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EYE
PLAB II-UKMLA CAPSULES
Conquer All 16, Score a Perfect 12!

Eye Stations – Visual Loss
Visual Loss

Acute

Painful

Chronic

Painless

PMH: PMR
+ Steroids

Acute Glaucoma

Retinal
Detachment

Cataract

GCA

Optic Neuritis

Ocular
Toxoplasmosis

Scleritis

Bacterial Keratitis

Others

Chronic glaucoma

ARMD

Ocular Herpes

Retinopathy

Diabetic
Retinopathy

HTN Retinopathy

Idiopathic ICH

Pituitary
Adenoma

Eye Stations – Others (Red Eye & Discharge)
1
...
Blepharitis

3
...
Arcus Senilis

SCHEME


OPEN QUESTION: Could You Tell Me More About That ?



FREQUENCY, TIME & TRIGGERS (FTT) + ANALYSIS OF THE MAIN COMPLAINT: SOCRATES



1) FREQUENCY: Is It The First Time For This To Happen ? 2) TIME: When Did It First Started ? Or For How Long This Have Been
Going On ? 3) TRIGGERS: Can You Think Of Anything That Might Have Triggered It ?



SOCRATES / FODPARA – In One or Both Eyes ?



RED FLAGS:



1) Any Eye Pain / Visual Problems ? 2) Any Fever ? 3) Any Headache ? 4) Any Vomiting Especially In The Early Morning ?



5) Any Weakness Or Numbness In Any Part Of The Body ?



SPECIFIC QUESTIONS (DDs)



MMA: Regarding your General Health, Any medical conditions ? Any medications ? Any Allergies ?



IMPACT & SUPPORT: I can see that 2 weeks of eye pain/Visual Disturbances is quite a long period, so how did you cope with
that ? How did it affect your life and mood? Job: What Do you do for a living ? Do you have anyone around to support you?



LIFESTYLE HABITS: Going to your Lifestyle habits, Do you smoke, Do you drink ?



DRIVING: Do you drive? So how did you come here today ?



IDEA & CONCERN: Do you have any idea what might be going on ? Do you have any concerns at all ?

6) Any Joint Pain ?

SCHEME


EXAMINATION:



1) Fundoscopy: That is to check the back of your eyes (Avoid in Glaucoma) 2) Visual Acuity: To see how well you can see



3) Visual Field: To see how well you can see in front of you and on the sides 4) Tonometry: To check the pressure inside your
eyes
...
Glaucoma



Avoid Driving
...


Acute Visual Loss: (Usually Within 24 Hours) (Immediate Referral)
A) Painful:
1
...
N: Avoid Driving
2
...

Management: Immediate Referral – Pain Killer: NSAIDs – Specialist will provide you with Steroids - Tests – Involve Senior - S
...
GCA (Giant Cell Arthritis) (PMR)
Key Points: Headache On The Side (Temporal Area) – Joint Pain - Jaw Pain While Chewing And Scalp Tenderness On Combing

Management: Immediate Referral – Pain Killer – High Dose Prednisolone, contact the specialist & discuss the case & we might even
give you the first dose now – Temporal Artery Sample / US – Blood ESR/CRP– Steroids Up To 2 Years Or Forever – Involve Senior - S
...
N Avoid Driving
4
...
N Avoid Driving – Avoid Contact Lenses For Few Weeks

Acute Visual Loss: (Usually Within 24 Hours) (Immediate Referral)

B) Painless:
1
...
N: Avoid Driving

2
...
P – Nerve Study
– Steroids – Involve Senior - S
...
Cataract (Examination - Manikan) (Routine Referral Except If In Both Eyes And Affecting Daily Activity – Urgent
Referral)
Key Points: Frequent Change Of Glasses / Contact Lenses - Cloudiness Infront Of Your Eyes - Difficulty To See At Night
Management: Routine Referral – One Day Surgery – Remove Old One And Put New One – 3 Months In Between
Every Eye Operation – Complications – S
...
Ocular Toxoplasmosis (Examination - Manikin) (Immediate Referral To Eye Specialist & Urgent Referral To Infectious
Disease Specialist)
Key Points: Been In Contact With Cats Recently - Immunocompromised
Management: Immediate Referral To Eye Specialist & Urgent Referral To Infectious Disease Specialist – Blood Tests – Different
Antibiotics (Pyrimethamine, Sulfadiazine & Folinic Acid) 6 Weeks – MRI – Advices: Avoid Undercooked Meat – Wash Hands Before
And After Dealing With Cats - Avoid Cat Faeces Or Use Gloves - S
...
Chronic Glaucoma (Routine Referral)
Key Points: Symptoms as Acute Glaucoma but Without Pain – Referred From Optician for High Pressure in The Eyes
...
N: Pain And Loss Of Vision
...
ARMD (Urgent Referral Within One Week)
Key Points: Old Age + Straight Lines Appear Wavy + Central Black Spot Infront Of Your Eyes
Management: Urgent Referral Within 1 Week – Scan The Back Of The Eye Whether – Dry Type: Magnifying Glasses Or Wet Type:
Multivitamins Injection Inside The Eyes Or Light Treatment – Avoid Driving – For More Inf
...
N Sudden Loss
Of Vision – Avoid Driving
...
Ocular Herpes (Immediate Referral)
Key Points: Rashes And Pain Around The Eye Preceded With Numbness – HX Of Herpetic Whitlow Or Cold Sores – Previous Attack Recurrent
Management: Immediate Referral – Pain Killer – Do Not Start Treatment – Swab – Oral Acyclovir If Presented Within 72 H – Advices:
Avoid Touch, Wash Hands, No Contact Lens- SN Getting Worse – Loss Of Vision
4
...
Diabetic Retinopathy (Examination - Manikan) (Routine Referral To Urgent Referral)

Key Points: Uncontrolled Diabetes – Referred By Optician – Detect The Cause Of Uncontrolled DM: F/U – Medication – Diet
Management: Routine To Urgent Referral- KFT – Metformin – Lifestyle (DESA) – Diabetic Clinic – Laser Therapy If Needed – Avoid
Driving – SN: Loss Of Vision

Chronic Visual Loss (Usually Weeks to Months)
6
...
N Any Weakness Or
Numbness In Any Part Of The Body
...
Pituitary Adenoma (Urgent Referral Within 2 Weeks)
Key Points: Two Incidents Of Scratching The Side Door Of The Car While Driving + No Other Symptoms Or PMH (But Ask
About Milk Discharge)
Management: Urgent Referral Within 2 Weeks to Endocrinologist – MRI – Prolactin Level – will offer meds that help
shrink the tumor and other options like : Surgery & Radiotherapy - Avoid Driving - S
...
Allergic Conjunctivitis (Routine Referral to Allergy Clinic)
Key Points: PMH/FH of Hay Fever/ Allergy/ Asthma
Management: Routine Referral – Self-limited - Antihistaminic Eye Drops – Avoid Trigger And Keep Diary
– Cold Compressions – Avoid Lenses And Eye Makeup – SN: Deterioration Of Vision – Pain
...
Sub Conjunctival Hemorrhage (Follow Up)
Key Points: Dark Redness in the Eye + H/o Sneezing/Coughing or Blood Thinners – All Of A Sudden
...

3
...

4
...

Management: Reassure – Lipid Profile – Advices (DESA) – SN: Visual Problem, Pain Or Redness – Offer
contact lenses for aesthetic reasons if bothering the patient

Eye Stations – UKMLA Cases
1
...
CRAO

3
...
Orbital – periorbital cellulitis

5
...
Uveitis / Iritis (Immediate Referral)

Key Points: Sudden (but could happen over a few days) – Blurry Vision, Eye Redness + Uveitis: Flashes & Floaters,
Usually Not painful – Iritis: Painful, Sensitivity to light, irregular pupil size on examination
...

3
...

5
...

Management: Assure – Usually Self limiting but might take some time – Advices: Warm Compressions, Gentle
Massage after the warm compressions, clean the eyelids twice daily with a cotton & warm water, Avoid Wearing any
contact lens until healed, Do not try to burst it – Chalazion: If Persisted Might consider steroid cream or a small surgery
– Stye: Painkillers – Might consider Antibiotics if not improved – S
...


Eye Stations – UKMLA Cases

8
...
N: Getting Worse, Pain On Moving Your Eyes, Bulging
Eyes, Affected Eye Vision – F/U After 48 Hours: Will Refer To Eye Specialist If Not Improved
...


9
...

Management: Urgent Referral To Eye Specialist Who Might Consider Giving Eye Steroids – Pain Killers, Artificial Tear
Drops For The Dry Eyes – Treatment Of The Thyroid Disease & Routine Referral To Gland Specialist: But Avoid Radioactive
Iodine As It Worsens The Eye Condition – Avoid Driving & Inform DVLA (If Vision Affected) – Advices: Wear Sunglasses,
Avoid Wearing Contact Lens, Avoid Staying For A Long Time In Smoky Or Air-conditioned Areas, Avoid Smoking, Balanced
diet & Good Hydration – S
...
: Getting Worse, Sudden Visual Loss Or Severe Pain – F/u After 1 week
...


➢

Scleritis: Condition Where There Is Inflammation In The White Part Of Your Eye
...


➢

Bacterial Keratitis: Condition In Which There Is An Infection Of The Most Transparent Part Of Your Eye Which Called Cornea
With A Bug

➢

Uveitis / Iritis: Serious Condition In Which There Is Inflammation Inside The Front Part Of The Eye
...


➢

Optic Neuritis: Condition In Which There Is An Inflammation Of The Nerves Of The Eye That Connect The Eye To The Brain
...


➢

Cataract: Condition In Which The Lens Inside The Eye Lose Its Transparency And Becomes Clouded
...


➢

Chronic Glaucoma: Chronic Glaucoma Is A Condition In Which There Is An Increase Of The Pressure Inside The Eye, And Is
Painless

➢

ARMD: Condition In Which There Is Degeneration Of The Back Of The Eyes
...


Definitions
➢

Diabetic Retinopathy: Condition In Which There Is Damage Of The Back Of The Eye Called Retina Due To Uncontrolled
Diabetes
...


➢

Bitemporal Hemianopia Due To Pituitary Adenoma: Condition In Which There Is Loss Of The Vision On Both Sides Of The Eye
Due To Benign Tumor Of Part Of Your Brain Called Pituitary Gland That Comprising The Nerves Of The Eyes
...


➢

Orbital Cellulitis: Serious Condition In Which There Is Inflammation Of The Orbital Tissue Of The Eye
...


➢

Allergic Conjunctivitis: Condition In Which There Is Inflammation Of The Outer Lining Of The Eye Globe Called Conjunctivitis
Due To Allergy
...


➢

Blepharitis: Condition In Which There Is An Inflammation Of The Edges Of The Eye Lid Causing Swelling, Itching And Crusts
...


➢

Eye Lid Problems: Condition In Which There Is A Lump Of The Eye Lid That Goes Away By Itself
...
However, since you are now here, we are going to act quickly and
accordingly to help you out and preserve your vision
...


➢

Why this happened to me? Well Since you’ve mentioned you are on escitalopram / Salbutamol – So I suppose this
might have caused your condition as it is one of its side effects
...


➢

Can I go to the hospital tomorrow ? Have children? Well, Am afraid you will have to go right away, cause as I told you
it is a serious condition, so it is very important to be referred immediately for further assessment and to start the
treatment as soon as possible
...


➢

Scleritis
Why this happened to me? Well, Scleritis can be associated with other systemic autoimmune disorders such as
rheumatoid arthritis
...


➢

Will it come back ? Well, Am Sorry to tell you that recurrence is possible, but with the follow up and treatment we will
reduce the probability of it recurring
...


➢

Is it serious? Well, Am Really sorry to tell you that it is a serious condition and unfortunately it is Sight threatening and
might lead to visual loss am afraid
...


➢

Can I go tomorrow? Well, I can see that you would like to go tomorrow, but may I ask you why? Well, Am afraid you will
have to go right away, cause as I told you it is a serious condition, so it is very important to be referred immediately for
further assessment and to start the treatment as soon as possible
...


➢

Concerns
GCA (Giant Cell Arthritis)
Will I get my vision again ? Unfortunately, We can't be sure of that but since you are now here, we are going to act
quickly and accordingly to help you out and preserve your vision
...


➢

➢

Is it important to do it ? Am afraid it is important to confirm the diagnosis and start the treatment
...
We will do regular
tests and follow up visits to re-evaluate your condition and adjust the dose accordingly
...


Concerns
Optic Neuritis
Will I lose my vision? I am really sorry you feel this way however we will do our best to prevent this from happening
or slow down this disease

➢

Can I Go to give my presentation ? Well, Am afraid you will have to go right away, cause as I told you it is a serious
condition, so it is very important to be referred immediately for further assessment and to start the treatment as soon as
possible
...


➢

Do I have MS ? Sorry to say that your condition most probably happens with MS but at the moment you don’t have
any nerve related complaints - explain MS , however we cannot confirm this until we run some blood tests and scans
...
But in such a case, let me assure you that we will do our best to slow down the process
...
But it usually happens with age or due to surgery or a trauma
to the eye
...
So that’s
why we will need to act quickly and refer you immediately to the hospital
...


➢

Could it happen again? Am afraid it might occur again
...


➢

Will I do the operation in both eyes at the same day ? No there will be a 3 months period between each operation
...


Why this happened to me? Well there are different causes for that, but in your case the long term steroid intake could
have caused it
...


How DVLA going to assess me ? The DVLA medical examination will consist of a medical questionnaire, some blood tests &
Visual assessment and according to the result they will decide whether you are eligible to drive or not
...


➢

➢

Will I be able to read again? Definitely, but you might need to use a reading glasses
...


Ocular Toxoplasmosis
Why this happened to me ? As you have mentioned you are growing up 3 cats so I believe you contracted the bug from
their poo
...
However since you have a weak immunity, unfortunately it might cause
serious complications, so it is highly recommended to start the antibiotics and follow up on time
...


➢

Concerns
Chronic Glaucoma
➢

What is high pressure ? The pressure of the fluid inside the eye is high which unfortunately affects the vision
...


Why I have this glaucoma ? Well there are many reasons, could be Age related – sometimes family history - sometime
there is no reason

➢

Can I drive? Well, There are DVLA regulations on fitness to drive since Glaucoma can affect the part of your visual field
needed to meet these requirements
...


➢

Will it get better? Unfortunately, the damage is irreversible but will do our best to slow down the progression of the
disease
...


Is it serious? Is it curable ? Most of the case show complete resolution, however some case might get some complications if the disease spread
inside eye, therefore we will start the treatment quickly along with some advices to prevent the spreading
...


Will I lose my vision? I am really sorry you feel this way, Let me assure you that your condition is still not serious since the infection is s outside
the eye
...


➢

Why this happened to me ? Because of the uncontrolled sugar level in your body, as it damages the blood vessels in the back of your eye and therefore
affecting your vision
...
But obesity might risk it happening
...


➢

Concerns
Pituitary Adenoma
➢

What is wrong with me ? Tumour of pituitary gland inside your brain, but the good news is that it is benign
...


➢

Is the surgery dangerous ? Well, let me assure you that with the help of the surgery we can remove the tumour easily
...


Concerns
Allergic Conjunctivitis
Will I lose my vision ? Well, let me assure you that its highly unlikely that your vision will be affected, & we will do our best
to prevent this from happening
...


➢

Why it happened to me ? Well Usually it could happen with people who have a history or a family history of allergies
...


Is there any treatment for my condition? As I told you it is self limited & there is no need for any treatment
...


➢

➢

Is it serious? Well let me assure you it is not serious & it is a Self-limited condition, usually takes 1 -2 weeks to resolve
...


➢

Will I lose my vision? Well let me assure you that its highly unlikely that your vision will be affected
...


Why it happened to me ? It is age related, but sometimes it could happen due to high cholesterol levels in the body so
that’s why we will check your lipid profile and follow up with you
...
nhs
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nhs
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nhs
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pdf

Retinal Detachment
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https://mft
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uk/app/uploads/sites/2/2021/08/REH-283-Microbial-Keratitis-2
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nhs
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imperial
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uk/-/media/website/patient-information-leaflets/ophthalmology/scleritisfinal
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nhs
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nhs
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gloshospitals
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uk/media/documents/Chronic_glaucoma_GHPI0595_04_21
...
nhs
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esht
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uk/wp-content/uploads/2020/11/0871
...
nhs
...
nhs
...
nhs
...
nhs
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Diabetic Retinopathy
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https://www
...
uk/conditions/age-related-macular-degeneration-amd/

https://www
...
nhs
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pdf

Blepharitis
❖

https://www
...
uk/conditions/blepharitis/



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