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 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.
1. Name the anatomical structures numbered in this normal drainage angle. 12 11 13 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
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)
2. What is the normal route of aqueous flow? (Numbered: from à to) 12 11 13
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
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
3. How is this picture best described? n Incomplete posterior synechiae n Plateau iris syndrome n Peripheral anterior synechiae (PAS) n Iris bombé
4. Which risk factor least likely contributes to these slit lamp presentations?
4. Which risk factor least likely contributes to these slit lamp presentations? n Shorter axial length n Age n Myopia n Smaller corneal diameter
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
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
6. What is this called? n Caucasian male, aged 39 n Asymptomatic n Attending routine eye examination n Rx -3.00DS
6. What is this called? n Weiss Ring n Krukenberg Spindle n Kayser-Fleischer Ring n Glaucomfleken
7. What would be the management criteria for this condition? Caucasian male, aged 39, IOP 26 mmhg, -3.00DS, Central fields full.
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
8. What is an underlying cause of this presentation?
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
9. Which of the following prognoses is least likely to occur with this condition? Female, 73. Dilated with 1% Tropicamide. Asymptomatic
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.
10. Which glaucomatous condition may occur with this type of cataract? Male, aged 69. Light perception only.
10. Which glaucomatous condition may occur with this type of cataract? n Phacolytic glaucoma n Inflammatory glaucoma n Phacomatoses n Angle recession glaucoma
11. Name this method of treatment
11. Name this method of treatment n Laser peripheral iridotomy n Surgical peripheral iridectomy n Limbal paracentesis n Trabeculectomy
12. Name this method of treatment
12. Name this method of treatment n Laser peripheral iridotomy n Surgical peripheral iridectomy n Limbal paracentesis n Trabeculectomy