Ophthalmology Conditions

Question 1

how does blepharitis present?

Answer 1

gritty eyes

bilateral

Question 2

anterior ve posterior blepharitis?

Answer 2

anterior = usually a bacterial infection (Staph)
dandruff in eyelashes
posterior = meibomian gland dysfunction, glands become blocked so tear film becomes unstable

Question 3

how is blepharitis managed?

Answer 3

primarily targeted at lid hygiene
warm compress
artificial tears for comfort

Question 4

bacterial conjunctivitis?

Answer 4

thick sticky discharge
red eye
usually unilateral but progresses to bilateral
papillae

Question 5

what usually causes bacterial conjunctivitis?

Answer 5

staph aureus
strep pneumonia
h. influenzae (esp children)

Question 6

how is bacterial conjunctivitis managed?

Answer 6

usually self limiting

chloramphenicol drop if severe or persistent

Question 7

how does viral conjunctivitis present?

Answer 7

watery discharge
may have had a recent cold/URTI
follicles on lids

Question 8

what usually causes viral conjunctivitis?

Answer 8

adenovirus

Question 9

how is viral conjunctivitis managed?

Answer 9

self limiting but very contagious

good lid hygiene

Question 10

how does chlamydial conjunctivitis present?

Answer 10

on-going red eye (2 or more weeks)
rice grain follicles on lids
unresponsive to previous treatment

Question 11

how is chlamydial conjunctivitis managed?

Answer 11

oxytetracycline

Question 12

what condition may present with blue/green discolouration in the eye?

Answer 12

keratitis

Question 13

how does keratitis present?

Answer 13

pain
usually unilateral
redness
photophobia
reduced vision
epiphora

Question 14

characteristic feature of bacterial keratitis? how is this managed?

Answer 14

hypopyon
required debridement and admission for hourly drops of fluroquinolones
requires corneal scrape to determine antibiotic sensitivities

Question 15

what usually causes viral keratitis and how does this present?

Answer 15

adenoviral
herpes simplex = terminal end bulbs
herpes zoster = involvement of ophthalmic division of the trigeminal nerve (unilateral vesicular rash, Hutchinson’s sign)

Question 16

how is viral keratitis managed?

Answer 16

HSV = acyclovir
HZ = ocular lubricants and systemic pain relief

Question 17

main risk factor for keratitis?

Answer 17

contact lens wearer

Question 18

how does anterior uveitis present?

Answer 18

pain
circumlimbal redness
reduced vision (especially accommodation)
photophobia (can be recurring)

Question 19

what are the 5 types of anterior uveitis?

Answer 19

autoimmune
infective (HSV, HZ)
malignancy
trauma
idiopathic

Question 20

which autoimmune conditions are associated with anterior uveitis?

Answer 20

reiters (reactive arthritis)
UC
ankylosing spondylitis
sarcoidosis

Question 21

what is reiters syndrome?

Answer 21

reactive arthritis with triad

• uveitis
• urethritis
• arthritis

Question 22

signs of anterior uveitis on investigation?

Answer 22

cells and flare in anterior chamber seen on slit lamp investigation
keratic precipitates
hypopyon
synechiae (misshapen pupil)

Question 23

how is anterior uveitis managed?

Answer 23

topical steroids (prednisolone acetate) and cyclopentolate

Question 24

how does cataract present?

Answer 24

gradual deterioration (over several years) in vision
glare
painless
opacity in the lens

Question 25

what can cause cataract?

Answer 25

most are age related congenital traumatic drug induced

Question 26

how is cataract managed?

Answer 26

surgery | lens replacement

Question 27

what is glaucoma?

Answer 27

group of diseases characterised by progressive neuropathy resulting in characteristic visual field defects due to damage to individual bundles of nerve fibres in the optic nerve head)

Question 28

what increases risk of angle closure glaucoma?

Answer 28

+ve family history Chinese ethnicity shallow anterior compartment hypermetropic eye prescription

Question 29

how does angle colure glaucoma present?

Answer 29

``` sudden pain nausea vomiting often in the evening pupil mid-dilated redness cells and flare very high intraocular pressure (40+ mmHg) ```

Question 30

how is angle closure glaucoma managed?

Answer 30

pilocarpine and acetazolamide | peripheral iridotomy

Question 31

what are the important 3 Cs in assessing glaucoma?

Answer 31

contour colour cup (when looking at the optic disc)

Question 32

what are the 3 classifications of diabetic retinopathy?

Answer 32

no retinopathy non-proliferative (mild, mod, severe) proliferative

Question 33

describe the 3 stages of diabetic retinopathy

Answer 33

background retinopathy = microaneurysms, microhaemorrhages, hard exudates pre-proliferative = cotton wool spots, dot and blot haemorrhages, abnormalities in venous calibre proliferative = new vessel formation on fundus, can have rubeosis iridis (new vessels on the irido-corneal angle)

Question 34

how is diabetic retinopathy managed?

Answer 34

optimise medical management of diabetes lasers (sacrifice peripheral retina to maintain central vision) surgery (vitrectomy) - to prevent traction on new blood vessels causing haemorrhage

Question 35

dry vs wet macular degeneration?

Answer 35

``` dry = most common, no treatment but less severe than wet, drusen visible on examination wet = sudden loss of central vision, distortion of straight lines, haemorrhage and exudates ```

Question 36

risk factors for ARMD?

Answer 36

female Caucasian age smoking

Question 37

treatment for wet ARMD?

Answer 37

anti VEGF injections

Question 38

how does retinal detachment present?

Answer 38

sudden reduced vision like veil/curtain coming down flashing lights floaters painless may have history of trauma may have RAPD detachment is often visible on examinaiton

Question 39

how is retinal detachment treated?

Answer 39

emergency surgery

Question 40

how does central retinal artery occlusion present?

Answer 40

``` sudden painless loss of vision RAPD may have carotid artery disease cherry red spot rarely recovers ```

Question 41

how does branch retinal vein occlusion?

Answer 41

may be asymptomatic or be aware of a blind spot | often history of uncontrolled hypertension

Question 42

how does central retinal vein occlusion present?

Answer 42

visual loss

Question 43

how is central retinal vein occlusion managed?

Answer 43

anti VEGF | address risk factors

Question 44

what is amaurosis fugax?

Answer 44

transient central retinal artery occlusion transient complete loss of vision short duration (few mins) followed by a full recovery

Question 45

how does giant cell arteritis present?

Answer 45

headache jaw claudication scalp tenderness malaise can affect the eyes - arteritic ischaemic optic neuropathy (AION) - non-arteritic ischaemic optic neuropathy (NAION)

Question 46

how does AION present?

Answer 46

sudden visual loss (severe) | pale, swollen optic disc

Question 47

how is AION managed?

Answer 47

irreversible but emergency treatment with steroids to prevent bilateral vision loss

Question 48

how does NAION present?

Answer 48

hyperaemic swelling altitudinal visual field defect atherosclerosis

Question 49

how is NAION managed?

Answer 49

treat the cause

Question 50

what is papilloedema and how does it present?

Answer 50

``` optic disc swelling secondary to raised ICP nausea vomiting headaches transient visual loss enlarged blind spot may have CN VI palsy due to raised ICP usually in young females with high BMI ```

Question 51

how is papilloedema managed?

Answer 51

``` identify cause (usually benign intracranial hypertension) best treatment = weight loss acetazolamide also an option ```

Question 52

what condition is the patient likely to have is they have optic neuritis?

Answer 52

multiple sclerosis

Question 53

how does 4th nerve palsy present?

Answer 53

will struggle to focus down and in (think walking downstairs while reading)

Question 54

how will a 6th nerve palsy present?

Answer 54

poor abduction of eye

Question 55

common story in sub-conjunctival haemorrhage?

Answer 55

red eye noticed it waking up this morning no pain normal vision