KEY OPHTHALMOLOGY

Question 1

What is glaucoma?

Answer 1

Optic nerve damage caused by a significant rise in IOP.

Question 2

Pathophysiology in open angle glaucoma?

Answer 2

Gradual increase in resistance through trabecular meshwork
More difficult for aqueous humour to pass through
Pressure slowly builds

Question 3

Pathophysiology in acute angle closure glaucoma?

Answer 3

Iris bulges forwards and seals off trabecular meshwork
Prevents aqueous humour from being able to drain away
Leads to continual build up of pressure

Question 4

Effect of increased IOP on optic disc?

Answer 4

Cupping of optic disc.

Question 5

Presentation of open angle glaucoma?

Answer 5

Asymptomatic for a long time. 
Affects peripheral vision (leads to tunnel vision)
Fluctuating pain + headaches
Blurred vision
Haloes around lights

Question 6

Gold standard way to measure IOP?

Answer 6

Goldmann application tonometry

Question 7

Management of open angle glaucoma?

Answer 7

1st line = prostaglandin eye drops (Latanoprost).
2nd line = timolol, carbonic anhydrase inhibitors, sympathomimetics.
3rd line = trabeculectomy.

Question 8

When is treatment of open angle glaucoma usually started?

Answer 8

At an IOP of 24mmHg or above.

Question 9

MoA of Latanoprost (prostaglandins eye drops)?

Answer 9

Increase uveoslceral outflow.

SEs: eyelash growth, eyelid pigmentation, iris pigmentation (browning).

Question 10

MoA of Timolol?

Answer 10

Reduce production of aqueous humour.

Question 11

MoA of Carbonic anhydrase inhibitors?

Answer 11

Reduce production of aqueous humour.

Question 12

MoA of sympathomimetics?

For example, Brimonidine.

Answer 12

Reduce production of aqueous fluid + increase uveoscleral outflow.

Question 13

Surgical option for open angle glaucoma?

Answer 13

Trabeculectomy if eyedrops options are ineffective.

Question 14

Medications which can precipitate acute angle closure glaucoma?

Answer 14

Adrenergic medications (noradrenaline)
Anticholinergic medications (Oxybutynin)
TCAs

Question 15

Acute angle closure glaucoma presentation?

Answer 15

Severely painful red eye
Blurred vision
Haloes around lights
Headache, nausea + vomiting

Question 16

Signs of angle closure glaucoma?

Answer 16

Red, teary eye
Hazy cornea
Decreased visual acuity
Dilatation of affected pupil
Fixed pupil size
Firm eyeball on palpation

Question 17

Initial management of acute angle closure glaucoma?

Answer 17

Pilocarpine (2% for blue eyes, 4% for brown)
Acetazolomide
Analgesia + antiemetic if required.

Question 18

Secondary care management of acute angle closure glaucoma?

Answer 18

Pilocarpine
Acetazolomide
Hyperosmotic agents (glycerol/ mannitol)
Timolol
Dorzolamide
Brimonidine

Question 19

MoA of hyper osmotic agents (glycerol/ mannitol)?

Answer 19

Increase osmotic gradient between blood and fluid in the eye.

Question 20

MoA of pilocarpine?

Answer 20

Acts on muscarinic receptors to cause constriction of the pupil.

Question 21

MoA of acetazolamide?

Answer 21

Carbonic anhydrase inhibitor which reduces production of aqueous humour.

Question 22

Surgical management option for definitive management of acute angle closure glaucoma?

Answer 22

Laser iridotomy

Question 23

Management dry age related macular degeneration?

Answer 23

Lifestyle measures

Question 24

Management in wet age related macular degeneration?

Answer 24

Anti-VEGF medications (Ranibizumab/ bevacizumab/ pegaptanib).

**These are injected directly into the vitreous chamber.

Question 25

Two categories of diabetic retinopathy?

Answer 25

Proliferative and non-proliferative.

Question 26

Findings in non-proliferative diabetic retinopathy?

Answer 26

Mild - micro aneurysms Moderate - micro aneurysms, blot haemorrhages, hard exudates, cotton wool spots Severe - blot haemorrhages + micro aneurysms in 4 quadrants.

Question 27

Findings in proliferative retinopathy?

Answer 27

Neovascularisation | Vitreous haemorrhage

Question 28

Findings in diabetic maculopathy?

Answer 28

Macular oedema | Ischaemic maculopathy

Question 29

Management of diabetic retinopathy?

Answer 29

Photocoagulation Anti-VEGF Vitreoretinal surgery

Question 30

Stage 1 hypertensive retinopathy?

Answer 30

Mild narrowing of arterioles

Question 31

Stage 2 hypertensive retinopathy?

Answer 31

Focal constriction of blood vessels | AV nipping

Question 32

Stage 3 hypertensive retinopathy?

Answer 32

Cotton wool patches Hard exudates Flame haemorrhages

Question 33

Stage 4 hypertensive retinopathy?

Answer 33

Papilloedema

Question 34

Presentation of cataracts?

Answer 34

Very slow reduction in vision Progressive blurring Change in colour vision (colours more yellow/ brown) Starbursts appearing around lights, particularly at night time

Question 35

Rare but serious complication of cataract surgery?

Answer 35

Endophthalmitis

Question 36

Cause of blepharitis?

Answer 36

Dysfunctional meibomian glands.

Question 37

Blepharitis presentation?

Answer 37

Inflammation of eyelid margins. | Gritty, itchy and dry sensation in the eyes.

Question 38

Management of blepharitis?

Answer 38

Hot compresses + gentle cleansing of the eyelid margins to remove debris.

Question 39

What is entropion?

Answer 39

Eyelashes turn inwards.

Question 40

What is ectropion?

Answer 40

Outwards turning of the eyelid.

Question 41

What is periorbital cellulitis?

Answer 41

Infection of eyelid and skin in front of orbital septum.

Question 42

What is orbital cellulitis?

Answer 42

Infection around eyeball involving tissues behind orbital septum.

Question 43

Features that differentiates orbital cellulitis from periorbital cellulitis?

Answer 43

Orbital cellulitis = pain on eye movement, reduced eye movements, changes in vision, abnormal pupil reactions and forward movement of the eyeball.

Question 44

3 causes of painless red eye?

Answer 44

Conjunctivitis Episcleritis Subconjunctival haemorrhage

Question 45

Pathognomonic findings of anterior uveitis?

Answer 45

ciliary flush (red spreading from cornea outwards) photophobia abnormally shaped pupil