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Cases in practice

A diverse range of anterior segment cases is presented to test the practitioner’s ability to recognise and manage each condition.

Image A


01 In relation to the image shown, which of the following statements is correct? 

a) The anterior chamber is completely quiet
b) There is evidence of hyphema in the anterior chamber
c) Mild anterior chamber cells and flare can be seen
d) Hypopyon is present in the anterior chamber

02 In relation to this case, which of the following statements is incorrect?

a) It can be caused by a postoperative infection within the eye
b) It can be caused by a penetrating eye injury
c) This should be referred routinely to the GP
d) It is useful to measure the height of the anomaly to monitor the response to treatment

03 In terms of treatment of this condition, which of the following statements in incorrect? 

a) The causative organism needs to be identified in order to target the treatment
b) Treatment is with intensive topical steroids only
c) Usually a combination of antimicrobial and steroid is required
d) Patients normally require hospital admission to allow for intensive treatment

Image B


04 What is the likely condition shown in the image?

a) Herpes simplex keratitis
b) Microbial keratitis
c) Acanthamoeba keratitis
d) Fungal keratitis

05 In relation to this condition which of the following statements is incorrect?

a) Corneal sensation is normally increased in these eyes
b) Fluorescein is useful to show this lesion up in its entirety
c) The patient is often in considerable pain
d) The effect on vision depends on size and location of the lesion on the cornea

06 Which of the following management steps in incorrect?

a) Contact the on-call ophthalmologist to seek an urgent review
b) Topical steroids are used during the active phase of this condition
c) Treatment is often with topical and oral acyclovir
d) Topical steroids may be used in the later inactive phase to reduce corneal scarring

Image C


07 What is the main feature in this image?

a) Early posterior subcapsular cataract
b) Mild nuclear cataract
c) Moderate cortical cataract
d) Dense cortical and nuclear cataract

08 In terms of management, which of the following statements is incorrect? 

a) All cataracts must be treated before they get to this stage
b) Treatment is generally indicated if an improvement to visual function is possible
c) There may be risks to the eye by allowing a cataract to become hyper-mature
d) Ultrasound is sometimes required in these cases to assess the posterior segment

09 Which of the following statements relating to mature cataract and IOP is incorrect? 

a) IOP can increase if the cataract narrows the drainage angle of the eye
b) Removal of a dense cataract is sometimes indicated purely from an IOP control perspective
c) Debris from a mature cataract can cause inflammation which will lower the IOP
d) A dense cataract lens can subluxate and cause direct impairment of aqueous outflow

Image D


10 Which procedure has this patient recently undergone? 

a) Peripheral iridotomy
b) Iridectomy
c) Glaucoma tube/valve surgery
d) Trabeculectomy

11 In terms of complications with this procedure which of the following statements is incorrect?  

a) If the site of surgery leaks, the IOP can become too low
b) The drainage channel can scar over and become sealed
c )The patient can develop inflammation at the the site of surgery
d) Massaging the site of surgery can cause the IOP to increase

12 In relation to this procedure, which of the following statements is incorrect? 

a) Suitable eye protection is required for sports/work as the globe is more prone to injury
b) Patients sometimes require additional management with an antimetabolite
c) Patients never experience foreign body sensation following this surgery
d) Ocular lubrication can be indicated for these patients

About the author

Stanley Keys BSc (Hons), FCOptom, Dip Glauc, Dip TP (IP), is principal optometrist and clinical teacher at Ninewells Hospital in Dundee. He also works in private optometric practice and has gained independent prescribing status, as well as the College of Optometrists Diploma in Glaucoma. He is active in optometric education through his work with NHS Education Scotland and works with Optometry Scotland on professional development


  1. Carbonaro, F and Hammond, C. Optometric management of anterior segment eye disease – diagnosis and treatment of conjunctivitis and anterior uveitis. Optometry Today. 7 September 2009
  2. Buckley, R. Disorders of the cornea, part 1: Keratitis: Clinical signs and management: Module 8 Therapeutics in clinical practice, part 8. Optometry Today. 29 July 2005
  3. Heath, G. Management of primary open-angle glaucoma medical and surgical strategies: Module 7 Therapeutics in practice, part 5. Optometry Today. 5 November 2004

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    It would be nice to see the answers once the exam is past its date to find out where you went wrong and what was correct

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