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3b/4 > Opthalmology > Flashcards

Opthalmology Flashcards

1
Q

define glaucoma?

A

refers to a number of disorders where there is a progressive optic neuropathy and raised intraocular pressure is typically a key factor

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2
Q

which condition is characterised by a normal angle between the iris and cornea. It is divided into primary and secondary forms?

A

open angle glaucoma

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3
Q

commonest form of glaucoma?

A

primary open angle glaucoma

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4
Q

which condition is characterised by a closing or narrowing of the angle between the iris and cornea. Again may be split into primary and secondary forms?

A

angle-closure glaucoma

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5
Q

pathology closed angle glaucoma??

A

The closure of the anterior chamber angle (cornea-iris. due to lens being pushed against the iris) results in reduced drainage of the aqueous humour and rising IOP rapidly - cupping
pressure builds up particularly in posterior chamber

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6
Q

threshold above which IOPs are said to be raised?

A

21mmHg

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7
Q

what are the boundaries of the anterior chamber of the eye?

A

cornea - iris

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8
Q

what are the boundaries of the posterior chamber of the eye?

A

iris - lens `

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9
Q

boundaries of the vitreous chamber?

A

lens-back of the eye

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10
Q

anterior chamber filled with??

A

aqueous humor

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11
Q

posterior chamber filled with ??

A

vitreous humor

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12
Q

what does the cilliary epithelium do in the eye?

A

produces the aqueous humor

provides structural support

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13
Q

what is the normal pathway of the aqueous humor in the eye?

A 
produced by the cilliary epithelium into post chamber
flows to anterior chamber
through trabecular meshwork 
canal of schemm 
aqueous veins 
(part of the episcleral venous system)
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14
Q

pathology open angle glaucoma?

A

angle between cornea and iris ‘open’ - slow clogging of trabecular meshwork over time
-> gradual increase in pressure on Optic nerve - cupping
-> outer rim atrophy - decrease in peripheral vision
THEN central vision loss as pressure increases

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15
Q

symptoms of closed angle glaucoma?

A

eye pain, redness, blurred vision, headaches, nausea, visual halos

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16
Q

what does tonometry assess?

A

introccular pressure

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17
Q

what will optic nerve imaging and direct observation show in closed angle glaucoma?

A

‘cupping’

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18
Q

medications for glaucoma?

A

to lower pressure by decreasing aqueous humor production - 1. BBs,
carbonic anhydrase inhibitors (dorzolamide)
to increase outflow of humor - prostaglandin analogues also 1.
to do both: alpha adrenergic agonists

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19
Q

treatments (non-pharm) for glaucoma:

A

trabeculoplasty - OA

laser iridotomy - CA

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20
Q

causes of ectropion:

A

muscle weakness
bell’s palsy - facial paralysis
trauma/previous surgery
eyelid growths

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21
Q

watery eyes, excessive dryness of eyes - gritty and sandy
easy irritated eyes - burning sensation and redness
photophobia:

A

ectropion

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22
Q

ectropion mx:

A

surgical definitive

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23
Q

what causes stye?

A

saureus

can be described in questions as an eyelid abscess

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24
Q

differentiate between stye and chalazion?

A

styes are typically tender to palpate

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25
Q

what respiratory abnormality may be the cause of papilloedema?

A

hypercapnia

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26
Q

commonest cause of unilateral red eye?

A

conjunctivitis

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27
Q

Contact lens wearers who present with a red painful eye mx?

A

always refer to opthalm to assess and rule out microbial keratitis

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28
Q

define keratitis?

A

inflammation of the cornea

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29
Q

aims of angle-closure glaucoma tx?

A

reduce aqueous humor secretion

induce pupillary constriction (to make pupil smaller and create more space for outflow)

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30
Q

74-year-old woman presents to the emergency department with a sudden loss of vision in her left eye, which occurred three hours ago and lasted for approximately 3 minutes. She describes the episode as a ‘black-out’ of her vision in that eye, with no associated pain or nausea, and denies any other symptoms. PMH: vasculopath - dx?

A

Amaurosis fugax

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31
Q

what is amaurosis fugax?

A

painless, transient monocular blindness together with the description of a ‘black curtain coming down’ is characteristic of amaurosis fugax

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32
Q

You perform a cover test to gather further information. Which one of the following findings would be consistent with a right esotropia?

A

on covering the left eye the right eye moves laterally to take up fixation

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33
Q

man presents with a ‘droopy eyelid’ on the right side. You also notice that his right pupil appears smaller than the left: indicates??

A

horner’s syndrome

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34
Q

59-year-old man complains of dry, sore eyes for the past six months. There has been no change in his vision and he doesn’t wear contact lens. The only past history of note is hypothyroidism. dx?

A

blepharitis

can be associated with seborrheoic dematitis

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35
Q

what is blepharitis?

A

inflammation of the eyelid margins

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36
Q

what can lead to fungal infections, which in turn can cause corneal ulcers?

A

steroid eye drops

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37
Q

Blunt ocular trauma with associated hyphema indicates?

A

high risk of glaucoma as raised ICP

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38
Q

man who presents to eye casualty with sudden onset loss of vision in his left eye. He is not experiencing any pain and has a past medical history of diet-controlled type 2 diabetes mellitus and hypertension. Slit-lamp examination reveals red blood cells in the anterior vitreous. dx?

A

vitreous haemorrhage

especially consider in diabetics

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39
Q

what disease is characterised by drusen - yellow round spots in Bruch’s membrane?

A

dry age related macular degeneration

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40
Q

what disease is characterised by choroidal neovascularisation.?

A

wet age related macular degeneration

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41
Q

sudden painless loss of vision, severe retinal haemorrhages on fundoscopy - dx?

A

CRVO

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42
Q

3 risk factors for CRVO?

A

increasing age
glaucoma
polycythaemia

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43
Q

pale retina on fundoscopy indicates ?

A

CRAO

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44
Q

features include afferent pupillary defect, ‘cherry red’ spot on a pale retina

A

CRAO

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45
Q

name some risk factors for vitreous haemorrhage:

A 
Diabetes
Trauma
Anticoagulants
Coagulation disorders
Severe short sightedness
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46
Q

55-year-old lady presenting with red-tinged vision along with dark spots. These are typical features of ?

A

vitreous haemorrhage

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47
Q

Peripheral curtain over vision + spider webs + flashing lights in vision think??

A

retinal detachment

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48
Q

unilateral black shadow at the top of her right vision. She has also been experiencing flashing lights in spindly shapes, this came on suddenly a few hours ago. dx?

A

retinal detachment

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49
Q

28-year-old male with controlled ulcerative colitis (UC) presents to the clinic with an acute painful right eye. There is decreased vision and redness around the right eye. This is the first time presenting with these symptoms. smaller pupil in right eye.
Slit light examination shows inflammatory cells and an aqueous flare in the anterior chamber. dx?

A

anterior uveitis

also hypopyon (pus in anterior chamber)

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50
Q

tx anterior uveitis?

A

steroid eye drops with mydriatic eye drops

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51
Q

what is a suitable screening test for childhood squints?

A

corneal light reflection test

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52
Q 
sudden vision loss. painless
loss of red reflex
cannot see retina
poorly controlled DM
dx?
A

vitreous haemorrhage

red hue to vision

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53
Q

6-yom to ED: swelling around his right eye. This has been present or the past 2 days and during this time he has been feverish and lethargic. He denies any loss of vision or trauma to the eye.
38.2ºC. right-sided proptosis, and all eye movements are reduced and painful in the affected eye. Fundoscopy is normal, visual acuity is 6/6 in the left and 6/12 in the right eye.
What is the most likely diagnosis?

A

orbital cellulitis

ceftriaxone

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54
Q

differentiating periorbital/orbital cellulitis?

A

reduced visual acuity, proptosis, ophthalmoplegia/pain with eye movements are NOT consistent with periorbital (preseptal) cellulitis

CT with contrast

Absence of painful movements, diplopia and visual impairment indicates periorbital

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55
Q

common causes of orbital cellulitis?

A

strep, staph, hib

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56
Q

severe pain: may be ocular or headache
decreased visual acuity
symptoms worse with mydriasis (e.g. watching TV in a dark room)
hard, red-eye (corneal injection)
haloes around lights at night
semi-dilated non-reacting pupil (fixed, dilated)
corneal oedema results in dull or hazy cornea
systemic upset may be seen, such as nausea and vomiting and even abdominal pain
dx?

A

acute angle-closure glaucoma

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57
Q

NICE guidelines say that any patient with life/sight-threatening causes of red eye should be…..?

A

referred to opthalm for same day assessment

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58
Q

2 methods for measuring IOP?

A

non-contact tonometry

goldmann’s applanation

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59
Q

when to start tx open angle glaucoma and first line tx?

A

started when IOP >24mmHg
1st line: PG analogue eye drops: latanoprost.
SE: eyelash growth, eyelid pigmentation, iris pigmentation.
2nd line: BB (timolol; reduce production aq humour). Carbonic anhydrase inhibitors (dorzolamide).
Surgery: trabeculotomy: create a new channel under sclera.

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60
Q

which medications can cause acute angle closure glaucoma?

A

adrenergic (adrenaline), anticholinergics (oxybutynin), TCA

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61
Q

if delay in ambulance for closed angle glaucoma pt, what mx can help in interim?

A

Lie patient on their back without a pillow
**Give pilocarpine eye drops (2% for blue, 4% for brown eyes) – acts on muscarinic receptos in the sphincter muscles and causes constriction of the pupil (headache, blurred vision).
+ ciliary muscle contraction – opens up the pathyway for the flow of aqeuus humour
**Give acetazolamide 500 mg orally(reduce production aqeuos humour)
Given analgesia and an antiemetic if required

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62
Q

which chemical stimulates the development of new vessels in wet age related macular degeneration?

A

VEG-F

Vascular endothelial growth factor

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63
Q

Gradual worseningcentral visual field loss
-Reducedvisual acuity
Crooked or wavy appearance to straight lines
refers to ???

A

ARMD

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64
Q

what is a Scotoma?

A

central patch of vision loss

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65
Q

how is AMD diagnosed?

A

slit-lamp exam by opthalmologist
optical coherence tomography
fluorescein angiography

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66
Q

dry AMD mx?

A

lifestyle factors to slow progression

smoking, BP, vitamins

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67
Q

wet AMD mx?

A

anti-VEGF drugs
ranibizumab,bevacizumabandpegaptanib
monthly injections into vitreous chamber
start <3/12 to be effective

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68
Q

fundoscopy changes: cotton wool spots, neurovascularisation, blot haemorrhages, hard exudates, microaneurysms - dx?

A

diabetic retinopathy

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69
Q

how is diabetic retinopathy classified?

A

proliferative or non-proliferative depending on whether new vessels have developed

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70
Q

cx of diabetic retinopathy:

A

Retinal detachment
Vitreous haemorrhage(bleeding in to the vitreous humour)
Rebeosis iridis(new blood vessel formation in the iris)
Optic neuropathy
Cataracts

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71
Q

mx diabetic retinopathy:

A

Laser photocoagulation
Anti-VEGFmedications -ranibizumab/bevacizumab
Vitreoretinal surgery(keyhole) may be required in severe disease

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72
Q

fundoscopy changes:

cotton wool spots, retinal haemorrhages, papilloedema, arteriovenous nipping, hard exudates, silver wiring - dx?

A

hypertensive retinopathy

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73
Q

mx: hypertensive retinopathy:

A

Management is focused on controlling the blood pressure and other risk factors such as smoking and blood lipid levels.

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74
Q

what is the role of the lens in physiology?

A

to focus light on the retina

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75
Q

which part of the eye anatomy contracts and relaxes to focus the lens?

A

cilliary body

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76
Q

how are congenital cataracts screened for?

A

red light reflex - new born assessment

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77
Q

“Starbursts” can appear around lights, particularly at night time
asymmetrical, generalised slow reduction in vision, blurriness
colour changes -> brown/yellows
dx?

A

cataracts

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78
Q

ix for cataracts?

A

loss of red light reflex

lens can appear grey or white when testing red reflex

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79
Q

tx cataracts:

A

Cataract surgery involves drilling and breaking the lens into pieces, removing the pieces and then implanting anartificial lensinto the eye. This is usually done as a day case under local anaesthetic. It usually gives good results.
regardless of acuity!

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80
Q

rare but serious cx of cataracts surgery:

A

Endophthalmitis - inflammationof the inner contents of the eye, usually caused by infection. It can be treated withintravitrealantibiotics
can cause loss of vision

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81
Q

mx blepharitis?

A

hot compress
eye hygeine
lubricating eye drops - hypromellose, polyvinyl alc(1), carbomer

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82
Q

Hordeolum externum is?

A

infection of glands of zeiss (sebaceous) and moll (sweat)

stye

83
Q

Hordeolum internum is?

A

stye
infection of theMeibomian glands. They are deeper, tend to be more painful and may point inwards towards the eyeball underneath the eyelid.

84
Q

tx stye:

A

hot compress
analgesia
top abx if association with conjunctivitis

85
Q

what is a chalazion?

A

blockage of meibomian glands

typically non-tender swelling eyelid

86
Q

mx chalazion?

A

hot compress and analgesia. Consider topic antibiotics (i.e. chloramphenicol) if acutely inflamed
rarely surgical drainage

87
Q

what is entropion?

A

eyelid turns inwards with the lashes against the eyeball -> pain, corneal damage, ulceration

88
Q

what eyelid disorder is sensitive to wind and can present with excessive tearing and itching?

A

entropion

89
Q

tx entropion?

A

Taping the eyelid down to prevent it turning inwards. Prevent the eye drying out by using regular lubricating eye drops.
Definitive management = surgical intervention

90
Q

what is an ectropion?

A

eyelid turns outwards

with inner eyelid exposed (mostly bottom eyelid).-> exposure keratopathy

91
Q

red irritated eye, inability to close eye, dry eye, itching. eyelashes turned outwards.
dx?

A

ectropion

92
Q

mx ectropion?

A

Mild cases - nil
Regular lubricating eye drops - protect the surface of the eye.
severe - surgery to correct the defect

93
Q

what is trichiasis?

A

inward growth of eyelashes -> pain, corneal damage, ulceration

94
Q

mx trichiasis?

A

specialist is to remove the eyelash (epilation). Recurrent cases may require electrolysis, cryotherapy or laser treatment

95
Q

where is the infection in periorbital cellulitis?

A

orbital septum - in front of the eye

96
Q

swelling, redness, hot skin around eyelids and eye - dx?

A

periorbital cellulitis

97
Q

mx periorbital cellulitis?

A

Hot compresses and analgesia.
Topical antibiotics (i.e. chloramphenicol).
Conservative management fails then surgical drainage may be required

98
Q

where is the infection in orbital cellulitis?

A

behind orbital septum - around the eyeball

99
Q

pain on eye movement, reduced eye movements, changes in vision, abnormal pupil reactions and forward movement of the eyeball (proptosis) - indicate?

A

orbital cellulitis

100
Q

mx orbital cellulitis?

A

This is a medical emergency that requires admission and IV antibiotics. They may require surgical drainage if an abscess forms.

101
Q

what is the conjunctiva?

A

thin layer that covers the inside of the eyelid and the sclera of the eye

102
Q

3 main types of conjunctivitis?

A

bacterial, viral, allergic

103
Q

Unilateral or bilateral, Red eyes, Bloodshot, Itchy or gritty sensation, Discharge from the eye
painless. acuity intact. dx?

A

conjunctivitis

104
Q

purulent dischargeand an inflamed conjunctiva. It is typically worse in the morning when the eyes may be stuck together. It usually starts in one eye and then can spread to the other. It is highly contagious - which type of conjuctivitis?

A

bacterial

105
Q

clear discharge. It is often associated with other symptoms of a infection such as dry cough, sore throat and blocked nose. You may find tenderpreauricularlymph nodes (in front of the ears). It is also contagious - which type of conjunctivitis?

A

viral

106
Q

significant watery discharge and itch - which type of conjunctivitis?

A

allergic

107
Q

painless red eye ddx (3):

A

Conjunctivitis
Episcleritis
Subconjunctival Haemorrhage

108
Q

painful red eye ddx (5):

A 
Glaucoma
Anterior uveitis
Scleritis
Corneal abrasions or ulceration
Keratitis
Foreign body
Traumatic or chemical injury
109
Q

mx conjunctivitis?

A

self-limiting 1-2 weeks
hygiene, avoid contact lenses,
?Bacterial conjunctivitis abx considered: Chloramphenicolandfuscidic acideye drops

110
Q

why do patients under 1 month old need urgent opthalm review if conjunctivitis?

A

neonatal conjunctivitiscan be associatedgonococcal infectionand can cause loss of sight and more severe complications such as pneumonia.

111
Q

allergic conjunctivitis mx:

A
  • Antihistamines(oral or topical) can be used to reduce symptoms. Azelsiitne
  • Topicalmast-cell stabiliserscan be used in patients with chronic seasonal symptoms.
112
Q

what does the uvea refer to?

A

iris,ciliary bodyandchoroid.

also referred to as iritis

113
Q

pathology anterior uveitis?

A

flooding of anterior chamber with neutrophils, m0s and lymphocytes, autoimmuneprocess but can be due toinfection,trauma,ischaemiaormalignancy.

114
Q

floatersin the patient’s vision - think ?

A

anterior uveitis

115
Q

which eye condition is associated with HLA B27 conditions such as anky spond, IBD< RA?

A

anterior uveitis

116
Q

Dull, aching, painful red eye
Ciliary flush(a ring of red spreading from the cornea outwards)
Reduced visual acuity
Floaters and flashes
miosis, photophobia, lacrimation, posterior synechiae, hyponion
dx?

A

ant uveitis

117
Q

ix: anterior uveitis?

A

Clinical dx. Slit lamp: IOP pressures etc + FBC, ESR< CRP

118
Q

mx anterior uveitis?

A
  1. Steroids(oral, top or iv)
  2. Cycloplegic-mydriaticmedications such ascyclopentolateoratropineeye drops. These dilate the pupil and reduce pain
  3. Immunosuppressants- DMARDSandTNF inhibitors
  4. Laser therapy, cryotherapy or surgery (vitrectomy) in severe
119
Q

Cycloplegicmeans

A

paralysing the ciliary muscles

120
Q

Mydriaticmeans

A

dilating the pupils

121
Q

what is episcleritis?

A

benign and self-limitinginflammationof theepisclera,the outermost layer of the sclera

122
Q

which conditions is episcleritis associated with ?

A

inflammatory disorders such asrheumatoid arthritisandinflammatory bowel disease.

123
Q 
acute onset unilateral symptoms:
Typically not painful but there can be mild pain
Segmental redness (rather than diffuse). There is usually a patch of redness in the lateral sclera.
Foreign body sensation
Dilated episcleral vessels
photophobia
Watering of eye
No discharge
dx?
A

episcleritis

124
Q

tx episcleritis:

A

self limiting and will recover in 1-4 weeks.
Lubricating eye drops can help symptoms.
Simpleanalgesia,cold compressesandsafety-net adviceare appropriate.
severe cases - systemicNSAIDs(e.g. naproxen) or topical steroid eye drops.

125
Q

what is scleritis?

A

inflammationof the full thickness of thesclera.

126
Q

most severe type of scleritis is called??

A

necrotising scleritis -> perforation of sclera

127
Q

associations of scleritis?

A

50% people present w/ RA, IBD, SLE< sarcoid, GPA

128
Q 
50 % are bilateral 
Severe pain****
Pain with eye movement
Photophobia
Eye watering
Reduced visual acuity
Abnormal pupil reaction to light
Tenderness to palpation of the eye
describes which eye condition?
A

scleritis

129
Q

what is differentiator between scleritis and necrotising scleritis?

A

necrotising - no pain, visual impairment

130
Q

mx scleritits?

A 
urgent opthalm
underlying condition 
nsaids
steroids
immunosuppression
131
Q

causes of corneal abrasions:

A 
Contact lenses
Foreign bodies
Finger nails
Eyelashes
Entropion (inward turning eyelid)
132
Q

which infection should be suspected in contact lens wearers with corneal abrasions?

A

pseudomonas

133
Q 
History of contact lenses or foreign body
Painful red eye
Foreign body sensation
Watering eye
Blurring vision
Photophobia
dx/
A

corneal abrasion

134
Q

ix corneal abrasion?

A

fluorescein stain

slit lamp for more significant ones

135
Q

mx corneal abrasion?

A

same day referral opthalm
analgesia (e.g. paracetamol)
Lubricating eye drops can improve symptoms
Antibiotic eye drops (i.e. chloramphenicol)
Bring the patient back after 1 week to check it has healed

136
Q

what do cyclophenolate eye drops do?

A

dilate the pupil - improves sx like photophobia

137
Q

how long do uncomplicated corneal abrasions take to heal?

A

2-3 days

138
Q

what is keratitis?

A

inflammation of the cornea - can cause ulcers

139
Q

commonest cause of keratitis?

A

viral infection with HSV commonest

140
Q

which bacteria can cause keratitis?

A

pseudomonas or saureus

141
Q

which fungi cause karatitis?

A

candida or aspergillus

142
Q

what does CLARE stand for?

A

contact lens acute red eye

143
Q 
Painful red eye
Photophobia
Vesicles around the eye
Foreign body sensation
Watering eye
Reduced visual acuity. This can vary from subtle to significant.
Diagnosis?
A

keratitis

144
Q

what will fluorescein stain show if HSV causing keratitis?

A

dendritic ulcer

145
Q

how is keratitis dx?

A

slit lamp opthalm

146
Q

how can pathogen be isolated in keratitis?

A

swab or scraping of cornea viral culture, pcr

147
Q

mx keratitis?

A

opthalm same day referral
Aciclovir (topical or oral)
Ganciclovir eye gel
Topical steroids may be used alongside antivirals to treat stromal keratitis

148
Q

what may be required to treat stromal keratitis?

A

corneal transplant

149
Q

what happens in retinal detachment?

A

retina detaches from choroid underneath

vitreous fluid fills the space

150
Q 
painless
Peripheral vision loss. This is often sudden and like a shadow coming across the vision.
Blurred or distorted vision
Flashesandfloaters
dx?
A

retinal detachment

151
Q

mx of retinal tear?

A

opthalm - sight threat. aim to reattach the retina
aims to create adhesions between the retina and the choroid to prevent detachment:
Laser therapy
Cryotherapy
surgery to reattach**

152
Q

surgery to repair retinal detachment:

A

Vitrectomy
Scleral buckling
Pneumatic retinopexy

153
Q

what causes CRVO or CRAO?

A

thrombus formation in vessels

154
Q

role and anatomical position of retinal vein?

A

runs through optic nerve and drains blood from the retina

155
Q

retinal vein occlusion pathology:

A

pooling of blood in the retina. This results in leakage of fluid and blood causingmacular oedemaandretinal haemorrhages. This results in damage to the tissue in the retina and loss of vision. It also leads to the release ofVEGF, which stimulates the development of new blood vessels (neovascularisation).

156
Q

sudden painless loss of vision - think?

A

crvo

157
Q

Fundoscopy examination is diagnostic of retinal vein occlusion. It give characteristic findings:
(3)

A

Flame and blot haemorrhages
Optic disc oedema
Macula oedema

158
Q

other ix for retinal vein occlusion - 4

A

FBCfor leukaemia
ESRfor inflammatory disorders
Blood pressurefor hypertension
Serum glucosefor diabetes

159
Q

mx retinal vein occlusion:

A

Laser photocoagulation
Intravitreal steroids (e.g. a dexamethasone intravitreal implant)
Anti-VEGF therapies (e.g. ranibizumab, aflibercept or bevacizumab)
refer immediately

160
Q

vascular anatomy of Central retinal artery?

A

branch of the opthalmic artery which is a branch of the ICA

161
Q

causes of CRAO?

A

atherosclerosis. It can also be caused bygiant cell arteritis, wherevasculitis

162
Q

sudden painless loss of vision.

There will be arelative afferent pupillary defect - dx?

A

crao

163
Q

fundoscopy for CRAO?

A

pale retina

-cherry-red spot

164
Q

other ix for CRAO?

A

GCA ix - ESR, temporal artery biopsy

165
Q

mx crao:

A

opthalm refer immediately
GCA - prednisolone 60mg
primary prevention: RFs = CV RFs (smoking, HTN, CAD, chol)
Secondary prevention M/CVA e.g. aspirin
?anterior chamber paracentesis (if <24 hours)

166
Q

bright red blood. No visual changes. resolves within 1-2/52)????

A

subconjunctival haemorrhage - caused by increased BP, cough, exertion

167
Q

Night blindness + peripheral to central visual loss - dx?

A

retinitis pigmentosa

168
Q

Colour vision (‘red desaturation’) is affected in?

A

optic neuritis

169
Q

59-M-> ED blurred vision in his left eye, progressively worsening over the past 24 hours. He has never had trouble with his eyesight before and is alarmed at the symptoms he is experiencing. Denies headache but reports pain on movement of his left eye. Colour red appears less vibrant than usual. He is normally fit and well. Underlying cause of his visual disturbance?

A

MS
Optic neuritis
high dose steroids

170
Q

angle closure glaucome gold standard ix?

A

gonioscopy

171
Q

give to angle closure glaucoma patients in emergency?

A

top timolol, top pilocarpine and IV acetazolamide

172
Q

Bilateral grittiness -

A

blepharitis

173
Q

A 68-M with T2DM worsening eye sight. Mydriatic drops are applied and fundoscopy reveals pre-proliferative diabetic retinopathy. A referral to ophthalmology is made. Later in the evening whilst driving home he develops pain in his left eye associated with decreased visual acuity. What is the most likely diagnosis?

A

acute angle closure glaucome

due to the mydriatic drops being applied

174
Q

what is Hutchinson’s sign: and what is the opthalmology relevance?

A

vesicles extending to the tip of the nose. This is strongly associated with ocular involvement in shingles - opthalm assessment same day

175
Q

risk factors for cataracts:

A 
hypocalcaemia
DM
downs syndrome
uveitis
long-term steroid use
sm, alc
176
Q

hypermetropia sign seen in ? (long sightedness)

A

acute angle closure glaucoma

177
Q

myopia seen in ? (short sightedness)

A

primary open angle glaucome

178
Q

49-F known MS -> GP. Partner has noticed a change in the appearance of her eyes over the past few weeks. Has a ptosis on the left side associated with a small left pupil. Fundoscopy is nomal. dx?

A

horner’s syndrome
Ptosis + dilated pupil = third nerve palsy;
ptosis + constricted pupil = Horner’s

179
Q

Keith-Wagener stages of hypertensive retinopathy:

A 
I	Arteriolar narrowing and tortuosity
Increased light reflex - silver wiring
II	Arteriovenous nipping
III	Cotton-wool exudates, Flame and blot haemorrhages
IV	Papilloedema
180
Q

72-F vesicular rash around her left eye. The left eye is red and there is a degree of photophobia. A presumptive diagnosis of herpes zoster ophthalmicus is made and an urgent referral to ophthalmology is made.
What treatment is she most likely to be given?

A

Oral aciclovir

HZO - trigeminal distribution
cx - ant uveitis

181
Q

Tortuosity and silver wiring are features of Grade _ hypertensive retinopathy?
(also which classification system)?

A

1

Keith-Wagener

182
Q

miosis + ptosis + enophthalmos +/- anhydrosis?

A

horner’s syndrome

183
Q

A 42-year-old man is diagnosed with syphilis following months of ill health. On examination he is noted to have bilateral small pupils which accommodate but do not respond to light. dx?

A

argyll-robinson pupil
(also DM)
Accommodation Reflex Present (ARP) but Pupillary Reflex Absent (PRA)

184
Q

In diabetic retinopathy, cotton wool spots represent areas of??

A

retinal infarction

185
Q

26F GP practice with a painful lump on the edge of her left eyelid. Otherwise well, no PMH. Small pus-filled abscess in the area. Her visual field not affected. Dx, tx?

A 
stye
hot compress (+removal of debris)
186
Q

sudden painless loss of vision, severe retinal haemorrhages on fundoscopy. also relative afferent pupillary defect noted. dx?

A

CRVO

“flare haemorrhages, cotton wool spots”

187
Q

Red eye - glaucoma or uveitis?

A

glaucoma: severe pain, haloes, ‘semi-dilated’ pupil
uveitis: small, fixed oval pupil, ciliary flush

188
Q

Key side effects of prostaglandin analogues (latanoprost) include:

A

increased eyelash length, iris pigmentation and periocular pigmentation

189
Q

3F ->GP as her mother has noticed that she is ‘cross-eyed’. The corneal light reflection test confirms this. What is the most appropriate management?

A

refer to opthalmology

190
Q

eg of 3 combination drops given in acute angle closure glaucome as first line?

A

top timolol
top dorzolamide
top brimonidine

191
Q

A 35-year-old male presents to his GP with a 4-day history of sudden onset dull pain in the orbital region, eye redness, lacrimation and photophobia. On examination, he has an irregular, constricted pupil.
dx, mx?

A

anterior uveitis

steroid and cycloplegic eye drops

192
Q

Horner’s syndrome - anhydrosis determines site of lesion:

A

head, arm, trunk = central lesion: stroke, syringomyelia
just face = pre-ganglionic lesion: Pancoast’s, cervical rib
absent = post-ganglionic lesion: carotid artery

193
Q

what is useful to identify refractive errors as the cause of blurred vision?

A

pinhole occluder

194
Q

if horner’s syndrome and ?pancoast - what question will assist in dx?

A

smoking hx

195
Q

A mother brings her 8-week-old child in for review. Since birth his right eye has been watering. His symptoms have got worse over the past few days after he picked up a mild viral illness. Clinical examination is unremarkable. What is the most appropriate action?

A

teach nasolacrimal duct massage

duct obstruction likely

196
Q

An obese 22-year-old female presents to her GP with a 2-week history of daily headaches. Her headaches are bilateral across her forehead, constant throughout the day and worse on bending over. They are not associated with an aura. On fundoscopy, blurring of the optic disc is observed. dx?

A

idiopathic intracranial HTN

197
Q

RAPD which pupil?

A

marcus-gunn

198
Q

Those with a positive family history of glaucoma should be screened?

A

annually from age 40

199
Q

Pain out of proportion of clinical presentation, contact lens and recent freshwater swimming is classical of ?

A

acanthamoebic keratitis

200
Q

Following an uneventful pregnancy, a 19-year-old woman delivers a male child vaginally. At assessment one week later the child is noted to have purulent discharge and crusting of the eyelids. What is the next step in the management of the child?

A

swabs urgently

201
Q

A 79-year-old gentleman presents with a 3 months history of a red swollen left upper eyelid. He remembers initially developing a bump on the eyelid which was uncomfortable but then got bigger forming a hard lump. He reports no pain currently and has not noted any problems with his vision and the eye itself appears healthy. dx?

A

chalazion
no pain
meibomian cyst

202
Q

Anisocoria worse in bright light implies a problem with the??

A

dilated pupil - ciliary ganglion

203
Q

papilloedema on fundoscopy?

A

blurring of optic disc margin on fundoscopy

204
Q

In episcleritis, the injected vessels are ?

A

mobile when pressed gently with cotton wool

in scleritis fixed deeper - do not move

3b/4 (19 decks)

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