12 Ophtalmo Diseases

Question 1

Age related macular degeneration

Age related macular degeneration

Answer 1

Most common cause of blindness in developed, females more

Question 2

Age related macular degeneration

Answer 2

Age above 75 3x, smoker, FH 4x, HTN, DM, Dyslipidemia

Question 3

Age related macular degeneration fundoscopy?

Answer 3

Degeneration photoreceptor -> Drusen formation ( yellow round spots in Bruch membrane)

Question 4

Age related macular degeneration types?

Answer 4

Dry/Atrophy/early: 90%, Drusen, later become confluent
Wet/Exudative/Neovascular degeneration/Late: Leakage serous fluid/blood causes rapid loss of vision, red patches, worst prognosis

Question 5

Age related macular degeneration symptoms?

Answer 5

Gradual dry/subacute wet visual acuity reduction, near vision more
Impaired, dark adaptation, deteriorating vision at night
Photospia, flashing/flickering lights, glare around objects, Line distortion (Amsler grid)
Charles bonnet and visual hallucination
Fluctuation in visual disturbance from day to day

Question 6

Age related macular degeneration investigation?

Answer 6

Slit lamp, colour fundus photography, Fluorescin angiography ( in neovascular ), Optical coherence tomography ( 3D retinal view, gold standard)

Question 7

Age related macular degeneration management?

Answer 7

Mild (dry): Vit A, E, C, zinc
Moderate (wet): Anti VEGF monthly injection: Ranibizumab, Bevacizumab, Pegaptanib
*Laser may help in neovascularization but has risk of acute vision loss after treatment.

Question 8

Open angle glaucoma features?

Answer 8

Optic disc cupping (cup/disk ratio more than 0.6)

Question 9

Open angle glaucoma symptoms?

Answer 9

Painless insidious peripheral visual loss, tunnel vision in late stages, central scotoma,

Question 10

Open angle glaucoma Investigation?

Answer 10

Tonometry, Perimetry, OCT (optical coherence tomography)

Question 11

Open angle glaucoma Treatment?

Answer 11

latanoprost (prostaglandin analogue)+ Timolol, brimonidine, dorzolamide -> Laser, surgery

Question 12

Acute closed angle glaucoma Trigger?

Answer 12

Going to dark cinema, Anticholinergic for overactive bladder , nasal decongestant

Question 13

Acute closed angle glaucoma symptoms?

Answer 13

Emergency, headache,N/V, Severe ocular pain, hard red eye, decreased visual acuity, halos around lights, fixed dilated non reactive pupil, worsening symptoms with mydriasis ( watching TV in a dark room ), Corneal edema/hazy/dull, even abdominal pain

Question 14

Acute closed angle glaucoma RF

Answer 14

Female, Asian, Hyper metropia (long sightedness),senile lens growth, Pupil dilation (dark room, Anticoholingergic),

Question 15

Acute closed angle glaucoma Investigation?

Answer 15

(begin treatment, do not delay): Tonometry ( IOP ) , Gonioscopy ( slit lamp angle)

Question 16

Acute closed angle glaucoma Immediate treatment?

Answer 16

Acetazolamide IV: Reduce aqueous secretion/production
Timolol: BB, Decrease Aqueous humour production
Apraclonidine, brimonidine: A2 agonist, Double agent ( Production , Flow)
Pilocarpine: Direct parasympathetic, contraction ciliary muscle, opening trabecular meshwork, increase aqueous humour flow
Topical steroids

Question 17

Acute closed angle glaucoma Definitive treatment?

Answer 17

*cyclopentolate worsens. avoid mydriatic.
After Acute attack settles, definitive treatment:
Laser peripheral iridotomy ( tiny hole in iris allowing to flow )

Question 18

Anterior Uveitis/Iritis Causes?

Answer 18

Important DD of red eye, Idiopathic, HLA B27 related, usually unilateral
AS, Reactive arthritis, Psoriatic arthritis, IBD, Behcet, Sarcoidosis

Question 19

Anterior Uveitis/Iritis symptoms?

Answer 19

Acute, Discomfort and pain, Miosis irregular Pupil (posterior synechiae formation, iris adhered to anterior lens capsule), intense photophobia, blurred vision, red eye, tearing, visual acuity initially normal -> impaired

Question 20

Anterior Uveitis/Iritis Investigation?

Answer 20

Fundoscopy: Normal
Slit lamp:
Hypopyon: Pus and inflammatory cells in anterior chamber, fluid level
Ciliary flush: red ring spreading outwards

Question 21

Anterior Uveitis/Iritis Management?

Answer 21

corton eye drop + Atropine, cyclopentolate (Cycloplegic, relieve pain and photophobia )

Question 22

Hypertensive retinopathy Stages

Answer 22

1: copper wiring, Artery narrowing and tortuosity, increased light reflex
2:Arterio venous nicking, silver wiring
3: Cotton wool , hard exudates, flame and blot hemorrhage, macular star
4: papilledema (bilateral optic disc swelling)

Question 23

Papilledema

Answer 23

bilateral optic disc swelling due to Raised ICP, venous engorgement, loss of venous pulsation, blurring optic disc margin, elevation optic disc, loss of optic cup, paton lines ( Radial retinal lines cascading from optic disc), Rare causes: Hypo para, hypocalcemia, Vit A toxicitty

Question 24

Central Artery occlusion:

Answer 24

Pale retina, cherry red spot , Emboli (thrombolysis) or temporal arteritis (corton), boxcar shape, hollenhorst plaque cholesterol

Question 24

Charles bonnet syndrome

Answer 24

Poor vision, visual/auditory hallucination

Question 24

Vein

Answer 24

Anti VEGF (ranibizumab , aflibercept intra vitreous) Steroids, Panretinal photocoagulation (PRP) branch vein treatment: same + focal retinal photocoagulation

Question 25

Both vein/hypertensive

Answer 25

Flame hemorrhage, stormy sunset, hyper emia,

Question 26

Retinal detachment

Answer 26

floaters, Curtain/veil/ slowly spreads across vision

Question 27

D1, reduced acuity, Several dot hemorrhages and circinate hard exudates adjacent to macula

Answer 27

Targeted laser therapy *Short term tight glycemic can worsen the eye

Question 28

Retinitis pigmentosa

Answer 28

rogressive loss of night/peripheral vision, tunnel vision, bilateral retinal pigment with Bone spicules, FH +

Question 29

Retinitis pigmentosa syndromes?

Answer 29

Homocystinuria, myotonic dystrophy, Usher syndrome(Deafness ataxia) Rafsum (PHYH), abetalipoproteinemia, Kearns sayre, Alport, Lawrence moon biedl syndrome

Question 30

Corneal ulcer

Answer 30

Usually secondary to infection, contact lens (pseudomonas, acanthamoeba), vit a deficiency, Slit lamp, focal fluorescein staining cornea First topical genta for keratitis If perforation moxifloxacin, tobramycin, cefazolin

Question 30

Refsum

Answer 30

Autosomal recessive, sensorimotor peripheral neuropathy, accumulation phytanic acid, 20s, deafness, anosmia, ataxia, pes cavus, short 4th toe (epiphyseal dysplasia), cardiomyopathy, treatment restriction of food

Question 31

Diabetic retinopathy stages:

Answer 31

Mild: 1 or more micro aneurysm Moderate: Microaneurysms, blot hemorrhage, hard exudate, cotton wool spots, venous beading, inter retinal microvascular abnormalities (IRMA), yearly retinal photography Severe: microaneurysms + Blot hemorrhages in all 4 quadrants, venous beading in 2, IRMA in 1, Treat with laser Proliferative Neovascularization, vitreous hemorrhage, fibrous tissue anterior to retinal disc, More common in D1, 50% blind in 5 years, Panretinal laser but 50% will have reduced visual field and night vision + Anti VEGF like ranibizumab Maculopathy: Hard exudates and background changes around macula, More common in D2, Anti VEGF

Question 32

Posterior vitreous detachment

Answer 32

Flashes of light (photopsia), floaters often on temporal side of central vision

Question 33

Retinal detachment

Answer 33

Dense shadow starts at periphery, progress to central, a veil over the field of vision, straight lines appear curved

Question 33

Vitreous hemorrhage

Answer 33

DM, anticoagulant, Large bleeds cause sudden visual loss, moderate may cause numerous dark spots, small bleeds floaters , can turn into -> retinal detachment