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Anterior eye cases.

A range of different clinical scenarios is presented to test the practitioner's recognition and management skills. Readers are guided towards sources of reference to aid completion of the task.


               CONDUCT        DISEASE

A 67-year-old presents complaining of blurred vision, glare and haloes around lights. All symptoms are worse in the morning and VA corrects to 6/10.

01 What is the most likely diagnosis?

a) Fuchs' corneal endothelial dystrophy

b) Contact lens over-wear

c) Corneal hydrops secondary to keratoconus

d) Posterior polymorphous dystrophy

02 What are the non-surgical treatment options?

a) Hypertonic 5% saline eye drop

b) Judicious use of a warm air source, such as a hair dryer

c) Therapeutic bandage contact lens

d) All of the above

03 Which surgical option can be undertaken with simultaneous cataract surgery for this condition?

a) Intrastromal corneal ring segments

b) Corneal collagen crosslinkmg with Riboflavin

c) Descemet's stripping automated endothelial keratoplasty

d) None of the above

Therapeutic optometrists      KNOWLEDGE   OPTIONS

Slit-lamp examination shows iris hyperpigmentation in the inferior temporal region of the left eye which the 76-year-old patient reports having since birth.

04 Which of the following is the most likely diagnosis?

a) Iris melanocytosis associated with increased risk of developing a uveal melanoma and should be referred

b) Iris melanocytosis which is not associated with increased risk of developing a uveal melanoma

c) Primary iris cyst which should be monitored and only referred if it changes size or shape

d) None of the above

05 What percentage of melanomas arise in the iris?

a) 80%

b) 50%

c) 12%

d) 8%

06 Which techniques may aid differential diagnosis?

a) Ultrasound biomicroscopy

b) Fine needle aspiration biopsy

c) Conventional trans-scleral biopsy

d) All of the above

An asymptomatic patient attends for contact lens aftercare with vision of 6/5. The topography image shows the change to her left cornea within a six-week period.

07 Which of the following is most likely to explain the degree of corneal change within the time period?

a) Corneal oedema due to over wear of a soft contact lens with a low Dk/t

b) Corneal warpage as a result of a poorly fitting RGP lens

c) Remoulding of the corneal shape using orthokeratology

d) Modification to the corneal curvature using a scleral contact lens

08 Which refractive error is most suitable for correction with this type of contact lens?

a) -2.50DS/-1.00DC x 180

b) -2.25DS/-1.50DC x 90

c) -7.50DS

d) +1.00DS/-1.00DC x 90

09 Which condition would be contraindicated for this lens type?

a) Keratoconus

b) Pellucid marginal degeneration

c) Epithelial basement membrane dystrophy

d) All of the above

10 Which imaging technique is being utilised in Image D?

a) Laser confocal meibography

b) Optical coherence tomographic meibography

c) Contact meibography

d) Non-contact infrared meibography

11 Considering eyelid anatomy, which of the following statements is true?

a) The meibomian gland, the Gland of Zeis and Gland of Moll are unilobar sebaceous glands

b) The meibomian gland and the Gland of Moll are sebaceous glands, the Gland of Zeis is a modified sweat gland

c) There are approximately 30-40 meibomian glands in the upper lid and 15-20 in the lower lid

d) There are approximately 50-60 meibomian glands in the upper lid and 30-40 in the lower lid

12 Which of the following statements is false?

a) The tear film can be disrupted by either low production of meibum (hyposecretion) or excessive amounts of poor quality meibum (hypersecretion)

b) Hyposecretion can be due to a physical obstruction of the ducts by keratinised epithelium

c) Reduced meibum production can be influenced by hormone levels, age, contact lens wear and various medications

d) Hypersecretory changes are not commonly linked to dermatitis, acne rosacea and atopic disease O

Exam questions

Under the enhanced CET rules of the GOC, MCQs for this exam appear online at Please complete online by midnight on 23 December, 2015. You will be unable to submit exams after this date. CET points will be uploaded to the GOC within 10 working days. You will then need to log into your CET portfolio by clicking on 'MyGOC' on the GOC website ( to confirm your points.

Course code: C-42827 Deadline: 23 December 2015

Learning objectives

General Optical Council

Approved CET

For Optometrists

* To understand the appropriate management response for a range of anterior eye presentations (Group 2.2.5)

* To be able to recognise and investigate the presenting signs and symptoms of the patient (Group 6.1.2)

General Optical Council

Approved CET

For Therapeutic Optometrists

* To understand the presentation of a range of anterior eye conditions and the likely prognosis for the patient (Group 1.1.1)

* To understand the differential diagnosis for a range of anterior eye presentations (Group 2.1.4)

Craig McArthur MCOptom

* Craig McArthur

Craig McArthur is an optometrist working within independent practice. He is a visiting lecturer and clinical tutor to undergraduates at Glasgow Caledonian University where he also teaches the glaucoma module for the independent prescribing course.


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Title Annotation:VRICS: Corneal conditions
Author:McArthur, Craig
Publication:Optometry Today
Geographic Code:1USA
Date:Dec 1, 2015
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