Questions Flashcards
(94 cards)
1
Q
Both [investigations] should be performed in patients with suspected acute angle-closure glaucoma
A
Both tonometry and gonioscopy should be performed in patients with suspected acute angle-closure glaucoma
2
Q
Describe how you distinguish between CMV and TG retinitis in a patient with HIV? [1]
A
Toxoplasmosis: fundoscopy often shows features of retinal scaring from the parasite.
CMV Retinitis: Reduced visual acuity; fundoscopy reveals a classic “pizza pie” appearance
3
Q
Pain out of proportion of clinical presentation, contact lens and recent freshwater swimming is classical of [] keratitis
A
Pain out of proportion of clinical presentation, contact lens and recent freshwater swimming is classical of acanthamoebic keratitis
4
Q
Herpes simplex keratitis most commonly presents with a []
A
Herpes simplex keratitis most commonly presents with a dendritic corneal ulcer.
5
Q
Definitive treatment for wet AMD is []
A
Definitive treatment for wet AMD is anti-VEGF
6
Q
Anterior uveitis is most likely to be treated with a [2]
A
Anterior uveitis is most likely to be treated with a steroid + cycloplegic (mydriatic) drops
7
Q
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
A
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
8
Q
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.
A
9
Q
What is found on fundoscopy? [1]
Explain your answer [1]
A
Macular degeneration
- The image shows drusen and pigmentary changes in the macula, which are characteristic findings in age-related macular degeneration (AMD).
10
Q
A
Central retinal vein occlusion
11
Q
1st line of treatment for blepharitis is []
A
1st line of treatment for blepharitis is hot compresses
12
Q
[3] in vision think retinal detachment
A
Peripheral curtain over vision + spider webs + flashing lights in vision think retinal detachment
13
Q
Describe the presentation of an ocular migraine [+]
A
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
14
Q
What would indicate dry vs wet related macular degeneration? [1]
A
Drusen = Dry macular degeneration
15
Q
[] is the definitive treatment for acute angle-closure glaucoma
A
Laser peripheral iridotomy is the definitive treatment for acute angle-closure glaucoma
16
Q
Argyll-Robertson pupil can be caused by syphilis and which other pathology? [1]
A
diabetes mellitus
17
Q
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]
A
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)
18
Q
How does Argyll-Roberston pupil present? [1]
A
Bilaterally small pupils that accommodate but don’t react to bright light.
- Accommodation Reflex Present (ARP) but Pupillary Reflex Absent (PRA)
19
Q
Describe what is meany by an Adie pupil (presentation [3] & cause [2])
A
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.
20
Q
Describe what causes and the presentation of a Marcus-Gunn pupil [3]
A
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.
21
Q
Describe what is meant by & presentation of Hutchinson’s pupil [2]
A
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)
22
Q
[3] should cause high suspicion of wet age-related macular degeneration
A
Decreasing vision over months with metamorphopsia and central scotoma should cause high suspicion of wet age-related macular degeneration
23
Q
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
A
24
Q
What is a mneumonic for different grades of hypertensive retinopathy? [4]
A
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
25
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
**Reduces aqueous secretion by the ciliary body**
26
A patient with an organic foreign body in their eye (eg grass seed) tx? [1]
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)**
27
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
**Reducing aqueous secretion + inducing pupillary constriction**
28
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
**Central scotoma**
- Central scotoma, or a blind spot in the centre of the visual field, is a common feature of this condition.
29
When do you screen for glaucoma for patients with a strong FHx? [1]
Those with a positive family history of glaucoma should be **screened annually from aged 40 years**
30
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
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).**
31
What is dacryocystitis? [1]
Describe the presention [1]
State the treatment [2]
**Dacryocystitis**: infection of the lacrimal sac
- **pain, a feeling of fullness, and erythema near the medial canthus of right eye**
- **oral antibiotics** are effective for treating the acute infection in most uncomplicated cases of dacryocystitis. **Surgical intervention** is considered for chronic cases or after acute infection resolution.
32
The typical presentation is a **gradual painless visual loss that affects central vision**
What does this describe? [1]
**age-related macular degeneration**
33
Which of the following additional features most points to a diagnosis of orbital cellulitis?
Proptosis
Eyelid oedema
Eyelid tenderness
Conjunctival oedema
Recent sinus infection
**Proptosis**
* This is seen in orbital cellulitis and warrants urgent hospital admission if severe
* Not seen in pre-septal, unlike the other features
34
If wash contact lenses in the sink - what is the main likely cause of infection? [1]
**Acanthamoeba**
35
Describe how primary herpes simplex keratitis will usually present [2]
Primary herpes simplex keratitis will usually present with **vesicles on the lids and conjunctiva** with **subsequent infections affecting the cornea.**
- The typical presentation is of a foreign body sensation, photophobia and redness.
36
Describe what eye test might indiciate MS [1]
In optic neuritis, **unilateral examination may reveal apparent bilateral pupillary response** due to the **involvement of the ipsilateral optic nerve**, resulting in **paradoxical dilation upon examination of the unaffected eye**.
- E.g. Upon shining a light into her left eye, both pupils appear to constrict. When the light is immediately moved to her right eye, both appear to dilate.
37
[] needs to be completed within 72h to prevent further neovascularisation
**Urgent laser photocoagulation** needs to be completed within 72h to prevent further neovascularisation
38
How do you treat vitreous haemorrhage? [1]
Diagnosis is confirmed by ultrasonography where fundoscopy is limited. The **blood is normally re-absorbed over a period of weeks**, leading to slow improvement in symptoms. This makes observation the most appropriate answer.
- **Vitrectomy**: Surgical removal of the vitreous may be necessary in severe cases.
39
There is no curative medical treatment for dry AMD. High dose of **[4]** can be given to slow deterioration of visual loss
There is no curative medical treatment for dry AMD. High dose of **beta-carotene, vitamins C and E, and zinc** can be given to slow deterioration of visual loss
40
How do you differentiate vitreous haemorrhage to retinal detachment? [2]
Both cause acute, painless vision loss:
- **VH**: Patients may **complain of dark spots in their vision**. Fundoscopy typically shows haemorrhage within the vitreous cavity.
- **RD**: It would typically present as a **dense shadow that starts peripherally and progresses centrally**. It may progress from posterior vitreous detachment and so patients may complain of **flashes and floaters in their vision before retinal detachment occurs.**
## Footnote
**NB**: Diabetes is a big risk factor for VH
41
Dx? [1]
Presentation? [2]
**Retinal detachment**. This condition presents with symptoms such as sudden or gradual reduction in vision, often described by patients as a '**curtain coming down**'.
- Fundoscopy reveals an **elevated retina with folds and a visible retinal tear.**
42
A patient has Thyroid eye disease. Which treatment would worsen this/ [1]
**Radioactive iodine ablation therapy** worsens thyroid eye disease. The mechanism is proposed to centre on an initial increase in the number of thyroid antigens in the circulation following iodine ablation. These antigens then react with antibodies which go on to cross react with similar antigens in the extraocular muscles and fibroblasts
43
**[]** (to check for distortion of line perception) may be useful in testing patients with suspected age related macular degeneration
**Amsler grid testing** (to check for distortion of line perception) may be useful in testing patients with suspected age related macular degeneration
44
Describe the difference in eye presentation in TED and MG [1]
**Lid retraction** (Dalrymple's sign) and l**id lag on down gaze** (Von Graefe's sign) are classic features of **TED**.
**MG**:
- **fatigable ptosis and weakness**
45
How do you distinguish retinal detachment from vitreous haemorrhage and / or detachment? [1]
**All have flashing / floaters**
But only **retinal detachment has curtain descending of central vision**
46
Describe myopia can lead to retinal detachment [1]
. In **myopia**, the **eye is bigger and therefore the retina is thinner** and is **more easily torn**
47
CRVO can lead to which condition? [1]
He has **developed neovascular glaucoma or "90-day glaucoma"**, a complication of ischaemic CRVO that usually develops within a **few months of onset.**
48
A 63-year-old gentleman is diagnosed with primary open angle glaucoma. He asks how untreated glaucoma is most likely to affect vision?
Impairs colour vision, with red colour vision affected first
Impairs central vision
Impairs peripheral visual fields
Impairs visual acuity
Impairs night vision
**Impairs peripheral visual fields**
## Footnote
NB: **P**rimary open angle glaucoma = **p**eripharl visual fields
49
A 32-year-old man presents with night sweats and a cervical lymph node. Aspirate of the node reveals many acid-fast bacilli and PCR confirms the presence of Mycobacterium tuberculosis. He is started on quadruple therapy.
As part of the counselling, you warn him of potential side effects including optic neuritis.
What symptom should he be warned about?
Diplopia
Pain relieved by eye movements
Peripheral visual loss
Red desaturation
Sudden monocular blindness
**Colour vision ('red desaturation') is affected in optic neuritis**
50
A 30-year-old man has presented to the eye emergency department after being hit across the face with a baseball bat. On examination, the right eye has blood in the anterior chamber.
Which of the following does the blood most put him at risk for?
Cataract
Ectopia lentis
Endophthalmitis
Glaucoma
Uveitis
A 30-year-old man has presented to the eye emergency department after being hit across the face with a baseball bat. On examination, the right eye has blood in the anterior chamber.
Which of the following does the blood most put him at risk for?
Cataract
Ectopia lentis
Endophthalmitis
**Glaucoma** - increased pressure
Uveitis
51
Tx for anterior uveitis? [2]
**Steroid drops and cycloplegic drops**
52
Describe the vision loss seen in:
- **primary open angle glaucoma**
- **age macular degeneration**
- **vitreous haemorrhage**
- **retinal detachment**
**primary open angle glaucoma**: peripheral vision loss
**age macular degeneration**: central vision loss
**vitreous haemorrhage**: dark spots appear
**retinal detachment**: curtain or shadow progressing to the centre of the visual field from the periphery; w flashers and floaters
53
54
What are key features of optic neuritis? [5]
**RAPD**
**A central scotoma** is a blind spot or area of decreased vision that appears in the center of your field of vision
**Unilat visual acuity worse**
**Pain w eye movement**
**Colour harder to distinguish**
55
Latanoprost can cause which changes as side effects? [3]
**Increase eye lashes; iris pigmentation**
56
How do you differentiate between retinal detachment and posterior vitreous haemorrhage? [1]
**RD**:
- Curtain down; FF;
**PVD**:
- FF; more blurred vision than loss
57
Sx of anterior uveitis? [3]
Acute;
Blurred vision
Small fixed oval pupils
58
How do you manage squint? [1]
Patch the good eye
- force weaker eye to take up fixation
59
If unsure between epi- and scleritis, what is a quick test can do to check? [1]
**Episcleritis**:
- the **injected vessels are mobile** when gentle pressure is applied, which is not the case here.
**Scleritis**
- **injected vessels are not mobile**
60
What are the first line treatments for allergic conjunctivitis? [2]
According to NICE guidelines, the 1st line treatment is a **topical mast cell stabilizer (sodium cromoglycate) and topical antihistamine (antazoline).**
61
A patient presents with ? herpes zoster ophthalmicus. What further sign would increase the likeliness of this?
**Hutchinson’s sign**
- Presence of nose-tip involvement
Presence of this sign makes it likely that the eye will be affected
62
Orbital blow out fracture. This is commonly caused by sports injuries.
How does the injury occur? [1]
Which bone is commonly affected? [1]
The **pressure** from the **force** causes **fracture of the orbital floor**
The **ethmoid bone** forms the **medial** **wall** of the **orbit**, which is **commonly fractured as it is very thin**
63
Describe the CN findings of an orbital fracture [1]
**Vertical diplopia and restriction of upgaze** - can occur due to entrapment the **inferior rectus muscle**
64
[1] is a risk factor for the development or worsening of thyroid eye disease, hence it should be used with caution in patients with active thyroid eye disease and risk factors for progression.
**Previous radioiodine therapy** is a risk factor for the development or worsening of thyroid eye disease, hence it should be used with caution in patients with active thyroid eye disease and risk factors for progression.
65
Slit lamp examination reveals red blood cells in the anterior vitreous of the left eye. Cotton wool spots, neovascularisation, and hard exudates are also noted to the retina bilaterally.
What is the most common cause? [1]
**Proliferative diabetic retinopathy** is the most common underlying cause of a **vitreous haemorrhage**
- RBC - think DM --> vitreous haemorrhage
66
*On examination, the conjunctiva is mildly injected, and the cornea appears clear. Fluorescein staining reveals a small area of corneal uptake, and the rest of the eye examination is unremarkable*
Dx? [1]
Mx? [1]
**Corneal abrasion**: **topical antibiotics** should be given to prevent secondary bacterial infection
67
Describe a complication that occurs in 50% of people with pan-retinalphotocoagulation [1]
**Following panretinal laser photocoagulation** up to **50% of patients have a noticeable reduction in their visual field**
68
Herpes zoster ophthalmicus requires urgent ophthalmological review and 7-10 days of **[]**
**oral antivirals** - **oral famciclovir**
69
Describe what causes blepharitis [2] and how it is treated [1]
**Blepharitis** refers to **inflammation of the eyelid margins.**
It causes a **gritty, itchy, dry sensation in the eyes**. It can be **associated with dysfunction of the Meibomian glands**, which are **responsible for secreting meibum (oil)** onto the **surface of the eye**. It can lead to **styes and chalazions**.
70
Describe the clinical features of blepharitis [+]
**symptoms** are usually **bilateral**
**grittiness and discomfort,** particularly around the **eyelid margins**
**eyes** may be **sticky** in the **morning**
**eyelid margins may be red**. **Swollen eyelids** may be seen in **staphylococcal blepharitis**
**styes and chalazions** are more common in patients with **blepharitis**
**secondary conjunctivitis may occur**
71
Mx of blepharitis? [3]
**softening of the lid margin** using **hot compresses twice a day**
**'lid hygiene'** - mechanical removal of the debris from lid margins
- **cotton wool buds dipped in a mixture of cooled boiled water** and **baby shampoo is often used**
**artificial tears** may be given for symptom relief in people with dry eyes or an abnormal tear film
72
What is a stye [1]
How is it treated? [2]
**Infection** of the **glands** (glands of Zeis or glands of Moll) of the **eyelids,** at the **base of the eyelashes**
**Mx**:
* **Styes** are **treated with hot compresses and analgesia**.
* **Topical antibiotics** (e.g., **chloramphenicol**) may be considered if it is associated with conjunctivitis or if symptoms are persistent.
## Footnote
**Hordeolum externum** is an infection of the glands of Zeis or glands of Moll.
73
What is a chalazion? [1]
Tx? [2]
A **chalazion** occurs when a **Meibomian gland** becomes **blocked and swells.** It is often called a **Meibomian cyst**. It presents with a swelling in the eyelid that is typically not tender (however, it can be tender and red).
**Tx**:
Treatment is with **warm compresses** and **gentle massage towards the eyelashes** (to encourage drainage). Rarely, surgical drainage may be required.
74
What is the difference betwen an entropion and an ectropion? [2]
What can they lead to? [2]
**Entropion** refers to when the **eyelid turns inwards** with the **lashes pressed against the eye**.
- This causes pain and can result in **corneal damage and ulceration.**
**Ectropion** refers to when the eyelid **turns outwards, exposing the inner aspect.**
- It usually **affects the bottom lid**. This can result in **exposure keratopathy**, as the **eyeball is exposed and not adequately lubricated and protected.**
75
Tx for entropion or ectropion? [2]
**Entropion**:
- Initial management is by **taping** the eyelid down to **prevent it from turning inwards** - when the eyelid is taped down, it is **essential to prevent the eye from drying out** by using **regular lubricating eye drops. **
- Definitive management is **surgical**
**Ectropion**:
* **Mild cases may not require treatment**.
* **Regular lubricating eye drops** are used to protect the surface of the eye. More significant cases may require surgery to correct the defect
76
What is trichiasis? [1]
Mx? [1]
**Trichiasis** refers to **inward growth of the eyelashes**. It results in pain and can **cause corneal damage and ulceration.**
**Management** involves **removing the affected eyelashes**. Recurrent cases may require **electrolysis, cryotherapy or laser treatment to prevent them from regrowing.** A same-day referral to ophthalmology is required if there is a risk to sight.
77
History of contact lens is typical for stem questions related to **[]**
History of contact lens is typical for stem questions related to **keratitis**
78
79
bacterial keratitis:
- typically caused by which pathogen? [1]
- In contact lens wearers? [1]
**bacterial**
* typically **Staphylococcus aureus**
* **Pseudomonas** **aeruginosa** is seen in contact lens wearers
80
What is key about presentation of acanthamoebic keratitis? [1]
**pain is classically out of proportion to the findings**
81
The use of mydriatic drops in a predisposed individual can precipitate **[1]**
Why? [1]
The use of mydriatic drops in a predisposed individual can precipitate **acute angle closure glaucoma by dilating the pupil, which causes the peripheral iris to bunch up and block the drainage angle of the anterior chamber**
82
A 32-year-old contact lens wearer presented with a painful red eye and photophobia. Examination revealed a corneal ulcer with a hypopyon.
What is the most likely cause? [1]
**Pseudomonas aeruginosa**
- common cause of infective keratitis in contact lens users, often presenting with a corneal ulcer and hypopyon.
83
Which presentation of orbital cellulitis is most concerning? Why? [2]
**decreased colour vision** is the most concerning as it indicates **impending optic nerve necrosis.**
84
flashers x curtain over his vision in his right eye = ? [1]
Retinal d
85
A 51 year old female patient attends A&E complaining of a red right eye. She reports that her red eye started suddenly, and she can hear a 'whooshing noise'. She also reports diplopia, a headache and loss of vision.
On examination her visual acuity is 1/60 in her right eye. Her conjunctiva is injected, and she has a restriction in her right eye movements in all direction. The eye is severely proptosed and pulsatile.
What is the most likely diagnosis? [1]
**Carotid-cavernous fistula**
This a communication between the carotid artery and the cavernous sinus. All cranial nerves that run through the cavernous sinus may be affected which include (III, IV, V1, V2 and VI). The eye is usually proptosed with an injected conjunctiva and may be pulsatile
**Whoosing = fistula**
86
Which cranial nerves are found in which parts of the brainstem? [12]
mid brain: CN 1, 2, 3, 4
pons: CN 5, 6, 7, 8
medulla: CN 9, 10, 11, 12
87
A 45-year-old woman presents with a painful, swollen, and erythematous area just below the medial canthus of her right eye. She reports increased tearing, tenderness, and discharge. Examination reveals swelling over the lacrimal sac, and gentle pressure causes purulent material to be expressed.
What is the most likely diagnosis? [1]
How does this typically present? [1]
**Dacryocystitis** is an **infection of the lacrimal sac** that leads to pain, swelling, and erythema over the medial canthus, with associated tearing and purulent discharg
88
What is the most appropriate management?
**Antioxidants and smoking cessation**
* This patient has experienced insidious-onset central vision blurring and metamorphopsia (distortion of vision). The changes shown on the retina are well demarcated, yellow deposits known as drusen which are seen in **age related macular degeneration.**
* There is **no evidence of neovascularisation in the macula**, making this a case of **dry age-related macular degeneration (ARMD)**
* **Antioxidant therapy and smoking cessation have been shown to reduce the risk of progression in ARMD, although there is currently no cure**
89
A patient is presenting with acute progression of dry ARDM to wet ARMD. When treating wet ARMD, what is the key focus of tx? [1]
How is this done? [1]
presenting with acute progression of dry ARDM to wet ARMD. **When treating wet ARMD, prevention of further neovascularisation is essential**
- This is achieved through **anti-VEGF agents such as Bevacizumab,** which can be injected directly into the vitreous to increase its bioavailability to the choroid
90
A patient suffers from a blow out fracture.
Which cranial nerve is most likely damaged in these cases? [1]
blowout fracture of his right orbit. This occurs when the orbit is struck with blunt force by an object of a larger diameter than the orbit. The force is transmitted through the contents of the orbit, **most commonly fracturing the inferior orbit wall,** causing **herniation** and **entrapment** of the **inferior rectus muscle.**
91
What is metamorphopsia? [1]
What does it indicate? [1]
where **straight lines may appear wavy**
- It is a sign of macular pathology: often seen in **AMD**
92
On examination there is a bitemporal superior quadrantanopia
What is this most likely caused by? [1]
In ophthalmology, a **bitemporal superior quadrantanopia** and galactorrhoea may suggest a **pituitary adenoma** with compression of the optic chiasm.
93
What is a side effect of pan-photocoagulation? [1]
Decline in night vision
94
Describe the difference in Holmes-Adie pupil and Argyll-Robertson presentation [2]
**HAP**:
- Accomodation and reacts **slowly**
- *Sherlock home reacts slowly to not give away clues*
**AR**:
- Accom but **does NOT react**
- *Prostitutes accom but do not react*
