Ophthalmology

Question 1

Which structures produce aqueous humour?

Where does it flow?

And which structures drain aqueous humour?

Answer 1

Ciliary bodies produce aqueous humour

It flows from posterior chamber to anterior chamber

Trabecular meshwork drains aqueous humour

Question 2

Acute angle closure glaucoma - all features

Answer 2

• severe pain - 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
• dull/hazy cornea (due to corneal oedema)
• nausea/vomiting

Question 3

What is cupping?

Answer 3

Optic cup takes up more than half of the optic disc.

This could indicate glaucoma.

Question 4

Presentation of glaucoma

Answer 4

• Loss of peripheral vision (tunnel vision)
• Halos around lights at night

+ fluctuating pain, headaches, blurred vision

Question 5

Screening method for measuring intraocular pressure?

+ Gold standard investigation for measuring intraocular pressure

Answer 5

Screening: Non-contact tonometry

Gold standard: Goldmann application tonometry
(GOLD standard = GOLDmann)

Question 6

AACG - dilated or constricted pupil?

Answer 6

Semi-dilated, non-reactive pupil

Question 7

First line medical management for glaucoma

(And what does it do?)

Answer 7

Prostaglandin analogues eye drops, e.g. Latanoprost

(Causes aqueous humour to flow out of anterior chamber angle)

Question 8

Side effects of prostaglandin analogue eye drops, e.g. Latanoprost

Answer 8

• eyelash growth
• eyelid pigmentation
• iris pigmentation (browning)

Question 9

Surgical management of glaucoma

Answer 9

Trabeculectomy

(Forms a new channel through which aqueous humour can drain from the eye)

Question 10

Explain acute angle-closure glaucoma

Answer 10

Iris bulges (due to pressure)

This closes off the anterior chamber angle, where aqueous humour drains (through the trabecular meshwork)

Question 11

Diabetic retinopathy fundoscopy findings

Answer 11

Blot haemorrhage
Hard exudates
Microaneurysms
Cotton wool spots

Proliferative diabetic retinopathy:
- neovascularisation

Question 12

Hypertensive retinopathy fundoscopy findings

Answer 12

• Silver/copper wiring
• Arteriovenous nipping
• Cotton wool spots (damage to nerve fibres)
• Hard exudates
• Retinal haemorrhages
• Papilloedema

Question 13

Describe retinal detachment

Answer 13

Retina detaches from retinal pigment epithelium.

Usually due to a retinal tear, causing vitreous fluid to build up between the layers.

• causes a dense shadow starting peripherally and progressing centrally

This can effect the blood supply to the retina, making this a sight-threatening condition.

Question 14

Central retinal artery occlusion vs Central retinal vein occlusion

Answer 14

Both:
- Sudden, painless loss of vision (curtain coming down)
- RAPD

Fundoscopy:
CRAO = pale retina with a cherry-red spot at the fovea centralis + atheromatous plaques
CRVO = “blood and thunder” appearance:
- Dilated tortuous retinal veins
- Flame and blot haemorrhages
- Retinal oedema
- Cotton wool spots
- Hard exudates

Question 15

Red eye - small, fixed oval pupil, ciliary flush (congestion)

Answer 15

Anterior uveitis

• associated with AS

Question 16

Potential complication of panretinal laser photocoagulation?

Answer 16

Decreased night vision

Question 17

retinal detachment - 4 Fs

Answer 17

F Floaters
F Flashes
F Field loss
F Falling acuity

Question 18

Blurred vision - how to exclude a refractive error?`

Answer 18

Use a pinhole occluder

Question 19

Macular degeneration fundoscopy findings?

Answer 19

Drusen + pigmentary changes in macula

Question 20

Episcleritis vs scleritis

Answer 20

Scleritis is painful

Episcleritis is not (not as deep)

Question 21

Treatment for anterior uveitis

Answer 21

steroid + cycloplegic (mydriatic) drops

e.g. prednisolone acetate + cyclopentolate

Question 22

Urgent management of orbital compartment syndrome ?

Answer 22

Immediate canthotomy (decompression)

Question 23

Contact lens wearer + red painful eye

Answer 23

Urgent referral to eye casualty

• could be microbial keratitis

Question 24

blurring of small words and straight lines appearing ‘curvy’

Answer 24

Macular degeneration

Question 25

Corneal abrasion - what to prescribe ?

Answer 25

Topical chloramphenicol (antibiotic)

Question 26

Dendritic ulcer is linked with which infection?

Answer 26

Herpes simplex virus

Question 27

Eye complication in steroid use ?

Answer 27

Subcapsular cataracts

Question 28

Cataract surgery major complication?

Answer 28

Endophthalmitis - inflammation of the aqueous and/or vitreous humour

Question 29

Which investigations should be performed to confirm diagnosis of AACG?

Answer 29

Both tonometry and gonioscopy (tonometry checks intraocular pressure, gonioscopy involves slit lamp and a special lens to check the angle)

Question 30

Eczema of the nipple vs Paget's disease of the nipple

Answer 30

Eczema starts on areola Paget's starts on nipple and spreads to areola

Question 31

Describe retinitis pigmentosa

Answer 31

night blindness, further developing into tunnel vision (peripheral vision loss)

Question 32

MOA of timolol eye drops

Answer 32

decrease the production of aqueous fluid

Question 33

Distinguishing factor between scleritis and uveitis?

Answer 33

Uveitis = photophobia

Question 34

What actually are cotton wool spots?

Answer 34

Retinal infarctions

Question 35

potential complication of panretinal photocoagulation?

Answer 35

Decrease in night vision

Question 36

What is ambylopia?

Answer 36

Lazy eye. Amblyopia, just lazily ambling along.

Question 37

Complications of panretinal laser photocoagulation?

Answer 37

Reduction in visual fields (up to 50%) Also: - decrease in night vision - decreased visual acuity - macular oedema