NB topics

Question 1

6 Eye problems in HIV/ AIDS

Answer 1

1. Abnormal conjunctival lesions
2. Abnormal vernal keratoconjunctivitis
3. HZ infection
4. Herpes Simplex Keratitis in periphery
5. Kaposi’s Sarcoma
6. Orbital cellulitis

Question 2

What is needed for near vision

Answer 2

1. Convergence
2. Pupillary constriction
3. Accommodation

Question 3

Hypermetropia
Indications for treatment
Treatment

Answer 3

Indications for treatment: < VA, eye exhaustion, strabismus
Treatment:
1. Convex lenses
2. Contact lenses

Question 4

Myopia

treatment

Answer 4

1. Concave lens
2. Contact lenses
3. Refractory surgery

Question 5

Anterior Uveitis: Clinical tests

Answer 5

1. Consensual light reflex–> Pain in contralateral eye
2. Accommodation test
3. Eclipse test

Question 6

Posterior Uveitis
Symptoms
Causes
Signs
Complications

Answer 6

Symptoms: < VA
Causes: Toxoplasmosis from animals
Signs: Dull fundus, yellow/white choroid, retinal vasculitis
Complications: Chorio-retinal scar formation, exudative retinal detachment, rhegmatogenous retinal detachment, papillitis

Question 7

Diagnostic drugs

Answer 7

• Fluorescein: orange liquid, under blue light bright green/yellow
• Midriatics: parasympathetic drugs -> paralysis of iris sphincter:
oAtropine sulphate: 7-14 days (longest) -> therapeutic
oScopolamine: 2-3 days
oTropicamide: 6-8hrs -> shortest
oCyclopentolate: 6-24 hrs
oSide-effects: nausea; vomiting; pallor
oSympathomimetics: Phenylephrine (use in combination with pSympathetic)

Question 8

Side effects: Steroids, Ethambutol, Phenothiazine

Answer 8

• Steroids: cataracts; glaucoma
• Ethambutol: optic neuritis
• Phenothiazine: opacities in lens/corneal epithelium

Question 9

Meibomian Cyst
Definition
Clinical picture
Treatment

Answer 9

• Definition: Lipogranulomatous inflammation secondary to the retention of meibomian due to obstruction
• Clinical Picture: firm round swelling in tarsal plate; often painless; red raised conjunctiva
• Treatment: Incision and curettage

Question 10

Blepharitis treatment

Answer 10

1. Lid hygiene
2. topical antibiotic, post. Blepharitis = systemic tetracyclines
3. warm compress; expression of meibomian glands

Question 11

Ptosis classifications and treatment

Answer 11

Classification: Neurogenic, Aponeuritic, Mechanical, Myogenic
Treatment: refer to ophthalmologist, avoid amblyopia, suspect CN III palsy

Question 12

Causes of mucin & lipid layer deficiency

Answer 12

1. Chemical burns
2. Trachoma
3. Steven-Johnson syndrome
4. Vit A deficiency

Question 13

Lid Abnormalities: Causes of abnormal lid contours & disruption of lid movement

Answer 13

Countour: Trachoma, Trauma, Tumour

Lid Movement: fascial paralysis, Simblephara (trauma, Steven-Johnson, Trachoma)

Question 14

Dacryocystitis: Definition, Signs & Treatment

Answer 14

Definition: obstruction of the tear flow distal to lacrimal sac leading to stasis, secondary infection can occur, filling sac with pus
Symptoms: Epiphora, Pain
Signs: Swelling, Redness, Tenderness over lacrimal sac, can break skin
Treatment: local/systemic antibiotics, drainage of abscess

Question 15

Difference between pre-orbital cellulitis & orbital cellulitis

Answer 15

Orbital: Chemosis, Redness, Pain, Proptosis, Decrease in eye movement
Pre-orbital: opposite of above

Question 16

Pterygium: Treatment & Indications for surgery

Answer 16

Treatment:

1. artificial tears
2. antihistamines
3. vasoconstrictors
4. antibiotics, steroids

Indications:

1. medical treatment failure
2. increasing astigmatism,
3. growth over visual axis,
4. to be able to wear contact lenses,
5. cosmesis
6. suspected malignancy

Question 17

Classify bacterial conjunctivitis, viral conjunctivitis, allergic conjunctivitis

Answer 17

1. Bacterial: Acute, Gonococcal, Chlamydial, Chronic blepharoconjunctivitis
2. Viral: Adeno virus (pharyngo (adeno 3 & 7), epidemic keratoconjunctivitis (8 & 19)) Acute haemorrhagic; Herpes simplex; Molluscum contagiosum keratoconjunctivitis
3. Allergic: Hayfever; Acute allergic blepharoconjunctivitis; Vernal conjunctivitis; Giant papillary conjunctivitis; Steven-Johnson

Question 18

Adenovirus conjunctivitis syndromes: Clinical picture & treatment

Answer 18

Picture: acute follicular conjunctivitis with pre-auricular lymphadenopathy; red eyes; years; itches; photophobia
Treatment: no specific Mx, antibiotic & vasoconstrictor drops (steroids only if vision is affected & herpes simplex excluded)

Question 19

Allergic Conjunctivitis: Treatment

Answer 19

1. Antihistamines
2. Vasoconstrictors
3. Ice packs
4. Topical steroids

Question 20

Bacterial Keratitis: Organisms, treatment & complications

Answer 20

Organisms: Pneumococci, Pseudomonas, Staph. Aureus/epidermidis

Treatment:

1. Cover eye
2. Cycloplegic drugs
3. Local antibiotics

Complication: corneal thinning, corneal opacification, corneal perforation, endophthalmitis

Question 21

Phlyctenulosis: Causes, variance, treatment

Answer 21

Causes: usually TB, reaction against staph.cocc. organism

Variance: conjunctival phlycten (raised pink nodule close the limbus) & corneal phlycten (starts in limbus, may spread centrally, ulcerates)

Treatment: steroids

Question 22

Keratoconus: Munsen’s sign, Clinical picture and treatment

Answer 22

Munsen sign: in keratoconus, the extra bowing of the lower eyelid caused by the misshapen cornea as the eye rotates downward.

Treatment:

1. Corneal transplant
2. Hard contact lenses

Question 23

Optic Neuritis: Classification, Causes, Clinical Picture

Answer 23

Classification: Papillitis, Retrobulbar neuritis

Causes: MS most common in adults, Viral most common in children, idiopathic, autoimmune, systemic infection

Clinical Picture: unilateral loss of vision, retrobulbar pain

Question 24

Optic disk clinical characteristics

Answer 24

1. colour
2. cup
3. contour
4. cardiovascular

Question 25

Strabismus: Consequences

Answer 25

1. Amblyopia (strabismus amblyopia, depravation, refractive) 2. Suppression of image (coping mechanism) 3. Diplopia

Question 26

Strabismus: Commitant (refractive error) vs. Incommitant (eye movement fucked)

Answer 26

Incommitant: deviation will vary with direction of gaze, impairment of movement, angle of deviation maximal in affected muscle test, not present in all directions of gaze, head position is held where affected muscle is least used Commitant: no impairment of eye movement -> angle of deviation same in all directions

Question 27

CN III Palsy: Consequences & Causes

Answer 27

Causes: space-occupying lesions, vascular causes (ischaemia, thrombosis), Consequences: horizontal & vertical diplopia, inability to elevate & duct, ptosis of the upper eyelid, pupil may be dilated

Question 28

Horner’s syndrome: Characteristics

Answer 28

1. Miosis 2. ptosis 3. pseudoenophtalmos 4. anhydrosis 5. heterochromia of the iris

Question 29

Differential diagnosis of leucocoria (pupil displays white)

Answer 29

* Cataract * Retinoblastoma * Retinal detachment * Post. Uveitis * Old virteous haemorrhage * Retinopathy of prematurity * Persistant hyperplastic primary vitreous * Tunica vasculosa lentis

Question 30

Anterior & Posterior Uveitis: Signs, Symptoms, Complication

Answer 30

Anterior: o Signs: decreased visual acuity, ciliary congestion, anterior chamber opacification, hypopion, miosis o Symptoms: dull vision, redness, photophobia, deep eye pain o Complications: anterior/posterior synechiae, cataracts, hypotonia, blocking of trabecular network, glaucoma Posterior: o Symptoms: decrease in visual acuity o Signs: dull fundus, cotton-wool choroid and retina, vasculitis o Complications: exudative/rhegmatoid retinal detachement, papillitis, scar formation

Question 31

Glaucoma: Diagnosis, Signs & Symptoms, Treatment

Answer 31

``` Closed angle: Diagnosis: nature of pain, fixed mid-dilated pupils corneal oedema Symptoms: acute onset, unilateral pain radiating to ipsilateral hemicranium, can vomit from pain, red eyes, big decrease visual acuity, coloured halos around lights, photophobia Signs: fixated middilated pupils, ciliary congestion, corneal opacification Treatment: 1. acetozolamide (diamox) 2. emergency Mx 3. glycerol 4. topical B-blockers 5. pilocarpine 6. systemic analgesia 7. anti-emetic agent ``` Open Angle: Diagnosis: optic disk indicative of disease, referral Symptoms: almost always asymptomatic Signs: decrease in visual acuity when terminal, loss of visual fields, increased IOP Optic disk changes: colour pale, cup large (C/D > 0.5), vessels has nasal displacement, border has nerve fibre haemorrhage Treatment: 1. adrenaline 2. B-blocker

Question 32

Cataracts: Indications & contra-indications for surgery

Answer 32

Indications: impact on daily functioning, diabetic patient, pale fundus, lens-induced disease Contra-indications: patient don’t want, glasses & other medical treatment works fine, surgery won’t improve

Question 33

Cataracts: Indications & contra-indications for surgery

Answer 33

Indications: impact on daily functioning, diabetic patient, pale fundus, lens-induced disease Contra-indications: patient don’t want, glasses & other medical treatment works fine, surgery won’t improve

Question 34

Retinoblastoma: Clinical picture & treatment

Answer 34

Clinical picture: 1. Leucocoria 2. strabismus 3. proptosis 4. uveitis, 5. glaucoma Treatment: 1. radiotherapy 2. chemotherapy 3. cryotherapy 4. enucleation 5. photocoagulation

Question 35

Blow-out fracture: Clinical Picture & Treatment

Answer 35

Clinical: 1. diplopia 2. proptosis 3. enophthalmos 4. periorbital crepitus 5. reduced sensation Treatment: 1. antibiotics 2. don’t blow nose (eye in maxillary sinus – eye can come out!)

Question 36

Hyphema: Complications & treatment

Answer 36

Complications: raised IOP, discolourisation of corneal stroma, secondary bleeding Treatment: 1. Topical steroids 2. oral cyclocapron 3. topical cycloplegics 4. B-blockers 5. Diamox

Question 37

Acute central retinal venous occlusion: Associations, Symptoms, Signs, Treatment

Answer 37

Associations: hypertension, glaucoma, diabetes, phlebitis, Symptoms: sudden unilateral loss of vision in a white eye Signs: visual acuity & field decrease, RAPD, optic disc swelling, cotton wool spots Complications: Neovascularisation Treatment: photocoagulation

Question 38

Differential diagnosis of painful red eyes

Answer 38

* Acute closed angle glaucoma * Open eye injuries * Chemical burn * Corneal abscess

Question 39

Differential diagnosis of painless white eyes

Answer 39

* Acute retinal arterial occlusion * AION * Acute retinal tear * Retinal detachment that threatens macula * Acute extra-ocular muscle paralysis with headache

Question 40

Rhegmatogenous retinal detachment: Cause/Process & Treatment

Answer 40

Cause/Process: retinal hole formation is caused by: vitreous traction during post vitreous detachment, vitreous traction during blunt eye trauma, degenerative holes with vitreous traction Treatment: 1. laser or cryotherapy 2. drainage of fluid

Question 41

Acute central retinal artery occlusion: Causes, Symptoms, Signs, Treatment

Answer 41

Causes: thrombosis, embolism Symptoms: white eye and sudden unilateral loss of vision, amaurosis fugax (fleeting vision), Signs: decreased visual acuity, decreased visual field, RAPD, milky-white retina, cherry red spot, Treatment: 1. massage 2. 95% O2 + Co2 3. vasodilators 4. acetozolamide

Question 42

Eyelid blunt trauma: Treatment

Answer 42

1. Clean thoroughly 2. topical broad spectrum antibiotics, systemic analgesia 3. anti-inflammatory drugs

Question 43

Contusion of eye: Complications

Answer 43

1. Peri/retrobulbar bleeding 2. Proptosis 3. Limitation eye movement

Question 44

Chemical burn: Treatment and complications

Answer 44

Complications: glaucoma, corneal scarring, simblepharon, entropion, dry eyes Treatment: 1. Rinsing of eye with water 2. Sterile isotonic salt mixture in palpebral 3. Wet cotton bud 4. Local anaesthetic 5. Systemic painkillers

Question 45

Age Related Macular Degeneration: Classification, Symptoms, Treatment

Answer 45

``` • Classification: Dry and Wet • Symptoms: painless decrease in visual acuity (wet=fast)(dry=insidious), picture distortion, central scotoma •Treatment: 1. dry=non-specific 2. wet=laser photocoagulation ```

Question 46

Diabetic Retinopathy: Microvascularopathy & treatment

Answer 46

Microvascularopathy: vascular leakage, microvascular occlusion Treatment: 1. Monitor blood glucose 2. Argon laser photocoagulation 3. Regular ophthalmologist visits 4. Blood pressure control 5. Aneamic control 6. Infection control

Question 47

Complications of neovascularisation

Answer 47

* Neovascular glaucoma * Massive intra-retinal exudates * Vitreous haemorrhage * Vitreous traction cords * Retinal traction detachment

Question 48

Hyperthyroidism

Answer 48

1. Fatty tissue increased inside orbit -> exophthalmos

Question 49

Rheumatoid Arthritis

Answer 49

1. Dry eyes 2. Corneal thinning 3. Episcleritis 4. Scleritis