Ophthalmology

Question 1

What are the features and treatment of open angle glaucoma

Answer 1

Aysymptomatic, blurred vision, halos around lights

goldmann applanation tonometry- gold standard

Management
360 degree selective laser traveculoplasty
Prostaglandin analogue eye drops - lantanoprost

Question 2

What are the features and treatment of acute angle closure glaucoma

Answer 2

Emergency
Severe painful red eye, blurred vision, halos around lights, headache, nausea and vomiting, hazy cornea, mid dilated pupil (fixed size)

Management
Lie patient back on a pillow
Pilocarpine eye drops to constrict pupil

Acetazolamide 500mg orally

Question 3

What are the features of macular degeneration

Answer 3

Drusen - yellow on fundoscpy

Wet AMD- new vessels develop and leak fluid causing oedema - VEGF

Presentation
Visual changes, reduced acquity, crooked or wavy lines

Wet AMD more acute presentation than dry

Management
Dry AMD- monitor and lifestyle

Wet AMD- anti VEGF injections

Question 4

What are the features of diabetic retinopathy

Answer 4

Background- microaneurysms, retinal haemorrhages, hard exudates, cotton wool spots

Pre-proliferative- venous beading, multiple blot haemorrhages, intra retinal microvascular abnormality

Proliferative- neovascularisation and vitreous haemorrhage

Management
Non prolif- monitor
Prolif- Pan retinal photocoagulation
Anti VEGF
Surgery

Question 5

What are the features of hypertensive rentiopathy

Answer 5

Damage to small blood vessels of retina
Silver wiring. copper wiring
AV nipping
Hard exudates
Retinal haemorrhages
Papilloedema

Keith wegner classification
1. mild narrowing
4. Papilloedema

Question 6

What is endopthalmitis

Answer 6

Inflam of inner contents of eye due to recent surgery- treated with intravitreal antibiotics

Question 7

What happens in a third nerve palsy

Answer 7

Ptosis, dilated and unreactive pupil, divergent strabismus (squint)

Eye will be down and out

Associated with
Cavernous sinus thrombosis, posterior communicating artery aneurysm, raised ICP

Question 8

What are the features of Horner’s syndrome

Answer 8

Ptosis, miosis, anhidrosis
Damage to sympathetic nervous system

Location of horners syndrome decided by the anhidrosis location

Central lesion - 4S
Stroke, MS, Swelling, Syringomyelia

Pre-ganglionic 4T
Tumour (Pancoast), trauma, thyroidectomy, top rib

Post ganglionic 4C
Carotif aneurysm
Carotid artery dissection
Cavernous sinus thrombosis
Cluster headache

Cocaine eye drops used to test for horner’s syndrome

Question 9

What is Holmes-Adie pupil

Answer 9

Damage to post ganglionic parasympathetic fibres- unknown cause

Dilated pupil, slow to dilate after constriction and slow to react to light
Absent knee and ankle reflexes too

Question 10

Describe the features of peri orbital cellulitis

Answer 10

Eyelid/ skin infection of orbital septum
Swollen hot red skin around eye
Needs to be distinguished from orbital cellulitis which is an emergency

Treat with systemic antibiotics as it can develop into orbital cellulitis

Difference between it and orbital cellulitis

Orbital cellulitis will cause pain with eye movement, proptosis and abnormal pupils

Question 11

What are the treatment options for conjunctivitis

Answer 11

Resolves in 1-2 weeks

Chlorapahenicol or fusidic acid eye drops for bacteria

Neonates need urgent ophthalmology assessment- gonococcal infection

Question 12

What are the features of anterior uveitis

Answer 12

Inflam of the anterior uvea - iris, ciliary body, choroid

Autoimmune, infection, trauma etc

Inflam of anterior chamber- neutrophils etc gather causing Hypopyon (fluid collection of inflam cells)

Associations
Seronegative spondyloarthropathies
IBD
Sarcoid
Bechets

Painful red eye, photophobia, reduced acuity, tears , ciliary flush, mitosis

Urgent assessment, steroids and cytoplegins to dilate pupil

Question 13

What are the features of episcleritis

Answer 13

Bengin and self limiting
Common in RA and IBD- young adults

Acute unilateral onset, red patch in lateral sclera, no pain, no photophobia and normal acuity

Phyelephrine eye drops will cause redness to disappear in episcleritis but not scleritis

Analgesia and lubricating eye drops

Question 14

What are the features of scleritis

Answer 14

Inflam of sclera - white part
Associated with RA, vasculitis (granulomatosis with polyangitis) - think CT

Red inflamed sclera, gradual onset, severe pain, pain with eye movement, tears, photophobia

Treatment
NSAID’s
Steroids
Immunosuppression

Question 15

What are the features of posterior vitreous detachment

Answer 15

Common in older age
Floaters and flashed, blurred vision or asymptomatic

No treatment needed but can predispose to retinal tears and detachment so need to exclude these

Question 16

What are the features of retinal detachment

Answer 16

Painless, sudden loss of vision- particularly peripheral (curtain coming down), flashes and floaters

Management
Laser therapy
Cryotherapy
Virectomy - keyhole surgery
Scleral buckling

Question 18

What are the features of Retinal vein occlusion

Answer 18

Blood clot in retinal veins- increased pressure c causes fluid leak and macular oedema- retinal ischaemia can cause neovascularisation

Risk factors
HTN, HCL, Diabetes, Smoking, myeloma, myleoproliferative disorders, inflam conditions

Painless blurred vision, branch retinal vein occlusion- only vision loss in one area of retina

Fundoscopy- dilated retinal veins, flame and blot haemorrhages- blood and thunder, cotton wool spots

Management
Anti VEGF
Laser photocoag

Question 19

What are the features of a central retinal artery occlusion

Answer 19

Branch of ophthalmic artery of internal carotid

Common cause- atherosclerosis or GCA

Sudden painless vision loss
RELATIVE AFFERENT PUPILLARY DEFECT

Pale retina with a cherry red spot

Ocular massage
Anterior chamber paracentesis
Inhaled carbogen/ sublingual GTN
IV actazolamide/ mannitol
Topical timolol