211 OB: @ Ful 54% CQ — @ plabikeys.com/20ophthalrr the Most Recent Recalls and the UK Guidel eee Anterior welsis one of the important liferentias ofa red eye. It sao referred to as IB Anterior uveitis describes inflammation ofthe anterior portion of the uvea “iris and ciliary body”. Eeatires SESE + Acute onset, progressive (over afew hours/ days) Ocular discomfort & pain (may increase with use) ‘# Pupil may be irregular, distorted, constricted, sluggish to react. + Photophobia (often intense) ‘Blurred vision ‘Red eye conris @ ratateyscom read: Wie work extremely hard on our content to keep it updated for the sake of you and the candidates. Please, note that sharing and distributing our content for free is legal and it wi Updating it as we will lose our enthusiasm. This will affect future candidates and will severely orts and the source of income of our dedicated team, nly note that in the name of all eligions, we do nat forgive anyone who shares and clstribu Ml O <22808 -. @ Frail 54% G CQ — @ plabikeys.com/20ophthalrr Lacrimation (watering) Ciliary flush ‘¢ Hypopyon; describes pus and inflammatory cells (flare and cells) in the anterior chamber, often resulting in a visible fluid level ‘Visual acuity initially normal ~ later, impaired [Ankylosing spondjiti [Reactive arthritis [ulcerative colts, Crobm’s disease Urgent review by ophthalmology ¥ Cycloplegics (e.g. Cyclopentolate) + it dilates the pupil which prevents adhesion between lens and iris and helps to relieve pain and photophobia) e.¢. Atropine, cyclopentolate ¥ Prednisolone eye drops -> reduce inflammation. conyiens @ aviteyscon read: Wie work extremely hard on our content to keep it updated for the sake of you and the candidates. Please, note that sharing and distributing our content for free is legal and it wi Updating it as we will lose our enthusiasm. This will affect future candidates and will severely orts and the source of income of our dedicated team, nidly note that in the name of all religions, we do not forgive anyone who shares and clstribu Ml O <22808 -. @ Frail 54% G CQ — @ plabikeys.com/20ophthalrr ‘Acute Iritis ‘Acute Angle Closure Glaucoma (AACG) (Anterior Uveitis) Photophobia Marked Mita Anterior Cells and Flare “Hypopyon” Shallow anterior chamber chamber Pupit Irregular “distorted”, constricted, sluggish to react, lop Variable ich Comea Keratitic precipitates Oedema “Hazy, Dull, Cloudy” Associations Ankylosing Spondylitis _Systemic association eg. Reactive Anioitis Nausea and Vomiting 1BD (UC, CD), Rx + Cyclopentolate, ‘ Acetazolamide + Atropine, ¢ Pilocarpine v + Prednisolone ‘+ beta-blockers, steroids, analgesics, antiemetics ‘Peripheral iridotomy (IP) copra © Ptaterncon read: Wie work extremely hard on our content to keep it updated for the sake of you and the candidates. Please, note that sharing and distributing our content for free is legal and it wi Updating it as we will lose our enthusiasm. This will affect future candidates and will severely orts and the source of income of our dedicated team, nly note that in the name of all eligions, we do nat forgive anyone who shares and clstribu Ml O <22808 -. BA ul 54% & CQ — @ plabikeys.com/20ophthalrr Version 2 (2020) "Corrected, Updated, Light” [Walt a few moments for the content to load) copyigns @ matateyzcon Example 1, 50 YO man presents with painful, red, photophobic eye with slightly blurred vision and watering for 2 days. On the anterior chamber. The pupi it lamp examination -> cells and flare in sluggish to react. > = (iridoeyettis) “Any is correct” Example 2, ‘4.36 YO man presents with painful, red, photophobic eye for 24-hours. He also complains of blurred vision. The pupils irregular/ Distorted in shape. He hhas Hx of cervical spondylitis and back pain and stiffness for which he is on NSAIDs for the last 3 years, > cute iit = = (iridocyciti) “Any is correct” The affect part > ig connie © Matiterscom read: Wie work extremely hard on our content to keep it updated for the sake of you and the candidates. Please, note that sharing and distributing our content for free is legal and it wi Updating it as we will lose our enthusiasm. This will affect future candidates and will severely orts and the source of income of our dedicated team, nidly note that in the name of all religions, we do not forgive anyone who shares and clstribu Ml O <22808 -. BA ul 54% & CQ — @ plabikeys.com/20ophthalrr Example Painful red eye of 4 days. Sclera and Corneal junction are red with tearing. Pupil is irregular shape. Fluorescein staining is normal. Diagnosis? a. Corneal ulcer bb. Acute conjunctivitis €.Anatior Uv D. Keratitis key | ERETeierineset ny (especially seen DM 2), Fundoscopy findings: Dots (microaneurysms) [Blots (hemorrhages) [| Hard exudates The above + Cotton wool spots 4 The above + Neovascularisation (New vessel formation) 4 This type requires -> [laser photocoagulation. ' Progress rapidly to blindness. Cony © Mabsteyscom read: Wie work extremely hard on our content to keep it updated for the sake of you and the candidates. Please, note that sharing and distributing our content for free is legal and it wi Updating it as we will lose our enthusiasm. This will affect future candidates and will severely orts and the source of income of our dedicated team, nidly note that in the name of all religions, we do not forgive anyone who shares and clstribu Ml O <BF 54% 212808: Q — @ plabtkeys.com/20ophthalrr Woes Version 2 (2020) "Corrected, Updated, Light IWait a few moments for the content to load] Floaters in vision. Non-proliferative Proliferative diabetic retinopathy diabetic retinopathy Aneurysm} Hemorrhage Growth of abnormal blood vessels Hard exudate The important concept to know is that once there is neovascularisation, itis proliferative retinopathy which needs -> Laser Photocoagulation| Key | On fundoscopy of Etat PAM net, besides macular edema, hard exudates, dots and blots, one or more of the following would be a clincher: copys @ ratateyncon Il Oo <22808 -. @ Ful 54% & Q — @ plabtkeys.com/20ophthalrr Arteriovenous nipping/ Copper or silver wiring/ Flamed shaped hemorrhage Management -> Control HTN. Note, the Hx of uncontrolled HTN (> 140/90) + dots and bots, ischemic changes, hard exudates > “The above clinchers may not always be given. Arteriovenous nicking, also known as AV nipping, Is the phenomenon where, (on examination of the eye, a small artery (arteriole) is seen crossing a small vein (venule), which results in the compression of the vein with bulging on either side of the crossing. It is seen in Hypertensive Retinopathy. conyions @ raviteyscon Ml Oo <e 54% & 212 BO: CQ — @ plabikeys.com/20ophthalrr (Woy Suivi yd vers conrigns © rabsteyscon Ml O <212 8O8 - @ Ful 54% & Q — @ plabtkeys.com/20ophthalrr Woes Version 2 (2020) "Corrected, Remember its association with Multiple Sclerosis. Swollen, Pale optic disc Veye pain especially on movement V Reduced vision. Reduced colour vision (initially red colour vision loss) Sometimes, Hx of remitting and relapsing of symptoms would be given beside muscle weakness, exaggerated reflexes. ‘The affected structure is -> Optic Nerval ‘¢ Management -> (Corticosteroids, Remember, the management of Multiple Sclerosis V In acute cases (during a Relapse} (initial) -> Oral or IV Methylprednisolone. ¥ Long-term -> Glatiramer acetate [or] Interferon-beta. connie @ ratsteyscon Ml Oo <212 OB -- @ Frail 54% G Q — @ plabtkeys.com/20ophthalrr i Version 2 (2020) "Corrected, ey ws CERES eeroncant ‘V Sudden (over seconds), painless, unilateral loss of vision, no eye redness. Vale or white retina Cherry red spots at macula [Vessels attenuation. ‘© Central retinal artery is a branch of the Ophthal of the Internal carotid artery. artery which is a branch Vif a patient presents within 100 minutes of the symptoms ~> Firm ocular massage may be performed as a trial to dislodge the occlusion. Then, Refer Important, Central Retinal Artery Occlusion may be associated with Giant Cell Arteritis (Temporal Arteritis). It may be given as a hint by mentioning that the patient complains of unilateral headaches and pain especially on chewing. GEYER n eA Cinder ettety has a similar presentation (Sudden, painless loss of vision). HOWEVER, Connie © Matsterncom ee Il Oo <212 OB -- @ Frail 54% G Q — @ plabtkeys.com/20ophthalrr Woes Version 2 (2020) "Corrected, ap “Central retinal ARTERY occlusion’, the retina ‘and the macula shows Cherry red spots # Attenuation of vessels. “Central retinal VEIN occlusion’, the retina is haemorrhagic “often flame- shaped scattered hemorrhages” and the macula is swollen “oedematous”. 1m Sudden painless loss of vision + Pale retina + Cherry red macula # Vessels, attenuation > cRAO “Central Retinal Artery Occlusion”. Sudden painless loss of vision + Optic disc and macular edema “swelling” + retinal hemorrhage (flame-shaped) engorged, tortuous veins > cRVO “Central Retinal Vein Occlusion”. Comrie @ Patateyscon Il Oo <212 OB -- 54% & Q — @ plabtkeys.com/20ophthalrr wali mportant Hints towards [Cataract] # High Myopia - a risk factor. # Long-term Oral Steroid intake (e.g. Asthma, COPD, RA) with progressive loss of vision/ DM. (Risk Factors). # Glare at night > Lights appear brighter than usual. Dazzling (halos) around lights. ‘# Frequent change spectacles (glasses) = refraction changes (ens problem). ‘# Exposure to significant amounts of ultra violet light (with no glasses wearing). 4 Eye trauma can also cause cataract. ony © rabsteyscom22808 -. BA 54%H Q — @ plabtkeys.com/20ophthalrr [ Ophthalmology Version 2 (2020) "Corrected, Updated, Light” Example, ‘849 YO asthmatic patient presents with left eye reduced vision and glare especially at night. The likely Dx -> Steroid induced Cataract. The likely cause - long-term ['Oral” Steroid intake for asthma. (not inhaled)! copyigns © ratsteyzcom 0 Ml O <212 OB -- @ Frail 54% G Q — @ plabtkeys.com/20ophthalrr Woes Version 2 (2020) "Corrected, key| Viral conjunctivitis ‘# Redness, no pain, no discharge (or if present, its watery -serous-], no vision impairment. ‘¢ Commonly occurred due to URTI. ‘# The commonest causative organism -> Adenovirus. ‘¢ Rx > Reassure|+ Supportive (e.g. artificial tears) Bacterial ‘© Purulent discharge conjunctivitis ¢ Eyes may be ‘stuck together’ in the mor 64 Hix tits media +H ‘Vinal > Settcare, Clean discharge using cotton wool soaked in water ‘V Severe/ Prolonged (> 1week)? Topical antibiotics drops (e.g. Chloramphenicol “first-line”, Fusidic acid). Viral '* Serous “watery” discharge conjunctivitis * Recent URT! ‘++ Preauricular lymph nodes + BB Reassurance + Supportive management Allergic 4 Bilateral Redness + Itching + Chemoss (swelling of Conjunctivitis conjunctiva eyelids) connie @ rabiteyscon RE Il Oo <213 BOB -- @ Frail 54% G Q — @ plabtkeys.com/20ophthalrr ‘Hix of atopy or seasonal (due to pollen) or perennial (due to dust mite, washing powder or other allergens 1B > Topica ant nitamines(rs-tne) Key | A Quick Ophthalmology Collection 9 18 Dots, blots, hard exudates in OM 1 patient. (maybe + Hx of HTN to trick you}. > hon-proliferative “background” retinopath Dots, blots, hard exudates + cotton wool spots in DM 1 patient. > Pre-proliferative retinopathy, 1 The above + neovascularisation “new vessels” in DM 1 patient. (maybe + Hx of HTN to trick you to choose HTN retinopathy) ~ Proliferative retinopathy, (Laser photocoagulation is required) connie @ Pabsteyscon Il Oo <213808 - BA ul 54% & Q — @ plabtkeys.com/20ophthalrr Konner Version’2 a0) "corecte, 1 Hx of uncontrolled HTN + any of: dots, blots, exudates, ischemic changes, ‘macular edema * Arteriovenous nipping/ Copper or silver wirine/ Flamed shaped hemorrhage > Hypertensive retinopathy. 1m Sudden painless loss of vision + Pale retina + Cherry red macula + Vessels, attenuation (maybe + Hx of HTN to trick you to choose HTN retinopathy) > CRAO “Central Retinal Artery Occlusion”. -> (Firm Ocular Massage) 1 Sudden painless loss of vision + Optic disc and macular edema “swelling” + ‘retinal hemorrhages (flame-shaped) + engorged, tortuous veins (maybe + Hx of HTN to trick you to choose HTN retinopathy) > CRVO “Central Retinal Vein Occlusion Sudden, painless, “transient” loss of vision + a curtain falling down his vision ->[aurosis Raga, Transient occlusion ofthe Bantral retinal ater) '§ Sudden painless loss of vision + a curtain “black shadow” falling down his vision ‘grey opaque retina that balloons forwards « RFs (e.g. Myopia). Floaters ~ Flashes ~ Field visual loss > [Retinal Detachment > Rx 1 Night blindness (difficulty driving, tripping) + Peripheral visual loss + Hereditary Connie @ Mabsteyscon Ml Oo <213 OB: @ Frail 54% G OQ @ plabikeys.com/20ophthalrr Woes Version 2 (2020) "Corrected, > Retinitis Pigmentosa|-> Routine ophthalmologist referral HIV positive (homosexual, weight loss) + progressive visual deterioration + retinal hemorrhages and yellow exudates. > EMV retinitis, Long term steroid intake (oral steroids e.g. in asthma, COPD), Glare at night, Dazzling “halos” around lights. Others: exposure to UV light excessively without wearing glasses/ frequently changing spectacles/ high myopia trauma to eye > Eataracll The cause if he is asthmatic or has COPD -> [Oral Corticosteroids, A child presents with periorbital redness and edema + Proptosis + Ptosis + Restricted painful eye movement + systemic (e.g. Nausea) > Orbital Cellulitis > Admit and admi Pog Herpes Zoster Ophthalm ¥ Reactivation of Varicella Zoster Virus (VZV) in the Ophthalmic branch of the Trigeminal nerve (5*" CN) Conjunctivitis, Keratitis, pain around an eye, painful Vesicles/ Rash around aneye ..ete. VRK-> Aciclovir. Connie © Mataterncom Il Oo <213 OB - @ Ful 54% & Q — @ plabtkeys.com/20ophthalrr '= Careful, the affected nerve — [Trigeminal Nerve “the ophthalmic branch’, Note, ‘4 Keratitis can be a complication of Herpes Zoster Ophthalmicus. # Keratitis can also be due to Herpes Simplex Keratitis (dendritic corneal ulcer), for which, Topic Aciclovir is uses. key FE itis inherited, 1 It primarily affects the peripheral retina resulting in tunnel vision. = Features V Night blindness is often the initial sign V Tunnel vision due to loss of the peripheral retina (occasionally referred to as funnel vision) ¥ Its progressive, meaning that it will end up with central blindness. 1 Fundoscopy: black bone spicule-shaped pigmentation in the peripheral retina, mottling of the retinal pigment epithelium copys © Mabateyecon Ml Oo <213 BOB -- @ Frail 54% G Q — @ plabtkeys.com/20ophthalrr > Routine ophthalmologist referral Flix, gradual loss of “peripheral” vision, especially at night, Difficult night driving, tripping “stumbling” at night Optic disc swelling that is caused by increased intracranial pressure. Its almost always bilateral. Some causes ¥ Space-occupying lesions. ¥ Malignant hypertension. ‘¢ The first sign is usually > venous engorgement. '§ So, ifa patient was found to have papilledema on fundoscopy, the affected part is -> Optic Disc, Remember, in Optic neuritis where fundoscopy would show swollen pale optic disc with painful eye especially on movement + reduced colour vision especially for Red # features of MS, the affected partis > Dpticnerve. Cony © rabateyecom Il Oo <213 BOB -- @ Frail 55% a Woes Version 2 (2020) "Corrected, Key coprigns @ ratateyscon @ plablkeys.com/20ophthalir (Stine rete ¥ Sudden painless loss of vision, 'V Floaters - Flashes - Field visual loss - Fallin visual acuity -> Retinal Detachment. "A curtain falling down” or “Dark shadow over my vision”. 1 important Risk factors maybe given > Myopia [Extraction of cataracts surgically [Hx of trauma a few days carer & Direct ophthalmoscope ~ Grey, Opalescent “Opaque” retina, Ballooning forward. However, optic disc may show normal. & Management: \V Head to be tilted backward. Surgical or mechanical reattachment (e.g. photocoagulation, cryotherapy, injection of expansile gas into the vitreal cavity). - Selva buekng (belt around the sclera) “important v" Il Oo <213 BOB -- @ Frail 55% a connie @ Matsterscon @ plablkeys.com/20ophthalir Important Note, (Amaurosis Fugax may present similarly “painless unilateral loss of vision with a sensation that a black curtain has come down over my vision”. However, Amaurosis Fugax is “transient”; usually resolves in §-30 minutes. It is due to temporary retinal ischemia “transient occlusion of the central retinal artery’. Example 1) [A'55 YO myopic man presents with unilateral sudden painless visual loss. He says that he felt asa black curtain was coming down his vision. Ophthalmoscope reveals grey opaque retina that balloons forward. ‘The likely Dx > Retinal detachment + Appropriate management -> Scleral buckling. Example 2, 530 © has floaters and flashed of light over the past 6 days inher eft visual field. She has difficulty driving as she finds it difficult to see with her left eye. There is no pain or redness in her eyes and no Hx of trauma. Her visual acuity with glasses is 6/6 on the right and 6/24 on the left eye. Il Oo <213 BOB -- @F il 55% & Q — @ plabtkeys.com/20ophthalrr (Me) sSuureleaelesy4 Version 2 (2020) "Corrected, Updated, Light” The likely Dx > Retinal Detachment. 'V Floaters ~ Flashes — Field visual loss ~ Fall in visual acuity -> Retinal Detachment. ‘VRE > Myopia Remember, in Cataract > Glare at night] D2zzing (halos) around lights, ‘¢1n Retinitis Pigmentosa -> Night blindness (difficulty driving, tripping) + Peripheral visual loss + Here HIV patient with eye/ retina manifestation (e.g. progressive visual impairment). > think Cytomegalovirus retinitis (the causative organism is CMV) ‘The question may not directly tell you that the patient is HIV positive. They would rather give you some hints towards HIV. Such common hints are > Homosexual + Weight loss. ‘¢ Another hint towards CMV retinitis: Fundoscopy + retinal hemorrhage + yellow-white areas of exudates. Coorg © rabsteyscom Il Oo <213808 - @ Frail 55% CQ — @ plabikeys.com/20ophthalrr [ Ophthalmology [Walt a few moments for the content to load |p! Exar ‘A homosexual man with weight loss presents with progressive visual impairment. His fundoscopy shows retinal hemorrhage with white-yellow areas of exudates. (The likely causative organism > Gytomegaloviru. See! Remember that many opportunistic infections may develop in a HIV-positive patient (immunocompromised). The following are important examples: D4 > 200 cellsimm*: ¥ Oral thrush -> Candida albicans. V Shingles -> Herpes zoster. V Hairy leucoplakia -> Epstein-Barr Virus (EBV) v Kaposi sarcoma > HHV-8 "Human Herpes Virus 9”. (D4 < 200 cellsimm*: connigns @rabateyscom Ml Oo <213 BOB -- @ Fl 55% Q — @ plabtkeys.com/20ophthalrr Woes Version 2 (2020) "Corrected, Updated, Light mrave v Pneumocystis Jirovecii (Carinii) pneumonia V Cerebral Toxoplasmosis. V Oesophageal Candidiasis -> Candida albicans. v Cytomegalovirus retinitis -> CMV (especially if CD 4 < 50) EReentanie iit Clr irae) ‘¢ symptomless. ‘Due to small bleed from a minor conjunctival vessel either spontaneously or post-trauma. ¥ Check Blood Pressure to R/O systemic HTN. Vif patient is on anticoagulant -> Check INR. If spontaneous, no Hx of trauma or anticoagulation therapy > Reassurd Key | m Sudden painless loss of vision + Pale retina + Cherry red macula 16 | 5 cRao “Central Retinal Artery Occlusion”. 1 Sudden painless oss of vision + Optic disc and macular edema “swelling” # retinal hemorrhage (flame-shaped) + engorged, tortuous veins > cRVO “Central Retinal Vein Occlusion conrions @ rotsteyscon Il Oo <213808 - @ Frail 55% CQ — @ plabikeys.com/20ophthalrr [ Ophthalmology Key | Eye signs of Grave's disease, what to do? > TT 7 (Thyroid Function Tests are superior to Autoantibodies as we need to establish the diagnosis of hyperthyroidism before looking for its aetiology). Graves disease 41. Eye signs ~ exomphalos, ophthalmoplegia, lid lag and lid retraction 2. Pretibial myxoedema 3. Thyroid acropachy Leese ene ey V Lid lag. Lid retraction. v Exophthalmos. v Diplopia. Restricted eye movements (Ophthalmoplegia). + Other manifestation of Grave's “Thyrotoxicosis” e.g. tachycardia, weight loss, sweating, agitation and nervousness, intolerance to hot weather..etc. The most appropriate investigation -> [Thyroid function tests (TFT), opr @ rotateyscon Ml Oo <213 BOB -- @ Frail 55% Q — @ plabtkeys.com/20ophthalrr Page il Ophthalmology Version 2 (2020) "Corrected, Updated, Light” Careful not to mix Grave's ophthalmopathy up with {ASS eon eMeEeTeN (3° nerve palsy) ~> Diplopia, PtOsis, Mydriasis “Fixed dilated pupil”, outward and downward eye deviation. Insuch a case, order > CTangiagraphy (to R/O Posterior communicating artery aneurysm). Others, space-occupying lesions. Key Mice Gra) 18 V Also known as the Marcus-Gunn pupil V Relative afferent pupillary defect is found by the 'swi ig light test’. Vitis caused by a lesion anterior to the optic chiasm i.e. optic nerve or retina. Finding ‘Both the affected and the normal eye appear to dilate (instead of to constrict) when light is shone on the affected eye. 4 Firstly, Light to the i fact eye > both pupils constrict. ‘4 Then immediately, Light to the affected eye > both pupils appear to dilate. Causes (Lesion anterior to optic chiasm; retina, optic nerve) ‘Retina > Retinal detachment copys © rabateyecon Il Oo <213 BOB -- @F il 55% & Q — @ plabtkeys.com/20ophthalrr ¢ Optic nerve: $ Optic neuritis e.g. in multiple sclerosis a commonly given hint) In Optic Neuritis, ¥ Generally, and more commonly association -> Central Scotoma. Vif associated with RAPD “Relative afferent pupillary defect” > pick “Monocular visual field loss? instead or Lentrat scotoma. Note, = Central scotoma is also seen in Macular degeneration, = Monocular visual field loss is also seen in Amaurosis Fugax. ~ In optic neuritis (MS), if there is RAPD -> Monocular visual field loss. - In optic neuritis (MS), if there is No RAPD -> Central scotoma. = Remember: in pituitary adenoma and acromegaly ~ bitemporal +hemianopia. Acute angle closure glaucoma -> coloured halos. Conran © Pabiheyscom Il Oo <213 BOB -- @ Frail 55% Q — @ plabtkeys.com/20ophthalrr Right eye Optic Neuritis or Retinal Detachment ‘Marcus Gun Pupil “Relative Afferent Pupllary Defect RAPD” athenscon oe Directing the light othe “intact” eye > Normal Response (pups in both eyes wil consti) Directing the ight tothe “affected” eye RAPD of > Pupisin both eyes will appear to Right Eye > date, I Dots, blots exudates + neovascularisation “new vessels” in DM 1 patient (maybe + Hx of HTN to trek you to choose HTN retinopathy) ~ Proliferative retinopathy (Laser photocoagulation is required), 1m Sudden painless loss of vision + Pale retina + Cherry red macula + Vessels, attenuation (maybe + Hx of HTN to trick you to choose HTN retinopathy) > CRAO “Central Retinal Artery Occlusion” -> (Firm Ocular Massag '@ Sudden painless loss of vision + a curtain “black shadow” falling down his vision + grey opaque retina that balloons forwards * RFs (e.g. Myopia). Coons @Mabsteyscom Il Oo <214 OB -- @ Al 55% H Q — @ plabtkeys.com/20ophthalrr (Me) sSuureleaelesy4 Version 2 (2020) "Corrected, Updated, Light” > Retinal Detachment > Rx: ‘Unilateral severe painful, red, watery eye, headache + hard globe t sees halos + blurring of vision ~> Narrow angie glaucomal-> ‘one ofthe lines of x” Itchy, dry, mildly painful eyes + Reduced lacrimation (Schirmer’s test < 10 mm) > kertoconanetts Se > Use rfid tarde g. ypromellose drops, NaC, Godium Ryaluronatd Any of which would be a valid answer! (einen ‘An infection of the “lacrimal sac” (at the nasal side of the lower lid). Features Watering eye (epiphora). Swelling, pain and erythema at the inner canthus of the eye that can extend, over the neighbouring areas. V4 Mucoid discharge can be expressed from the lacrimal sac. copy © rabsteyecom Il Oo <214808 -- @ Frail 55% CQ — @ plabikeys.com/20ophthalrr '§ Management is with systemic antibiotics. ¥ Intravenous antibiotics are indicated if there is associated periorbital cellulitis. ‘Acute Dacryocystitis ~ Left eye Key |A 22 YO male presents complaining of a 3-day burning, redness and stickiness 21 | of his right eye associated with greenish discharge. The likely part affected > “Bacterial Conjunctivitis” + fe 7 dayd > self-care, including gently cleaning the discharges with cotton wool soaked in water. +¢if> 7 days -> Topical antibiotic drops e.g. Chloramphenicol “which is bacteriostatic to both gram ve and -ve organisms. (Topical fusidic acid in pregnancy), Coprigns @ Matsteyscom Ml O <2:14 Gd ae @ Frail 55% OQ @ plabikeys.com/20ophthalrr ck to Cha Korie & Key 22 Retinal Artery cor) ree eAS) ‘Sudden Not complete; but Pabst complete lossof ton | mesponds ee the area supplied by the afected branch, Pale Retina, “ischemia” A wedge-shaped area of pallor while the rest of retina is Fund + Macula -> Cherry red spot: tundoscopy + Macula > Cherry red spots 0 ‘as its supplied by a different artery’. + Attenuation of vessels. Inlay Attempt Frm Ocular Masagel"wa vials aod the occur? Remember, 1m Sudden painless loss of vision + Optic disc and macular edema “swelling” + scattered multiple retinal hemorrhages (flame-shaped) + engorged, tortuous > cRVO “Central Retinal Vein Occlusion”. Il Oo <214808 -- @ Frail 55% Q — @ plabtkeys.com/20ophthalrr [eo] ck to Cha Wore app key Coreen 23 Dr ec) THE ROOT OF THE IRIS OCCLUDES THE ANTERIOR CHAMBER ANGLE AND PREVENTS THE PASSAGE OF| ‘THE HUMOR AQUEOUS FROM THE POSTERIOR TO THE ANTERIOR CHAMBER AQUEOUS CANNOT REACH OUTFLOW PATHWAY AND COLLECTS IN THE EYEBALL THE RESULT ISA RAPIOELEVATIONOF INTRAOCULAR PRESSURE IOP) ITISAN OPHTHALMIC EMERGENCY AND MAY CAUSE PERMANENT VISUAL LOSS UNLESS MANAGED IMMEDIATELY AND PROPERLY. connie © Pataterncom Ml O <214808: a 55% & @ plablkeys.com/20ophthalir (Me) sSuureleaelesy4 Tee bang Sayer] ‘+ Impaired aqueous outflow -> ‘ Intra-Ocular Pressure (‘P 1OP). BEES > Hypermetropia [Pupillary dilatation, + FESHGES: ‘Acute severely painful and red eye. ‘¢ Headache, Blurred vision, Ocular pain. ‘Seeing coloured “Halos” around lights “this feature is in cataract as well” ‘¢ The pupil is semi-dilated non-reacting. ‘#4 pupil dilatation (Mydriasis) such as when watching TV in a dark room > Worsens Symptoms. Connie © rabiterscon214 OB -- @ Fl 55% Q — @ plabtkeys.com/20ophthalrr OE > Hard globe Cloudy: dull- hazy cornea “Corneal Oedema” [Shallow anterior chamber. ‘Systemic > Nausea, vomiting Medical management \VTo reduce aqueous secretions > Acetazolamide \VTo induce pupillary constriction > topical pilocarping| Vv Others: beta-blockers, steroids, analgesics, anti-emetics Valter stabilising the patient, urgently efer to an ophthalmologist. Surgical management ‘V Peripheral iridotomy (P!): “Preferred”. Surgical iridectomy. Example!) ‘AAT YO 2 presents complaining of severe right-sided headache. Her right eye is painful, red and watery. She also has intermittent blurred vision and sees, coloured halos. + Hard globe The likely Dx -> (Acute Angle Closure Glaucoma “Narrow Angle Glaucoma”. coprtns @ raviteyscom Il Oo <214 OB -- @ Frail 55% Q — @ plabtkeys.com/20ophthalrr [ Ophthalmology \V The next step > Measure intra-ocular pressure’ (IOP). Do not get tricked thinking that this is @ case of cluster headache. Even though the presentation is similar, cluster headache does not present with halos around lights. Also, cluster headache would have a Hx of recurrent attacks. Example 2, After being in a dark room watching a movie with her friends, a girl has been brought to the ED complaining of sudden severe right eye pain and redness + nausea and vomiting. She has Hx of blurred vision and recurrent episodes of headaches. Her pupil is fixed, dilated, ovoi \ The likely Dx -> Ace angle sure glaucoma “Narrow angle glaucomat. \VThe likely visual symptom — Coloured Halos, VThe next step > measure oP. \V The likly affected structure > anterior charnbed copra @ ratsteyscon Il Oo <214808 -- @ Frail 55% CQ — @ plabikeys.com/20ophthalrr [ Ophthalmology Unilateral severe painful, red, watery eye, headache + hard globe + sees halos + blurring of vision > mage > one of the lines of fx” While he is working at his office, a 31 YO < suddenly developed excruciating, headache to his left side associated with left eye pain. He experienced similar episodes 3 months ago. His left eye is red, swollen and with lacrimation. The likely Ox > Cluster headache) The Management [Management (Acute phase 100% 02 for 10-20 minutes. Sumatriptan (Nasal or Subcutaneous), VIF first time attack - refer to specialist as it may require CT to R/O other Obs. 1m Prophylaxis: -> Calcium Channel Blockers (e.g. Verapamil) copnigns © raviteyscon Ml Oo <214808 -- @ Frail 55% Q — @ plabtkeys.com/20ophthalrr Woes Jap Excruciating = very sever, eye pain swelling redness and with lacrimation are features of cluster headache. The Hx of similar attacks is also important. Always same side. Acute Iritis Acute Angle Closure Glaucoma (ACG) Photophobia Marked Mild Anterior Cells and Flare “Hypopyon” Shallow anterior chamber chamber Pupil Irregular “distorted”, Fixed, semi-dilated constricted, sluggish to react 1oP Variable High Comea Keratitic precipitates Oedema “Hazy, Dull, Cloudy” Associations Ankylosing Spondylitis Systemic association e.g Reactive Arthritis, Nausea and Vomiting 180 (UC, CO). Rx Cyclopentolate, ‘Acetazolamide Atropine, Pilocarpine eye drops. (eaves © rabitecom aay Il Oo <214808 -- @ Frail 55% CQ — @ plabikeys.com/20ophthalrr aa rose Prednisolone beta-blockers, steroids, analgesics, antiemetics Peripheral iridotomy (IP) Coglorbital Cellulit: ¥Common in Children = Presentation Redness and swelling around the eye (Periorbital redness and edema) Severe ocular pain Visual disturbance ith eye movements Eyelid oedema and ptosis Drowsiness +/- Nausea/vomiting in meningeal involvement (Rare) Comyn © Pabiteyscom Ml O <@ Frail 55% 214 OB Q — @ plabtkeys.com/20ophthalrr Woes Version 2 (2020) "Corrected, Updated, Light IWait a few moments for the content to load] § Differentiating orbital from preseptal cellulitis Reduced visual acuity, proptosis, ophthalmoplegia/pain with eye movements are NOT consistent with preseptal cellulitis. = Management > Admission to hospital for IV antibiotics Key | ech, dry, milly painful eyes + Reduced lacrimation Schirmer’ test <0 mm) » WeatocojuneviSieza > vse ca nad og ppromelos oe Raa] Sain aaa Any of which would be a valid answer! Important eye association! conyies © Pabiteyscom Il Oo <2: a Woes Version 2 (2020) "Corrected, 4ao8 -- @ Frail 55% @ plablkeys.com/20ophthalir 13 Ankylosing spondylitis (morning back pain and stifiness) > Iritis “the affected part is iris” = Rheumatoid arthritis (morning stiffness and pain of SMALL joints) Scleritis/ episcleritis (Acute red painful eye) “the affected part -> eleray” In RA, the commonest eye association is Keratoconjunctivitis Sicca. Note, as RA patients are usually on long-term steroids, they may also develop ~ {steroid-induced cataract “Look for cataract features such as Glare at night Dazzling (halos) around lights. Refresh Your Memory “Anatomy - Eye” Remember OETA 0 (Oculomotor) 3" CNT (Trochlear) 4" CN A (Abducens) 6" CN Sameside Oppotite side Same side Dilated pupil, ptOsis _Diplopia on Downgaze _Diplopia on Lateral gaze copy © ratateyecom Il Oo <214 OB -- @ Frail 55% Q — @ plabtkeys.com/20ophthalrr Woes Version 2 (2020) "Corrected, OTA Oculomotor (3%), Trochlear (4), Abducens (6") Same, Opposite, Same Ptosis, Downward gaze, Lateral Gaze Key | Progressive J in visual acuity and peripheral visual field in an elderly (>60 YO), 29 | Myopic (Short-sightedness) » (pen ange Glaucoma & Features of open angle glaucom: ¥(s)) peripheral visual field (nasal scotoma -> tunnel vision). V(s)) visual acuity. ¥ Optic dise cupping. \V FHx, Black people, Myopia. V¥>60¥O = When to consider cataract? @ If there is a Hx of Steroid intake (e.g. Asthma, COPD, RA). 4 Glare at night [ Dazzling (halos) around lights. @ Frequent change spectacles. copys @ Matateyzcom Il Oo <214808: a 55% & @ plablkeys.com/20ophthalir @ Exposure to significant amounts of ultra violet light. Caprio @Fabiterscon Important Collection Myopia > Open angle Glaucoma, “Progressive 4) visual acuity and peripheral filed vision in an elderly + dise cupping” (4 GRaraAY“Gtore, Dazzing— halos, Hx of ona sterold intake. Changing glasses”, 4 etinal detachmend “Floaters and Flashes + Curtain falling over vision’. = Hypermetropia > 4 (Acute Angle Closure Glaucomd (Headache, Halos, pupil is semi-dilated, Hard lobe, Corneal edema) (Mooren’s ulcer is NOT a degenerative corneal Disease, ‘Some Degenerative corneal diseases: Band Keratopathy. Il Oo <214 OB -- @ Frail 55% Q — @ plabtkeys.com/20ophthalrr Woes Version 2 (2020) "Corrected, ar V Keratoconus. Pellucid marginal degeneration, ¥ Terrien marginal degeneration. Key |Red eye, no pain, no sticky discharge 32 > [Reassure (likely viral conjunctivitis). Key | Headache, vomiting, painful eye 33 > [Acute close angle glaucoma Acute Iritis Glaucoma (AACG) Photophobia Marked Mild Anterior Cells and Flare “Hypopyon” Shallow anterior chamber chamber P Irregular “distorted”, constricted, sluggish to react Intraocular Variable High pressure connie @ rabateyscon Il Oo <214 OB - CQ — @ plabikeys.com/20ophthalrr ae Comea Keratitic precipitates edema “Hazy, Dull, Cloudy” Associations Ankylosing Spondylitis ‘Systemic association e.g. Reine atin Nausea and Vomiting IBD (UC, CO). Rx + Cyclopentolate, ¢ Acetazolamide Atropine, #Pilocarpine v + Prednisolone ‘+ beta-blockers, steroids, analgesics, antiemetics ‘Peripheral iridotomy (IP) Key 34 D-shaped pupil > ores @ mabe con Ml O2: a 15@O8 -: @ plablkeys.com/20ophthalir Key 35 ‘A middle age female comes complaining of sudden painless loss of vision + Floaters and Flashes with Field visual loss. > Retinal Detachment a ler ocing Important Collection = Myopia > @ Open angle Glaucoma, “Progressive visual acuity and peripheral filed vision in an elderly * disc cupping” @ Cataract “Glare, Dazzling ~ halos-, Hx of long steroid intake, Hx of changing glasses”, ‘# Retinal detachment “Floaters and Flashes # Curtain falling over vision’. 1 hypermetropia > (@ iAcute Angle Closure Glaucoma (Headache, Holos, pupil is semv-diloted, Hard ‘lobe, Corea! Oedema, Nausee and vomiting) conn Ml O <55% & 215 ao8 -. e Q — @ plabtkeys.com/20ophthalrr VA chalazion (Meibomian cyst) is a retention cyst of the Meibomian gland. Vit presents as a firm painless lump in the eyelid. The majority of cases resolve spontaneously (conservative) but some require surgical drainage V4 weeks after conservative management (e.g. a the chalazion still present: > refer to an ophthalmologist (esp. if large and symptomatic) coprigns @ rabsteyscom Ml Oo <215 ao8 -. Ol 55%E CQ — @ plabikeys.com/20ophthalrr (Woy Suivi yd Applying a warm compress to the affected eye can help | Key | On fundoscopy of (REE cnenen Gene etany, besides macular edema, 37 | hard exudates, dots and blots, one or more of the following would be a clincher: Arteriovenous nipping/ Copper or silver wiring/ Flamed shaped hemorrhage Management > Control HTN. conyians © rabsteyscom Ml O <215 ao8 -. @ Frail 55% CQ — @ plabikeys.com/20ophthalrr [ Ophthalmology ‘Note, the Hx of uncontrolled HTN (> 140/90) + dots and blots, ischemic changes, hard exudates -> Hypertensive retinopathy, The above clinchers may not always be given. ‘After being in a dark room watching a movie with her friends, a girl has been brought to the ED complaining of sudden severe right eye pain and redness + nausea and vomiting, She has Hx of blurred vision and recurrent episodes of headaches. Her pupil is fixed, dilated, ovoid. The likely Ox -> Acute angle closure glauicomal “Narrow angle glaucoma”, \VThe likely visual symptom — eloured Halos \VThe nest step > cular tonometry ‘measure IOP”. ¥ The likely affected structure > Anterior chamber. Remember: Photophobia Marked conn @ rabsteyscon Ml Oo <215 OB -- @ Frail 55% Q — @ plabtkeys.com/20ophthalrr (Me) sSuureleaelesy4 ow ‘Anterior Cells and Flare “Hypopyon” Shallow anterior chamber chamber Pupit Irregular “distorted”, Fixed, semi-dilated constricted, sluggish to react lop Variable High Cornea Keratitic precipitates Oedema “Hazy, Dull, Cloudy” Associations Ankylosing Spondylitis Systemic association e.g, ae Nausea and Vomiting IBD (UC, CD). Rx Cyclopentolate, Acetazolamide Atropine, Pilocarpine eye drops. Prednisolone beta-blockers, steroids, analgesics, antiemetics Peripheral iridotomy (IP) Key | Frequent change of spectacles (glasses) but always come again for error of 39 | refraction = refraction changes (lens problem) + Myopia coprigns @ rebsteyscon Il Oo <215 OB -- @ Frail 55% Q — @ plabtkeys.com/20ophthalrr [ Ophthalmology Version 2 (2020) "Corrected, Updated, Light” Suspect — Cataract. Important Collection = Myopia > 4 “Progressive visual ociity and peripheral filed vision in an elderly + disc cupping” 4 “Glare, Dazzling ~ halos-, Hx of long steroid intake, Hx of Changing glasses’, 4 fietinal detachmend ‘Floaters and Flashes + Curtain falling over vision’. 1 Hypermetropia > @ [Acute Angle Closure Glaucoma (Headache, Halos, pupil is semi-dilated, Hard globe, Corneal Oedema, Nausea and vomiting) Key | A question on woman with eyes defect came back from a travel to ‘Turkey’ 40 | with visual acuity of 6/12 and 6/18 for L/R respectively. She is hypertensive with BP of 156/90 and also has DM type 2. Fundoscopy attached What is the diagnosis? (IMAGE BASED Q) copyigns @ Matateyzcom Il Oo <215 OB -- 55% & Q — @ plabtkeys.com/20ophthalrr Wee sion 2 (2¢ orrect A. Diabetic retinopathy 8. Hypertensive retinopathy C. Retinal artery occlusion D.glaucoma E. retinitis pigmentosa Arteriovenous nicking, also known as AV nipping, isthe phenomenon where, con examination of the eye, a small artery (arteriole) is seen crossing a small vein (venule), which results in the compression of the vein with bulging on either side of the crossing. Itis seen in Hypertensive Retinopathy. ‘opr © Pobtteyscom Il Oo <215 ao8 -. @ Ful 55% & CQ — @ plabikeys.com/20ophthalrr ny On fundoscopy of SUPER cae ReM Gone ray besides macular edema, hard exudates, dots and blots, one or more of the following would be a clincher: Arteriovenous nipping/ Copper or silver wiring/ Flamed shaped hemorrhage Management > Control HTN. Note, the Hx of uncontrolled HTN (> 140/90) + dots and blots, ischemic changes, hard exudates > [Hypertensive retinopathy. The above clinchers may not always be given. Copies @ Pobtreyscom Ml O <215 OB - Q — @ plabtkeys.com/20ophthalrr Wee Also remember: CEERER einer (especially seen OM 1), Fundoscopy findings: Dots (microaneurysms) J Blots (hemorrhages) [| Hard exudates The above + Cotton wool spots The above + Neovascularisation (New vessel formation) © This type requires > Progress rapidly to blindness. Floaters in vision. Coprins @ rubateyscom Ml O <215 OB -- @ Frail 55% Q — @ plabtkeys.com/20ophthalrr Non: proliferative Proliferative diabetic retinopathy diabetic retinopathy Aneurysm] Hemorrhage Growth of abnormal blood vessels Hard exudate The important concept to know is that once there is neovascularisation, it is proliferative retinopathy which needs > Laser Photocoagulation, Key | 30yr old having progressive painless peripheral visual loss of 6 months 41 duration. Worse at night. Similar history in father. What to do? A Routine ophthalmologist referral 2. Ora prednisolone Chigh oral steroid D steroid eye drop capris @ Punateyscam Il Oo <215 OB -- BA 55% H OQ @ plabikeys.com/20ophthalrr Errefer to his optician '& Night blindness (difficulty driving, tripping) + Peripheral visual loss + Hereditary > Retinitis Pigments ~ Routine ophthalmologist referral Key |A patient in depression. Switched from fluoxetine to citalopram. Presents 42__with painful right red eye with visual blurring. ‘A fusidic acid eye drop B. Urgent referral to psychiatric C. Urgent referral to ophthalmology, D. clomipramine Citalopram (a SSRI) is associated with acute angle-closure glaucoma as one of the side-effects. Key | Painful red eye of 4 days. Sclera and Corneal junction are red with tearing. 43. Pupil is irregular shape. Fluorescein staining is normal. Diagnosis? a. Corneal uleer b. Acute conjunctivitis, c. Anterior Uveitis| Coors @ Pobikeyscom —_ Il Oo <215 OB OQ @ plabikeys.com/20ophthalrr @ Frail 55% D. Keratitis| Photophobia Anterior chamber Pupil Comea Associations oprans @ raoareyscom Acute Iritis (Anterior Uveitis) Marked Cells and Flare “Hypopyon”” Irregular “distorted”, constricted, sluggish to react Variable Keratitic precipitates Ankylosing Spondylitis Reactive Arthritis, 180 (UC, CO). + Cyclopentolate, # Atropine, ¢Prednisolone Acute Angle Closure Glaucoma (AACG) Mild Shallow anterior chamber Fixed, semi-dilated High edema “Hary, Dull, Cloudy” Systemic association eg. Nausea and Vomiting ‘ Acetazolamide + Pilocarpine v + beta-blockers, steroids, analgesics, antiemetics ++ Peripheral iridotomy (IP)215 OB -- BA 55% & Q — @ plabtkeys.com/20ophthalrr Key Patient with dry eyes. Schirmer’s test shows mm (N> 15). (+) ANA. 45 Management? ‘A: Hypromellose (an artificial tear) 8. Timolol «acetazolamide d. antibioties e. maryrose oil itchy, dry, mildly painful eyes + Reduced lacrimation (Schirmer's test < 10 mm) > Keratoconjunctivits $i > Use rtificial tears e.g, Hypromellose drops, NaCl, Godium hyaluronate, ‘Any of which would be a valid answer! jegren's syndi capri @ rantteyecom Il Oo <215 OB -- @ Frail 56% & Q — @ plabtkeys.com/20ophthalrr 12 Sjogren's syndrome is an autoimmune disorder affecting exocrine glands resulting in dry mucosal surfaces. 19 It may be primary (PSS) or secondary to SLE, rheumatoid arthritis or other connective tissue disorders 1 Sjogren's syndrome is much more common in females (ratio 9:1). Features “important” Bry eyed > keratoconjunctvt sicca “The patient may have itchy eyes, a sandy sensation under their eyes -due to low lacrimal production” # Schirmer’s test -> 4 tear production, 4 Rose Bengal stain > may show Corneal ulcerations “2ry to dry eyes”. bry mouth “They may complain of difficulty in swallowing food -due to low saliva” -v Recurrent Parotiti > Bilateral enlargement of Parotid glands. V Others: vaginal dryness, arthralgia, Raynaud's, myalgia, sensory polyneuropathy, renal tubular acidosis (usually subclinical) Il Oo <215 OB -- @ Frail 56% & OQ @ plabikeys.com/20ophthalrr ‘V Schirmer's test: filter paper near conjunctival sac to measure tear formation decreased tear production. ‘V Rose Bengal stain -> may show Corneal ulcerations “2ry to dry eyes”. ‘V Rheumatoid factor (RF) positive in nearly 100% of patients. \VAnti-Ro (SSA) antibodies in 70%. ‘V anti-La (SSB) antibodies in 30%, Management No Cure. ‘# Give artificial saliva and tears (e.g. Hypromellose drops). Key | A question on woman with eyes defect came back from a travel to Turkey’ 46 with visual acuity of 6/12 and 6/18 for L/R respectively. She is hypertensive with BP of 156/90 and also has DM type 2. Fundoscopy attached What is the diagnosis? (IMAGE BASED Q) capris @ Pubtteyscam Il Oo <2:16 OB -- QF il 56% & Q — @ plabtkeys.com/20ophthalrr If Ophthalmology 48 ‘A. Diabetic retinopathy 8. Hypertensive retinopathy, C. Retinal artery occlusion D.glaucoma E. retinitis pigmentosa Arteriovenous nicking, also known as AV nipping, is the phenomenon where, (on examination of the eye, a small artery (arteriole) is seen crossing a small vein (venule), which results in the compression of the vein with bulging on either side of the crossing. Its seen in Hypertensive Retinonathy, Il Oo <216OB @ Q — @ plabtkeys.com/20ophthalrr 3 [ESSE SESS SESSA ASAE] an 2 (2020 TEC! Arteriovenous nicking, also known as AV nipping, is the phenomenon where, (on examination of the eye, a small artery (arteriole) is seen crossing a small vein (venule), which results in the compression of the vein with bulging on either side of the crossing. Its seen in Hypertensive Retinopathy. capris © Punateyscom On fundoscopy of (MEE ene eM eraeerany besides macular edema, hard exudates, dots and blots, one or more of the following would be a clincher: Arteriovenous nipping/ Copper or silver wiring/ Flamed shaped hemorrhage Management > Control HTN. Ml O <216 OB CQ — @ plabikeys.com/20ophthalrr | Ophthalmology Management -> Control HTN. Note, the Hx of uncontrolled HTN (> 140/90) + dots and blots changes, hard exudates -> [Hypertensive retinopathy. The above clinchers may not always be given. Copriens @ Pubareyscom Also remember: DEERE einen (especially seen OM 1), Fundoscopy findings: Dots (microaneurysms) Blots (hemorrhages) [Hard exudates The above + Cotton wool spots 4 The above + Neovascularisation (New vessel formation) 4 This toe reauires -> Laser shotocoarulation. Ul O <56% 2:16 OB -- Q — @ plabtkeys.com/20ophthalrr Wee Progress rapidly to blindness Floaters in vision. Coprigns @ rantteyscom Non: proliferative Proliferative diabetic retinopathy diabetic retinopathy ‘Aneurysm] Hemorrhage Growth of abnormal blood vessels Hard exudate ‘The important concept to know is that once there is neovascularisation, itis proliferative retinopathy which needs ~> Laser Photocoagulatios2:16 Gd ae BA 56% G OQ @ plabikeys.com/20ophthalrr Ee om Key |A54 yr old man with left sided facial pain and painful rash extending to the 47 midline of his nose. He had complained of headache 2 weeks prior with no cause found. What is the affected structure? a) extra cranial Facial nerve »b) Trigeminal ophthalmic nerve! ©) Vestibulocochlear nerve apres © Panton d) Oculomotor nerve Cieeresr: Eni ‘Reactivation of Varicella Zoster Virus (VZV) inthe Ophthalmic branch of the ‘Trigeminal nerve (5" CN). ‘V Conjunctivitis, Keratitis, Painful Vesicles around the eye (unilateral facial painful rash) ..etc V Rx Aciclovir Also Remember: CRMs) V Reactivation of Varicella Zoster Virus (VZV) in the geniculate ganglion of the facial nerve (7" CN) > Facial nals (insilateral facial oalsv. oss of taste). Il Oo <216 OB: QF il 56% & 4d) Oculomotor nerve \V Reactivation of Varicella Zoster Virus (VZV) in the Ophthalmic branch of the ‘Trigeminal nerve (5" CN). ‘V Conjunctivitis, Keratitis, Painful Vesicles around the eye (unilateral facial painful rash) ..etc. VRx-> Aciclovir Also Remember: Chemrstnmnnsncicn ‘V Reactivation of Varicella Zoster Virus (VZV) in the geniculate ganglion of the facial nerve (7" CN) -> Facial palsy (ipsilateral facial palsy, loss of taste). - Otalgia “ear pain” “First symptom”, Tinnitus, Vertigo, Unilateral Hearing loss, Painful rash/ vesicles around the ear or on the auditory canal ‘V Rx > Oral Aciclovir + Corticosteroids + Amitriptyline “for the pain”. copy ranateyecam read: We work extremely hard on our content to keep it updated for the sake of you and the candidates. Please, note that sharing and distributing our content for fee is illegal and it wil Updating it as we will lose our enthusiasm. This will afect future candidates and will severely arts and the source of income of our dedicated team. rly note that in the name of all religions, we do not forgive anyone who shares and distribu twithout our permission. If he could escape his damaging act nov, we will nat forgive him/h vent day for the harm they hed caused. s on how to Scroll up and down Zoom in lf Solve chapter's not loading issue, Clic pyright 2020. Plabtkeys.com, All Rights Reserved, Contact us at: info@plabtkeys.com ff Il Oo <