Opthalmology

Question 1

What is glaucoma?

Answer 1

Glaucoma is a group of disorders characterised by optic neuropathy due, in the majority of patients, to raised intraocular pressure (IOP).

Question 2

What is acute angle-closure glaucoma?

Answer 2

Rise in IOP 2nd to impairment of aqueous outflow

Question 3

What can predispose to AACG?

Answer 3

Hypermetropria- long sightedness
Pupillary dilated ion
Lens growth associated with age

Question 4

Give some features of AACG

Answer 4

Severe pain, ocular/headache
Decreased visual acuity
Worse symptoms with mydriasis- watching TV in dark room
Hard red eye
Haloes around eye
Semi dilated non reacting pupil
Corneal oedema results in dull/hazy cornea
Systemic- nausea/vomiting/abdo pain

Question 5

Is AACG an emergency?

Answer 5

Yes, needs prompt urgent referral

Question 6

How would you treat AACG?

Answer 6

Need to lower IOP
1. Eye drops-
e.g. pilocarpine to contract ciliary muscle to open trabecular mesh work and increase outflow
Beta blocker- timolol to decrease aqueous humour production
Alpha -2 agonisr e.g. apraclonide dual mechanism
2. IV acetazolamide- decrease aqueous secretions
3. Definitive= laser peripheral iridotomy

Question 7

What is age related macular degeneration?

Answer 7

Degeneration of the central retina the macular (retinal photoreceptors resulting in formation of drusden can be seen on fundoscopy and retinal photography)

Question 8

Give risk factors for age related macular degeneration?

Answer 8

Advancing age
Smoking
More common in females
Family history
Ischaemic cardiovascular disease risk factors like DM,HTN

Question 9

What are the two forms of macular degeneration?

Answer 9

1. Dry macular degeneration 90%
2. Wet macular degeneration 10%

Question 10

What is Dry macular degeneration characterised by?

Answer 10

Atrophic
Drusden= Yellow round spots in Bruch’s membrane

Question 11

What is wet macular degeneration characterised by?

Answer 11

Exudative
Choroidal neovasularisation

Question 12

Does dry or wet macular degeneration carry a worse prognosis?

Answer 12

Wet macular degeneration- leakage of serous fluid and blood can subsequently result in rapid loss of vision

Question 13

What are some symptoms of age related macular degeneration?

Answer 13

1. Reduction in visual acuity, particularly for near field objects
   gradual in dry ARMD
   subacute in wet ARMD
2. Difficulties in dark adaptation
3. Fluctuations in visual disturbance
4. Photopsia (perception of flickering or flashing lights) and glare around objects
5. Visual hallucinations may result in Charles bonnet syndrome

Question 14

Give some signs of age related macular degeneration?

Answer 14

1. Distortion of line perception may be noted on masker grid testing
2. Fundoscopy may reveal drusden and in late disease a macular scar
3. In wet, well demarcated red patches which represent intersectional/subretinal fluid leakage or haemorrhage

Question 15

How to investigate age related macular degeneration?

Answer 15

Slit lamp and colour fungus photography to provide a baseline

Fluorescien angiography if wet is detected and can guide intervention with anti-VEGF

OCT to visualise retina in 3D