Unit 6/8 Risk Factors, Symptoms, and Management of Common Ocular Conditions

What is the primary risk factor for Primary Open-Angle Glaucoma (POAG)?

Age: risk increases significantly after age 40, especially over 60.

Which ethnic groups are at higher risk for POAG?

Afro-Caribbean and Hispanic.

What systemic conditions are associated with an increased risk of POAG?

Diabetes and hypertension.

What ocular condition is characterized by high intraocular pressure (IOP)?

Glaucoma.

What are the key risk factors for Angle-Closure Glaucoma?

Hyperopia, shallow anterior chamber, older age, female sex, and East Asian ethnicity.

What is the strongest risk factor for cataracts?

Age.

Which lifestyle factor is a significant risk for cataracts?

Smoking.

What is a major risk factor for Diabetic Retinopathy?

Duration of diabetes.

How does poor glycaemic control affect Diabetic Retinopathy risk?

High HbA1c levels increase the risk.

What dietary factor is associated with Age-Related Macular Degeneration (AMD)?

High-fat diet/poor nutrition.

What is the strongest modifiable risk factor for AMD?

Smoking.

What symptoms indicate a red flag in ocular health assessment?

Sudden loss of vision, painful red eye, distortion, flashes & floaters, double vision, halos around lights.

What does LOFTSEA stand for in interpreting presenting symptoms?

Location, Onset, Frequency, Type, Severity, Effect on activities, Associated symptoms.

What is the significance of Shafer's sign?

Indicates risk of retinal tear/detachment.

What test is used to assess reduced vision?

Visual acuity (VA) monocular and pinhole.

What is the purpose of the Amsler grid test?

To detect metamorphopsia and assess macular function.

What is the rationale for using Goldmann applanation tonometry?

It is the most accurate method for confirming raised IOP.

What should be included in a management plan for ocular symptoms?

Immediate action, referral decision, guideline justification, safety-netting advice.

What is the gold standard for examining the external eye?

Slit lamp

What are common external eye pathologies to identify?

Staining, hyperaemia, tear film quality, collarettes, debris, chalazion.

What should be documented after an external eye examination?

Initial and follow-up findings clearly.

What is the importance of understanding pharmaceutical agents in ocular care?

To know their legal status, indications, contraindications, and side effects.

What is a significant risk factor for posterior subcapsular cataracts?

Long-term corticosteroid use.

What is the role of family history in assessing glaucoma risk?

Having first-degree relatives with glaucoma increases risk.

What lifestyle factors can increase the risk of diabetic retinopathy?

Poor glycaemic control, hypertension, hyperlipidaemia.

What is the relationship between age and AMD risk?

Risk rises sharply after age 65.

What condition is characterized by a shallow anterior chamber and hyperopia?

Angle-Closure Glaucoma.

What technique is used for an external eye examination?

Slit lamp with diffuse and parallelepiped illumination

What are common findings in dry eye disease?

Tear film debris, reduced TBUT, lid margin telangiectasia, collarettes on lashes, mild conjunctival hyperaemia

What is the management plan for dry eye disease secondary to MGD?

Warm compresses, lid hygiene, lubricants, lifestyle advice

What is the 20-20-20 rule?

Every 20 minutes, look at something 20 feet away for 20 seconds to reduce eye strain.

What should be done if significant bacterial component is suspected in blepharitis?

Consider chloramphenicol ointment and discuss indications/contraindications.

What are the signs of a chalazion?

Firm, non-tender lid lump

What is the management for a hordeolum?

Warm compresses, lid hygiene, avoid squeezing, chloramphenicol ointment if secondary infection suspected.

What are common symptoms of allergic conjunctivitis?

Papillae, itching, watery discharge

What is the recommended management for subconjunctival hemorrhage?

Reassurance, artificial tears for comfort, explain resolution in 1-2 weeks.

What are the indications for using OCT?

Suspicion of macular pathology, glaucoma assessment, unexplained reduced VA, vitreomacular interface disorders, diabetic maculopathy suspicion.

What does a raised IOP indicate?

Possible glaucoma or other anterior eye disorders.

What lifestyle advice should be given for managing dry eye?

Increase blink rate, use a humidifier, avoid air conditioning.

What is the purpose of safety-netting in eye examinations?

To advise patients to return sooner if symptoms worsen or new symptoms develop.

What is the grading system used for hyperaemia?

Efron grading system (1-2 for hyperaemia) and CCLRU for staining.

What are the common findings in cataracts?

Lens opacities, reduced visual acuity not improving with pinhole, glare symptoms.

What is a common non-surgical management strategy for cataracts?

Updated refraction, increased illumination, anti-glare measures.

What should be documented when referring a patient for cataract surgery?

Relevant history, examination findings, impact on lifestyle, non-surgical management attempted.

What are the potential side effects of chloramphenicol ointment?

Stinging and blurred vision.

What is the significance of the Amsler grid in eye examinations?

To assess for macular symptoms and detect distortion.

What are the signs of glaucoma?

Raised IOP, suspicious discs, RNFL defects, visual field defects.

What is the management for allergic conjunctivitis?

Cold compresses, avoid rubbing, OTC antihistamine/mast-cell stabilizer drops.

What is the role of omega-3 supplementation in dry eye management?

To potentially improve symptoms of dry eye disease.

What is the expected resolution time for subconjunctival hemorrhage?

1-2 weeks.

What should be done if a patient shows signs of significant cataract?

Consider referral based on visual acuity thresholds and functional impact.

What is the purpose of using a slit lamp in eye examinations?

To assess the anterior segment of the eye.

What are the signs of anterior blepharitis?

Collarettes present on lashes.

What are the symptoms that indicate a cataract significantly affecting daily activities?

Visual acuity below local referral threshold, symptoms consistent with visually significant cataract, and patient motivation for surgery.

What are the benefits of cataract surgery?

Improved clarity, reduced glare, and improved mobility.

What are some risks associated with cataract surgery?

Infection, inflammation, retinal detachment (rare), and refractive surprises.

What is the typical process for cataract surgery?

Day-case surgery under local anaesthetic with rapid recovery.

What advice should be given to a patient awaiting cataract surgery?

Continue current spectacles, avoid night driving if unsafe, and return if sudden vision drop, pain, or new symptoms occur.

What findings might indicate a patient does NOT need cataract referral?

Visual acuity improving with refraction, early nuclear sclerosis, and no significant difficulty with daily activities.

What is the rationale for not referring a patient for cataract surgery?

Cataract is not visually significant, symptoms are manageable with conservative measures, and the patient reports no functional impairment.

What should be included in the management plan for a patient with a red eye?

Obtain relevant information on onset, pain level, discharge, vision changes, and systemic associations.

What examination techniques are used for assessing red eye conditions?

Slit lamp examination, fluorescein staining, eyelid eversion, and IOP measurement.

What are the differential diagnoses for a patient presenting with a red eye?

Viral conjunctivitis, bacterial conjunctivitis, allergic conjunctivitis, dry eye, and keratitis.

What are the red flags requiring urgent referral in a patient with a red eye?

Severe pain, photophobia, reduced vision, corneal ulcer/infiltrate, and suspected HSV keratitis.

What are key glaucoma risk factors?

Age over 40, family history of glaucoma, ethnicity, raised IOP, thin CCT, and visual field defects.

What findings suggest open-angle glaucoma?

Raised or asymmetric IOP, suspicious optic disc cupping, RNFL wedge defects, and repeatable visual field defects.

What findings suggest angle-closure risk?

Shallow anterior chamber, narrow angles on gonioscopy, and symptoms of intermittent angle closure.

What is the management plan for a patient suspected of having glaucoma?

Use findings and risk factors to determine referral urgency and appropriate pathway.

What examination techniques are used for glaucoma assessment?

IOP measurement, Van Herick for angle depth, optic disc assessment, and visual fields.

What is the clinical impression for a patient suspected of early primary open-angle glaucoma?

Glaucoma suspect - likely early POAG.

How should a patient with viral conjunctivitis be managed?

Hygiene advice, cold compresses, lubricants, and avoid contact lens wear.

What is the management for bacterial conjunctivitis?

Lubricants, consider chloramphenicol if moderate discharge, hygiene advice, and avoid contact lens wear.

What advice should be given to a patient with allergic conjunctivitis?

Cold compresses, avoid rubbing, and consider antihistamine drops.

What is the significance of a patient's visual acuity in determining cataract surgery referral?

Visual acuity must be below the local referral threshold to consider surgery.

What is the role of patient education in cataract management?

Patients should be informed about the expected progression of cataracts and when referral would be appropriate.

What should be monitored in patients with cataracts who are not referred?

Review in 12 months or sooner if symptoms worsen, and maintain good lighting.

What are the common symptoms of red eye conditions?

Redness, discomfort, discharge, and potential vision changes.

What is the importance of safety-netting in eye management?

To ensure patients know when to return if symptoms worsen or new symptoms develop.

What is the expected outcome of cataract surgery?

Improved vision and quality of life for patients with significant cataracts.

What is the urgency for glaucoma referral?

Routine or soon, depending on severity.

What is the primary treatment for glaucoma?

IOP-lowering drops.

What are the early symptoms of glaucoma?

Usually asymptomatic.

What distinguishes wet AMD from dry AMD?

Wet AMD has sudden central blur and distortion; dry AMD has gradual central blur.

What is the management for dry AMD?

Lifestyle advice, monitoring, supplements, low vision support.

What is the recommended action for wet AMD?

Urgent referral within 1-2 days.

What are the clinical findings in dry AMD?

Drusen, RPE changes, geographic atrophy.

What are the clinical findings in wet AMD?

Subretinal fluid, intraretinal hemorrhages, lipid exudates.

What is the importance of early treatment in AMD?

Early treatment improves outcomes.

What are the stages of diabetic retinopathy?

Background DR, diabetic maculopathy, pre-proliferative DR, proliferative DR.

What is the referral urgency for proliferative DR?

Same day or within 24 hours.

What is the main treatment for proliferative diabetic retinopathy?

Anti-VEGF injections.

What lifestyle changes are recommended for diabetic eye disease?

Smoking cessation, good glycemic control, and regular screenings.

What are common treatments for cataracts?

Cataract extraction with IOL implantation.

What are the risks associated with cataract surgery?

Infection, inflammation, retinal detachment, refractive surprise.

What is the management for dry eye or MGD?

Lubricants, warm compresses, lid hygiene.

What are the symptoms of retinal detachment?

High myopia, previous detachment, family history, trauma.

What examination techniques are used for assessing retinal detachment?

Dilated fundoscopy, BIO with 20D lens, slit lamp with Volk lens.

What interim advice should be given to glaucoma patients?

Continue normal activities and avoid missing referral appointments.

What are the visual function impacts of macular degeneration?

Impact on reading, driving, mobility, and emotional well-being.

What should be monitored in patients with diabetic eye disease?

Systemic control (HbA1c, BP, cholesterol) and eye health.