Ophthalmic presentations

Question 1

What is photopsia?

Answer 1

Light flashes without a light source

Question 2

What are some causes photopsia?

Answer 2

1. posterior vitreous detachment
2. migraine with aura
3. migraine aura without headache
4. retinal break or detachment

Question 3

What is posterior vitreous detachment?

Answer 3

The separation of the posterior vitreous cortex and the internal limiting membrane of the retina

(The layers peel apart)

Question 4

What causes retinal detachment?

Answer 4

Ageing
Injury of the eye

Question 5

What are the different types of retinal detachment?

Answer 5

1. rhegmatogenous: caused by a hole or tear in the retina that allows fluid to pass through and collect underneath the retina causing the retina to pull away from underlying tissues
2. Tractional: scar tissue allow separation like in diabetes mellitus
3. Exudative: when fluid builds up between the layers

Question 6

What are vitreoretinal diseases?

Answer 6

Diseases that affect the structure of the eye

Eg. macular degeneration, retinal tears, retinal detachment, macular holes, and diabetic retinopathy

Question 7

What is laser-assisted in situ keratomileusis (LASIK)?

Answer 7

It changes the shape of your cornea to improve how light hits your retina

Question 8

What is photorefractive keratectomy (PRK)?

Answer 8

A laser refractive procedure used to ablate the corneal stroma to correct refractive errors

Question 9

What is upper eye lid eversion?

Answer 9

Can be congenital and needs surgical treatment

Essential in examination of the upper palpebral conjunctivas

Question 10

What is an anterior chamber depth assessment?

Answer 10

Tests the space between the cornea and the iris

Done by shining a light at the temporal side of the eye, is there is a shadow on the nasal iris then it suggests a shallow anterior chamber

Done is glaucoma diagnosis

Question 11

How are foreign bodies removed from the eye?

Answer 11

1. Assess visual acuity
2. Put anaesthetic drops in
3. Remove object

May need referral to an ophthalmologist is deep or central

Question 12

How can pupils be dilated?

Answer 12

Cyclopentolate drops

Other causes:
- Recreational drugs
- Dim lighting
- Reaction to medication
- Adrenaline
- Sexual arousal
- Brain injury

Question 13

What is Mydriasis?

Answer 13

Dilated pupils

Question 14

How is intraocular pressure assessed?

Answer 14

By applanation tonometry

Estimates pressure based on the resistance to flattening of the small area around the cornea

Question 15

What is fluorescein staining used for?

Answer 15

Checking for corneal or vessel abnormalities

It diffuses into intraocular spaces resulting in staining

Question 16

Which tests confirm multiple sclerosis?

Answer 16

MRI to look for plaques in the CNS

Question 17

Which tests confirm giant cell arteritis?

Answer 17

• Biopsy (gold standard)
• Bloods to show elevated ESR or CRP
• A scan of the aorta and it’s branches
  Eg. CT with angiography or MRI with angiography

Question 18

Which tests confirm Guillian-Barre syndrome?

Answer 18

• Spinal tap (show elevated protein levels, which reflects the widespread inflammation, and normal WBC’s)
• Electromyography
• Nerve conduction test

Clinical findings: reduced reflexes

Question 19

What is Electromyography?

Answer 19

Measures muscle response or electrical activity in response to a nerve’s stimulation of the muscle

Question 20

Which tests confirm myasthenia gravis?

Answer 20

Anti-acetylcholine receptor (AChR) antibody (Ab) blood test

Question 21

Which tests confirm meningitis?

Answer 21

• A spinal tap. Will show low sugar levels with increased WBC’s and increased proteins
• MRI helps evaluate complications

Analysis of CSF will show the causative organism

Question 22

Which tests confirm viral encephalitis?

Answer 22

• Lumbar puncture
• Imaging like MRI or CT

Question 23

Which tests are done to confirm Bell’s Palsy?

Answer 23

No confirming tests, just tests to exclude other causes

Eg. Bloods to exclude infection, Ct/MRI to exclude structural causes, EMG to determine extent of nerve involvement

Question 24

Which tests confirm herpes zoster infection?

Answer 24

• PCR
• Swabs from lesions

Question 25

What other diseases in myasthenia gravis associated with?

Answer 25

- Autoimmune disease like rheumatoid arthritis, SLE - Hypertension, heart disease, diabetes, respiratory diseases, dyslipidemia - Teratoma - Thymoma (cancer of the thymus)

Question 26

What is cerebral salt wasting syndrome?

Answer 26

Renal loss of sodium during intracranial disease leading to hyponatremia and a decrease in extracellular fluid volume

Question 27

What are some causes of ptosis?

Answer 27

- 3rd nerve palsy - Horner's syndrome - Age - Myasthenia gravis - Chronic progressive external ophthalmoplegia (mitochondrial myopathy)

Question 28

How does thyroid disease affect the eyelid?

Answer 28

Causes retraction of eyelids making it look like you're staring

Question 29

What is papilloedaema?

Answer 29

Optic disc swelling specifically due to raised intracranial pressure Often refers to a swollen disc

Question 30

What is bone-spicule pigmentation of the retina?

Answer 30

Migration of pigment into the interstitial spaces (Black markings around the borders of a fundoscopy image)

Question 31

What is retinitis pigmentosa?

Answer 31

A group of rare eye diseases that affect the retina Triad of symptoms: - arteriolar attenuation - bone–spicule peripheral retinal pigmentation - waxy optic disc pallor

Question 32

What is arteriolar attenuation?

Answer 32

Narrowing of blood vessels at the back of the eye A defining sign of hypertensive retinopathy