Computer generated transcript

Warning!
The following transcript was generated automatically from the content and has not been checked or corrected manually.

so welcome everyone to ask you see, if you guys don't really notice, please do follow us in other social media today, we're gonna be doing a final TV section on ophthalmology. It is a very potent topic to finals, and it comes out quite a bit. So we have Vincent, you're teaching. But before that, let's just, uh, have a quick look at our sponsors we'd like to try a grasp on. It is very much we have, firstly medical protection services to offer fantastic legal services. They have a weekly 183 lbs draw that are you. You automatically be entered. And if you sign up for the membership is free. So feel free to sign up and potentially win 100 and 83 lbs week meaty drop em deal or another medical difference organization on, and they provide this type of legal supporters. Well, if you're interested people to check them out for any F ones on the call, it is 10 lbs to renew your membership and a shoulder to medalis. Well, for helping us out there certificates, um, and feedback forms. If you don't already have an account place to create a counted metal. They're fantastic. That form, um, especially do these this amazing question question it. They're fantastic questions and, um, eating explanations that end to the questions. If you're interested in purchasing a membership and 1 20% off used to discount codes are squeezy 20 and you'll get 20% off your Quest Med purchased. We created an Oscar easy community. It's an open space to ask questions, literally asked about anything, whether it's ask used exams, welfare, finals of pre clinical stuff and things like that, and we'll drivers to answer them or guide you in the right direction for the answer. A quick addition to that we have launched our new peer, I, oh, account appear I. O is a online platform where you can try a lower past quizzes and stuff. So last year's majority of last year's quizzes forgot to be uploaded there a day or one free. You can bruise through all the quizzes and try them out. Attempt them to see how you do and all the answers and explanations also on the platform. It's off the reason why the the answer is the way this so feel free to check them out. That's why I think it's a three platforms. Is a few a few ground rules. Please engage in the pool pools. Please take your microphone and Cameron mute. Um, yeah, this This is the SBA basically, uh, as be a best session. So it's always good to engage in the polls, even if you get it wrong. Uh, it's fine, because you remember that way. Uh, session will be recorded, and the feedback from will be sent around three quarters into the session. So you get these slights is relatively the recording on the, uh, middle of that form. Uh, since we're a free platform, please, please share. It's on your social. That'll be able to get forms this and straight of fun. This do McConn so pleased traditional on your social explicitly your friends to communicate in our sessions if you find them useful. Uh, these are social media, all right. Today's presenter is Vincent, and he is He has a great interest in ophthalmology. He is our Cardiff's ophthalmology president Excellence. He the azelastine the chief financial officer on call, founder of false Keesey. I will, uh, let him, uh, take it away. Thank you very much. refined right? All right. The Highland Vincent on before the medical student at Cardiff on today will be going through, um, ophthalmology for finals. So first of all, before you begin, and I just want to all of you to just haven't image of this picture of the anatomy, because ophthalmology. It's a very visual subject. It's after Molly, isn't it? But I'm a lot of the conditions in ophthalmology can quite be quite easily differentiated by actually seeing. Looking at a condition itself on there for for endoscopy is the main investigation tool for all of most of the eye conditions. So by having a good image off what? How'd I anatomy? Looks like it's very important because it will be going Teo each, uh, ethology according to the location in a systematic manner in order to help you guys to remember on better. Sure. Let's go. Let's start off with the first FDA. How about the post, please? Yeah, Okay. Went in the cold has been called. Sure. So from the pool, I can see the majority of, um a, which is allergic. Hunter. Fight it, um, and then followed by until your bladder. I it is. And posterior both writers. This is actually quite a interesting question. Um, let's go through this question together. Um, the answer is actually interior of the brightest on the reason being is because the means presenting symptom in this patient is the grittiness feeling in his eyes on down, especially when infused like itchy in time to time. Uh, it shows that, like this, that the grittiness it's basically stuck to the eye eye lashes Onda fact that his I stick together when he wakes up in the morning. It's kind of quite classic presentation of left ear. I just and then. Then you asked her differential between and tear in first year of the right is on. Even the posterior don't fry it is is a more common type of left right is until your blood Friday. It's more associated with a seborrheic dermatitis. As you can see in this patient on this patient, this past medical history was using a rash with the course jealous scales in the stuff that's always a nappy area, and this is basically an indicative off support dermatitis in child, on which, which is one of the causes off interior black. Friday's to the fried is basically means the inflammation of island margins. On anterior estimation, it's mainly due to support and dermatitis or a staph infection. And posterior, even though it's more common, is a mania due to a moment and clan dysfunction. And you can see in this picture off. But fry it is. You can see this like crossed in grittiness phoned in the eyelashes on Day one of the classics. Intense. It's like a sticky eyelids when people wake up in the morning. Um, management for deaf writers can basically just be a warm compress er and let hygiene on. You can consider giving artificial tears if someone's feeling really itchy and dry, so their hygiene basically means that the use off cotton bud. And then just to try and relieve a lot of these and crusting on there, I lashes Hello there, too, and slight complication of there for writers if it's not treated or if you manage it port on which is style and lazy on sort of Easter conditions, what we call like a lump. I I love most common condition, like most common causes of islands. Oh yeah, let swelling I'm a style. Listen or no or it alone and then basically shows an abscess in the last follicle and at the plans of disease or move on the oh me um, gland. And this is mainly due to stuff infection, as this is a common complication of writers, and the main difference in Phoenix down actually easier is that style. It's normally painful Marshallese on this normal, painless on. In a classical examination question, they were always say, like a lesion is someone presents for their I lump, which points in words and on touching, refused for a small on, different from an style. Cialis, you're on is not an abscess. It's more or less like assist. And this is mainly due to the blockage of member me, um, plants and duck on. The management for both of these conditions are very similar to Blepharitis A. Such you both use a warm compresses to try and and help the patient relief the feeding of itchiness and sensation. But at the same time, because style is an accessory, consider giving antibiotics, especially vest, associate a constant Vitus. Unless you can see in this picture in the style, just like a small abscess. This yellow puss at the inch of the eyelash and until easier on you in DC basically found round lump. And when you press on it, it's supposed to feel firm and moving on to question, too. We have to push. Um, it it it's up to you when you want to call it in. Just give it up, people. When you say that again, we give it in 20 seconds. It is their stances. Fight split at the moment, right? I think what you call it that on. I think the majority of you and we won't compresses at the answer, followed by analgesia. And then the rest of you have pick or and keep politics. I've been about six and surgical excision that theon send this question is actually already antibiotics. And I'll go through this question and you understand why is because a me a 21 month old baby, 20 month or 21 month old is actually the median age for peri orbital cellulitis on day? If you know the age of like like some clinical like on some theology, knowledge, off period or bit of cellulitis, when you see 21 month or you could just carry orbital cellulitis right away. But it's it's the same time you can see this, like swollen red eyelids on. Do is we're still on the topic of eyelids. There's an island infection. It can either be a blepharitis or, if you'd be a periorbital orbital cellulitis associated with it. And then, as you can see in just constantly crying, which worsens when you're trying your eyelids, it shows that it's painful whenever you touch it. But then she's not Pyrex it. So you're thinking along the lines it could be a cellulitis, but because it's not, I wrecks it. So it's not on towards that, or it was a delight in this, and then whenever and then going through, they're really little. And all that cellulite is, as I mentioned previously, 21 months old. It's kind of like gave it away trade a way of, you know, s the median age. But very orbital cellulitis basically shows infection of soft tissues on deteriorate your orbit of septum. But this exclusive all bit itself well compared to a little cellulitis. Because the infection is in a deeper level of the fat and muscles, which is first tier, it always accept, including a little bit. Therefore, the symptoms are a lot more worse and period or with the cellulitis, and as a result, the associative management is also more aggressive than peri orbital cellulitis. Little light is a medical emergency because it can cause a permanent damage in on vision and competitive peri orbital cellulitis, which only had a red swollen, painful eyelids. Orbital cellulitis basically the same symptoms except the pain. It's a lot more worse, as a deeper will require oxygen people clear pain on public that we also have some visual changes, Um, such as reduce visual acuity, reduced television and our HCG, which revenge has explained really well in this than previous in your own lecture of year with us and proptosis to profusely. And then the reason why I put the toy dangling around. It shows that one key differential between over to a satellite visit carry over to this is a life. Is that the fact that the fat and muscle is infected, then hot and angry whenever you try and move the eye, the pain from the orbital cellulitis will increase a lot more and as a result, on symptoms, presence of eye movement and until that Because albuterol satellite it is Yes, Come can also start excusing and also course if even delays a systemic upstairs in the patient for investigation even though, if you quite confidence of peri orbital cellulitis, you're normally commonly do the same investigation just to rule up orbital cellulitis. Still, obviously, you do the F, B, C and swaps to see one organism of this. But on top of that, you also trying to contrast CT had an orbit 80 or and the most common organisms for both the cellulitis stuff a lot of guys or each unstrapped 97 wise you would for peri orbital cellulitis, your DHEA or okra Amoxil. I'm well over the satellite is you're treated more like sepsis, so you need a minute the patient and get them IV antibiotics. And if the symptoms worsen, would be more systemic. Upset. You were considering starting the sepsis halfway the moving on away from my eyelid. Questions on disses. Ah, third question. So can we launch the bulls? These that's given it on 20 seconds. All right, let's send it there, said the the majority of you guys answered and stuff. Four East and followed by clean Medio and as an insult behind a contract to bind it is. And then we've also got a few answers for having a virus on be trapped in a moment. So this is not your real easy and tricky question. Um, even Yeah. So basically, um, I said in this, uh, in this question, um, just because it's 14 days ago. So it's more cattle guys, a sub acute onset off infection on which is associative remedia infection. And then on top of that, because, um, the main given where is that? The system discharged over mixture of nutrition and plus, uh, ***. Both, um, uterus and pastas charge well for staph aureus of bacteria infection. You're more likely having a prudent a discharge or, in other words, just a plus discharge, rather than mixing it with mucus and most of the time, stop worries and had in a virus infection tend to be bilateral. It would normally start off in a lateral first before becoming bilateral. This is especially true for every new virus because of how infectious it is. But this is also company semen. Staph aureus for notice on commonly seen in adenovirus. That's a chlamydia It's mainly just on when I on, and the fact that the contact lens on he's been using contact lens for the last 30 years has allowed us to rule out allergic content, my interest, which I could see from the force no one has picked. So that's good. So let's go to cringe in my gist. So Clinton got sorry. So this is a picture of Clinton Vitus, um, one of them very common conditions that GPC all the time. I'm more than 50% of the cases. Result of the treatment, especially in 1 to 2 weeks on it is a bacteria infection is resolving incorrectly in quicker in less than a week's time on. In general, the management you want for people for going to invite is, um, device and maintaining bit high IgE. And try and avoid using contact lens during a period as contact lens uses. I have a much higher risk of having constant Vitus the non contact lens uses, and if it's a bacterial causation, immediate causation. You're used topical antibiotic, so card and physical and the foot the media. You also go to your gum clinic and treat the chlamydia infection systematically on it. It's allergic conjunctivitis, and you would get an active tested me to try and calm the surgery reaction. And, as I mentioned previously, in order to the friendship that causes off bacteria viral comedian allergic and then start off from the location. It's even viral, usually unilateral, before becoming bilateral. Wow, allergic normally bilateral because you could contact lenses. Know most of people. But contact lenses on both eye volatile, just lateral and chlamydia is unilateral, and it's more like a sub acute onset symptoms wise on down, more or less quite similar. You more or less having read a sticky or gritty. I feeling off having some foreign on this, and he most is basically a fancy term for this kind of the swelling, dizziness and immitis, uh, looking in the eye. So basically next, people black touched it. I'm all. That's why it's very important to ask the patient to maintain good hygiene hand hygiene on. Yeah, so I really want to. Next question and you have the post, please. 20 seconds. All right, let's send it back. I see the vast majority of on participants have picked DS eons removal rust and get topical antibiotics on. That is in fact, the correct answer. And this is a picture of a foreign body, and it's quite a Z. Conceive this picture on this read this black dots right in the, uh, things like the other day 16 showing what we call a rust ring. And this is basically the product of oxidation on the I in tissue to your oxidation. Nothing after being in contact with metallic objects. And you can see because Boniva is extremely sensitive and one of the organs are part of the body with the highest entity off innovation. And as a result, any foreign bodies or any accidents or just corn you're scraping will have, like a poor print disproportionate sensation. So you get extreme pain, even though it was like a small scratch, and this is shown here with extremely painful eye on because of the feeling of a foreign body. There's a increased lack formation, just like the fact that his optometrist friend try and remove the foreign object three hours ago, which I try to trick you with. Is that because it's a metallic object and there's a rust ring on? Even after removing foreign body just to need to go in the and trying to remove to rust around it and just moving onto question. Five. Before we go through more details about foreign bodies You're on the poles again. Please given in a 10 seconds. All right, let's call it that The majority of the participants has picked Be Topical Antibiotic as the answer, which is followed by corn. You're scraping and idea because it has a result in mind. I topical anti on public. A anti balletic is actually a good pick, however, if you look at this picture here and even though it's a good answer, but it's not the most appropriate answer on because this picture shows than anyone tell me what this picture shows on the tract. Just yeah, uh huh, I put my own is more like Think of it more like a soup, and it's It's not a hyper prior in this context, it's like, uh, it's called me out a lot of people, his answer cornea out, and in fact, this is one complication that carry tight it is, and the fact that you have a cornea. I was in this case, the first thing you have to do just like it, just like a person Abscess is you need to scrape it off as soon as possible before you start any other treatment. Because if not the treatment you started later on, we're not the effective. It's because it's a cornea ulcer, and it's non healing. So as long as there's a house today, again cause risk to further and visual damage on, the antibiotics would not be able to reach like, uh, the cornea in order to kill the bacteria. Thank you. I've also written that his professional swim on because of the one of the causes of your diet is is could be an Intamin ated water on. When you do Bactroban trading, there's when you do back stroke, you're looking up to the sky so it shows that this foot sleight photophobia and this comfort for the patient and contact lenses, just like a transient of itis, is one of the risk factors is all on then breathing on too, on foreign bodies. So I'm foreign bodies, and when you have foreign bodies, obviously you've got a feeding off on body, and this also associated with a red swollen, painful eye on. This is exact spirited. Whenever you try and even blink because of the foreign body being physically there and because of the foreign body, your body would try and get it off on whatever. It's not supposed to be there, and as a result you have an increased doctrine, a shin on because of the swelling bread and everything information going on, you tend to have low revisionist well, and you can have photophobias. That's all, as we mentioned in the previous Westchester in and we have seen a picture of the Rust ring, which is basically an oxidize metallic objects, if then investigate Foreign body. Most of the time for endoscopy is more than enough because you can literally see that foreign body being that, However, if you know able to see any foreign body and and if you know it's a metallic object, you would go for X ray. And if not, you go for an MRI happen. It's been it's quite straightforward on remove whatever it's not supposed to you there and give topical antibiotic just to left of prophylaxis and breathe. Corneal abrasion is basically when the epithelium covering the cornea, which is a very thin layer, pretty li UM, which is highly and innovated, is damaged and reached. And, I said mentioned before it's extremely painful because it's the highest. It's like innovation, density area and whole body symptoms. Very similar to foreign body on investigation This classic See you poor fluorescent and dye into your formula, and then you shine it with cold will blue light and then, if there's any damage, you know what color it was like double There's any damage on in breaches in the cornea. They put in a chat. Yep, in fact, amazing of the it's green. So you see at like a green color. Bad on the management. The cornea abrasion is given and get them cycloplegic, I said, Please. It was actually very useful. Whenever patients have thought of photophobia to relieve the symptoms and then you think consider giving topical antibiotics depending on group the insult, or whether or not you think there's a high chance of third investment throat infection shins? No, not not these. We also have a chemical injuries, and alkaline actually does more damage than assets because outline products are able to cause something called liquid Factive necrosis. Basically think of it like basically dissolving corn, you're straight away and as a result that it allows it penetrate deeper tissues of the I better to acid and course more damage. And, uh, this is problematic because most of the household hide items people have actually outlying more than acid. The college behind us is that because of the chemical injuries, it can cause damage to limbo, stemcell, niche and the cornea. And as a result of this, this courses on the limbic limbo epithelial oh layer to be completely lost on this is and forms of court process called Concerta vital ization. But this might be doing that for, like, uh, final examination. But we quite useful if you're gonna do to do that with the exam in the nation in the early this year. Basically, in simple terms of the chemical injuries, it is very important to treat right away by an irrigation on in order to reduce the damage caused by the chemical list and the sentence very similar to foreign body, except the fact that it's most of it and you can also see a hemorrhage. Is ulceration necrosis well on? I would have asked what the normal key issue of the eye voices. But as I've written down there already, So you just try and irrigate the eyeball is because you can until the pH is around 7.5 and you keep doing that on by rechecking it with a PH paper for every 20 minutes. Okay. And then we've gone to, um, carry tightest this of different several courses of current tightest. You've got bacteria, of course. I mean, I can't go amoebic and causes, which is a protease Owen infection. Fungal course, which is extremely rare. It's just see herpes simplex virus and Uncle Chad Circle Uncle Uncle Circle. I do apologize for about pronunciation, but this is a parasitic infection in general. Order it titers infections. You have a very similar symptoms off having a red swollen painful I untold that on. Patients normally tend to present with photophobia swell and reduced the acuity and because off impossible of having a cornea ulcer, you can get a foreign body sensation as well, and you can have tearing discharge on management in general. First of all is you need to remove contact lens of your wearing contact lens because this kind of the source of infection, or both characteristics and conjunctivitis. And on top of that, as I mentioned in a previous question on if there's a presence of cornea, you need to you're calling your scrape as soon as possible and going into deeper details on the management on specific courses occurred. Times is of bacterial has mentioned previously. You stopped using contact lenses, and you do intensive topical planted biotics and age of sight of plegic is to help with the symptoms of photophobia and discomfort, and then, plus a minus or a tetracycline is depending on the severity on. You can give fighting and see relations with the assistant and chronic bacterial carrot tightest uh, which is? I don't think you come commonly come up and find exams, but just something to bear in mind on. But the most common cause off, um, bacteria keratitis, especially for patients with hungry lenses. Student morning. I agree nose up on stuff or east, and then we're going to have protozoan infection and which is also when the highest risk factors as mentioned shoes, this contact lens uses but also exposed to contaminated water and on soil. So in this end, in the previous question, I'm trying to point towards on I can't oh amoebic and course of carrot itis because that the patient which presented a any was a swimmer and she also used to wear contact lens. So therefore increases her risk off exposure to contaminated water. I'm, as I mentioned previously, we stopped contact lens and then we get intensive anti amoebic agent, which is called a big wine night, and you get cycle Fiji. It's for symptomatic relief. So here's ah, bleak picture off how ugly this port is. Owen infections. Yes, I I do apologize for those who is really into a solid year and like a parasitic infections and stuff. But I'm not the biggest fan of that. So we belong to and and then course is a current tightest fungal keratitis, just like a fungal infections. But fungal and pneumonia and stuff is extremely rare, and that's more or less exclusively seen in patients that are immunosuppressants. The Jews said. I see you have HIV and which has progressive eight or those here on long term for the steroids as well as strong, including Lasix surgery. Whatever slightly increased risk of having fungal parotitis on because it's a fungal infection, you just give them anti fungal on treatment and then the cycle of the different type of carrot itis. You just like the side of rejects in order to help the patient for you better. So it says V. This is usually post left for Contrave itis and, as usual, seen, and patients here, like childhood 100 patients, especial officials, HST and Carrot Titers is that it can be a symptomatic on. People can actually have it without realizing that have it, and that comes and go. But if you disrespect patient, they just be carrot. Tightest, when you could do is give them antiviral and obviously given cycle plegic of their symptoms. And you can consider getting steroids for and you can also considering giving them steroids as well. And then we want t o the infamous Africa River blindness caused by this on call Terkel infection. As you can see, this is I got parasite infection on day for parasitic infections is pretty straightforward. Well, you just give anti parasitic I've ever met him and you give that a PGA. It's for the Yeah, symptomatic Pretty So just a quick conclusion. Quick summary for current tightest. You just need to stop on contact lenses for every patient and give them cycloplegic sport photophobia and then another medication used to treat the cause of it would basically didn't depend on the course of it. And I'm willing to question six. Okay. You had the post, please. I think the contact lenses, you know, we start until yeah, you know, we're starting to It's result given a study seconds. All right, Cool. So let's end of that. The vast majority of participants aspect is the answer, which is topical steroids plus cycle six full of, like, a mix up everything, actually that. Yeah, and says correct ago. Steroids inside the feeding on basically about problems as a thought and basically points awards an IBD infection. So if it's an IBD infection and ankle spondylitis and makes you think of on what type of conditions which can cause, uh and I problem and this is really hot, like I I'm facing, we pull someone, put it on a chat. What isco and indicate. Yep, yep. So and someone put their answer off the condition, but what type of condition or these? Like ankylosing spondylitis? Um I mean, like, you see, Yeah, I did you What time? Yep. Actually B 27. Perfect. I knew that were associated with your uveitis on, but the symptoms of you buy it. It's, uh, showing a red painful eyes in both eyes for the full B and blow visions. So on into your vitals and cancer and 90% of all the UV like this. And it's the inflammation iris. And so everybody's and the the rest of the 10% um, posterior uveitis this and it causes off the interior of the itis, vast majority of them idiopathic, and vast majority of them listed Shelley. So it's not majority. Sorry. It's a 50 50 split between being idiopathic and actually be 27. Associative conditions on these conditions includes my reading reactive arthritis and ankylosing spondylitis. Is it considered them view? Spine message Disease cycle goes this this well on, Didn't it is very rarely do to herpes virus, but it's very rare course that we, uh if you kind of you kind of back of your mind because I've seen questions come out with a herpes virus. Causing uveitis symptoms includes a acute onset of redness, pain and blurred vision, and also 44 E A. And also, as you can see under right, this is a classic picture of what we call assisted reflush, so illiterate, or the have blood vessels in on basically having a flush. And then I pull Pull Point in, as we mentioned previously, is like Puss on Inflammatory Cells and anterior chamber. How could a picture of that and when we send the slides out so you can visualize what it looks like? But it's more like more or less like some and fluids on filled inside your and he retained, uh, covering your eyes, and as a result of that, obviously reduce. This is your purity. The management, as most of you has got a correct, is a topical steroids and cycloplegic it's and then vision HSV. Do you get acid clover and the viral for HSV courses, but which is very, very rare. Want to question seven that we give it 20 seconds? It's in. We have stopped the pool now. Okay, sure, So I can see the majority of people chose and and certain steroids while others truth that answers and methotrexate. And then, um next between a B and D and how I understand why you guys have chosen on do certain steroids and and set on methotrexate. In this context, I am us. What condition are you guys thinking more about? When you chose and said steroids and and six methotrexate all in fact, on inside of pledge IQ. Feet six and yeah, immune modulated. I retook the lab and fixing my favorite and tract. Yes, someone said and swear I just and either on ST you can see in this, um, in this patient he only has slight discomfort when looking right place, and there's no changes in visual acuity or colored vision changes. I saw a note that he doesn't even have, like even reading this associated pain is only just a slight redness in his eyes, which started yesterday, and as a result, a second. See it's one active form. It E is one of the main was. It is osteoarthritis tests, but also a distal writers as well. But even but it's more commonly causing and spur itis and Episco. All right, is this connective tissue disorders, uh, more common causes off on episode ritis. If I'm not wrong and that's the result, you give them energies and sent it home. So unless the righteous, that's what this patient had and it has basically inflammation at the sclera, this is a lot more common dense. The right is which is an emergency on the course of both of these conditions are very similar autoimmune disease, especially room that rheumatoid arthritis. How the office will write is is classically a painless, uh, presentation combat. You're very Cimzia dull ache, deep pain in the eyeball and people waste come like in a vignette or in exam question. It could be something like, um so and so has always had this. Ah, classic pain and his eyes with developed over a few days and weeks, him up at night does more of a picture of the writers on all this to you, and you have read NIST and never school writers as well. But you can also have a mild, very mild photophobia watering, which this patient did not have from Mediscare writers, which is lot more angry because the sclera is much deeper than episclera. Guess you Dan Epithelium sits on top of this, so it was deeper, more closer to the center of the eye. So you think about it it's more closes, center and symptoms would be more will be worse than those which is superficial. And as a result of that, with the management for school ritis, it's a lot more than the management episcleritis. So, as I mentioned and question on the management office, still writers conservative so you could just give them some pain killers and then send them away. And first the writers very sorry for my cough, but let's get the writers and you differently. Weather's and necrotizing spare rightists or non necrotizing, is the writers if we treat it necrotizing. Some common signs of a necrotizing scleritis is that you can see the redness of the scare. Uh, and then basically it's necrotic haven't necrotizing as a result. In that case, you give them and sets and steroids. It's not know necrotizing. You get steroids immunosuppressants. So it could be anything from methotrexate infliximab and is very serious for the writers you consider giving them cyclophosphamide on, uh, investigation going to be useful to differentiate spitting at the school writers. That's the rightist. This by putting like pressure on the scleral vessels and see where they're not be able to move them around President's Day, right? Is this much deep, So you cannot you physically be able to move them around 12, and a fiscal right is because it's more on the service, so it's more likely that you'll be able to move them around, send anything the trees that's giving a 20 seconds. This is quite a tricky question. All right, cool. So let's call it that. So I can see the majority of the participants has picked week for 40 hours before surgery and then followed by a week for five days before surgery. In fact, one of these two are actually correct. Answer. But is it a 48 hours or five days? Still, in this case, let's look at a question on unless the patient is on warfarin. So I have a second conservative management for I mean pre op management of water, and you normally tend to stop the five days before surgery on because this isn't an option off. Let's say get, uh, if prothrombin complex right away and send him a surgery for the most appropriate answer. In this case, we're actually B C, which is the weight wait for five days before surgery on D some of you might ask. Oh, isn't a retinal detachment on surgical emergency in what you need to get surgical opinion straight away and then do a five corrected me and then followed by and gas a temp in our to fix, fixated that right in the back into correct position. It is correct. In fact, it is an emergency. However, there's a slight twist in this question is that his macular has been fully attached, and when the market has been fully detached surgery within 7 to 10 days, the difference in official outcome is exactly the same. So if this line is in there, the most appropriate answer would probably be give this patient Proton been complex and sent him to emergency surgery right away. But because of this, it's more twist there on bears in this option off sending him straight for a surgery way for five days before surgery will be most appropriate aunts in this case. So so, just quickly going through this question threatened attachments one of the rare complications off cataract surgery. And when you see the four F's flashing lights, floaters, what are the other after you have in a retinal detachment they put it on the track. Yeah, So exactly. A foreign acuity, which is showing an infusion Us? Exactly. So just remembered, four F is likely to be retinal detachment. A Z can see rapid and red reflex. It seems very abnormal. So shows the extent off the retinal detachment. I mean, I've felt going confirm this by six. His mattress fully has been fully detached it So So let's go through a retinal detachment and some other possible difference. You're diagnosed business fault. So retinal the patron, Exactly what it says on the 10 is a separation of retina from the retinal pigment, a thelium. Later, there's actually a different types of recommend detachment. There's something Rycam back to Genesis Retina. Detachment is when the retina detaches with the tear. So this's the most common classic retinal detachment. Then, when we say retina detachment, it's moved. May need this type on. But the main cause of this s an aging, because when your age a retinal pigment, um, epithelium deteriorates just like all your other 1000 body, and it's more prone to Terry on my opium. I'm short sightedness, cataract and surgery. Cataract surgery, which is like this is a very rare complication of it. And then you also have extra dated cause and tractional caused it now for a couple of guys have got that year. But yeah, traction A little basically a success on a 10 traction or force. And as you guys have very correctly pointed out, the four AP psych FLOTUS latches for your loss and four and visual acuity. I'm retinal detachment. It's usually pain in this, and sometimes in a question they can also describe US. Curtain descending. So investigation for retinal detachment is actually a friend oscopy. It still will be enough, and this will last from that clinical picture and you cannot see the detachment and using for not a P. You can consider using ultrasound because ultrasounds very, very accurately detect correct no detachment Management association management. So it direct to me and then unfolded. Buy gas temple, huh? And as I mentioned previously, one Learning Point. And that one's a Mac less completely detached. Study shows that so you have in 7 to 10 days, so they're different. And now come another problem with the retina and a half. It's posterior virtuous detachment is due to that the generation due to normal aging. A lot of people actually have it on because it's like a normal aging from the aging process. Uh, what's a visual acuity? And this new few time normal, very small flotus and flashes. But the extent of floaters and flashes are far less than a retinal detachment virtuous hemorrhage and is only indicated in a very refreshing for real field, an investigation as many fruits and oscopy to rule out other causes. I'm management wise is just a curse. Monitoring red dress him originally is basically what it says on the 10. This hemorrhage bleeding in the virtuous you you did your retina in your basket is a shin No, the most common cause of return your vascular very solution as proliferative diabetic retinopathy. But I can also we do two a progressive, posterial virtuous detachment, therefore, which this condition needs close monitoring. Then obviously troll mess. Well, because I'm rich, it's like bleeding, one of the most common causes of a sudden, painless lost the vision on you have a reduced visual acuity and reduce visual feud just as you're in a retinal detachment investigation with this is often oscopy, but you can also use a half a restaurant and yaga a free. So basically, you put the dye in, and then you basically try and visualize in in your vascular ization as well as any hemorrhage box hemorrhage on areas as well. And if you see there's a newer vascular reason in in a small area you basically treated conservatively as well as hemorrhage you treated conservatively. But if the hemorrhage is a large area and the symptoms is very, very, uh, serious. So a great reduction this reputation, visual fuses, you do it urgent, Right? Structure me five This basic feel a new thing of buttressed vitreous human up foods and then moving it. A cataract has the most common cause of blindness in the world and encloses of characterize age main. Cause of it is age, and then also you have sunlight smoking alcohol on GM time when a pipe PDM radiation, steroid use and dehydration. And the reason why these are the courses off after act is that because all of this and courses oxidative stress oxidation and as a result on because of the progressive oxidation accumulation, the protein and I protein and lenses the gentlemen denatures in the generates and, as a result, forming this and pass a cloudy lens appearance. Symptoms basically is gradually increased. Blurry vision on reduced this your acuity, and you also have a reduction. In contrast, sensitivity, color perception glare. Um, on a nuclear and diplopia. My sometimes occurs well, and ghosting on investigation is pretty obvious for endoscopy in literally see that on this cloudy lens right there and reduce red reflex on day management is use cataract surgery to replace the lens, which is most commonly amusing phaco and use if it cation and replacing it with intraocular lens, which is tailored to the patient faithful. And this ification, basically involved, need the use of ultrasound. The basic feet destroy and damaged the original. Tried the lens before you can remove it and replace the lens, we'll pick it down. Here is basically how most people see by the cataract like their cataract. This is what we called ghosting when my way can see shadows like ghosts, meaning like a pen. Ultimate question. Question nine. Kind of the pools, please. Sorry. Got options about and I will give it in 10 seconds. All right, let's call it so I I think the majority of people pick A is the answer and know vesica answer even though all of the other answers are suitable. But they're not the best answer in this case because this is closed. Angle on this acute so well you want to do is basically drawing hole into it as soon as possible and to relieve the pressure because if not as a i o. P. And increases and build up and then course on further pressure and damage on the nerves and as well, I started using blood flow, and as a result, I can cause a permanent vision damage on the long side. And this is one of the key risk factors placed ankle on. This is basically a picture of ah, how, uh, perfect in the sweat. Ah, like the importance off like having I brooks a good flow of the fluids in order for the anterior posterior chamber to communicate. And in this picture you can see the differently and open and close and go and in a closed angle the main reason why is very, uh, acute and very dangerous as an emergency is because of the building block and as a result, of block, which does not occur in an open angle or chronic open angle because of the sudden block that basically forces a posterior chamber to anterior chamber, no longer able to communicate or, in other words, close ankle can also be the non communicating. Um, a Zyrtec is ult because, um uh, fluid to block the pressure behind the iris increases, and as a result, it causes the peripheral iris to blow up and then and course is the anger too close and the IOP increases rapidly and normally on my opiates, normally at around 21. But it can go a new thing up to 58 or even 108 and then as a result, this, as I mentioned previously, you can cause damage to the optic nerves and reduce but supply and causes Kenya chronicle like oh Mr into chronic open angle and acute. Close that and go on. There's actually a lot more different types, like like, but I think these two are the most common cold you need to know for a final examinations. The chronic open angle it's normally do two of the generation of trabecular meshwork filter, and as a result, of course, it's actually feel the ganglion nursing, directed and well, in a huge close angle know it's normally acute, as mentioned announced. That is very during the upper stressful situation on because of that on, because is the period doctor come on suddenly and causes that acute onset off symptoms on, um, like chronic open angle? This is associate of long sightedness or a chronic this associated with short sightedness? I didn't tell it. Still, in terms for chronic open angle is that, um, people can describe. It's a tunnel vision and some because central vision, it's normally spread because you to density off that, uh, for the sensitive cells on visual lost normally occur in the peripheral areas first, and then just like acute flows angle, you always have the increased. I'll pee more than 21 on you. Conducive Fund. This exam on you shows a cup to dysplasia was greater than 0.7, which they're going 47 7 is normal on. You can see optic this is coming and then, on the other hand, keep it closed. Angle the symptoms. I'm more acute and you got a symptom that more serious or more serious, so you get an extreme pain. The vision looks. It was basically rings around. Light sources you can see, and because of the increased pressure back to your brain as well, you can feel nausea and vomiting. I Most of the time it's only on one eye, and that's a mentioned a race. I hope you're 52 80 even 100 because of the pressure, you can observe cornea and the muscle investigation wise, um, from the investigation to defend your acute from chronic as something called been oscopy, which is used to basically do the I read Oh, cornu angle especially, Yeah, differentiate closed angle from Oakland and go. It's a management for acute and chronic. It can be more or less the same because acute closed angle. As you guys answer correctly on this many do you use by a laser peripheral were adopted me on. Usually do by laughter. Oh, that laser period for adult to me, because people tend to have long psychic NIST. So if you had acute closed angle black or brown one night, your risk of having a group plus angle glaucoma and you had the highest, much higher So you would do a prophylactic later peripheral or a doctor. Me forget die for chronic open angle and basically the management or the different options. And you guys did not pick and you can give topical be two blocker prostaglandin and lock Alberto agonist, carbonic anhydrase inhibitor. And then and all of this does not control your mind. Open angle glaucoma. Well, you could be referred for laser trabeculoplasty. Basically. Then this is's name Trabeculoplasty and basically burns down the trabecular meshwork filter. And as a result, it burns found a match work. You have more space for the fluid to go and therefore less pressure. However, if this is associated with the rest of Lehi failure rate of about 50% after five years. So most people will tend to stay away from this treatment unless a sentence really bothering him for her on the medical management. He's not effective. Anything on it, too. My last question. Okay. And 20 seconds. Nothing would call it that. So the majority of people picked she is the answer, which is sent to retinal vein occlusion on. As you can see in this eyeball is basically, um, classic appearance of central retinal vein occlusion, and someone put it on a chat on how how you would describe this appearance of two words. Same hemorrhage is direct. You can see you. Same hemorrhage. Yeah, you do have a sunset, but anything else, son says one of the words, exactly. Now that says pizza. Like, I know you guys are hungry, but it won't be long, but it's not pizza, but as stormy sunsets. The correct answer on Basically, as you can see, it's It's quite angry looking appearance, and then you have, like a stormy sunset appearance. That's what they call it. And so I just couldn't be going through this question. Sudden pain is loss of vision, and that's good. The reason I didn't I like this. It's because it's not differentiate whether or not as and you're like central retinal artery occlusion of stent. True retinal vein occlusion risk factors of having central retinal vein Occlusion becomes more parent when we go through his current medications. He's going to be taking ramipril and a lot of green in batter might and spironolactone. So basically he's on four different medications for his hypertension. So you would think in your brain is like this guy's, but we have some resistant hypertension. And until that he's also diabetic because off his use of metformin, that's what prompted me to think that he might have diabetic diabetes and hypertension and, in fact, that Onda diabetes and hypertension are two risk factors or fentanyl vein occlusion but as well as um left in the artery occlusion but as the appearance which gave it away. So let's go through the central retinal artery artery occlusion first. So basically, it's exactly what says, um, tin occlusion in a central retinal artery. And the causes of this, this many causes. But it's more or less the same. That's like a risk factors for stroke. So hypertension, diabetes at the sclerosis and is classically. And the question will be like a dramatic loss of vision in 19 within seconds. And it is not associate with any pain associates with our GG and then a classic example and scenario. We showed that this patient on examination shows that there's a cherry red spot. As you can see in this picture here. Reason why it's a cherry red spot is because of the contrast between the macula on the surrounding, because McClair is a very rich collateral blood supply. I never think occlusion, despite the areas around it being severely affected. So there's a result. Can see as much pain at a normal Have you put a side by side of normal philosophy? But it has seemed at the same time, Um, because off how pale the surrounding is and how, uh, blood, blood rich, dense, the center of the macula is it shows a big contrast and therefore showing this a classic cherry red spots on examination. Cherry red spot spot. Basically, it's more or less central retinal artery occlusion and then other investigation. You can do this. BP on glucose at peace. Yes, are basically these are the investigation to look for the causes of risk factors for central retinal artery occlusion. But can anyone tell me what's the importance of es are lifted program than poorer artery biopsy exception of it. Now it's written down this just because one of the top differential diagnosis off central retinal artery occlusion on giant cell arteritis is so It's something you need to rule out the management for a central retinal artery occlusion five in the middle. That IV s set it zolamide, and then you can give Auckland massage and then that that doesn't work on. You can consider using Ampyra and change. That person teases basically any kind of trying to need some of the anterior chamber liquid on liquid in orders to relieve the pressure on. But this is extremely similar to the center artery occlusion. It's a retinal vein occlusion. There's actually many different types of retinal vein occlusion minute mean, maybe a central and branch retinal vein occlusion. But I don't think we need to know in that deter. But in general, the majority, uh, course the risk factors are retinal vein occlusion, a small, less same a central artery, um, occlusion. Then there's also a sudden Penis loss of vision in one night. But they can also be a symptomatic because of it, because it's a retinal vein. So the loss of vision it's less dramatic that central retinal artery occlusion and it's less likely associated with our PT. As a result, investigation is more or less the same. Less central retinal artery occlusion. You try and do the blood and go through all the risk factors. But at the same time, with endoscopy appearance as Ellen has mentioned correctly, and you would see a stormy sunset appearance. So basically it Trulicity and validation of the central retinal vein in this also clot in one spot. And blood hemorrhage is everywhere on my sins of this place that you consider giving an anti VGEF. Because neovascularization it's one of the risk factors off a retinal vein occlusion. And then you consider giving descemetocele implying, because it has for patients who cannot tolerate anti veg f and then and then your vasculitis duration. It's very extensive, as you can see in this case, you're considered using a hand retinal photocoagulation laser, which is basically a fancy name, and using the laser to burn off like the extensive new vascular a Shins vascular elicitation area. Right, so last in on these just quickly go through eight related macular degeneration. This is an active needing course of blindness for patients of 15 years older, above in the West and in fact, in the UK on this, many do two and increasing age because as you age as I mentioned previously, you have toxic metabolic products, much accumulating I, and as a result, you have to no pigment epithelium degenerates and causes nerve aspiration was susceptible. Thank you. The GS. And as a result of this, I'm just not ready. Generate. And that plays what provides you with the highest density of photosensitivity sensitive cells. You have a reduced visual acuity. And then we got something called matter more force. You met, um, more Fosa than anyone. Time on a chat with this. Me evens met him before. See anyone know where this needs. It's something you can find out using an insulin. So basically, uh, uh, fancy term for saying like, twisted or when you're trying to look at the straight line. Basically, it's like a twisted line. And also you have reduced this your food alongside a related maximum two generations. So these three are the key symptoms in patients of age related macular degeneration and then investigation. Just like what I conditions you do for endoscopy, where you also do a hamster feud to check with Metamorphosis year on CT. And there's two main types of age related macular degeneration. They need a weapon of dry type. The reason why it's called wet is because you can see us. There's extensive vascular ization off the macular and as a result, missing blood readiness everywhere. So it looks, went and then because this presence of new vascular ization and the symptoms tend to progress more rapidly than dry. Well, I I try macrogenitosomia in. I'm the management know wet, uh, macular degeneration is obviously to stop the progression off. New vector is a shin on a Xarelto. You give them interest in vitro and TV on digests on example really sentenced and dry macular degeneration and write it. And seeing Avastin is a shin, you see something called inducing and the retinal pigment epithelium layer will be changes well, so you can see an atrophy of that or focal hyper pigmentation manager and writes for this, however, on you cannot give Auntie Veg F because there's no new vascular ization. So it's more like a conservative management, and some will consider high dose anti often and supplements in order to slow down there, buildup off toxic products. But there's only like, limited evidence about it. And then you have my one No one drusen all So you guys, I wonder what answer a few s. So this is basically answer food. It's basically a square with some grades on lines and then for patients with age related macular degeneration. Yes, you can see a matter more full. Full Z, um, is basically the twisting of the lines when they try and document it. Er and Sigrid. And then So this is a very good picture of showing the difference between a dry Indian wet and E, and the dry nd can see drews. And so these are the spots on ball. So this, um, atrophy of the retinal pigment a thelium layer? Yes, that less, um pigmentation. And then for what? The mg Um, that's more neuro. I'm new vascular ization and also some Retin A hemorrhage. As a result, off the excessive new Avastin is a shin on day, the's picture. Do you guys know where these pictures are bouncing like this image modality. What do you call this, uh, image? My God, no, that is an old CT. Basically, it allows us to visualize the layers off the retinal pigment a thelium. And as you can see, this and this is something we call a cyst or a macular edema shown, which is more prominent wet mg. That's actually Yeah, and this is all city is something to use on a lot, especially when we try and look for mitochondria optic neuropathy. These and then I think, started. That's it for the ophthalmologist session.