virtual clinic session

Question 1

what investigations would you do?

and what is the likely diagnoses?

Answer 1

From most important to least:

• visual acuity
• pupils
• slit lamp
• fluorescein stain

-Metallic foreign body

Question 2

what is management for metallic foreign body?

Answer 2

• remove it!!!

- clorophene?? ointment for a week to help heal it

Question 3

-only abduction is working

which allied health professional may you ask for help?
differentials?
next steps?

Answer 3

• orthopotist
• CNIII palsy

-imaging (CT/MRI)

Question 4

what is the diagnoses?

Answer 4

-age related macular degeneration (ARMD)

Question 5

what allied health professional may help in ARMD?

Answer 5

-opthalmic imaging technician who could do an OCT scan

Question 6

what is the UKs most common cause of blindness?

Answer 6

-age related macular degeneration

Question 7

what is age related macular degeneration?

Answer 7

Age-related macular degeneration is a condition where there is degeneration in the macula that cause a progressive deterioration in vision.

Question 8

what are the two types of ARMD?

Answer 8

• wet (10%)

- dry (90%)

Question 9

what are the 4 layers of the macula?

Answer 9

• choroid layer (bottom)
• Bruch’s membrane
• retinal pigment epithelium
• photoreceptors (top)

Question 10

describe what you see and what is the diagnoses?

Answer 10

-basal cell carcinoma

Question 11

what is the diagnoses?

Answer 11

-most likely is inflammation in the anterior section

Question 12

what is usually seen on fundoscopy for age related macular disease?

Answer 12

• drusen seen on funcdoscopy
• drusen are yellow deposits of proteins and lipids that appear between the retinal pigment epithelium and Bruch’s membrane

Question 13

what are drusen?

Answer 13

-yellow deposits of proteins and lipids that appear between the retinal pigment epithelium and Bruch’s membrane

Question 14

what are some features of both wet and dry AMD?

Answer 14

• drusens
• atrophy of the retinal pigment epithelium
• degeneration of the photoreceptors

Question 15

what occurs in wet AMD?

Answer 15

• there is a development of new vessels growing from the choroid layer into the retina
• these vessels can leak fluid or blood and cause oedema and more rapid vision loss

-a key chemical that stimulates the development of new vessels is the vascular endothelial growth factor (VEGF) and this is the target of medications to treat wet AMD

Question 16

what are risk factors for AMD?

Answer 16

• increase in age
• smoking
• white or Chinese ethnic origin
• family history
• cardiovascular disease

Question 17

how does AMD present?

Answer 17

• gradual worsening of central vision loss
• reduced visual acuity
• crooked or wavy appearance to straight lines

Wet AMD presents more acutely. It can present with a loss of vision over days and progress to full loss of vision over 2-3 years. It often progresses to bilateral disease

Question 18

what is management for wet AMD?

Answer 18

anti-VEGF medications (e.g. ranibizumab, bevacizumab and pegaptanib)

Question 19

what sort of squint is this?-

Answer 19

-left esotropia

if it was turning out it would be left exotropia