urgent presentations in opthal 2

Question 1

retinal detatchment

Answer 1

partial or complete loss of vision
flashes and floaters and visual field loss
more commonly affecting myopic patient

Question 2

why is retainal detatchment time sensitive

Answer 2

prognosis poorer if the macula is involved ie. patient has lost central vision

Question 3

treatment of retinal detatchement

Answer 3

surgery - stick the retina back on to the back of the eye
opthal referral

Question 4

vitreous heamorrhage

Answer 4

bleed into the jelly of the eye
commonly caused by diabetic retinopathy
red shadow
may be caused by trauma
you may be able to check for lack of red reflex

Question 5

proliferative diabetic eye disease

Answer 5

new abnormal blood vessels proliferating

Question 6

management of vitreous haemorrhage

Answer 6

diabetics controlled - opthal may laser the back of the eye

Question 7

ARMD (wet)

Answer 7

sudden central loss of vision - scotoma
elderly patient
painless
caused by new bleed at the back of the eye from abnormal blood vessels

Question 8

treatment of wet ARMD

Answer 8

anti-VEGF injections
(risk of endopthalmitis)

Question 9

retinal arterial and venous occlusions

Answer 9

sudden painless vision loss
central retinal artery - complete loss of vision
branch retinal artery occlusion - scotoma

Question 10

how to treat retinal arterial occlusion

Answer 10

THIS IS A STROKE PATIENT
gen med/neuro referral
antiplatelet agent
corotid doppler
thrones thoracic echo
stroke work up
ECG and check pulse - see if theyre in AF
glucose, BP, fasting lipids

Question 11

hallmark of central retinal artery occlusion

Answer 11

cherry red spot

Question 12

retinal vein occlusion

Answer 12

hypertensive patient usually
arteriosclerosis
blood can’t get out through th veins so it bleeds into the retina

Question 13

retinal vein occlusion management

Answer 13

BP
opthal referral
you can usually improve vision for these patients (not so much with arterial occlusion)
occular massage
anterior chamber paracentesis to release some fluid, decompressing the eye may dislodge and embolus
hyperbaric chamber

Question 14

papilloedema

Answer 14

brain tumour until proven otherwise
check blood pressure and organise neuroimaging
may be idiopathic intracranial hypertension
blurred outline of the optic disc

Question 15

giant cell arteritis

Answer 15

scalp hurts, headache
unilateral optic nerve swelling
thickening of the intima of the temporal artery causes loss of blood supply to the opthalmitis artery
tender temporal artery - sometimes you may not feel a pulse because the blood supply is so diminished

Question 16

GCA management

Answer 16

FBC, CRP and ESR
platelets
treat with high dose steroids
temporal artery biopsy
dont delay pred

Question 17

why do you do a temporal artery biopsy

Answer 17

bacuse you have to give the patient so much steorid do you need to be sure its GCA that they have

Question 18

what is strabismus

Answer 18

squint

Question 19

what does the forth nerve do

Answer 19

turns the eye down when it is adducted (facing toward the nose)

Question 20

forth nerve diplopia

Answer 20

vertical diplopia on downward gaze eg. when tryng to read or waalk down stairs

Question 21

third nerve plasy

Answer 21

down and out
ptosis
midriasis - dilation of the pupil

Question 22

sixth nerve palsy

Answer 22

double vision looking toward affected side
usually benign

Question 23

forth nerve palsy tilt

Answer 23

people tilt head away from the affcted side
straightening heead will make vertical diplopia worse

Question 24

horners syndrome

Answer 24

ptosis
miosis (small pupil)
anhydrosis

Question 25

horners syndrome is caused by

Answer 25

problem in the sympathtic chain
threat to lifee

Question 26

proptosis

Answer 26

thryoid eye disease
caant close eyes completely - corneal exposure causing corneal erosions and infection

Question 27

leucocoria

Answer 27

white pupil reflex instead of a red reflex
urgent assessment - may be retinoblastoma, threat to sight and life