Special Senses

Question 1

How to manage acute angle closure glaucoma

Answer 1

IV acetazolamide, timolol, pilocarpine and apraclonidine eyedrops

Acetazolamide reduces aqueous humour production

Timolol is a BB which does the same

Pilo and apra constrict the pupil to further reduce the IOP

Question 2

Gold standard investigation for optic neuritis

Answer 2

Contrast MRI of brain and orbits

Question 3

Definitive management for wet age-related macula degeneration

Answer 3

Anti-vascular endothelial growth factor (anti-VEGF)

Anti-VEGF is a potent mitogen and drives increased vascular permeability in patients with wet ARMD, decreasing the leakage

Question 4

How to differentiate between anterior uveitis, scleritis and episcleritis

Answer 4

All red eye

AU has red, painful eye with photophobia with small pupil and blurred vision

Scleritis is red, painful eye with photophobia and gradual reduction in vision worse with movement and eye watering. Associated with autoimmunity

Episcleritis is painless red eye

Question 5

What is the mechanism and terminology of near/far sightedness

Answer 5

Near-sighted = myopia = either lens is too strong or eye is too long meaning light is focused in front of the retina= can’t see things far away

Far-sighted= hypermetropia= either lens is too weak or eye is too short meaning light is focused behind the retina= can’t see things close

Question 6

How to treat anterior uveititis

Answer 6

Topical steroid e.g. pred

and topical cycloplegic (mydriatic) drops e.g. atropine that dilate the eye

Question 7

How to manage optic neuritis

Answer 7

IM corticosteroids e.g. hydrocortisone

And MRI of the brain and orbits to investigate underlying cause

Question 8

How to distinguish between the cause of an upper quadrant bitemporal hemianopia and lower quadrant bitemporal hemianopia

Answer 8

Upper is caused by Pituitary adenoma which compresses the inferior chiasm causing upper loss

Lower is caused by craniopharyngioma which compresses the superior chiasm causing lower loss

Question 9

What is the definitive treatment for acute angle-closure glaucoma

Answer 9

Laser peripheral iridotomy

Question 10

Cherry-red spot on the retina and painless vision loss in one eye which condition

Answer 10

Central retinal artery occlusion

Normal consensual light reaction but poor direct pupillary response

Question 11

Blood in vitreous humour with painless loss of vision

Answer 11

Vitreous haemorrhage

CRAO presents with same but cherry-red spot on retina