Anterior Segments
........................ Beginning with the lid, the most common case is likely to be tumour especially basal cell carcinoma. In the presence of an eyelid tumour you are likely to be asked about the differential diagnosis of a pigmented or non-pigmented tumour depending on the appearance of the lesion. 
After the lid, the conjunctiva may harbour some physical signs which one could easily miss unless the eyelids are everted. Abnormlity of the sclera rarely appears in the examination except for scleromalacia perforans. This is usually found under the upper lid and may be overlooked unless the patient is asked to look down and the upper lid elevated. 

                         Common lesions in the lids, conjunctiva & sclera

        • basal cell carcinoma
        • plexiform neuroma
        • cicatricial ectropion
        • adrenochrome
        • ocular cicatricial pemphigoid
        • scleromalacia perforans

The cornea is often the site of interest in the clinical examination involving the use of a slit-lamp. Therefore, it is important that you are familiar with the appearance of the most common corneal disorders especially the various corneal dystrophies. As the clinical pictures of corneal disorders may differ from one to another depending on the stages of development, the use of atlasesis invaluable in giving the candidate an idea how similar condition may have similar different appearance. For example,  an early keratoconus may only show Vogt's striaes compared with an advanced case in which acute hydrop produces a corneal scar. 

Also remember that: 

  • always examine the two eyes starting with the right then move to the left
  • always beware that more than one pathology may be present

                         Common corneal cases

        • buphthalmos
        • corneal graft
        • vortex keratopathy
        • band keratopathy
        • interstitial kertitis
        • Mooren's ulcer
        • keratoconus
        • Reis-Buckler's dystrophy
        • lattice dystrophy
        • macular dystrophy
        • granular dystrophy
        • Fuch's endothelial dystrophy
        • Peter's anomaly
        • radial keratotomy
        • chemical burnt

The anterior chamber and the iris are also common sites where abnormalities may be found. There are usually obvious except for Monteno's tube and iris transillumination which may be easily overlooked unless one bear in mind these possibilities. 

                         Common cases of the anterior chamber and iris

        • Molteno's tube
        • silicone oil
        • iris melanoma
        • iridocorneal endothelial syndrome
        • Axenfeld's anomaly
        • reiger's anomaly
        • aniridia
        • iris coloboma
        • siderosis bulbi
        • albinism
        • iris transillumination

The various physical signs associated with secondary glaucoma are favored by examiners. Inevitably, the presence of these signs lead to a discussion on the medical management of glaucoma. Look up the mechanisms of new anti-glaucoma drugs such as latanoprost and their side effects . 

        • trabeculectomy
        • pigment dispersion syndorme
        • pseudoexfoliation syndorme
        • Fuch's heterochromic uveitis
        • rubeosis iridis
        • previous acute glaucoma

The lens abnormalities seen in the clinical cases are usually associated with other physical signs in the anterior chamber (such as psudoexfoliation syndodrme, cataract in Fuch's heterochromic uveitis, pseudophakia in bullous keratopathy ) except for ectopia lentis. 

        • cataract of various types
        • ectopia lentis
        • psudophakia
        • aphakia
Return to station 1