Questions

Question 1

Both [investigations] should be performed in patients with suspected acute angle-closure glaucoma

Answer 1

Both tonometry and gonioscopy should be performed in patients with suspected acute angle-closure glaucoma

Question 2

Pain out of proportion of clinical presentation, contact lens and recent freshwater swimming is classical of [] keratitis

Answer 2

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

Question 3

Herpes simplex keratitis most commonly presents with a []

Answer 3

Herpes simplex keratitis most commonly presents with a dendritic corneal ulcer.

Question 4

Definitive treatment for wet AMD is []

Answer 4

Definitive treatment for wet AMD is anti-VEGF

Question 5

Anterior uveitis is most likely to be treated with a [2]

Answer 5

Anterior uveitis is most likely to be treated with a steroid + cycloplegic (mydriatic) drops

Question 6

Which one of the following best describes the action of latanoprost in the management of primary open-angle glaucoma?

Carbonic anhydrase inhibitor
Reduces aqueous production + increases outflow
Opens up drainage pores
Increases uveoscleral outflow
Reduces aqueous production

Answer 6

Which one of the following best describes the action of latanoprost in the management of primary open-angle glaucoma?

Carbonic anhydrase inhibitor
Reduces aqueous production + increases outflow
Opens up drainage pores
Increases uveoscleral outflow
Reduces aqueous production

Question 7

Describe why steroid eye drops can lead to this presentation: [1]

A 58-year-old male presents with a painful right eye. He also has some tearing of the eye and a reduced vision. On examination you identify a corneal ulcer.

Question 8

What is found on fundoscopy? [1]
Explain your answer [1]

Answer 8

Macular degeneration
- The image shows drusen and pigmentary changes in the macula, which are characteristic findings in age-related macular degeneration (AMD).

Question 9

Answer 9

Central retinal vein occlusion

Question 10

1st line of treatment for blepharitis is []

Answer 10

1st line of treatment for blepharitis is hot compresses

Question 11

[3] in vision think retinal detachment

Answer 11

Peripheral curtain over vision + spider webs + flashing lights in vision think retinal detachment

Question 12

Describe the presentation of an ocular migraine [+]

Answer 12

Scintillating phenomena are common and patients may describe distortions as shimmering, kaleidoscope or swimming in appearance

In other cases they may have a scotoma or even total monocular visual loss.

Crucially these changes develop gradually over at least five minutes and last less than one hour.

NB: Ocular migraines are more prevalent in children and young adults

Question 13

What would indicate dry vs wet related macular degeneration? [1]

Answer 13

Drusen = Dry macular degeneration

Question 14

[] is the definitive treatment for acute angle-closure glaucoma

Answer 14

Laser peripheral iridotomy is the definitive treatment for acute angle-closure glaucoma

Question 15

Argyll-Robertson pupil can be caused by syphilis and which other pathology? [1]

Answer 15

diabetes mellitus

Question 16

Argyll-Robertson pupil is one of the classic pupillary syndrome. It is sometimes seen in neurosyphilis. A
mnemonic used for the Argyll-Robertson Pupil (ARP) is … [1]

Answer 16

Argyll-Robertson pupil is one of the classic pupillary syndrome. It is sometimes seen in neurosyphilis. A mnemonic used for the Argyll-Robertson Pupil (ARP) is Accommodation Reflex Present (ARP) but Pupillary Reflex Absent (PRA)

Question 17

How does Argyll-Roberston pupil present? [1]

Answer 17

Bilaterally small pupils that accommodate but don’t react to bright light.
- Accommodation Reflex Present (ARP) but Pupillary Reflex Absent (PRA)

Question 18

Describe what is meany by an Adie pupil (presentation [3] & cause [2])

Answer 18

Tonically dilated pupil, slowly reactive to light with more definite accommodation response.
- accompanied by absent knee or ankle jerks.
- Caused by damage to parasympathetic innervation of the eye due to viral or bacterial infection.

Question 19

Describe what causes and the presentation of a Marcus-Gunn pupil [3]

Answer 19

Relative afferent pupillary defect, seen during the swinging light examination of pupil response
- The pupils constrict less and therefore appear to dilate when a light is swung from unaffected to affected eye
- Most commonly caused by damage to the optic nerve or severe retinal disease.

Question 20

Describe what is meant by & presentation of Hutchinson’s pupil [2]

Answer 20

Unilaterally dilated pupil which is unresponsive to light
- A result of compression of the occulomotor nerve of the same side, by an intracranial mass (e.g. tumour, haematoma)

Question 21

[3] should cause high suspicion of wet age-related macular degeneration

Answer 21

Decreasing vision over months with metamorphopsia and central scotoma should cause high suspicion of wet age-related macular degeneration

Question 22

A 71-year-old patient with a background of hypertensive retinopathy presents for an eye check. Fundoscopy demonstrates retinal arteriole tortuosity with nil other abnormalities noted. According to the Keith-Wagener classification, which grade of hypertensive retinopathy is this most likely to represent?

Grade 0
Grade 1
Grade 2
Grade 3
Grade 4

Question 23

What is a mneumonic for different grades of hypertensive retinopathy? [4]

Answer 23

SAVE for remembering the grading – not perfect but HTN grading isn’t very clinically important:
1. Silvering (and Tortuosity)
2. Arterio nipping
3. Venous haemorrhages
4. Edema

Question 24

A 68-year-old retired biomedical scientist is diagnosed with primary open-angle glaucoma after visual field testing revealed peripheral sight loss. She is commenced on timolol.

What is the mechanism of action of this drug?

Both reduces aqueous secretion and increases aqueous outflow
Destroys part of the secretory component of the ciliary body
Increases aqueous outflow via the uveoscleral route
Opens aqueous drainage channels in the trabecular meshwork
Reduces aqueous secretion by the ciliary body

Answer 24

Reduces aqueous secretion by the ciliary body

Question 25

A patient with an organic foreign body in their eye (eg grass seed) tx? [1]

Answer 25

A patient with an organic foreign body in their eye (eg grass seed) **should be referred immediately to ophthalmology for assessment (due to infection risk)**

Question 26

A 72-year-old man presents with a painful, red eye to the Emergency Department. Due to the severity of his symptoms and reduced visual acuity he is referred on to ophthalmology who make a diagnosis of acute glaucoma. Which of the following should be the aims of treatment? Reducing aqueous secretion + inducing pupillary constriction Increasing intraocular pressure to reduce the risk of optic nerve compression Increasing aqueous secretion + inducing pupillary constriction Lowering systemic blood pressure + inducing pupillary dilation Reducing aqueous secretion + inducing pupillary dilation

Answer 26

**Reducing aqueous secretion + inducing pupillary constriction**

Question 27

A 34-year-old woman with a history of multiple sclerosis presents to the ophthalmology clinic complaining of pain in her left eye that worsens with movement, which she has experienced for the past two days. On examination, her visual acuity is measured at 6/20 in the affected eye and 6/6 in the unaffected eye. What additional finding might be expected on an examination given the most likely diagnosis? Anisocoria Central scotoma Dendritic ulcer Holmes-Adie pupil Hypopyon

Answer 27

**Central scotoma** - Central scotoma, or a blind spot in the centre of the visual field, is a common feature of this condition.

Question 28

When do you screen for glaucoma for patients with a strong FHx? [1]

Answer 28

Those with a positive family history of glaucoma should be **screened annually from aged 40 years**

Question 29

most likely to be seen? Miosis + third cranial nerve palsy Mydriasis + ptosis + exophthalmos Mydriasis + anhydrosis on the affected side of the face Miosis + ptosis + enophthalmos Mydriasis + ptosis + enophthalmos

Answer 29

The correct answer is **Miosis + ptosis + enophthalmos** - Horner's syndrome is a combination of symptoms caused by the disruption of a nerve pathway from the brain to the face and eye on one side of the body. **The classic triad of symptoms in Horner's syndrome includes miosis (constriction of the pupil), ptosis (drooping of the upper eyelid), and enophthalmos (inward sinking of the eye into its socket).**