Aoc

Question 1

Entropion

Answer 1

Sign- rolling inwards of lid margin Redness of Bulgaria conjunctiva

Symptoms- none - eyelashes rub against conjunctiva/cornea could cause pain and lacrimation Reduce va

Pathogenesis- spasm of obicularis oculi mainly
occurs in elderly, can be caused by scar tissue on conjunctiva

Treatment- referral to GP - urgency based on symptoms Bandage cl surgery to remove eyelashes

Question 2

Ectropian

Answer 2

Signs- lower lid rolls away from globe, palpabral conjunctiva exposed= dry eye and red

Symptoms - painless

Pathogenesis- loss of muscle tone in obicularis oculi cx wipes tears down increasing issue &contact dermatitis scar tissue can cause ectropion

Treatment - refer to GP surgery to eyelid margin. Bandage CL to protect cornea drying exposure keratitis advise to wipe up

Question 3

Blepharitis

Answer 3

Signs- Redness & scaling, crusty lid margin debris in eyelashes(dandruff) reduction in lashes. In chronic cases ulcers can form along lid margin. Posterior - obstruction of meibomain. Thick cloudy meibomain hyperaemia- lid margin

Symptoms tired, itchy, sometimes worse on morning greasing of CL due to sebaceous secretion - none in mild cases

Pathogenesis- long term chronic inflammation of lid margin, usually older cx, poor diet, systemic illness, dandruff scalp eyebrows can be seborrhoeic/ associated with chronic staphylococcal infection/ demodex mites

Treatment lid hygiene warm compress, demodex wipe tree tree oil referral to optom/ gp if chronic, artifical tears for comfort cease CL wear

Question 4

Pinguecula

Answer 4

Signs- raised yellow lump, para Limbaugh areas bulbar conjunctiva, more prominent and yellow with age

Symptoms- generally none CL can cause irritation

Pathogenesis- degeneration of conjunctiva collagen can be senile expose to sunlight and hot, dry conditions

Treatment- if cosmetically unacceptable then surgery, UV protection

Question 5

Pterygium (silent p)

Answer 5

Signs- wing shaped triangle, growth on conjunctiva, can invade cornea, usually nasally (often bilateral) pink/yellow colour

Symptoms- FB sensation, mild irritation- irritation if wear CL, astigmatism produced if cornea becomes distorted, reduced VA

Pathogenesis- degeneration of conjunctiva collagen, arises from fibrous vascular connective tissue with epithelium, hot dry dusty climates

Treatment- referral to GP, urgency based on presentation, surgery before encroaches pupil/ cause corneal distortion, regrowth Common, radiation to prevent re growth

Question 6

Arcus

Answer 6

Signs - grayish white band in peripheral cornea commences as an arc in Upper & lower cornea 1mm annulus around cornea, clear separation from limbus

Symptoms - none

Pathogenesis- fat deposits in the limiting lamellae - not sight threatening

Treatment patient reassured if cx below 50 = routine referral to GP for health check

Question 7

Hordoleum externum (stye)

Blockage of gland moll & zies

Answer 7

Signs- red swelling of lid margin, associated with lashes may develop a yellow centre or point

Symptoms- painful

Pathogenesis- bacterial infection of eyelashes follicle usually staphylococcus
Glands of moll = sweat, zies =sebaceous

Treatment- hot compress to accelerate the pointing Pus evacuated by removal of eyelash, advise improve hygiene, recurring =GP referral for health check possible antibiotics

Question 8

Chalazion (tarsal gland)

Answer 8

Signs- swelling inside eyelid, hard gradually enlarges, localised grayish area on tarsal conjunctiva on lid emersion

Symptoms- painless, if growth continues can put pressure on and distort cornea

Pathogenesis- swelling of tarsal gland, due to blockage of duct or infection, recurs with blepharitis

Treatment
Patient reassured, referral to GP for surgical removal if required

Question 9

Hordoleum Internum (infection)

Answer 9

Signs- same as chalazion but infection, red swelling of eyelid, red inflammation of tarsal conjunctiva on generalised inflammation of surrounding area

Symptoms- painful

Pathogenesis- infection of tarsal gland, usually staphylococcal bacteria

Treatment- refer to optometrist/GP if acute, hot compress, may need GP for antibiotics and surgical drainage

Question 10

Dacrocystis

Blocked tear duct lacrimal sac

Answer 10

Signs - inflammation of lacrimal sac below inner canthus localised inflammation and mucopurulent discharge, nasal conjunctiva can also be reddened

Symptoms- painful in acute form, painless in chronic, epiphora (over spill of tears)

Pathogenesis- acute due to infection of lacrimal sac, usually bacterial, chronic due to blockage of nasalacrimal duct injury or infection

Treatment- referral to GP, HES urgent if acute (under 16 rules apply), systemic antibiotics, hot compress,possible surgery to release content of sac or re open lacrimal passages

Question 11

Dacryoadentis

Inflammation of lacrimal gland

Answer 11

Signs- swelling beneath lateral end of upper eyelid inflammation

Symptoms- very painful

Pathogenesis- bacterial infection occasionally occurs in mumps & glandular fever. Chronic dacryoadentis may accompany iritis (anterior uveitis) in systemic diseases such as tuberculosis

Treatment antibiotics- local/ systemic are given for acute, treatment for any underlying systemic co diction is also required

Question 12

Ptosis

Answer 12

Signs- abnormally low position of upper lid reduction in size of palpebral aperture, pupil can be covered, cx elevate eyebrows to counter drooping of lid unilateral/bilateral

Symptoms - none (unless pupil covered) if other symptoms the ptosis is due to underlying cause dipoles, anisocria, strabismus anhydrous of face

Pathogenesis- most common cause by defect of levator palpebral superioris (or its innervation) can be congenital or acquired, result from trauma, associated with myasthenia gravis, honers syndrome results in triade miosis/ptosis/ anhindrosis 3rd nerve palsy

Treatment - refer to GP emergency/ urgent if other symptoms surgical intervention, surgery not normally carried out on young people unless risk of amblyopia

Question 13

Xanthelasma

Answer 13

Signs- flat yellowish makes of fat deposited below the skin

Symptoms- none

Pathogenesis- indicate a high level of blood cholesterol more common in diabetics

Treatment- referral to GP for health check & cholesterol check can be removed if cosmetically unacceptable

Question 14

Contact dermatitis

Answer 14

Signs- localised allergic reaction, inflammation of conjunctiva & eyelids, eyelids red & puffy may extend down cheeks

Symptoms- severe itching and discomfort

Pathogenesis- reaction to cosmetics fluids

Treatment - refer to GP, cool compress to soothe irritation, steroid drops or cream to reduce inflammation

Question 15

Epicanthus

Answer 15

Signs- vertical fold of skin covering the inner canthus, usually bilateral & gives the appearance esotropia

Symptoms- none

Pathogenesis- normal feature that gradually disappear in the first few years of life

Treatment- none parents reassured sight test to ensure no BV issues

Question 16

Keratoconus

Answer 16

Signs- bulging of the cornea into a conical shape usually bilateral irregular astigmatism on examination, munsons sign in servere cases corneal oedema

Symptoms acuity progressively reduces due to irregular astigmatism, monocular diplopia can occur in severe cases sudden drop in acuity if oedema occurs

Pathogenesis- reduced corneal thickness, more common in males usually onset 10-20 years, usually gradual onset

Treatment- refer to optometrist/ opthalmology RGP CL which form a tear prism reducing effects of irregular astigmatism, piggy back CL used if RGP not tolerated, corneal graft if severe or collage crosslinking

Question 17

Retinoblastoma

Answer 17

Signs- unilater/bilateral, white pupil reflex (leukocoria) caused by pale tumour at eye posterior white reflex shows in flash photography squint can occur with reduced VA, can cause iris colour to change

Symptoms due to age of child acuity reduction (often none) is not identified, occasionally painful and redeye

Pathogenesis- most common paediatric malignancy of the eye 1/2000 births. Mostly sporadic, but can be inherited arises from foetal retinal development usually presents 8 months if inherited, 25 month if sporadic,

Treatment - urgent referral enucleation to avoid metastasis tumour can spread to orbit and optical canal so early detection paramount, radiotherapy/ phototherapy/ chemotherapy 50% of children will present with second tumour

Question 18

Naevus

Answer 18

Signs- augmented area on surface of iris, equivalent to frexkle/ mole flat or raised, usually regular in shape

Symptoms- none

Pathogenesis- accumulation of pigmented cells on anterior of the iris

Treatment- none reassure cx naevi should be monitored (pictures) change in size, character could indicate malignant melanoma

Question 19

Coloboma

Answer 19

Signs- section of inferior part of the iris missing, keyhole shape pupil usually bilateral

Symptoms- photophobia glare, reduced VA due to poor retinal image aberrations

Pathogenesis- failure of the optic fissure to close, occurs 5th week of embryonic life, may effect choroid and retina

Treatment- no Treatment, more focused on improving cosmetics/ va cosmetic CL

Question 20

Iris melanoma

Answer 20

Signs-area of iris is a different colour of surrounding area maybe thicker & cause distortion of pupil, can bleed causing hyphaema

Symptoms- none, unless blockage of angle

Pathogenesis- uncontrolled growth of melanocytes . Usually develops from pre existing naevi,more common 60+

Treatment-refer to GP/HES depending on presentation surgery if advanced enucleated

Question 21

Orbital cellulitis

Answer 21

Signs- red swollen, eyelids closing the palpebral aperture, conjunctiva swollen inflamed

Symptoms- moderate/ severe pain more so on movement, reduced acuity, diplopia, feverish

Pathogenesis-bacterial infection spread from infected tooth/sinus, milder form presentation cellulitis can occur following infected wound/ insect bite on or near eyelid

Treatment- systemic antibiotics, orbital emergency HES possibility of inflammation of the optic nerve possible surgery

Question 22

Aqueous flare

Tyndall phenomena

Answer 22

Scattering of light in the anterior chamber due to the pressure of white blood cells and other proteins in the aqueous
Indicates inflammation in the eye

Question 23

Keratitis precipitates

Kps

Answer 23

White blood cells can become attached to the endothelium back of cornea
Normally form a triangle shape

Question 24

Subconjunctival Haemorrhage

Answer 24

Signs- pooling blood in the conjunctiva bright red blood obscures sclera accumulates between the conjunctiva and tenons capsule

Symptoms - often no symptoms looks more dramatic than prognosis occasionally slight discomfort/ soreness

Pathogenesis- small amount of bleeding occurs beneath the conjunctiva. Appears bright red as conjunctiva is transparent
1. Sporadic strain/ exertion 2. Hypertension/ systemic issue 3. Trauma

Do advice 1 sporadic not happend before tell when resolve cx reassured no referral- drops

2 recurring routine referral to gp
3 trauma - emergency referral to hes

Question 25

Scleritis

Diffused mixed injection

Answer 25

Signs- generalised deep inflammation of the sclera seen through conjunctiva diffuse Bulgaria injection and hyperaemia of sclera tissue
Anterior chamber response ( aqueous flare)

Symptoms deep intense pain also can effect forehead and jaw, photophobia, epiphora, if posterior sclera involved or anterior chamber response may cause reduction in acuity

Pathogenesis- associated with collagen vascular diseases rheumatoid arthritis hepes zoster
Accompanied by Uveitis glaucoma and cataract
Posterior - can affect optoc nerve vause RD

Do advice - emergency referral treated with steroid drugs systemic and topical systemic immunsuppressants
Generally unsuitable for CL wear

Question 26

Episclearitis

Super facial inflammation

Answer 26

Signs- mild inflammation/ injection of the superficial layers of the sclera can be localised or segmented, slight Oedema

Symptoms - irritation minor lacrimation

Pathogenesis- inflammation of the vascular connective tissue that lies between sclera and conjunctiva 1/3 cases associated with systemic disorders collagen vascular disease

Do Treatment- cx reassured ocular lubricants can ease irritation, self limiting rarely associated with systemic issues if recurring then referral to optometrist /GP warranted

Question 27

Anterior Uveitis (iritis)

Answer 27

Signs inflammation of iris, Limbal (ciliary) injection
Iris nodules
Anterior chamber response/ infiltrates, iris bombe can form

Symptoms- sudden or insidious (slowly), in chronic - none,
In acute servere pain lacrimation photophobia
Reduced acuity

Pathogenesis- white blood cells block trabecular mesh work- secondary glaucoma, Uveitis related to systemic diseases such as aid,TB, sarcoidosis, behects, psoriasis, secondary condition to keratitis or viral ulcer, in children juvenile chronic arthritis if untreated optic nerve issues and sight loss

DO Treatment- emergency referral to GP
Treatment is focused on preventing damage to ocular structures suppressing inflammation topical steroid treatment

Use mydriatic drugs dilating pupil reduces pain associated with ciliary spasm

Question 28

Keratitis (bacterial)

Answer 28

Signs - white corneal opacity (ulcer) visible under slit lamp (sometimes with naked eye) , mucus discharge, inflammation, ciliary injection can be diffuse, hypopyon KP ( severe cases)

Symptoms- servere pain lacrimation, photophobia in early stages FB sensation reduced VA

Pathogenesis- bacterial infection of the cornea, dry eye or breaches in corneal epithelium by trauma or contact lens wear can allow ingress of bacteria, bacteria types include staphylococcus aureus if acute can lead to iritis/ secondary glaucoma

DO Treatment- emergency referral assessed by optom if symptoms allow immediately available

Scrapes are taken to culture and identify bacterium, so that ab effective antibiotic can be prescribed, topical application

Question 29

Viral keratitis

Answer 29

Signs- dendritic ulcer visble under slit lamp, inflammation of the cornea, ciliary injection hypopyon/KP ( severe cases)

Symptoms- pain, photophobia, lacrimation acuity loss if ulcer central

Pathogenesis- viral infection of the cornea, dry eye or breaches in corneal epithelium by trauma, or CL wear can allow ingress of virus, usually caused by herpes simplex more at risk

Do Treatment emergency referral

Question 30

Keratitis ( acanthamoeba)

Answer 30

Signs- diffuse red eye,one or more white patches on cornea ring shaped ulcer if advanced, epiphora

Symptoms- severe pain, blurred vision, photophobia

Pathogenesis- inflammation of the cornea due to infection by the protozoa acanthamoeba, can penetrste an intact corneal epithelium can be caused by swimming in CL or washing CL case with water

Question 31

Systemic conditions Uveitis

Answer 31

Juvenile chronic arthritis
Ankylosing spondylosis
Psoriatic arthritis

Question 32

Systemic causes of cataract

Answer 32

Diabetes 
Metabolic disorders 
Systemic drugs steroids 
X radiation 
Infection congenital rubella 
Syndrome downs lowe

Question 33

Classification of the glaucoma

Primary

Answer 33

Chronic open angle

Acute and chronic closed angle

Question 34

Classification of glaucoma

Congenital

Answer 34

Primary
Secondary to maternal rubella infection
Secondary to inherited ocular disorders eg aniridia absence of the iris

Question 35

Classification of glaucoma

Secondary glaucoma causes

Answer 35

Trauma 
Ocular surgery
Ocular disease eg Uveitis 
Raised episcleral venous pressure 
Steroid induced

Question 36

Primary chronic open angle glaucoma

Answer 36

Increase resistance to the outflow of aqueous = elevated ocular pressure
The causes of outflow obstruction include - thickening of the trabecular lamellae which reduces pore size
Reduction in the number of lining trabecular cells

A form also exists- field loss loss and cupping of optic disc not high IOP - optic nerve head usually susceptible to the IOP and has a low blood supply

Question 37

Closed angle glaucoma

Answer 37

Occurs in small eyes hypermetropic- shallow anterior chamber
Pupil dilation when the peripheral iris may be bunched up in the angle
Resistance increased, increased pressure gradient bows the iris forward and closes the drainage angle, aqueous cannot drain through trabecular mesh work
IOP rises usually abruptly
Deprives whole cornea of nutrition, posterior of oxygen supply = corneal Oedema and clouding