents with an acute, painful red eye associated with photophobia and blurred vision. On examination the pupil is small and irregular

Answer 43

Anterior uveitis

Question 44

Smoking is a massive risk factor for which condition?

Answer 44

Macular degeneration