1&2. Introduction and How To Anterior Eye

Question 1

Describe sclera lenses

Answer 1

Large diameter lenses covering cornea and sclera

Question 2

Sclera lenses have a hole in them describe its purpose and what is that hole called?

Answer 2

Fenestration hole: Allow fresh tears to circulate and movement of oxygen into the lens.

Question 3

Describe RGPs (Rigid gas permeable lenses)

Answer 3

This are small diameter lenses that fit within the limbus

Question 4

The surface of RGPs is hard describe the benefit of this

Answer 4

Tears are hence formed under the lens, Improving Visual acuity

Question 5

Describe the structure of soft (hydrogel) lenses

Answer 5

Large diameter lenses that cover the cornea and limbus

Question 6

What are hybrid lenses

Answer 6

Combination of CL with the central RGP design and soft (hydrogel) peripheral skirt

Question 7

Application of contact lenses (6)

Answer 7

1. Cosmetic
2. Correcting irregular corneas (keratoconus)
3. Therapeutic (bandage lens)
4. Myopia management
5. Orthokeratology
6. Aphakia

Question 8

What baseline data is required for fitting contact lenses?

Answer 8

1. History and symptoms
2. Spectacle prescription
3. Keratometry
4. Baseline measurements (HVID, VPA, pupil sizes)
5. Anterior eye examinations

Question 9

Why check the health of the anterior eye? (3)

Answer 9

1. Opportunity to check the eye health.
2. Assess the suitability for contact lenses.
3. Record the baseline values before contact lens fitting.

Question 10

Why are grading scales used? (3)

Answer 10

1. Helps objectively decide the level of normality or severity (Improving accuracy and consistency of record keeping).
2. Record baseline values for new lens fit.
3. Monitor progression of ocular complications.

Question 11

The most popular grading scale?

Answer 11

Efron grading scale

Question 12

Beginning step of slit lamp (4)

Answer 12

1. Cleaning chin and forehead rest in advance
2. Set PD and focus eye pieces
3. Check to ensure instruments are coupled
4. Heights should be aligned

Question 13

Example of direction illumination

Answer 13

Optical Section

Question 14

Example of indirect illumination

Answer 14

Retro illumination

Question 15

What is the systematic order of an eye exam?

Answer 15

1. Tear film assessment
2. Lids and lashes
3. Conjunctiva and sclera
4. Limbus
5. Cornea
6. Fluorescein insertion
7. Lid eversion

Question 16

What slit lamp settings used to observe the tear film?

Answer 16

16 times magnification and thin beam used (Optical section)

Question 17

What is observed when looking at the tear film?

Answer 17

Debris

Question 18

Why is the tear film looked at first?

Answer 18

Since it is sensitive and can cause changes to the final observation

Question 19

Illumination in the slit lamp is controlled by?

Answer 19

Rheostat

Question 20

What rheostat is used for observing the tear film?

Answer 20

Medium- high

Question 21

What beam and mag used to observe lids and lashes? What illumination? What rheostat?

Answer 21

6x-10x
Wide beam with diffuser
Direct or indirect illumination
Low- med rheostat

Question 22

What is being observed when examining lids and lashes?

Answer 22

Lid regularity, redness, lumps and bumps, presence of any glands, eyelash position, eyelash appearance.

Question 23

Mag, beam and brightness used to examine the sclera and conjunctiva? What type of illumination is used?

Answer 23

x6-10
widish beam
direct or indirect illumination
low-med rheostat

Question 24

What is being observed when looking at the conjunctiva and sclera?

Answer 24

Presence of any vessels, lumps, bumps, scleral vessels and redness

Question 25

What mag, beam and rheostat used to observe the limbus?

Answer 25

x10-16 med-narrow beam width medium rheostat

Question 26

What is recorded when observing the limbus?

Answer 26

Limbal redness, Neovascularization measured in mm. Extent measured in mm using green filter

Question 27

How are sclera lens designed for individuals?

Answer 27

Using ocular impressions

Question 28

Are large diameter RGPs available?

Answer 28

Yes, also called as mini-sclerals.

Question 29

How are contact lenses useful in correcting irregular cornea's?

Answer 29

1. Keratoconus 2. Corneal scarring from lacerations

Question 30

How can contact lenses be used as bandage lenses for therapeutic purposes?

Answer 30

This lenses reduce irritation when blinking incase a person has stiches

Question 31

How much of grade change is consider to be clinically significant? - Efron grading scale

Answer 31

Change greater then 1 grade (From 1 to 3 within 2 visits)

Question 32

What settings are used to observe the corena?

Answer 32

Med- high mag Thin beam: parallelpiped (direct, indircet, retro- illumination) Optical section used to determine depth Med- high rheostat

Question 33

In which 2 structures are all limbal zones scanned?

Answer 33

Cornea and Conjunctiva: px is instructed to change fixation.

Question 34

What is looked for when scanning the cornea?

Answer 34

1. Corneal abnormalities 2. Scars, ulcers and infiltrates 3. Corneal thickness

Question 35

Describe the use of fluorescein? (2)

Answer 35

1. Stain damage epithelial cells 2. Allow visualization of the transparent tear film

Question 36

Why is the lid everted?

Answer 36

To expose palpebral conjunctiva, The redness and roughness is graded.

Question 37

What mag, beam and brightness used in lid eversion?

Answer 37

10-16X mag Medium rheostat beam Parallelepiped