Opthalmology

Question 1

What is keratitis?

Answer 1

Corneal inflammation

Question 2

What are the causes of keratitis and their respective treatments?

Answer 2

• Viral: HSV (dendritic shape when use fluorescein) - topical acyclovir
• Bacterial: s.aureus/pseudomonas - abx drops
• Trauma/foreign body: remove after topical analegesics
• Allergic ‘marginal keratitis’

Question 3

What are corneal abrasions and how do you treat them?

Answer 3

Corneal abrasions are small scratches on the cornea (causing a gritty feeling, in a red eye with photophobia)
Rx: topical abx erythromycin and NSAIDs

Question 4

How do corneal ulcers present?

Answer 4

Extreme pain, squinting, reduced vision, increased tears

+/- anterior uveitis signs - miosis, aqueous flare and redness

Question 5

How would you dx corneal ulcers?

Answer 5

Slit lamp with fluorescein dye

Question 6

How do you treat corneal ulcers?

Answer 6

Remove infective cause - abx
(G+ve - chloramphenicol // G-ve - ofloxacin)
- Patch/bandage contact lens as aggrevated by dryness
- If not healing they may need surgical debridement

Question 7

What is glaucoma?

Answer 7

Optic neuropathy due to raised IOP

Question 8

Define acute-closed angle glaucoma

Answer 8

when the anterior angle of the anterior chamber narrows causing a sudden increase in IOP

Question 9

How does scleritis present?

Answer 9

Very painful red eye
Headache, photophobia
Generalised inflammation of the sclera with oedema of the conjunctiva
Scleral thinning - makes it look blue
Non-blanching with cotton bud/phenylephrine

Question 10

50% of people with scleritis have systemic disease.

Give examples of the systemic diseases

Answer 10

• Sjogrens
• Ra
• Wegeners (granulomatosis with polyangitis)

Question 11

How do you treat scleritis?

Answer 11

Reduced the inflammation
PO prednisolone
- If they have systemic disease you can use methotrexate/azathioprine or rituximab

Question 12

What is the urea made up of?

Answer 12

Iris
Ciliary body
Choroid

Question 13

What diseases is anterior uveitis associated with?

Answer 13

AI diseases - ank spondylitis, IBD, reactive arthritis

JIA in children

Question 14

How might the presentation of anterior uveitis differ from ACAG?

Answer 14

AU - may have an irregular constricted pupil
Less hazy cornea
Ciliary flush

Question 15

How do you treat anterior uveitis?

Answer 15

Steroid drops

0.5%-1% prednisolone drops

Question 16

How would you treat a bacterial cause of conjunctivitis?

Answer 16

Chloramphenicol drops

or fusidic acid drops

Question 17

How would you treat a chlamydial infection of the conjunctiva/trachoma?

Answer 17

PO Azithromycin

Question 18

What is keratitis usually caused by?

Answer 18

HSV

Question 19

What is the key feature of viral keratitis?

Answer 19

Dendritic ulcers that stain with fluorescein

Question 20

How do you treat viral keratitis?

Answer 20

Topical aciclovir

Question 21

What are some of the causes of corneal ulcers?

Answer 21

Inflam: vasculitis/RA 
Infective: 
B 
V - HSV/varicella 
F - candida/aspergillus 
Parasites

Question 22

How do you treat acute closed angle glaucoma

Answer 22

M:
1) T BB = timolol
2) T carbonic anhydrase inhibitors = acetazolamide
3) Pilocarpine (miosis - constriction of pupil)
4) IV mannitol (osmotic diuresis)
S: lazer iridotomy

Question 23

How do you investigate acute closed angle glaucoma?

Answer 23

1) Gonioscopy
2) Slit lamp (shallow anterior chamber)
3) Static perimetry (look for visual field loss)

Question 24

Describe diabetic retinopathy

Answer 24

Retinal disease due to progressive diabetic microvascular leakage (loss of pericytes) + occlusion (due to endothelial cell damage, RBC changes and increased platelet stickiness)

Question 25

How do you treat diabetic retinopathy?

Answer 25

Intravitreal anti-VEGF (ranibizumab + afilbercept) Macular laser therapy Pan retinal photocoagulation

Question 26

How do you screen for chronic open angle glaucoma

Answer 26

1) Tomometry - IOP 2) Perimetry - visual field defect 3) Fundoscopy - Disc/cupping

Question 27

Give an example of a topical carbonic anhydrase inhibitor

Answer 27

T carbonic anhydrase inhibitors = acetazolamide or dozolamine

Question 28

How does retinal detachment present?

Answer 28

``` 4F's Flashing lights Floaters Field loss Fall in acuity ``` 'A dense shadow that starts peripherally and progressed towards the centre of vision.'

Question 29

Give some causes of painless sudden loss of vision

Answer 29

Ischaemic optic neuropathy Occlusion of central retinal artery/vein Viterous haemorrhage Retinal detachment

Question 30

How can retinal detachment be treated?

Answer 30

With lazer photocoagulation therapy | - vitrectomy + gas tamponade

Question 31

What is a vitreous haemorrhage?

Answer 31

Its the extravasation of blood into areas around the vitreous humour of the eye Bleeding into the vitreous humour

Question 32

Give some of the common underlying causes of vitreous haemorrhage

Answer 32

- Proliferative diabetic retinopathy - Posterior vitreous detachment - Ocular trauma - Neovascular age-related macular degeneration

Question 33

How would you examine someone with vitreous haemorrhage?

Answer 33

Measure: - Intraocular pressures + Visual acuity - Dilated fundoscopy - Slit lamp - would show blood in the anterior vitreous - Gonioscopy ? new vessels in the angular drainage? - USS - Orbital CT

Question 34

Management of vitreous haemorrhage

Answer 34

Urgent referral to ophthalmology - X retinal detachment - bed rest with head up - Laser photocoagulation - Anterior retinal cryotherapy

Question 35

What are the fundoscopy signs of primary open-angle glaucoma?

Answer 35

1) Optic disc cupping 2) Optic disc pallor 3) Bayonetting of vessels (vessels have breaks as they disappear into the cup and reappear at the base) 4) Disc haemorrhages

Question 36

What would you see on fundoscopy with papilloedema?

Answer 36

``` Venous engorgement Loss of venous pulsation Blurring of the optic disc margin Elevation of optic disc Loss of optic cup ```

Question 37

Give some RF for age-related macular degeneration

Answer 37

Advancing age Smoking FHx Others: ischaemic CVD - HTN, DM and high cholesterol

Question 38

How does age-related macular degeneration present?

Answer 38

Reduction in visual acuity - near things Difficulties in dark adaptation Fluctuations in visual disturbance - Photopsia = perception of flickering/flashing lights

Question 39

What investigations do you do with ARMD?

Answer 39

- slit lamp microscopy | - Fluorescein angiography (for neovascular ARMD and can guide the anti-VEGF rx)

Question 40

How do you treat dry ARMD?

Answer 40

Zinc with anti-oxidant vitamins A, C, E (reduce the progression of disease in 1/3rd)

Question 41

How do you treat wet ARMD?

Answer 41

1) Anti-Vascular endothelial GF (VEGF) - intravitreal injections = Ranibizumab / afilbercept 2) Laser photocoagulation