Ophtalmo finals revision

Question 1

Conjunctivitis

Answer 1

85% are self-limiting-but need to make sure so treat all
Dont treat agressively, if no cornea issue

sore red eye, feeling like foreign body, visual acuity decrease, cellulitis around eye, sticky eyes
bacterial-purulent, sticky
Viral-watery discharge
allergic-both eyes at same time

Mx-(care it ressembles iritis, corneal ulcers, ulcer, foreign body)
topical abx-chloramphenamine
hygene
emoliants
allergic-topical or systemic anit-histamine

Question 2

Acute glaucoma

Answer 2

blockage of eye ducts leading to severe IOP increase—smoking, HTN

severe pain/headache around eye
Reduced visual acuity
WORSE in DARK
hard red eyes,
SEMI-DILATED NON REACTIVE PUPIL
systemic upset-nausea and vomit

mx- topical parasympathomimetic-pilocarpine, topical bblock (timolol), topical a2 agonist (apraclonidine)

and definitive-laser peripheral iridotomy

Question 3

Age related macular degeneration

Answer 3

old, smoking, fhx (strong)
either dry-90% or wet -10%

dry - assox with drusen (fatty deposit in retina)
slow reduct of visual acuity in dry, acute in wet (2-3w)
diffulties in dark adaptation, light flashes

mx- VEGF can slow down and maybe reverse wet
Laserphotocoagulopathy for sx

Question 4

Uveitis

Answer 4

very assox with HLAB27 - UC, Ank Spond, reactive arth

acute onset painful red eye
visual blurring
pupil small/irregular-
acuity initally normal-> then reduced

mx- r/v by opthal, steroids eye drop

Question 5

Blepharitis

Answer 5

assox with Roseaca

bilatteral grittiness, esp in eyelids
worse in morning, gunk in eye
styes
VISUAL FIELD NORMAL, NOT red eyes

mx-hygene
soft wash of eye lids with hot compress
Manually washing eyes with boilED water and soap
Fake tears
steroid eye drops

Question 6

Blurred vision ddx and assement

Answer 6

refractive error: most common
cataracts
retinal detachment
age-related macular degeneration
acute angle closure glaucoma
optic neuritis
amaurosis fugax

depends on the suspected underlying cause
if gradual onset, corrected by pinhole occluder and no other associated symptoms then an optician review would be the next step
other patients should be seen by ophthalmology. If there are associated symptoms such as visual loss or pain this should be urgent

Question 7

sudden loss of vision ddx

Answer 7

ischaemic/vascular (e.g. thrombosis, embolism, temporal arteritis etc). This includes recognised syndromes e.g. occlusion of central retinal vein and occlusion of central retinal artery

vitreous haemorrhage
retinal detachment
retinal migraine

Question 8

Retinal detachment

Answer 8

RF- DIABETES, age, smoking, eye surgery, vitrious detatch

New floaters and flashes of light
sudden onset painless visual loss (from the outside into central)-like a curtain going across
RAPD

mx- ophtal referal

Question 9

Vitrious heammorgages

Answer 9

causes-diabetic eye disease, vitreous detach, trauma, ANTICOAG

Large bleeds cause sudden visual loss
Moderate bleeds may be described as numerous dark spots
Small bleeds may cause floaters
Usually described as “i see red”-tinted red-ish, or a large block in vision
see it in fundoscopy

mx- ophtalmology

Question 10

vitrous detachment

Answer 10

separation of the vitreous membrane from the retina

no pain or loss of vision
BUT rarely the separation of the vitreous membrane can lead to tears and detachment of the retina

usually-sudden onset floaters and flashes
blurred vision
Cobweb on vision
CURTAIN loss of vision-retinal detachment with

mx-opthal referal

Question 11

vitrious detach vs retinal dicharge vs vitrious heamoragges

Answer 11

vit detatch–
Flashes of light (photopsia) - in the peripheral field of vision
Floaters, often on the temporal side of the central vision

retinal detatch
Dense shadow that starts peripherally progresses towards the central vision
A veil or curtain over the field of vision
Straight lines appear curved
Central visual loss

vitreous-
Large bleeds cause sudden visual loss
Moderate bleeds may be described as numerous dark spots
Small bleeds may cause floater

Question 12

Keratitis

Answer 12

cornea breakdown- and not vascular -scars are bad
classically s.aureus, contact-pseudomonas
viral- herpetic keratitis

red eye, pain and erythema
photophobia
reduced vision
gritty foreign body sensation
usually eye r/v

mx-stop using lens, topical abx (quinolones)
pain relief

Question 13

iritis

Answer 13

assox with AID_ ask about sx or do a panel themselves

redness around iris, dilation of pupil
Blurring of vision, unilateral

Question 14

Scleritis vs episcleritis

Answer 14

episcleritis- localised blood vessels in eye- and they move

Scleritis- big red veins/arteries visible all around eye

Question 15

Orbital, peri-orbital, pre-septal cellulitis

Answer 15

s.aureus main cause

pre-septal -in catilage of upper eyelid- further away from eye that other 2- less dangerous

pre-orbital- life threatening as it can progress to orbital- need inpatient abx

orbital- also might need surgery to drain puss
admission and IV abx

Question 16

central artery occlusion

Answer 16

thrombus or embolus-
need intervention within 1/2 h
Features
sudden, painless unilateral visual loss
relative afferent pupillary defect
‘cherry red’ spot on a pale retina

mx-massage the eye to remove embolus
often too late, as if more than 1h before- too late
thrombosis can be tried

Question 17

central vein occulsion

Answer 17

sudden, painless reduction or loss of visual acuity, usually unilaterally
fundoscopy
widespread hyperaemia
severe retinal haemorrhages - ‘stormy sunset’

mx-self limiting in 4-8w before assessing macula for oedema (then VEGF)