A 65-year-old man with a 16 year history of type 2 diabetes mellitus presents complaining of poor eye sight and blurred vision. Visual acuity measured using a Snellen chart is reduced to 6/12 in the right eye and 6/18 in the left eye. Fundoscopy reveals a number of yellow deposits in the left eye consistent with drusen formation. Similar changes but to a lesser extent are seen in the right eye.
What is the most likely diagnosis?
Correct Answer E: Drusen = Dry macular degeneration.
Age related macular degeneration:
Age related macular degeneration is the most common cause of blindness in the UK. Degeneration of the central retina (macula) is the key feature with changes usually bilateral.
Traditionally two forms of macular degeneration are seen:
Recently there has been a move to a more updated classification:
Risk factors:
Features:
Investigation and diagnosis:
General management:
Dry macular degeneration - no current medical treatments.
Wet macular degeneration:
Which one of the following is associated with the Holmes-Adie pupil?
Correct Answer A: Holmes ADIe = Dilated pupil, females, absent leg reflexes.
Holmes-Adie pupil:
Holmes-Adie pupil is a benign condition most commonly seen in women. It is one of the differentials of a dilated pupil.
Overview:
Holmes-Adie syndrome:
A 71-year-old man presents with a burning sensation around his right eye. On examination an erythematous blistering rash can be seen in the right trigeminal distribution.
Correct Answer D:
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.
Management:
Which one of the following is least associated with the development of optic atrophy?
Correct Answer A: Optic atrophy is seen as pale, well demarcated disc on fundoscopy. It is usually bilateral and causes a gradual loss of vision*. Causes may be acquired or congenital.
1- Acquired causes:
2- Congenital causes:
*Strictly speaking optic atrophy is a descriptive term, it is the optic neuropathy that results in visual loss
A 34-year-old woman presents complaining of headaches. Examination of her pupils using a light shone alternately in each eye reveals that when the light is shone in the right eye both pupils constrict but when the light source immediately moves to the left eye both eyes appear to dilate.
Correct Answer D: This is the 'swinging light test' and reveals a relative afferent pupillary defect. As there is a defect in the afferent nerve on the left side the pupils constrict less than normal, giving the impression of dilation.
Given her age, multiple sclerosis causing optic neuritis is the likely underlying diagnosis. Optic neuritis typically causes a dull ache in the region of the eye which is aggravated by movement.
Relative afferent pupillary defect:
Also known as the Marcus-Gunn pupil, a relative afferent pupillary defect is found by the 'swinging light test'. It is caused by a lesion anterior to the optic chiasm i.e. optic nerve or retina.
Causes:
Pathway of pupillary light reflex:
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