Ophthalmology

Question 1

What is chronic (open angle) glaucoma?

Answer 1

resistance to draining of aqueous fluid in the eye, causing an increase in IOP, leading to damage to the optic nerve.

Question 2

Risk factors for chronic glaucoma? (4)

Answer 2

1. old age
2. black ethnicity
3. diabetes
4. near-sightedness

Question 3

Classical presentation of chronic glaucoma? (5)

Answer 3

1. initially asymptomatic, then develop painful red eye
2. halo around lights (worst at night)
3. peripheral vision loss (tunnel vision)
4. headache
5. nausea and vomiting

Question 4

Investigations for chronic glaucoma?

Answer 4

1. visual fields
2. fundoscopy - cupping
3. tonometry - assess pressure in eye
4. geniometry - assess draining system in the eye

Question 5

Management of chronic glaucoma

Answer 5

1. Prostaglandin analogue (latanoprost) - increase uveoscleral outflow
2. Beta blockers (reduce fluid)
3. Sympathomimetics
4. Acetazolamide (reduce fluid)
5. Surgery: trabeculoplasty

Question 6

Side effects of prostaglandin analogues (e.g. Latanoprost)

Answer 6

1. lid irritation
2. iris pigmentation
3. lid pigmentation

Question 7

Action of prostaglandin analogues in chronic glaucoma?

Answer 7

Increase the uveoscleral outflow to reduce the fluid in the eye.

Question 8

What is cataracts?

Answer 8

Opacification of the lens

Question 9

Cause of cataracts?

Answer 9

Unknown. Believed to be due to environmental damage (e.g. UV lights) and normal ageing making the lens susceptible to damage.

Question 10

Clinical presentation of cataracts? (5)

Answer 10

1. gradual vision loss
2. starbursts
3. colour changes (appearing more yellow/brown)
4. blurred vision
5. loss of red reflex (white/grey pupil)

Question 11

Diagnosis of cataracts? (3)

Answer 11

1. Reduced visual acuity
2. Absent red reflex
3. further investigations with slit lamp

Question 12

Management of cataracts? (mild and severe)

Answer 12

mild - no management

severe - surgical lens replacement

Question 13

Complication of surgical lens replacement for cataracts? (2)

Answer 13

1. endophthalmitis (infection of the fluid in the eye)

2. scar tissue behind the lens implant

Question 14

What is congenital cataracts? How is it diagnosed?

Answer 14

1. Cataracts arising in newborns.

2. Screened for during the newborn examination using the red-reflex.

Question 15

Risk factors for cataracts? (6)

Answer 15

1. age
2. smoking
3. diabetes
4. trauma
5. infection
6. steroids

Question 16

What is age related macular degeneration?

Answer 16

Degeneration to the macula.

Question 17

What are the risk factors of AMD?

Answer 17

1. age
2. family history
3. white/Chinese ethnicity

Question 18

Clinical presentation of AMD? (4)

Answer 18

1. painLESS gradual loss of vision
2. central scotoma
3. straight lines appear wavy
4. reduced visual acuity

Question 19

Diagnosis of AMD?

Answer 19

1. visual fields testing
2. fundoscopy - drusen, neovascularisation (wet)
3. Amsler grid

Question 20

2 main types of AMD? What do they mean?

Answer 20

1. wet - neovascularisation (vessels from the choroid penetrate through the retina)
2. dry - no new vessels

Question 21

Characteristic features of AMD on fundoscopy?

Answer 21

1. Drusen
2. neovascularisation
3. retinal oedema
4. atrophy

Question 22

Management of AMD? (wet and dry)

Answer 22

Dry - no management. Lifestyle advice (stop smoking, control bp, vitamins)
Wet - anti-VEGF once a month

Question 23

What is drusen?

Answer 23

Yellow deposits seen on fundoscopy caused by build up of proteins and lipids between Bruch’s and RPE. Small amounts can be normal.

Question 24

What causes retinal detachment?

Answer 24

Tears in the retina causes vitreous fluid to separate the retina from the underlying choroid.

Question 25

Risk factors for retinal detachment? (5)

Answer 25

1. diabetes 2. short-sightedness 3. Family history 4. trauma 5. cancer

Question 26

Clinical presentation of retinal detachment? (4)

Answer 26

1. shadow in the peripheral vision 2. floaters/flashers 3. blurred/distorted vision 4. painless

Question 27

Diagnosis of retinal detachment?

Answer 27

1. fundoscopy 2. CT/MRI to rule out cancer/foreign body 3. slit lamp

Question 28

Management of retinal detachment?

Answer 28

1. Laser photocoagulation (to reattach the retina) 2. Vitrectomy (insertion of gas, silicon oil or air into vitreous body) 3. Silicon buckle (around the eye to reattach)

Question 29

Complications of retinal detachment?

Answer 29

Sight threatening

Question 30

What is central retinal artery occlusion?

Answer 30

Occlusion of a retinal artery commonly due to thrombosis, causing retinal ischaemia.

Question 31

Central retinal artery occlusion is commonly associated with what condition?

Answer 31

Giant Cell Arteritis

Question 32

Clinical presentation of Central retinal artery occlusion?

Answer 32

1. complete acute loss of vision (grey curtains) 2. painLESS 3. RAPD

Question 33

What is seen during the swinging light test in a patient with Central retinal artery occlusion?

Answer 33

RAPD - pupil dilates when light is shone and no consensual reflex

Question 34

Risk factors for Central retinal artery occlusion?

Answer 34

Same as cardiovascular disease risk factors

Question 35

Management of Central retinal artery occlusion?

Answer 35

1. High dose steroids (IV methylprednisolone) - GCA associated 2. Intra-arterial Tissue plasminogen activator (tPA) (e.g. Alteplase) 3. surgical management

Question 36

Which vessel is the tPA injected into for Central retinal artery occlusion?

Answer 36

Ophthalmic artery

Question 37

Classical features of Central retinal artery occlusion on fundoscopy?

Answer 37

1. cherry red spot | 2. pale retina

Question 38

Long term management of Central retinal artery occlusion?

Answer 38

Address cardiovascular risk factors and start secondary prevention (e.g., antiplatelets, statins, antihypertensives)