OSCE notes
Layman’s explanations:
Pterygium
Triangular shaped thickening of your conjunctiva, the clear part of your eye
This thickening extends from your cornea (the clear window at the front of your eye) and
grows from 3 o'clock to 9 o clock, usually on the nasal side of your eye
It is caused by long standing exposure of eyes to UV light, dust and wind. (ask px did you
grow up in a hot country?) Sometimes if it pulls on the tissue it can cause some tension and
change the shape of your cornea which may result in something called astigmatism which
can reduce the sharpness of your vision Some people may complain of some irritation and
so if you feel any gritty sensation or feeling of something in your eye you can use some
lubricating eye drops to control this sensation This pterygium can sometimes grow towards
the middle of your eye and if affecting vision you can have a small procedure to remove it
but we will monitor its growth and you must wear UV protection to minimise its
development
Pinguecula
Small raised area that may be white to yellowish in colour and is on your limbus which is
where the white of your eye called tour sclera meets the clear part of your eye called your
cornea This is usually due to age and is very common in people over the age of 70 but can
also be caused by long term exposure to UV light It usually affects both eyes but does not
cause any symptoms or effect your vision However if it ever becomes inflamed it can cause
some local redness and irritation or discomfort in which case some eye drops may be
recommended I will examine the pinguecula carefully with each sight test and distinguish it
from other spots and cysts that may occur and you must use sunglasses and hats to slow
down further growth
Episcleritis
Inflammation of the episclera which is just underneath the outer skin of the white of your
eye called the sclera. it is most commonly seen between the ages of 40-60 and usually one
eye, and sometimes people have inflammation elsewhere in the body such as rheumatoid
arthritis. the symptoms are usually sudden redness and aching /tenderness in the eye but
your vision would not usually be affected .This condition can go by itself in 7-10 days but can
return so if there is a second recurrence can refer for investigation by an ophthalmologist If
you have any symptoms cold compresses and artificial tears can help relieve them but if
anything gets worse you may need some additional steroid eye drops and/or anti
inflammatory tablets.
Scleritis
Scleritis means inflammation of the white part of your eye called the sclera .It is more
common in elderly women and usually people with another form of inflammation such as
rheumatoid arthritis. This is usually a gradual condition that causes eye pain and aching
,OSCE notes
which may be severe and cause blurred vision and sensitivity to lights. There are two forms
of scleritis: anterior scleritis is 90% of cases and causes redness and swelling. Necrotising
scleritis is another form of more severe anterior scleritis and causes scleral tissue to melt
away with disruption of vision. Posterior scleritis is 10% and affects the part back of the eye
too. Scleritis is a serious condition and it is recommended that all cases be referred as
emergencies to the ophthalmologist, who will usually treat the condition with oral
medication that reduce inflammation and suppress the body’s immune system
Herpes Simplex Keratitis
Around 90% of people in the UK have an inactive infection due to the herpes simplex virus
which is usually acquired in childhood by contact with an adult and sometimes can be
activated by poor health. If it happens in your trigeminal nerve (nerve for head and neck
sensations) this can cause an infection of your skin e.g. a cold sore or on the eye surface
called your cornea. If your cornea if affected you get something called herpes simplex
keratitis and usually affects only 1 eye. Usually this causes an ulcer which a branching
outline called a dendritic ulcer and this infection can recur or cause scars if not treated
quickly with some anti-viral eye drops or ointment This usually requires a same day referral
and if associated with contact lenses must cease lens wear.
Fuchs corneal dystrophy
A condition which affects your cornea, the clear window on the front of your eye, and
causes it to lose its normal transparency. It is usually inherited and affects both eyes. This is
not inflammation or an infection, but more so a condition where the cells in the back of your
cornea (endothelial) no longer work properly This condition is usually painless but if a late
stage can sometimes cause a pain from a blister if it bursts .If vision is greatly affected or
there is a lot of pain a corneal transplant may be recommended which has a
very good prognosis.
Microbial keratitis (bacterial, fungal)
This is an infection of your cornea, the clear window on the front of your eye. This is usually
caused by germs involved in contact lens wear or for other reasons such as not blinking
normally or from injury or surgery to the eye, it usually comes on suddenly with redness and
pain in one eye and there may be watering and discharge with sensitivity to light. Vision
may be blurry. There may be an ulcer on the cornea. This requires an immediate
(emergency) referral to the hospital eye service so that an eye doctor can take some swabs
and treat your eye with some antibiotic eye drops.
Microbial keratitis (Acanthamoeba sp.)
Acanthamoeba is an organism that can be spread in water and is normally harmless to
humans but if transferred to the eye on a contaminated contact lens it can infect your
,OSCE notes
cornea, the clear window at the front of your eye . This usually causes discomfort, redness
and light sensitivity of your eye and can become painful so requires an emergency referral
to prescribe special eye drops (anti-amoebic) .If there is much scarring of the cornea
following the eventual elimination of the infection, and vision is badly affected, a corneal
transplant may be recommended.
Keratitis, CL-associated infiltrative
This is Contact lens-associated infiltrative events, including:
○ contact lens-associated peripheral ulcer (CLPU)
○ contact lens-associated infiltrative keratitis
This condition is inflammatory but not infective and means the cornea is inflamed due to a
reaction from bacteria which is on the surface of the contact lens. This causes some
discomfort, redness and watery eye and i may see some opaque areas near the edge of
your cornea and some inflammation of the white of your eye .I will distinguish this from an
infection of your cornea which is much more serious . To help treat this keratitis you need to
stop wearing CL for at least 48 hours to resolve the signs and symptoms but for long term
you need to be more hygienic and remember to wash your hands for handling and replace
your lens case frequently and not sleep or shower in your lenses.
Marginal Keratitis
This is a slightly unusual condition caused by a reaction to the presence of bacteria near the
eye, for example on the edges of the eyelids. It is an inflammation, not an infection.
Patients experience redness, watering and pain in the eye. A shallow ulcer develops at the
edge of the cornea (the clear window of the eye), which can resemble several other
conditions including infection. The condition usually resolves by itself, but it may be dealt
with more quickly if steroid and antibiotic drops are prescribed. If blepharitis (inflammation
of the edges of the eyelids) is the cause, this should be treated. Blepharitis is usually the
most common cause and needs to be continually treated to avoid recurrence.
, OSCE notes
Photokeratitis (Ultraviolet [UV] burn, Arc eye, Snow Blindness)
This condition is also known as Arc Eye and Snow Blindness. It is caused when the eyes are
exposed to too much ultraviolet (UV) light. After a delay of 6 to 12 hours following exposure
to arc welding, sun lamps or other sources of UV light, the eyes become red, painful, watery
and unduly sensitive to light. The vision may become blurred and the eyelids may be red
and swollen. These symptoms are caused by temporary damage to the cells on the surface
of the eye. Fortunately the condition gets better by itself and there is usually no permanent
damage. Eye drops can be prescribed or purchased to make the eyes more comfortable
while they recover. Pain relief tablets may be needed also.
Basal cell carcinoma (BCC) (periocular)
This is found on the skin around the eye and is a low-risk cancer that is the most common
malignant tumour of the skin of caucasian people . It rarely spreads to other parts of the
body and is a slow enlargement which is painless but may occur with
bleeding from the surface. It is usually a small hard whitish nodule that appears on the
lower eyelid and can be more common with higher UV exposure eg people working
outdoors This would be referred urgently for a small sample called a biopsy to exam in the
lab and determine the diagnosis and develop treatment plan if needed .The usual treatment
is either radiotherapy or surgery to remove the tumour which is usually a great prognosis.
Hordeolum
A hordeolum is an acute bacterial infection of the glands of the eyelid. An internal
hordeolum affects the. Meibomian (oil) glands within the eyelids whereas an external
hordeolum (commonly referred to as a stye) affects the glands associated with the
eyelashes. Both conditions cause red and tender swellings of the eyelid. Traditional
remedies such as hot spoon bathing and/or warm compresses may relieve symptoms. In
some cases, treatment with antibiotic drops or ointment is needed to speed up recovery. In
the case of a severe infection, antibiotic tablets may be required.
Chalazion
A chalazion is a harmless cyst caused by a blocked meibomian gland in the eyelid.
Meibomian glands in the eyelid produce an oil which helps keep the eye moist. If the gland
becomes blocked, the oil builds up into a cyst which looks like a small lump in the eyelid.
The lump can become irritated and red and, occasionally, infected.
A chalazion commonly occurs due to inflammation around the opening of the oil glands at
the base of your eyelashes. This is called blepharitis.
Chalazions tend to only last a few weeks and are typically not painful.
Many chalazions can be treated effectively at home but if the infection spreads or if there is
a large cyst that persists, the surgery may be possible to speed up the healing process. In
most cases it can be treated with lid bathing and warm compresses, if persistent it may
need treated by a small surgery where it is removed.
Layman’s explanations:
Pterygium
Triangular shaped thickening of your conjunctiva, the clear part of your eye
This thickening extends from your cornea (the clear window at the front of your eye) and
grows from 3 o'clock to 9 o clock, usually on the nasal side of your eye
It is caused by long standing exposure of eyes to UV light, dust and wind. (ask px did you
grow up in a hot country?) Sometimes if it pulls on the tissue it can cause some tension and
change the shape of your cornea which may result in something called astigmatism which
can reduce the sharpness of your vision Some people may complain of some irritation and
so if you feel any gritty sensation or feeling of something in your eye you can use some
lubricating eye drops to control this sensation This pterygium can sometimes grow towards
the middle of your eye and if affecting vision you can have a small procedure to remove it
but we will monitor its growth and you must wear UV protection to minimise its
development
Pinguecula
Small raised area that may be white to yellowish in colour and is on your limbus which is
where the white of your eye called tour sclera meets the clear part of your eye called your
cornea This is usually due to age and is very common in people over the age of 70 but can
also be caused by long term exposure to UV light It usually affects both eyes but does not
cause any symptoms or effect your vision However if it ever becomes inflamed it can cause
some local redness and irritation or discomfort in which case some eye drops may be
recommended I will examine the pinguecula carefully with each sight test and distinguish it
from other spots and cysts that may occur and you must use sunglasses and hats to slow
down further growth
Episcleritis
Inflammation of the episclera which is just underneath the outer skin of the white of your
eye called the sclera. it is most commonly seen between the ages of 40-60 and usually one
eye, and sometimes people have inflammation elsewhere in the body such as rheumatoid
arthritis. the symptoms are usually sudden redness and aching /tenderness in the eye but
your vision would not usually be affected .This condition can go by itself in 7-10 days but can
return so if there is a second recurrence can refer for investigation by an ophthalmologist If
you have any symptoms cold compresses and artificial tears can help relieve them but if
anything gets worse you may need some additional steroid eye drops and/or anti
inflammatory tablets.
Scleritis
Scleritis means inflammation of the white part of your eye called the sclera .It is more
common in elderly women and usually people with another form of inflammation such as
rheumatoid arthritis. This is usually a gradual condition that causes eye pain and aching
,OSCE notes
which may be severe and cause blurred vision and sensitivity to lights. There are two forms
of scleritis: anterior scleritis is 90% of cases and causes redness and swelling. Necrotising
scleritis is another form of more severe anterior scleritis and causes scleral tissue to melt
away with disruption of vision. Posterior scleritis is 10% and affects the part back of the eye
too. Scleritis is a serious condition and it is recommended that all cases be referred as
emergencies to the ophthalmologist, who will usually treat the condition with oral
medication that reduce inflammation and suppress the body’s immune system
Herpes Simplex Keratitis
Around 90% of people in the UK have an inactive infection due to the herpes simplex virus
which is usually acquired in childhood by contact with an adult and sometimes can be
activated by poor health. If it happens in your trigeminal nerve (nerve for head and neck
sensations) this can cause an infection of your skin e.g. a cold sore or on the eye surface
called your cornea. If your cornea if affected you get something called herpes simplex
keratitis and usually affects only 1 eye. Usually this causes an ulcer which a branching
outline called a dendritic ulcer and this infection can recur or cause scars if not treated
quickly with some anti-viral eye drops or ointment This usually requires a same day referral
and if associated with contact lenses must cease lens wear.
Fuchs corneal dystrophy
A condition which affects your cornea, the clear window on the front of your eye, and
causes it to lose its normal transparency. It is usually inherited and affects both eyes. This is
not inflammation or an infection, but more so a condition where the cells in the back of your
cornea (endothelial) no longer work properly This condition is usually painless but if a late
stage can sometimes cause a pain from a blister if it bursts .If vision is greatly affected or
there is a lot of pain a corneal transplant may be recommended which has a
very good prognosis.
Microbial keratitis (bacterial, fungal)
This is an infection of your cornea, the clear window on the front of your eye. This is usually
caused by germs involved in contact lens wear or for other reasons such as not blinking
normally or from injury or surgery to the eye, it usually comes on suddenly with redness and
pain in one eye and there may be watering and discharge with sensitivity to light. Vision
may be blurry. There may be an ulcer on the cornea. This requires an immediate
(emergency) referral to the hospital eye service so that an eye doctor can take some swabs
and treat your eye with some antibiotic eye drops.
Microbial keratitis (Acanthamoeba sp.)
Acanthamoeba is an organism that can be spread in water and is normally harmless to
humans but if transferred to the eye on a contaminated contact lens it can infect your
,OSCE notes
cornea, the clear window at the front of your eye . This usually causes discomfort, redness
and light sensitivity of your eye and can become painful so requires an emergency referral
to prescribe special eye drops (anti-amoebic) .If there is much scarring of the cornea
following the eventual elimination of the infection, and vision is badly affected, a corneal
transplant may be recommended.
Keratitis, CL-associated infiltrative
This is Contact lens-associated infiltrative events, including:
○ contact lens-associated peripheral ulcer (CLPU)
○ contact lens-associated infiltrative keratitis
This condition is inflammatory but not infective and means the cornea is inflamed due to a
reaction from bacteria which is on the surface of the contact lens. This causes some
discomfort, redness and watery eye and i may see some opaque areas near the edge of
your cornea and some inflammation of the white of your eye .I will distinguish this from an
infection of your cornea which is much more serious . To help treat this keratitis you need to
stop wearing CL for at least 48 hours to resolve the signs and symptoms but for long term
you need to be more hygienic and remember to wash your hands for handling and replace
your lens case frequently and not sleep or shower in your lenses.
Marginal Keratitis
This is a slightly unusual condition caused by a reaction to the presence of bacteria near the
eye, for example on the edges of the eyelids. It is an inflammation, not an infection.
Patients experience redness, watering and pain in the eye. A shallow ulcer develops at the
edge of the cornea (the clear window of the eye), which can resemble several other
conditions including infection. The condition usually resolves by itself, but it may be dealt
with more quickly if steroid and antibiotic drops are prescribed. If blepharitis (inflammation
of the edges of the eyelids) is the cause, this should be treated. Blepharitis is usually the
most common cause and needs to be continually treated to avoid recurrence.
, OSCE notes
Photokeratitis (Ultraviolet [UV] burn, Arc eye, Snow Blindness)
This condition is also known as Arc Eye and Snow Blindness. It is caused when the eyes are
exposed to too much ultraviolet (UV) light. After a delay of 6 to 12 hours following exposure
to arc welding, sun lamps or other sources of UV light, the eyes become red, painful, watery
and unduly sensitive to light. The vision may become blurred and the eyelids may be red
and swollen. These symptoms are caused by temporary damage to the cells on the surface
of the eye. Fortunately the condition gets better by itself and there is usually no permanent
damage. Eye drops can be prescribed or purchased to make the eyes more comfortable
while they recover. Pain relief tablets may be needed also.
Basal cell carcinoma (BCC) (periocular)
This is found on the skin around the eye and is a low-risk cancer that is the most common
malignant tumour of the skin of caucasian people . It rarely spreads to other parts of the
body and is a slow enlargement which is painless but may occur with
bleeding from the surface. It is usually a small hard whitish nodule that appears on the
lower eyelid and can be more common with higher UV exposure eg people working
outdoors This would be referred urgently for a small sample called a biopsy to exam in the
lab and determine the diagnosis and develop treatment plan if needed .The usual treatment
is either radiotherapy or surgery to remove the tumour which is usually a great prognosis.
Hordeolum
A hordeolum is an acute bacterial infection of the glands of the eyelid. An internal
hordeolum affects the. Meibomian (oil) glands within the eyelids whereas an external
hordeolum (commonly referred to as a stye) affects the glands associated with the
eyelashes. Both conditions cause red and tender swellings of the eyelid. Traditional
remedies such as hot spoon bathing and/or warm compresses may relieve symptoms. In
some cases, treatment with antibiotic drops or ointment is needed to speed up recovery. In
the case of a severe infection, antibiotic tablets may be required.
Chalazion
A chalazion is a harmless cyst caused by a blocked meibomian gland in the eyelid.
Meibomian glands in the eyelid produce an oil which helps keep the eye moist. If the gland
becomes blocked, the oil builds up into a cyst which looks like a small lump in the eyelid.
The lump can become irritated and red and, occasionally, infected.
A chalazion commonly occurs due to inflammation around the opening of the oil glands at
the base of your eyelashes. This is called blepharitis.
Chalazions tend to only last a few weeks and are typically not painful.
Many chalazions can be treated effectively at home but if the infection spreads or if there is
a large cyst that persists, the surgery may be possible to speed up the healing process. In
most cases it can be treated with lid bathing and warm compresses, if persistent it may
need treated by a small surgery where it is removed.
