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OPHTHALMOLOGY Finals2Foundation Dr Mallaika Viswanath Question 1 A 28 year old woman presents to GP with gritty, itchy eyes. It started after a rosacea flare and her left eye is now red and swollen, with crusting along the eyelash line. Which of the following is the most likely diagnosis.? a) Iritis b) Stye c) Conjunctivitis d) Blepharitis Question 1 A 28 year old woman presents to GP with gritty, itchy eyes. It started after a rosacea flare and her left eye is now red and swollen, with crusting along the eyelash line. Which of the following is the most likely diagnosis.? a) Iritis b) Stye c) Conjunctivitis d) Blepharitis Question 2 A 28 year old woman presents to GP with a 2 month history of itchy swollen eyes. Which of the following is the most appropriate initial management? a) Topical steroid drops b) Warm compress and eye hygiene c) Topical Chloramphenicol d) Urgent referral to Ophthalmology Question 2 A 28 year old woman presents to GP with a 2 month history of itchy swollen eyes. Which of the following is the most appropriate initial management? a) Topical steroid drops b) Warm compress and eye hygiene c) Topical Chloramphenicol d) Urgent referral to OphthalmologyQuestion 3 A 14 year old girl presents with red, itchy eyes and a watery discharge for the past 3 days. She denies any pain or visual disturbances but mentions that her symptoms began shortly after she recovered from a cold. O/E: both eyes appear injected with mild conjunctival swelling. No purulent discharge is noted. What is the most likely diagnosis? A) Allergic conjunctivitis B) Bacterial conjunctivitis C) Viral conjunctivitis D) Acute angle-closure glaucoma E) Subconjunctival haemorrhageQuestion 3 A 14 year old girl presents with red, itchy eyes and a watery discharge for the past 3 days. She denies any pain or visual disturbances but mentions that her symptoms began shortly after she recovered from a cold. O/E: both eyes appear injected with mild conjunctival swelling. No purulent discharge is noted. What is the most likely diagnosis? A) Allergic conjunctivitis B) Bacterial conjunctivitis C) Viral conjunctivitis D) Acute angle-closure glaucoma E) Subconjunctival haemorrhageQuestion 4 A 14 year old girl presents with red, itchy eyes and a watery discharge for the past 3 days. She denies any pain or visual disturbances but mentions that her symptoms began shortly after she recovered from a cold. O/E: both eyes appear injected with mild conjunctival swelling. No purulent discharge is noted. What is the best management? A) Topical chloramphenicol B) Do nothing C) Urgent opthal referral D) Topical steroidQuestion 4 A 14 year old girl presents with red, itchy eyes and a watery discharge for the past 3 days. She denies any pain or visual disturbances but mentions that her symptoms began shortly after she recovered from a cold. O/E: both eyes appear injected with mild conjunctival swelling. No purulent discharge is noted. What is the best management? A) Topical chloramphenicol B) Do nothing C) Urgent opthal referral D) Topical steroidComparing blepharitis vs conjunctivitis Blepharitis Conjunctivitis Site Eyelids Conjunctiva affected Common Bacteria, clogged or irritated oil Bacterial, Viruses, allergies, causes glands irritants Symptoms Red, swollen, or tender eyelids, Red eyes, gritty feeling, pus, itchy watery or sticky discharge, eyes, watery eyes, burning eyes, burning or stinging, itching, light swollen eyelids, blurred vision, sensitivity, blurred vision sensitivity to light, tearing Treatment Hygiene, warm compresses, Antibiotics, antihistamines, topical antibiotics, medication for eyedrops, flushing or cleaning the underlying issues eyeQuestion 5 A 37 year old gentleman has been referred for urgent ophthalmology assessment for anterior uveitis. Which of the following symptoms/ exam findings would we expect to see? A. Purulent discharge B. Conjunctival injection C. Ciliary flush D. Painless red eyeQuestion 5 Or miosis A 37 year old gentleman has been referred for urgent ophthalmology assessment for anterior uveitis. Which of the following symptoms/ exam findings would we expect to see? A. Purulent discharge B. Conjunctival injection C. Ciliary flush D. Painless red eye Ref: 0-finalsQuestion 6 Or miosis A 37 year old gentleman has been referred for urgent ophthalmology assessment for anterior uveitis. They treat him with steroid eye drops to reduce inflammation and cyclopentolate. Write in the chat the mechanism of action of Cyclopentolate. Ref: 0-finalsQuestion 6 A 37 year old gentleman has been referred for urgent ophthalmology assessment for anterior uveitis. They treat him Cycloplegic! with steroid eye drops to reduce inflammation and cyclopentolate. Write in the chat the mechanism of action of Cyclopentolate.Question 7: Quick recall: which drug helps differentiate between scleritis and episcleritis? A. chloramphenicol B. Phenylephrine C. Atropine D. Lubricating eye dropsQuestion 7: quick recall: which drug helps differentiate between scleritis and episcleritis? A. chloramphenicol B. Phenylephrine C. Atropine D. Lubricating eye dropsQuestion 8 A 45-year-old woman presents with a 3-week history of severe, dull, and persistent pain in her right eye. The pain worsens with eye movement and is associated with redness and photophobia. She denies any discharge or vision changes. Her past medical history is significant for rheumatoid arthritis. On examination, there is diffuse redness of the sclera without discharge, and her visual acuity is intact. Which of the following is the most likely diagnosis? A) Conjunctivitis B) Episcleritis C) Anterior scleritis D) Acute angle-closure glaucomaQuestion 8 A 45-year-old woman presents with a 3-week history of severe, dull, and persistent pain in her right eye. The pain worsens with eye movement and is associated with redness and photophobia. She denies any discharge or vision changes. Her past medical history is significant for rheumatoid arthritis. On examination, there is diffuse redness of the sclera without discharge, and her visual acuity is intact. Which of the following is the most likely diagnosis? A) Conjunctivitis B) Episcleritis C) Anterior scleritis D) Acute angle-closure glaucoma SPOT DIAGNOSIS Bonus point for naming the stainHERPES KERATITIS Dendritic ulcer seen on fluorescein stain Viral infection (e.g., herpes simplex) Bacterial infection (e.g., Pseudomonas or Staphylococcus) Causes of Fungal infection (e.g., Candida or Aspergillus) keratitis Contact lens (often associated with swimming!) Exposure keratitis, caused by inadequate eyelid coverage (e.g., ectropion- saggy eyelid)Question 10 A 30-year-old woman presents with a sudden onset of blurred vision in her right eye over the past two days. She describes pain in the eye, especially with movement. She also reports that colours appear “washed out” in the affected eye. Her past medical history is unremarkable. On examination, there is decreased visual acuity in the right eye, a relative afferent pupillary defect (RAPD), and reduced colour vision. Fundoscopy shows no abnormalities. What is the most likely diagnosis? A) Retinal detachment B) Optic neuritis C) Central retinal artery occlusion D) Acute angle-closure glaucomaQuestion 10 A 30-year-old woman presents with a sudden onset of blurred vision in her right eye over the past two days. She describes pain in the eye, especially with movement. She also reports that colours appear “washed out” in the affected eye. Her past medical history is unremarkable. On examination, there is decreased visual acuity in the right eye, a relative afferent pupillary defect (RAPD), and reduced colour vision. Fundoscopy shows no abnormalities. What is the most likely diagnosis? A) Retinal detachment B) Optic neuritis C) Central retinal artery occlusion D) Acute angle-closure glaucoma Ref: osmosisRED EYE This Photo by Unknown Author is licensed under CC BY-SA-NCDifferentials Painless red eye Painful red eyes: Conjunctivitis Acute angle-closure glaucoma Anterior uveitis Episcleritis Subconjunctival haemorrhage Scleritis Corneal abrasions or ulceration Blepharitis Keratitis Foreign body Traumatic or chemical injury Question 11 A 6-year-old boy is brought to the emergency department by his parents with swelling and redness around his left eye. He had a cold with nasal congestion and fever for the past 4 days. Now, he complains of worsening pain, particularly when trying to move his eye. His parents also notice that his left eyelid has become puffy, and he has started having double vision. On examination, there is left periorbital swelling, proptosis, restricted eye movements, and tenderness around the orbit. His temperature is 38.9 °C (102°F). What is the most likely diagnosis? A) Preseptal cellulitis B) Conjunctivitis C) Allergic conjunctivitis D) Orbital cellulitis Question 11 A 6-year-old boy is brought to the emergency department by his parents with swelling and redness around his left eye. He had a cold with nasal congestion and fever for the past 4 days. Now, he complains of worsening pain, particularly when trying to move his eye. His parents also notice that his left eyelid has become puffy, and he has started having double vision. On examination, there is left periorbital swelling, proptosis, restricted eye movements, and tenderness around the orbit. His temperature is 38.9 °C (102°F). What is the most likely diagnosis? A) Preseptal cellulitis B) Conjunctivitis C) Allergic conjunctivitis D) Orbital cellulitisRed flags for orbital cellulitis Painful or restricted eye movements reduced acuity relative afferent Visual impairment: pupil defect SEPSIS 6! Proptosis diplopia Severe headache or other features of intracranial involvement Conditions covered ❖ Blepharitis ❖ Conjunctivitis ❖ Subconjunctival haemorrhage ❖ Iritis ❖ Infective keratitis ❖ Scleritis/Uveitis ❖ Optic neuritis ❖ Periorbital and orbital cellulitis Useful resources: BMJ best practice, NICE CKS Guidelines, NHS inform, 0-finalsQUESTIONS Thanks for listening!