A 65-year-old man with a known history of Paget's disease is noted to have irregular dark red lines radiating from the optic nerve.
What is the likely diagnosis?
Correct Answer C: This is a typical description of angioid retinal streaks which are associated with Paget's disease.
Angioid retinal: streaks Angioid retinal streaks are seen on fundoscopy as irregular dark red streaks radiating from the optic nerve head.
They are caused by degeneration, calcification and breaks in Bruch's membrane.
Causes:
A 64-year-old woman presents with bilateral sore eyelids. She also complains of her eyes being dry all the time. On examination her eyelid margins are erythematous at the margins but are not swollen.
Of the given options, what is the most appropriate initial management?
Correct Answer D: Artificial tears may also be given for symptom relief of blepharitis.
Blepharitis: Blepharitis is inflammation of the eyelid margins. It may due to either meibomian gland dysfunction (common, posterior blepharitis) or seborrhoeic dermatitis/staphylococcal infection (less common, anterior blepharitis).
Blepharitis is also more common in patients with rosacea.
The meibomian glands secrete oil on to the eye surface to prevent rapid evaporation of the tear film. Any problem affecting the meibomian glands (as in blepharitis) can hence cause drying of the eyes which in turns leads to irritation.
Features:
Management:
*An alternative is sodium bicarbonate, a teaspoonful in a cup of cooled water that has recently been boiled
A 67-year-old woman presents for review. She has recently been diagnosed with dry age-related macular degeneration.
Which one of the following is the strongest risk factor for developing this condition?
Correct Answer C: Macular degeneration - smoking is risk factor.
Having a balanced diet, with plenty of fresh fruits and vegetables may also slow the progression of macular degeneration. There is still ongoing research looking at the role of supplementary antioxidants.
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:
Investigation and diagnosis:
General management:
Dry macular degeneration:
Wet macular degeneration:
A 34-year-old man is referred to ophthalmology following a deterioration in his vision. He is noted to be tall with thin, long fingers and a degree of learning disabilities. Following review he is suspected as having a displacement of his lens on the right side.
What is the most likely underlying diagnosis?
Correct Answer B: The presence of learning difficulties points to a diagnosis of homocystinuria rather than Marfan's syndrome.
Homocystinuria: Homocystinuria is a rare autosomal recessive disease caused by deficiency of cystathionine beta synthase. This results in an accumulation of homocysteine which is then oxidized to homocystine.
Diagnosis is made by the cyanide-nitroprusside test, which is also positive in cystinuria Treatment is vitamin B6 (pyridoxine) supplements.
A 62-year-old man presents with sudden visual loss in his right eye. He is otherwise asymptomatic.
Which one of the following conditions is least likely to be responsible?
Correct Answer D: Whilst optic neuritis can present with sudden loss, in this 62-year-old man it is the least likely option. Typically there is a unilateral decrease in visual acuity over hours or days. There may be poor discrimination of colours and eye pain on movement.
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:
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