Systemic Disease

Question 1

What is Hutchinson’s sign?

Answer 1

A lesion on the tip of the nose, indicates that intraocular involvement is likely via the nasociliary nerve

Question 2

Management of varicella zoster opthalmicus

Answer 2

Topical: Potassium permanganate soaks to skin, flamazine ointment for pain and chloramphenicol ointment for eyelid lesion

Systemic: acyclovir 800mg po 5xdly for 7 days

Analgesia: amitriptyline 50-150mg nocte

Refer if VA affected or painful red eye

Question 3

Commonest eye infection in HIV

Answer 3

CMV retinitis

Question 4

Treatment of CMV retinitis

Answer 4

Weekly intravitreal ganciclovir

Question 5

How does a squamous carcinoma of the conjunctiva present?

Answer 5

• looks like a pterygium
• becomes very raised and keratinised
• grows rapidly
• does not respond to topical lubricants/NSAIDS

Question 6

When is B plaque irradiation used?

Answer 6

Following excision of squamous Ca conjunctiva

Helps prevent recurrence and invasion

Question 7

Cidofovir can cause …

Answer 7

Uveitis and hypotony

Question 8

Rifabytin can cause

Answer 8

Uveitis

Question 9

Didanosine can cause

Answer 9

Midperipheral pigmentary retinopathy

Question 10

HAART can cause

Answer 10

Immune recovery uveitis if pre-existing CMV is present

Question 11

Features of thyroid associated ophthalmopathy

Answer 11

• lid retraction
• exophthalmos
• lid lag
• red gritty eye
• lid and conjunctival swelling
• visual loss secondary to optic nerve compression

Question 12

Risk factors for progressive thyroid associated ophthalmopathy

Answer 12

• any history of cigarette smoking
• radioactive iodine without steroid cover
• poor thyroid hormone control

Question 13

Systemic management of TAO

Answer 13

• persuade patient to stop smoking
• treat dry eye symptomatically
• control thyroid status
• give prednisone with radioactive iodine
• refer to ophthalmology for radiotherapy and immunosuppression if severe active eye disease

Question 14

When to refer for thyroid disease

Answer 14

New onset:

• exophthalmos
• diplopia
• loss of vision

Question 15

Syphilis can cause:

Answer 15

• chancre of lid
• interstitial keratitis
• uveitis
• chorioretinitis
• optic neuritis
• optic atrophy

Question 16

What is scleritis associated with?

Answer 16

• RA
• SLE
• Wegener’s granulomatosis
• relapsing polychondritis
• other granulomatous and vasculitic diseases

Question 17

What is non-granulomatous uveitis associated with?

Answer 17

Seronegative spondylo-arthropathies

Question 18

What is granulomatous uveitis associated with?

Answer 18

• TB
• syphilis
• sarcoid
• leprosy
• Brucella

Question 19

Features of JIA and uveitis

Answer 19

• blindness without eye pain or redness

Question 20

Which types of JIA carry the greatest risk?

Answer 20

• pauciarticular

- RF neg, ANA pos

Question 21

Conditions associated with atopy

Answer 21

• atopic conjunctivitis
• cataract
• keratoconus
• poor resistance to herpes simplex

Question 22

Pathophysiology of pemphygoid and SJS

Answer 22

• cause corneal scarring by destroying conjunctival goblet cells and lacrimal gland orifices

Question 23

Management of pemphygoid and SJS

Answer 23

• lubricate!

- refer early

Question 24

Drugs with ocular side effects

Answer 24

• steroids
• ethambutol, isoniazid and streptomycin
• chloroquine
• sympathomimetics
• anticholinergics
• amiodarone and digoxin

Question 25

What ocular side effects can steroids cause?

Answer 25

• cataract
• glaucoma
• topical can cause corneal melt, perforation and blindness in presence of herpes

Question 26

What can TB meds cause?

Answer 26

• loss of central and colour vision

- due to toxic optic neuropathy

Question 27

What can chloroquine cause?

Answer 27

• central blindness
• bulls eye maculopathy
• innucuous corneal deposits

Question 28

Management of a patient on chloroquine

Answer 28

• refer for visual field test at commencement of therapy

- again after 4 years of treatment

Question 29

Which drugs can precipitate angle-closure glaucoma?

Answer 29

• sympathomimetics (psudoephedrine, adrenaline)

- antichol (amitriptyline, antihistamines, atropine)

Question 30

What can amiodarone cause?

Answer 30

• optic neuropathy

- innocuous corneal deposits

Question 31

What can digoxin cause?

Answer 31

• xanthopsia (yellow vision)

Question 32

Side effects of B-blockers

Answer 32

• tiredness and impotence

- contraindicated in asthma, heart block and PVD

Question 33

Side effects of acetazolomide

Answer 33

• lassitude
• paraesthesiae
• renal stones
• impotence

Question 34

Side effecs of A2 agonists

Answer 34

• tiredness

- respiratory arrest in babies

Question 35

Side effects of pilocarpine

Answer 35

scoline apnoea

Question 36

Ocular signs in myaesthenia gravis

Answer 36

• ptosis

- diplopia

Question 37

Ice test

Answer 37

ptosis improves after crushed ice held on the lid for 2 minutes in myaesthenia gravis

Question 38

Ocular associations in Marfan’s syndrome

Answer 38

• dislocated lens
• retinal detachemtn
• thoracic aortic aneurysms

Question 39

Other things to look out for with psuedoxanthoma elasticum

Answer 39

• HT
• renovascular disease
• GIT haemorrhage
• aortic aneurysm

Question 40

Retinal features of malignant hypertension

Answer 40

• haemorrhages
• cotton wool spots
• dilated tortuous vessels

Question 41

NB when managing malignant hypertension

Answer 41

• dont drop BP rapidly with nefedipine

- risk of ischaemic optic neuropathy

Question 42

Features of neurofibromatosis

Answer 42

• Lisch nodules on iris
• plexiform neurofibroma of orbit
• cafe au lait spots

Question 43

Features of albinism

Answer 43

• high myopia
• astigmatism
• nystagmus
• VA <6/36

Question 44

Features of congenital rubella

Answer 44

• corneal opacity
• cataract
• glaucoma
• retinopathy
• microphthalmia

Question 45

Management of congenital rubella

Answer 45

Refer Day 1 after birth if abnormal red reflex