Ophthalmology Flashcards
(691 cards)
1
Q
What are the three layers of the eyeball? Outline the components of each.
A
Fibrous: Sclera (fibrous layer, white) and cornea (transparent, central)
Vascular: Choroid, ciliary body and iris
- Choroid: CT layer and BVs
- Ciliary body: ciliary muscle and processes; attach to lens of eye via ciliary processes to control lens shape and formation of (aq) humour
- Iris: circulator structure which is situated between lens and cornea
Inner: Retina
- Pigmented (outer) layer: retinal pigment epithelium allowing light absorption, epithelium transport and secretion of growth factors
- Neural (inner) layer: Photoreceptors
2
Q
What are the two components of the fibrous layer of the eyeball?
A
Sclera
Cornea
3
Q
What fibrous layer of the eyeball provides attachment to the extra ocular muscles?
A
Sclera (Tenon’s capsule/Sclera)
4
Q
What two components make up the ciliary body?
A
Ciliary muscles
Ciliary processes
5
Q
What is the function of the ciliary body?
A
Change the shape of the lens of the eye to control refraction of light to the retina
6
Q
What is the function of the iris?
A
Alter the diameter of the pupil (the aperture within the iris)
7
Q
Functionally, which is the most important layer of the eyeball?
A
Neural layer, bearing the retina
8
Q
Which fascial sheet surrounds the eye?
What does it connect to anteriorly and posteriorly?
What potential space is between it and the sclera?
A
Tenon’s capsule
Anteriorly: Sclera
Posteriorly: Meninges around the optic nerve
Episcleral space
9
Q
Which ligament is formed by the tendon sleeve around the tendon of the medial rectus muscle?
Where does it attach to?
A
Medial check ligament
Lacrimal bone
10
Q
Which ligament is formed by the tendon sleeve around the tendon of the lateral rectus muscle?
Where does it attach to?
A
Lateral check ligament
Zygomatic bone
11
Q
At what site of the eyeball is the optic nerve perforating the eye?
A
Posterior scleral foramen
12
Q
At the posterior scleral foramen, what portions of sclera are continuous with the meningeal sheath of the optic nerve?
Which meningeal layer forms the sheath surrounding the optic nerve?
A
2/3 outer of sclera continuous with the dural sheath of optic nerve
13
Q
What structure is formed by the inner third of the sclera pieced by the fibres of the optic nerve?
A
Lamina cribrosa
14
Q
What 4 apertures does the sclera contain?
A
4 anterior apertures: Scleral attachments of rectus muscles, transmitting anterior ciliary arteries
4-5 middle apertures: vorticose veins (posterior to equator of eye)
Posterior apertures: passage of long and short ciliary arteries, veins and nerves
Posterior scleral foramen: Optic nerve pierces sclera
15
Q
What is the term for the point at which the sclera meets the cornea?
A
Corneoscleral junction (CSJ)
16
Q
What structure lies posterior to the Corneoscleral junction and within the internal surface of the sclera?
A
Canal of Schlemm (internal scleral sulcus)
17
Q
At which point of the internal scleral sulcus is the ciliary muscle attached to?
A
Scleral spur (anteriorly and inwards)
18
Q
What are the 3 layers of the sclera?
A
Episclera (connective tissue layer)
Scleral stroma (dense irregular CT - white colour)
Lamina fusca (melanocytes)
19
Q
What is the potential space between the lamina fascia and choroid termed?
Which structures traverse it?
A
Perichoroidal space
Traversed by long and short posterior ciliary arteries and nerves
20
Q
Outline the vascular supply to the sclera?
A
Anterior: Episcleral plexus
Posterior: Branches of long and short posterior ciliary arteries
21
Q
What is the innervation of the sclera?
A
Anterior: Long ciliary nerves
Posterior: Short ciliary nerves
22
Q
What is the term for the convex surface at the corneoscleral junction?
A
Sulcus sclerae
23
Q
What are the layers that form the cornea?
A
Corneal epithelium: 5 cell layers (central) - 10 cell layers (peripheral)
Bowman’s membrane: acellular with irregularly arranged collagen fibrils
Substantia propria (corneal stroma): 90% thickness of cornea; parallel-arranged collagen fibres
Descemet’s membrane: basement membrane of underlying cornea endothelium; collagen fibres; peripherally, protrusions projecting into anterior chamber of eye (Hassal-Henle bodies); continuous with meshwork of Schlemm’s canal; line of junction of Descemet’s membrane and trabecular meshwork of Schlemm’s canal is called line of Schwalbe
Corneal endothelium: single layer of endothelial cells; continuous with surface of iris; forms barrier between cornea and surrounding structures; do not undergo mitosis thus if injured, corneal surface is permanently opaque
24
Q
The protrusions of Descemet’s membrane which project into anterior chamber of eye are termed?
A
Hassal-Henle bodies
25
At what point do Descemet's membrane and trabecular meshwork of canal of Schlemm meet?
Line of Schwalbe
26
What supplies blood to the cornea?
Cornea is an avascular structure; nourished by nutrients of aqueous humor via endothelial layer
27
What innervates the cornea?
Annular plexus in perichoroidal space (fr. Long Ciliary Nerves)
28
What structure of the eye has the highest refractory power?
Cornea - 42 diopters of light
29
What is the unit of measurement for refractivity? Explain this
Diopters
unit of measurement of the optical power of a lens or curved mirror, which is equal to the reciprocal of the focal length measured in metres
30
What structures make up the uvea?
Choroid, ciliary body and iris
31
What is the most vascular layer of the eye?
Choroid of the vascular layer (uvea)
32
What are the layers of the choroid?
3 layers:
1) Vessel layer: Melanocytes + BVs
2) Capillary layer: melanocytes + branches of BVs
3) Bruch's membrane: BM of endothelium of capillaries; collagen; elastic fibres and BM of pigmented layer of retina
33
What innervates the choroid?
Long and short ciliary nerves in the perichoroidal space
34
What is the function of the choroid?
Perfusion of outer layers of the retina and between eye
35
What is the ciliary body continuous with?
Choroid posteriorly and iris anteriorly, forming the uvea
36
What is the roughened base of the ciliary body called?
COrona ciliaris
37
What is the smoothened, posterior surface of the ciliary body called?
Orbiculus ciliates
38
What are the components of the ciliary body?
Ciliary epithelium: 2 layers; inner layer is non-pigmented and continuous with retina posteriorly; pigmented cells which are continuous with pigmented epithelium of retina
Ciliary stroma: loose CT and rich in BV
Ciliary muscle: smooth muscle in the ciliary stroma; pulling ciliary body anteriorly leading to loosening of zonular fibres of lens so lens shrinks and becomes more convex to enhance refractive power of lens (in accommodation)
39
What innervates the ciliary body?
Short ciliary nerves (parasympathetic input from CN III)
40
What are the functions of the ciliary body?
Produce aqueous humor
Accommodation of the eye
41
What structure of the eye represents the border of the anterior and posterior chambers of the eye?
Iris
42
What is the periphery of the iris termed?
Ciliary margin
43
What is the term for the angle formed by iris root (ciliary margin) and cornea?
Iridocorneal angle (filtration angle)
44
Where is the trabecular meshwork, facilitating aq drainage of humor present?
At the iridocorneal (filtration) angle of the iris and cornea
45
Which two muscles does the iris contain?
Smooth muscle
Sphincter pupillae muscle
Dilator pupillae
46
What are Fuch's crypts?
gaps between radial streaks (collagen fibre bands) converging towards the pupil
Present on the anterior surface of the iris
47
What colour is the posterior surface of the iris?
What does it contain?
Black
Radial contraction folds with contraction furrows (several circular lines) marking the ciliary portion
48
What is the blood supply to the iris?
Majort arterial circle (anterior + posterior ciliary arteries)
Radial arteries anastomose to form minor arterial circle of iris (at level of collarette of the iris)
Minor venous circle (veins of pupillary margin which strain into vorticose veins)
49
What innervates the iris?
Long and short ciliary nerves (br. CN V1)
```
Papillary muscles (autonomic function):
- Sphincter pupillae (short ciliary nerves of CN III)
```
- Dilator pupillae (superior cervical ganglion)
50
What are the functions of the iris?
Explain how muscle contractions alter the shape of the pupils.
Accommodation (refracting light accordingly to see an image)
Contraction of dilator pupillae muscle (Sup. cervical ganglion) causes dilation of the pupil called mydriasis
Contraction of the sphincter pupillae muscle reduces the pupil size called minis
51
What are the two parts of the retina?
What us the term for the space between these layers?
Neurosensory retina (inner)
Retinal pigmented epithelium (outer)
Potential space = sub retinal space
52
What is the term for the anterior retinal end at its junction with the ciliary body?
Ora serrata
53
What is the non-visual layer of the retina?
Ciliary epithelium (as it is continuous with the retina)
54
What is the site of clearest vision, containing the highest amount of photoreceptor cells?
Macula lutea
55
What is the term for the shallow depression in the centre of the region with the highest amount of photoreceptor cells?
What is this region called?
Fovea centralis
Macula lutea
56
What are the two main types of photoreceptor?
Outline their function and distribution in the retina
Rods and Cones
Cones:
- Cone shaped
- High-intensity light
- Colour vision
- Dense presence at fovea centralis
Rods:
- Conical shape
- Low-intensity light
- Grayscale
- Peripherally distributed
57
Which cells synapse with the photoreceptors and transmit an action potential to ganglion cells?
Bipolar cells
58
What are the second order neurones in the visual pathway?
Ganglion cells, synapsing with bipolar and amacrine cells
59
What are the function of horizontal cells?
Distributed around the apices of rods and cones, these release GABA which inhibits distant ganglion cells, enabling optic nerve to transmit signals from photoreceptors most excited and contributing to the formation of a clear image
60
What is the function of the amacrine cells?
bipolar cells stimulate the amacrine cells, which in turn stimulate the ganglion cells with which they synapse. Therefore, the amacrine cells are the indirect connection between bipolar and ganglion cells and their function is to modulate the photoreceptive process by ensuring that all the relevant ganglion cells are stimulated
61
What cells are most abundant in the outer limiting layer? What role do they play?
Muller cells (Supporting cells) which connect with photoreceptor cells.
Muller cell processes reach anterior surface of retina with terminal dilation covered by BM which forms the inner limiting membrane.
Other supporting cells:
- Retinal astrocytes
- Perivascular glial cells
- Microglial cells
62
what are the 10 retinal layers?
Mnemonic: In New Generation It Is Only Ophthalmologist Examines Patient's Retina
```
Inner Limiting Membrane
Nerve fibre layer
Ganglion cell
Inner plexiform layer
Inner Nuclear layer
Outer nuclear layer
Outer plexiform layer
External limiting membrane
Photoreceptors
Retinal pigment epithelium
```
63
Outline the features of the 10 retinal layers.
Inner Limiting Membrane (Muller cell processes)
Nerve fibre layer (axons and ganglion cells)
Ganglion cell (nuclei of ganglion cells)
Inner plexiform layer (synapses of bipolar, amacrine and ganglion cells)
Inner Nuclear layer (nuclei of bipolar, horizontal, amacrine and Muller cells)
Outer nuclear layer (synapses of rods and cones, bipolar and horizontal cells)
Outer plexiform layer (synapses between terminal processes of rods and cones, bipolar and horizontal cells)
External limiting membrane (Muller cells and supporting cells)
Photoreceptors (rods and cones)
Retinal pigment epithelium (cuboidal cells with pigment)
64
What is the function of the retinal pigment epithelium?
1) The cells of the RPE contain a high amount of dark pigment. Their function is to absorb light which passes through the retina and prevent it from reflecting back to the neurosensory layer. This feature is of great importance for a clear vision
2) Additionally, the cells of the RPE contribute to nourishing of the retina and it forms the blood-retinal barrier. The barrier is composed of the tight junctions between the cells of the RPE and its function is to prevent the diffusion of large and/or toxic molecules from the choroid into the retina.
65
What is the blood supply to the retina?
1-6 = central retinal artery
7-10 = choroid
66
What are the components of the lens?
Capsule
Epithelium: SCE deep to lens capsule
Lens fibres: transformed, elongated epithelial cells
67
What fibres hold the lens in place? Where do they extend from?
Zonular fibres which summate to form suspensory ligament of lens
Arise from ciliary processes
68
What is the anterior concavity adapted to fit with the convexity of the lens called?
Hyaloid fossa
69
What channel extends from the optic disc to the posterior pole of the lens?
What is its relevance?
Hyaloid channel
Bears hyaloid artery in foetal life
70
What is aqueous humor?
The aqueous humor is a nutrient-rich fluid that fills the anterior and posterior chambers of the eye. The amount of aqueous humor in a healthy human eye is 200 milliliters. The aqueous humor is produced by the ciliary processes and delivered into the posterior chamber of the eye.
71
Outline the drainage of aqueous humor.
Produced by ciliary processes and delivered into posterior chamber of eye.
Humor passes through zonular fibres and into iris to reach anterior chamber of eye. Flows via trabecular meshwork of Schlemm's canal and drains into it.
72
What structure produces aqueous humor?
Ciliary body (ciliary epithelium)
73
What is normal intraocular pressure?
How is this created?
10-21mmHg
Resistance to flow through trabecular meshwork into Canal of Schlemm
74
Outline the pathophysiology in open-angle glaucoma.
Gradual increase in resistance via trabecular meshwork thus chronic onset of glaucoma
75
Outline the pathophysiology in close-angle glaucoma.
Iris bulges forward to occlude trabecular meshwork from anterior chamber resulting in accumulation of aq humor and subsequent pressure rise
76
What is a normal cup-disc ratio?
0.4-0.7
77
What are the clinical features of glaucoma?
```
Vision loss: Tunnel vision
Eye pain
Headaches
Blurred vision
Halos around lights
```
78
How may you measure IO pressure in an emergency?
Tanometry (non-contact or Goldmann application)
CT-Ocular
79
What is the gold-standard way of measuring intraocular pressure?
Goldmann application tanometry
80
How do you manage open-angle glaucoma?
PG analogue: Latanoprost
2nd
ß-blockers: Timolol
Sympathomimetic: Brimonidine
CAi: Acetazolamide
Miotics: Pilocarpine
Surgery: Trabeculectomy
81
What is the MOA of latanoprost in Glaucoma?
Increase uveoscleral outflow
82
What are the side effects of latanoprost?
Eyelash growth
Eyelid pigmentation
Iris pigmentation
83
What is the MOA of ß-blockers in glaucoma?
Reduce aq humor production
84
What is the MOA of CA-i in glaucoma?
Reduce aq humor production
85
What is the MOA of Briminodine in glaucoma?
Sympathomimetic (a2 agonist) thus reduce aq production and increase outflow
86
What surgery may be able to treat Open-Angle glaucoma refractors to eye drops?
Trabeculectomy surgery may be required where eye drops are ineffective. This involves creating a new channel from the anterior chamber, through the sclera to a location under the conjunctiva.
87
Which patients should not receive Timolol?
Asthmatics
Heart block
88
What are the side effects of Brimonidine?
Hyperaemia
89
What are the side effects of pilocarpine?
Miosis
Headache
Blurred vision
90
What are the clinical features of acute angle closure glaucoma?
severe pain: may be ocular or headache
decreased visual acuity
symptoms worse with mydriasis (e.g. watching TV in a dark room)
hard, red-eye
haloes around lights
semi-dilated non-reacting pupil
corneal oedema results in dull or hazy cornea
systemic upset may be seen, such as nausea and vomiting and even abdominal pain
91
What is the management of acute angle closure glaucoma?
Pilocarpine
Timolol
Acetazolamide
Surgical: Laser peripheral iridotomy
92
What is the most common cause of blindness in the UK?
ARMD
93
What are the risk factors for Age Related Macular Degeneration?
Age
Smoking
FHx
Arteriopath
94
What form of macular degeneration os most commonly seen?
90% is Dry Macular Degeneration
95
What are the clinical features of macular degeneration?
```
Reduced visual acuity
Central scotoma
Distortion of straight lines
Visual changes
Photopsia (flickering/flashing lights)
```
Drusen
Red patches with fluid leak or haemorrhage
96
How is ARMD managed?
Dry:
Supportive: Stop smoking; BP control; Vitamin supplementation
Wet: Randibizumab
±
Laser photocoagulation
97
Outline the pathophysiology of diabetic retinopathy.
Chronic hyperglycaemia leads to AGEPs which damages the endothelial cells resulting in increased vascular permeability; micro aneurysms; exudates and axonal damage (cotton wool spots) and neovascularisation due to aberrant healing
98
What are the two main types of Diabetic Retinopathy?
Non-Proliferative
Proliferative
Maculopathy
99
What are the severities of non-proliferative diabetic retinopathy?
Mild: Microaneurysms
Moderate: Microaneurysms, blot haemorrhages, exudates, cotton wool spots, venous beading
Severe: Blot haemorrhages and micro aneurysms in all 4 quadrants; venous beading in 2 quadrants and intraretinal microvascular abnormality in any quadrant
100
How do you manage diabetic retinopathy?
Supportive: Glycaemic control; hypertension control; dyslipidaemia control; ophthalmology review
± Non-proliferative
- Observation
If severe:
- Laser photocoagulation
± Proliferative:
- Laser photocoagulation
+
- Intravitreal VEGFi: Randabizumab
Maculopathy:
- VEGFi: Randabizumab
101
What component of the eye produces aqueous humor?
Pars plicata of the ciliary body
102
What investigation allows direct visualisation of the chamber angle?
Gonioscopy
103
In which condition is a Sampaolesi line commonly seen?
What is observed?
Pseudoexfoliation (Pigment dispersion syndrome)
Abundance of pigment at Schwalbe's line (collagen tissue condensation at the edge of Descemet's membrane)
104
Outline the structures seen at the anterior angle?
Mnemonic: I Can See This Stuff
Iris
Ciliary body
Scleral spur
Trabecular meshwork
Schwalbe's line
105
By what process does do ganglion cells die in Glaucoma?
Apoptosis
106
What are the thickest portions of the neuroretinal rim?
Mnemonic: ISNT
Inferior > Superior > Nasal > Temporal
107
In which ethnicities is Primary Angle Closure Glaucoma most common?
Asian
108
In which ethnicities is Primary Open Angle Glaucoma more common?
European
African
109
What are the risk factors of POAG?
```
Increasing age
Afro-caribbean ethnicity
European heritage
Myopia
Hypertension
Diabetes Mellitus
```
110
What are the potential side effects of Dorzolamide?
Sulphonamide-like reactions
Mnemonic: SULPHONAMIDES
```
SJS
Urinary stones
Lyell's Syndrome (TEN)
Photosensitivity
Haematological/Hepatic
Ocular side effects
Neonatal jaundice
Antimetabolites (inhibit THF reductase)
Miscarriage
Intolerance
Dermatitis
Eosinophilia
Serum sickness
```
111
What relation may central cornea thickness have to glaucoma risk?
A thinner cornea may be a risk factor for patients with OHT due to poor measurement of IOP (reads lower cf actual) and potentially less rigid support structure around optic nerve head
112
What other investigation may be used to assess the anterior chamber angle in conjunction with Gonioscopy?
Van Herick test - looks at ratio of anterior chamber depth cf corneal thickness
113
What is the management of primary open angle glaucoma?
Vision loss is irreversible, aim to halt the progression
Supportive: Patient education; Annual Review (set target for IOP lowering)
+
Medical: Topical Latanoprost > Timolol > CAi
±
Surgery: Laser trabeculoplasty OR Trabeculectomy
114
Describe pseudoexfoliation syndrome.
Exfoliation (pseudoexfoliation) Syndrome is characterized by the fibrillar deposits in the anterior segment of the eye.
115
What are the risk factors for Pseudoexfoliation syndrome?
Advanced age: 50+
| Scandinavian heritage
116
What extracellular matrix products are deposited in high quantities in Pseudoexfoliation syndrome?
Fibrillin
alpha-Elastin
Laminin
117
What are the clinical features of Pseudoexfoliation syndrome?
Relatively asymptomatic
Increased IOP
Possible glaucomatous damage to optic nerve
Sampaolesi line (increased pigment) of trabecular meshwork
Fibrillar flaky deposits on anterior lens capsule
118
How is pseudoexfoliation syndrome managed?
Supportive: Review examination; glaucoma monitoring
± Glaucomatous changes
- Timolol
119
What is a posterior synechiae?
Posterior joining of the iris to the ciliary body, preventing aqueous humor draining from the anterior of the eye into the posterior chamber
120
What are the three routes for aqueous humor to drain from the anterior to posterior chamber?
Trabecular
Uveoscleral outflow
121
What are 3 risk factors for PACG?
```
Advancing age
Hyperopia
FHx
Female gender
Asian descent
Shallow anterior chamber depth
Thicker lens
```
122
What is the gold-standard for diagnosing primary closed angle glaucoma?
Gonioscopy
123
What are the clinical features of PACG?
```
Visual loss: Tunnel vision (arcuate distribution of temporal retinal fibres)
Blurred vision
Rainbows
Halos around lights
Eye pain
Nausea and vomiting
```
Raised IOP
Mid-dilated pupil (iris sphincter ischaemia) -> Sectoral iris atrophy
Optic nerve atrophy -> Cupping
124
How is PACG managed?
Vision loss is irreversible, a medical emergency
Medical: topical Timolol + topical Latanoprost + Topical Pilocarpine + IV Acetazolamide
±
Surgery: Laser peripheral iridotomy
125
Describe Pigment Dispersion Syndrome.
spectrum of the same disease characterized by excessive pigment liberation throughout the anterior segment of the eye
Triad: Dense trabecular meshwork pigmentation + Iris transillumination defects + Central cornea posterior surface pigment deposition
126
What is the purported aetiology of pigmented dispersion syndrome?
concave iris contour which causes rubbing of the posterior iris surface against the anterior lens zonules bundles during physiological pupil movement, leading to disruption of the iris pigment epithelial cell membrane and release of pigment granule
127
What are the risk factors for Pigment Dispersion Syndrome?
```
Male gender
Advanced age
Myopia
African ancestry
Concave iris
Flat cornea
FHx
```
128
What are the clinical features of Pigment Dispersion syndrome?
Haloes; Blurry vision
Krukenberg spindles (vertical corneal pigmentation) + TM pigmentation + Transillumination defects
129
How is Pigment Dispersion Syndrome managed?
Latanoprost
or
Timolol
or
Pilocarpine
130
What causes 100 day glaucoma? Outline the pathophysiology behind this.
Diabetes mellitus; Carotic occlusive disease; Central Retinal Vein Occlusion with glaucoma forming due to neovascularisation
This occurs in the aforementioned diseases whereby retinal ischaemia occurs, resulting in VEGF production which supports new vessel growth on the iris. The new vessels have surrounding fibrovascular membranes which produce radial traction resulting in peripheral anterior synechiae (iris with TM) which results in open angle glaucoma which may progress to angle closure glaucoma.
131
How is Neovascular Glaucoma (NVG) managed?
Surgical: Pan-retinal photocoagulation (PRP)
± Medical
Medical: ß-blockers/CAi/PG analogues/Cholinergics
132
What are the drugs that cause cataract?
Amiodarone
Busulfan
Chlorpromazine/ Corticosteroids
Dexamethasone
133
What are the boundaries of the orbit?
Roof: Front-Less (Frontal + Lesser wing of Sphenoid)
Lateral: Great-Z (Greater wing of Sphenoid + Zygomatic
Medial: SMEL (Sphenoid + Maxilla + Ethmoid + Lacrimal)
Floor: My Zipped Pants (Maxialla + Zygomatic + Palatine)
134
Outline the structures present at the superior orbital fissure.
Use common tendinous ring as a reference point
Outside ring:
LFTs - Lacrimal nerve (CNV1) + Frontal Nerve (CNV1) + Trochlear nerve (CN IV)
```
CN III (Superior and Inferior)
Abducens nerve (lateral)
Nasociliary nerve (medial)
Ophthalmic art.
Ophthalmic nerve (CN I)
```
135
What is the cause of Thyroid Eye disease?
Hyperthyroidism (90%) cases in which elevated T3 and T4 may exert effects on orbital fibroblasts
136
What are the risk factors for Thyroid Eye Disease?
Female
Hyperthyroidism (Grave's)
Smoking
Stress/Infection
137
What is the main risk factor for Thyroid Eye Disease?
Smoking
138
What is the most common muscle affected by Thyroid Eye Disease?
Inferior Rectus (CN III)
139
What are the clinical features of thyroid eye disease?
```
Gritty eyes
Photophobia
Lacrimation
Dry eyes
Protrusion of the eye (Exomthalmos)
Vision changes: Blurred; Double vision
```
```
Eyelid retraction (Dalrymple's sign)
Lid lag (Kocher sign)
Exompthalmos
Eye muscle involvement (IM SLOw)
Compressive optic neuropathy (fulminant visual loss)
```
140
What is the refractive index of the lens?
1.4
141
What are the 3 portions of the lens?
Capsule
Cortex
Nucleus
142
What collagen type makes up the capsule?
Type 4
143
What type of epithelia is present on the lens?
Simple cuboidal cells
144
What structures connect the ciliary body to the lens nucleus?
What is it made of?
Zonules of Zinn make up the Zones
Fibrillin
145
What type of cataracts give you a myopic shift with second sight of the aged?
Nuclear sclerotic cataract
146
What gives the nuclear sclerotic cataract its yellow colour?
Urochrome deposition
147
You observe a cataract with a wedge-shape opacity? What type of age-related cataract is it?
Cortical cataract
148
What type of cataracts cause significant visual defect with glare?
Subcapsular cataracts
149
What type of cataracts are observed in myotonic dystrophy?
Iridescent cortical opacities
Star-shaped cortical opacities
150
What type of cataracts are seen in Atopic dermatitis?
Shield-like, dense anterior plaques
151
What is the most common cause of secondary cataracts?
Chronic uveitis
152
What type of cataract is observed in acute congestive angle closure?
Glaucomflecken - small, anterior grey-white sub capsular opacities
153
Which of the following IOLs are especially prone to the development of posterior capsular opacification?
| Polymethylmethacrylate (PMMA) IOLs.
154
What bacterium is the cause of post-op endophthalmitis?
S epidermidis
155
What is the most common late complication of cataract surgery?
Posterior capsular opacification (PCO)
156
Which form of lens in cataract surgery is associated with posterior capsular opacification?
PMMA IOLs
157
What are the clinical features of posterior capsular opacification?
Persistently slowly worsening blurring & glare.
Reduced VA.
Vacuolated (pearl-type) PCO – consists of proliferating swollen lens epithelial cells.
Fibrosis-type PCO – due to fibroblastic metaplasia of epithelial cells.
Soemmering ring – a whitish annular or doughnut-shaped proliferation of residual cells that classically forms at the periphery of the capsular bag following older methods of cataract surgery.
158
How is posterior capsular opacification managed?
Posterior capsulotomy – create an opening in the posterior capsule using a Nd-YAG laser.
159
What type of clinical sign is a centra oil droplet cataract pathognomonic of?
Congenital cataract
160
How do you manage bilateral dense cataracts?
urgery between 4-10 weeks to prevent development of stimulus deprivation amblyopia.
161
How do you manage unilateral dense cataracts?
4-6 weeks
162
What is the most common cause of proptosis in adults?
Thyroid Eye Disease
163
How may Thyroid Eye Disease be classified?
Mild vs Moderate-Severe
Mild:
- Lid retraction <2mm
- Exophthalmos <3mm
- Transient/absent diplopia
- Mild soft tissue involvement
Moderate-Severe:
- Lid retraction >2mm
- Exophthalmos >3mm
- Diplopia
- Moderate-severe soft tissue involvement
164
When do you conduct an orbital decompression in moderate-severe active thyroid eye disease?
6/12
165
What are the features of sight-threatening thyroid eye disease?
Optic neuropathy
Corneal breakdown
166
How do you manage a patient with dysthyroid optic neuropathy?
High dose IV glucocorticoids – treatment of choice.
| Orbital decompression – if GC response poor after 1-2 weeks or GC side effects intolerable
167
What type of cellulitis most commonly follows a sinus infection?
Orbital cellulitis
168
What clinical features are fundamentally different in preseptal and orbital cellulitis?
Proptosis, VA reduced, ophthalmoplegia and diplopia
169
What is the gold-standard investigation in Orbital Cellulitis?
CT-Orbit
170
What is the most common cause o a direct carotid cavernous fistula?
Trauma
171
A patient presents following a head injury. They have a pulsatile proptosis and conjunctival chemosis. They say they can hear a whooshing noise in the head.
O/E there is optic disc swelling and ophthalmoplegia.
What is your DDx?
Direct carotid cavernous fistula
172
What is the gold-standard investigation for Carotid Cavernous Fistula?
Digital subtraction angiography
173
How do you manage a carotid cavernous fistula?
Direct: Transarterial repair
Indirect: Transvenous occlusion
174
A child presents with a bright red, superficial cutaneous lesion on the eyelid.
What is your DDx?
Capillary haemangioma
175
What is your Tx for a Capillary Haemangioma?
Oral propanolol
176
What is the most common orbital tumour in adults?
Cavernous haemangioma
177
Where is a cavernous haemangioma most commonly found?
Lateral portion of muscle cone behind the globe
178
How do you manage a cavernous haemangioma?
Observe if asymptomatic
Surgical removal if symptomatic.
179
How is aqueous humor secreted?
Active transport
180
What is the main route by which aqueous humor travels out of the eye?
Trabecular outflow
181
From posterior to anterior, what are the AC angle structures that can be seen on gonioscopy?
Iris process -> ciliary body -> scleral spur -> trabeculum -> Schwalbe line.
182
Which visual field defects is not typically seen in glaucoma?
Central scotoma
183
Which of the following is not a side effect of Timolol?
A. Bronchospasm
B. Tachyphylaxis
C. Heart block
D. Paraesthesia
D. Paraesthesia
184
Which of the following is not a side effect of Timolol?
A. Bronchospasm
B. Tachyphylaxis
C. Increased urination
D. Heart block
C. Increased urination
185
Which of the following is not a side effect of Dorzolamide?
A. Stinging sensation
B. Bitter taste
C. Paraesthesia
D. Dermatitis
C. Paraesthesia
186
Which of the following is not a side effect of pilocarpine?
A. Miosis
B. Brow ache
C. Conjunctival hyperaemia
D. Myopia
C. Conjunctival hyperaemia
187
Which of the following is not a side effect of Latanoprost?
A. Eyelash growth
B. Brow ache
C. Conjunctival hyperaemia
D. Hyperpigmentation of iris
B. Brow ache
188
Which region has the highest incidence of Pseudoexfoliation Syndrome?
Scandinavia
189
A young myopic man has blurry vision on exertion. Slit lamp examination shows spoke-like iris transillumination defects. What is the most likely diagnosis?
```
(A) Pseudoexfoliation syndrome
(B) Pigment dispersion syndrome.
(C) Acute angle closure glaucoma.
(D) Neovascular glaucoma.
```
(B) Pigment dispersion syndrome.
190
What is the refractive index of the cornea?
1.376
|
191
Where is the thickest portion of the cornea?
Thickest towards the periphery
192
How many layers are there of the cornea?
Outline them and their contents
A-E
Epithelium (above): SSE; can regenerate
Bowman: Acellular
Stroma (C): Type I collagen
Descemet: elastic Type IV collagen; can regenerate
Endothelium: polygonal cells; pump excess fluids out of stroma - keep cornea dehydrated and transparent
193
What is the most important risk factor for developing bacterial keratitis?
```
A. Contact lens wear.
B. Eye trauma.
C. Pre-existing corneal ulcer.
D. Immunosuppression.
```
A. Contact lens wear.
194
Which pathogen predominantly causes Bacterial Keratitis?
A. S. aureus
B. Streptococci
C. Klebsiella
D. P. aeruginosa
D. P. aeruginosa
195
What investigation do you use in a suspected case of bacterial keratitis?
Corneal draping for MC+S
196
How do you manage a case of bacterial keratitis?
Supportive: Stop CL wearing
+
Medical: Topical Ciprofloxacin + Cyclopentolate
197
Why do you prescribe Cyclopentolate in a case of Bacterial Keratitis?
prevent formation of posterior synechiae & reduce pain.
|
198
A patient presents with unilateral eye redness, pain and photophobia. On examination with fluorescein, you note the following stellate fluorescent shapes. What is the diagnosis?
Herpes Simplex Keratitis
199
What strain of Herpes Simplex is associated with blepharoconjunctivitis?
HSV-1
200
A patient presents with unilateral eye redness, pain and photophobia. On examination with fluorescein, you note the following stellate fluorescent shapes.
What is your management?
Topical aciclovir 3%
201
In severe herpes simplex keratitis, the union of multiple dendritic ulcers is called?
Geographic ulcer
202
Why do you not use topical steroids in Herpes Simplex Keratitis?
| Do not use topical steroids – risk of corneal perforation.
203
A 52 y/o M presents with malaise and fever for 5/7; facial pruritus and the presence of some vesicles on the left side of the nose. The rash was maculopapular just yesterday. Fluorescein dye shows dendritic epithelial lesions with tapered ends. Slit-lamp shows iris atrophy.
What is your DDx?
What is the cause of this condition?
What sign is associated with this condition?
How do you manage this condition?
Herpes Zoster ophthalmic
VZV affecting CNV1
Hutchinson Sign
Tx:
Medical: Oral acyclovir 5 times a day within 72 hours of rash
+
VZV vaccine
204
What layer of the cornea is affected in Interstitial Keratitis?
Corneal stroma
205
A patient presents with a reduced vision. They had a history of failure to thrive and maculopapular rash as a neonate.
O/E you see a saddle-shaped nose deformity. On slit-lamp examination, you notice a pink salmon patch with deep stromal vascularisation.
What is your diagnosis?
A. Herpes simplex keratitis
B. Interstitial keratitis
C. Bacterial keratitis
D. Acanthamoeba keratitis
B. Interstitial keratitis
206
Which of the following signs is pathognomonic for acanthamoeba keratitis?
```
A. Perineural infiltrates.
B. Ring abscess.
C. Anterior stromal infiltrates.
D. Eye pain out of proportion of clinical findings.
```
A. Perineural infiltrates.
207
A patient presents with blurry vision and eye pain which is disproportional to what the GP observed. O/E there is dVA. Slit-lamp examination shows perineurial infiltrates.
What is your management for this condition?
A. Chlorhexidine
B. PMHB
C. Oxifloxacin
D. Fusidic Acid
B. PMHB
208
What condition is most commonly associated with peripheral corneal infiltration, ulceration or thinning?
A. OA
B. Sjogren's
C. RA
D. SLE
C. RA
209
A patient presents with reduced vision 2/52. They describe pain, redness, tearing and photophobia. O/E you see crescentic ulceration.
What is your DDx?
A. Herpes simplex keratitis
B. Peripheral ulcerative keratitis
C. Bacterial keratitis
D. Acanthamoeba keratitis
B. Peripheral ulcerative keratitis
210
A patient presents with reduced vision 2/52. They describe pain, redness, tearing and photophobia. O/E you see crescentic ulceration.
What is your Tx?
A. Chlorhexidine
B. PMHB
C. Oral steroids
D. Fusidic Acid
C. Oral steroids
211
A patient presents with reduced vision over the past few months. They describe their vision is not what it used to be.
O/E you see an apical protrusion of the cornea. You notice an 'oil droplet' red reflex.
Slit-lamp shows fine vertical stromal lines.
What are the clinical features observed?
Oil droplet red reflex
Vogt lines
212
A patient presents with reduced vision over the past few months. They describe their vision is not what it used to be.
O/E you see an apical protrusion of the cornea. You notice an 'oil droplet' red reflex.
Slit-lamp shows fine vertical stromal lines.
What condition is this?
Keratoconus
213
A patient presents with reduced vision over the past few months. They describe their vision is not what it used to be.
O/E you see an apical protrusion of the cornea. You notice an 'oil droplet' red reflex.
Slit-lamp shows fine vertical stromal lines.
What is your management of this?
A. Fusidic acid topical
B. Deep anterior lamellar keratoplasty
C. Steroids
D. Laser iridotomy
B. Deep anterior lamellar keratoplasty
214
Corneal oedema which causes worsening vision, irregular warts on the Descemet membrane and a beaten metal endothelial appearance are signs of?
Fuchs endothelial corneal dystrophy
215
Corneal oedema which causes worsening vision, irregular warts on the Descemet membrane and a beaten metal endothelial appearance are signs of?
How would you manage this?
Fuchs Endothelial Corneal Dystrophy
Descemet membrane endothelial keratoplasty
216
What are the layers of the eyelid?
Anterior to Posterior
Skin
Fat
Fascia
Orbicularis oculi
Orbital septum
Levator palpebral superioris
Muller muscle
Conjunctiva
217
What nerve innervates orbicularis oculi?
CN VII - Facial Nerve, temporal and zygomatic divisions
218
What nerve innervates levator palpebral superioris?
Superior division of CN III (Oculomotor nerve)
219
A patient presents with an enlarging nodule around the eyelid. The nodule has been enlarging over a few week. It is red, painful and hard.
What is your management?
Supportive: Observation (often resolves; hot compresses
± Medical: Oral ABX
± Surgery: Incision and curettage
220
A patient presents with a skin lesion on their eyelid. The lesion is shiny, firm and has a pearly appearance. The centre is ulcerated and around it there are some dilated blood vessels.
What is your DDx?
BCC
221
A patient presents with a skin lesion on their eyelid. The lesion is shiny, firm and has a pearly appearance. The centre is ulcerated and around it there are some dilated blood vessels.
What is your management?
Mohs micrographic surgical excision
222
What proportion of SCC metastasises to regional lymph nodes?
A. 30%
B. 20%
C. 40%
D. 50%
B. 20%
223
A 68 year old patient presents with a skin lesion around the eye. The lesion appears hyperkeratotic, with crusting, erosions and fissures. It has grown very quickly, over a matter of weeks.
What is your DDx?
SCC
224
A 68 year old patient presents with a skin lesion around the eye. The lesion appears hyperkeratotic, with crusting, erosions and fissures. It has grown very quickly, over a matter of weeks.
What is your management?
Mohs surgical excision
225
A 68 year old patient presents with a skin lesion around the eye. The lesion appears yellow on the upper eyelid. The eyelid margin has been thickened with some eyelash distortion.
What is your DDx?
A. BCC
B. SCC
C. Meiobian Cyst
D. Sebaceous Gland Carcinoma
D. Sebaceous Gland Carcinoma
226
Which of the following is not a condition associated with blepharitis?
```
A. Acne rosacea.
B. Seborrhoeic dermatitis.
C. Atopic dermatitis.
D. Acne vulgaris.
```
D. Acne vulgaris.
227
What is the difference between anterior and posterior blepharitis?
Anterior: inflammation of eyelid skin around bases of eyelash
Posterior: meibomian gland dysfunction with altered secretion
228
Which condition is associated more with staphylococcal blepharitis?
A. Demodex folliculorum
B. Acne rosacea
C. Atopic dermatitis
D. Seborrheic dermatitis
C. Atopic dermatitis
229
Which condition is associated more with posterior blepharitis?
A. Demodex folliculorum
B. Acne rosacea
C. Atopic dermatitis
D. Seborrheic dermatitis
B. Acne rosacea
230
Which condition is associated more with seborrheic blepharitis?
A. Demodex folliculorum
B. Acne rosacea
C. Atopic dermatitis
D. Seborrheic dermatitis
D. Seborrheic dermatitis
231
What is the main management for blepharitis?
Supportive: Lid hygiene
± Topical ABX
232
A 43 year old patient presents with hard scales and crusting around the eyelash. The lid margins appear hypaeamix and greasy. Lashes are adhering to each other.
What is your ddx?
What is your ddx?
A. Staphylococcal blepharitis
B. Posterior blepharitis
C. Anterior blepharitis
D. Seborrheic blepharitis
D. Seborrheic blepharitis
233
A 49 year old patient presents with oil globules seen at meibomian gland orifices and unstable tear film.
What is your ddx?
A. Staphylococcal blepharitis
B. Posterior blepharitis
C. Anterior blepharitis
D. Seborrheic blepharitis
B. Posterior blepharitis
234
Describe the Marcus-Gunn jaw-winking phenomenon.
retraction of a ptotic lid when ipsilateral pterygoid muscles are activated (eg chewing, opening the mouth).
235
What is Gradenigo syndrome?
Ear pain + inability to abduct eye (CN6 palsy)
236
What is the usual position of the upper lid?
2mm below the superior limbus
237
What forms the tarsal plates?
Orbital septum
238
Which 3 muscles retract the eyelid?
Levator palpebral superioris (CN III)
Muller's Muscle (sympathetic)
Frontalis (CN VIII)
239
Which muscle is responsible for eyelid closure?
Orbicularis oculi (CN VII)
240
The corneal limb of the blink reflex is conducted via which nerve?
A. CN V1
B. CN VI
C. CN II
D. CN VIII
A. CN V1
241
The light stimulus of the blink reflex is conducted via which nerve?
A. CN V1
B. CN VI
C. CN II
D. CN VIII
C. CN II
242
The auditory stimulus of the blink reflex is conducted via which nerve?
A. CN V1
B. CN VI
C. CN II
D. CN VIII
D. CN VIII
243
A patient demonstrates globe rotation up and out during forced lid closure. What is this called?
Bell's Phenomenon
244
How many canthal tendons are there?
2 per orbit: medial and lateral
245
In what order is the eyelid repaired in a deep laceration, penetrating other lamellae?
Both posterior and anterior lamellae require construction; posterior (tarsus and conjunctiva) before anterior (skin and orbicularis)
246
What pathogen is typically associated with Blepharitis?
Staphylococcal
247
How may blepharitis be classified?
Anterior: Staph or Seborrheic
Posterior: Meibomian glands
248
What ABX can be used to treat blepharitis?
What is the MOA?
Tetracyclines limit fatty acid production which can decrease the inflammatory secretions
249
A patient presents with foamy tear film, crusty eyelashes.
What is your DDx?
Meibomian Gland Dysfunction (secondary to chronic posterior blepharitis)
250
A patient presents with foamy tear film, crusty eyelashes.
What is the gold-standard investigation for this?
Tear film breakup time <5 seconds
251
How do you manage Meibomian Gland Dysfunction?
Based on clinical features.
Supportive: diet; lid hygiene
± Mild discomfort
- Topical lubricants
± Inflammatory changes
- Orał doxycycline
252
How is trichiasis managed?
Epilation
Lash destruction (only a few abnormal lashes)
Surgery (pentagon excision to remove focal groups)
253
What is a stye?
A painful lid abscess caused by Staphylococcus infection.
254
How may a hordeolum be classified?
Hordeolum is classified according to the affected gland:
External (anterior lamella): abscess of Zeis or Moll glands
Internal (posterior lamella): abscess of Meibomian gland
255
What is the fundamental difference between a hordeolum and a chalazion?
Chalazion = painless
Hordeolum = painful
256
A chronic translucent cyst is present in the anterior lamella glands.
What type is it?
Cyst of Moll
257
A chronic non-translucent cyst is present in the anterior lamella glands.
What type is it?
Cyst of Zeis
258
In a patient who cannot have a BCC resected, what management is recommended?
A. Vismodegib
B. Cisplatin
C. FU
D. Prednisolone
A. Vismodegib
259
Where does a melanoma metastasise to?
Liver
260
A recurrent unilateral blepharitis should raise suspicion of?
Sebaceous gland carcinoma
261
What is the most common form of ectropion?
A. Cicatrical
B. Paralytic
C. Congenital
D. Involutional
D. Involutional
262
Ectropion due to shortage of skin is?
A. Cicatrical
B. Paralytic
C. Congenital
D. Involutional
C. Congenital
263
Ectropion due to orbicularis weakness is called ?
A. Cicatrical
B. Paralytic
C. Congenital
D. Involutional
B. Paralytic
264
Ectropion due to shortened anterior lamellar due to chronic dermatitis is called?
A. Cicatrical
B. Paralytic
C. Congenital
D. Involutional
A. Cicatrical
265
A patient presents with an outward turned eyelid. It is deemed to be an involutional ectropion, with horizontal lid laxity.
What is your management?
A. Lateral tarsal strip
B. Diamond excision
C. Graft and flap
D. Ocular lubricant only
A. Lateral tarsal strip
266
A patient presents with an outward turned eyelid. There is a shortened, inflamed anterior lamella due to chronic inflammation.
What is your management?
A. Lateral tarsal strip
B. Diamond excision
C. Graft and flap
D. Ocular lubricant only
C. Graft and flap
267
What is the most common form of entropion?
A. Cicatricial
B. Involutional
C. Paralytic
D. Idiopathic
B. Involutional
268
What is of the following is not a management for entropion of the involutional kind?
A. Transverse tarsotomy
B. Jones procedure
C. Everting sutures
D. Membrane graft
269
A patient presents with a Ptosis following a history of Myaesthenia Gravis.
What type of ptosis is this?
A. Involutional
B. Neurogenic
C. Congenital
D. Pseudoptosis
B
270
A patient presents with a Ptosis in addition to abnormal eye movements and a mydriatic pupil.
What type of ptosis is this?
A. Involutional
B. Neurogenic
C. Congenital
D. Pseudoptosis
B, CN III palsy
271
A patient presents with a Ptosis which is deemed to be organic following exclusion of other causes.
What type of ptosis is this?
A. Involutional
B. Neurogenic
C. Congenital
D. Pseudoptosis
A. Involutional
272
The spread of ethmoid cellulitis to orbital cellulitis is via which membrane?
Lamina papyracea of the medial wall of the orbit
273
What are the contents of the optic foramen?
Transmits the optic nerve and the ophthalmic artery
274
What are the contents of the superior orbital fissure?
LFTs
Lacrimal (CNV1)
Frontal (CNV1)
Trochlear (CN4)
Common tendinous ring:
- Superior and inferior Occulomotor nerves
- Nasociliary nerve (CNV1)
- Abducens nerve (CN 6)
275
What are the contents of the
276
What are the contents of the inferior orbital fissure?
```
Infraorbital nerve (CNV2)
Zygomatic nerve (CNV2)
Inferior ophthalmic vein
```
277
What pathogen commonly causes preseptal cellulitis?
A. S. pneumoniae
B. Haemophilus
C. S. aureus
D. Klesiella
C
278
What pathogen commonly causes orbital cellulitis?
S pneumoniae
279
What is the gold-standard investigation for orbital cellulitis?
CT-Orbit
280
What is the most common cause of axial proptosis in adults?
A. TED
B. Cavernous haemangioma
C. Optic nerve glioma
D. Lacrimal gland pathology
A
281
What causes lid retraction in TED?
A. Parasympathetic stimulation of Muller's Muscle
B. Stimulation of superior levator palpebrae
C. Sympathetic Muller's muscle stimulation
D. Proptosis
282
What causes lid retraction in TED?
A. Parasympathetic stimulation of Muller's Muscle
B. Stimulation of superior levator palpebrae
C. Sympathetic Muller's muscle stimulation
D. Proptosis
B
283
The occurrence of headache, ophthalmoplegia and periorbital sensory loss is seen in?
A. Sarcoidosis
B. Tolosa-Hunt Syndrome
C. Granulomatosis with polyangiitis
D. TED
B
284
A patient with positive cANCA and orbital inflammation is most likely to have?
A. Sarcoidosis
B. Tolosa-Hunt Syndrome
C. Granulomatosis with polyangiitis
D. TED
C
285
A patient presenting with orbital inflammation on a b/g of noncaseating granulomas present in the lung as well as elevated serum ACEi is most likely to have?
A. Sarcoidosis
B. Tolosa-Hunt Syndrome
C. Granulomatosis with polyangiitis
D. TED
A
286
What is the gold-standard investigation to diagnose Tolosa-Hunt syndrome?
What are the clinical features of this condition?
MRI/Biopsy
Headache + Periorbital sensory loss + Ophthalmoplegia
287
What is the commonest primary childhood orbital malignancy?
A. Neuroblastoma
B. Rhabdomyosarcoma
C. Capillary haemangioma
D. Optic nerve glioma
B
288
A child presents with a lump present in the supers-nasal orbit which is causing a unilateral proptosis which is painless.
What is the diagnosis?
A. Neuroblastoma
B. Rhabdomyosarcoma
C. Capillary haemangioma
D. Optic nerve glioma
B
289
A child presents with an eye lump which shows Homer-wright rosettes on histology.
What is the DDx?
A. Neuroblastoma
B. Rhabdomyosarcoma
C. Capillary haemangioma
D. Optic nerve glioma
A
290
A child presents with an eye lump which has blanching and a red unilateral lesion of the upper eyelid.
What is the DDx?
A. Neuroblastoma
B. Rhabdomyosarcoma
C. Capillary haemangioma
D. Optic nerve glioma
C
291
A child presents with an eye lump is causing a unilateral proptosis and RAPD O/E.
What is the DDx?
A. Neuroblastoma
B. Rhabdomyosarcoma
C. Capillary haemangioma
D. Optic nerve glioma
D
292
A 57 year old presents with vision loss in one eye. The vision loss is painless.
O-CT shows a thick optic nerve sheath.
What is your DDx?
A. Neuroblastoma
B. Optic nerve sheath meningioma
C. Cavernous haemangioma
D. Optic nerve glioma
B
293
A 57 year old presents with reduced visual acuity and slow progressing axial proptosis.
O-CT shows a lesion within the common tendinous ring.
What is your DDx?
A. Neuroblastoma
B. Optic nerve sheath meningioma
C. Cavernous haemangioma
D. Optic nerve glioma
C
294
A patient presents with an ocular bruit, hearing a whooshing sound. O/E there are visual defects.
What is your DDx?
A. Indirect CCF
B. Direct CCF
C. Cavernous sinus thrombosis
D. Orbital varices
B
295
A patient presents with an irritated eye and corkscrew epibulbar vessels shown.
What is your DDx?
A. Indirect CCF
B. Direct CCF
C. Cavernous sinus thrombosis
D. Orbital varices
A
296
A patient presents with a sudden onset headache. They feel nauseous and have double vision. What is your diagnosis?
A. Central retinal vein occlusion
B. Central retinal artery occlusion
C. Cavernous Sinus Thrombosis
D. Orbital varices
C
297
Which eye movement will be affected first in a cavernous sinus thrombosis?
A. Eye abduction
B. Eye adduction
C. Eye moving inferiorly
D. Eye moving superiorly
A - CN 6 is affected first
CN6 is first affected because it travels within the sinus as opposed to CN3 and CN4 which travel within the walls of the sinus.
298
What is the most ocular toxic heavy metal commonly used?
A. Copper
B. Iron
C. Aluminium
D. Zinc
A
299
A foreign body is propelled into the orbit. A CT-Orbit shows the deposits to be present in the cornea.
How would you remove the foreign body?
A. Fine forceps
B. 26G needle
C. Scleral trapdoor approach
D. Electromagnetic removal
B
300
A foreign body is propelled into the orbit. Following slit-lamp examination and CT-Orbit, the deposits are deemed to be present in the anterior chamber.
How would you remove the foreign body?
A. Fine forceps
B. 26G needle
C. Scleral trapdoor approach
D. Electromagnetic removal
A
301
A foreign body is propelled into the orbit. Following slit-lamp examination and CT-Orbit, the deposits are deemed to be present in the angle of the anterior chamber.
How would you remove the foreign body?
A. Fine forceps
B. 26G needle
C. Scleral trapdoor approach
D. Electromagnetic removal
C
302
A foreign body is propelled into the orbit. Following slit-lamp examination and CT-Orbit, the deposits are deemed to be present in the ciliary body.
How would you remove the foreign body?
A. Fine forceps
B. Intraocular magnet
C. Scleral trapdoor approach
D. Electromagnetic removal
D
303
A foreign body is propelled into the orbit. Following slit-lamp examination and CT-Orbit, the deposits are deemed to be present in the posterior segment.
How would you remove the foreign body?
A. Fine forceps
B. Intraocular magnet
C. Scleral trapdoor approach
D. Electromagnetic removal
B
304
Which is worse, alkali or acid burn?
Alkali > Acid as causes liquefactive necrosis
305
What is the initial management of a chemical burn in the eye?
A. Irrigation
B. Topical steroids
C. Doxycycline
D. Ascorbic acid
A
306
Which of the following work by aiding collagen formation in an alkali burn?
A. Irrigation
B. Topical steroids
C. Doxycycline
D. Ascorbic acid
D
307
Which of the following treatments are contraindicated in an acid burn?
A. Irrigation
B. Topical steroids
C. Doxycycline
D. Ascorbic acid
D
308
A 23 year old man presents following a fist fight where he has been punched multiple times in the face. O/E there is periorbital bruising and vertical diplopia.
Which muscle is the cause for the vertical diplopia?
A. LR
B. IR
C. SO
D. IO
B
309
A 34 year old Rangers fan presents following punching himself in the face. There is a painful loss of vision, a rigid proptosis and a RAPD on examination. Furthermore, there are restricted ocular movements.
What is your DDx?
A. Orbital floor fracture
B. Retrobulbar haemorrhage
C. Hyphema
D. Foreign body
B
310
A 34 year old Rangers fan presents following punching himself in the face. There is a painful loss of vision, a rigid proptosis and a RAPD on examination. Furthermore, there are restricted ocular movements.
How should you manage this?
A. IV mannitol + IV Acetazolamide
B. IV mannitol + IV Acetazolamide + Topical Latanoprost
C. IV mannitol
D. IV mannitol + IV Acetazolamide + IV Methylprednisolone
311
Describe the conjunctiva.
The conjunctiva is a thin transparent membrane that lines the surface of the sclera and the underside of the eyelid. It can be thought of as a modified layer of skin.
312
What are the three portions of the conjunctiva?
Bulbar
Palpebral
Conjunctival fornix
313
An enlargement of the conjunctival vessels is known as?
A. Cicatrization
B. Chemosis
C. Hyperaemia
D. Follicles
C
314
A transparent swelling of the conjunctiva is known as?
A. Cicatrization
B. Chemosis
C. Hyperaemia
D. Follicles
B
315
Scarring of the conjunctiva is known as?
A. Cicatrization
B. Chemosis
C. Hyperaemia
D. Follicles
A
316
Which is the predominant cause of bacterial conjunctivitis in warm climates?
A. H aegyptius
B. H influenzae
C. S aureus
D. S pneumoniae
A
317
Which is the predominant cause of bacterial conjunctivitis in children?
A. H aegyptius
B. H influenzae
C. S aureus
D. S pneumoniae
B
318
A 7 year old child presents with red sticky eyes. There is purulent discharge coming out. The patient says their eyes are stuck together.
Swabs are positive for H influenzae.
What is your management?
A. Chloramphenicol topical
B. Oral doxycycline
C. Ceftriaxone
D. Co-amoxiclav
D
319
A 17 year old presents with red sticky eyes. There is purulent discharge coming out. The patient says their eyes are stuck together.
What is your management?
A. Chloramphenicol topical
B. Oral doxycycline
C. Ceftriaxone
D. Co-amoxiclav
A
320
A 17 year old presents with red sticky eyes. There is purulent discharge coming out. The patient says their eyes are stuck together. Additionally they have some urethritis.
A urethral swab and conjunctival swab are positive for gram negative diplococci.
What is your management?
A. Chloramphenicol topical
B. Oral doxycycline
C. Ceftriaxone
D. Co-amoxiclav
C
321
Serotypes D-K cause which complication of chlamydia in the eyes?
Inclusion Body Chlamydial Conjunctivitis
322
Serotypes A-C cause which complication of chlamydia in the eyes?
Trachoma
323
A patient presents with an inferior follicular conjunctivitis with mucopurulent discharge.
Swabs and PCR are positive for a gram negative, rod-shaped obligate organism.
What is your diagnosis?
A. Bacterial conjunctivitis
B. Inclusion Body Chlamydial Conjunctivitis
C. Trachoma
D. Gonococcal conjunctivitis
B
324
What is the leading cause of preventable blindness worldwide?
Trachoma
325
A patient from Eritrea presents with superior follicular conjunctivitis. A thick band of scar tissue is seen in the conjunctiva.
What is your differential diagnosis?
What is your management?
Trachoma
```
Mnemonic: SAFE
Surgery for trichiasis
Azithromycin 1mg PO
Facial hygiene
Environmental improvement
```
326
What is the treatment of gonococcal conjunctivitis?
Topical ofloxacin + Ceftriaxone 1mg STAT
327
Describe ophthalmia neonatorum.
Conjunctivitis within <30 days of life
328
A neonate aged 8 days old is found to have ophthalmia neonatorum. Swabs show a gram negative rod-shaped bacteria.
What is the management?
A. Erythromycin PO
B. IM Ceftriaxone and IV Penicillin
C. IV Acyclovir
D. Topical chloramphenicol
A
329
A neonate aged 8 days old is found to have ophthalmia neonatorum. Swabs show a gram negative diplococci.
What is the management?
A. Erythromycin PO
B. IM Ceftriaxone and IV Penicillin
C. IV Acyclovir
D. Topical chloramphenicol
B
330
A neonate aged 8 days old is found to have ophthalmia neonatorum. Swabs are positive for HSV.
What is the management?
A. Erythromycin PO
B. IM Ceftriaxone and IV Penicillin
C. IV Acyclovir
D. Topical chloramphenicol
C
331
A neonate aged 8 days old is found to have ophthalmia neonatorum. Swabs show a cluster of gram negative bacteria.
What is the management?
A. Erythromycin PO
B. IM Ceftriaxone and IV Penicillin
C. IV Acyclovir
D. Topical chloramphenicol
D
332
What is the most common cause of viral conjunctivitis?
Adenovirus
333
Which serovar of adenovirus does not cause Pharyngoconjunctival Fever?
A. 3
B. 8
C. 4
D. 7
B
334
What is the difference between perennial and seasonal conjunctivitis?
All year round; both type 1
335
What are the key features of vernal keratoconjunctivitis?
Teenage boys
Type 1 -> Type 4 hypersensitivity
Summer
Upper conjunctiva with cobblestone appearance
336
Which conditions is atopic keratoconjunctivitis associated with?
Atopy:
Allergic rhinitis
Eczema
Asthma
337
In ocular mucous membrane pemphigoid, antibodies target which membrane?
Basement membrane of mucosal surfaces
338
What is the main difference between a pterygium and a pinguecula?
They key difference is that pterygium invades into the cornea, pinguecula does not.
339
What type of collagen makes up Descemet's membrane?
Type 4
340
What structure of the eye has the highest refractive power?
45D
341
What investigation may be used to measure cornea thickness?
A. Pachymetry
B. OCT
C. Fluorescein staining
D. Specular microscopy
342
What is the commonest cause of bacterial keratitis in contact lens wearers?
P aeruginosa
343
What do you use to treat a fungal keratitis caused by candida?
Voriconazole or Amphotericin
344
What do you use to treat a fungal keratitis caused by candida?
Voriconazole or Amphotericin
345
What do you use to treat a fungal keratitis caused by candida?
Natamycin drops
346
Marginal keratitis is an autoimmune reaction against which toxin?
A. S epidermidis
B. H influenzae
C. M tuberculosis
D. Acanthamoeba
A
347
Which nerve does HSV lie dormant in to cause a herpes simplex keratitis?
A. CN VI
B. CN VII
C. CN IV
D. CN V
D
348
What clinical finds would be suggestive of filamentary keratitis?
Comma shaped lesions which move whilst blinking following rose bengal staining
349
What is the management for filamentary keratitis?
Acetylcysteine drops
350
What is the most common epithelial dystrophy?
A. Cogan
B. Meesman
C. Reis-Buckler
D. Meretoja
A
351
Histology shows a thickened basement membrane over Bowman's layer. What epithelial dystrophy is this?
A. Cogan
B. Meesman
C. Reis-Buckler
D. Meretoja
A
352
Histology shows cysts. What epithelial dystrophy is this?
A. Cogan
B. Meesman
C. Reis-Buckler
D. Meretoja
B
353
Histology shows replacement of bowman's by connective bands. What epithelial dystrophy is this?
A. Cogan
B. Meesman
C. Bowmans
D. Meretoja
C
354
Outline the stromal dystrophies and their corresponding stain.
Mnemonic: Marilyn Monroe Always; Gets Her Men; in L.A. County
Macular - Mucopolysaccharide - Alcian blue
Granular - Hyaline - Masson trichome
Lattice - Amyloid - Congo red
355
Why are symptoms worse in the morning for Fuchs Endothelial Dystrophy?
Symptoms are worse in the morning because the eyes are shut overnight and corneal fluid evaporation in limited. The endothelial pump is dysfunctional so fluid accumulation occurs. Throughout the day the eyes are open and blinking, this allows better clearing of the accumulated fluid.
356
What visual defect does keratoconus lead to?
Irregular astigmatism
357
What are the clinical features of keratoconus?
Typically bilateral and presents in adolescents.
Munson sign - lower lid protrudes on downward gaze
Vogt striae - corneal stromal striations seen on slit lamp
358
How do you manage a Keratoconus?
Dependent on severity (<48D vs >54D)
Mild (<48D):
- Rigid contact lenses
Severe (>54D):
- Keratoplasty
359
Corneal topography shows a butterfly pattern in a child with bilateral blurring of vision over time.
What is your DDx?
Pellucid Marginal Degeneration
360
A patient presents with reduced corneal sensation on a background of corneal ulceration.
What is your Ddx?
Neurotrophic keratopathy
361
What is the cause for exposure keratopathy?
Lagophthalmos
362
What is the management for a patient presenting with Kayser-Fleischer rings in the descet membrane?
Penicillamine-D
363
What two divisions of the ciliary body are there?
Anterior functional - pars plicate
Posterior non-functional - pars plant
364
Which layer of the choroid produces aqueous? Is it pigmented?
Non-pigmented and produces aqueous
365
What is the fundamental discriminator between episcleritis and scleritis?
Additional of 10% phenylephrine makes the red eye blanche
Scleritis is potentially blinding thus requires high dose steroids and taper down
366
What do stellate KPs indicate in anterior uveitis?
Non-granulomatous inflammation
367
What do mutton fat KPs indicate in anterior uveitis?
Granulomatous
368
What haplotype is associated with Behcet's Disease?
HLAB51
369
Outline the flow of tears.
1. Secretion by lacrimal gland
2. Channeled medially via orbicularis pump
3. Drains into nasolacrimal system via upper and lower puncta
4. Flow through upper and lower cannaliculi into common cannaliculi
5. Flows via nasolacrimal sac into duct into inferior meatus and into nasolacrimal canal
370
What are the layers of tear film?
Lipid (Meibomian)
Aqueous (lacrimal gland)
Mucin (conjunctival goblet cells)
371
What is the sensorimotor innervation of the lacrimal gland?
Parasympathetic of CN VII
372
What is the sensory innervation of the lacrimal gland?
Lacrimal nerve (CN V1)
373
What are the difference between the accessory lacrimal glands?
Krause glands found in conjunctival fornices which are more abundant in upper fornix
Wolfring glands are less numerous but bigger found in the tarsal plate
374
What is the criteria for a positive Schirmer test?
<5mm
375
What is the criteria for an abnormal tear film-break up time test?
<5 seconds
376
What us the first line treatment for dry eyes?
Lubrication and artificial tears
377
What antibodies are present in Sjogren Syndrome?
Anti-Ro
Anti-La
378
What is the cause of xerophthalmia?
Vitamin A deficiency
379
What are the two main mechanisms of epiphora?
1) Nasolacrimal drainage failure
| 2) Hypersecretion
380
What is the cause of a congenital nasolacrimal duct obstruction?
Imperforate membrane over valve of Hasner
381
How do you manage a congenital nasolacrimal duct obstruction?
>12 months:
1) Syringing and probing
2) Silicone stent intubation
3) DCR
382
How do you treat punctal stenosis?
Punctoplasty
383
How do you treat punctual eversion?
Cautery
384
How do you treat orbicularis pump failure?
Lower lid tightening with LTS
385
How do you treat nasolacrimal duct obstruction?
DCR
386
How do you treat a canalicular obstruction?
DCR with retrograde intubation
387
Which groups of patients tend to have dermatochalasis?
Elderly
Obese
388
How is dermatochalasis treated?
Upper lid blepharoplasty
389
A patient presents with painful upper lateral lid. There is a swelling and medial hyoglobus.
What is your diagnosis and management?
Dacryoadenitis
Oral NSAID/Steroids
390
what is the most common cause of canaliculitis?
Actinomyces
391
What is the management for chronic dacryocystitis?
Dacryocystorhinostomy
392
What antioxidants are present in the lens, stopping deterioration?
Glutathione
Ascorbic acid
393
What type of collagen makes up the lens?
Type 4 collagen
394
Which fibres arise from the ciliary body and attach as a sheet to the lens capsule?
Zonular fibres
395
What are the zonular fibres made of?
Fibrillin
396
What is the refractive index of the adult lens?
1.4
397
Outline the Helmholtz Theory of Accommodation.
```
Ciliary muscles contract
Ciliary body becomes larger and moves closer to the lens
Zonular fibres relax
Lens thickens (increases power)
Pupils constrict and converge
Choroid and ora errata stretch forward
```
398
What is the loss of refractive index power with ageing referred to as?
Presbyopia
399
What is the pathophysiology of glaucoma?
Ageing, reduced biochemical activities and loss of antioxidants (glutathione and ascorbic acid) cause lens to become thicker.
Alpha and gamma crystallins are reduced and beta crystallins become dispersed
400
A cataract appears yellow with a central lens affected and myopic shift.
What type of age-related cataract is this?
A. Nuclear sclerotic
B. Cortical
C. Anterior subcapsular
D. Posterior sub capsular
A
401
A cataract appears wedge-shaped and affects the peripheral lens.
What type of age-related cataract is this?
A. Nuclear sclerotic
B. Cortical
C. Anterior subcapsular
D. Posterior sub capsular
B
402
A cataract appears to be associated with blunt trauma.
What type of age-related cataract is this?
A. Nuclear sclerotic
B. Cortical
C. Anterior subcapsular
D. Posterior sub capsular
C
403
A cataract appears following corticosteroid usage.
What type of age-related cataract is this?
A. Nuclear sclerotic
B. Cortical
C. Anterior subcapsular
D. Posterior sub capsular
D
404
A cataract appears following chloroquine usage.
What type of age-related cataract is this?
A. Nuclear sclerotic
B. Cortical
C. Anterior subcapsular
D. Posterior sub capsular
D
405
A Christmas tree cataract is seen.
What condition is this associated with?
A. Myotonic dystrophy
B. Down Syndrome
C. Rubella
D. Wilson's disease
A
406
A blue dot cataract is seen.
What condition is this associated with?
A. Myotonic dystrophy
B. Down Syndrome
C. Rubella
D. Wilson's disease
B
407
A Sunflower cataract is seen.
What condition is this associated with?
A. Myotonic dystrophy
B. Down Syndrome
C. Rubella
D. Wilson's disease
D
408
A Pearly nuclear sclerotic cataract is seen.
What condition is this associated with?
A. Myotonic dystrophy
B. Down Syndrome
C. Rubella
D. Wilson's disease
C
409
A shield cataract is seen.
What condition is this associated with?
A. Myotonic dystrophy
B. Down Syndrome
C. Rubella
D. Atopic dermatitis
D
410
What inheritance pattern is mainly present in congenital cataracts?
Autosomal dominant
411
When should unilateral congenital cataracts be removed?
6 weeks
412
When should bilateral congenital cataracts be removed?
10 weeks
413
What investigations is used to determine the type of lens to be implanted in a cataract surgery?
Biometry - determines axial length, corneal curvature, anterior chamber depth
414
What are the two main types of IOL?
Rigid vs Flexible
415
Which of the following IOLs is associated with glare?
A. Silicone
B. PMMA
C. Acrylic hydrophobic
D. Acrylic hydrophilic
C
416
Which of the following IOLs is associated with the best biocompatibility?
A. Silicone
B. PMMA
C. Acrylic hydrophobic
D. Acrylic hydrophilic
D
417
What is the most common intra-operative complication of cataract surgery?
Posterior capsular rupture with vitreous loss
418
What is the most common post-operative complication of cataract surgery?
Posterior capsular opacification - 10% in 2 years
419
What is the gold standard operation technique in cataract surgery?
Phacoemulsification
420
What step is taken to prevent endophthalmitis during cataract surgery?
5% povidone-iodine
Intracameral cefuroxime
421
What frequency does the phaco-tip vibrate at?
30-60kHz
422
Describe the process of phacoemulsification.
cataract broken with direct contact of the ultrasound tip on the nucleus and fragments asperitated
423
What medication is associated with floppy iris syndrome?
Tamsulosin
424
What risk of choroidal haemorrhage is there in cataract surgery?
How do you manage choroidal haemorrhage?
0.1% risk
Suture wound + IV acetazolamide + Topical steroids
425
A patient presents with painless blurry vision several weeks after cataract surgery. OCT shows retinal layers being raised.
What is your DDx?
A. Posterior capsular opacification
B. Endophthalmitis
C. Cystoid Macular Oedema
D. Zonular dehiscence
C
426
How is posterior capsular opacification treated?
Nd:YAG laser capsulotomy
427
Which of the following conditions is associated with glaucoma?
A. Familial ectopia lentis
B. Marfan syndrome
C. Homocystinuria
D. Weill-Marchesani Syndrome
D, anterior inferior displacement of ectopic lentis which obstructs normal aqueous flow
428
How do you manage a major ectopia lentis?
Lensectomy
429
In which condition do you see anterior lenticonus?
Alport Syndrome
430
What sign would you see on lentiglobus?
Retroillumination with slit lamp shows classic oil droplet sign
431
What is the critical angle?
The critical angle (θc) is the angle of incidence at which light is first reflected instead of refracted
432
What is the critical angle for normal spectacles?
41 degrees
433
Define total internal reflection.
Angle of incidence exceeds the critical angle thus light is not refracted but reflected back into the medium
434
A plus lens has what effect on vergence?
Converges light as mergence is measured in D;
D = 1/f(m)
Thus a +2 = +1/2m
435
A minus lens has what effect on vergence?
Diverges light as mergence is measured in D;
D = 1/f(m)
Thus a -2 = -1/2m
436
Light from an object 2m away is travelling to a +2D lens. At what distance is the image going to be formed?
U + D = V
U = 1/2 = 0.5; light from natural object is divergent (minus) thus -0.5
D = +2
V = -0.5 + 2 = +1.5D
D = 1/f(m)
Thus
1.5 = 1/f(m)
= 1/1.5 = 0.67m
Thus image will form on 0.67m on the other side
437
What image quality is produced by a minus lens?
Virtual, erect and diminished
438
What is the most common investigation used to test visual acuity?
Retinoscopy
439
What is the minimum driving requirement?
6/12
440
In a Duochrome test, if a red background makes it clearer, what is occurring?
Red has a longer wavelength and focuses behind the retina thus the patient has a hyperopia.
441
In a Duochrome Test, is a green background makes the letters clearer, what is occurring?
Green is a shorter wavelength, focussing light onto the retina thus the patient has myopia.
442
In Retinoscopy, if the red reflex moves against the direction of the light, what is noted?
Myopia
443
In Retinoscopy, if the red reflex moves with the direction of the light, what is noted?
Hyperopia
444
At what age is colour vision developed?
6 months
445
At 6 months, what should the snellen score be?
6/30
446
What are the 3 types of ametropia?
Myopia
Hyperopia
Astigmatism
447
Describe the pathophysiology of Myopia.
Eye has a higher refractive power than normal
Increased refractive power causes a reduced focal length so image is focused in front of the retina thus they are short-sighted
448
Outline the pathophysiology of Hyperopia.
Eye has a lower refractive power than normal
Power reduced thus focal length increases and image is focused behind the retina.
An object further away allows them to see the image clearer as this pulls the point of focus from behind the retina.
449
What is the visible spectrum of light in humans?
380-750nm
450
What type of lens would you use in myopia?
Minus lens as they are concave and diverge light
451
What type of lens would you use in presbyopia?
Plus lenses which are convex and converge light
452
What type of lens would you use in astigmatism?
Toric lenses
453
How is astigmatism classified?
Regular
- WTR (90 degrees perp)
- ATR (180 degrees)
Irregular
454
How is irregular astigmatism treated?
Rigid gas permeable contact lenses (RGP CLs)
455
How is regular astigmatism treated?
Toric lenses
456
which of the following statements are true?
A. Stimulation of beta-2 receptors increase secretion and inhibition of alpha-2 receptors increase secretion of aqueous humor
B. Stimulation of beta-2 receptors increase secretion and stimulation of alpha-2 receptors increase secretion of aqueous humor
C. Inhibition of beta-2 receptors increase secretion and stimulation of alpha-2 receptors increase secretion of aqueous humor
D. Inhibition of beta-2 receptors increase secretion and inhibition of alpha-2 receptors increase secretion of aqueous humor
A
457
Which part of the TM bears the greatest resistance to normal AQH outflow via conventional route?
Juxtacanalicular meshwork
458
What is the normal range of IOP?
11-21mmHg
459
When does IOP peak?
In the morning
460
What optic disc changes are seen in glaucomatous disease processes?
Neuroretinal rim reduces - retinal neuronal cells die off
Neuroretinal rim does not follow ISNT rule
Cup to disc ratio is increased
461
What is the best test for monitoring glaucoma?
Humphrey 24-2 perimetry
462
What is the order of use of medication in glaucoma?
Latanoprost
Timolol
Brinzolamide
Brimonidine
463
Which eye drops are used to treat glaucoma in pregnancy?
No eye drops licensed for use in pregnancy
Briminodine in 1st trimester
Timolol in 3rd trimester
464
Which of the following is not a side effect of
latanoprost?
A. Iris pigmentation
B. Lash lengthening
C. Lacrimation
D. Macular oedema
C
465
Which of the following is not a side effect of
latanoprost?
A. Iris pigmentation
B. Lash lengthening
C. Uveitis
D. Diarrhoea
D
466
Which of the following is not a side effect of
Beta blockers?
A. Exacerbates asthma
B. Bradycardia
C. Macular oedema
C
467
Which of the following ß-blockers is selective for ß1?
A. Timolol
B. Bisoprolol
C. Carteolol
D. Betaxolol
D
468
Why should you be cautious of using Briminodine in young children?
A2 selective blockers are lipophilic thus cross BBB which may result in respiratory depression
469
What is the MOA of Briminodine when used in Glaucoma?
Reduced aq production + increased uveosacral outflow
470
Which alpha 2 agonist is A2 selective?
Briminodine
471
When medications fail to control chronic glaucoma, what is the next management?
Trabeculectomy - fistula from AC to subtenant space
Use antimetabolites to reduce risk of bleb failure - 5-FU; Mitomycin C
472
Which of the following is used in a peripheral iridoplasty?
A. Argon
B. ND:YAG
C. Frequency doubled Q-switched ND:YAG
D. Trabeculectomy
A
473
Which of the following is used in a peripheral iridotomy?
A. Argon
B. ND:YAG
C. Frequency doubled Q-switched ND:YAG
D. Trabeculectomy
B
474
Which of the following is used in a selective laser trabeculoplasty (SLT)?
A. Argon
B. ND:YAG
C. Frequency doubled Q-switched ND:YAG
D. Trabeculectomy
C
475
Which of the following is not a risk factor for primary open angle glaucoma?
A. Myopia
B. Afro-caribbean race
C. Increased age
D. Migraine history
D
476
What is the first line management for a patient with primary open angle glaucoma?
Topical Latanoprost
If no IOP reduction, try alt. first line
If no IOP reduction, combine medications
477
What surgical procedure may be used in a patient with Primary Open Angle Glaucoma who has failed medical management?
Selective Laser Trabeculoplasty
478
Which anti-epileptic medication is associated with bilateral PACG?
Topiramate
479
What are the essential clinical features to diagnose primary angle closure glaucoma?
AC angle closure + Sudden pain + blurred vision + nausea + red eye + glaucomatous changes
480
How do you manage PACG?
IV Acetazolamide + Timolol + Apraclonidine + Steroids + Pilocarpine + lay supine
+
Bilateral peripheral iridotomy
481
Primary congenital glaucoma is associated with which gene mutation?
CYP1B1
482
What is the normal range for infant IOP?
10-12mmHg
483
What is the surgical management of primary congenital glaucoma in infants?
Goniotomy (cornea clear)
OR
Trabeculectomy (cornea cloudy)
484
Can glaucoma occur with a normal IOP?
Yes, in Normal Tension Glaucoma (NTG)
IOP ≤ 21mmHg
485
What is Ocular Hypertension?
Raised IOP (>21mmHg) without glaucomatous damage
486
Which of the following is not a risk factor for conversion of ocular hypertension to primary open angle glaucoma?
A. Older
B. Higher IOP
C. Larger cup:disc ratio
D. Thicker cornea
D
487
A 20 year old male presents with unilateral, blurred vision. O/E he has a white eye and IOP is 40-80mmHg. Additionally, gonioscopy shows an open angle with no synechiae.
What is your differential?
A. Pseudoexfoliation Syndrome
B. Posner-Schlossman Syndrome
C. Pigment Dispersion Syndrome
D. Phacolytic Glaucoma
B
488
What is the management for Posner-Schlossman Syndrome?
Topical steroids
489
What mutation gives rise to Pseudoexfoliation Syndrome?
LOX1
490
A 52 year old Scandinavian female presents with reduced peripheral vision. O/E there is raised IOP and a sampaolesi line noted
What is your differential?
A. Pseudoexfoliation Syndrome
B. Posner-Schlossman Syndrome
C. Pigment Dispersion Syndrome
D. Phacolytic Glaucoma
A
491
A patient presents with blurry vision. They say the vision gets blurry when they are exerting themselves carrying boxes.
O/E there is elevated IOP and cupping. TM pigmentation is noted with Krukenberg spindles noted.
What is your differential?
A. Pseudoexfoliation Syndrome
B. Posner-Schlossman Syndrome
C. Pigment Dispersion Syndrome
D. Phacolytic Glaucoma
C
492
A patient presents with a painful red eye. O/E there are foamy macrophages present in a AC tap. Slit lamp shows a hyper mature cataract.
What is your DDx?
A. Pseudoexfoliation Syndrome
B. Posner-Schlossman Syndrome
C. Pigment Dispersion Syndrome
D. Phacolytic Glaucoma
D
493
What is the main risk factor for angle recession glaucoma?
Blunt ocular trauma
494
A finding of irregular widening of the ciliary body upon Gonioscopy is suggestive of which diagnosis?
A. Pseudoexfoliation Syndrome
B. Angle recession Glaucoma
C. Pigment Dispersion Syndrome
D. Phacolytic Glaucoma
B
495
What is the difference between red cell and ghost glaucoma?
Red cell shows fresh, red cells blocking the T which occurs acutely after hyphaema and blunt trauma.
Ghost cell are degenerated old red cells blocking the TM which occur after a few weeks following vitreous haemorrhage
496
In which condition are tan coloured red cells seen in the anterior chamber?
A. Red Cell Glaucoma
B. Posner-Schlossman Syndrome
C. Pigment Dispersion Syndrome
D. Ghost Cell Glaucoma
D
497
A patient presents with unilateral eye pain and blurry vision. O/E there is a port wine stain on the same side. They have a history of seizures.
What is your DDx?
A. Pseudoexfoliation Syndrome
B. Posner-Schlossman Syndrome
C. Sturge-Weber Syndrome
D. Phacolytic Glaucoma
C
498
A finding of rubeosis iridis, elevated IOP and blurry vision is suggestive of?
A. Possner-Schlossman Syndrome
B. Aqueous Misdirection Syndrome
C. Iridocorneal Endothelial Syndrome
D. Neovascular Glaucoma
D
499
What is the management for Neovascular Glaucoma?
PRP ± Intravitral anti-VEGF
500
Why should you not give Pilocarpine in Neovascular Glaucoma?
May worsen synechial angle closure
501
What is the management for a lens subluxation glaucoma?
Lie supine + Miotics
502
What are the clinical features of Aqueous Misdirection Syndrome?
Acute highly raised IOP + Shallow AC + no pupil block
503
What viral infection is believed to be related to Iridocorneal Endothelial Syndrome?
HSV infection
504
A 32 year old woman presents with unilateral pain and blurred vision.
Slit lamp shows corneal oedema, corneal guttate. Gonioscopy shows peripheral anterior synechiae.
The tissue is shown to be corneal.
What is your DDx?
A. Cogan-Reese Syndrome
B. Neovascular Glaucoma
C. Aqueous Misdirection Syndrome
D. Chandler Syndrome
D
505
A 32 year old woman presents with unilateral pain and blurred vision.
Slit lamp shows corneal oedema, corneal guttate. Gonioscopy shows peripheral anterior synechiae.
The tissue is shown to be nodular following iris stromal tissue change.
What is your DDx?
A. Cogan-Reese Syndrome
B. Neovascular Glaucoma
C. Aqueous Misdirection Syndrome
D. Chandler Syndrome
A
506
Outline the physiological process of Meiosis.
Light/near convergence as stimuli
1) Light --> retinal ganglion cells --> Optic nerve --> Chiasm --> Exit at optic tract before LGN --> Enter dorsal midbrain --> Synapse with ipsilateral pretectal nucleus --> projections to bilateral Edinger-Westphal nuclei --> CN3 innervates the ciliary ganglion which causes sphincter pupillae and ciliary body contraction via short ciliary nerves
2) Near reflex --> visual cortex/ CN3 --> Frontal lobe eye fields --> CN3/Edinger-Westphal nucleus --> Medial recti convergence + Ciliary body contracts ciliary muscle with zonular relaxation thus lens thickens
507
Outline the physiological pathway of pupillary dilation.
1st order fibres start in hypothalamus and project down spinal cord to C8-T10
2nd order preganglionic fibres leave spinal cord, traverse over lung apex and synapse at superior cervical ganglion at carotid bifurcation
3rd order post-ganglionic fibres traverse the wall of internal carotid artery and enter globe via long ciliary nerve to innervate dilator pupillae
508
What is the shortest division of the optic nerve?
Intraocular
509
What is the longest division of the optic nerve?
Intra-orbital
510
What is the blood supply of the optic nerve?
Short posterior ciliary artery to the intraocular division
Ophthalmic artery (Pial vessels) supplies the rest
511
Which fibres give rise to Willebrand's Knee?
Inferonasal fibres of optic nerve notch forward into contralateral optic nerve before going posteriorly into contralateral tract
512
Pathology of Willebrand's knee gives rise to which type of visual defect?
Junctional scotoma
513
A middle chasmal lesion results in which visual defect?
Bitemporal hemianopia
514
Posterior chasmal lesions cause which visual field defect?
Paracentral scotoma
515
Where do the optic tracts project to?
LGN
516
Which fibres do the optic tracts carry?
Ipsilateral temporal fibres and contralateral nasal fibres
517
A lesion of the left optic tract causes which visual field defect?
Right homonymous hemianopia
518
What are the two divisions of the optic radiations?
Dorsal loop - travels through parietal lobe carrying inferior visual fields to primary visual cortex
Meyer's Loop - travels through temporal lobe carrying superior visual fields to primary visual cortex
519
A lesion of the left temporal lobe causes what visual field defect?
Right superior homonymous quadrantopia
520
A lesion of the right parietal lobe in Dorsal loop gives rise to which visual field defect?
Right inferior homonymous quandrantopia
521
What visual field defect occurs in a posterior cerebral artery occlusion?
Homonymous hemianopia with macular sparing
522
Which visual field defect is caused by a systemic hypoperfusion?
Homonymous hemianopia with central scotoma
523
Which visual stream is responsible for localising vision?
Dorsal stream --> Parietal lobe
524
Which visual stream is responsible for visual identification?
Ventral stream -> Temporal lobe
525
What investigation is used to assess visual fields?
Perimetry
526
In which directions does the visual fields extend in each area?
Superior = 50
Nasal = 60
Inferior = 70
Temporally = 90
Mnemonic: SNIT
527
An enlargement of the blindspot is termed a?
Seidel scotoma
528
What is the difference between Humphrey and Goldman?
Humphrey is automated and static cf Goldman is manual and kinetic
529
In which types of conditions are red-green loss seen?
Optic nerve problems
530
In which conditions is blue-yellow vision loss seen?
Macular problems
Glaucoma
531
What does Sherrington's Law state?
Increased innervation of an agonist results in a decreased innervation of its antagonist
532
What does Hering's Law state?
yolk muscles receive equal innervation. I.e contraction of left LR will simultaneously produce equal contraction of the right MR
533
What is the origin of SO?
Lesser wing of sphenoid
534
What is the origin of IO?
Orbital floor
535
What is the origin of LR?
Common tendinous ring
536
What is the origin of MR?
Common tendinous ring
537
Which extra ocular muscle inserts closest to the limbus?
Medial rectus
538
What is the innervation of LR?
CN 6
539
What is the innervation of SO?
CN IV
540
What is the innervation of all recti muscles?
CN III
541
What is the innervation of IO?
CN III
542
Which muscles control elevation?
SR and IO
543
Which muscles control depression of the eye?
IR + SO
544
Which muscles control Adduction of the eye?
MR + SR + IR
545
Which muscles control abduction?
LR + SO + IO
546
Which muscle controls intorsion?
SO
547
Which muscle of the eye controls extortion?
IO
548
Where are voluntary saccades initiated?
Frontal lobe, on opposite side to direction of saccade
549
Outline the process of a left saccade.
Originates in right frontal lobe frontal eye field (FEF) --> impulse reaches PONS --> activates PPRF and CN6 Nucleus --> impulse splits down to CN6 acting on ipsilateral lateral rectus (abduction) and CN3 contralaterally to medial rectus (abduction)
550
Testing the dolls head reflex and it showing as intact suggests what?
Internuclear pathways intact
551
An upbeat nystagmus shows?
Medullary lesions
552
A downbeat nystagmus shows?
Arnold-Chiari malformations
553
A latest horizontal nystagmus when one eye covered suggests?
Infantile esotropia
554
A vestibular nystagmus suggests?
Vestibular lesion thus nystagmus towards the lesion
555
What are the 3 types of optic neuritis pathologies?
Papillitis: Inflammation of the optic disc. Typically presents in post-viral children with flame hemorrhages and an oedematous optic nerve
Retrobulbar neuritis: disc is spared but the segment behind the eyeball is affected. The disc looks normal in this acute setting. More common in adults
Neuroretinitis: The disc and retina are both involved. Occurs in lyme disease and cat scratch
556
What visual field defect occurs in papilloedema?
Loss of the inferior nasal quadrant of vision
557
A patient is seen with a history of headaches and tenderness, sudden onset painful loss of vision unilaterally.
O/e the disc is chalky white.
ESR is elevated.
What is your diagnosis?
What is your management?
Anterior Ischaemic Optic Neuropathy secondary to GCA
Intravitreal Methylprednisolone
558
What is the pathophysiology of MS?
T-cell mediated type 4 autoimmune neurodegenerative disorder of myelin in the central nervous system, which leads to inflammation and sclerosis.
559
Which of the following is a mitochondrially inherited condition which affects the retinal ganglions?
A. MS
B. Leber Hereditary Optic Neuropathy
C. Neuromyelitis Optica
D. Miller-Fischer Syndrome
B
560
A fundoycopic triad of pseudo oedema, telangiectasia and tortuous vessels are seen in a young man with painless, worsening central scotoma.
What is your diagnosis?
A. MS
B. Leber Hereditary Optic Neuropathy
C. Neuromyelitis Optica
D. Miller-Fischer Syndrome
B
561
A patient presents with severe retrobulbar neuritis and muscle weakness and spasms.
IgG bodies are present against astrocytic AQP4.
What is your diagnosis?
A. MS
B. Leber Hereditary Optic Neuropathy
C. Neuromyelitis Optica
D. Miller-Fischer Syndrome
C
562
A patient presents with ataxia, areflexia, ophthalmoplegia and facial diplegia.
It is associated with GQ1B auto-antibody.
What is your diagnosis?
A. MS
B. Leber Hereditary Optic Neuropathy
C. Neuromyelitis Optica
D. Miller-Fischer Syndrome
D
563
Light to the left eye causes both eyes to constrict.
Light to the right eye does not cause constriction but if light is swung to the right, both eyes are seen to dilate.
What pathology is seen?
A right Marcus-Gunn pupil
564
Light to the left eye causes both eyes to constrict.
Light to the right eye does not cause constriction but if light is swung to the right, both eyes are seen to dilate.
Where is the lesion?
Lesion of Optic nerve between the retina and pretectal nucleus thus no light stimulus
565
A bilateral, irregular meiosis that does not react to light but accommodates suggests what lesion?
Dorsal midbrain lesion
566
A bilateral, irregular meiosis that does not react to light but accommodates suggests what type of pupil defect?
Argyll-Robertson Pupil
567
A unilateral dilated pupil that does not react to light and has a vermiform iris to movements is termed?
Adie's pupil (the dilated)
Mnemonic: aDie's pupil is Dilated
568
A unilateral dilated pupil that does not react to light and has a vermiform iris to movements is caused by what type of lesion?
Lesion of the post ciliary ganglion parasympathetic fibres
569
How do you test for an Adie's pupil?
0.1% Pilocarpine which dilates the pupil
thus treatment is low dose pilocarpine to both eyes which causes denervation hypersensitivity constriction of the Adie pupil
570
What is Holmes-Adie syndrome?
Holmes-adie syndrome is: Aldie pupil + decreased lower limb reflexes
571
What is the triad of Horner Syndrome?
Ptosis + Anhidrosis + Miosis
572
A lesion of the brain and spinal cord causing a Horner's Syndrome is which order?
1st
573
A pan coast tumour causing Horner's syndrome is what order?
2nd
574
A horner syndrome without anhidrosis caused by a CCF is what order?
3rd
575
Why is there no anhidrosis in 3rd order Horner Syndrome?
secretomotor fibers that supply the sweat glands of the face leave this pathway before the third order neuron. Therefore, lesion of the third neuron will not affect sweat gland function.
576
Which of the following will cause the normal pupil to dilate via NA-reuptake can be used to confirm a Horner Syndrome?
A. Cocaine
B. Apraclonidine
C. Hydroxyamphetamine
D. Dilute adrenaline
A - blocks NA reuptake thus enhances sympathetic effect and causes mydriasis in normal people.
Horner pupil will not dilate but normal will
577
Which of the following will cause the Horner pupil to dilate via hypersensitivity can be used to confirm a Horner Syndrome?
A. Cocaine
B. Apraclonidine
C. Hydroxyamphetamine
D. Dilute adrenaline
B - sympathetic pathway broken thus effector muscles at end of pathway are hypersensitive thus Horner eye dilates more than normal eye
578
Which of the following will cause the Horner pupil not to dilate thus can be used to confirm a 3rd order Horner Syndrome?
A. Cocaine
B. Apraclonidine
C. Hydroxyamphetamine
D. Dilute adrenaline
C
579
Which of the following will cause the Horner pupil to dilate thus can be used to confirm a 3rd order Horner Syndrome?
A. Cocaine
B. Apraclonidine
C. Hydroxyamphetamine
D. Dilute adrenaline
D
580
What condition may present as Painful Horner Syndrome?
Carotid dissection
581
What is a surgical CN3 lesion?
A lesion that affects the pupil - not reacting to light
582
Why do medical CN3 lesions tend to spare the pupils?
Microvascular problems are unlikely to effect these superficial fibers because of rich blood supply via pial vessels. Hence the pupil reflexes are spared in medical CN3 lesions.
583
What is the presentation of a CN3 lesion?
Ptosis
Ophthalmoplegia (only abduction preserved)
Down and out eye
Dilated pupil (if surgical)
584
What are the features of Weber's Stroke?
CN3 palsy and contralateral hemiparesis
585
How does a CN4 nerve lesion present?
Vertical diplopia and hypertrophia
586
What test is used to identify a CN4 lesion?
Park's Test
587
If the left eye has a CN4 lesion, what head movements exacerbate this?
Diplopia is worse on right gaze (contralateral direction)
Diplopia is worse on left head tilt (ipsilateral head tilt)
588
What is the most common cause of CN6 lesion?
Microvascular disease causing nerve ischaemia
589
How does a CN6 nerve lesion present?
Horizontal diplopia and esotropia (eye inwards)
Reduced abduction
590
Infection of ear and CN6 palsy is termed?
Gradenigo Syndrome
591
What is the communication between the CN6 nucleus and the opposite CN3 nucleus?
Median Longitudinal Fasciculus (MLF)
592
How is internuclear ophthalmoplegia caused?
Damage to the MLF q
593
On attempted left gaze, the patient is unable to adduct the right eye and there is abducting nystagmus of the left eye.
Attempted right gaze is normal.
What is the lesion?
Right MLF lesion - resulting in reduced connection between the MLF of the CN6 and CN3
594
What causes a bilateral INO?
Both MLF damaged
595
On attempted Left gaze, there is abducting nystagmus of the left eye and unable to adduct the right eye.
On attempted right gaze, there is abducting nystagmus of the right eye and unable to adduct the left eye.
What lesion is present?
BINO
596
What is the cause of one and a half syndrome?
Horizontal gaze palsy due to lesion of CN 6 nucleus or PPRF which stops functioning of ipsilateral abduction or adduction but allows contralateral abduction (as CN6 nucleus on opposite side is intact)
597
A patient presents with double vision. On attempted right gaze, the right eye does not move, nor does the left eye.
On left gaze, the left eye can abduct but the right eye will not move.
What is your diagnosis?
A. CN6 palsy
B. INO
C. BINO
D. One and a Half Syndrome
D. One and a half syndrome.
598
Bilateral lid retraction, up gaze paresis and convergence retraction nystagmus are signs of?
A. Parinaud Syndrome
B. BINO
C. INO
D. CN 6 palsy
A
599
A patient presents with diplopia towards the end of the day. Repetitive movements worsen fatigue and weakness.
What is your diagnosis?
Myaesthenia Gravis
600
A patient presents with diplopia towards the end of the day. Repetitive movements worsen fatigue and weakness.
What is your management?
ACEase inhibitors - Neostigmine
601
What gene mutation causes Myotonic Dystrophy?
CTG trinucleotide expansion on DMPK gene
602
A patient presents with a bilateral ptosis and ophthalmoplegia.
The report muscle weakness with delayed relaxation.
O/E you see christmas tree cataracts and confirmation of the ophthalmoplegia.
What is your diagnosis?
Myotonic Dystrophy
603
At birth there is a bilateral ptosis and pigmentary salt and pepper retinopathy.
What is your diagnosis?
A. Kearns-Sayre Syndrome
B. NF 1
C. Myaesthenia
D. Myotonic Dystrophy
A
604
What gene is Type 2 NF found in?
Feurofibromin 2 gene on Chromosome 22
605
What are the ophthalmological features of NF Type 1?
Optic nerve gliomas
| Iris hamartomas
606
What is the difference between a tropia and phoria?
A tropia is when the eyes are always deviated (manifest deviation)
A phoria is a more subtle deviation which is hidden by binocular fusion, and becomes apparent when this is broken during testing.
607
What is esotropia associated with?
Hypermetropia
608
What is exotropia associated with?
Myopia
609
Outline how a Hirschberg test detects a right exotropia.
Ophthalmoscope shone and corneal light reflex located.
Corneal light reflex of right eye located more medial to pupil thus outward deviation of the eyeball
610
In esotropia of the right eye, what would a cover test show?
Cover L eye, R eye moves outwards to return to normal position.
Uncover L eye = R eye moves back to esotropic position
611
In esophoria of the right eye, what would a cover test show?
Cover L eye = no change to R eye
Move cover from L eye to right eye = no movement of L eye
Moving cover from right eye back to left eye causes the right eye to move out. This is to correct the esophoria which was occurring when the right eye was covered and binocular vision was broken.
612
Duane Syndrome is caused by?
aberrant co-innervation of both the LR and MR by CN3
613
What is the most common type of Duane Syndrome? What signs are seen?
Duane 1
Abduction + Esotropia
614
Upgaze causes a clicking sensation, what is your diagnosis?
What causes this?
Brown Syndrome
Mechanical restriction of SO
615
Shortening of the muscle to strengthen to treat strabismus is what type of technique?
A. Resection
B. Recession
C. Advancement
D. Tucking
A
616
Loosening of the muscle to weaken to treat strabismus is what type of technique?
A. Resection
B. Recession
C. Advancement
D. Tucking
B
617
Strengthening of the muscle which is previously recessed to treat strabismus is what type of technique?
A. Resection
B. Recession
C. Advancement
D. Tucking
C
618
Strengthening the superior oblique muscle is what type of technique?
A. Resection
B. Recession
C. Advancement
D. Tucking
D
619
How do you manage amblyopia?
Occlusion (of good eye)
Atropine penalisation (to good eye)
620
What blood vessels supply the retina?
Inner 2/3 retina = Central retinal artery
Outer 1/3 retina = Choroidal vessels
Retinal drainage by central retinal vein
621
What artery forms an anastomosis between the central retinal artery and the choroidal vessels?
Cilioretinal artery
622
Where is the blind spot located?
Optic disc
623
How many layers does the retina have?
What are they?
Which are neurosensory?
10
Internal limiting membrane
Nerve fiber (contains ganglion cell axons)
Ganglion cell layer (contains cell bodies of ganglion cells)
Inner plexiform
Inner nuclear (contains cell bodies of glial cells and bipolar cells)
Outer plexiform
Outer nuclear (contains cell bodies of photoreceptors)
External limiting membrane
Photoreceptors
Mnemonic: In New Generation It Is Only Ophthalmologists Examine Patient Retina's
9 neurosensory; 1 RPE
624
What is the main visual pigment in rod cells?
Rhodopsin
625
Where is the highest concentration of cones?
Fovea
626
Which type of pigment is not found in the fovea?
Short iodopsin
627
What is long iodopsin responsible for?
Red vision
628
What is medium iodopsin responsible for?
Green
629
What is syneresis?
Vitreous gel becomes increasingly runny with age thus small pools of fluid within the vitreous thus can cause posterior vitreous detachment from the retina
630
How is Diabetic Retinopathy classified?
Non-Proliferative: micro aneurysms; retinal haemorrhages; venous looping
Proliferative: Any neovascularisation; vitreous haemorrhage; pre-retinal haemorrhage
Macular oedema: significant macular oedema
631
How is non-proliferative diabetic retinopathy managed?
Monitoring
632
How is proliferative diabetic retinopathy managed?
PRP
633
How is clinically significant maculopathy managed?
Macular grid laser
634
What are the stages of Hypertensive retinopathy?
Arteriolar narrowing
AV nipping OR silver wiring
Flame hemorrhages OR cotton wool spots
Disc swelling OR hard exudates OR retinal oedema
635
How do you manage hypertensive retinopathy?
Control systemic hypertension - if papilloedema/malignant hypertension, conduct emergency assessment
636
A patient presents with sudden, painless loss of vision.
RAPD and a pale retina is seen as well as a cherry red spot in the macula.
What is your diagnosis?
CRAO
637
A patient experiences a sudden painless visual field defect at altitude. You see a swollen white vessel across the retina.
What is your diagnosis?
BRAO
638
A patient presents with sudden painless loss of vision, dilation of the branches of a vessel and dot/flame haemorrhages in all 4 quadrants.
The optic disc looks swollen.
What is your diagnosis?
CRVO without ischaemia
639
A patient presents with sudden painless loss of vision, dilation of the branches of a vessel and dot/flame haemorrhages in all 4 quadrants.
The optic disc looks swollen. A RAPD is seen as well as rubeosis iridis.
What is your diagnosis?
CRVO with ischaemia
640
A patient presents with reduced painless vision, an altitudinal visual field defect and retinal haemorrhages seen in the superotemporal quadrant.
What is your diagnosis?
BRVO
641
What is the management of CRAO?
```
Ocular massage
+
IV Acetazolamide
+
AC paracentesis
```
642
What is ocular ischaemic syndrome?
Angina of the eye caused by carotid obstruction secondary to atherosclerosis
643
A patient presents with painful, gradual reduction in vision with episodes of transient vision loss and orbital aching pain.
There is a flare shown in the AC.
What is your diagnosis?
Ocular Ischaemic Syndrome
644
What genotype of Sickle Cell is most associated with ocular disease?
HbSC
645
How is diagnosis of Sickle cell made?
Haemoglobin electrophoresis
646
What is used to treat Sickle Cell Retinopathy?
Scatter laser photocoagulation
647
A young Indian male presents with some neovascularisation and a vitreous haemorrhage.
What is the diagnosis?
Eales Disease
648
A patient presents with strabismus, retinal telangiectasia and intraretinal exudation.
What is your diagnosis?
Coats Disease
649
Which investigations should you consider in suspected macular degeneration due to a patient with a central scotoma?
OCT = shows druse and sub retinal fluid
FFA = neovascularisation
650
How do you treat Dry ARMD?
AREDS2 diet (Vitamin C + E + Lutein + Zeaxanthin + Zinc)
651
How do you treat Wet ARMD?
Anti-VEGF Intravitreal injections
652
A patient presents with a scotoma and blurry vision. They say straight lines appear curved.
What is your diagnosis?
Cystoid Macular Oedema
653
How is CMO diagnosed?
OCT
654
How is CMO managed?
Steroids
± > 1/12
- Periorbital steroid injection
± >2/12
- Intravitreal or systemic steroids
±
CAi
/
anti-VEGF
655
A 50 year old man presents with sudden unilateral reduction in vision and a blindspot.
What investigation will you order?
OCT
656
A 50 year old man presents with sudden unilateral reduction in vision and a blindspot.
OCT shows sub retinal fluid.
What is your management?
Argon laser this patient has a central serous chorioretinopathy
657
What is pseudoxanthoma elasticum associated with?
Angioid streaks - atrophied streaks from the optic disc to the outer retina
658
Which conditions are associated with angioid streaks?
Mnemonic PEPSI
Pseudoxanthoma elastic; Paget's; Sickle Cell; Idiopathic
659
What is protective to degenerative myopia?
Time spent outdoors
660
What is degenerative myopia classically associated with?
Connective tissue disorders
661
What is the most common inheritance of Retinitis Pigmentosa?
AD
662
The worst forms of Retinitis Pigmentosa are inherited in which manner?
X-Linked
663
What is the most common gene mutation for Retinitis Pigmentosa?
Rhodopsin gene on Chromosome 3
664
Otoscopy shows a waxy disc with bony spicules and arteriolar attenuation.
ERG is electronegative.
What is your diagnosis?
RP
665
The presence of RP and sensorineural deafness and blindness are part of?
A. Usher Syndrome
B. Refsum Syndrome
C. Barder-Biedl Syndrome
D. Bassen Kornzweig Syndrome
A
666
The presence of RP and anosmia, peripheral neuropathy and ichthyosis are part of?
A. Usher Syndrome
B. Refsum Syndrome
C. Barder-Biedl Syndrome
D. Bassen Kornzweig Syndrome
B
667
RP associated with polydactyly and obesity is part of?
A. Usher Syndrome
B. Refsum Syndrome
C. Barder-Biedl Syndrome
D. Bassen Kornzweig Syndrome
C
668
The presence of RP featuring spinocerebellar ataxia and acanthocytosis is part of?
A. Usher Syndrome
B. Refsum Syndrome
C. Barder-Biedl Syndrome
D. Bassen Kornzweig Syndrome
D
669
A patient presents with salt and pepper retinopathy and a bulls eye maculopathy.
What is your diagnosis?
Leber Congenital Amaurosis
670
A patient presents with bilateral egg yolk macular.
ERG is normal but EOG is abnormal.
What is your diagnosis?
Best Disease
671
A patient presents with reading difficulties at the age of 14. A FFA shows a dark choroid and a beaten bronze macula.
What is your diagnosis?
Stargardt Disease
672
A patient presents with reduced visual acuity, nystagmus and iris hypopigmentation.
What is your diagnosis?
Albinism
673
On fundoscopy, a zig-zag white line is seen and small round holes can be seen.
Which form of peripheral retinal degeneration is this?
Who is it more common in?
Lattice Degeneration
Myopes and CT disorders
674
On fundoscopy, in the inferotemporal region of the fundus, a smooth elevation of the retina is seen.
What form of peripheral retinal degeneration is this?
Who is ti most common in?
Degenerative retinoschisis
Hyperopes and bilateral
675
What are the types of retinal tear?
U-shaped
Giant = extend more than 1/4
Retinal dialysis = tear of retina at ora errata
676
What is the location of retinal dialysis due to trauma?
Superonasal
677
What is the form of retinal dialysis which is idiopathic?
Inferotemporally
678
Which type of retinal tear has the highest risk to retinal detachment?
Giant
679
How is retinal dialysis treated?
Scleral buckling
680
How are U-shaped and giant retinal tears managed?
Retinopexy
681
What is the most common form of retinal detachment?
Rhegmatogenous retinal detachment
682
Which form of retinal detachment is usually seen in Diabetic Retinopathy?
Tractional
683
What is the pathophysiology retinal detachment?
NSR separates from the RPE - fluid (rhegmatogenous); traction (tractional) or failure of BRB (fluid accumulation and retinal detachment)
684
What are Shaffer Sign pathognomonic of?
Tobacco dust in the anterior vitreous following a PVD
685
What is the management of PVD?
Vigilance for RD
686
What are the management options in a vitreous haemorrhage?
Fundal view present --> PRP
Obstructed fundal view --> Intravitreal anti-VEGF
Persistent haemorrhage or associated RD --> Pars plan vitrectomy
687
What gene is associated with Retinoblastoma?
RB1 on Ch13
688
A child who is 3 presents with leukocoria, strabismus and reduced visual acuity.
O/E a white round mass is seen in the fundus.
How is this managed?
This is Retinoblastoma and the treatment is enucleation
689
A premature infant who weighs 1kg and experienced some hypoxia presents.
They were born at 28 weeks.
When should they be screened?
32 weeks
27-32 weeks or >32 weeks + <1500g = screen 4 weeks postnatally
690
A premature infant who weighs 1kg and experienced some hypoxia presents.
They were born at 26 weeks.
When should they be screened?
Screen at 30 weeks
691
A premature infant who weighs 1kg and experienced some hypoxia presents.
They are screened at 30 weeks and retinal vessels are noted to reach between the edge of the disc to the ora serrata.
What is your diagnosis?
What is your management?
Zone 2 Retinopathy of Prematurity
Zone 1 → radius 2x distance from disc to fovea with disc at centre
Zone 2 → Edge of 1 to nasal ora serrata
Zone 3 → From 2 to remaining retina
Transpupillary diode laser within 48 hours
