Ophthal

Question 1

What conditions are associated with blepharitis?

Answer 1

meibomian gland dysfunction (common, posterior blepharitis) or seborrhoeic dermatitis/staphylococcal infection (less common, anterior blepharitis)
-acne rosacea

Question 2

Why do patients with orbital cellulitis require admission to hospital?
Name a RF for orbital cellulitis.
What are features of the condition?

Answer 2

-for IV antibiotics due to the risk of cavernous sinus thrombosis and intracranial spread
-sinusitis,Lack of Haemophilus influenzae type b (Hib) vaccination
-Ophthalmoplegia/pain with eye movements, redness and swelling around the eye, ocular pain

Question 3

How does timolol work in POAG?

Answer 3

reducing aqueous production

Question 4

What feature is seen in congenital Horner’s disease?

Answer 4

Heterochromia

Question 5

What is the definition and cause of RAPD?

Answer 5

-affected and normal eye appears to dilate when light is shone on the affected eye
-caused by a lesion anterior to the optic chiasm i.e. optic nerve or retina

Question 6

What is the most common complication of panretinal laser photocoagulation?

Answer 6

Reduced visual field

Question 7

Latanoprost is a prostaglandin analog used in glaucoma.How does it work?

Answer 7

By increasing uveoscleral outflow

Question 8

Why might peripheral vision seem less clear after PRP?

Answer 8

Reduced rod cell function-decrease in night vision

Question 9

What is the Keith-Wagener classification of hypertensive retinopathy?

Answer 9

I Arteriolar narrowing and tortuosity
Increased light reflex - silver wiring

II Arteriovenous nipping

III Cotton-wool exudates
Flame and blot haemorrhages
These may collect around the fovea resulting in a ‘macular star’

IV Papilloedema

Question 10

What is retinitis pigmentosa? What is seen on fundoscopy?

Answer 10

group of inherited retinal disorders characterized by progressive degeneration of the retina, leading to night blindness and peripheral vision loss.

-black bone spicule-shaped pigmentation in the peripheral retina, mottling of the retinal pigment epithelium

Question 11

What is the presentation of CRVO?

Answer 11

Sudden painless loss of vision, severe retinal haemorrhages on fundoscopy (stormy sunset)

Question 12

What is a big risk factor for retinal detachment?

Answer 12

Myopia

Question 13

Why does Keratoconjunctivitis sicca occur? What sx does it typically present with?

Answer 13

-occurs due to autoimmune-mediated inflammation of the lacrimal glands, leading to reduced tear production and subsequent ocular surface damage
-foreign body sensation, burning, and ocular fatigue.

Question 14

What are flashes + floaters are most commonly caused by? What finding is seen on ophthalmoscopy ?

Answer 14

PVD
-Weiss ring (peripapillary glial tissue that remains attached to the posterior vitreous cortex following posterior vitreous detachment)

Question 15

Why are highly myopic (near-sighted) patients are also at increased risk of developing posterior vitreous detachment earlier in life?

Answer 15

the myopic eye has a longer axial length than an emmetropic eye.

Question 16

What are some associations of Holmes-Adie pupil?

Answer 16

Female
Dilated pupil
Absent ankle/knee reflexes

Question 17

How should amaurosis fugax (monocular transient painless loss of vision) be treated?

Answer 17

Aspirin 300mg (like a TIA)

Question 18

What are the site of lesion and type of disease in which anhydrosis determines site of lesion in Horner’s syndrome ?

Answer 18

head, arm, trunk = central lesion: stroke, syringomyelia
just face = pre-ganglionic lesion: Pancoast’s, cervical rib
absent = post-ganglionic lesion: carotid artery

pre,central,post: TSC

Question 19

What are the features of optic neuritis?

Answer 19

-unilateral decrease in visual acuity over hours or days
-poor discrimination of colours, ‘red desaturation’
-pain worse on eye movement
-relative afferent pupillary defect
-central scotoma

Question 20

How to differentiate between glaucoma and uveitis in a ‘red eye’ presentation?

Answer 20

glaucoma: severe pain, haloes, ‘semi-dilated’ pupil
uveitis: small, fixed oval pupil, ciliary flush

Question 21

What is ischaemic optic neuropathy due to?

Answer 21

ischaemic optic neuropathy is due to occlusion of the short posterior ciliary arteries, causing damage to the optic nerve

Question 22

What is the 1st line tx in POAG?

Answer 22

Lantoprost (prostaglandin analogue)
-increasing the outflow of aqueous humour from the eye,

Question 23

Why might someone with psoriasis get bilateral papilloedema?

Answer 23

Vitamin A toxicity due to retinoids

Question 24

What are features of AACG?

Answer 24

severe pain, haloes, ‘semi-dilated’ pupil
Hazy cornea due to raised IOP

Question 25

What is an ophthalmological finding of pseudoxanthoma elasticum?

Answer 25

Anginoid retinal streaks -irregular dark red streaks radiating from the optic nerve head. They are caused by degeneration, calcification and breaks in Bruch's membrane .

Question 26

What is the 1st line tx for blepharitis?

Answer 26

Hot compress + mechanical removal of lid debris

Question 27

How does dorzolamide work?

Answer 27

carbonic anhydrase inhibitor which works by decreasing the production of aqueous humour in the eye

Question 28

What drugs precipitate acute glaucoma?

Answer 28

anticholinergics and tricyclic antidepressants

Question 29

Which patients are at increased risk of PVD?

Answer 29

Myopic (short sighted) patients

Question 30

What is the strongest risk factor for ARMD?

Answer 30

Smoking

Question 31

What are some acquired cause of optic atrophy?

Answer 31

Acquired causes: multiple sclerosis papilloedema (longstanding) raised intraocular pressure (e.g. glaucoma, tumour) retinal damage (e.g. choroiditis, retinitis pigmentosa) ischaemia toxins: tobacco amblyopia, quinine, methanol, arsenic, lead nutritional: vitamin B1, B2, B6 and B12 deficiency

Question 32

What sign is predictive for ocular involvement in HZO ?

Answer 32

Hutchinson’s sign- rash at tip of nose

Question 33

What are key features supporting the diagnosis of keratitis?

Answer 33

severe eye pain, inability to wear contact lenses, corneal haziness, and reduced visual acuity. The presence of a hypopyon (accumulation of white blood cells in the anterior chamber) is particularly significant and commonly occurs in severe bacterial keratitis.

Question 34

What is the mx of herpes simplex keratitis (presents with dendritic corneal ulcer)?

Answer 34

immediate referral to an ophthalmologist & topical aciclovir

Question 35

Why is antioxidant dietary supplements not recommended in smokers for ARMD?

Answer 35

Beta-carotene has been found to increase the risk of lung cancer and hence antioxidant dietary supplements are not recommended in current smokers

Question 36

What is the MOA of pilocarpine?

Answer 36

Muscarinic receptor agonist

Question 37

What drops can precipitate AACG

Answer 37

Mydriatic drops

Question 38

Is AACG associated with hypermetropia or myopia?

Answer 38

Acute angle closure glaucoma is associated with hypermetropia, where as primary open-angle glaucoma is associated with myopia