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Question 1

Left pupil slightly dilated
Sluggish reaction of left pupil to light/accommodation
Absent ankle/knee reflexes

Answer 1

Holmes-Adie syndrome

unilateral in 80% of cases
dilated pupil
once the pupil has constricted it remains small for an abnormally long time
slowly reactive to accommodation but very poorly (if at all) to light

Question 2

Dorzolamide MOA? Use?

Answer 2

Carbonic anhydrase inhibitor
Raised intra-ocular pressure in open angle glaucoma
Reduces aqueous production

Question 3

Bilateral grittiness
Worse in mornings
Sticky eyelids

Answer 3

Belpharitis

Inflammation of eyelid margins

Question 4

Bilateral grittiness
Worse at end of day
Pain

Answer 4

Dry eye syndrome

Question 5

Red inflamed tender eye
Fever
Discharge
Proptosis

Answer 5

Cellulitis

Question 6

Unilateral grittiness

Answer 6

Basal cell carcinoma

Question 7

Itchy eyes
Watery eyes 
Rhinorrhoea
Sneezing
Itchy nose

Answer 7

Allergic rhinitis

Question 8

Anterior vs posterior blepharitis?

Answer 8

Meibomian gland dysfunction (common, posterior blepharitis)

Seborrhoeic dermatitis/staphylococcal infection (less common, anterior blepharitis)

Question 9

Function of Meibomian gland?

Answer 9

secrete oil on to the eye surface to prevent rapid evaporation of the tear film

Question 10

Management of blepharitis

Answer 10

Softening of the lid margin using hot compresses twice a day
Mechanical removal of the debris from lid margins - cotton wool buds dipped in a mixture of cooled boiled water and baby shampoo is often used
Artificial tears may be given for symptom relief in people with dry eyes or an abnormal tear film

Question 11

Burning sensation around right eye

Erythematous blistering rash in right trigeminal distribution

Answer 11

Herpes zoster ophthalmicus

Question 12

Hutchinson’s sign

Answer 12

rash on tip or side of nose
Indicates nasociliary involvement of HZO
- strong risk factor for ocular involvement

Question 13

Management of HZO

Answer 13

(Reactivation of varicella zoster in area of ophthalmic division of trigeminal)
ANTIVIRAL CORTICOSTEROIDS OPHTH REVIEW

Oral antiviral treatment for 7-10 days, ideally started within 72 hours. Topical antiviral treatment is not given in HZO
Oral corticosteroids may reduce the duration of pain but do not reduce the incidence of post-herpetic neuralgia
Ocular involvement requires urgent ophthalmology review

Question 14

Complications of HZO

Answer 14

ocular: conjunctivitis, keratitis, episcleritis, anterior uveitis
ptosis
post-herpetic neuralgia

Question 15

Risk factors for primary open angle glaucoma

Answer 15

Myopia
DM
HTN
FHx
Afro-C ethnicity Black
Steroids 
Genetics

(Hypermetropia for acute angle closure glaucoma)

Question 16

Define:
Belpharitis
Stye
Chalazion
Entropion
Ectropion

Answer 16

Blepharitis: Inflammation of the eyelid margins typically leading to red eye
Stye: infection of glands of the eyelids
Chalazion: Meibomian cyst
Entropion: In-turning of the eyelids
Ectropion: out-turning of the eyelids