Classic Presentations

Question 1

A red eye with sticky discharge

Answer 1

Bacterial conjunctivitis

Question 2

A red eye with watery discharge

Answer 2

Viral conjunctivitis

Question 3

Bilateral red eyes in a young adult with follicles under the eyelid

Answer 3

Chlamydial conjunctivitis

Question 4

Red eyes with string discharge and itch

Answer 4

Allergic conjunctivitis

Question 5

Focal white infiltrates on the cornea and/or hypopyon (thick white line at the bottom of the cornea caused by inflammatory cells in the anterior chamber of the eye)

Answer 5

Bacterial keratitis

Question 6

Watery/gritty/red eye, pain, reduced corneal sensation and dendritic ulcer

Answer 6

Herpetic keratitis

Question 7

Bilateral white subepithelial infiltrates

Answer 7

Adenoviral keratitis

Question 8

Red eye with pain and discharge in a farm worker with history of trauma from vegetation to the eye

Answer 8

Fungal keratitis

Question 9

Red swelling around the eye + painful eye movements

Answer 9

Orbital cellulitis

Question 10

A very red eye post-surgery that is painful with decreasing vision

Answer 10

Endophthalmitis

Question 11

A patient with a cat experiences mild flu like symptoms. A protozoa is seen in the retina

Answer 11

Toxoplasmosis

Question 12

A patient with a dog forms granulomas in their eye

Answer 12

Toxocara

Question 13

Inflamed eyelids with scale and dandruff

Answer 13

Seborrhoeic (anterior) blepharitis

Question 14

Inflamed eyelids with loss of lashes/ingrowing lashes/tepee sign +/- styes, ulcers of lid margin, corneal staining and marginal ulcers

Answer 14

Staphylococcal (anterior) blepharitis

Question 15

A patient with rosacea has swollen meibomian glands, dried secretions at the gland openings +/- meibomian cysts

Answer 15

Posterior blepharitis

Question 16

Eye pain, redness, reduced vision and photophobia + cells and flare in anterior chamber on examination

Answer 16

Anterior uveitis

Question 17

Red, irritated eye with the inflammation limited to a specific area of the globe

Answer 17

Episcleritis

Question 18

A patient with a serious systemic condition (eg Rh arthritis, Wegener’s etc) has an extremely painful red eye (sometimes with purple hue), photophobia and decreased visual acuity. Ocular pain radiates to temple or jaw

Answer 18

Scleritis

Question 19

Trauma to one eye causes inflammation in both eyes

Answer 19

Sympathetic ophthalmia

Question 20

A patient is hit with blunt force to the eye with an object larger than the eye socket. Teardrop sign is seen on MRI.

Answer 20

Blowout fracture

Question 21

A patient is hit with blunt force to the eye with an object larger than the eye socket. Teardrop sign is seen on MRI. The patient is also unable to look up

Answer 21

Blowout fracture + inferior rectus muscle trapped in the sinus below

Question 22

Microaneurysms / dot + blot haemorrhages, hard exudate, cotton wool spots and new vessel formation

Answer 22

Diabetic retinopathy

Question 23

Copper or silver wiring, cotton wool spots, hard exudates and flame hemorrhages

Answer 23

Hypertensive retinopathy

Question 24

Sudden, painless, profound loss of vision with RAPD, pale odematous retina, poor optic disc contour (fluffy and blending into surrounding area) and cherry red spot on the macula on examination

Answer 24

Central retinal artery occlusion

Question 25

Sudden painless visual loss (moderate-severe) with flame hemorrhages, dilated tortuous veins and disc and macular swelling

Answer 25

Severe central retinal vein occlusion

Question 26

Transient visual loss characteristically worse on waking and improves during the day. On examination there is flame hemorrhages, dilated tortuous veins and disc and macular swelling

Answer 26

Mild central retinal vein occlusion

Question 27

Sudden, painless vision loss + scalp tenderness, headache and jaw claudication

Answer 27

GCA

Question 28

Unilateral (mainly) progressive visual loss over 24-48hrs, pain behind eye exacerbated by movement, colour desaturation and central scotoma

Answer 28

Optic neuritis

Question 29

Eye cannot abduct + horizontal diplopia worse on distance vision and looking to the affected side + esotropia

Answer 29

CN VI (abducens nerve) palsy - affects lateral rectus

Question 30

Vertical double vision worse on downgaze + compensatory head tilt (down and to the side opposite the affected eye) + hypertropia on cover test that worsens on downgaze

Answer 30

CN IV (trochlear) nerve palsy - affects superior oblique muscle

Question 31

Eye looks 'down and out' with drooping eyelid, large pupil and diplopia

Answer 31

CN III (oculomotor) nerve palsy - affects superior, inferior, and medial recti and inferior oblique (eye muscles), levator palpebrae superioris (upper eyelid) and sphincter pupillae (pupillary constriction)

Question 32

Painful CN III nerve palsy

Answer 32

Aneurysm

Question 33

Impairment of adduction in a patient with MS etc

Answer 33

Inter-nuclear ophthalmoplegia

Question 34

Headache, enlarged blind spot, blurring of vision, loss of vision and bilateral swollen disks on ophthalmoscopy

Answer 34

Papilloedema

Question 35

Loss of vision, floaters, loss of red reflex +/- haemorrhage on fundoscopy

Answer 35

Vitreous haemorrhage - can be caused by retinal tear, diabetic retinopathy or retinal vein occlusion

Question 36

A short-sighted person experiences a painless partial loss of vision 'like a curtain coming down' + sudden onset of flashes/floaters

Answer 36

Retinal tear

Question 37

Rapid central visual loss, metamorphopsia (curved distortion of linear objects) and haemorrhage/exudate on fundoscopy

Answer 37

Wet age-related macular degeneration

Question 38

Gradual decline in vision, central scotoma (missing central vision) + drusen (white dots) in macula area and atrophic patches of retina

Answer 38

Dry age-related macular degeneration

Question 39

Reduced visual fields, cupped disc (large cup to disk ratio) and increased IOP

Answer 39

Open angle glaucoma

Question 40

Painful red eye, visual loss, headache, nausea, vomiting, halo around lights, cloudy cornea and stony hard eye

Answer 40

Closed angle glaucoma

Question 41

Gradual decline in vision that cannot be corrected with glasses, vision is hazy/blurred +/- glare

Answer 41

Cataract