OPTHAL

Question 1

emergency eye conditions that need to be seen urgently by ophthalmologist

Answer 1

penetrating eye injury
acute post op endopthalmitis
chemical injury \
orbital cellulitis
GCA with eye symptoms
sudden vision loss <6hrs

painful red eye with visual loss
retinal detachment
diplopia with pain
corneal ulcer
corneal graft rejection
blunt trauma with raised IOP

Question 2

causes of red eye

Answer 2

Blephoritis
conjunctivitis
keratitis
scleritis/ episcleritis
uveitis
entropion
subconjunctival haemorrhage
corneal ulcer
corneal abrasion
contact lens related problem
foreign body
chemical burns
acute glaucoma

Question 3

Causes of blurred vision

Answer 3

irititis
redused visual acuity
cataract
optic neuritis

Question 4

red flag signs with red eye (refer immediately to eye ED)

Answer 4

pain
reduced acuity
pupil asymmetry
loss of red reflex
photophobia
Hx of trauma
ciliary flush
corneal infiltrate

Question 5

Important questions in opthal Hx

Answer 5

contact lens wearer?
Trauma
Pain/ photophobia
Itching- conjunctivitis/ allergy
discharge- purulant(bac) or watery (viral/allergy)
other contacts affected
mono or binocular
changes in vision
recent URTI

Question 6

subconjunctival haemorrhage

Answer 6

fragile vessels rupture due to trauma, valsalva pressure spikes, sneezing, diving, hypertension

cornea not affected
resolves in 2 weeks

bright red- dark red- orange- green

Question 7

stye (hordeolum)

Answer 7

usually staph aureus
hot compress
topical ABx cream

Question 8

what is chalazeon

Answer 8

when a stye becomes a cyst

Question 9

blephoritis

Answer 9

chronic inflammation and swelling of eyelids
associated with rosacea

Mx: warm compres s
lid hygiene
topical antibiotics/ steroid

Question 10

conjunctivitis

Answer 10

bacterial/ allergic/ chemical/ foreign body/ viral

uni/bilateral
itchy/ gritty eye

Question 11

common causative organisms of bacterial conjunctivitis

Answer 11

staph aureus
strep pneumoniae
haemophilus
pseudomonas

rarely chlamydia

give moxifloxacin/ levofloxacin eye drops

Question 12

what is keratitis

Answer 12

breakdown of the corneal epithelium caused by trauma, infection, contact lens over wearing, dry eyes, over exposure

The typical presentation usually involves a red eye, photophobia, pain and gritty sensation. Wearing contact lenses is a known risk factor.

seen best with fluoroscein dye

Be careful not to miss an ulcer caused by herpes - branching epithelial dendritic ulcer

Question 13

common causative organisms of keratitis

Answer 13

bacterial-
viral-
fungal
acanthamoeba - contact len and swimming

Question 14

treatment of herpes simplex ulcer

Answer 14

aciclovir 400mg QDS
steroids

Question 15

acute glaucoma

Answer 15

primary angle closure- increase in pressure causing a pupilary block

Question 16

management of acute glaucoma

Answer 16

eye drops- bblockers, alpha agonists, carbonic anhydrase inhibitors, pilocarpine

oral or IV acetazolemide

oral hyperosmotic agenet (glycerol)

IV hyperosmotic agent (mannitol)

topical steroids

lazer therapy

Question 17

what is pseudoexfoliation syndrome

Answer 17

Pseudoexfoliation syndrome is a chronic, age-related disorder of the extracellular matrix that results in the deposition of abnormal fibrillary (pseudoexfoliative) material within various body tissues. This condition manifests primarily in the anterior segment of the eye

Question 18

episcleritis

Answer 18

inflammation of episclera

self limiting and mild
anti inflammatory tablets

Question 19

scleritis

Answer 19

severe
inflammation of sclera
risk of visual loss
urgent referral and treatment required

Question 20

how to differentiate between episcleritis and scleritis

Answer 20

most of the time scleritis is diffuse

2.5% phenylephrin, wait 10-15 minutes- if after that the eye is white then it is episcleritis as the drops are a vasoconstrictor. the vessels in scleritis are much deeper which the drops dont get to

Question 21

management of periorbital/ orbital cellulitis

Answer 21

Major opthal emergency
can be life threatening

Admission
IV antibiotics
surgical

Question 22

most common cause of orbital cellulitis

Answer 22

staph aureus

Question 23

cause of sudden loss of vision

Answer 23

central retinal artery or vein occlusion

is completely painless

Question 24

RFs for central retinal artery occlusion

Answer 24

Thrombus/ embolus
HPTN
diabetes
sickle cell
trauma

Question 25

signs and symptoms of central retinal artery occlusion

Answer 25

sudden painless loss of vision

visual acuity limited to light reaction in affected eye

pupil reflex: dilated and nonreactive in affected eye

Question 26

dry macular degeneration

Answer 26

90% of cases
also known as atrophic
characterised by drusen - yellow round spots in Bruch’s membrane

Question 27

wet macular degeneration

Answer 27

sudden onset reduction of vision due to oedema and angiogenesis

also known as exudative or neovascular macular degeneration
characterised by choroidal neovascularisation
leakage of serous fluid and blood can subsequently result in a rapid loss of vision
carries the worst prognosis

Question 28

Papilloedemea

Answer 28

can be life threatening
optic nerve swelling
due to raised ICP

Question 29

features of wet macular degeneration

Answer 29

decreasing vision, metamorphopsia (seeing straight lines as wavy), and central scotoma (a blind spot in the middle of the field of vision) are classic signs of wet age-related macular degeneration (AMD).

Question 30

features of central retinal artery occlusion

Answer 30

sudden, painless unilateral visual loss
relative afferent pupillary defect
‘cherry red’ spot on a pale retina

Question 31

what is ectropion

Answer 31

outward turning of the lower eyelid, often due to age-related laxity of the tissues.

Question 32

common eyelid problems

Answer 32

blepharitis: inflammation of the eyelid margins typically leading to a red eye

stye: infection of the glands of the eyelids
chalazion (Meibomian cyst)

entropion: in-turning of the eyelids

ectropion: out-turning of the eyelids

Question 33

night blindness + tunnel vision

Answer 33

Retinitis pigmentosa

Question 34

features of Retinitis pigmentosa

Answer 34

night blindness is often the initial sign
tunnel vision due to loss of the peripheral retina (occasionally referred to as funnel vision)
fundoscopy: black bone spicule-shaped pigmentation in the peripheral retina, mottling of the retinal pigment epithelium

Question 35

Causes of ptosis

Answer 35

3rd nerve palsy
Horners
Aging
Myasthenia Gravis
Myopathy, e.g. chronic progressive external ophthalmoplegia

Question 36

causes of an abnormally large pupil

Answer 36

pharmacological
acute glaucoma
3rd nerve palsy

Question 37

causes of abnormally small pupil

Answer 37

opioids
Horners

Question 38

complications of herpes zoster ophthalmicus

Answer 38

conjunctivitis
keratitis
uveitis
corneal blisters
extraoccular muscle palsy

Question 39

what is the Hutchinson’s sign?

Answer 39

in herpes zoster opthalmicus, if the tip of the nose is affected then the nasociliary nerve is affected meaning the eyeball is likely to be involved

Question 40

what is hyphaemia

Answer 40

blood in the anterior chamber
(between cornea and iris).

Question 41

what is A hypopyon

Answer 41

collection of pus in the anterior chamber and indicates endophthalmitis, usually following cataract surgery or intravitreal injection

Question 42

most common cause of hyphameia

Answer 42

blunt trauma to the eye