Ocular Pharmacology and Emergency Eye Care
What this domain tests
Pharmacology questions cover drug class, indication, contraindication and duration; emergency questions test immediate sight-saving actions and safe referral.
Key drugs
- Mydriatics: phenylephrine 2.5% (α1); cycloplegics: tropicamide, cyclopentolate, atropine.
- Topical anaesthetics: proxymetacaine, tetracaine - for procedures only, never for home use.
- Anti-infectives, topical NSAIDs, steroids and anti-glaucoma agents (beta-blockers, prostaglandin analogues, carbonic anhydrase inhibitors).
- Fluorescein stains epithelial defects; use with cobalt blue light.
Emergencies
- Chemical injury: irrigate immediately with saline or Ringer's for at least 30 minutes, check pH, remove particulate matter, refer. Alkali is worse than acid.
- Acute angle closure: severely raised IOP, mid-dilated pupil, halos, nausea; urgent IOP lowering and referral.
- Penetrating injury: no pressure, shield, nil by mouth, urgent referral.
- CRAO: emergency referral; follow local protocol.
Worked example
A patient presents after alkali splashed in the eye. Reasoning: alkali causes liquefactive necrosis and deep penetration. Start irrigation before acuity or history, evert the lids, remove particles, irrigate until pH is neutral, then refer for slit-lamp and medical review.
Traps
Using a topical anaesthetic as a take-home treatment; prescribing a steroid without excluding herpes; delaying irrigation to complete paperwork; giving a mydriatic in a shallow anterior chamber.