practical stuff

Question 1

visual field exam

Answer 1

start by asking pt if any part of your face is missing when they are looking at you

instruct pt to look at face

ask if they can see fingers

get pt to cover their left eye so right eye can be assessed

examiner covers the same side , instruct pt to keep looking at your eye and to Lett you know when they can see your hand

Question 2

pupil exam

Answer 2

ask pt to look in distance

look at both pupils to begin with

comment on size , equalises (anioscoria)

comment on direct reaction and con sensual reaction to light

then. do swinging test

ask pt to look at near object

then get them to look at distance and then back at near object

finish exam by commenting e.g. ‘‘pupils are normal size, equal , react well to light , no rapd etc.’’

Question 3

90d

Answer 3

instruct pt to look at ear

large slit of 2mm should be located in the centre of the cornea

should be carried out on a low mag 10-15x

hold lens 1cm from the cornea

avoid touching the pts eyelashes

rest finger on headrest

Question 4

steps for ant seg exam

Answer 4

explain role + what exam will entail

correctly portion pt on lamp

lids and lashes - examine upper and lower lids and lashes

can manipulate the lids by gently touching pts face

give 3 relevant postive or negative findings

 Student may choose to examine conjunctiva separately to sclera or both at the same time
 Student should comment on 3 relevant positive or negative findings
 Student should ask the patient to look in specific directions to adequately assess inferior, nasal, superior, temporal and bulbar conjunctiva and/or sclera
 Student can gently lift the upper lid if the patient consents
 Light settings for this stage do not need to be commented on as they can be unchanged from previous section
 Student should indicate their chosen light settings chosen for cornea assessment
 Student should comment on 3 relevant positive or negative findings
 Student should attempt to assess the entire corneal surface in cross section
 Van Herrick’s may be performed at this point unless otherwise indicated
 Van Herrick’s may be performed at this point unless otherwise indicated
 Student should comment on 2 relevant positive or negative findings
 Student may ask the patient to move the eye up and down to assess activity status
 Student may change the light settings to 1x1mm bright beam with high mag to assess activity
 Student should comment on the iris and whether it is normal or abnormal
 Student should comment on the pupil margin and whether it is regular or irregular
 Student may comment on the PUPIL reactivity but should not comment on PUPILS reactivity
 Magnification should be at a minimum of 16x

 Student should ensure they have a suitable light setting to assess lens status (tall and thin bright beam)
 Student may increase magnification and should not attempt to comment on lens status at a magnification of anything less than 16x
 Student should comment on whether the lens is clear or opaque
 Student may comment on cataract if applicable

Question 5

specific settings for slit lamp (lids and lashes)

Answer 5

Lids and lashes
Angled (around 45)
Broad Dim 10x
Lid position (is there any entropion/ectropion); any lumps; any inflammation
Are lashes in correct position? Any trichiasis?

Question 6

specific settings for slit lamp (conj and sclera)

Answer 6

Conj and sclera
Angled (around 45)
Broad Dim 10x Any inflammation/redness?
Any pigmented lesions?
Any pingueculum/pterygium present?
Any conjunctival cysts?

Question 7

specific settings for slit lamp (cornea)

Answer 7

Cornea
Angled (around 45)
Thin slit Bright 16x
Corneal surface smooth?
Is the cornea clear?
Any ulcers/epithelial defects visible?
Any evidence of corneal grafts?

Question 8

specific settings for sit lamp (anterior chamber)

Answer 8

Anterior chamber
Angled (around 45)
Thin Bright 16x
Comment on the depth
Quick comment on whether or not it appears quiet

Question 9

specific settings for slit lamp (lens)

Answer 9

Lens
Angled (around 45)
Mid/thin Bright 10x or 16x
Is it clear? Any cataract present?
(May be easier to examine on 16x mag since slit lamp settings should already be on 16x)

Question 10

specific settings for slit lamp (retina)

Answer 10

Retina
STRAIGHT Mid Dim 10x
Ask patient to look at your ear (right ear for right eye)
Examine disc – comment on colour, contour, and cup-to-disc ratio
Examine macular area – comment on any obvious findings (e.g. drusen, exudates, cotton wool spots, haemorrhage)
Ideally examine peripheral retina as well

Question 11

features of BRVO

Answer 11

totrousity and dilation of the blood vessels

retinal hamehorhhages , flame shaped , dot haemorrhages
microanyerusms

multiple hard exudates
hypertension alone can cause brave

Question 12

features of pre- retinal hamehorrhage

Answer 12

retinal hamehorhhages : dots and blots

microanyerusms

causes , trauma , secondary to diabetic retinopathy

looks like a big sac/pool of blood

Question 13

features of central retinal vein occlusion

Answer 13

CRVO- main clinical features- papillodema

tortusoity and dilation of the central retinal vein

retinal haemorrhages
flame dot, shaped hamehorrhgaes in all 4 quadrants

cotton wool spots
cotton wool spots due to iscahemia
hypertension = cause of CRVO

Question 14

features of central retinal artery occlusion

Answer 14

attenuation of the arteries and veins

central cherry red spot with surrounding pale retina

cherry red spot is seen because macular arterial supply from the choroid can stil remain intact

Question 15

features of age related macular degeneration

Answer 15

drusen in the macula area

presence of haemorrhages and oedema in the macula area would suggest wet changes (not seen here)

Question 16

features of background diabetic retinpathy

Answer 16

blot haemorrhages

hard exudates

microanyerusms
if hard exudates on the macula area can cause maculopathy

Question 17

features of diabetic maculpathy

Answer 17

multiple hard exudates in the macula area some are circinate

haemorrhages and microanyerusms

hypertension is a risk factor for the development of diabetic maculopthay

hameh

Question 18

features of pre-proliferative diabetic retinpathy

Answer 18

multiple dot and blot haemorrhages

cotton wool spots

intra- retinal microvascular abormalities

new vessel formation on the disc

Question 19

features of glauocoma on a fundus image

Answer 19

large cup to disc ratio (indicating cupping of the optic disc)

superior polar notching

nasal displacement of central blood vessels

large cup to disc ratio = more than 0.5

presentation: tonometry will reveal an increased pressure

can be coniirmed using visual fields

central scotoma and painful eyes in most cases

diagnosis = mergence ongoing ishcameica due to pressure can cause vision loss