Attention should be given to the wording of the question which often directs the candidate where to look:
Always stand back and examine the patient as a whole. Age / gender / ethnicity are often useful in narrowing the potential differential diagnoses. Iris heterochromia, symblephara, ankyloblepharon and forniceal shortening are often more obvious on gross inspection before beginning the slit lamp examination.
In addition, look at each corneal layer:
The presence of one sign (e.g. a conical cornea) should prompt you to look for other associated signs of that condition (e.g. Down syndrome, vernal kerato-conjunctivitis, Fleischer ring- best seen with cobalt blue light, prominent corneal nerves, hydrops / corneal scarring and Vogt striae of keratoconus).
If an ocular surface mass is present (e.g. Ocular surface squamous neoplasia), you must exclude orbital invasion. Check for:
If an intraocular mass is present (e.g. iris melanoma), then check for:
Record important negatives (e.g. absence of hypopyon / synechiae in infection). Consider further examination / testing: fluorescein staining, corneal sensation, Schirmer’s test.
Draw diagrams as large as possible. Measure all lesions. If there is time in the examination, diagrams may be colour coded.
Investigations will be dictated by findings, but may include:
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Vitreoretinal Surgery Online
This open-source textbook provides step-by-step instructions for the full spectrum of vitreoretinal surgical procedures. An international collaboration from over 90 authors worldwide, this text is rich in high quality videos and illustrations.