Q1\A 30-year-old man develops an acute red eye associated with a watery discharge. Vision is unaffected but the eye irritates. He is otherwise fit and well.
Questions
What is the diagnosis
What confirmatory signs would you look for on examination?
A\Answers (case NO>20 lecture note )
The patient has viral conjunctivitis (see p. 68). Examination for a pre- auricular lymph node and conjunctival follicles on the lower tarsus would confirm the diagnosis. This form of conjunctivitis is highly contagious; it is important to ensure that hands and equipment are thoroughly cleaned following the examination and that the importance of good hygiene is emphasized to the patient.
Q2\A 27-year-old man presents with a 2-day history of a painful red right eye; the vision is slightly blurred and he dislikes bright lights. He is otherwise fit and well, but complains of some backache. He wears no glasses.
Questions
What is the likely diagnosis?
What would you expect to find on examination of the eye? What treatment would you give?
What is the eye condition likely to be associated with?
Answers (case 10 lecture note )
The patient has iritis (Examination would reveal a reduction in visual acuity, redness of the eye that is worse at the limbus, cells in the anterior chamber and possibly on the cornea (keratic precipitate) or a collection at the bottom of the anterior chamber (hypopyon). The iris may be stuck to the lens (posterior synechiae). There may be inflammation of the vitreous and retina. The patient is treated with steroid eye drops to reduce the inflammation and dilating drops to prevent the formation of posterior synechiae. The history of backache suggests that the patient may have ankylosing spondylitis
Q3While working in the laboratory a colleague inadvertently sprays his eyes with an alkali solution.
Questions
What is the immediate treatment? What should you do next?
Answers(case no 9 lecture note )
The eyes must be washed out with copious quantities (litres) of water immediately. Alkalis are very toxic to the eye. Failure to treat immediately
Q4\how can you differentiate between concomitant and incomittant squint
Concomitant: angle of squint not change in different visual direction
Incomittant:angle chanced
Q5\enumerate the cause of optic neuropathy :
Compression of optic nerveIschemic optic neuropathy
Retinal artery and vein occlusion )
Glaucoma
Optic neuritis
Inherited optic nerve disease
Inherited retinal disease
Toxic optic neuropathy
Tobacco ,alcoholic ,nutritional ,vitamin, amblyopia
Q6\what are the emergency measure in central retinal artery occlusion ?
Q7 \what are the presentation of congenital glaucoma ?
It may present at birth or within the first year.
Symptoms and signs include:
• Excessive tearing;
• An increased corneal diameter (buphthalmos);
• A cloudy cornea due to epithelial oedema;
• Splits in Descemet’s membrane.
Q8\symptom of macular disease
Blurred central vision.
• Distorted vision (metamorphopsia) caused by a disturbance in the arrangement of the photoreceptors e.g. macular oedema.
• A reduction (micropsia) or enlargement (macropsia) of object size may also occur if the photoreceptors become stretched apart or compressed together.
• areas of loss of the central visual field (scotomata) if part of the photoreceptor layer becomes covered, e.g. by blood, or if the photoreceptors are destroyed.
Q9\A\classify retinal detachment according to the etiology ?
rhegmato genous retinal detachment
tractional retinal detachment
exudative retinal detachment
B\what are the risk factor for retinal tear ?
1. posterior vitreous detachment.2. lattice degeneration,
3. Highly myopic
4. Trauma to the eye whether blunt , penetrating or surgical
5. Vitreous loss during surgery.
Q10\
Interruption of the sympathetic pathway causes:A small pupil on the affected side. This is more noticeable in the dark when the fellow, normal pupil, dilates more than the affected pupil.
A slight ptosis on the affected side.
Lack of sweating on the affected side if the sympathetic pathway is affected proximal to the base of the skull.
An apparent enophthalmos
Because of its extended course the sympathetic pathway may be affected by a multitude of pathologies. Examples include:
Syringomyelia,
Disease of the lung apex catches the cervical sympathetic chain (e.g. neoplasia). Involvement of the brachial plexus gives rise to pain and to T1 wasting of the small muscles of the hand, in Pancoast’s syndrome.
Neck injury, disease or surgery.
Cavernous sinus disease.
congenital. Here the iris colour may be altered when compared to the fellow eye (heterochromia).
In these pupillary abnormalities the reaction of the pupils to light is much less than to the near (accommodative) response.
There is no condition in which the light reflex is intact but the near reflex is defective.
A light–near dissociation is seen in diabetes and multiple sclerosis or may be caused by periaqueductal brainstem lesions
.