The first request was slit-lamp examination. The patient was a 64 year old man. Slit-lamp examination showed a right corneal graft. The graft was sutured with a combined interrupted and continuous suture techniques. The graft and the donor cornea were clear and there were no signs of rejection. I then looked at the recipient cornea for clues to the graft but there were no evidence of any stromal dystrophy and the patient was phakic. On the other eye, the cornea was thickened and the endothelium showed guttatae. I made a diagnosis of Fuch's endothelial dystrophy.
The examiner wanted to know the indication for removal of corneal graft suture. I mentioned infection, presence of neovascularization around the suture and excessive astigmatism.
The second examiner asked me the advantages and disadvantages of using a small graft vs a large graft. I mentioned increased astigmatism with small graft but decreased risk of rejection as it is away from the limbus compared with a large graft.
The second patient was a 80 year old woman. The examiner wanted me to perform the ocular motility examination. I noted the patient wore a pair of high hypermetropic glasses and mentioned that I would like to know if there were prisms in the glasses. The examiner told me that there were no prisms incorporated.
I began the examination by looking at the corneal reflexes with a torch light. The patient had a small right esotropia. Ocular movement revealed poor right abduction. I diagnosed right lateral rectus palsy. The examiner asked me to repeat the test but all that I could find was poor abduction. The examiner then demonstrated to me the presence of palpebral narrowing when the right eye adducted and also a small upshooting of the right eye on adduction. The diagnosis was Duane's syndrome. It did not occur to me that a 80 year old woman would have Duane's syndrome. "Patients with Duane's syndrome do grow old !" was the response from the examiner.
I was a bit disheartened after this case.
This was examination with a indirect ophthalmoscopy with a 20D lens. Unfortunately, the pupils were poorly dilated. I mentioned these to the examiner and was asked to proceed anyway. The discs appeared normal but there were some exudates in the macula in both eyes. I made a diagnosis of diabetic maculopathy. The examiner then asked me about the definition of clinically significant macular oedema
This was a slit-lamp case. The patient was about 40 years old and I was asked to examine the anterior segments. The pupils were not dilated. There was a right pseudoexfoliation syndrome and some iris transillumination and pigments on the endothelium. The left eye was normal.
The examiner questioned me on the difficulty that I would anticipate if the patient were to require surgery. I mentioned poor pupil dilatation and weak zonules leading to zonulysis during cataract surgery.
The last case was also a slit lamp examination. The patient was a young girl. There was a right disciform scar with some anterior chamber activity. Before I was asked any questions the bell went.
I was asked to observe the patient. He was undresses to the waist and had right hemiplegic posture with the elbow and the wrist in flexion. I gave the finding and suggested that the patient may have cerebrovascular accident involving the motor cortex of the left hemisphere.
The examiner then asked me what else I would like to examine. I mentioned upper limb examination and cardiovascular examination including the blood pressure. It turned out that he wanted me to perform visual field examination. I was expecting to find a right homonymous hemianopia but my examination showed normal visual field.
The examiner told me that this patient had a right VA of 6/18 and left VA of 6/12. I was then asked to perform another visual field examination. I noted that the patient had a right superior field defect and a left inferior field defect. The findings suggested a bilateral altitudinal field loss. I was asked about the diagnosis and gave ischaemic optic neuropathy as the answer. The examiner then asked me to look into the patient's fundi with a direct ophthalmoscope. I noted both discs were pale
The patient was in hospital gown and had a head bandage. He had an obvious right complete ptosis. I was asked to perform the ocular motility examination. The patient had a pure right third nerve palsy. I gave a diagnosis of posterior communicating aneurysm. The examiner then asked me the complication of intracerebral aneurysm and the ocular signs associated with subarachnoid haemorrhage
I was asked to perform a complete cranial nerve examination on this patient. She had an obvious left seventh nerve palsy. During the examination, I also discovered that she had a left sixth nerve palsy, poor left corneal sensation and decreased hearing in her left ear.
I gave a diagnosis of cerebellopontine angle lesions. The examiner then asked me the different types of nystagmus one may get with such lesions