Ophthal

Question 1

Retinal detachment

Answer 1

• Flashing lights, floaters
• Sudden loss of vision
• PAINLESS
• One eye

can be caused by myopia

Question 2

Acute glaucoma and features

Answer 2

Eye condition where fluid pressure inside eye rises quickly >21mmHg -> blocked outflow of aqueous humour
- Headache (SEVERE) and eye pain
- Red eye
- Dilated pupil
- Vom
- Reduced acuity
- Halos around light
(long sightedness is a RF)

Question 3

What is this?

Answer 3

Branch retinal vein occlusion

Question 4

Glaucoma Ix to confirm dx

Answer 4

Measurement of intraocular Pa

Question 5

Optic neuritis

Answer 5

Inflammation to optic N

Question 6

Optic neuritis features

Answer 6

• Rapidly decreasing vision (hours to days)
• Pain
• Decreased colour vision
• Worse when changing gaze direction
• RAPD
• Central scotoma
• Often younger (18-45) F
• Associated w MS, diabetes

Question 7

Central retinal artery occlusion features

Answer 7

• Sudden loss of vision
• painless
• Afferent pupillary defect
• Red spot lateral to macula

Question 8

Scleritis features

Answer 8

• Painful, red eye
• DIFFUSE area of redness on sclera

Question 9

Amaurosis fugax features

Answer 9

• Unilateral
• Acute, painless TRANSIENT loss of vision
• ^curtain coming down
  (amaurosis = turn black, fugax = fleeting)

Like TIA of retinal artery
- Can be associated w AF/GCA

Question 10

Relative afferent lesion features

Answer 10

Swinging torch test:
- Optic n is afferent limb and detects light (sensory)
- Oculomotor n is efferent limb and does constriction (motor)
- Moving from intact L optic n to damaged R optic n, then will dilate

Question 11

Draw out the visual pathway

Answer 11

Question 12

Wet age-related macular degeneration features

Answer 12

• Acute on chronic picture
• Red patches on retina
  (new vascularisation, only happens in wet)

Question 13

What can be seen on fundoscopy?

Answer 13

(dry) Macular degeneration
- Drusen: yellow area

Question 14

Macular degeneration

Answer 14

Visual problems relating to age
- Distortion of line perception
RF:
- >75
- smoking
- FHx
- F

Question 15

Anterior uveitis and features

Answer 15

Inflamm of anterior portion of uvea
- Red eye + pain acutely
- PAIN
- Vision reduced
- Hypopyon!! pus in anterior chamber
- Photophobia
- Often associated with ankylosing spondylitis, or other inflamm conditions

Question 16

Acute glaucoma mx

Answer 16

Emergency referral to ophthal
Definitive: laser peripheral iridotomy
(make a hole - point laser into iris, and let the aqueous humour flow out and problem resolves)

Question 17

Herpes zoster opthalmicus mx

Answer 17

Urgent opthalmology r/v + 7-10 days acyclovir

Question 18

Hutchinson’s sign

Answer 18

Tip of nose involved in herpes zoster opthalmicus - indicates ocular involvement likely

Question 19

Optic neuritis mx

Answer 19

Refer to ophthal + steroids (IV methylprednisolone 72h followed by PO pred for 11days)

Question 20

Argyll Robertson pupil and features

Answer 20

Pupillary disorder seen in diabetes and neurosyphilis
- Accommodation reflex present
- Pupillary reflex absent

Question 21

Anterior uveitis mx

Answer 21

Refer + prednisolone drops

Question 22

Episcleritis v scleritis

Answer 22

Episcleritis is painless and vision not affected

Question 23

Corneal ulcer/keratitis feature

Answer 23

• Red, painful eye
• Vision affected
• White corneal opacity

Question 24

What is this

Answer 24

Central retinal vein occlusion
- swelling of veins as seen inferiorly
- bleeding in retina in all 4 corners

Question 25

What is this

Answer 25

Central retinal artery occlusion - cherry red spot (macula) - pale retina (due to a lack of perfusion with blood as central retinal artery supplies the blood to the retina)

Question 26

What is this

Answer 26

Branch retinal artery occlusion

Question 27

What is this

Answer 27

Dry age related macular degeneration

Question 28

What is this

Answer 28

Wet age related macular degeneration

Question 29

What is this

Answer 29

Diabetic maculopathy

Question 30

What is this

Answer 30

flame haemorrhage + cotton wool spot as seen in hypertensive retinopathy

Question 31

What is this

Answer 31

papilloedema as seen in hypertensive retinopathy

Question 32

Cataracts and presentation

Answer 32

Opacification of lens - gradual, painless deterioration of vision

Question 33

Unable to see in right lower quadrant of field - where is lesion?

Answer 33

L patietal lobe

Question 34

Anterior ischemic optic neuropathy (AION)

Answer 34

Caused by interruption of blood flow to optic N, leading to N damage. - Sudden vision loss - Painless - Older pts - +/- assoc w GCA/atherosclerosis

Question 35

Eye drops for dry eyes

Answer 35

Hypromellose

Question 36

WHat is Neo-vascularisation a sign of?

Answer 36

proliferative retinopathy

Question 37

dendritic pattern on fluorescein stained cornea

Answer 37

Herpes simplex ulcer

Question 38

Steps of diabetic retinopathy

Answer 38

Pre prolferative (mild, mod, severe) -> proliferative -> diabetic maculopathy

Question 39

What can be seen in mild non-proliferative diabetic retinopathy?

Answer 39

>= 1 miroaneurysm

Question 40

What can be seen in mod non-proliferative diabetic nephropathy?

Answer 40

dot & blot haemorrhages + hard exudates or cotton wool spots

Question 41

What can be seen in severe non-proliferative diabetic nephropathy?

Answer 41

venous changes

Question 42

What can be seen in proliferative diabetic retinopathy?

Answer 42

new vessel formation

Question 43

What can be seen in diabetic maculopathy?

Answer 43

retinal thickening + macular leaking (it all a lil blurry)

Question 44

Proliferative and diabetic maculopathy mx

Answer 44

urgent same day ophthal r/v

Question 45

What can be seen here?

Answer 45

photocoagulation scars

Question 46

Pale retina w/o cherry red spot on fundoscopy

Answer 46

ophthalmic artery occlusion

Question 47

visual blurring worse with heat

Answer 47

Optic neuritis (Uhthoff's phenomenon)