eye2

Question 1

Clinical Features of Anterior Uveitis?

Answer 1

CLassically - Red, painful, photophobic eye

RED - circumlimbal injection/ciliary flush

Photophobia

Painful

Irregular, small pupil

Keratic precipitates

Flare on slit lamp

Inflammatory cells in aqueous

Hypopyon

Causes - trauma, inflammatory, infective (HSV, HZV, Syphilis, TB),

50% HLA B27 - eg ANK SPOND,

Question 2

Investigations and management of anterior uveitis

Answer 2

Urgent same day referal to opthalmologist

Slit lamp - looking for flares and inflammatory cells in aqueous

• Steroids/cycloplegics
• Treat cause

Question 3

What are the clinical features of retinitis pigmentosa?

Answer 3

• Begins as night blindness in childhood
• Concentric narrowing of vision - periperal to central
• Usu blind by adolescence
• Irreversible
• may be delayed by Vitamin A

On opthalmoscapy

• optic atrophy
• Irregular patches of dark pigment especially at periphery

Question 4

What is the pathophysiology of retinitis pigmentosa?

Answer 4

Primary degeneration of retina - hereditary

degeneration of rods and cones

AND

displacement of melanin containing cells into superficial parts of retina.

Question 5

Clinical features of retinoblastoma?

Answer 5

1. Leukocoria (abnormal white reflex) loss or red reflex
2. Nystagmus
3. Strabismus
4. Red eye

Usually presents in children under age of 3

Mx options - chemo/Radio/Enucleation surg

Question 6

Blurred optic disc?

Answer 6

Pappiloedema

Question 7

Pale optic disc?

Answer 7

Optic atrophy

Question 8

Progression of diabetic retinopathy?

Answer 8

Pre-proliferative - dot and blot haemorrhages, hard exudates, cotton wool spots,

Proliferative - Neovascularisation (new blood vessels)

Can lead to tractional retinal detachment

Question 9

Changes unique to hypertensive retinopathy?

Answer 9

AV nipping, silver wiring, pappiloedema

(Also has flame haemorrhages, cotton wool spots and hard exudates (cholesterol deposition)

Question 10

Sun set storm on fundoscopy?

Answer 10

Central retinal vein occlusion

Question 11

Cherry red spot in macula?

Answer 11

Central retinal ARTERY occlusion

Question 12

What is an ectropion? How does it present? Causes

Answer 12

Turning outward of the eye

Causes: AGE, 7th Nerve Palsy, Cicatrical skin conditions (Eg scarring)

Can get tearing - due to problems with tears draining to nose

Mx - Mild -artificial tears

Severe - Surgical

Question 13

What is an entropion?

Answer 13

Eyelid turning inward

Causes:

1. Age
2. Trachoma - causes scarring and then turning inwards of lids

Eyelashes - mimic foreign body - red eye, gritty sensation

Can lead to corneal abrasions from trichiasis

Mx - surgical correction

Question 14

What is the difference between a chalazion and a stye?

Answer 14

Chalazion - focal inflammatory lesion in eyelid caused by obstruction in Meiobian gland.

NON Tender

associated with blepharitis often

STYE - external hordoleum is acute infection in glands of Zeiss or moll (next to lashes). Internal hordoleum is infection of meiobian gland.

Tender and red

Question 15

What is management of a chalazion or stye?

Answer 15

1. Explain to patient that calazia and styes usually disappear on their own.
2. Treat with warm compresses (Clean, warm washcloth held against closed eyelid) 2-5 minutes. 2 to 4 times a day.
3. Discontinue eye make up to support healing
4. Explain that most will expand in size and spontaneously rupture.
5. Refer non-urgently if a chalazion has not resolved after 3 months (Stye - several weeks) for incision and curretage or glucocorticosteroid injection.
6. If surrounding skin becomes cellulitic - can be treated with oral flucloxacillin.

Question 16

Risk factors for subconjunctival haemorrhage

Answer 16

Older age (incidence highest at age 60-80)

Trauma (including contact lens related injury)

Systemic hypertension

Anticoagulant medication

Diabetes and other systemic vascular disorders

Bleeding abnormality

Long term topical steroid treatment

Conjunctival vascular lesion

Question 17

Complications of stye or chalazion?

Answer 17

1. Pre-orbital cellulitis
2. Non healing - needing incision and curretage

Question 18

A child with Type 1 Diabetes and recent DKA episode presents with reduced red reflex? Diagnosis? If this led to visual loss - complication is likely?

Answer 18

Cataracts

This can lead to secondary acute angle closure glaucoma

or sensory deprivation amblyopia

Question 19

What are the steps in the eye examination?

Answer 19

1. Measure visual acuity with snellen charts
2. Assess eye movements
3. Assess visual fields
4. Assess macula with Amsler chart
5. Colour vision with Ishihara charts
6. Inspect the surface of the eye (cornea/sclera) and surrounding face.
7. Evert eyelid and inspect for foreign body.
8. Stain with 1% fluoroscein eye drop and assess with cobalt blue light for corneal abrasion
9. Assess pupil shape, size, and reactions including light reflex
10. Fundoscopic examination including red reflex (preferably post dilatation with drops)
11. Check intraocular pressure.

Question 20

Which organism represents 60% of contact lens related keratitis?

Answer 20

Pseudomonas Aeruginosa

Question 21

Which organisms associated with keratitis can penetrate in tact corneal epithelium

Answer 21

Neisseria species

Hib

Question 22

Visual loss, pain with eye movements and normal looking optic nerve (with RAPD)

Answer 22

Retrobulbar optic neuritis - MS related

Question 23

Occasional inward turning of an infants eye - with normal examination. Management?

Answer 23

if Occasional/intermittent and normal examination

Then review at 3 months

if still happening for semi-urgent referral to opthalmology

If CONSTANT or sudden onset constant inward turning - refer at any age

Question 24

Infant eye exam?

Answer 24

checking visual acuity and ocular motility (by seeing if the infant can fix and follow with a light or toy)

checking fundoscopy

checking for absence / presence of the red reflex and white reflex

checking pupillary sizes and reactions

Question 25

Causes of an acute horners syndrome

Answer 25

a dissection of the internal carotid artery dissection, brainstem / cerebellar stroke, cervical spondylosis, an apical lung tumour or surgery to the chest / neck.

Question 26

Ipsilateral, ptosis of upper eye lid, miosis and anhidrosis of ipsilateral face AND neck pain?

Answer 26

Patients presenting with acute Horner’s syndrome and ipsilateral ocular, face or neck pain should are considered to have an ## Footnote internal carotid artery dissection until proven otherwise.

Question 27

Ipsilateral, ptosis of upper eye lid, miosis and anhidrosis of ipsilateral face

Answer 27

Horners syndrome

Question 28

Common side effects of LASIK eye surgery?

Answer 28

**Dry eye and seeing halos around lights** are both common risks associated with LASIK surgery. This surgery can result in a temporary decrease in tear production. It is also common to experience glare, halos and double vision in the first few weeks after surgery, particularly at night. While cataracts, glaucoma and keratoconus can all result in halos around lights, given the timeframe of Jenny’s recent surgery and the dry eye symptoms, the LASIK procedure is the most likely diagnosis in this scenario.

Question 29

Acute management of Contact lens associated Microbial keratitis?

Answer 29

Refer for emergency Ophthalmological review the same day, advise her to wear glasses instead of contact lenses and to take her contact with her to the appointment today so that they can be sent for culture

Question 30

What is a pterygium? Mx? What is a pinguecula?

Answer 30

Triangular fibrovascular conjunctival tissue that grows from the nasal side of the conjunctivae to the cornea (usually in windy, sunny northern parts of aus - farmers, surfers, welders) Grows medial to lateral - Widebrimmed hat, sunglasses, and LUBRICANT EYE DROPS If involving more cornea and affecting vision - then surgical management A pinguecula - does not involve the cornea (stays in conjunctiva) - naphazoline eye drops

Question 31

Causes of a bitemporal hemianopia? Where is the lesion?

Answer 31

Lesion is at the optic chiasm Usually pituitary adenoma Meningioma Craniopharyngoma Secondary tumour

Question 32

Causes of a homomynous hemianopia? Where is the lesion

Answer 32

This is a lesion in the contralateral optic tract or optic radiation - Cause is a primary or secondary tumour OR infarction

Question 33

Lesion causing a homomynous hemionopia but sparing of the macula (central vision spared). Location? Cause?

Answer 33

Location is at the posterior cerebral artery leading to ischaemia of the visual cortex. Causes are primary or secondary tumour infarction

Question 34

Painful, red, watery eye, No uptake of fluoroscein

Answer 34

Scleritis | (does not affect cornea so no uptake)

Question 35

What changes might you see with fluroscein in the following: a) Viral conjunctivitis b) Bacterial keratitis c) HSV kertatitis d) Foreign body

Answer 35

a) diffuse, minute, punctate erosions b) Geographic ulcer (large defect) c) Dendritic ulcer d) Linear scratches

Question 36

Transient visual loss in a man with CV risk factors?

Answer 36

Transient loss of vision in a man with cardiovascular risk factors suggests amaurosis fugax resulting from an embolus of cholesterol or thrombus arising from the internal courted arterial system. In adults, in most cases the cause is atherosclerotic emboli from the carotid artery bifurcation. Risk factors for amaurosis fugax include: diabetes, heart disease, smoking, hypertension, hyperlipidemia, advanced age, use of cocaine.

Question 37

Inferolateral deviation of the eye with diplopia and ptosis in context of Diabetes?

Answer 37

DIABETIC THIRD NERVE PALSY Caused by microvascular infarction of the blood supply to the oculomotor cranial nerve; manifests as inferolateral deviation of the eye with diplopia and ptosis; recovery generally occurs over weeks to months, although deficits that are present after six months are usually permanent