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Question 1

what is coloboma and what is the type of coloboma

Answer 1

Coloboma is the imcomplete closure of the embryonic fissure

types of coloboma:
- lid, iris, lens, retina, onh,ciliary body, choroid

Question 2

what is lid coloboma

Answer 2

congenital, and it vary from small marginal notch to a full thickness absence of the entire lid margin (1/3 to 1/2 )

• its common in upper lid and at the junction of middle and middle 3rd of upper lid
• astigmatism is common

Question 3

what is the management plan for lid coloboma

Answer 3

medical:
- corneal protection - artificial tear and oiltment, moist chamber bandages, bed time patching
- amblyopia management

surgical: patch lid tgt
- defect small w/o corneal exposure / obstruction of visual axis = delay surgery till 3-4 yo

Question 4

what is a iris coloboma and ssx

Answer 4

it is the failure of embryonic fissure to close in 5th week of gestation. “keyhole” pupil

typically located at inferonasal quadrant

ssx(includes/ may): photophobia in bright condition and glare, visual distortion and monocular diplopia

in PA 3/4 iris will move and constrict towards the notch.

Question 5

mx of iris coloboma

Answer 5

• special cl: that cover the keyhole shape pupil(round looking), improve cosmetic appearance of the eye as well as reducing light sensitivity
• surgery (option for some) - sew iris together correct pupil share and reduce light sensitivity (coloma region = sensitive)

Question 6

what is lens coloboma

Answer 6

• flattening of equator of the lens in an area of absence of zonular fibers.
• vx may be affected because of change in lens shape caused by notch / dent
• may have some catact - causing blur, misty vision, colour appearing dull and glare in vision

*big notch = vision uncorrectable

best visualised in dilated eyes and may be incidentally diagnose as they are almost always asymtom

Question 7

mx of lens coloboma

Answer 7

rx - treat w correction lens
- severe case (-) correct manifest refraction = consider lens extraction with iol placement to prevent amblyopia from developing *zonular abnormalities may exist and complicate surgery

Question 8

general mx of coloboma

Answer 8

-no medication and surgery can cure and reverse this and make eye whole again
-correct rx with spx/cl
- monitor for amblyopia
- treat eye condition present with coloboma e.g cataract (lens) / arise from coloboma
- use low vision
- genetic counselling

Question 9

what is megalocornea and its association

Answer 9

anterior segment dysgenesis
is the HVID or 13mm or larger, bilateral and non-progressive
its x-linked recessive (90% males affected)
associated with marfan syndrome, ehlers - danlos,down syndrome

Question 10

what is the objectives of megalocornea

Answer 10

normal al, fundus and onh,
reduce vitreous chamber and deep anterior chamber
normal vision and iop
- no symptom

Question 11

complication of megalocornea

Answer 11

• astig at birth
• presenile cataract - complicated surgery as zonular fibre is weaker with normal lens
• ectopia lentis
• glaucoma
• retinal detachment

Question 12

assessment and plan of megalocornea

Answer 12

congenital glaucoma (chronic poag) - trabescular meshwork not well developed

plan: education and reassurance

Question 13

what is microcornea

Answer 13

its a bilateral, HVID of 10 or smaller
autosomal dominant

Question 14

objectives of microcornea

Answer 14

associated with hyperopia, and shallow anterior chamber, normal vision

Question 15

assessment and plan for microcornea

Answer 15

• risk of high iop - due to narrow angle

plan - routine glaucoma(aacg) screening

Question 16

what is aniridia and its association

Answer 16

bilateral absence of the iris, total/ small stump of the iris base (iris hypoplasia), autosomal dominant

associated with: ectopia lentis, cataract, foveal and onh hypoplasia, nystagmus, conjunctivalization of peripheral cornea

Question 17

ssx of aniridia

Answer 17

glare, poor va (6/60 or worse), dry eyes

Question 18

assessment and plan for aniridia

Answer 18

check for glaucoma.
plan: cosmetic cl, low vision aid, sunglasses, artificial implantable iris, genetic counselling

Question 19

what is albinism

Answer 19

melanocyte are present but do not produce melanin.
its autosomal recessive.
white hair, pale skin, pink eye.

Question 20

ssx of albinism

Answer 20

poor vision (worse than 6/120)
high myopia and astig
nystagmus
macular hypoplasia
poor rpe fn
photophobia

Question 21

assessment and plan of albinism

Answer 21

handle px w meticulous care - dim as possible
-low vx aid, genetic counselling, dark sunglasses, good protection again UV - easily sunburnt

Question 22

what is heterochromia irides

Answer 22

asymmetric colour of the 2 iris

can be congenital(AD) /secondary to disease process

Question 23

what is the assessment of heterochromia irides

Answer 23

ddx from fuch heterochromia cyclitis, siderosis, iris melanosis, iris melanoma

Question 24

plan for heterochromia irides

Answer 24

photodocumentation, px education and reassurance

Question 25

what is persistent pupillary membrane

Answer 25

strand of iris linkinf iris

can be broken due to pupil dilation - stick on anterior lens capsule/ floats in anterior chamber

Question 26

mx of persistent pupillary membrane

Answer 26

1st year of life = ppm atrophy, no treatment
if it persist after 1 year it is less likely to regress spontaneously and this will increase the risk of deprivational amblyopia

small ppm - mydriatics, rx correction, patching (successful)
thick fibrotic membrane - may require surgical excision - usually @ first week of month of life , with good visual prognosis
*(-)tx=(-) affect vx

Question 27

what is ectopia lentis

Answer 27

dislocation/ displacement of the natural cystalline lens. caused by weakened/ deformed zonules
onset in teenagers, AR

luxated- dislocated - completely outside of the hyaloid fossa, free floating in vitreous in anterior chamber / directly on retina

subluxated - partially displaced but remains within the lens sPACE.
MARFAN syndrome @ risk

Question 28

ssx of ectopia lentis

Answer 28

monocular diplopia,myopia and astigmatism

Question 29

plan of ectopia lentis

Answer 29

annual monitoring of VA and rx to prevent refractive ambyploia
advise against contact sport
- many predisposing disease are hereditary - genetic counselling

Question 30

what is ditichiasis

Answer 30

extra row of lash behind meibomian gland
can be acquired - when lash grow at dysfunctional meibomian gland, may causetrichiases

Question 31

mx and assessment of ditichiasis

Answer 31

assess for cornea intergrity
mx: epilation, electrolysis, laser, cryotherapy

Question 32

what is leukocoria and its ssx

Answer 32

white pupil.

poor va, tropia , nystagmus (if bilateral)

Question 33

what is the role of optometrist in leukocoria

Answer 33

careful hx and examination

refer for dfe/ laser tx and or surgery

refractive correction / patching after removal of opacity - stimulus deprivation amblyopia tx

Question 34

disease presented with leukocoria

Answer 34

retinoblastoma
rop
congenital catarct
rd
onh/ choroidal retinal coloboma
persistent hyperplastic primary vitreous
coats disease