AKT – Ophthalmology

Michelle Layton, aged 35, presents with a 3-day history of a painful, red left eye and photophobia. She wears monthly contact lenses and admits to occasionally sleeping with them in. She denies any trauma. She reports blurred vision and describes the pain as sharp and constant. There is no discharge.

Past medical history includes mild asthma. No recent upper respiratory illness. No previous similar episodes.

On examination, her left eye is injected, with ciliary flush. Visual acuity is 6/6 in the right eye and 6/18 in the left. There is no hypopyon. Fluorescein staining reveals a round central corneal ulcer with a hazy base.

What is the most appropriate next step in management?

Graham Peterson, aged 72, presents with sudden painless loss of vision in his right eye which occurred two hours ago. He describes it as a curtain descending over his vision. There is no trauma. He has hypertension and hyperlipidaemia.

He is on ramipril and atorvastatin. Fundoscopy shows a pale retina with a cherry-red spot at the macula.

What is the most likely diagnosis?

Sophie Nguyen, aged 28, presents with a gritty sensation in her right eye and excessive tearing. She works as a barista and reports being struck in the eye by a coffee ground while cleaning the machine this morning. She has kept the eye closed since.

Examination shows normal visual acuity, conjunctival injection, and a positive fluorescein uptake in a linear vertical pattern.

What is the most appropriate management?

Harry Sanderson, aged 60, presents with progressive bilateral vision blurring over months. He also reports difficulty with night driving and seeing halos around lights. No history of pain or redness.

Past medical history includes type 2 diabetes and hypertension. On examination, red reflex is absent bilaterally and lens opacities are visible.

What is the most likely diagnosis?

Imogen Black, aged 24, presents with painful right eye and photophobia following a weekend camping trip. She reports having had cold sores in the past. Visual acuity is 6/6. Examination reveals conjunctival injection, mild lid oedema and dendritic staining of the cornea with fluorescein.

What is the most appropriate treatment?

David Franks, aged 58, presents with a one-day history of red, painful right eye with purulent discharge and lid swelling. He has no history of trauma. He wears reading glasses only. Vision is unaffected. His eyelid appears erythematous and tender with a central pustule at the lid margin.

What is the most appropriate initial management?

Angela Li, aged 45, presents with a two-week history of gradually worsening visual distortion in her left eye. Straight lines appear bent and she struggles to read with that eye. There is no pain. She has a history of hypertension and hyperlipidaemia.

Fundoscopy reveals subretinal fluid and haemorrhage at the macula.

What is the most likely diagnosis?

Marcus Bentley, aged 16, presents with photophobia, a red left eye, and mild blurred vision. He has had a sore right knee for the past week and was treated recently for urethritis.

On examination, the eye is injected with ciliary flush and constricted pupil. Fundoscopy is difficult due to discomfort.

What is the most likely diagnosis?

Vanessa Holt, aged 70, presents with a sudden onset of severe left eye pain, nausea and blurred vision. She describes seeing halos around lights. On examination, her left eye is red with a fixed, mid-dilated pupil and a hazy cornea.

What is the most appropriate immediate management?

Samuel Isaacs, aged 52, presents with painless progressive central vision loss in both eyes. He has difficulty recognising faces and reading. No associated systemic symptoms. He is a non-smoker with no past ocular history.

Fundoscopy shows drusen deposits in the macula region bilaterally without haemorrhage or fluid.

What is the most likely diagnosis?

Leah Woodward, aged 6, is brought in by her father due to a white reflex in her left eye visible in flash photography. She has no pain or redness, and her vision appears reduced on that side.

On examination, the left pupil displays leukocoria. Fundoscopy is not possible in clinic.

What is the most appropriate next step?

Amelia Grant, aged 48, presents with persistent redness and irritation of both eyes for 3 months. She reports a gritty sensation, worse in the evening. Examination reveals conjunctival injection, meibomian gland dysfunction, and punctate staining of the cornea on fluorescein.

What is the most appropriate first-line management?

Nina Costa, aged 34, presents with sudden painless monocular vision loss in the left eye. She reports flashing lights and a sensation of a shadow across her vision. No pain or discharge.

On examination, her left visual acuity is hand movements only. Fundoscopy reveals a detached retina with retinal folds.

What is the most important next step?

James McInnes, aged 67, presents with a history of recurrent episodes of monocular vision loss lasting a few minutes. He describes them as a “curtain falling” that resolves spontaneously.

He has a history of hypertension and carotid artery stenosis. Ophthalmic and neurological exams are currently normal.

What is the most likely cause of his symptoms?

Oliver Tran, aged 10, presents with itchy, watery eyes and sneezing during spring. He has a history of eczema and hay fever. Examination shows bilateral conjunctival injection, lid oedema, and clear watery discharge.

What is the most appropriate first-line treatment?

Rebecca Singh, aged 38, presents with progressive proptosis and eye discomfort. She has also noticed recent weight loss, heat intolerance and anxiety. On examination, she has lid lag, bilateral exophthalmos and conjunctival injection.

What is the most likely underlying diagnosis?

Joseph Taylor, aged 50, presents with sudden onset of diplopia when looking to the left. He denies pain. He has poorly controlled diabetes. Examination shows restricted left eye abduction with horizontal diplopia. Pupil is spared.

What is the most likely diagnosis?

Clara Jennings, aged 45, presents with left eye pain worsened by movement and reduced colour vision. She reports recent fatigue and numbness in her right leg. Visual acuity is reduced in the left eye. Fundoscopy appears normal.

What is the most likely diagnosis?

Daniel O’Rourke, aged 9, presents with a red, sore left eye and mucopurulent discharge for 2 days. No photophobia or vision changes. His younger sibling had a similar illness last week. On examination, the conjunctiva is injected and the cornea is clear.

What is the most likely diagnosis?

Felicity Brown, aged 61, presents with floaters and flashing lights in her right eye for the past 24 hours. She is myopic and has had cataract surgery 3 months ago. Visual acuity is slightly reduced.

What is the most likely cause?

Patrick Nolan, aged 65, presents with painless loss of peripheral vision in both eyes, noticed gradually over the last year. He has no headaches or diplopia. Intraocular pressure is elevated and fundoscopy reveals cupping of the optic disc.

What is the most likely diagnosis?

Emily Zhang, aged 4, presents with watery, red eyes and frequent eye rubbing. Her mother reports these symptoms occur every spring. On examination, Emily has bilateral conjunctival injection, mild lid oedema, and clear watery discharge.

What is the most appropriate first-line treatment?

Ronald James, aged 76, presents with persistent ocular irritation and a foreign body sensation in the right eye. He has a visible inward turning of the lower eyelid and lashes touching the cornea.

What is the most appropriate next step?

Natalie Kerr, aged 23, presents with right eye pain and photophobia. She is a soft contact lens wearer. Visual acuity is 6/12 in the right eye. Fluorescein staining shows a dendritic lesion.

What is the most appropriate treatment?

Amanda Sharpe, aged 70, presents with acute right-sided temporal headache, jaw claudication, and blurred vision. ESR and CRP are elevated.

What is the most appropriate next step in management?

Chloe Matthews, aged 32, presents with redness and a dull ache in her right eye for the past 2 days. She has no discharge or photophobia. Her vision is normal. Examination shows sectoral episcleral injection without corneal involvement or pupillary abnormalities.

What is the most likely diagnosis?

Thomas Eden, aged 55, presents with painful red eye and blurred vision. He describes the pain as severe and deep. On examination, his sclera appears violaceous and tender to touch. Visual acuity is reduced.

What is the most likely diagnosis?

Mark Toller, aged 47, presents with bilateral visual blurring and difficulty reading. He has no pain or systemic symptoms. Fundoscopy reveals optic disc swelling in both eyes. BP is 190/110 mmHg.

What is the most likely cause of his optic disc findings?

Sarah Bishop, aged 36, presents with recurrent episodes of blurred vision and eye discomfort associated with contact lens wear. She recently changed to extended-wear lenses. On examination, small punctate epithelial erosions are noted on fluorescein staining.

What is the most appropriate management?

Julia Conway, aged 59, presents with a red, swollen upper eyelid and fever. She has a recent history of sinusitis. On examination, she has restricted extraocular movements and periorbital erythema.

What is the most appropriate next step?

Oscar Lam, aged 27, presents with right eye pain, redness, and photophobia. He has a history of ankylosing spondylitis. Visual acuity is slightly reduced. On slit-lamp exam, there is cell and flare in the anterior chamber.

What is the most appropriate initial management?

Alice Stone, aged 18, presents with gradual onset blurred vision in her right eye. She reports eye discomfort, pain on movement, and colour desaturation. Visual acuity is 6/36. Fundoscopy is normal.

What investigation is most likely to confirm the diagnosis?

Brian West, aged 82, presents after a fall where he struck his right orbit. He has periorbital bruising and swelling, and cannot look up with the right eye. He reports diplopia.

What is the most likely diagnosis?

Emma Rawlins, aged 40, presents with persistent watery right eye and intermittent eye discomfort. On examination, mild redness of the medial canthus is noted and pressure over the lacrimal sac produces mucopurulent reflux.

What is the most likely diagnosis?

Sophie Delaney, aged 29, presents with persistent eye discomfort and photophobia following an episode of viral conjunctivitis. Examination reveals subepithelial corneal infiltrates and decreased contrast sensitivity.

What is the most appropriate management?

Caleb Murphy, aged 64, presents with painless monocular vision loss upon waking. He describes it as a shadow over the lower half of his right visual field. He has hypertension and hyperlipidaemia. Fundoscopy reveals a swollen pale optic disc.

What is the most likely diagnosis?

Karen Forbes, aged 56, presents with a rapidly enlarging, painless mass in the upper eyelid over the last month. She denies redness or discharge. The lesion is firm, non-tender, and not attached to overlying skin.

What is the most likely diagnosis?

Trevor Lang, aged 71, presents with right-sided ptosis and anisocoria. The right pupil is smaller and reacts normally to light. He has a history of smoking and hypertension.

What is the most likely diagnosis?

Isla Nguyen, aged 10, presents with left eye redness, itching and a thick mucous discharge that crusts her eyelashes. It has persisted despite regular face washing. Examination shows erythema of the lid margins and debris on lashes.

What is the most appropriate initial treatment?

Luke Pearce, aged 44, presents with left eye pain, redness and photophobia. He was diagnosed with shingles 4 days ago involving the left side of his forehead and scalp. On exam, there is conjunctival injection and corneal staining with fluorescein.

What is the most likely cause of his symptoms?

Riley Hampton, aged 7, presents with white discharge and redness in both eyes for 1 day. He attends primary school and several classmates have had similar symptoms. There is no photophobia or pain.

What is the most appropriate management?

Stephanie Clegg, aged 63, presents with reduced vision in her right eye, which has developed gradually over 3 months. She notes glare at night and ‘cloudy’ vision. Fundoscopy shows lens opacification.

What is the most likely diagnosis?

Yasmin Noor, aged 29, presents with gritty eye sensation and dry mouth. She is known to have rheumatoid arthritis. On exam, tear meniscus is reduced bilaterally.

What is the most likely diagnosis?

Matilda O’Brien, aged 58, complains of persistent floaters and flashes of light in her left eye. On examination, visual acuity is intact but fundoscopy shows pigmented cells in the vitreous and a horseshoe retinal tear.

What is the most appropriate management?

Edward Kwong, aged 61, presents with right eye redness and pain after accidentally splashing bleach during cleaning. Immediate irrigation was not performed.

What is the most important immediate management?

Hannah Doyle, aged 26, presents with a two-day history of left-sided facial weakness. She is unable to close her left eye fully and complains of eye dryness.

What is the most appropriate eye-related management?

Anthony Rogers, aged 46, presents with an enlarging pigmented lesion on his conjunctiva. It is irregular in shape and has changed colour recently.

What is the most appropriate next step?

Liam Brooks, aged 33, presents with pain and redness in his right eye after being struck by a tree branch. Vision is slightly reduced. There is a positive Seidel test.

What does this finding indicate?

Julia Hyde, aged 72, presents with central vision distortion and straight lines appearing wavy in her right eye. Fundoscopy reveals subretinal neovascularisation and fluid at the macula.

What is the most appropriate treatment?

Nathan Fry, aged 36, presents with double vision when looking to the right. He recently had a head trauma in a car accident. There is restricted movement of the right eye in lateral gaze.

What cranial nerve is most likely affected?