Ophthalmology 👁️

A 33 year old man has an acute painful, red right eye for the last 24 hours. He complains of blurring of vision. He had a similar episode a year ago. His pupil is irregular in shape and he is very sensitive to light. He has been taking diclofenac for three years now because of back pain and stiffness. What is the SINGLE most likely clinical diagnosis?

A 54 year old myopic develops flashes of light and then sudden painless loss of vision. He says that it initially felt like a curtain was falling down. Ophthalmoscope shows a grey opalescent retina, ballooning forward. What is the SINGLE most appropriate treatment?

A 45 year old man with type 1 diabetes mellitus has his annual check ups. Ophthalmoscopy shows dot and blot haemorrhage with hard exudates. What is the SINGLE most likely diagnosis?

A 25 year old man has a burning sensation in his left eye for the last 2 days. His eye is red and has thick purulent discharge. His lids are often stuck shut on waking. What is the SINGLE most appropriate initial management?

A 33 year old man presents to clinic with a history of early morning back pain, stiffness and a painful red right eye. The pain in the eye started last night. On examination, his right pupil is seen to have a distorted pupil shape. His visual acuity is unaffected. What is the SINGLE most likely affected anatomical structure?

A 48 year old woman presents with severe left-sided headaches, ocular pain and a red, watering eye that worsened over the past 3 days. She has intermittent blurring of vision and sees coloured haloes and coloured rainbows around lights. She is systematically unwell with nausea and abdominal pain On examination, her visual acuity is reduced. What is the SINGLE most appropriate next step of action?

A 48 year old man attends clinic for a routine eye check up as he has a history of type 1 diabetes. Fundoscopy shows neovascularization at the retina. What is the SINGLE most appropriate management?

A 39 year old woman has been having gradual loss of vision in both eyes over the past 6 months. She has a diagnosis of rheumatoid arthritis and has been on treatment for it for the past 4 years. Her intraocular pressure is within normal limits and red reflex is absent in both eyes. What is the SINGLE most likely diagnosis?

A 49 year old woman complains of reduction of vision and dull pain in her left eye for the past 2 weeks. Her past medical history includes multiple sclerosis which was diagnosed 2 years ago. On examination, both pupils constrict when light is directed to the right eye but both pupils fail to constrict fully when light is directed to the left eye. What is the SINGLE most likely defect to accompany her diagnosis?

A 52 year old woman who suffers from depression attends the GP surgery with complaints of nausea and headache. In discussion, she describes a recent pain and redness in her right eye. She also mentioned that her vision from her right eye has become blurry. Based on her medication history, she was switched from fluoxetine to clomipramine 5 weeks ago for her depression. She has been feeling low and has lost interest in meeting her friends. She works as a florist but has not gone to work for the past month because of her depression. What is the SINGLE most appropriate management?

A 48 year old woman is seen in the eye clinic as she finds that her left visual field has been affected. She is unable to see objects on the left of her vision. She was given the diagnosis of homonymous hemianopsia in clinic. Which anatomic structure is most likely affected?

A 55 year old man presents with blurred vision, which has gradually occurred over a few months. His medical history includes type 2 diabetes mellitus and hypertension. A fundoscopy reveals:

What is the most likely diagnosis?

A 33 year old female complains of double vision which started yesterday. On examination, a fixed dilated pupil which does not accommodate and drooping eyelid can be seen on the left eye. Her left eye is displaced outward and downwards. She has no significant past medical history. There was no history of trauma. What is the SINGLE most appropriate investigation to perform?

A 48 year old woman is seen in the eye clinic as she finds that her left visual field has been affected. She is unable to see objects on the left of her vision. She was given the diagnosis of homonymous hemianopsia in clinic. Which anatomic structure is most likely affected?

A 55 year old man presents with blurred vision, which has gradually occurred over a few months. His medical history includes type 2 diabetes mellitus and hypertension. A fundoscopy reveals:

What is the most likely diagnosis?

A 33 year old female complains of double vision which started yesterday. On examination, a fixed dilated pupil which does not accommodate and drooping eyelid can be seen on the left eye. Her left eye is displaced outward and downwards. She has no significant past medical history. There was no history of trauma. What is the SINGLE most appropriate investigation to perform?

A 52 year old man has a painful, red, photophobic right eye with slightly blurred vision and watering for 2 days. He has had no similar episodes in the past. On slit lamp examination, there are cells and flares in the anterior chamber. The pupil is also sluggish to react. What is the SINGLE most appropriate clinical diagnosis?

A 24 year old has right eye pain and redness with congested conjunctiva for the past 8 days. He says that his eyes feel stuck together in the morning with discharge. What is the SINGLE most appropriate treatment?

A 47 year old man attends the GP surgery for a depression review. During the consultation, he describes a painful right eye, abdominal pain, nausea and a headache that started yesterday. He describes his right vision as blurry. He has switched from fluoxetine to citalopram 6 weeks ago as a trial for his depression. He has been feeling low and has lost interest in all his hobbies. He works as a delivery man but has not gone to work for the past 2 months because of his depression. He lives alone. What is the SINGLE most appropriate action?

A 51 year old man presents to the urgent ophthalmology clinic with a mild headache, ocular pain and a red right eye which started 24 hours ago. The pain is confined to the eye and orbit. He has nausea and has been vomiting. He has intermittent blurring of vision with halos on his right eye. There was no history of trauma. The pupil on his right eye is abnormal in shape. He has no significant medical history. What is the SINGLE most appropriate management?

A 45 year old woman has itchy, dry eyes. There is mild pain in the morning but worsens during the day. She says her eyes feel gritty especially in an air conditioning room. A Schirmer’s test was performed and results show 7 mm of moisture on the filter paper. What is the SINGLE most appropriate management?

(A normal Schirmer’s test is considered to have more than 10 mm of moisture on the filter paper)

A 48 year man who has been taking medications for asthma for several years has now presented with a decreased vision in his right eye. He has frequent asthma exacerbations. He complains of glare, especially during the night. What SINGLE medication is most likely to cause his visual deterioration?

A 32 year old woman complains of dull pain in her right eye for the past one week which worsens when moving her eye. Her past medical history includes multiple sclerosis which was diagnosed 6 months ago. An ophthalmoscopy shows pallor of the optic disc. Which anatomical site is most likely to be affected?

A 44 year old man has a burning sensation and itching in his left eye for the last 5 days. He feels grittiness and irritation in that eye. His eye is red and has thick purulent discharge. The discharge forms a crust on his left eyelashes during the night. There is increasing tearing of the left eye. There was no trauma and he does not wear contacts. On examination, conjunctival injection with dilated conjunctival vessels is seen. What is the SINGLE most appropriate management?

A 10 year old girl is brought to the hospital by her mother. She had a fever, cough and runny nose a week ago. 3 days ago, she developed pain in her right eye which has been worsening over the past day. There is no history of trauma to the right eye. She continues to feel malaise. Examination shows redness of the right eye, a protrusion of the same eye, restricted and painful eye movement and swelling. She has a visual acuity of 6/6. Her temperature is 39°C. What is the SINGLE most appropriate initial investigation?

A 49 year old man has sudden complete loss of vision from his left eye over a couple of seconds. There was no pain associated with it and there is no redness of the eye. Ophthalmoscopy reveals a pale retina with a cherry red spot at the macula and attenuation of the vessels. What is the SINGLE most likely diagnosis?

A 27 year old female was brought to the emergency department by her friend from a movie theatre. She complains of sudden severe pain in the eye followed by vomiting. She sees coloured halos, has blurry vision and a red eye. She gives a past history of recurrent headaches which used to resolve spontaneously. Examination shows fixed, dilated avoid pupils. What is the SINGLE most appropriate initial investigation?

A 55 year old man presents with a mild headache, ocular pain and a red left eye which started 2 days ago. He also complains of worsening nausea. He has intermittent blurring of vision with halos. There was no history of trauma. Palpation of the left globe of the eye reveals it to be hard. What is the SINGLE most appropriate management?

A 2 year old girl is seen with her mother at Urgent Care in the hospital. She is having pain around her right eye. The pain started 2 days ago. She is febrile with a temperature of 38.1°C. There is no history of trauma. She is irritable. On examination, there is a tender, erythematous swelling around his right eye. An image can be seen below:

There are no gaze restrictions or pain with eye movements. What is the SINGLE most appropriate management?

A 44 year old man presents to the emergency Ophthalmology clinic with a painful left eye which started 3 days ago. His left sclera and conjunctiva are red. His left pupil is irregular in shape. His visual acuity on his left eye is slightly reduced. A fluorescein stain shows no further abnormalities. What is the SINGLE most likely diagnosis?

A 60 year old woman has decreased vision over the past year. She is not able to see well at night. She has changed her spectacles several times recently due to refraction changed but she still complains of glare. She has a normal pupil on examination. What is the SINGLE most likely diagnosis?

A 30 year old man attends the eye clinic with complaints of gradual loss of peripheral vision in both eyes especially at night while driving. He first noticed his visual problems 5 months ago when he started tripping over things at night in the dark which he would normally see. He said his father used to have similar problems with his vision at a similar age before it worsened to a degree that he was almost blind by age 50. He is otherwise fit and well with no medical problems. What is the SINGLE most likely diagnosis?

A 34 year old man has an acute painful, red right eye for the last 24 hours. He complains of blurring of vision. He has a past medical history of cervical spondylitis and is on chronic diclofenac treatment for the past 4 years for back pain and stiffness. On examination, his pupil is irregular in shape and he is very sensitive to light. What is the SINGLE most likely clinical diagnosis?

A 63 year old woman has progressive decrease in her visual acuity and peripheral visual field loss. She is shortsighted and needs to wear glasses. On examination, she has normal pupils on both eyes. What is the SINGLE most likely diagnosis?

A 25 year old woman attends the GP surgery with a lump over the lower eyelid of her left eye. She noticed it three weeks ago. The lump started off slightly tender but now it is painless. Her vision is unaffected. She is afebrile. Below are two images of her eye:

What is the SINGLE most likely diagnosis?

An 82 year old woman has developed a painful blistering rash on one side of her forehead and anterior scalp a few days ago. She also has a red-eye on the same side as the rash with mucopurulent discharge, decreased visual acuity and epiphora alongside the forehead tenderness. The pain and altered sensation initially started a week before the rash appeared. What is the SINGLE most likely nerve affected?

A 17 year old has acute pain around his right eye that started a week ago followed by a blistering inflamed rash in the dermatome distribution of the ophthalmic division of the trigeminal nerve. What is the SINGLE most likely diagnosis?

A 35 year old HIV positive man presents with progressive visual deterioration. He complains of blurred vision and floaters. On examination, multiple cotton wool spots are seen in both eyes. What is the SINGLE most likely causative organism?

A 62 year old hypertensive man comes into the Ophthalmology clinic with blurred vision in both eyes. His left eye has a visual acuity of 6/12 and right eye has a visual acuity of 6/18. He usually takes amlodipine to manage his blood pressure and has been taking it for the past 10 years. His blood pressure currently ranges between 150/90 mmHg to 160/100 mmHg. A fundoscopy reveals arterio-venous nicking, flamed shaped haemorrhages, exudates, ischaemic changes and dot blot haemorrhage. What is the SINGLE most likely diagnosis?

A 37 year old lady has been suffering from early morning stiffness of her small joints for several months. She takes regular NSAIDS to manage the pain of her joints. She attends clinic with a painful red eye. What is the SINGLE most likely affected anatomical structure?

A 41 year old man presents with visual symptoms and a headache. An ophthalmoscopic examination shows papilloedema. Which anatomical site is most likely to be affected?

A 20 year old man comes with a 3 day history of a burning red left eye with sticky greenish discharge. For the past few mornings, he says that his eyelids are stuck shut an waking. What is the SINGLE most likely affected anatomical structure?

A 56 year old woman has been having worsening visual acuity over the past several months. Her left eye has a visual acuity of 6/18 and the right eye has a visual acuity of 6/18. Her medical history includes hypertension. She takes regular amlodipine. Her BMI is 35 kg/m2. Below is a picture of one of her fundus:

What is the SINGLE most likely diagnosis?

Which of the following is not a degenerative corneal disease?

A 50 year old man presents to the clinic with a painful rash on his face. He reports that his recent health has been fine apart from a headache one week ago for which he did not seek help and which completely abated itself. He is an airtraffic controller and a pack a day cigarette smoker which he says helps reduce his stress levels. On physical examination, there is a left-sided vesiculomacular skin rash predominantly on his forehead which extends to his eyelid but does not cross the mid-line and there is no nasal involvement. Which structure is most likely affected?

A 44 year old man presents with a painful red right eye. The pain started 24 hours ago followed by nausea and vomiting. He complains of a blurry vision. On examination, his pupils are abnormally shaped. His visual acuity is reduced on the right eye. What is the SINGLE most likely diagnosis?

A 38 year old female has reduced vision and eye pain worse on her right eye that has progressed over the past few days. She has had a similar episode about a year ago which resolved completely within 3 months. The pain is worse on eye movement. She says that the red colour appears “washed out”. On physical examination, mild weakness of right upper limb was appreciated and exaggerated reflexes was appreciated. What is the SINGLE most appropriate management?

A 49 year old myopic develops floaters and flashes of light over the past week in her right visual field. She finds it difficult to see with her right eye. A few days ago she almost hit another car while driving as she could not see the car coming from the right. She has no pain in her eyes and there is no redness. There has been no history of trauma. Her visual acuity with glasses is 6/6 on the left and 6/24 on her right. What is the SINGLE most likely diagnosis?

A 52 year old man presents with sudden complete loss of vision from the right eye. He also had been complaining of right sided headaches which would come up more on chewing. On fundoscopy, the retina was pale and a cherry red spot could be seen in the macular region. What is the SINGLE most likely cause of vision loss?

A 45 year old woman had her visual acuity checked at her local optician. Several hours later she presents to the emergency department with severe acular pain and redness in her eye. She also complains of seeing coloured halos. What SINGLE anatomical structure is most likely to be involved?

A 58 year old man comes to the GP surgery with complaints of redness of his left eye which started 3 days ago. He has no pain and denies any eye discharge. He has no complaints about his vision. There was no history of trauma. His blood pressure is 130/84 mmHg. He is not on any anticoagulants. Below is a picture of his eye. What is the SINGLE most appropriate action?

A 70 year old man who has a medical history of diabetes mellitus and hypertension experiences acute painless monocular blindness which resolved completely after 30 minutes. He describes this as a curtain coming down vertically into the field of vision of one eye. What is the SINGLE most likely diagnosis?

A 40 year old man has pain, redness and swelling over the nasal end of his right lower eyelid. The eye is watery with some purulent discharge. The redness extends on to the nasal peri-orbital area and mucoid discharge can be expressed from the lacrimal punctum. What is the SINGLE most appropriate clinical diagnosis?

A 49 year old man attends the GP surgery with a history of a headache over the past 2 days, blurry vision and double vision. On examination, he has diplopia when looking down. He has difficulty with abduction of his right eye. What is the SINGLE mast appropriate investigation?

A 33 year old man attends his GP with complaints of progressive vision loss over the past 6 months. He finds it difficult to drive especially as he does not see the cars coming from his peripheral vision. His vision is poor at night. He said his father used to have similar problems with his vision at a similar age before it worsened to a degree that he was almost blind by age 48. What is the SINGLE most appropriate action?

A 60 year old man experienced sudden painless loss of vision. On ophthalmoscopy. multiple flame-shaped

haemorrhages were seen scattered throughout his fundus with optic disc and macular oedema. What is the SINGLE most likely diagnosis?

A 48 year old man presents to the clinic with a 2 day history of a painful vesicular rash around his left forehead and the tip of his nose. Two days before the onset of the rash, he had a tingling sensation on his left forehead. He has no visual disturbances. He has a medical history of Crohn’s disease which he takes azathioprine. He had a flare of his Crohn’s disease four days ago during which he was prescribed prednisolone. He has a history of chicken pox as a child. On examination, there is a widespread vesicular rash on his left forehead and the tip of his nose. What is the SINGLE most appropriate management?

A 30 year old woman has a sudden acute headache with abdominal pain, nausea and vomiting. She has a red, painful left eye. The symptoms started when she was watching television in a dark room. Palpation of the globe reveals it to be hard. What is the SINGLE most likely visual symptom?

A 25 year old man has a red painful left eye which started a few days ago. He has blurred vision in his left eye. He also complains of increased sensitivity to light and a foreign body sensation. There is no history of trauma. On examination of the cornea using fluorescein staining, dendritic ulcers can be seen. What is the SINGLE most likely diagnosis?

A 58 year old female presented to her GP with the complaint of double vision. She describes it as seeing two images overlapped with each other when she looks up. She has no family history of thyroid disease or malignancy. On examination, she appears to be nervous and agitated. Bath her eyes are seen bulging anteriorly out of the orbit. An eye examination revealed restricted eye movements that evoked pain. When the patient was asked to follow a pen slowly with her eyes from the upper to the lower field of vision, lid lag was noticed.

Her vitals are as follows:

Temperature 37.1°C

Respiratory rate 18 breaths/min

Heart rate 110 beats/min

Blood Pressure 145/92 mmHg

What is the SINGLE most appropriate investigation to aid in the diagnosis of this patient?

A 42 year old woman is seen in the eye clinic as she has trouble with her vision. She has been unable to see cars coming on the left of her car. She finds both eyes having difficulty with left vision. On examination, there is a deficit in her left visual field in both eyes. Which anatomic structure is most likely affected?

A 67 year old man has deteriorating vision in his left eye. He complains that his vision has been slowly getting more blurry over the last few months. Glare from the headlights of cars is particularly a problem when driving at night. He has a history of longstanding COPD and is on multiple medications for it. What is the SINGLE medication most likely to cause his visual deterioration?

A 61 year old woman has been having gradual loss of vision in both eyes over the past 12 months. She is using her glasses to drive but she still finds her vision to be poor especially at night. Her left eye has a visual acuity of 6/30 and the right eye has a visual acuity of 6/18. Her blood pressure in the clinic is recorded as 125/80 mmHg. She smokes an average of 12 cigarettes a day for the past 30 years. Her intraocular pressure is within normal limits. On ophthalmoscopy, her fundus is abscured by dense opacities. What is the SINGLE most likely diagnosis?

A 34 year old homosexual man attends clinic with a history of weight loss and progressive visual deterioration. A funduscopic examination reveals retinal haemorrhages and yellow-white areas with perivascular exudates. What is the SINGLE most appropriate causative organism?

An 8 year old boy is brought by his mother to the Emergency Department because of swelling of his eyelid that has developed over the past 2 days. His right eyelid is erythematous. He has obvious proptosis and periorbital oedema of his right eye. He describes painful restricted eye movements. He feels very unwell with nausea. What is the most appropriate management?

A 33 year old woman started seeing tiny black dots followed by a painless sudden loss of vision in her left eye a few hours ago. She says that it initially felt like a curtain was falling down. On fundoscopy, the optic disc is normal. What is the SINGLE most likely underlying pathology?

A 68 year old patient attends for retinal screening. He is found to have hard exudates, macular oedema and arteriovenous nipping. He is on long term treatment with amlodipine. What is the SINGLE most likely diagnosis?

A 62 year old man complains of headaches and decreased vision. He has a blood pressure of 180/95 mmHg. Fundoscopy reveals disc swelling and a flame shaped and dot blat haemorrhage. What is the SINGLE most likely diagnosis?

An 81 year old man has been having difficulty with his vision. He feels his vision has been deteriorating over the past 6 months. He is unable to read clearly or drive at night due to his vision. When he looks at straight lines, he sees them as bending. He finds the colours more dull than they used to be. His optician has examined his eye and can find no abnormalities that can be corrected with glasses. His cornea and conjunctiva appear to be normal. What is the SINGLE most likely diagnosis?

A 49 year old hypertensive man has a sudden complete loss of vision from his left eye. There was no pain associated with it and there is no redness of the eye. Ophthalmoscopy reveals a pale retina with a cherry-red spot at the macula and attenuation of the vessels.

What is the SINGLE most appropriate management?

A 44 year old hypertensive male, loses vision in his left eye overnight. There is no pain or redness associated with his visual loss. On fundoscopy, venous dilation, tortuosity, and retinal haemorrhages are observed on his left eye. No abnormalities are found on his right eye on fundoscopy. What is the SINGLE most likely cause of his unilateral visual loss?

A 44 year old man has sudden severe eye pain, red eye, visual blurring. It started when he went to watch a movie in the theatre. It was accompanied by nausea and vomiting. Slit-lamp findings include shallow anterior chambers in both eyes with corneal epithelial oedema. What is the SINGLE most likely diagnosis?

A 48 year old hypertensive man is seen in the minor eye conditions service with complaints of vision loss in his left eye overnight. There is no pain or redness associated with his visual loss. A picture of his left eye on fundoscopy is seen below:

What is the SINGLE most appropriate action?

A 33 year old woman comes to the GP surgery with complaints of redness of her left eye which started 2 days ago. She has no pain and denies any discharge. She recently recovered from an upper respiratory tract infection two days ago. Her vision was assessed during her appointment and was normal. Below is a picture of her eye. What is the SINGLE most appropriate action?

A 22 year old woman attends the GP surgery with a lump over the lower eyelid. She noticed it two weeks ago. The lump is painless and not itchy. Her vision is not affected. She is afebrile.

What is the most appropriate treatment?

A 4 year old child is taken by his mother to the Emergency Department as he is having pain around his right eye. He is febrile with a temperature of 38.5°C. This swelling started two days ago with a gradual onset. On examination, there is a tender, erythematous swelling around his right eye. What is the SINGLE most likely diagnosis?

A 67 year old man attends his GP surgery accompanied by his wife with complaints of seeing coloured patterns, faces and animals that are not there. This phenomenon has been on going for the past four months. He knows they are not real. He has no auditory hallucinations. He has had a rapid decline in his vision over the past year. He has a normal cranial nerve examination. What is the SINGLE most appropriate next investigation?

A 62 year old woman has recently travelled back from Egypt after having stayed there for a few years. She attends the ophthalmology clinic with complaints of decreased visual acuity. Her left eye has a visual acuity of 6/24 and the right eye has a visual acuity of 6/18. Her blood pressure in the clinic is recorded as 165/100 mmHg. Her medical history includes type 2 diabetes. Below is a picture of the fundus:

What is the SINGLE most likely diagnosis?