Each one of the following predisposes to cataract formation, except:
Correct Answer B:
Cataracts:
Majority:
Systemic:
Ocular:
Classification:
A 65-year-old woman presents to the Emergency Department with visual problems. She has rheumatoid arthritis, depression and takes medication to control her blood pressure. Over the past few days she has been getting troublesome headaches and blurred vision but today has noted a marked reduction in vision in the right eye. On examination her right eye is red, has a sluggish pupil and a corrected visual acuity 6/30. Her medication has recently been changed.
Which one of the following drugs is most likely to have precipitated this event?
Correct Answer C: Drugs which may precipitate acute glaucoma include anticholinergics and tricyclic antidepressants.
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:
Features:
Management:
Which one of the following is associated with heterochromia in congenital disease?
Correct Answer E:
Horner's syndrome:
Distinguishing between causes:
*In reality the appearance is due to a narrow palpebral aperture rather than true enophthalmos.
A 64-year-old woman with type 2 diabetes mellitus presents as she has started to bump into things since the morning. Over the previous two days she had noticed some 'floating spots in her eyes'. Examination reveals she has no vision in her right eye. The red reflex on the right side is difficult to elicit and you are unable to visualize the retina on the right side during fundoscopy. Examination of the left fundus reveals changes consistent with pre-proliferative diabetic retinopathy.
What is the most likely diagnosis?
Correct Answer B: The history of diabetes, complete loss of vision in the affected eye and inability to visualize the retina point towards a diagnosis of vitreous haemorrhage. Please see the table below for help in differentiating retinal detachment from vitreous haemorrhage.
Sudden painless loss of vision:
The most common causes of a sudden painless loss of vision are as follows:
Ischaemic optic neuropathy:
Central retinal vein occlusion:
Central retinal artery occlusion:
Vitreous haemorrhage:
Retinal detachment:
Differentiating posterior vitreous detachment, retinal detachment and vitreous haemorrhage:
A 72-year-old woman presents with a vesicular rash around her left eye. The left eye is red and there is a degree of photophobia. A presumptive diagnosis of herpes zoster ophthalmicus is made and an urgent referral to ophthalmology is made.
What treatment is she most likely to be given?
Herpes zoster ophthalmicus:
Herpes zoster ophthalmicus (HZO) describes the reactivation of the varicella zoster virus in the area supplied by the ophthalmic division of the trigeminal nerve. It accounts for around 10% of case of shingles.
Complications:
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