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Question 1

what are the two different reactions shown in the conjucitva in response to inflammation

Answer 1

the two reactions are follicles and papillae , follicles are collections of inflammatroy cells called lymphyocytes , appearing as white rice grain like structures , papillae on the other had present as exubrent red blood vessles giving the conjuctiva a velvety smooth and red apperance

Question 2

How does meibomian gland dysfunction contribute to worsening symptoms of dry eye, particularly on awakening?

Answer 2

Meibomian gland dysfunction leads to unhealthy lipid secretion, causing poor tear film quality. During sleep, reduced blinking allows the unhealthy tear film to stagnate, exacerbating symptoms upon awakening.

Question 3

What are the common tests used for diagnosing dry eye?

Answer 3

Common tests for diagnosing dry eye include the fluorescein eye drop test to assess tear film quality, Tear Film Break-Up Time (TFBUT) to evaluate tear film stability, and the Schirmer test to measure tear production.

Question 4

What are some symptoms and presentations of blepharitis?

Answer 4

Symptoms of blepharitis include a gritty or foreign body sensation, watery eyes, and the presence of lumps or cysts on eyelid margins. Presentations may involve thickened red eyelashes, loss of eyelashes, and flaky material in the eyebrows.

Question 5

How can you differentiate between viral and allergic conjunctivitis based on clinical presentation?

Answer 5

in viral conjunctivitis, white spots known as subepithelial infiltrates may appear in the cornea. Allergic conjunctivitis often presents with papillae due to an allergic reaction.

Question 6

redness around the whole eye

Answer 6

diffuse redness

Question 7

What is the significance of Hutchinson’s sign in herpes zoster ophthalmicus?

Answer 7

Hutchinson’s sign indicates the involvement of the nasociliary nerve in herpes zoster ophthalmicus. It suggests the potential presence of corneal ulcers or other complications due to varicella-zoster virus reactivation.

Question 8

How does acute angle-closure glaucoma manifest clinically?

Answer 8

Acute angle-closure glaucoma presents with a sudden onset of severe eye pain, diffuse redness, hazy cornea, and a mid-dilated pupil due to increased intraocular pressure.

Question 9

What are the three layers of tear film, and what is the function of each layer?

Answer 9

The three layers of tear film are the lipid layer (outermost), aqueous layer, and mucin layer (innermost). The lipid layer prevents evaporation, the aqueous layer provides moisture, and the mucin layer helps in adhering the tear film to the surface of the eye.

Question 10

How does the Tear Film Break-Up Time (TFBUT) test help diagnose dry eye syndrome?

Answer 10

The TFBUT test involves observing how quickly dark spots appear in the tear film after instilling fluorescein. A shorter TFBUT time indicates instability of the tear film, suggesting dry eye syndrome.

Question 11

What is the significance of the Schirmer test in diagnosing dry eye syndrome?

Answer 11

The Schirmer test measures tear production by placing a paper strip in the lower eyelid fornix. A lower wetness measurement indicates reduced tear production, which is indicative of dry eye syndrome.

Question 12

What are some common viral causes of conjunctivitis, and how do they differ in presentation?

Answer 12

Common viral causes include herpes simplex virus and adenovirus. Herpes simplex virus may lead to dendritic ulcers, while adenoviral infections can present with subepithelial infiltrates in the cornea.

Question 13

Describe the differences between adult inclusion conjunctivitis and neonatal conjunctivitis.

Answer 13

Adult inclusion conjunctivitis is typically sexually transmitted and presents with a red eye and discharge. Neonatal conjunctivitis occurs in infants due to exposure during childbirth and requires immediate treatment to prevent complications.

Question 14

How do dendritic ulcers caused by herpes simplex virus differ from geographical ulcers?

Answer 14

Dendritic ulcers have a branch-like appearance due to the virus’s spread along corneal nerves, while geographical ulcers result from healed ulcers attracting blood vessels from the conjunctiva, potentially leading to poor vision.

Question 15

What is the primary organism responsible for corneal ulcers in contact lens wearers, and how does it differ from other bacterial infections?

Answer 15

Acanthamoeba is the primary organism in contact lens-related corneal ulcers. Unlike other bacterial infections, it forms cysts and requires intensified treatment with both topical antibiotics and steroids.

Question 16

What are the clinical features of acute anterior uveitis (iritis), and why is it important to investigate systemic associations?

Answer 16

Acute anterior uveitis presents with white dots (keratic precipitates) in the cornea and may be associated with conditions like inflammatory bowel disease or sarcoidosis, making it crucial to investigate systemic associations.

Question 17

How can you differentiate between episcleritis and scleritis based on clinical findings?

Answer 17

Episcleritis presents with bright red blood vessels that blanch with vasoconstricting eye drops like phenylephrine. In contrast, scleritis causes deep, intense pain and is associated with systemic inflammation, potentially leading to sight-threatening complications.

Question 18

What are the common causes and clinical presentations of eyelid malpositions?

Answer 18

Eyelid malpositions can result from conditions like entropion and ectropion, leading to eyelashes rubbing against the eye or exposure of the conjunctiva, respectively. Symptoms include redness, irritation, and foreign body sensation.

Question 19

What is a subconjunctival hemorrhage, and what are its characteristics?

Answer 19

A subconjunctival hemorrhage is a benign condition characterized by the presence of blood under the conjunctiva. It typically presents as a painless, red patch on the white part of the eye.

Question 20

What are the key differences between viral and bacterial conjunctivitis in terms of clinical presentation and management?

Answer 20

Viral conjunctivitis often presents with watery discharge and follicles, while bacterial conjunctivitis may have purulent discharge and papillae. Treatment for viral conjunctivitis is supportive, while bacterial conjunctivitis may require topical antibiotics.

Question 21

How do corneal foreign bodies contribute to corneal abrasions, and what are the potential complications?

Answer 21

Corneal foreign bodies can cause corneal abrasions, leading to pain, redness, and foreign body sensation. Complications may include corneal infections or scarring if not promptly treated.

Question 22

What are the clinical features and systemic associations of acute anterior uveitis (iritis)?

Answer 22

Acute anterior uveitis presents with eye pain, photophobia, and decreased vision. Systemic associations may include inflammatory bowel disease, psoriasis, or ankylosing spondylitis.

Question 23

Differentiate between episcleritis and scleritis based on clinical findings and management.

Answer 23

Episcleritis presents with localized redness and discomfort that blanches with vasoconstrictors. Scleritis causes severe, deep pain and may be associated with systemic conditions. Management involves anti-inflammatory agents and treating underlying systemic diseases.

Question 24

what medications make dry eye worse

Answer 24

oral histamines

Question 25

what are you looking for with the TFBUT with furoscein

Answer 25

how quickly the dark spots appear

Question 26

misidirected eyelashes

Answer 26

trichaisis

Question 27

presentation of chronic blepharitis affecting the meibomian gland

Answer 27

notching and smoothing of eyelids = gone

because meibomian glands are blocked up - lid margins become red and poor tear film

Question 28

treatment for blepharitis

Answer 28

lid hygiene

clean lid margins (using warm water and clean lid margins)
get rid of deposits from openings of the meibomian glands and makes them secreate better

lubraicants for symptoms of dry eyes

chloremphenicol for active infection

topical steroids because its inflammation

sometimes in children oral antibuotics (low dose) are given because they have an antiinflammatory effect acts as an anti-inflammatroy not an antibiotic

Question 29

what are examples of viral eyelid infections

Answer 29

Herpes simplex
palloric virus (warts around the lid margin) - may/may not cause red eye due to proximity to lid margin

Question 30

a stye is an

Answer 30

infection of the root of the hair follicle - pulling out the lash releases the infection

Question 31

herpes simplex needs to be treated with what

Answer 31

needs to be treated with an oral antiviral
Redness on inside of eyelid - evert the eyelid- topical medicine needs to be given

Question 32

when you see blisters on the tip of the noose in herpes zoster opthalmicus

what should you do

Answer 32

When you see blisters on the tip of the nose - the surface of the eye must be examined because the nasocillary nerve supplies sensation to the surface of the eye (may be a corneal ulcer and they are unaware of it) (hutchinsons sign)- positive hutchinsons sign indicated reactivation of the varicella zoster virus on the trigeminal nerve , specifically in the ophthalmic branch

Question 33

what would a sight threatning presentation of herpes zoster opthalmicus look like

Answer 33

Herpes zoster opthalmicus

Sight threatening presentation = when surface of the cornea has turned white

Question 34

why can malpoistion of the eyelids cause an red eye

Answer 34

Eyelashes are rubbing on the surface of the eye due to inwards turn of lid margin = inflammation

Requires surgery

Question 35

what can happen in llower lid margin has fallen away from the globe

Answer 35

Exposed fornicial conjuctiva , becomes red because of exposure , can happen in pts who have 7th nerve or facial nerve palsy

Need to ensure pt can close eyelids , night time exposure will cause significant redness of the eyes, sx = required

Question 36

subconjuctival haemhorrhage

Answer 36

not sight threatining

uncomfortable/ foreign body sensattion

if you cant see anything on posterior margin - may be a history of trauma

benign condiiton can also be caused by coughing and sneezing

Question 37

differentiation between discharge produced by viral infection and bacterial

Answer 37

viral infection

watery discharge

sticky/purlent = bacterial

blood stained tears = severe vrial infection

conditons such as diptheria can present with conjuctivits

vision not affected may cuase blurring because of the discharge

Question 38

viral infection vs allergic when eyelid inverted

Answer 38

viral infection = follicels

allergic reaction = papillae

Question 39

adenoviral infections

Answer 39

in cases of viral conjuctvitis

white spots on the superfical layer of the cornea= sub epitheliel infiltrates- if affecting centre of the pupillary area then vision will be affected , however if in periphery then will get better - inflammatory response of the cornea to a viral infection

if central cornea = affected then steroids should be given carefully

Question 40

what are the three types of bacterial conjuctvitis caused by chlyamidia ,

Answer 40

depending on serotype can cause three types of infection and can cause trachoma

= disease of poor hygiene

adult inclusion conjuctivits = caused by an STI

nenonatal conjuctivits - if mom is affected , passed through the birth caanl passage to the birth canal will cause the infants eyes to be affected

Question 41

what is ABC treated with

Answer 41

chloremphenicol + fusidic

Question 42

if an eyelid is white when inverted what could it be indicative of

Answer 42

white lid underenath the lid - when lid has been inverted - scarring because of repeat infection

Question 43

trachoma is /….

Answer 43

causes infection by recurrent infection , potenitllay blinding condiion

Question 44

what must you do if adult inlcusion conjuctivits happens

Answer 44

red eye+ discharge - so swab must be taken using a clean sterile cotton swab, rub against conjuctiva + send to lab for diagnosis

Question 45

what is opthalmia neonatorium

Answer 45

Opthalmia neonatorium - conjunctivitis in the first 3 weeks of life

Question 46

what is allergic conjuctvitis

Answer 46

Allergic conjuctitvits - acute type 1 (hypersensitivity) due to sudden exposure to allergen,

Atopy = persons tendency to be reacting to allergens in an exaggerated manner , if someones has chronic itchy eyes all year ask for history of eczema + hay fever gives an indication that they are prone to having these conditions

Question 47

giant papillary conjuctivits

Answer 47

Giant papillary conjunctivitis in people who wear CL = edge of cornea not fitting well, will continue to irritate , the conjuctiva lining the upper lid, that will cause inflammation and allergic reaction,

Question 48

presentation of vernal keratoconjuctivits

Answer 48

Vernal keratoconjuctvitis , flip over the upper eyelid- very red + big papillae + discharge , papillae rub against eye when pt is blinking + may cause corneal ulcer

These corneal papillae will therefore be treated with steroids

Question 49

contact dermatitis and allergic conjuctvitis due to eye dropsn

Answer 49

Contact dermatitis and Allergic conjuctitvitis due to eye drops - causes redness of the eye around the skin , drops have seeped out the eye causing contact dermatitis

Question 50

chemical conjuctivits

Answer 50

Chemical conjunctivitis - usually because of an injury with acid or an alkalia - urgency of wash out= more important , can take up to an hr of irrigation - wash out with water

Question 51

if the whole eye is red and their are some red spots what is this indicative of

Answer 51

that is indicative of bleaching and that the blood supply is gone from that area - meaning that the whole of the corneal epithelium is gone - which is why you may get a diffuse green colour which is picked up as a epithelial defect (this is called limbal ischemia) because the blood supply is gone wheree their is a junction of cornea and sclera - depedning upon the extent of limbal isahemia if it is more than 180 degrees - serious sight threatening - can build up and cause increased intraocular pressure and intraocular inflammation.

Question 52

are acid or alkalia injuries more worse

Answer 52

Alkali injuries are safer , when acid gets in touch with the surface of the eye causes couagulation of proteins , that prevents deeper penetration into the eye

Question 53

what to do if presented with corneal foreign body

Answer 53

Corneal foreign body this can be taken out under topical anesthesisa oon a it amp , dont remove full foreign body , e.g. if iron rust becomes superficial over a period of time + can take out
If left over a period over time in situ - attracts inflammatory blood vessels for it to heal and this can cause a scar , dosnt apear to be in the centre of the pupil so not sight threatening
If you see corneal foreign body before sending patient way lift up top lid and look for what you call a sub tarsal foreign body
To reveal this put a drop of fluroscein and you will see linear abrasions - everytime the person is blinking the foreign body is rubbing on the surface of the cornea so it can cause linear abrasions of things

Question 54

dendritic ulcer presentation

Answer 54

Dendritic ulcer - branch like shape - reason being corneal nerves - looks like a branch of tree- this virus is a nuerotropic virus - spreads along the nerves - treatment topical antiviral= acyclovoir

Question 55

herpes simplex keratitis shouldnt be treated with

Answer 55

• shouldnt be treated with steroid - enhances grow with steroid
  Geographical ulcer (amboeid ulcer) is caused - when has healed attracts blood vessles from the conjuctiva and will result in poor vision so is sight threatining

Question 56

what stains will reveal what

Answer 56

Fluroscein staines any corneal defects
Rose bengal will stain any diseased epithelium and will reveal an amboeid ulcer

Question 57

what is the presentation of corneal infection: bacterial keratitis

Answer 57

Bacterial infections = commoner in people who wear soft contact lense (extended wear) or in trauma
Commonest organism for corneal ulcer with contact lenses- acanthomeba (swimming with cl + sleeping with cl)

Question 58

are corneal infections sight threatning

Answer 58

Corneal infections are serious they can cause sight loss - tretament is usually with intensified topical steroids + topical antibiotics

Question 59

allergic corneal ulcer can produce what

Answer 59

marginal keratitis (inflammatory allergic reaction)

Question 60

blepharitis can cause

Answer 60

Blepharitis - because the lid is opposed to the surface of the eye - causes secondary inflammatory response in the cornea - called marginal keratitis because if affects the margin of the cornea - because it is inflammation and not infection the treament is usually with steroids

Question 61

acute anterior uveitis presentation

Answer 61

40% of people with iritis have systemic assocations e..g inflmmatiory bowel disease , psorasis important to ask history of any joint pain , mouth ulcers or bowel pain or skin changes with these conditions

Also you can have patients with conditions such as tuberculosis and sarcodidis who first present with iririts so that is why it is important to investigate

Question 62

how to differentiate between conjuctivitis and acute anterior uveitis

Answer 62

Unlike conjunctivitis which will be a painful condition / discomfort - this condition will not cause pain , usually one eye is affected unlike conjunctivitis and another feature is they will be extremely sensitive to light because of the inflammation of the iris

Structure of uvea: iris , cillary body, choroid all one layer , if you have inflammation of the iris tissue what stops the cillary body being infglamed - caused a spasm , any light coming to the eye makes the spasm worse -

also reduced va because the he pupil can become small and mishapen and because of anterior chamber activity

Question 63

AAU clinical signs

Answer 63

clinical signs - white dots - keratiic percipitaes- inflammation is in the iris - cells in the ac - these cells form clumps in the corena and they stick to the bottom part of the cornea and they are called keratitic percipitates (keratiic= corena, precipitates = clump of cells)
These are neutrophils and lymphocytes

If you dont treat this then then the pupil will remain mishapen forever
Posterior synachie= between the iris and the lens
Anterior synachie = between the cornea and the iris

Fibrin or intense inflammation causes the pouring out of protein from the iris blood vessels = fibrin - when you investigate send patients for routine test e..g. Sarcodoisis e.g. chest xray

Question 64

another reason for red eye could be

Answer 64

Antoher reason for red eye could be that their is inflammation of the episclera and sclera

Conjucitva covers sclera - most superficial part of sclera= episclera
Difference between sclera and episclera = episclera = vascular has got a blood supply - episclear = thin vascular layer
Usually presents in 30s and 40s and is benign - causes a bit of ache but no changes in the vision
Scleritis = extremely rare usually presents with systemic inflammation= rheumatoid arthritis
If paient has red eye and scleritis they will mention that the pain prevents them from going to sleep deep pain - can cause sclera to melt and the eye can lose its integrity - so it is a potentially sight threatening problem