1. Surprises at the Slit Lamp

2. Female aged 42, complaining of mild FBS.
Non-contact lens wearer.

3. SLK (superior limbic keratoconjunctivits)
Other signs: tarsal papillary reaction.
Usually bilateral, may be asymmetrical.
Seen in soft CL wearers in conjunction with thiomersal preserved solutions.
Seen in patients with thyroid problems.
Can be associated with rheumatoid arthritis and Sjogrens. Other signs: filaments

4. Optometrist’s Management
Unpreserved artificial tears
Bandage CL
Plug the upper puncta
All of the above
Refer

5. Bilateral Appearance
Male aged 36. Asymptomatic.
Routine eye exam.

6. Refer or not?
Refer
Don’t refer

7. Ectropion Uveae
It is posterior pigmented iris epithelium on the anterior surface of the iris.
Rare, congenital, non-progressive.

8. 7 year old male c/o bilateral itchy eyes.
No tarsal involvement.

9. Phlyctens Normally asymptomatic. Can be single or multiple.
They are prone to recur, are thought to be due to a type of allergy to certain bacteria.
Associated with TB, intestinal parasites, tonsilitis, ulcerative blepharitis.

10. Optometrist’s Management
Lid hygiene (LH) and refer for steroids
LH alone
LH and OTC anti-allergy drops.

11. 45 year old man had bilateral LASIK to correct hyperopia.
6 mths post-operatively (3mths after being discharged) he came in c/o intermittent blur around lights coming from his RE only.
He had no symptoms at the time of presentation.
bilateral LASIK to correct
hyperopia
IOPs were R:23 L:18 mm Hg

12. Optometrist’s Management
Same day referral to ophthalmologist
Refer to ophthalmologist within a week
Refer to ophthalmologist via the GP
Instil pilocarpine and refer immediately

13. Blue-eyed 28 year old female. R:-1.00/-0.75x180 VA 6/5
L:-1.00/-0.75x175 VA 6/5
6/5
6/5
Px reports disabling glare
from headlights at night.
Px also reports that she
does not tan easily.
Image from
Atlas of ophthalmology, ophthalmology unit, University of Malaysia and ophthalmology
Department, Sarawak general hospital

14. Albinoidism
Albinoidism is diagnosed when the patient has iris transillumination defects but normal VA, no nystagmus and no foveal hypoplasia. This is what differentiates it from albinism.

15. Optometrist’s Management
Amber tinted glasses for night driving
MAR coated glasses for night driving
Grey tinted glasses for night driving
Opaque tinted contact lenses
Polarised glasses

16. Tints for Night Driving
Yellow or amber tinted lenses have been shown to be dangerous for night driving.
According to European standards lenses with less than 75% transmission (or greater than 25% absorption) should not be used for night driving.
Ultravision make a hydrogel custom-made opaque tinted lens to any Rx and base curve.

17. Female aged 35. Routine eye exam.
Non-contact lens wearer.

18. EyeRounds.org, the University of Iowa
Image retrieved from:
EyeRounds.org, the University of Iowa

19. Pigment Dispersion Syndrome
IOP spikes sometimes during or after exercise.
Associations: males, age 20 – 40, myopia.
It is estimated that approx 30% of patients with PDS will develop pigmentary glaucoma with men three times more likely to develop glaucoma than women.
Pigment stops dispersing at around age 40.

20. Optometrist’s Management
Refer to ophthalmologist
Monitor fields and IOPs every 3 mths and refer if they change
Monitor fields and IOPs every 6 mths and refer if they change
Monitor fields and IOPs annually and refer if they change

21. 35 yr old female, full time soft CL wearer
35 yr old female, full time soft CL wearer. Asymptomatic but bothered by cosmetic appearance of red eye.
Unilateral. Hyperaemia
confined to temporal
bulbar conjunctiva. No other
findings or relevant history.

22. Episcleritis Inflammation of the episclera. Cause unknown.
May be associated with rheumatoid arthritis, lupus, IBS, herpes, stress, hormonal changes.
Most cases will resolve spontaneously within 2 – 3 weeks.
Px can be referred for steroid drops to speed resolution.

23. A full time CL wearer comes in to you with unilateral episcleritis
A full time CL wearer comes in to you with unilateral episcleritis. Does the patient have to cease lens wear until the condition has resolved?
Yes No

24. Elderly,
asymptomatic
patient.

25. Crocodile Shagreen
This is the result of an irregularity of the stromal collagen lamellae which occurs with age.
Associated with older patients.
Asymptomatic. No effect on vision.

26. Female.
Age 45
Difficulty
with night
driving.
R:-2.50/-0.25x35 VA 6/9.5 L:-2.25/-0.75x165 VA 6/9.5+2

27. Corneal Farinata Ageing change of the cornea
Bilateral deep stromal opacities.
Best seen on retro illumination
They have no effect on vision and therefore require no treatment