Eye quick

Question 1

What is seen in a Fundoscopy in Age-Related Macular Degeneration?

Answer 1

1. Dry: drusen (yellow deposits)

2.Wet: neovascularisation, subretinal fluid
=multiple fatty deposits across the retina

Distortion of central vision

Question 2

Age-Related Macular Degeneration clue

Answer 2

1. Elderly patient with central vision loss
   (eg, trouble reading faces)
2. Straight lines look wavy (metamorphopsia)
3. Dry AMD (90%): gradual, bilateral - Visual fluctuation. Difficulty reading stuff
4. Wet AMD: sudden, more severe, unilateral. Subconjunctival haemorrhage. choroidal neovascularisation. New blood vessels

= wet AMD progresses more rapidly than dry AMD

Question 3

Management of dry and wet AMD

Answer 3

Dry: no cure = Zinc and antioxidant vitamin supplementation. STOP SMOKING

Wet: anti-VEGF injections
= ranibizumab

Question 4

Investigations of Age-Related Macular Degeneration

Answer 4

1. Amsler grid (lines distorted)
2. OCT (optical coherence tomography)

To confirm WET - Fluorescein angiography

Question 5

What is Central Retinal Artery Occlusion

Answer 5

1. Sudden painless vision loss
2. Usually complete in one eye
3. History of AF or carotid disease.

Fundoscopy:
4. Pale retina with a cherry-red spot at the macula - small red opacification

Management:
5. Emergency! refer urgently
6. Ocular massage
7. lower intraocular pressure = acetazolamide

Question 6

What is Central Retinal Vein Occlusion?

Answer 6

1. Sudden painless vision loss, but not total
2. Often hypertensive or diabetic.

Fundoscopy:
3. “Blood and thunder” appearance – diffuse retinal haemorrhages, dilated tortuous veins
= ‘stormy sunset’

Management:
4. Refer to ophthalmology
5. Treat risk factors = (A) Hypertension (B) diabetes
6. Anti-VEGF may help in macular oedema

Question 7

What is Retinal Detachment?

Answer 7

1. Flashes, floaters, “curtain” coming over vision (painless)

Fundoscopy
2, May show detached retina (greyish folds)

Management
3. Urgent referral for surgical repair

Question 8

What are the 3 types of diabetic retinopathy?

Answer 8

1. Non-proliferative
2. Proliferative
3. Maculopathy

Question 9

What is Non-proliferative diabetic retinopathy?

Answer 9

microaneurysms, haemorrhages, hard exudates

= ‘dots’, large ‘blots’

Question 10

What is Proliferative diabetic retinopathy?

Answer 10

new vessels

Question 11

What is maculopathy?

Answer 11

central vision affected

Question 12

Management for diabetic retinopathy

Answer 12

1. Control blood sugar, BP, lipids
2. Laser photocoagulation (proliferative)
3. Anti-VEGF for macular oedema

Question 13

What is the grading system for hypertensive retinopathy, and what are the characteristics of each grade?

Answer 13

(1) Grade I: Vascular attenuation =narrowing of retinal arteries
= Increased light reflex - silver wiring

(2) Grade II: Vascular attenuation + AV nipping

(3) Grade III: Vascular attenuation + AV nipping + retinal haemorrhages, hard exudates, and cotton wool spots + flame

(4) Grade IV: Everything + pa lipoedema

Question 14

What is hypertensive retinopathy?

Answer 14

1. History of hypertension
2. vision may be unaffected

Signs:
3. Arteriolar narrowing
4. AV nicking
5. Flame haemorrhages
6. Cotton wool spots
7. Papilloedema (if severe)

8. Graded I–IV

Question 15

What is Anterior Uveitis (Iritis)?

Answer 15

1. Painful red eye
2. Photophobia
3. Blurred vision
4. Small, irregular pupil

Slit lamp
5. Cells and flare

Associations
6. HLA-B27 (e.g. ankylosing spondylitis, IBD)

Management:
7. Urgent ophthalmology
8. Topical steroids + cycloplegics
= Cyclopentolate

Question 16

What is Herpes Zoster Ophthalmicus?

Answer 16

1. Elderly with painful vesicular rash in V1 dermatome on forehead + tip of nose
2. = Hutchinson’s sign
3. Red eye, vision issues

Complication
4. Can cause keratitis or uveitis

Management:
5. Oral aciclovir 7–10 days (start within 72 hrs) + urgent eye review if vision is involved

Question 17

What is Optic Neuritis?

Answer 17

1. Young woman
2. Painful eye movements
3. Central scotoma
   = blind spot or area of reduced vision in the centre of the visual field
4. RAPD (Marcus Gunn pupil)

Association
5. Multiple sclerosis

Investigation
6. MRI brain + orbits

Management:
7. Neurology referral
8. IV methylprednisolone

Question 18

What is Cataracts?

Answer 18

1. Gradual, painless blurring of vision, glare in lights, older person

Signs:
2. Reduced red reflex
3. Cloudy lens

Management
4. Elective phacoemulsification surgery

Question 19

What is Viral Conjunctivitis?

Answer 19

1. Watery discharge
2. red eye
3. recent URTI
4. both eyes

Management:
5. Self-limiting, hygiene advice

6. Adenovirus
7. Illnesss
8. Palpable pre-auricular lymph nodes

Question 20

What is Bacterial Conjunctivitis?

Answer 20

1. Purulent discharge
2. Sticky eyes

Management:
3. Topical antibiotics (e.g. chloramphenicol)

Question 21

What is Allergic Conjunctivitis?

Answer 21

1. Bilateral itchy eyes
2. Watery discharge
3. Allergic hx

Management:
4. Antihistamines or mast cell stabilisers

5. sodium cromoglycate and antazoline drops

Question 22

Painless vision loss + Optic disc swelling suggest what?

Answer 22

Ischaemic optic neuropathy

jaw claudication is associated with Arteritic Ischemic Optic Neuropathy

Question 23

Cherry red spot at the macula with retinal whitening

Answer 23

Retinal Artery Occlusion

Question 24

Drusen in the macula with gradual central vision loss

Answer 24

Macular Degeneration

Question 25

Crusting of eyelashes with inflammation of the eyelid margins

Answer 25

Blepharitis

Question 26

Cloudy vision with halos around lights, especially at night

Answer 26

Cataracts

Question 27

Misalignment of the eyes, leading to double vision

Answer 27

Strabismus

Question 28

Increased intraocular pressure (IOP) with cupping of the optic disc

Answer 28

Glaucoma

Question 29

Bilateral optic disc swelling due to raised intracranial pressure

Answer 29

Papilloedema

Question 30

"On examination, her peripheral nervous system is unremarkable. Upon shining a light into her left eye, both pupils appear to constrict. When the light is immediately moved to her right eye, both appear to dilate" Why is the answer right-sided optic neuritis and not left-sided optic neuritis?

Answer 30

The answer is right-sided optic neuritis because the pupils dilate when light moves to the right eye. This indicates an afferent pupillary defect in the right optic nerve, as it fails to properly sense light, causing abnormal dilation of both pupils instead of constriction

Question 31

1. Blurred or wavy central vision 2. Colours may look faded or washed out 3. Dark or empty spot in the centre of vision (in severe cases) If these symptoms come up, what does this mean + management

Answer 31

Macular oedema = Anti-VEGF injections (e.g. ranibizumab, aflibercept)

Question 32

A 67-year-old woman with a history of type 2 diabetes presents with sudden visual loss preceded by a red hue to their vision to the emergency department. She is on multiple medications for her diabetes. Bloods done one week ago at her GP revealed an HbA1c of 87 mmol/mol. What is the most likely diagnosis?

Answer 32

Vitreous haemorrhage = most common causes of sudden painless loss of vision in diabetics

Question 33

Describe Retinal detachment

Answer 33

1. Dark floaters are common. 2. Flashes of light and a shadow or curtain effect over vision. 3. Red hue may also occur if there's blood in the vitreous, but typically more associated with a detached retina.

Question 34

Describe Vitreous haemorrhage

Answer 34

1. Dark floaters. 2. Red or black hue in vision due to blood in the vitreous body. 3. Vision loss can be gradual, but there’s often no curtain effect