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Routine cases in practice

Practitioners are invited to assess the cases presented and consider the diagnosis, aetiology and management.

Image A

Figure 1 close up of an eye

01 What is the most likely diagnosis of the case shown?

a) Episcleritis
b) Subconjunctival haemorrhage
c) Scleritis
d) Acute anterior uveitis

02 Which of the following symptoms is the patient most likely to report?

a) Mild irritation or ache
b) Marked photophobia
c) Severe pain
d) Reduced vision

03 Which of the following management steps is incorrect?

a) Use a cold compress to improve comfort
b) Commence topical steroids two hourly
c) Measure the patients blood pressure
d) Ocular lubrication to aid comfort

Image B

Figure 2

04 What is the corneal topography plot most likely to indicate?

a) Regular astigmatism
b) Post-corneal graft
c) Herpes simplex keratitis
d) Keratoconus

05 Which of the following is not a risk factor for this condition?

a) Chronic eye rubbing
b) Family history
c) Atopy
d) Being over the age of 65

06 Which of the following is not a suitable management option?

a) Prophylactic topical steroid eye drops
b) Therapeutic contact lenses
c) Corneal cross-linking
d) Corneal graft surgery

Image C

Figure 3

07 What type of visual defect is shown?

a) Homonymous hemianopia
b) Bitemporal hemianopia
c) Binasal hemianopia
d) None of these options are correct

08 Where in the visual pathway is the defect likely to arise from?

a) Optic chiasm
b) Optic nerves
c) Lateral geniculate nuclei
d) Visual cortex

09 Which of the following is the most likely cause of this defect?

a) Trauma to the back of the head
b) Primary open angle glaucoma
c) Pituitary gland adenoma
d) Stroke

Image D

Figure 4

10 What does the OCT image show?

a) Large area of geographic atrophy at the macula
b) Pigment epithelial detachment with subretinal fluid temporal to fixation
c) Marked intraretinal fluid
d) Intraretinal cysts

11 What is the most likely cause of this presentation?

a) Dry macular degeneration
b) Cystoid macular oedema
c) Central serous retinopathy
d) Wet macular degeneration

12 What is the most likely treatment?

a) Argon grid laser
b) PDT laser
c) Intravitreal injection with an anti-VEGF
d) Intravitreal injection with a steroid

About the author

Stanley Keys BSc (Hons), FCOptom, Dip Glauc, Dip Tp (IP) is principal optometrist at Raigmore Hospital in Inverness. He also works in private optometric practice and has gained independent prescribing status, as well as the College of Optometrists Diploma in Glaucoma. Mr Keys is a Fellow of the College of Optometrists. 

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