Ophthalmology Investigations and Management

Question 1

Neonatal bacterial conjunctivitis

Answer 1

Refer all cases to ophthalmology

Question 2

Bacterial conjunctivitis management

Answer 2

Supportive treatment
Swab (only if recurrent and suspect chlamydia)
Topical antibiotic (chloramphenicol)

Avoid chloramphenicol if history of aplastic anaemia or allergy

Question 3

Bacterial keratitis management

Answer 3

Admission for hourly drops

Daily review

Question 4

Herpes simplex keratitis

Answer 4

Topical aciclovir

Question 5

Acanthamoeba keratitis investigation

Answer 5

Contact lens culture

Question 6

Orbital cellulitis investigation

Answer 6

CT scan

Question 7

Orbital cellulitis management

Answer 7

Broad spectrum AB and monitor closely

Sometimes an abscess will require drainage

Question 8

Endophthalmitis management

Answer 8

Intravitreal amicakin/certazidime/vancomycin
Topical antibiotics
Maybe systemic antibiotics

Question 9

Management of toxoplasmosis reactivation

Answer 9

Systemic treatment if sight threatening

Question 10

Bacterial keratitis investigation

Answer 10

Corneal scrape

Question 11

Endophthalmitis investigation

Answer 11

Aqueous/vitreous culture

Question 12

Acanthamoeba investigations

Answer 12

Microscopy/culture

Question 13

Investigations for toxoplasma/toxocara

Answer 13

Serology

Question 14

Chlamydial conjunctivitis management

Answer 14

Topical oxytetracycline

Oral azithromycin for genital infection

Question 15

Bacterial keratitis management

Answer 15

4-quinolone (ofloxacin)
Gentamicin and cefuroxime
(Think this is topical but not sure)

Question 16

Diabetic retinopathy management

Answer 16

Optimise medical management
Laser (pan-retinal photocoagulation, macular grid)
Surgery (vitrectomy for haemorrhage)
Rehabilitation (blind/partially sighted)

For maculopathy can also do anti-VEGF injection

Question 17

Thyroid eye disease management

Answer 17

Control thyroid dysfunction
Lubricants
Surgical decompression

Question 18

Open angle glaucoma management

Answer 18

Prostanoids (latanoprost)
Beta blockers (timiolol)
CA inhibitors (dorzolamide)
Alpha2 agonists (brimonidine)
Parasympathomimetic (pilocarpine)
Combo

Question 19

Open angle glaucoma investigation

Answer 19

Tonometry

Question 20

Eye dilation medication

Answer 20

Mydriatics (parasympathetic blockers e.g. tropicamide)

Sympathomimetics e.g. phenylephrine

Question 21

Orbital blowout fracture investigation

Answer 21

CT

Question 22

Orbital blowout fracture management

Answer 22

Fracture reduction and muscle release

Question 23

Management of hyphaema

Answer 23

REFER

Question 24

Optic nerve avulsion management

Answer 24

Nothing, blindness is irreversible

Question 25

Penetrating injury with leak investigation

Answer 25

Seidels test

Question 26

Intra-ocular foreign body investigation

Answer 26

X-ray

Question 27

Chemical injury management

Answer 27

``` Thorough irrigation Quick history Check toxbase if available Check pH Irrigate with 2L of saline or until pH normal Assess at slit lamp ```

Question 28

Idiopathic intracranial hypertension investigation

Answer 28

Lumbar puncture (shows raised CSF opening pressure)

Question 29

Sub-conjunctival haemorrhage management

Answer 29

Nothing, will disappear in about 1-2 weeks

Question 30

Blepharitis management

Answer 30

``` Lid hygeine (daily bathing/warm compresses) Supplementary tear drops (Oral doxycycline for 2-3 months) ```

Question 31

Autoimmune keratitis management

Answer 31

Oral/topical steroids

Question 32

Anterior uveitis management

Answer 32

Topical steroids Mydriatics Investigate for systemic associations if recurrent or chronic

Question 33

Episcleritis management

Answer 33

Lubrication/topical NSAIDs/mild steroids

Question 34

Scleritis management

Answer 34

Oral NSAID Oral steroids Steroid sparing agents

Question 35

Acute closed angle glaucoma

Answer 35

Drugs to reduce aqueous humour production Monitor IOP When IOP reduced then laser peripheral iridectomy

Question 36

Red eye affecting vision or causing marked photophobia management

Answer 36

Urgent referral

Question 37

Transient central retinal artery occlusion (amaurosis fugax) management

Answer 37

Urgent referral to stroke clinic

Question 38

Management of central retinal vein occlusion

Answer 38

``` Refer to opthalmology Treatment aimed at ameliorating secondary complications Anti-VEGF Intravitreal steroid Pan retinal photocoagulation ```

Question 39

Vitreous haemorrhage management

Answer 39

Spontaneous reabsorption | Dense may require vitrectomy