The Anterior Segment & Glaucoma Visual Recognition & Interpretation of Clinical Signs

Size: px

Start display at page:

Download "The Anterior Segment & Glaucoma Visual Recognition & Interpretation of Clinical Signs"

Rudolf Smith
6 years ago
Views:

1 The Anterior Segment & Glaucoma Visual Recognition & Interpretation of Clinical Signs Quiz created by Jane Macnaughton MCOptom & Peter Chapman BSc MCOptom FBDO

CET Accreditation C19095 2 CET Points (General) Instructions This VRICS poster quiz consists of a series of

You are encouraged to discuss with peers and/or use available materials to interpret the pictures and come to a

2 CET Accreditation C CET Points (General) Instructions This VRICS poster quiz consists of a series of anterior segment images and diagrams. You are encouraged to discuss with peers and/or use available materials to interpret the pictures and come to a accurate conclusion. To receive your CET points for this article, complete the Multiple Choice Questions. A pass mark of 66% (8 out of 12 correct answers) must be achieved. Only one attempt is allowed.

3 1. Name the anatomical structures numbered in this normal drainage angle Ø Anterior Chamber Ø Ciliary muscle Ø Ciliary Processes Ø Conjunctiva Ø Cornea Ø Iris Ø Lens Ø Posterior Chamber Ø Pupil Ø Schelmm s Canal Ø Sclera Ø Trabecular Meshwork Ø Vitreous

4 1. Name the anatomical structures numbered in this normal drainage angle. n (1. Cornea, 2. Conjunctiva, 3. Sclera, 4. Ciliary muscle, 5. Anterior Chamber, 6. Iris, 7. Posterior Chamber, 8. Vitreous, 9. Lens, 10. Pupil, 11.Schelmm s Canal, 12. Trabecular Meshwork, 13. Ciliary Processes) n (1. Sclera, 2. Conjunctiva, 3. Cornea, 4. Schelmm s Canal, 5. Vitreous, 6. Iris, 7. The Angle, 8. Anterior Chamber, 9. Lens, 10. Pupil, 11. Ciliary muscle, 12. Ciliary Processes, 13. Trabecular Meshwork ) n (1. Cornea, 2. Conjunctiva, 3. Sclera, 4. Schelmm s Canal, 5. Vitreous, 6. Iris, 7. The Angle, 8. Anterior Chamber, 9. Lens, 10. Pupil, 11. Ciliary muscle, 12. Ciliary Processes, 13. Trabecular Meshwork) n (1. Sclera, 2. Conjunctiva, 3. Cornea, 4. Ciliary muscle, 5. Anterior Chamber, 6. Iris, 7. Posterior Chamber, 8. Vitreous, 9. Lens, 10. Pupil, 11.Schelmm s Canal, 12. Trabecular Meshwork, 13. Ciliary Processes)

5 2. What is the normal route of aqueous flow? (Numbered: from à to)

6 2. What is the normal route of aqueous flow? (Numbered: from à to) n Flow of Aq: From 12à 5à 6à 7à 13à 4 n Flow of Aq: From 12à 5à 10à 7à 13à 4 n Flow of Aq: From 13à 7 à 10 à 5 à 12 à 11 n Flow of Aq: From 13 à 7 à 6 à 5 à 12 à 11

7 3. How is this picture best described? n 38 year old female with previous repeated episodes of anterior uveitis n Clinical features: n Ocular pain 2-3 days n Reduced VA to 6/18

8 3. How is this picture best described? n Incomplete posterior synechiae n Plateau iris syndrome n Peripheral anterior synechiae (PAS) n Iris bombé

9 4. Which risk factor least likely contributes to these slit lamp presentations?

10 4. Which risk factor least likely contributes to these slit lamp presentations? n Shorter axial length n Age n Myopia n Smaller corneal diameter

11 5. What is the most appropriate referral criteria for this condition? n Painful L eye, vision reduced to 6/18 from 6/5 n Dull ocular pain for past few days n RV 6/5 n Female Aged 53 n No previous ocular history

12 5. What is the most appropriate referral criteria for this condition? n Next day to General Medical Practitioner n Same day to Eye Casualty n Same day to Neurologist n Within the week to a Hospital Eye Department

13 6. What is this called? n Caucasian male, aged 39 n Asymptomatic n Attending routine eye examination n Rx -3.00DS

14 6. What is this called? n Weiss Ring n Krukenberg Spindle n Kayser-Fleischer Ring n Glaucomfleken

15 7. What would be the management criteria for this condition? Caucasian male, aged 39, IOP 26 mmhg, -3.00DS, Central fields full.

16 7. What would be the management criteria for this condition? Caucasian male, aged 39, IOP 26 mmhg n Emergency to eye casualty n Routine referral via GP to hospital eye service n Monitor in practice yearly n Monitor in practice every 3 months

17 8. What is an underlying cause of this presentation?

18 8. What is an underlying cause of this presentation? n Ischaemic central retinal vein occlusion n Diabetes mellitus n Long-standing retinal detachment n All of the above

19 9. Which of the following prognoses is least likely to occur with this condition? Female, 73. Dilated with 1% Tropicamide. Asymptomatic

20 9. Which of the following prognoses is least likely to occur with this condition? n Neovascularisation of the angle impairs aqueous outflow, producing secondary open-angle glaucoma. n Neovascularisation of the angle, impairs aqueous outflow, producing a secondary open angle glaucoma, followed by a secondary angle-closure. n A hyphema may occur leading to trabecular blockage by red blood cells and angle-closure. n Spontaneous regression of the rubeosis may occur following which the IOP reverts to normal. Patients may later be erroneously diagnosed as having normal-tension glaucoma.

21 10. Which glaucomatous condition may occur with this type of cataract? Male, aged 69. Light perception only.

22 10. Which glaucomatous condition may occur with this type of cataract? n Phacolytic glaucoma n Inflammatory glaucoma n Phacomatoses n Angle recession glaucoma

23 11. Name this method of treatment

24 11. Name this method of treatment n Laser peripheral iridotomy n Surgical peripheral iridectomy n Limbal paracentesis n Trabeculectomy

25 12. Name this method of treatment

26 12. Name this method of treatment n Laser peripheral iridotomy n Surgical peripheral iridectomy n Limbal paracentesis n Trabeculectomy

_ Assessment of the anterior chamber. Review of anatomy of the angle

_ Assessment of the anterior chamber. Review of anatomy of the angle Assessment of the anterior chamber Dr Simon Barnard PhD BSc FCOptom FAAO DCLP Department of Optometry & Visual Science City University London, UK Review of anatomy of the angle Figure 1. Anatomical section