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Question 1
Correct
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A 60-year-old woman comes to the clinic complaining of seeing a curtain moving from the right inferonasal side towards the centre for the past 3 days. She reports seeing flashes of lights at the right inferonasal side and an increase in the number of floaters in her right eye. Her central vision is not affected, and her vision is 6/6 in both eyes. What is the probable diagnosis?
Your Answer: Superotemporal macula-on retinal detachment
Explanation:Differentiating Types of Retinal Detachment Based on Symptoms
Retinal detachment is a serious condition that can cause vision loss if not treated promptly. Differentiating between the types of retinal detachment based on symptoms is crucial for proper diagnosis and treatment.
In the case of symptoms located at the inferonasal side, the detachment is likely located at the superotemporal side of the eye, which is the most common location of retinal tears and detachment. This is also most likely a macula-on detachment because the vision in the affected eye remained at 6/6. Therefore, the correct diagnosis is a superotemporal macula-on retinal detachment.
An inferonasal macula-off retinal detachment is unlikely because the vision is still 6/6. Similarly, an inferior or inferotemporal macula-off retinal detachment can be ruled out based on the location of symptoms and intact vision.
A superonasal macula-on retinal detachment is also unlikely because it would cause symptoms at the inferotemporal side. Therefore, understanding the location of symptoms and vision status can aid in differentiating between the types of retinal detachment.
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This question is part of the following fields:
- Ophthalmology
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Question 2
Correct
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A 68-year-old man visits his GP with a complaint of a droopy eyelid that started yesterday and has not improved. He has a medical history of poorly controlled type two diabetes mellitus and hypertension, which cause him recurrent foot ulcers. Additionally, he has been a smoker for his entire life.
During the eye examination, the doctor observes ptosis of the left palpebra with a constricted pupil. However, the patient's visual acuity is 6/6 in both eyes, and he has normal colour vision, intact central and peripheral fields. The patient had a similar episode after a motorbike accident, which was diagnosed as a nerve palsy and later resolved.
What is the most probable diagnosis?Your Answer: Horner's syndrome
Explanation:The correct diagnosis is Horner’s syndrome, which is characterized by ptosis and a constricted pupil. This syndrome is caused by a loss of sympathetic innervation and is likely due to a Pancoast tumor in this patient, who has a history of smoking. Other features of Horner’s syndrome include anhidrosis.
An abducens nerve palsy would cause horizontal diplopia and defective eye abduction. Lateral medullary syndrome, caused by a stroke, can also cause Horner’s syndrome but would present with additional symptoms such as ataxia and dysphagia.
An oculomotor nerve palsy would cause ptosis, a ‘down and out’ eye, and a dilated pupil. This patient only has ptosis and a constricted pupil, making oculomotor nerve palsy an incorrect diagnosis. A trochlear nerve palsy would cause vertical diplopia and limitations in eye movement.
Horner’s syndrome is a medical condition that is characterized by a set of symptoms including a small pupil (miosis), drooping of the upper eyelid (ptosis), sunken eye (enophthalmos), and loss of sweating on one side of the face (anhidrosis). The presence of heterochromia, or a difference in iris color, is often seen in cases of congenital Horner’s syndrome. Anhidrosis is also a distinguishing feature that can help differentiate between central, Preganglionic, and postganglionic lesions. Pharmacologic tests, such as the use of apraclonidine drops, can be helpful in confirming the diagnosis of Horner’s syndrome and localizing the lesion.
Central lesions, Preganglionic lesions, and postganglionic lesions can all cause Horner’s syndrome, with each type of lesion presenting with different symptoms. Central lesions can result in anhidrosis of the face, arm, and trunk, while Preganglionic lesions can cause anhidrosis of the face only. postganglionic lesions, on the other hand, do not typically result in anhidrosis.
There are many potential causes of Horner’s syndrome, including stroke, syringomyelia, multiple sclerosis, tumors, encephalitis, thyroidectomy, trauma, cervical rib, carotid artery dissection, carotid aneurysm, cavernous sinus thrombosis, and cluster headache. It is important to identify the underlying cause of Horner’s syndrome in order to determine the appropriate treatment plan.
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This question is part of the following fields:
- Ophthalmology
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Question 3
Correct
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A 72-year-old man comes to the clinic complaining of intense pain around his left eye and vomiting. Upon examination, his left eye appears red and there is a noticeable decrease in visual acuity. What is the best initial course of action for this patient?
Your Answer: Refer immediately to hospital
Explanation:Glaucoma is a group of disorders that cause optic neuropathy due to increased intraocular pressure (IOP). However, not all patients with raised IOP have glaucoma, and vice versa. Acute angle-closure glaucoma (AACG) is a type of glaucoma where there is a rise in IOP due to impaired aqueous outflow. Factors that increase the risk of AACG include hypermetropia, pupillary dilation, and lens growth associated with age. Symptoms of AACG include severe pain, decreased visual acuity, halos around lights, and a hard, red-eye. Management of AACG is an emergency and requires urgent referral to an ophthalmologist. Emergency medical treatment is necessary to lower the IOP, followed by definitive surgical treatment once the acute attack has subsided.
There are no specific guidelines for the initial medical treatment of AACG, but a combination of eye drops may be used, including a direct parasympathomimetic, a beta-blocker, and an alpha-2 agonist. Intravenous acetazolamide may also be administered to reduce aqueous secretions. Definitive management of AACG involves laser peripheral iridotomy, which creates a small hole in the peripheral iris to allow aqueous humour to flow to the angle. It is important to seek medical attention immediately if symptoms of AACG are present to prevent permanent vision loss.
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This question is part of the following fields:
- Ophthalmology
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Question 4
Incorrect
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A 78-year-old woman is presenting with a complaint of deteriorating vision that has been gradually worsening over the past few years. Upon examination, cataracts are evident in both eyes, but her best corrected visual acuity is only slightly diminished at 6/9. She has no prior history of eye problems.
What is the most suitable course of action for management?Your Answer: Reassure and monitor for progression
Correct Answer: Referral for cataract surgery
Explanation:It is important to note that rationing cataract removal operations based on visual acuity is not recommended according to NICE guidelines. Delaying surgery can lead to increased risks of falls and other complications, making cataract surgery a cost-effective solution. Although cataracts are not an urgent issue, delaying surgery is not a wise decision. Additionally, it is important to note that corticosteroids are a cause of cataracts, not a treatment.
Understanding Cataracts: Causes, Symptoms, and Management
A cataract is a common eye condition that affects the lens of the eye, causing it to become cloudy and reducing the amount of light that reaches the retina. This can lead to blurred or reduced vision, making it difficult to see clearly. Cataracts are more common in women and tend to increase in incidence with age. While the normal ageing process is the most common cause, other factors such as smoking, alcohol consumption, trauma, diabetes, and long-term corticosteroid use can also contribute to the development of cataracts.
Symptoms of cataracts include reduced vision, faded colour vision, glare, and halos around lights. A defect in the red reflex is also a sign of cataracts. Diagnosis is typically made through ophthalmoscopy and slit-lamp examination, which can reveal the presence of a visible cataract.
In the early stages, age-related cataracts can be managed conservatively with stronger glasses or contact lenses and brighter lighting. However, surgery is the only effective treatment for cataracts and involves removing the cloudy lens and replacing it with an artificial one. Referral for surgery should be based on the presence of visual impairment, impact on quality of life, and patient choice. Complications following surgery can include posterior capsule opacification, retinal detachment, posterior capsule rupture, and endophthalmitis.
Overall, cataracts are a common and treatable eye condition that can significantly impact a person’s vision. Understanding the causes, symptoms, and management options can help individuals make informed decisions about their eye health.
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This question is part of the following fields:
- Ophthalmology
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Question 5
Incorrect
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Which statement about childhood squints is accurate?
Your Answer: Amblyopia is a sign of a paralytic squint
Correct Answer: The corneal light reflection test is a suitable screening test
Explanation:Both paralytic and non-paralytic squints can lead to the development of amblyopia.
Squint, also known as strabismus, is a condition where the visual axes are misaligned. There are two types of squints: concomitant and paralytic. Concomitant squints are more common and are caused by an imbalance in the extraocular muscles. On the other hand, paralytic squints are rare and are caused by the paralysis of extraocular muscles. It is important to detect squints early on as they can lead to amblyopia, where the brain fails to process inputs from one eye and favours the other eye over time.
To detect a squint, a corneal light reflection test can be performed by holding a light source 30cm from the child’s face to see if the light reflects symmetrically on the pupils. The cover test is also used to identify the nature of the squint. This involves asking the child to focus on an object, covering one eye, and observing the movement of the uncovered eye. The test is then repeated with the other eye covered.
If a squint is detected, it is important to refer the child to secondary care. Eye patches may also be used to help prevent amblyopia.
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This question is part of the following fields:
- Ophthalmology
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Question 6
Incorrect
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A 78-year-old woman visits her GP with a complaint of gradual loss of peripheral vision over the past 4 months and a decline in overall visual acuity. She reports experiencing tunnel vision. The patient has a medical history of hypertension and type 2 diabetes mellitus and wears corrective glasses for her myopia. Upon fundoscopy, the doctor observes optic disc cupping and hemorrhages. What is the probable diagnosis?
Your Answer: Cataracts
Correct Answer: Primary open-angle glaucoma
Explanation:The main effect of glaucoma is the development of defects in the visual field.
Glaucoma is a condition where the optic nerve is damaged due to increased pressure in the eye. Primary open-angle glaucoma (POAG) is a type of glaucoma where the peripheral iris is clear of the trabecular meshwork, which is important in draining aqueous humour from the eye. POAG is more common in older individuals and those with a family history of the condition. It may present insidiously with symptoms such as peripheral visual field loss, decreased visual acuity, and optic disc cupping. Diagnosis is made through a series of investigations including automated perimetry, slit lamp examination, applanation tonometry, central corneal thickness measurement, and gonioscopy. It is important to assess the risk of future visual impairment based on factors such as IOP, CCT, family history, and life expectancy. Referral to an ophthalmologist is typically done through a GP.
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This question is part of the following fields:
- Ophthalmology
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Question 7
Incorrect
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An older woman presents to the Emergency Department with severe headache, nausea, vomiting and a painful, red right eye. She has reduced visual acuity in the right eye and normal visual acuity in the left eye. On examination, she had a stony hard eye with marked pericorneal reddening and a hazy corneal reflex. Tonometry revealed raised intraocular pressure.
Which of the following is the most appropriate management plan?Your Answer: Single dose of oral acetazolamide (500 mg) and then emergency referral to an ophthalmologist
Correct Answer: Admit for immediate review by on call ophthalmologist. Topical pilocarpine, followed by a single dose of oral acetazolamide (500 mg) if there is a significant delay prior to specialist review
Explanation:Emergency Management of Acute Closed Angle Glaucoma
Acute closed angle glaucoma is a medical emergency that requires urgent ophthalmological review. The condition causes sudden loss of vision, severe eye pain, and marked pericorneal injection. The patient may also experience nausea and vomiting. On examination, the eye is stony hard with a semi-dilated, non-reactive pupil, and tonometry reveals a high intraocular pressure (40–80 mmHg).
The primary treatment for acute closed angle glaucoma is urgent referral to an ophthalmologist. However, if there is a significant delay in specialist review, a single dose of oral acetazolamide (500 mg) can be given to reduce aqueous secretion, and topical pilocarpine can be used to cause pupillary constriction.
It is important to note that topical steroids are not effective in resolving the underlying problems of acute closed angle glaucoma. Urgent referral to a neurologist is also not appropriate for managing this condition. Additionally, topical tropicamide should not be used as it has the opposite effect to pilocarpine and can worsen attacks of glaucoma.
In summary, acute closed angle glaucoma is a medical emergency that requires urgent ophthalmological review. If there is a delay in specialist review, a single dose of oral acetazolamide and topical pilocarpine can be given to manage the condition.
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This question is part of the following fields:
- Ophthalmology
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Question 8
Incorrect
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A 25-year-old male patient arrives at the emergency department complaining of pain in his left eye. He has a medical history of recurring sinusitis and ankylosing spondylitis. Upon examination, there is swelling and redness around the left eye, and there is discomfort when testing eye movements. The pupils appear normal. What is the recommended course of action?
Your Answer: Oral antibiotics
Correct Answer: IV antibiotics
Explanation:The appropriate treatment for patients with orbital cellulitis is admission to the hospital for IV antibiotics. This is due to the potential risk of cavernous sinus thrombosis and intracranial spread. The symptoms of ocular pain, pain on eye movements, redness, and swelling around the eye suggest this condition. IV acetazolamide, oral antibiotics, and oral steroids are not suitable treatments for orbital cellulitis as they are intended for different conditions.
Understanding Orbital Cellulitis: Causes, Symptoms, and Management
Orbital cellulitis is a serious infection that affects the fat and muscles behind the orbital septum within the orbit, but not the globe. It is commonly caused by upper respiratory tract infections that spread from the sinuses and can lead to a high mortality rate. On the other hand, periorbital cellulitis is a less severe infection that occurs in the superficial tissues anterior to the orbital septum. However, it can progress to orbital cellulitis if left untreated.
Risk factors for orbital cellulitis include childhood, previous sinus infections, lack of Haemophilus influenzae type b (Hib) vaccination, recent eyelid infections or insect bites, and ear or facial infections. Symptoms of orbital cellulitis include redness and swelling around the eye, severe ocular pain, visual disturbance, proptosis, ophthalmoplegia, eyelid edema, and ptosis. In rare cases, meningeal involvement can cause drowsiness, nausea, and vomiting.
To differentiate between orbital and preseptal cellulitis, doctors look for reduced visual acuity, proptosis, and ophthalmoplegia, which are not consistent with preseptal cellulitis. Full blood count and clinical examination involving complete ophthalmological assessment are necessary to determine the severity of the infection. CT with contrast can also help identify inflammation of the orbital tissues deep to the septum and sinusitis. Blood culture and microbiological swab are also necessary to determine the organism causing the infection.
Management of orbital cellulitis requires hospital admission for IV antibiotics. It is a medical emergency that requires urgent senior review. Early diagnosis and treatment are crucial to prevent complications and reduce the risk of mortality.
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This question is part of the following fields:
- Ophthalmology
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Question 9
Incorrect
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A 70-year-old man presents to the Emergency Department with a right-sided headache associated with diplopia, binocularly. He is known to have hypertension and type II diabetes mellitus.
On examination, his visual acuity is 6/9 in both eyes. There is a ptosis of his right eye. His right pupil appears larger than the left. His right eye is abducted on primary gaze. His right eye movements are restricted in most directions except abduction.
Which one of the following is the most important cause you need to rule out in this condition?Your Answer: Demyelination
Correct Answer: Posterior-communicating artery aneurysm
Explanation:Causes of Third-Nerve Palsy and Their Differentiating Features
Third-nerve palsy is a condition that can be caused by various factors, each with its own differentiating features. One of the most urgent causes is a posterior-communicating artery aneurysm, which can be fatal due to subarachnoid hemorrhage. A space-occupying lesion can also compress onto the third nerve, but ruling out an impending subarachnoid hemorrhage caused by a posterior-communicating artery aneurysm is more urgent. On the other hand, an anterior-communicating artery aneurysm does not normally cause a third-nerve palsy. Demyelination can cause third-nerve palsy, but the presentation usually points towards a more ‘surgical’ than ‘medical’ cause. Microvascular ischemia is a common cause of ‘medical’ third-nerve palsy, but the pupillary fibers that control pupil dilation are not affected. Therefore, understanding the differentiating features of each cause is crucial in determining the appropriate treatment.
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This question is part of the following fields:
- Ophthalmology
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Question 10
Incorrect
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A 38-year-old man presents with a history of poor health for several months and is subsequently diagnosed with syphilis. During the physical examination, it is observed that he has small pupils on both sides that are able to accommodate but do not react to light. What is the probable diagnosis?
Your Answer: Internuclear ophthalmoplegia
Correct Answer: Argyll-Robertson pupil
Explanation:Argyll-Robertson Pupil: A Classic Pupillary Syndrome
The Argyll-Robertson Pupil (ARP) is a classic pupillary syndrome that is sometimes observed in neurosyphilis. It is characterized by small, irregular pupils that do not respond to light but do respond to accommodation. A useful mnemonic for remembering this syndrome is Accommodation Reflex Present (ARP) but Pupillary Reflex Absent (PRA).
The ARP can be caused by various factors, including diabetes mellitus and syphilis. It is important to note that the presence of an ARP may indicate underlying neurological or systemic disease and should prompt further evaluation and management. Proper diagnosis and treatment of the underlying condition can help prevent further complications and improve patient outcomes.
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This question is part of the following fields:
- Ophthalmology
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Question 11
Incorrect
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A 55-year-old woman with a history of multiple sclerosis visits her GP complaining of issues with her right eye and right shoulder pain. Upon examination, the GP notes ptosis on the right side, a small pupil, and narrowing of the palpebral fissure with right lid lag. The left eye appears normal, and fundoscopy reveals no abnormalities. The patient has a 30-year history of smoking 30 cigarettes daily and consuming 12 units of alcohol per week. She has also been taking paracetamol and ibuprofen for her shoulder pain. What is the most likely cause of her symptoms?
Your Answer: Oculomotor nerve palsy
Correct Answer: Horner's syndrome
Explanation:The patient is exhibiting symptoms consistent with Horner’s syndrome, including miosis (constricted pupil), ptosis (drooping eyelid), and enophthalmos (sunken eye). There may also be anhydrosis (lack of sweating) present. This could be indicative of a Pancoast tumor on the lung, which can infiltrate the brachial plexus and cause shoulder pain. It is important to note the patient’s smoking history in this case. Multiple sclerosis is not likely to be the cause of these symptoms. Argyll-Robertson pupil, Holmes-Adie pupil, and oculomotor nerve palsy are not applicable to this case.
Horner’s syndrome is a medical condition that is characterized by a set of symptoms including a small pupil (miosis), drooping of the upper eyelid (ptosis), sunken eye (enophthalmos), and loss of sweating on one side of the face (anhidrosis). The presence of heterochromia, or a difference in iris color, is often seen in cases of congenital Horner’s syndrome. Anhidrosis is also a distinguishing feature that can help differentiate between central, Preganglionic, and postganglionic lesions. Pharmacologic tests, such as the use of apraclonidine drops, can be helpful in confirming the diagnosis of Horner’s syndrome and localizing the lesion.
Central lesions, Preganglionic lesions, and postganglionic lesions can all cause Horner’s syndrome, with each type of lesion presenting with different symptoms. Central lesions can result in anhidrosis of the face, arm, and trunk, while Preganglionic lesions can cause anhidrosis of the face only. postganglionic lesions, on the other hand, do not typically result in anhidrosis.
There are many potential causes of Horner’s syndrome, including stroke, syringomyelia, multiple sclerosis, tumors, encephalitis, thyroidectomy, trauma, cervical rib, carotid artery dissection, carotid aneurysm, cavernous sinus thrombosis, and cluster headache. It is important to identify the underlying cause of Horner’s syndrome in order to determine the appropriate treatment plan.
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This question is part of the following fields:
- Ophthalmology
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Question 12
Incorrect
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A 26-year-old woman presents to the Eye Casualty with a sudden onset of painful reduction in vision in her left eye. She denies any other symptoms and has no significant medical history.
Upon examination, her right eye has a visual acuity of 6/6 while her left eye has a visual acuity of 6/36 with reduced color vision. Eye movements are normal, but the pain worsens. The swinging torch test reveals left pupil dilation when the torch light swings from the right eye to the left. Dilated fundoscopy shows a swollen optic disc in her left eye.
What is the recommended first-line treatment for this condition?Your Answer: Interferon beta
Correct Answer: Intravenous methylprednisolone
Explanation:Treatment Options for Optic Neuritis in Multiple Sclerosis Patients
Optic neuritis is a common symptom of multiple sclerosis (MS) and can cause vision loss or pain. While the condition may improve on its own, treatment with steroids is often recommended. Intravenous methylprednisolone is the preferred route of administration for this medication, although it can cause side effects such as mood changes and weight gain.
Glatiramer acetate and interferon beta are first-line treatments for MS, but are not typically used for isolated episodes of optic neuritis. Natalizumab is a second-line treatment option for MS, but may not be appropriate for all patients.
It is important to note that oral prednisolone alone is not recommended for optic neuritis in MS patients due to an increased risk of recurrence. Overall, treatment options for optic neuritis in MS patients should be carefully considered based on individual patient needs and medical history.
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This question is part of the following fields:
- Ophthalmology
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Question 13
Incorrect
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A 50-year-old man presents to the Emergency Department with sudden-onset blurring of vision in both eyes and light sensitivity. He is a known type II diabetic with well-controlled blood sugars through diet. His vital signs are as follows: temperature 36.6 °C, BP 191/127 mmHg, heart rate 80 bpm, respiratory rate 19, and O2 saturations 99% on room air. Dilated fundoscopy reveals swollen optic discs with widespread flame-shaped haemorrhages and cotton-wool spots. What is the initial treatment for this condition?
Your Answer: Sublingual glyceryl trinitrate (GTN) spray
Correct Answer: Intravenous (IV) labetalol
Explanation:Treatment Options for Hypertensive Retinopathy: Understanding the Appropriate Interventions
Hypertensive emergency with retinopathy requires careful management to avoid complications such as watershed infarcts in the brain. Intravenous (IV) labetalol is a suitable option for lowering blood pressure (BP) slowly, with the aim of reducing diastolic BP to 100 mmHg or 20-25 mmHg/day, whichever is lesser. However, intravitreal anti-vascular endothelial growth factor (anti-VEGF) injection is not a treatment for hypertensive retinopathy. Oral amlodipine, a calcium channel blocker, is also not useful in an acute setting of hypertensive emergency. Similarly, pan-retinal photocoagulation or any laser treatment for the eye is not a treatment for hypertensive retinopathy, but rather for proliferative diabetic retinopathy. Lastly, sublingual glyceryl trinitrate (GTN) spray, although capable of reducing blood pressure, is typically used in patients with angina and acute coronary syndrome (ACS). Understanding the appropriate interventions for hypertensive retinopathy is crucial for effective management.
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This question is part of the following fields:
- Ophthalmology
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Question 14
Incorrect
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A 40-year-old type 1 diabetic undergoes fundoscopy as part of his annual follow-up. His HbA1c is 9.5% (81 mmol/mol). Fundoscopy reveals haemorrhages, cotton-wool spots and the presence of new vessels.
What is the next step in his management?Your Answer: Refer to ophthalmology for specialised follow-up
Correct Answer: Urgent referral to ophthalmology
Explanation:Management of Diabetic Retinopathy: Referral Criteria and Pathways
Diabetic retinopathy is a common complication of diabetes that can lead to vision loss if left untreated. The National Screening Committee (NSC) has established grading criteria to help physicians assess the severity of diabetic retinopathy and determine the appropriate referral pathway.
The grading criteria include four levels of retinopathy severity: R0 (no retinopathy), R1 (background retinopathy), R2 (pre-proliferative retinopathy), and R3 (proliferative retinopathy). Additionally, there are two levels of maculopathy severity: M0 (nil present) and M1 (maculopathy present).
The management pathways for each level of severity are as follows:
– R0: Annual screening
– R1: Annual screening and inform diabetes care team
– R2: Refer to hospital eye service for specialized follow-up
– R3: Fast-track referral to hospital eye service
– M0: Annual screening
– M1: Refer to hospital eye serviceAny change in the macula, regardless of severity, should prompt urgent referral to ophthalmology.
It is important to note that patients with R0 disease who have well-controlled diabetes may continue yearly follow-up. However, any other stage of retinopathy warrants referral to ophthalmology.
In summary, early detection and appropriate management of diabetic retinopathy is crucial in preventing vision loss. Physicians should be familiar with the NSC grading criteria and referral pathways to ensure timely and effective treatment for their diabetic patients.
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This question is part of the following fields:
- Ophthalmology
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Question 15
Incorrect
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A 35-year-old woman comes to the General Practitioner complaining of a painful red photophobic eye with some blurred vision. She reports no discharge, headache, nausea or vomiting. She has a medical history of inflammatory bowel disease but is otherwise healthy.
What is the probable diagnosis?Your Answer: Episcleritis
Correct Answer: Uveitis
Explanation:Common Eye Inflammations and Their Symptoms
Uveitis, a condition that can affect people of all ages, is often associated with systemic diseases like inflammatory bowel disease, sarcoidosis, and seronegative arthritis. It typically presents as a painful red eye with photophobia, but there is usually no discharge. Upon examination, signs of intraocular inflammation such as cells in the anterior chamber will be present. Urgent referral to ophthalmology is necessary, and treatment may involve cycloplegics and steroid eye drops.
Conjunctivitis, on the other hand, is characterized by a red, sore eye with discharge that can be mucopurulent or clear depending on the cause. Tarsal conjunctiva inflammation is also likely.
Episcleritis, which affects mostly women and younger people, is self-limiting and causes mild pain, watering, and very mild photophobia. It does not cause any visual symptoms.
Acute glaucoma is an ophthalmological emergency that requires urgent referral to ophthalmology. Patients with this condition will present with an acutely painful red eye and systemic symptoms like nausea and vomiting. Medications to reduce intraocular pressure are necessary.
Keratitis, which refers to inflammation of the cornea, has many different causes, with infection being the most common, especially in contact lens wearers. While the symptoms may initially appear similar to uveitis, keratitis is unlikely to be associated with inflammatory bowel disease and will show abnormalities of the cornea upon examination.
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This question is part of the following fields:
- Ophthalmology
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Question 16
Incorrect
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A 35-year-old woman comes to the eye clinic complaining of sudden vision changes in her left eye for the past 2 days. She reports that her vision has been progressively deteriorating, as if she is looking through a cloud, and the colors around her appear less vivid. Additionally, she has been experiencing retro-orbital pain that worsens with eye movement. Her right eye is unaffected, and she has no prior history of eye problems or other medical conditions. What is the most probable finding on examination for this suspected diagnosis?
Your Answer: Vitreous haemorrhage
Correct Answer: Relative afferent pupillary defect
Explanation:Optic neuritis is a condition that affects the anterior visual pathway and is characterized by a specific sign called relative afferent pupillary defect (RAPD). RAPD is a reliable indicator of unilateral optic nerve disease and is commonly observed in optic neuritis. However, it is not present in cases of bilateral optic neuritis. Cotton wool spots, on the other hand, are small exudates on the retina that are associated with various diseases, such as hypertension and diabetes mellitus. They are not typically associated with optic neuritis, which does not affect the retina. Visual field defects can occur in optic neuritis, with central scotoma being the most common. The optic disc is usually normal in optic neuritis, although mild swelling may be present in some cases. However, RAPD is a more common finding and is therefore a more reliable diagnostic indicator.
Optic neuritis is a condition that can be caused by multiple sclerosis, diabetes, or syphilis. It is characterized by a decrease in visual acuity in one eye over a period of hours or days, as well as poor color discrimination and pain that worsens with eye movement. Other symptoms include a relative afferent pupillary defect and a central scotoma. The condition can be diagnosed through an MRI of the brain and orbits with gadolinium contrast. Treatment typically involves high-dose steroids, and recovery usually takes 4-6 weeks. If an MRI shows more than three white-matter lesions, the risk of developing multiple sclerosis within five years is approximately 50%.
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This question is part of the following fields:
- Ophthalmology
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Question 17
Incorrect
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A 75-year-old female comes to her doctor complaining of sudden left shoulder and arm pain that has been getting worse over the past week. The pain is now unbearable even with regular co-codamol. During the examination, the doctor observes that the patient's left pupil is smaller than the other and the eyelid is slightly drooping. What question would be most helpful in determining the diagnosis for this woman?
Your Answer: Exercise history
Correct Answer: Smoking history
Explanation:Smoking is responsible for the majority of cases of cancer that lead to Pancoast’s syndrome. The patient’s condition is not influenced by factors such as alcohol consumption, physical activity, or exposure to pathogens.
Horner’s syndrome is a medical condition that is characterized by a set of symptoms including a small pupil (miosis), drooping of the upper eyelid (ptosis), sunken eye (enophthalmos), and loss of sweating on one side of the face (anhidrosis). The presence of heterochromia, or a difference in iris color, is often seen in cases of congenital Horner’s syndrome. Anhidrosis is also a distinguishing feature that can help differentiate between central, Preganglionic, and postganglionic lesions. Pharmacologic tests, such as the use of apraclonidine drops, can be helpful in confirming the diagnosis of Horner’s syndrome and localizing the lesion.
Central lesions, Preganglionic lesions, and postganglionic lesions can all cause Horner’s syndrome, with each type of lesion presenting with different symptoms. Central lesions can result in anhidrosis of the face, arm, and trunk, while Preganglionic lesions can cause anhidrosis of the face only. postganglionic lesions, on the other hand, do not typically result in anhidrosis.
There are many potential causes of Horner’s syndrome, including stroke, syringomyelia, multiple sclerosis, tumors, encephalitis, thyroidectomy, trauma, cervical rib, carotid artery dissection, carotid aneurysm, cavernous sinus thrombosis, and cluster headache. It is important to identify the underlying cause of Horner’s syndrome in order to determine the appropriate treatment plan.
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This question is part of the following fields:
- Ophthalmology
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Question 18
Incorrect
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A 23-year-old female patient visits her GP complaining of vision abnormalities. She reports seeing a black shadow in her right eye's upper field of vision unilaterally. Additionally, she has been experiencing sudden flashing lights in spindly shapes for a few hours. Upon examination, there are no visible abnormalities in the eye, and both pupils are equal and reactive. The patient has no known medical conditions or allergies. What is the most probable diagnosis for this patient's symptoms?
Your Answer: Acute optic neuritis
Correct Answer: Retinal detachment
Explanation:The patient is experiencing painless vision loss with a peripheral curtain over her vision, spider web-like flashing lights, and requires an urgent referral to eye casualty. These symptoms are indicative of a retinal detachment, which is a serious condition that can lead to permanent vision loss if not treated promptly. Other potential causes of vision loss, such as ischemic optic neuropathy, vitreous hemorrhage, and acute optic neuritis, have been ruled out based on the patient’s symptoms and medical history.
Sudden loss of vision can be a scary symptom for patients, as it may indicate a serious issue or only be temporary. Transient monocular visual loss (TMVL) is a term used to describe a sudden, brief loss of vision that lasts less than 24 hours. The most common causes of sudden, painless loss of vision include ischaemic/vascular issues (such as thrombosis, embolism, and temporal arthritis), vitreous haemorrhage, retinal detachment, and retinal migraine.
Ischaemic/vascular issues, also known as ‘amaurosis fugax’, have a wide range of potential causes, including large artery disease, small artery occlusive disease, venous disease, and hypoperfusion. Altitudinal field defects are often seen, and ischaemic optic neuropathy can occur due to occlusion of the short posterior ciliary arteries. Central retinal vein occlusion is more common than arterial occlusion and can be caused by glaucoma, polycythaemia, or hypertension. Central retinal artery occlusion is typically caused by thromboembolism or arthritis and may present with an afferent pupillary defect and a ‘cherry red’ spot on a pale retina.
Vitreous haemorrhage can be caused by diabetes, bleeding disorders, or anticoagulants and may present with sudden visual loss and dark spots. Retinal detachment may be preceded by flashes of light or floaters, which are also common in posterior vitreous detachment. Differentiating between posterior vitreous detachment, retinal detachment, and vitreous haemorrhage can be challenging, but each has distinct features such as photopsia and floaters for posterior vitreous detachment, a dense shadow that progresses towards central vision for retinal detachment, and large bleeds causing sudden visual loss for vitreous haemorrhage.
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This question is part of the following fields:
- Ophthalmology
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Question 19
Incorrect
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A 30-year-old man reports experiencing a scratchy sensation in his eyes as the day goes on. He feels that his eyes become tired. These symptoms only occur during weekdays when he works as a computer programmer for a local business. During examination, there is mild conjunctival hyperemia, but the rest of the ocular examination is normal. Which nerve stimulation is linked to tear production?
Your Answer: Chorda tympani
Correct Answer: Intermediate nerve
Explanation:Cranial Nerves and Their Parasympathetic Functions
The cranial nerves play a crucial role in the parasympathetic nervous system, which is responsible for regulating various bodily functions. Here are some of the cranial nerves and their parasympathetic functions:
1. Intermediate Nerve: This nerve supplies secretomotor innervation to the lacrimal gland. The parasympathetic fibers originate from the geniculate ganglion of the facial nerve and travel through the greater petrosal nerve, deep petrosal nerve, Vidian nerve, and maxillary nerve to reach the lacrimal gland.
2. Oculomotor Nerve: The oculomotor nerve provides motor innervation to four of the six ocular muscles and parasympathetic innervation to the ciliary muscle and sphincter pupillae muscle of the iris.
3. Glossopharyngeal Nerve: This nerve provides secretomotor innervation to the parotid gland. The parasympathetic fibers travel through the tympanic branch of the glossopharyngeal nerve, tympanic plexus, lesser petrosal nerve, and auriculotemporal nerve to reach the parotid gland.
4. Vagus Nerve: The vagus nerve provides parasympathetic innervation to the heart, lung, and gastrointestinal tract.
5. Chorda Tympani: This branch of the facial nerve contains preganglionic parasympathetic fibers that synapse at the submandibular ganglion attached to the lingual nerve. The postganglionic parasympathetic fibers reach the submandibular and sublingual glands via the branches of the lingual nerve.
Understanding the parasympathetic functions of these cranial nerves is essential in diagnosing and treating various medical conditions.
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This question is part of the following fields:
- Ophthalmology
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Question 20
Incorrect
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A 67-year-old woman presents with a complaint of seeing an 'arc of white light and some cobwebs' in her vision with eye movements in her left eye for the past week. She also reports that her vision in the left eye is now very blurry. She denies any recent trauma and has a history of myopia in both eyes. Her past medical history is unremarkable. On examination, her left eye has a visual acuity of 6/18 while her right eye has a visual acuity of 6/6. Both anterior segments appear normal. However, on dilated fundoscopy, the view of the left fundus is blocked by some red and grey matter in the vitreous while the right fundus is unremarkable. What is the next most appropriate management step to determine the underlying cause of the findings in the left fundus?
Your Answer: Computed tomography (CT) scan of the head
Correct Answer: Ultrasound B-scan of the eye
Explanation:The Importance of Ultrasound B-Scan in Diagnosing Vitreous Haemorrhage
Vitreous haemorrhage is a condition that requires prompt diagnosis and treatment. While it may present with symptoms such as floaters and blurred vision, it is important to rule out any underlying causes such as retinal detachment. The most effective way to do this is through an ultrasound B-scan of the eye.
A CT scan of the head is not recommended as it exposes the patient to unnecessary radiation and does not provide useful information in diagnosing vitreous haemorrhage. Similarly, examining the fundus with a slit lamp, Volk lenses, or scleral indentation will not yield results as the haemorrhage obstructs the view.
An optical coherence tomography (OCT) of the macula may not be effective in ruling out important causes of vitreous haemorrhage due to the presence of the haemorrhage itself.
In conclusion, an ultrasound B-scan of the eye is the most effective way to diagnose vitreous haemorrhage and rule out any underlying causes such as retinal detachment. It is important to prioritize this diagnostic tool to ensure prompt and accurate treatment.
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This question is part of the following fields:
- Ophthalmology
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Question 21
Incorrect
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A 23-year-old female patient visits the GP complaining of visual symptoms. She states that her left eye's vision has significantly deteriorated in the last two days. Additionally, she experiences pain behind her left eye when moving it. The patient is healthy otherwise, without medical history, allergies, or regular medication intake. During the examination, a relative afferent pupillary defect is observed, and her left eye's visual acuity is lower than the right. What other symptom is she likely to mention?
Your Answer: Peripheral vision loss with central sparing
Correct Answer: Reduced colour vision
Explanation:The patient in the brief is a young female with acute unilateral vision loss and painful eye movements. Given her age and symptoms, optic neuritis is the most likely diagnosis. This is especially true since she does not have any other symptoms commonly associated with temporal arthritis, such as new headaches, general malaise, weight loss, and jaw claudication. Additionally, temporal arthritis typically affects older patients and does not cause painful eye movements.
While optic neuritis can result in any pattern of visual field defect, the most common one is central scotoma. Therefore, peripheral vision loss with central sparing is less likely to be reported. It is important to note that this patient is not likely to have optic neuritis associated with SLE, as this is a rare occurrence. Instead, she is more likely to have idiopathic optic neuritis or optic neuritis associated with multiple sclerosis.
Optic neuritis is a condition that can be caused by multiple sclerosis, diabetes, or syphilis. It is characterized by a decrease in visual acuity in one eye over a period of hours or days, as well as poor color discrimination and pain that worsens with eye movement. Other symptoms include a relative afferent pupillary defect and a central scotoma. The condition can be diagnosed through an MRI of the brain and orbits with gadolinium contrast. Treatment typically involves high-dose steroids, and recovery usually takes 4-6 weeks. If an MRI shows more than three white-matter lesions, the risk of developing multiple sclerosis within five years is approximately 50%.
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This question is part of the following fields:
- Ophthalmology
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Question 22
Incorrect
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A 65-year-old man comes to the emergency department with a sudden onset of vision loss in his right eye. He experienced flashes and floaters before the loss of vision, which began at the edges and progressed towards the centre. There was no history of trauma, headaches, or eye redness, but he has a medical history of type 2 diabetes mellitus. He wears corrective glasses and sometimes contact lenses, but cannot recall his prescription. What factor raises the likelihood of this patient developing this condition?
Your Answer: Contact lens use
Correct Answer: Type 2 diabetes mellitus
Explanation:Retinal detachment should be considered as a potential cause of sudden vision loss in patients with diabetes mellitus, as they are at an increased risk. Symptoms of RD may include a gradual loss of peripheral vision that progresses towards the centre, often described as a veil or curtain descending over the visual field. Prior to detachment, patients may experience flashes and floaters due to vitreous humour pulling on the retina. Prompt medical attention is necessary to prevent permanent vision loss.
Retinal detachment is a condition where the tissue at the back of the eye separates from the underlying pigment epithelium. This can cause vision loss, but if detected and treated early, it can be reversible. Risk factors for retinal detachment include diabetes, myopia, age, previous cataract surgery, and eye trauma. Symptoms may include new onset floaters or flashes, sudden painless visual field loss, and reduced peripheral and central vision. If the macula is involved, visual outcomes can be much worse. Diagnosis is made through fundoscopy, which may show retinal folds or a lost red reflex. Urgent referral to an ophthalmologist is necessary for assessment and treatment.
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This question is part of the following fields:
- Ophthalmology
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Question 23
Incorrect
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A 4-year-old boy is diagnosed with retinoblastoma after his mother noticed that the appearance of the child's left eye looked different to the right on photos. She had read in a magazine that this could be a dangerous sign and so reported it an optometrist.
Which one of the following statements about retinoblastoma is correct?Your Answer: Is caused by a defective gene located on chromosome 5
Correct Answer: Results from loss of heterozygosity of the normal Rb gene
Explanation:Retinoblastoma: Understanding the Mechanisms and Risks
Retinoblastoma is a type of cancer caused by a mutation in the Rb-1 gene, which is a tumour suppressor gene. This mutation can occur through loss of heterozygosity, where the normal Rb gene is lost in one region, but cancer only results when both copies of the normal gene are lost. While about 60% of cases are sporadic, the remaining 40% are inherited in an autosomal dominant manner, with a predisposition to non-ocular cancers such as pineal or suprasellar primitive neuroectodermal tumour. The Knudson’s two-hit hypothesis explains that in inherited cases, one genetic change is inherited from an affected parent, and the second mutation occurs after birth through somatic mutation. Understanding the mechanisms and risks of retinoblastoma is crucial for early detection and treatment.
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This question is part of the following fields:
- Ophthalmology
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Question 24
Incorrect
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An older man comes in with a severe headache, nausea, vomiting and a painful, red right eye. He has reduced visual acuity in the right eye and normal visual acuity in the left eye. During the examination, he had a stony hard eye with marked pericorneal reddening and a hazy corneal reflex. Tonometry revealed a raised intraocular pressure. The patient reports that he has recently been prescribed a new medication by his general practitioner.
What medication could be responsible for this sudden onset of symptoms?Your Answer: Bisoprolol
Correct Answer: Ipratropium nebuliser
Explanation:Understanding Acute Closed Angle Glaucoma and its Treatment Options
Acute closed angle glaucoma is a serious eye condition that can cause sudden vision loss, severe eye pain, and nausea. It occurs when the angle between the iris and cornea is reduced, leading to a blockage of the aqueous humour flow and increased intraocular pressure. Risk factors include female sex, Asian ethnicity, and hypermetropia.
Certain drugs, such as nebulised ipratropium and tricyclic antidepressants, can induce angle closure due to their antimuscarinic effects. Other antimuscarinic drug side-effects include dry eyes, xerostomia, bronchodilation, decreased gut motility, urinary outflow obstruction, and hallucinations.
Acetazolamide is a carbonic anhydrase inhibitor that is given intravenously to treat acute closed angle glaucoma. It helps to reduce intraocular pressure and prevent damage to the optic nerve. Bisoprolol is a β-blocker that does not precipitate an episode of acute closed angle glaucoma, while montelukast is used in the long-term management of asthma and does not increase the risk of acute closed angle glaucoma.
Topical pilocarpine is a miotic that is used to treat acute angle closure glaucoma by constricting the pupil and promoting aqueous humour flow. It is important to understand the causes and treatment options for acute closed angle glaucoma to prevent vision loss and other serious complications.
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This question is part of the following fields:
- Ophthalmology
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Question 25
Correct
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A 48-year-old man visits his doctor complaining of vision problems. He has been experiencing difficulty while driving for the past few months, as he is unable to see cars approaching him from the sides of his vision. He suspects that this may also be the cause of his occasional headaches, but he does not report any pain around his eyes or any current headache. The patient has a history of peripheral vascular disease, type II diabetes, and short-sightedness, and he often neglects to wear his glasses. What is the most probable diagnosis?
Your Answer: Primary open-angle glaucoma
Explanation:The patient is likely suffering from primary open-angle glaucoma, which causes gradual loss of peripheral vision. This is supported by the patient’s symptoms and risk factors, such as diabetes and myopia. The headaches are likely due to eye strain from not wearing glasses. Acute angle-closure glaucoma, age-related macular degeneration, and cataracts are unlikely causes as they present with different symptoms and risk factors.
Age-related macular degeneration (ARMD) is a common cause of blindness in the UK, characterized by the degeneration of the central retina (macula) and the formation of drusen. It is more prevalent in females and is strongly associated with advancing age, smoking, family history, and conditions that increase the risk of ischaemic cardiovascular disease. ARMD can be classified into two forms: dry and wet. Dry ARMD is more common and is characterized by drusen, while wet ARMD is characterized by choroidal neovascularisation and carries a worse prognosis. Clinical features of ARMD include subacute onset of visual loss, difficulties in dark adaptation, and visual disturbances such as photopsia and glare.
To diagnose ARMD, slit-lamp microscopy and color fundus photography are used to identify any pigmentary, exudative, or haemorrhagic changes affecting the retina. Fluorescein angiography and indocyanine green angiography may also be used to visualize changes in the choroidal circulation. Treatment for dry ARMD involves a combination of zinc with antioxidant vitamins A, C, and E, which has been shown to reduce disease progression by around one third. For wet ARMD, anti-VEGF agents such as ranibizumab, bevacizumab, and pegaptanib are used to limit disease progression and stabilize or reverse visual loss. Laser photocoagulation may also be used to slow progression, but anti-VEGF therapies are usually preferred due to the risk of acute visual loss after treatment.
In summary, ARMD is a common cause of blindness in the UK that is strongly associated with advancing age, smoking, and family history. It can be classified into dry and wet forms, with wet ARMD carrying a worse prognosis. Diagnosis involves the use of various imaging techniques, and treatment options include a combination of zinc and antioxidant vitamins for dry ARMD and anti-VEGF agents or laser photocoagulation for wet ARMD.
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This question is part of the following fields:
- Ophthalmology
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Question 26
Incorrect
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A 15-year-old boy arrives at the emergency department complaining of a severe headache. He has been experiencing this headache for the past 4 hours and has noticed that lights appear brighter and hurt his eyes. The boy is unable to touch his chin to his neck due to pain. Upon examination, there are no neurological deficits, but papilloedema is observed during fundoscopy. No rash is detected during the examination. The boy's early warning score is 1 due to a raised temperature, but otherwise, he is stable.
What is the most appropriate course of action for managing this patient's presentation?Your Answer: Start co-amoxiclav
Correct Answer: Start ceftriaxone
Explanation:A young man with symptoms of meningitis, including headache, photophobia, and neck stiffness, presents with papilloedema indicating raised intracranial pressure. Due to the risk of coning, an LP is contraindicated, and antibiotics should be started immediately. The choice of antibiotics depends on the patient’s age and location, with ceftriaxone being appropriate in this case. A CT head is not necessary as the symptoms point towards meningitis. Co-amoxiclav should not be used in the treatment of meningitis.
Understanding Papilloedema: Optic Disc Swelling Caused by Increased Intracranial Pressure
Papilloedema is a condition characterized by swelling of the optic disc due to increased pressure within the skull. This condition is typically bilateral and can be identified through fundoscopy. During this examination, venous engorgement is usually the first sign observed, followed by loss of venous pulsation, blurring of the optic disc margin, elevation of the optic disc, loss of the optic cup, and the presence of Paton’s lines, which are concentric or radial retinal lines cascading from the optic disc.
There are several potential causes of papilloedema, including space-occupying lesions such as tumors or vascular abnormalities, malignant hypertension, idiopathic intracranial hypertension, hydrocephalus, and hypercapnia. In rare cases, papilloedema may also be caused by hypoparathyroidism and hypocalcaemia, or vitamin A toxicity.
Overall, understanding papilloedema is important for identifying potential underlying conditions and providing appropriate treatment to prevent further complications.
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This question is part of the following fields:
- Ophthalmology
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Question 27
Incorrect
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A 29-year-old male presents to the emergency department with sudden onset of left eye pain and slightly blurred vision. He has no significant medical history and does not wear glasses or contact lenses. His family history includes type 2 diabetes and Crohn's disease.
Upon examination, the patient is wearing sunglasses due to photophobia and his left eye appears red. Ophthalmoscopy is not possible due to the severity of his symptoms. A white fluid level is visible in the inferior part of the anterior chamber and his pupil is small and irregular. Based on these findings, ophthalmology is urgently consulted. What is the likely diagnosis?Your Answer: Scleritis
Correct Answer: Anterior uveitis
Explanation:The patient has a medical history of a systemic condition such as rheumatoid arthritis or ankylosing spondylitis, which can lead to recurrent episodes. Although he has a family history of IBD, his symptoms do not match the typical presentation, as he does not experience a gritty sensation in his eye and his pupil does not appear abnormal.
Anterior uveitis, also known as iritis, is a type of inflammation that affects the iris and ciliary body in the front part of the uvea. It is a common cause of red eye and is associated with HLA-B27, which may also be linked to other conditions. Symptoms of anterior uveitis include sudden onset of eye discomfort and pain, small or irregular pupils, intense sensitivity to light, blurred vision, redness, tearing, and the presence of pus and inflammatory cells in the front part of the eye. This condition may be associated with ankylosing spondylitis, reactive arthritis, ulcerative colitis, Crohn’s disease, Behcet’s disease, and sarcoidosis. Urgent review by an ophthalmologist is necessary, and treatment may involve the use of cycloplegics and steroid eye drops.
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This question is part of the following fields:
- Ophthalmology
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Question 28
Correct
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A 32-year-old patient complains of a painful lump on their eyelid. The lump has been present for about 3 days and is gradually increasing in size. Upon examination, a tender, smooth lump measuring approximately 3 mm in diameter is observed, originating from the outer edge of the left upper eyelid. There is no redness in the eye, no orbital or periorbital erythema, and normal visual acuity.
What would be the most suitable approach to managing this condition?Your Answer: Provide advice on application of hot compresses and simple analgesia
Explanation:Management of Stye or Hordeolum: Hot Compresses and Simple Analgesia
A stye or hordeolum is a common condition that presents as an acute and painful swelling of the eyelid, usually around a single eyelash follicle. While it does not affect visual acuity, it can make the eye watery. The first-line management for a stye is the application of warm compresses a few times a day, which can help the stye resolve or drain. Incision and drainage is rarely used and should only be considered if symptoms do not resolve and needs to be performed by an experienced individual in the hospital setting/Eye Casualty. There is no indication to prescribe systemic antibiotics, as the patient is well and there are no signs of cellulitis over the eyelid. Topical antibiotics are not recommended in the absence of conjunctivitis.
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This question is part of the following fields:
- Ophthalmology
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Question 29
Incorrect
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A 25-year-old pregnant woman visits her General Practitioner (GP) with a complaint of redness, grittiness, and stickiness in both eyes for the past 5 days. She also reports experiencing whitish-yellow discharge on her lids, particularly in the morning. Upon examination, her vision is 6/6 in both eyes, and there is diffuse injection of the conjunctivae with mild chemosis. The cornea shows no fluorescein uptake. What is the recommended first-line treatment for this patient's eye condition?
Your Answer: Topical chloramphenicol eye drops
Correct Answer: Topical fusidic acid eye drops
Explanation:Treatment Options for Bacterial Conjunctivitis in Pregnant Women
Bacterial conjunctivitis is a common eye infection that can occur during pregnancy. While topical antibiotics are the mainstay of treatment, certain options should be avoided or used with caution in pregnant women. Here are the treatment options for bacterial conjunctivitis in pregnant women:
Topical Fusidic Acid Eye Drops: These eye drops are typically a second-line choice for treating bacterial conjunctivitis, but they are often the first-line treatment for pregnant women.
Topical Steroid Eye Drops: These eye drops are not recommended for bacterial conjunctivitis, especially in pregnant women.
Artificial Tears: While artificial tears can provide relief for dry eyes, they are not useful in treating bacterial conjunctivitis.
Eye Shield: An eye shield is not necessary for bacterial conjunctivitis.
Topical Chloramphenicol Eye Drops: Topical antibiotics are effective in treating bacterial conjunctivitis, but chloramphenicol should be avoided in pregnant women unless it is essential. The British National Formulary recommends avoiding topical chloramphenicol due to the risk of neonatal grey-baby syndrome with oral use in the third trimester.
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This question is part of the following fields:
- Ophthalmology
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Question 30
Incorrect
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A 35-year-old man visits his GP complaining of a painful and red right eye with photophobia for the past 2 days. He usually wears contact lenses but has been using glasses since the onset of pain. The patient has a medical history of allergic rhinitis and takes cetirizine daily.
During the examination, the doctor observes dilated conjunctival and episcleral vessels, mild eyelid swelling, and increased tearing in the right eye. The left eye appears normal, and the patient's corrected visual acuity is 6/6 in the left eye and 6/12 in the right eye.
What is the most appropriate course of action for this patient?Your Answer:
Correct Answer: Refer urgently to eye casualty
Explanation:If a person wearing contact lenses experiences a painful red eye, it is important to refer them to an eye casualty department to rule out the possibility of microbial keratitis.
Understanding Keratitis: Inflammation of the Cornea
Keratitis is a condition that refers to the inflammation of the cornea. While conjunctivitis is a common eye infection that is not usually serious, microbial keratitis can be sight-threatening and requires urgent evaluation and treatment. The causes of keratitis can vary, with bacterial infections typically caused by Staphylococcus aureus and Pseudomonas aeruginosa commonly seen in contact lens wearers. Fungal and amoebic infections can also cause keratitis, with acanthamoebic keratitis accounting for around 5% of cases. Parasitic infections such as onchocercal keratitis can also cause inflammation of the cornea.
Other factors that can cause keratitis include viral infections such as herpes simplex keratitis, environmental factors like photokeratitis (e.g. welder’s arc eye), and exposure keratitis. Clinical features of keratitis include a red eye with pain and erythema, photophobia, a foreign body sensation, and the presence of hypopyon. Referral is necessary for contact lens wearers who present with a painful red eye, as an accurate diagnosis can only be made with a slit-lamp examination.
Management of keratitis involves stopping the use of contact lenses until symptoms have fully resolved, as well as the use of topical antibiotics such as quinolones. Cycloplegic agents like cyclopentolate can also be used for pain relief. Complications of keratitis can include corneal scarring, perforation, endophthalmitis, and visual loss. Understanding the causes and symptoms of keratitis is important for prompt diagnosis and treatment to prevent serious complications.
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This question is part of the following fields:
- Ophthalmology
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