Management cards (Slide exam) Flashcards
Name, mx (3)
Conjunctival papilloma
Patient reassurance, optional surgery for cosmesis, general ddx (check FAT, feeder blood vessels, surround tissue invasion, biopsy)
.Name, mx (2)
CIN (conjunctival intraepithelial neoplasia):
Mx: surgery for removal, general ddx
Name, mx (1)
SCN:
Mx: surgery for removal, ddx
How should you manage any unusual/unepected growth on the eye (e.g. the ones in the image) or adnexa? (4)
- Check for fast development/spread (e.g. with FAT)
- Check amount of feeder blood vessels
- Check for surrounding tissue invasion
- Refer for biopsy as needed
.Name, mx (1)
Naevus: Benign ocular pigmented lesion
Mx: refer for biopsy if suspicious
Name, mx (1)
Congenital melanocytosis
Mx: (if malignant) refer for excision + biopsy
Name, When is a biopsy indicated? (2)
Primary Acquired Melanosis (PAM):
Biopsy indicated if: - diffuse lesion found at limbus + corneal involvement; - expansive/overgrowth of diffuse lesion in one eye (which shows its pleomorphic)
Name, Biopsy appearance (1), mx (1)
Melanoma
biopsy: invasive lesion with pleomorphism and anaplasia
Mx: surgical removal
Name, mx (2)
Telangiectasia:
Mx: surgery for cosmesis, tx any assoc. systemic conditions (e.g. sturge-weber, HHT)
Name, mx (7)
Kaposi’s sarcoma:
Mx: refer for diagnostic workup if AIDS dx unknown, or for therapy (e.g. HAART - highly active anti retroviral therapy) if AIDS present.;
Tx often palliative (i.e. relieve symptoms/pain), surgery, focal radiation, anti-mitotics, AIDS protease inhibitors
Name, mx (4)
Sturge-Weber Syndrome
Mx: consider referral for ax of neurological status; follow up appt. in 3-12 months to check for glaucoma; if choroidal hemangioma present = check for signs of retinal detachment. If choroidal hemangioma grows into central vision, leaks or causes detachment: tx it by laser or radiation
.Name, define, mx (1)
Cavernous sinus fistula:
.- Break in the cavernous sinus- i.e. “fistula” = break in wall of an artery –> causing higher arterial blood to enter venous space—-
Mx: refer for closure of fistula + mx of IOP
.Name, mx (4)
Cyst of Moll/sweat glands
Excision for cosmesis
• Pouching of small hydrocystoma
• Refer for excision
• Lidnocaine as skin anaesthetic before pouching
Name, mx (3)
Cyst of Zeis Gland - Opaque lesion
Mx: pouching incision, curettage, refer for excision
(note: curretage = Removal of tissue with a curette from the wall of a cavity or another surface)
Name, mx (4)
Stye/Hordeolum
Mx: Warm compress, Most resolve 2-3 days, Topical broad spectrum antibiotic (chlorsig) if persistent, Can lead to cellulitis (indicated by fever and V.A) –> that requires antibiotics tx
Name, mx (5)
Chalazion
Mx: spontaneous resolution in few months (when fluid resorbed), Tx = heat compress (qid), lid massage (to help glands open + soften oil), incision w/curettage + steroid injection (long lasting), doxycline if recurrent (40-100mg bid) or tetracycline (500mg bid)
Name, mx (3)
Sebaceous gland carcinoma: malignant tumour of sebaceous gland
Mx: careful examination, review with referral of suspicious cases, 6-12 monthly reviews
Name, mx (1)
Viral Warts (Verruca)
Mx: refer for excision + cautery
Name, Ax (2), Mx (3)
Molluscum contagiosum
Ax: check eyebrows and evert; ensure no lymphadenopathy, check lymph nodes
Mx: counsel about hygeine, spread skin-skin contact; self-limiting, non-scarring; refer for excision + cauterisation
name, ax (1), mx (3)
Keratoacanthoma
Ax: biopsy of keratin core
Mx: refer for excision + biopsy; exclude SCC; spontaneous involuted by one year
Name, mx (4)
Xanthelasma
refer to GP to manage systemic overlay
check /control lipid levels (TGs, cholesterol),
systemic work up (fasting blood lipids)
Consider excision for cosmesis(recurrent) + refer for biopsy (to make sure it’s benign)
Name, Ax (1), Mx (1)
Seborrheic Keratosis (SK):
Ax: referral for excision and biopsy (if suspicious)
Mx: progressive, suspicious or cosmesis excise excluding BCC, SCN
Solar or Actinic Keratosis. How do you manage it? (3)
malignant potential
photos to monitor
refer for biopsy & excision (exclude BCC, SCC)
Epithelial Basement Membrane Dystrophy (EBMD): Mx (4)
Lubricants; Mx of any co-existing surface disease if there are any symptoms; mx of any pre-existing erosion;
any co-existing surface disease will increase the risk of recurrent corneal erosions.
Meesman’s dystrophy: Mx (3)
Mx is conservative; Surface lubrication to minimise discomfort; Bandage CLs
How can you manage Reis-Buckler’s Dystrophy? (3)
Treat RCEs (recurrent corneal erosions) as required; Must monitor px for decreased vision; Difficult to mx because of reoccurence; surgical intervention often required for patients over 50
How can you manage Thiel-Behnke corneal dystrophy? (3)
Same as Reis-Bucklers. So: Treat RCEs (recurrent corneal erosions) as required; Must monitor px for decreased vision; Difficult to mx because of reoccurence; surgical intervention usually for over 50yo
How do you manage Lattice Dystrophy? (4)
Mx of any surface discomfort; Mx of RCEs; May refer to GP to determine if amyloidosis is systemic; surgical intervention (refer for PTK if vision significantly reduced)
How can you manage Granular Dystrophy (4.5)
Early tx involves treating symptoms (use lubricants); Try to reduce occurrence of RCEs (reccurent corneal erosions); Soft bandage CLs; surgical (superficial keratectomy or PTK, lamellar keratoplasty, penetrating keratoplasty)
Name, mx (1)
Avenillino Dystrophy:
tx same as for other stromal dystrophies
Name, mx (3)
Macular Dystrophy
Mx: Vision usually significantly affected by 30s; referral for PK; Recurrence in graft is uncommon
Name, mx (2)
Schnyder’s Crystalline Dystrophy:
Mx: Refer for workup of blood lipids as systemic disease may be life threatening; Refer for PTK to remove superficial crystals in px with severe glare
How can you manage Fuchs Endothelial Dystrophy? (4)
6mth review recommended (work up patchy, specular microscopy, IOP); Hypertonic saline, warm hairdryer upon waking to reduce corneal oedema; Ocular lubricants/bandage CL (for bullae); Eventual referral for PK
Name, mx (3)
Posterior polymorphous corneal dystrophy
Mx: Most don’t require tx for corneal changes; check IOP at each visit (b/c increased incidence of glaucoma with epithelial overgrowth); if tx required = as per Fuch’s
Name, mx (6)
Filamentary Keratopathy
Mx: Tx underlying conditions to prevent reoccurence; Remove filaments under topical anaesthesia w/sterile forceps; Removal will cause epithelial defect (warn px it’ll feel worse before it gets better); Prescribe prophylactic antibiotics and ocular lubricants (for comfort); Topical steroids if filaments persistent (except for HSV); Bandage CL
Name, mx (5)
Superficial punctate keratopathy (SPK)
Mx: Tx underlying cause; Will typically repair within 24 hours; Ocular lubricant to promote repair (non-preserved); If severe - may require prophylactic topical antibiotics cover or steroids if underlying condition is inflammatory; Discontinue any CL wear
What’s this? How can you manage it? (3)
Subepithelial Infiltrates
Mx: If symptomatic - ocular lubricants; topical corticosteroids w/slow taper; antibiotics if significant epithelial breakdown
Name, mx (6)
Neurotrophic keratopathy
Mx: Non-preserved ocular lubricants; Withdrawal of topical medicatiosn; Risk of microbial keratitis due to incomplete epithelium (consider prophylactic tx with chlorsig); Non-preserved topical corticosteroids (?); Bandage CL (?); Refer for surgery - tarsorrhaphy