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Dr Woojin Chae Ophthalmology Part 2 10/01/2022Revision from last time 1) Uveitis vs scleritis 2) Uveitis vs endophthalmitis 3) Anterior vs posterior blepharitisCase 1 A 60F presents with a gradual blurring of vision, she’s having trouble reading fine prints and says its really hard to drive at night time. She has a past medical history of RA and Crohn’s disease. No history of trauma. What’s the likely diagnosis? a) Senile cataracts b) Secondary cataracts c) Glaucoma d) Macular degeneration e) Retinitis pigmentosaHow does the surgery workCase 2 70F had a cataracts surgery, 4 days later she’s coming in to her GP with a painful red eye. Her vision (which was initially improved post op) has now become blurry and she is seeing “floaters”. What do we do? a Reassure her that the eye is settling b Needs to be referred to an eye unit immediately. c She will need steroid drops only. d Treatment of the condition requires intravitreal antibiotics only. e Do nothing and book her up for a follow up in 2 weeks.Case 3 60F patient who does not usually wear glasses. Presenting today due to a very painful eye, nausea and abdo pain. She says she has blurry vision and the lights in ED have halos around them when she looks up, but she tries not to and asks for the lights to be turned off as the light makes things worse. What do you expect on examination? What is the likely cause? a) Uveitis b) Glaucoma c) Cataracts d) Meningitis e) KeratitisCase 4 40M presents to your clinic after his optometrist visit for new glasses. He says that he has needed new glasses more frequently and noticed his peripheral vision isn’t as good as before. He plays in his sunday football league and says that it affects his performance, what's going on? a) Acute angle closure glaucoma b) Chronic angle closure glaucoma c) Primary open angle glaucoma d) Secondary open angle glaucoma e) Nothing… he’s just bad at footballImage courtesy of Santorio eye institute)Treatments - reducing IOP Medical - Beta-blockers - Pilocarpine - Prostaglandin analogues - Alpha 2 agonists Laser - Argon laser trabeculoplasty Surgical - Trabeculectomy - Implants - Cyclodestructive proceduresCase 5 A mother who had GDM brings her baby for her 6 week post natal check. The baby is noted to be on the heavier side, no head abnormalities, is warm well perfused, normal tone and movements of limbs. You hear a mid systolic murmur, lungs are clear and genitalia are normal. Barlow and Ortolani tests are negative and the spine has normal curvature with no lesions noted. You note a small opacity in the baby’s eye. a) Follow up appointment b) Refer to ophthal c) Reassure and discharge d) Give antibiotic drops e) Make sure the baby is eatingCase 6 80M coming in for routine eye check up. What can you see on the slide? a) AV nipping b) Atrophy c) Drusen d) Decreased pigmentation e) Disc cuppingCase 7 40M presenting with troubling driving at night a) Macular degeneration b) Cataracts c) Glaucoma d) Retinitis pigmentosa e) Diabetic retinopathyCase 8 Which of these do you not see? a) Haemorrhages b) Exudates c) Proliferation d) DotsCase 9 What is the likely diagnosis? a) Diabetic retinopathy b) Vitreous haemorrhage c) Retinitis pigmentosa d) Amaurosis fugaxDiabetic retinopathyMore on Diabetic Retinopathy Stage Features Mild Microaneurysms Moderate Dots and blots and another finding: - Cotton wool spots - Hard exudate - Venous beading Severe Following signs but NO neovascularisations - >20 dots/blots in all quadrants - Definite venous beading Proliferative If neovascularisation present or vitreous haemorrhageRetinal Vasculature A Window on the Brain J. David Spence and J. Alexander FraserHypertensive Retinopathy Stage Grade 1 Barely any arterial narrowing Grade 2 Obvious narrowing of arterials Grade 3 G2+retinal haemorrhages, exudates and cotton wool spots or retinal oedema Grade 4 G3+papilloedemaCase 10 Patient presents with sudden onset of blurry vision. No pain in eye. a) Hypertensive retinopathy b) Diabetic retinopathy c) Glaucoma d) Central retinal vein occlusion e) Central retinal artery occlusionCase 11 Patient with previous TAVI presents to ED with delirium and a fall. You are the ophthal reg helping out during the pandemic. You decide to do some teaching with the students on their ED rotation and show them this on fundoscopy. What do we see?Case 12 45M smoker comes in with sudden loss of vision in his left eye. What is the diagnosis: a) Hypertensive retinopathy b) Amaurosis fugax c) Glaucoma d) Central retinal vein occlusion e) Central retinal artery occlusionCase 13 Rugby lad presents to ED after a bad tackle, he was struck hard on his nose and eye by his opponents knee. He now cannot see very well out of the affected eye, it feels like a dark red shadow is in his vision. The eye isn’t too painful he says and is more bothered about his nose. What is the most likely cause? a) CRVO b) CRAO c) Retinal detachment d) Vitreous haemorrhage e) GlaucomaCase 14 Patient 70M presents to GP as he sees floaters. He says it started a few days ago and he has not had ocular trauma. He says he can also see flashing lights and something that resembles a shadow on the side of his left eye. a) Macular degeneration b) Retinal detachment c) Amaurosis fugax d) Glaucoma e) CataractsNot covered in these lectures Neuro ophthalmology and visual pathway disorders Paediatric ophthalmology Trauma and in depth surgical aspect of ophthal