Orth 423 written question station (practical exam) answers

1.Briefly discuss the management of HZO (3)

Prompt skin lesion management reduces ocular involvement risk.

If deeper cornea involved systemic antivirals with topical antivirals and topical steroids.

Advise patient they are infectious.

What is the current first line trx for ROP (1mark) List 3 advantages of this treatment in comparison to other treatments that are available (3 marks)

 Laser

Less myopia, better VA, fewer SE 

Fuch’s endothelial dystrophy (1)

Dermatoconjunctivitis (3)

Fuch’s - Endothelial transplant / Donor endothelium

Dermatoconjunctivitis - Remove offending medicine / preservative. Lubricating eye drops (preservative free) Cool compresses, avoid eye rubbing. If severe reaction steroids may be used

4.Describe the medical and nonmedical management used in DRY and wet ARMD (10 marks)

General/Dry: smoking cessation, diet, supplements (antioxidents),

• management of low vision (aids, increased lighting, soft/hardware)

• Counselling, Sight-Impairment registration

Wet:

• laser – PDT – surgical relocation

• antiVEGF treatments:e.g. ranibizumab – Lucentis,

• bevacizumab – Avastin,

• aflibercept - Eyelea.

compare the management options for bacterial and viral conjunctivitis. (10 marks) 

Bacterial - Self resolves ~ 1 week.

• Clean eyelids to relieve symptoms.

• Antibiotic (Eg. Chloramphenicol) drop or ointment an option.

• No CL wear while resolving. (4 marks)

Viral - Highly contagious (hygiene measures) but self resolves in 1-2 weeks.

• No Cl wear.

• Cold compresses.

• Lubricating eye drops.

• If corneal involvement topical steroids (6 marks )

6.Discuss the management of (10 marks)

1. a) Blepharitis (6)

• Lid hygiene Warm compress

• Lubricating eye drops Chloramphenicol / antibiotic topical steroids 

• Systemic antibiotics /  steroids 

1. b) Allergic Conjunctivitis (4)

• Self resolves, cold compresses

• avoid eye rubbing

• avoid allergen, drops - AH, MCS  

7. Compare the optical treatments and visual outcomes for children and adults after the removal of cataracts and explain why the differences occur (10 marks)

Depends on:  

Age at treatment eg congenital vs older child  

Unilateral vs bilateral eg in children or in adults with large anisometropia  

Any additional ophthalmic problems eg corneal problems prevent CL’s  

Adult: IOL – primary treatment Reading glasses to supplement – depends on target refraction VA outcome should be good if no additional problem 

 Children: IOL’s in older children, CL’s/glasses in babies  

VA outcome v variable dependent on amblyopia treatment 

 

8. What is the definitive treatment for paediatric glaucoma (1mark) What equipment is required for this procedure to view the anterior chamber angle and why (2marks)  Describe the advantages and disadvantages of this management option (7 marks)

Treatment

• goniotomy Equipment – gonioscopy because of total internal reflection

• advantages

  • Does not violate conjunctiva and prejudice success of future surgery ·

  • Direct visualisation of the angle allows precise location of incision

  • · Less traumatic and safer

  • Rapid and repeatable

  • No long-term risk of bleb related complications

  disadvantages

  • Not possible if details of angle structures not visible

  • Technically demanding with considerable surgical experience necessary ·

  • Requires special instruments ·

  • Discomfort for first few days if epithelium has been stripped