Ophthalmology

Question 1

What is the definitive management of acute angle-closure glaucoma?

Answer 1

laser peripheral iridotomy

Question 2

What is the medical management of acute angle-closure glaucoma?

Answer 2

Combination of:
Direct parasympathetic (e.g. pilocarpine
A beta-blocker (e.g. timolol)
Alpha-2 agonist

OR IV Acetazolamide

Question 3

What is the management of age-related macular degeneration?

Answer 3

Urgent ophthalmologist referral (1 week)
Wet: anti-VEGF
Dry: antioxidants

Question 4

What conditions are associated with anterior uveitis?

Answer 4

HLA-B27
- ankylosing spondylitis
- reactive arthritis
- ulcerative colitis, Crohn’s disease
- Behcet’s disease
- sarcoidosis: bilateral disease may be seen

Question 5

What is the management of anterior uveitis?

Answer 5

URGENT ophthal review
Cycloplegics (e.g. atropine and cyclopentolate)
Steroid eye drops

Question 6

What is the management of blepharitis?

Answer 6

1) Hot compresses BD
2) Lid hygiene
3) Artificial tears

Question 7

What is the management of retinal vein occlusion?

Answer 7

1) macular oedema - intravitreal anti-vascular endothelial growth factor (VEGF) agents
2) retinal neovascularization - laser photocoagulation

Question 8

What are fundoscopy findings for central retinal vein occlusion?

Answer 8

1) widespread hyperaemia
2) severe retinal haemorrhages - ‘stormy sunset’

Question 9

What are fundoscopy findings for central retinal artery occlusion?

Answer 9

‘cherry red’ spot on a pale retina

Question 10

What is the management of a corneal abrasion?

Answer 10

a topical antibiotic (prevent infection)- chloramphenicol ointment

Question 11

What is the management of diabetic retinopathy?

Answer 11

Maculopathy:
intravitreal VEGF

Non-proliferative:
- Regular observation
- if severe/very severe consider panretinal laser photocoagulation

Proliferative:
- panretinal laser photocoagulation
- intravitreal VEGF
- if severe or vitreous haemorrhage: vitreoretinal surgery

Question 12

How can you differentiate between scleritis and episcleritis?

Answer 12

1) phenylephrine drops: phenylephrine blanches the conjunctival and episcleral vessels but not the scleral vessels
2) Episcleritis is classically not painful whereas scleritis is

Question 13

What is the management of episcleritis?

Answer 13

1) conservative- artificial tears may sometimes be used

Question 14

How does HSV keratitis present?

Answer 14

Dendritic corneal ulcer

Question 15

What is the management of HSV keratitis?

Answer 15

Topical aciclovir

Question 16

What is the management of Herpes zoster ophthalmicus?

Answer 16

PO antivirals for 7-10 days +/- topical corticosteroids

Question 17

What are the features of Horners syndrome?

Answer 17

Miosis
Anhidrosis
Ptosis
Enopthalmos

Question 18

What is the management of keratitis?

Answer 18

1) Stop using contacts
2) Topical abx
3) cycloplegic for pain relief
e.g. cyclopentolate

Question 19

What are the causes of optic neuritis?

Answer 19

1) MS (most common)
2) Diabetes
3) Syphilis

NOTE: of prognosis MRI: if > 3 white-matter lesions, 5-year risk of developing multiple sclerosis is c. 50%

Question 20

What is the investigation for optic neuritis?

Answer 20

MRI of the brain and orbits with gadolinium contrast is diagnostic in most cases

Question 21

What is the management of optic neuritis?

Answer 21

high dose steroids

Question 22

How do you differentiate orbital from pre-septal cellulitis?

Answer 22

reduced visual acuity, proptosis, ophthalmoplegia/pain with eye movements are NOT consistent with preseptal cellulitis

Question 23

What is the management of primary open angle glaucoma?

Answer 23

1st line: offer 360° selective laser trabeculoplasty (SLT) first-line to people with an IOP of ≥ 24 mmHg

next-line: prostaglandin analogue (PGA) eyedrops

the next line of treatments includes:
- beta-blocker eye drops
- carbonic anhydrase inhibitor eye drops
- sympathomimetic eye drops

Question 24

What are the fundoscopy signs of primary open angle glaucoma?

Answer 24

1. Optic disc cupping
2. Optic disc pallor
3. Bayonetting of vessels
4. Additional features - Cup notching, Disc haemorrhages

Question 25

What are the causes of Relative afferent pupillary defect?

Answer 25

1) retina: detachment 2) optic nerve: optic neuritis e.g. multiple sclerosis

Question 26

What are the ocular manifestations of rheumatoid arthritis?

Answer 26

1) keratoconjunctivitis sicca (most common) 2) episcleritis (erythema) 3) scleritis (erythema and pain) 4) corneal ulceration 5) keratitis also some Iatrogenic 1) steroid-induced cataracts 2) chloroquine retinopathy

Question 27

What are the risk factors for scleritis?

Answer 27

1) rheumatoid arthritis (most commonly) 2) SLE 3) sarcoidosis 4) granulomatosis with polyangiitis

Question 28

What is the management of scleritis?

Answer 28

1) Same day ophthalmologist assessment 2) PO NSAIDS 1st line 3) PO glucocorticoids if severe 4) immunosuppressive drugs if resistant

Question 29

How does orbital lymphoma present?

Answer 29

Orbital lymphoma could present like a chronic unilateral conjunctivitis resistant to treatment

Question 30

What is the other term for stye?

Answer 30

hordeolum externum/inturnum

Question 31

What is drusen?

Answer 31

yellow round spots in Bruch's membrane- small accumulations of extracellular material between Bruch's membrane and the retinal pigment epithelium of the eye

Question 32

What test must you do in someone with chorioretinitis?

Answer 32

HIV test- most common cause CMV which affects up to 40% of AIDS pts

Question 33

What are causes of tunnel vision?

Answer 33

papilloedema glaucoma retinitis pigmentosa choroidoretinitis optic atrophy secondary to tabes dorsalis hysteria

Question 34

What is the most common cause of blurring of vision again years after cataracts surgery?

Answer 34

posterior capsule opacification

Question 35

What is the management of orbital compartment syndrome?

Answer 35

urgent lateral canthotomy (before diagnostic imaging) to decompress the orbit

Question 36

What is the criteria for the certification of blindness?

Answer 36

The criteria for the certification of blindness (severely sight impaired) is <3/60 with a full visual field

Question 37

How is someone certified as legally blind?

Answer 37

Only consultant ophthalmologists (rather than GPs) are allowed by law to certify patients as legally blind or partially sighted in the UK