Sudden Visual Disturbance

Question 1

damage to optic nerve results in

Answer 1

mononuclear field loss

Question 2

damage at the optic chiasm results in

Answer 2

bi-temporal hemianopia

common causes:

• pituitary adenoma
• craniopharyngioma
• intracranial aneurysm
• meningioma

Question 3

damage to the optic tracts results in

Answer 3

homonymous hemianopia on the same side

Question 4

damage to the whole optic radiation results in

Answer 4

homonymous hemianopia with macular sparing on the same side

Question 5

damage to the parietal optic radiation results in

Answer 5

inferior homonymous hemianopia

Question 6

damage to the temporal optic radiation results in

Answer 6

superior homonymous hemianopia

Question 7

what sits between the optic tract and the optic radiation

Answer 7

the lateral geniculate body

Question 8

what might cause a hole in vision affecting one eye (central scotoma)

Answer 8

optic nerve disease (neuritis)

Question 9

pupil constriction is cause by which division of the ANS

Answer 9

parasympathetic

Question 10

what are the causes of MIOSIS (small pupils)

Answer 10

senile miosis
horner's
argyll robertson pupil (no light but accommodation)
myotonic dystrophy
drugs (OPIATES, PILOCARPINE)

Question 11

what are the features of Horner’s syndrome

Answer 11

Ptosis
Miosis
Anhidrosis
Enophthalmos

Question 12

what are the causes of MYDRIASIS

Answer 12

Adie’s pupil
Third nerve palsy
drugs : AMPHETAMINES, ANTIDEPRESSANTS, TROPICAMIDE, ATROPINE
trauma/prev surgery

Question 13

describe the afferent loop of the pupillary light reflex

Answer 13

retina –> optic nerve –> LGN –> mid brain

Question 14

describe the efferent loop of the pupillary light reflex

Answer 14

ipsilateral AND contralateral EDINGER WESTPHAL nucleus –> third nerve –> colliery ganglion

Question 15

a patient is requiring examination of their retina. what drug would you suggest to dilate their pupil
Hx: 34, no medical conditions, blue eyes)

Answer 15

TROPICAMIDE
could also use cyclopentolate or atropine for mydriasis (toxicity in both)
phenylephrine is another option but longer onset

Question 16

treatment for uveitis

Answer 16

cyclopentolate

Question 17

treatment for dry eyes

eg at work

Answer 17

hypromellose
viscotears
(lacrilube ointment will cause blurred vision)

Question 18

dry mouth, flushing and confusion are side effects of which ocular drug

Answer 18

atropine most likely

Question 19

treatment for conjunctivits

Answer 19

chloramphenicol

Question 20

what should be used to flush eyes

Answer 20

sodium chloride 0.9 or tap water

Question 21

which drugs are associated with the development of acute glaucoma

Answer 21

any drug inducing mydriasis

phenylephrine, tropicamide, cyclopentolate or atropine

Question 22

what would you use to aid examination of a pt with foreign body in eye

Answer 22

flourescin drops

Question 23

what are long lasting eye drops for dry eyes

Answer 23

viscotears

lacrilube

Question 24

which drugs would you used for a carbonic anhydrase inhibitor for glaucoma

Answer 24

eye drop - DORZOLAMIDE

po ACETAZOLAMIDE

Question 25

which drug used in the treatment of glaucoma can cause breathlessness in asthmatics

Answer 25

timolol

Question 26

what are the symptoms of acute-angle closure glaucoma

Answer 26

``` sudden onset red painful eye N/V blurred vision headache ``` more likely to occur in dark conditions when pupil is dilated asian people are more at risk

Question 27

what are the functions of the tear film

Answer 27

flush away debris antibacterial protection optimal visual function lubricate eyelid movement

Question 28

which systemic drug gives the side effect of disturbance in colour vision

Answer 28

digoxin toxicity

Question 29

which systemic drug gives the side effect of halos esp during night time driving and optic neuropathy

Answer 29

amiodarone

Question 30

which systemic drug gives the side effect of blurred vision and corneal deposits

Answer 30

anti-psychotics

Question 31

which systemic drug gives the side effect of optic neuritis causign the loss of visual acuity and macular degeneration

Answer 31

ethambutol

Question 32

which systemic drug gives the side effect of orange staining of tears

Answer 32

rifampicin

Question 33

which systemic drug gives the side effect of blurred vision, disturbance of accommodation and increased IOP

Answer 33

TCAs

Question 34

which systemic drug gives the side effect of miosis

Answer 34

opiods

Question 35

which systemic drug gives the side effect of cataracts in long term use and increases IOP

Answer 35

corticosteroids

Question 36

which systemic drug gives the side effect of blurred vision and a reduction in tears

Answer 36

anti-histamines

Question 37

what is phenylephrine and what are its side effects

Answer 37

alpha-1 receptor antagonist photophobia and blurred vision acute glaucoma HTN and arrhythmias

Question 38

list three antimuscarinics and some side effects

Answer 38

ATOPINE CYCLOPENTOLATE TROPICAMIDE stinging on instillation raised IOP photophobia and blurred vision

Question 39

what is pilocarpine and what is it used for

Answer 39

muscarinic agonist reverses mydriasis and opens drainage channel in the trabecular meshwork (treatment for glaucoma) SE: head/brow ache myopia risk of retinal detachment

Question 40

which organism is the most common cause of conjunctivitis and blepharitis

Answer 40

straphyloccoci

Question 41

which antibiotic could be used for a conjuctivitis caused by pseudomonas aeruginosa

Answer 41

gentamicin, tobramycin, quinolone and polymyxin B

Question 42

what type of eyes are resistant to pupillary dilation

Answer 42

darkly pigmented irises

Question 43

what happens in primary open-angle glaucoma

Answer 43

obstruction of drainage of trabecular meshwork often from bowing of iris against trabecular meshwork painless onset, loss of peripheral vision more common in black africans

Question 44

what is uveitis and how would it present

Answer 44

inflammation of the uveal tract ``` blurred vision pain redness photophobia (anterior) floaters (posterior) ```

Question 45

what is retinal vein occlusion and how would it present

Answer 45

thrombus of central vein at/posterior to lamina cribosa sudden painless loss of vision ``` on fundoscopy: dilated veins retinal haemorrhage cotton wool spots retinal oedema ```

Question 46

what is retinal artery occlusion and how would it present

Answer 46

sudden painless loss of vision on fundoscopy: narrow arteries opaque and oedematous retina cherry red spot OPHTHALMIC EMERGENCY as irreversible within 90 mins

Question 47

how would retinal detachment present

Answer 47

progressive loss of visual fields | sudden onset of floaters and flashes of light

Question 48

how would DRY AMD present

Answer 48

painless progressive loss of central vision | on fundoscopy DRUSEN

Question 49

what would you see on WET AMD

Answer 49

choroidal neovascularisation