CONTINUING PROFESSIONAL DEVELOPMENT (CPD) Test your knowledge and understanding This page is designed to help you test your own understanding of the concepts covered in this issue, and to reflect on what you have learnt. We hope that you will also discuss the questions with your colleagues and other members of the eye care team, perhaps in a journal club. To complete the activities online – and get instant feedback – please visit www.cehjournal.org
1. The hospital manager is keen to implement a cataract surgical safety Select checklist to ensure that patient safety is managed well. The checklist: one Picture quiz Should be done before the patient arrives in theatre so as not to delay the a operation Should be done at three points in time: before the patient receives anaes- Allen Foster b thesia, before incision and before the patient leaves the operating room c Must be managed by the same person to ensure consistency d May be generic, i.e. from any health service Select 2. When obtaining consent from a patient it is NOT necessary to: This is a picture of a 12 year old girl in East Africa. one Q1. What abnormality can you see on examination? Check that the patient fully understands the proposed treatment and a a. Orbital cellulitis alternatives b. Ptosis left eye b Inform the patient of the possible consequences with and without the operation c. Lagophthalmos left eye d Inform patients of their right to refuse the treatment options provided d. Proptosis left eye e Discuss the patient’s details and medical history with the patient and family e. Enophthalmos right eye Select 3. An incident reporting system: Q2. Which of these examinations / investigations one would be appropriate and why? a Requires that there be a clinical governance group in place a. Ocular movements b. Examination of the cornea for exposure b Could demotivate staff c. Examination of the pupils ANSWERSc Focuses on assigning responsibility to individuals d. Orbital X-ray d Is time-consuming e. Thyroid function tests f. Biopsy of a palpable lymph node 4. A patient with suspected acute endophthalmitis following surgery Select should be: one Q3. What do you think is the differential diagnosis? a Managed with povidone iodine 5% applied to the cornea and conjuctival sac
ANSWERS cyclophosphamide.
b Started on corticosteroid drops without delay intravenous with treatment to responded She
Checked using B scan and urgently given a pars plana intravitreal tap to test tumours. abdominal with associated be may and progressive
c rapidly usually is It years. 5–15 aged children in Africa East in the vitreous using gram stain and culture, and then given intravitreal antibiotics proptosis of causes frequent more the of one is which lymphoma
d Observed until there are clear signs of hypopyon and vitreous opacities Burkitt’s to due proptosis unilateral had child This Africa.
children, and dysthroid eye disease is generally uncommon in in uncommon generally is disease eye dysthroid and children, 5. High myopia is associated with an increased risk of developing sight- Select in uncommon is this but disease, eye dysthyroid to due be
threatening conditions, including: one may adult European a in proptosis example, For presentation. of
Also, causes vary according to geographical distribution and age age and distribution geographical to according vary causes Also,
a Retinal detachment malignant. or benign is tumour the whether to as guide a be can
can cause proptosis. The rate of development of the proptosis proptosis the of development of rate The proptosis. cause can
b Sjogren’s disease which sinuses neighbouring and orbit the of lesions occupying There are various benign or malignant space- malignant or benign various are There Answer: 3.
c Stevens-Johnson’s syndrome
definitive diagnosis. definitive
d Strabismus a make to help may biopsy a then nodes lymph palpable
disease, although this is uncommon in children. If there are are there If children. in uncommon is this although disease,
Produced in collaboration with JCAHPO: the Joint Commission on Allied Health Personnel in eye dysthyroid in abnormal be may tests function Thyroid
Ophthalmology (www.jcahpo.org) abnormalities. sinus or bone orbital show may X-ray An vision. the optic nerve leading to an afferent pupil defect and loss of of loss and defect pupil afferent an to leading nerve optic the
ANSWERS compress may tumour orbital An vision. of loss and ulceration in high myopia), retinoschisis, posterior staphyloma, glaucoma retinal detachment, and cataract and detachment, retinal glaucoma staphyloma, posterior retinoschisis, myopia), high in Protrusion of the eye may lead to corneal exposure, corneal corneal exposure, corneal to lead may eye the of Protrusion
myopic macular degeneration (defined as atrophic changes or choroidal neovscularisation in the macular region region macular the in neovscularisation choroidal or changes atrophic as (defined degeneration macular myopic Ocular movements may be limited by a lesion in the orbit. the in lesion a by limited be may movements Ocular
5. a. a. 5. A. High myopia is associated with an increased risk of developing sight-threatening conditions such as as such conditions sight-threatening developing of risk increased an with associated is myopia High A. 2. Answer – all of the above tests are appropriate. are tests above the of all – Answer 2.
diagnosis and management must be followed as soon as possible. as soon as followed be must management and diagnosis
A suspected case of endophthalmitis should be treated as a medical emergency and a clear protocol of of protocol clear a and emergency medical a as treated be should endophthalmitis of case suspected A c. 4. right eye, rather the left eye is pushed out. pushed is eye left the rather eye, right
incident reports and formulate communication and training to encourage team members to improve patient safety. patient improve to members team encourage to training and communication formulate and reports incident sunken back into the orbit. There is no evidence of this in the the in this of evidence no is There orbit. the into back sunken
3. a. 3. A clinical governance group, made up of representatives from all departments, is ideally placed to analyse the the analyse to placed ideally is departments, all from representatives of up made group, governance clinical A picture – both eyes are open. Enophthalmos is when the eye is is eye the when is Enophthalmos open. are eyes both – picture
and dignity must be respected at all stages. all at respected be must dignity and open showing lagophthalmos – this is not evident in this this in evident not is this – lagophthalmos showing open
At the consent stage it is important that patient details are not disclosed to family members. Patients’ rights rights Patients’ members. family to disclosed not are details patient that important is it stage consent the At d. 2. the eyes, one eye would close and the other remain partially partially remain other the and close would eye one eyes, the
surgical safety checklist. It would also need to be tailored specifically for the local setting. local the for specifically tailored be to need also would It checklist. safety surgical To test for lagophthalmos one would ask the patient to close close to patient the ask would one lagophthalmos for test To
It is essential that the checklist in done by the team members at the three distinct stages described in the the in described stages distinct three the at members team the by done in checklist the that essential is It b. 1. The lid is not drooping over the cornea (ptosis). cornea the over drooping not is lid The There is no sign of inflammation (orbital cellulitis). (orbital inflammation of sign no is There
REFLECTIVE LEARNING (proptosis). protruding is eye left The
Visit www.cehjournal.org to complete the online ‘Time to reflect’ section. (d) Answer 1.
© The author/s and Community Eye Health Journal 2015. This is an Open Access COMMUNITY EYE HEALTH JOURNAL | VOLUME 28 ISSUE 90 | 2015 39 article distributed under the Creative Commons Attribution Non-Commercial License.