Indications and Contraindications

Question 1

P.C indications for BIO:

Answer 1

visual disturbance, photopsia, floaters, metamorphosia, metachromatopsia, shadows, veils, curtain of reduced vision, scotoma, VF deficit, headache, diplopia, lid ptosis, pupil abnormalities, tramua (hyphema)

Question 2

G.H/systemic indications for BIO:

Answer 2

diabetes/hypertension/cancer/high cholesterol/lupus

Question 3

General indications for BIO:

Answer 3

reduced best corrected VA/VF, Fundus exam, Indications for DFE (stereo and mid-periph retina), Myopia -6 diopters or worse, history of retinal lesions predisposing to ret. degen. (lattice, etc.), cataract

Question 4

Contraindications for BIO:

Answer 4

• any contraindications for dilation or fundus (since done together)

Question 5

Indications for Tonometry/measuring IOP:

Answer 5

• first time/40 yr olds (esp. prior to dilation)
• glaucoma (risk factors, FOH, diagnosed, signs + symptoms, management tx)
• ocular conditions
• recent refractive change in one eye
• systemic conditions: diabetes, HT, migraine
• (previous) surgery or ocular injury

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Question 6

Contraindications for Tonometry:

Answer 6

• Infections
• Central corneal epithelial defects
• Epithelial basement membrane dystrophy
• Sensitivity to local anaesthetics/sensitive patients
• Trauma to eye/perforation of globe

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Question 7

Indications for Dilating:

Answer 7

• new patient/routine every 2 years
• flashers/floaters
• unexplained vision loss/reduction
• progressive retinal diseases
• systemic conditions
• hx: of head injury, eye trauma/surgery, chronic uveitis, periph. ret. degen,
• refractive error: myopia to high myopia, hyperopia, anisometropia
• limited view of posterior pole

New systemic routine flashes are progressive and unexplained. Check patient’s refractive error and history for disease and injury

Question 8

Contraindications for Dilating:

Answer 8

• Angle Closure Glaucoma
• Pilocarpine for Glauc tx
• Dislocation of lens crystallin, or IOL lens
• Fixed iris
• Hyphema (blood in A.C)
• Acute corneal diseases
• Hypersensitivity to dilating eye drops

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Question 9

Possible but not necessarily contraindications for Dilating:

Answer 9

• pregnancy/lactation
• narrow AC angle
• petite/anorexic people
• kids/children
• sick people

pregnant petite kids are sick and narrow

Question 10

Indications for measuring corneal shape:

Answer 10

• screening tool
• CL practice
• stability of cornea and tear film
• diagnosis/monitoring of corneal pathology
• pre/post refractive surgery/orthoK evaluation
• estimating astig when unreliable refraction
• IOL determination for cataract surgery

screen contact stability is the gold standard for surgery evaluation and estimating astig and IOL pathology

Question 11

P.C Indications for Fundus Lens Examination:

Answer 11

visual disturbance, photopsia, floaters, metamorphosia, metachromotopsia, shadows, veils, curtain of reduced vision, scotoma, VF deficit, headache, diplopia, ptosis, pupil abnormalities, trauma (hyphema)

same as BIO

Question 12

POH and FOH indications for Fundus lens exam:

Answer 12

• ocular conditions

- diabeties, glaucoma, AMD

Question 13

GH indications for Fundus lens exam:

Answer 13

Diabetes/Hypertension/Cancer/High Choloesterol/Lupus

Question 14

General indications for Fundus:

Answer 14

Same as BIO

Question 15

Contraindications for Fundus:

Answer 15

any contraindication for dilation

Question 16

Indication for Fan and Block:

Answer 16

When JCC doesn’t work

Question 17

Indications for Gonioscopy:

Answer 17

• narrow angle (VH less than 0.3, iris shadow more than 0.5)
• glaucoma suspect + signs of ACG
• iris neovascularisation
• retinal ischaemia
• iris anomalies
• uveitis
• trauma (iridodialysis, angle recession)

Question 18

List 8 contraindications for Gonioscopy:

Answer 18

• anaesthetic reaction
• lacerated/perforated globe (pressure will cause aqueous to drain out)
• hyphaema (will cause a rebleed)
• pregnancy (reduced corneal healing)
• corneal/conjunctival infection or epithelial basement membrane dystrophy
• corneal epithelium already weak
• OCT

Question 19

What 7 structures are viewed using direct illumination

Answer 19

lids, lashes, cornea, lens, conjunctiva, iris, AC

Question 20

What 7 structures are viewed with diffuse illumination

Answer 20

corneal deposits, CL deposits, CL fit, external eyelid/lash abnormalities, conjunctival cornea

Question 21

What 6 structures are viewed with PPD?

Answer 21

cornea/lens epithelium, cornea/lens endothelium, corneal integrity, depth + extent of corneal abrasion, CL fit, and surface tear film

PPD is the common technique to assess cornea

Question 22

2 uses for small spot

Answer 22

• examine anterior chamber

- detection of floating debris and A.C cells and flare

Question 23

3 uses for indirect illumination

Answer 23

• detect faint irregularities
• deeper areas of tissue
• foreign bodies

Question 24

What 4 structures are examined in specular reflection?

Answer 24

• corneal endothelium
• lens capsule
• tear film
• surfaces

(specifically looks at tear film quality, corneal endothelium, and anterior lens surface, ant. lens surface looks like orange peel)

Question 25

What corneal condition can be seen with specular reflection?

Answer 25

Corneal guttata. Is associated with Fuch's dystrophy. Appears as dark spots on corneal endothelium.

Question 26

What 3 things can be seen with sclerotic scatter?

Answer 26

any area of abnormality including: scars, oedema (stromal), particle/FBs

Question 27

Indications for Colour Vision Assessment:

Answer 27

- first visit/new patients (legal requirement) - when advice needed to tailor the learning needs of kids - when advice needed for day-to-day visual tasks - when vocational advice needed (can I be a pilot) - when a certificate of fitness has been requested (e.g. for an occupation or licence) - when an ocular disease is suspected (acquired CV defect)