Tutorial

Question 1

Extremely painful eye for 48 hours, unable to open eye, reduced vision, tree-like green structure on cornea. How do you manage?

Answer 1

1. drop of local anaesthetic
2. fluroscein dye
3. treat dendritic ulcer with topical aciclovir

Question 2

Woman concerned with appearance of her eyes (lid retraction and proptosis) accompanied by pain and weight loss. Management?

Answer 2

? thyroid eye disease

–> test TSH and free T4

Question 3

4 day history of unilateral, sticky eye which is a bit sore, no photophobia, vision hazy when eye is sticky. How to manage?

Answer 3

Take a swab and send for culture and sensitivities. In the mean time start an antibiotic: topical chloramphenicol drops or ointement 4x day (if allergy use fucithalmic)

Question 4

Unilateral loss of vision which was painless and sudden. T2DM and hypertension.

Answer 4

1. Check RAPD
2. Fundoscopy for CRAO or CRVO
3. CRAO: ocular massage, breathe in paper bag, IV acetazolamide, surgical decompression
4. CRVO: no urgent treatment but reduce risk factors (smoking, diabetes, hypertension

Question 5

Blurred disc with pink cup

Answer 5

urgent referral to ophthalmology
? raised ICP –> tumour
? idiopathic intracranial hypertension (seen in obesity)

Question 6

gradual vision loss with pain on eye movement. How to manage?

Answer 6

1. test visual acuity
2. test visual fields
3. test pupillary reflex
   - ->if RAPD PRESENT: retinal or optic nerve pathology
4. fundoscopy
   - -> if swollen disc: optic neuritis

Question 7

headache + poorly defined contour of optic disc with no central cup and absent venous pulsation

Answer 7

Papilloedema