Ophthalmology

Question 1

Causes of lost red reflex

Answer 1

Paediatric - retinoblastoma

Adults - cataracts, retinal detachment, corneal scarring

Question 2

Posterior synechia

Answer 2

adhesion between the iris and the cornea, seen on ophthalmoscopy (examination of front of the eye)

Question 3

What is the difference between ophthalmoscopy and fundoscopy?

Answer 3

Ophthalmoscopy - examination of the front of the eye

Fundoscopy - examination of the back of the eye

Question 4

Causes of retinal haemorrhage

Answer 4

Diabetic retinopathy
Hypertensive retinopathy
Increased ICP - increased pressure causes papilloedema which can cause haemorrhage
Bleeding disorders - cofactor deficiencies, haemophilia
Malignancy
Retinal vein occlusion

Question 5

What is Poucher Syndrome?

Answer 5

Fat emboli from severe fractures travel to the eye causing retinal haemorrhages
Will see retinal haemorrhages and white spots on fundoscopy

Question 6

What are signs of hypertensive retinopathy on fundoscopy?

Answer 6

Generalised vessel thinning
Copper sign
Silver sign (when more severe)
AV nipping

Question 7

What are the signs of malignant hypertensive retinopathy on fundoscopy?

Answer 7

Papilloedema
Exudate
Haemorrhage

Question 8

What must you rule out if you see brain and retinal haemorrhages in a baby?

Answer 8

Shaken baby syndrome

Question 9

What are the two types of squint?

Answer 9

Isotropia - eye draws in, more common in children

Esotropia - eye draws out, more common in adults

Question 10

Define diplopia

Answer 10

Double visions

Question 11

Define confusion

Answer 11

Occurs in severe squints - patients will see two images in one visual field

Question 12

Define hypermetropia

Answer 12

Long sighted

Question 13

Define myopia

Answer 13

Short sighted

Question 14

Explain the process of accommodation

Answer 14

Change to the shape of the lens to increase its power, allowing light to converge on the retina to see the image

Question 15

Explain the swinging light test

• what abnormality is it looking for?
• describe normal and abnormal results

Answer 15

Test for pupillary reflex by swinging light source from one eye to the other and back again

Assessing for - Relative Afferent Pupillary Defect - caused by optic neuritis (commonly secondary to MS)

Normal - both pupils will constrict regardless of which eye the light is shone in

RAPD - there is normal constriction in both pupils when the light is shone in the normal eye but when light is shone in the abnormal eye there is reduced/no constriction (practically this looks like the pupils dilate when the light is shone in the abnormal eye)

Question 16

Describe a relative afferent pupillary defect

Answer 16

There is normal constriction in both pupils when the light is shone in the normal eye but when light is shone in the abnormal eye there is reduced/no constriction (practically this looks like the pupils dilate when the light is shone in the abnormal eye)

Question 17

List some differentials for a fixed dilated pupil

Answer 17

Drugs - eg: tropicamide
Iris trauma
Acute glaucoma
CN3 compression (emergency - surgical 3rd nerve palsy)

Question 18

Describe an efferent pupillary defect

Answer 18

Fixed, dilated pupil that does not react to light

Question 19

Describe a holmes-adie pupil

Answer 19

A tonic pupil - dilated pupil with no response to light and sluggish accommodation

Question 20

Describe an argyll-robertson pupil

Answer 20

Prostitute’s pupil - accommodates but doesn’t react: small irregular pupils that accommodate but do not react to light

Question 21

List the features of Horner’s syndrome

Answer 21

Ptosis
Anhydrosis
Miosis - small pupil

Question 22

What is the difference between a medical and a surgical 3rd nerve palsy?

Answer 22

Pupil sparing in medical 3rd nerve palsy (usually caused by DM)

Question 23

What is holmes-adie syndrome?

Answer 23

Triad of - tonic pupil + absent lower limb reflexes + hypotension

Question 24

List some causes of Horner’s syndrome

Answer 24

MS
Pancoast tumour
Trauma
Cavernous sinus thrombosis

Question 25

List some concerning signs in a patient presenting with a red eye

Answer 25

Photophobia Poor vision Corneal damage - fluorescein staining Abnormal pupil

Question 26

Name the 4 subtypes of glaucoma

Answer 26

primary angle closure (acute) intermittent angle closure (subacute) chronic angle closure primary open angle

Question 27

What is glaucoma?

Answer 27

A group of eye diseases causing progressive optic neuropathy with increased intraoccular pressure

Question 28

Name some drugs which can cause acute closed angle glaucoma

Answer 28

Anti-cholinergics Sympathomimetics TCAs Anti-histamines

Question 29

Which drugs is a big risk factor for simple (open angle) glaucoma?

Answer 29

Steroids

Question 30

What is Uveitis?

Answer 30

Inflammation of the iris, ciliary body and choroid causing red eye and blurred vision

Question 31

Define: dyschromatopsia

Answer 31

loss of colour discrimination

Question 32

what is the most common cause of optic neuritis?

Answer 32

MS

Question 33

Describe the presentation of retinal detachment (HINT: think 4Fs)

Answer 33

Floaters Flashes Field loss Fall in acuity

Question 34

Is retinal detachment painful?

Answer 34

No

Question 35

List the main causes of transient visual loss

Answer 35

``` Anterior ischaemia optic neuropathy (AION) Optic neuritis Vitreous haemorrhage Central retinal artery occlusion Central retinal vein occlusion Branch vessel occlusion Retinal detachment ```

Question 36

List the main causes of sudden vision loss

Answer 36

``` Vascular - TIA, migraine MS Subacute glaucoma Papilloedema GCA ```

Question 37

List some common causes of gradual vision loss

Answer 37

Diabetic retinopathy Macular degeneration (age-related) Cataracts Open angle glaucoma

Question 38

List some rare causes of gradual vision loss

Answer 38

Retinitis pigmentosa Hypertension Optic atrophy

Question 39

Define: strabismus

Answer 39

Squint

Question 40

Define: amblyopia

Answer 40

Lazy eye

Question 41

Define: myopia

Answer 41

Short sighted

Question 42

Define: hypermetropia

Answer 42

Long sighted

Question 43

Define: presbyopia

Answer 43

Age related visual changes

Question 44

List some causes of floaters

Answer 44

Retinal detachment Vitreous haemorrhage DM HTN

Question 45

List some causes of haloes

Answer 45

Cataracts - esp. if worsened by looking at the sun Acute glaucoma Migraine

Question 46

List some causes of flashes

Answer 46

Retinal detachment | Migraine

Question 47

What are the effects of anti-muscarinic eye drops (such as topicamide)?

Answer 47

Pupil dilation Loss of light reflex Blurred vision

Question 48

What are the effects of sympathomimetic eye drops (such as phenylephrine)?

Answer 48

Increase aqueous outflow Decrease aqueous production Pupil dilation

Question 49

What are the effects of miotics (eg: pilocarpine) eye drops and when are they prescribed?

Answer 49

Constrict the pupil via muscarinic agonism | Given in acute closed angle glaucoma