A 63-year-old man presents to his GP complaining of pain in his right eye. On examination the sclera is red and the pupil is dilated with a hazy cornea.
What is the most likely diagnosis?
Correct Answer C:
Red eye - glaucoma or uveitis?:
Red eye: There are many possible causes of a red eye. It is important to be able to recognise the causes which require urgent referral to an ophthalmologist. Below is a brief summary of the key distinguishing features.
Acute angle closure glaucoma:
Anterior uveitis:
Scleritis:
Conjunctivitis:
A 74-year-old man presents to ophthalmology clinic after seeing his optician. They have noticed raised intraocular pressure and decreased peripheral vision. His past medical history includes asthma and type 2 diabetes mellitus.
What is the most appropriate treatment given the likely diagnosis?
Correct Answer A: A prostaglandin analogue should be used first-line in patients with a history of asthma.
Primary open-angle glaucoma: management:
The majority of patients with primary open-angle glaucoma are managed with eye drops. These aim to lower intra-ocular pressure which in turn has been shown to prevent progressive loss of visual field.
Surgery in the form of a trabeculectomy may be considered in refractory cases.
A 54-year-old woman presents with a persistent watery left eye for the past 4 days. On examination there is erythema and swelling of the inner canthus of the left eye.
Correct Answer D:
Lacrimal duct problems:
Dacryocystitis is infection of the lacrimal sac: Features:
Congenital lacrimal duct obstruction affects around 5-10% of newborns. It is bilateral in around 20% of cases:
Features:
A 71-year-old man presents with severe pain around his right eye and vomiting. On examination the right eye is red and decreased visual acuity is noted.
Which one of the following options is the most appropriate initial treatment?
Correct Answer D: Treatment of acute glaucoma - acetazolamide + pilocarpine
Acute angle closure glaucoma: Glaucoma is a group disorders characterized by optic neuropathy due, in the majority of patients, to raised intraocular pressure (IOP). It is now recognized that a minority of patients with raised IOP do not have glaucoma and vice versa.
In acute angle closure glaucoma (AACG) there is a rise in IOP secondary to an impairment of aqueous outflow.
Factors predisposing to AACG include:
Management:
A 35-year-old man presents with visual problems. He has had very poor vision in the dark for a long time but is now worried as he is developing 'tunnel vision'. He states his grandfather had a similar problem and was registered blind in his 50's.
Correct Answer E: Retinitis pigmentosa - night blindness + tunnel vision
Retinitis pigmentosa: Retinitis pigmentosa primarily affects the peripheral retina resulting in tunnel vision.
Associated diseases:
Click to expand