Ophthalmology

Question 1

what are some risk factors for open angle glaucoma?

Answer 1

• increasing age
• family history
• black ethnic origin
• myopia (shortsightedness)

Question 2

what treatment is recommended for open angle glaucoma?

Answer 2

• 360 degrees selective laser trabeculoplasty
• during this, a laser is directed at the trabecular meshwork, improving drainage
• it may delay or prevent the need for eyedrops
• a second procedure may be needed at a later date

Question 3

apart from first line eye drops, what are some others than can be used in open angle glaucoma?

Answer 3

• beta blockers (eg. timolol): reduces the production of aqueous humour
• carbonic anhydrase inhibitors (eg. dorzolamide): reduces the production of aqueous humour
• sympathomimetic (eg. brimonidine): reduces the production of aqeuous fluid and increases uveroscleral outflow

Question 4

what is episcleritis usually associated with?

Answer 4

inflammatory disorders such as RA and IBD

Question 5

although less commonly due to infection, what bacteria can cause scleritis?

Answer 5

pseudomonas or s.aureus

Question 6

what are some systemic conditions associated with scleritis?

Answer 6

RA and vasculitis (particularly granulomatosis with polyangiitis)

Question 7

what is the treatment for wet AMD?

Answer 7

• anti-VEGF medications eg. ranibizumab, bevacizumab
• these block VEGF, slowing the development of new blodo vessels
• they’re injected directly into the vitreous chamber of the eye (intravitreal) once a month

Question 8

what is the macula?

Answer 8

• found in the centre of the retina
• generates high definition colour vision in the central visual field

Question 9

how does AMD present?

Answer 9

• tends to be unilateral
• gradual loss of central vision
• reduced visual acuity
• crooked or wavy appearance to straight lines (metamorphophsia)
• gradually worsening ability to read small text

Question 10

key examination findings of ARMD?

Answer 10

• reduced visual acuity
• scotoma
• amsler grid test to see distortion of straight lines
• drusen on fundoscopy

Question 11

what might recurrent cases of uveitis need?

Answer 11

DMARDs and anti-TNF medications

Question 12

how does CRAO present?

Answer 12

• sudden painless vision loss
• RAPD

Question 13

how does CRAO present on examination?

Answer 13

pale retina with cherry red spot

Question 14

how does retinal detachment present?

Answer 14

• painless
• peripheral vision loss (often sudden)
• blurred vision
• flashes or floaters

Question 15

what can abrasions due to contact lenses be associated with & what’s an important differential?

Answer 15

• pseudomonas infection
• herpes keratitis (antivirals for treatment)

Question 16

what are some different eye drops for corneal abrasions and how do they differ in viscocity?

Answer 16

• hypromellos (least viscous, effect lasts 10 minutes)
• polyvinyl alcohol drops (middle viscous)
• carbomer eye drop (most viscous, alsts around 30-60 minutes)

Question 17

how does a primary infection of herpes simplex keratitis present?

Answer 17

mild symptoms of blepharoconjunctivitis (inflammation of eyelid margins and conjunctiva)

Question 18

how can a recurrent infection of herpes keratitis present?

Answer 18

• painful
• red
• photophobia
• vesicles
• foreign body sensation
• watery discharge
• reduced visual acuity

Question 19

what are the features seen in hypertensive retinopathy?

Answer 19

• silver/copper wiring
  
  • where the walls of the arterioles become thickened and sclerosed and reflect more light on examination
• AV nipping
  
  • where the arterioles cause compression of the veins where they cross due to sclerosis and hardening of the arterioles
• cotton wool spots
  
  • fluffy white spots that appear in the retina due to nerve fibre damage from ischaemia
  • caused by ischaemia and infarction of the retina, causing damage to the nerve fibres
• hard exudates
  
  • caused by damaged vessels leaking lipids onto the retina
• retinal haemorrhages
  
  • caused by damaged vessels rupturing and releasing blood into the retina
• dot and blot haemorrhages
  
  • occur deeper, in the inner nuclear layer or outer plexiform layer
• flame haemorrhages
  
  • occur in the nerve fibre layer
• papilloedema
  
  • caused by ischaemia to the optic nerve, resulting in optic nerve oedema

Question 20

what are the 3 management options for retinal detachment?

Answer 20

• vitrectomy
• scleral buckling
• pneumatic retinopexy

Question 21

what are the treatment options for proliferative diabetic retinopathy?

Answer 21

• pan retinal photocoagulation: lasers on the retina to suppress the formation of new blood vessels
• anti-VEGF
• surgery (vitrectomy) if severe

Question 22

what are some complications of PRP?

Answer 22

• reduction in visual field, due to damage to the peripheral retina
• night vision difficulties

Question 23

what does fundoscopy examination show in retinal vein occlusion?

Answer 23

• dilated tortuous retinal veins
• flame and blot haemorrhages
• retinal oedema
• cotton wool spots
• hard exudates

Question 24

management options for CRVO?

Answer 24

• anti-VEGF therapies (eg. ranibizumab)
• dexamethasone intravitreal implant for macular oedema
• laster photocoagulation to treat new vessels/retinal neovascularisation

Question 25

what does blockage of a retinal vein cause?

Answer 25

- venous congestion in the retina - increased pressure in the retinal veins results in fluid and blood leaking into the retina, causing macular oedema and retinal haemorrhages - this results in retinal damage and vision loss

Question 26

=-[p0for patients with thyroid eye disease, which symptoms/signs should indicate the need for urgent review by an opthalmologist?

Answer 26

- unexplained deterioration in vision - change in intensity or quality of colour vision in one or both eyes - disc swelling - cornea visible when eyelids are shut - corneal opacity - globe subluxation (history of eyes suddenly popping out)

Question 27

features of thyroid eye disease?

Answer 27

- exophthalmos - conjunctival oedema - optic disc swelling - opthalmoplegia - inability to close the eyelids leading to sore, dry eyes - if severe and untreated, risk of exposure keratotherapy

Question 28

what are the causes of central/1st order neurone lesions in Horner's syndrome?

Answer 28

4S's - stroke - multiple sclerosis - swelling (tumours) - syringomyelia (cyst in spinal cord)

Question 29

what are the causes of pre ganglionic/2nd order neurone lesions in Horner's syndrome?

Answer 29

4T's - tumours (pan coast) - trauma - thyroidectomy - top rib

Question 30

what are the causes of post ganglionic/3rd order neurone lesions in Horner's syndrome?

Answer 30

4C's - carotid aneurysm - cavernous sinus thrombosis - carotid artery dissection - cluster headache

Question 31

how can you test for Horner's syndrome?

Answer 31

- **cocaine eye drops** - it acts on the eye to **stop noradrenaline re-uptake at the NMJ, therefore increasing the noradrenaline levels** - this causes a **normal eye to dilate** as **noradrenalin stimulates the dilator muscles** of the iris - in horner’s syndrome, the **nerves aren’t releasing noradrenaline/sympathetic response is loss/weakened so the dilator muscles won't respond to the cocaine and increased noradrenaline levels** - this means the pupil will be smaller (may constrict or dilate a tiny amount) - therefore an affected pupil won't dilate properly, indicating Horner's syndrome

Question 32

what is Holmes Adie pupil caused by and features?

Answer 32

- damage to the post ganglionic parasympathetic fibres - dilated - sluggish to react to light - responsive to accommodation (pupils constrict well when focusing on a near object) - slow to dilate following constriction ('tonic' pupil)

Question 33

what is Argyll-Robertson pupil found in and features?

Answer 33

- neurosyphilis - constricted pupil - accommodates when focusing on near objects - doesn't react to light - irregularly shaped

Question 34

how does anterior uveitis and acute angle closure glaucoma affect the pupil shape?

Answer 34

- **anterior uveitis** - can cause **adhesions** in the iris → irregular pupil shape - **AACG** - **ischaemic damage to the muscles** of the **iris** and an abnormal pupil shape, usually a **vertical oval**