6.1.5 oct indicated

Question 1

how to look for cataract

Answer 1

optic section
retroillumination of lens

Question 2

glaucoma/dus glaucoma

Answer 2

vertical elongation of cup
ISNT - OCT
disc ham

Question 3

blepharitis

Answer 3

Diffuse direct illumination - In this method the illumination beam and viewing system are sharply focused on the same area using a wide beam with a diffusing filter and low magnification (also useful for general viewing of the eye and adnexa).

Question 4

dry eye

Answer 4

• Non invasive to Invasive
• H&S
• Tear quality, Tear volume, Conjunctival folds, Non invasive TBUT using keratometry
• TBUT, LWE, ?Osmolarity?

Question 5

Answer 5

• halazion
  
  • Descript - Sterile inflammation of meibomian gland (cyst) causing stagnation of secretion from the gland, leading to a more chronic lesion. Can follow an internal hordeolum
  • Cause - May occur spontaneously or follow an acute hordeolum (internal), chronic bleph
  • Sxs - painless lid lump, rarely induced astigmatism
  • Management - warm compress & massage. Steroid or ex

Question 6

Answer 6

• scipt - Either external (stye-acute bacterial infection of eyelash glands) or internal (meibomian gland)
• Causes - chronic bleph
• Sxs - tenderness, pain if internal sometimes, watering
• Management - warm compress & massage, if mucous discharge then antibiotic treatment using chloramphenicol

Question 7

Answer 7

• trichiasis
  
  • Descript - misdirected lashes
  • Causes - chronic blepharitis, infection like herpes zoster, surgery, trauma
  • Management - removal, laser ablati

Question 8

Answer 8

• sqamous cell papilloma
  
  • Descript - benign epithelial tumour, skin-tag & wart like
  • Causes - human papilloma virus
  • Management - normally goes by itself, excision, cryotherapy & laser or chemical ablation

Question 9

Answer 9

• sebrborrhoeic Keratosis (basal cell papilloma) (look in kanski!)
  
  • Descript - light- to dark-brown plaque with a friable, greasy, verrucous surface and a ‘stuck-on’ appearance
  • Causes - elderly, common, numerous
  • Management - shave biopsy, excision, laser, cryotherapy

Question 10

Answer 10

• molluscum Contagiosum
  
  • Descript - viral infection; caused by poxvirus, very young or adults immuno compromised
  • Causes - linked with AIDs, eczema, swimming pools
  • Sxs - Skin nodule(s) (typically 2-3 mm diam), often with a central depression (‘umbilicated’), Can cause conjunctivitis - follicles, redness, watering, photophobia, epitheliopathy etc
    
    • White cheesy material can be discharged
  • Management - self-limiting (goes after few weeks or months), referral if no resolve for excision

Question 11

Answer 11

• basal cell carcinoma
  
  • Risk Factors - Old, White, UV exposure
  • Types:
    
    • Nodular - pearl like, few dilated vessels
    • Nodulo-ulcerative - centre ulcerated, pearly rolled edges, telangiectasia
    • Sclerosing - looks clear, margins hard to define. Don’t mistake for blepharitis!
  • Management - needs referral (soon) for biopsy

Question 12

Answer 12

• squamous cell carcinoma
  
  • Risk Factors - Old, White, UV exposure, Immunocompromised
  • Types:
    
    • Nodular - hyperkeratotic with crusting, erosions, fissures
    • Ulcerating - red base, defined “hard looking” borders with a slight crusty look
    • Cutaneous horn
  • Management - needs referral (urgent within a week) for b

Question 13

ectropion

Answer 13

• ectropian
  
  • Outward rotation of lid margin
  • TESTS:
  • Distraction test
    
    • if lower lid can be pulled >6mm from globe, it is lax, positive test indicates canthal tendon laxity
  • Snap-back test
    
    • with finger, pull lower lid down towards inferior orbital margin
      release: lid should snap back
      lid slow to return to its normal position: indicates poor orbicularis tone
  • Types - Involutional (age related causing laxity), Cicatricial (scarring of skin), Paralytic (facial palsy i.e. Bell’s), Mechanical (tumour, lid swelling etc), Congenital (rare bilateral condition)
  • Management - less lid rubbing (induces laxity), drops, routine referral if severe

Question 14

entropian

Answer 14

• ntropian
  
  • Inward rotation of lid margin
  • TESTS:
  • Distraction test
    
    • if lower lid can be pulled >6mm from globe, it is lax, positive test indicates canthal tendon laxity
  • Snap-back test
    
    • with finger, pull lower lid down towards inferior orbital margin
      release: lid should snap back
      lid slow to return to its normal position: indicates poor orbicularis tone
  • Test of Induced Entropion (TIE-2 test)
    
    • ask patient to look down
      hold upper lid up as high as possible
      ask patient to close the eyes as tightly as possible
      The TIE-2 test is positive if this provokes an intermittent lower lid
      entropion
  • Types - Involutional, Cicatricial (scarring & contraction of palp conj e.g. in chronic bleph), Spastic (random orbicularis contraction e.g. after surgery or blepharospasm), Congenital (rare)
  • Management - Lash epilation, Lubrication, routine

Question 15

macular hole

Answer 15

• if Lameller hole & not causing trouble with vision or too much distortion, then worth monitoring over next 6 months whilst giving amsler
• ERM

Question 16

erm

Answer 16

• monitor, 1 yr recall
• If VMT, then separate management as may progress to macula hole so might require referral within 3-4 weeks if vision worse than 6/7.5

Question 17

oedema

Answer 17

• Oedema
  
  • Referred urgently within 2 weeks e.g. proliferative DR, CRVO, after cataract surgery

Question 18

CSR

Answer 18

• Routinely referred soon 3-4 weeks
• Some HES will only want to see CSR if chronic for at least 4 months because normally it will resolve itself in 6 or so weeks. Photodynamic laser

Question 19

ped

Answer 19

• drusenoid, then regular AMD management
• If serous or fibrous with signs of AMD, then most likely urgent within 1-2 weeks as suspect wet AMD

Question 20

Answer 20

• RP

Descript - inherited diffuse retinal degenerative disease affecting rods then cones
- Cause - genes
- Signs - Dark adaptation trouble, VF loss, Bone-spicules, Narrower A/V, Disc pallor, Possible maculopathy
- Management - Genetic counselling, LVAs

Question 21

mauves vs meleooma

Answer 21

• C - Close to ON
• O - Orange pigment lipofuscin
• N - No drusen
• S - Symptoms (F+F, visual disturbance if raised)
• T - Thickness (>2mm)
• A - Absence of halo (ring of pallor)
• N - New
• T - Too big (>5mm)