KFP – Eye presentations (Ophthalmology)

Isabelle Thompson, aged 73, presents with sudden onset of painless vision loss in her right eye which began this morning. She describes it as a ‘curtain coming down’ over her vision. She denies any trauma. She has also noticed flashes of light and some floaters in the same eye over the past week.

Medications: Aspirin 100 mg daily, Atorvastatin 20 mg daily, Metformin 1 g BD

Past history: Type 2 diabetes mellitus, hypertension, hyperlipidaemia

Social history: Lives alone, independent in activities of daily living. Retired school teacher. Non-smoker. Drinks 1–2 glasses of wine per week.

Examination findings: Visual acuity in the right eye is reduced to hand movements only. The left eye is 6/9. There is an afferent pupillary defect on the right. Fundus examination is difficult due to poor view, but you note a grey, elevated, and detached retina in the right eye. Intraocular pressure is normal in both eyes.

What is the most likely diagnosis and appropriate next steps? Select three (3) from the following list:

Aliya Begum, aged 29, presents with a 3-day history of a painful red left eye. She reports photophobia, blurred vision, and a sensation of something in her eye. She wears monthly contact lenses and admits to occasionally sleeping in them. She denies trauma. She has no known medical conditions and takes no regular medications. She is a non-smoker and works as a nurse.

Examination findings: Visual acuity in the left eye is reduced to 6/18; the right is 6/6. The conjunctiva is injected, particularly around the cornea. There is a small central corneal opacity and fluorescein staining reveals an epithelial defect. There is no hypopyon. Pupil is reactive and intraocular pressure is normal.

What are the most appropriate next steps? Select three (3) from the following list:

David Forsyth, aged 67, presents with a red right eye that developed suddenly overnight. He describes moderate pain, photophobia, and blurred vision. He denies trauma. He has a history of seronegative spondyloarthritis and is currently taking methotrexate 15 mg weekly and naproxen PRN. He has no allergies.

Examination findings: Visual acuity is 6/12 in the right eye and 6/6 in the left. The right eye has a diffusely injected conjunctiva, a constricted pupil, and cells and flare are visible in the anterior chamber on slit lamp examination. There is no hypopyon or discharge. Fundoscopy is unremarkable. Intraocular pressures are normal bilaterally.

What is the most likely diagnosis and appropriate management? Select three (3) from the following list:

Jasmin Lowe, aged 58, presents to your practice with a sudden onset of a painful, red right eye and markedly reduced vision. She describes seeing haloes around lights and nausea. This began approximately two hours ago and has progressively worsened. She has no history of eye problems and no recent trauma. She has no significant past medical history and takes no regular medications.

Examination findings: Jasmin appears distressed and photophobic. Visual acuity in the right eye is counting fingers only; the left eye is 6/6. The right eye is red, with a mid-dilated and sluggishly reactive pupil. Cornea appears cloudy. The eye feels hard to palpation compared to the left. Intraocular pressure is markedly elevated at 52 mmHg (right) and 14 mmHg (left).

What are the most appropriate immediate steps in management? Select three (3) from the following list:

Thomas Zhang, aged 42, presents with a one-week history of a red, gritty left eye. He describes mild discomfort, watery discharge, and photophobia. He denies trauma or contact lens use. He has a past history of recurrent oral ulcers and genital ulcers but has never sought medical attention for this. He works as a chef and is otherwise healthy.

Examination findings: Visual acuity is 6/6 in both eyes. The left eye has conjunctival injection and a central dendritic corneal lesion that stains with fluorescein. There is no hypopyon. Intraocular pressure is normal. The right eye is normal.

What is the most likely diagnosis and appropriate management? Select three (3) from the following list:

Melanie Harris, aged 11, is brought in by her mother with a red, painful right eye that developed suddenly this morning. She describes it as ‘sore and swollen’, and her eyelid appears droopy. Melanie also reports mild fever and difficulty opening her eye due to pain. She denies visual changes. She had a cold one week ago but no history of trauma. She has no significant medical history and is not on any medications.

Examination findings: Temperature 38.3°C. Right upper eyelid is swollen, erythematous, and tender. There is mild proptosis and reduced extraocular movement in the right eye. Vision is 6/6 bilaterally. Pupils are equal and reactive. There is no afferent pupillary defect.

What is the most likely diagnosis and appropriate next steps? Select three (3) from the following list:

Margaret O’Leary, aged 76, presents with gradual bilateral loss of central vision over the past 6 months. She reports difficulty reading and recognising faces but denies pain, floaters, or peripheral visual field loss. Her past medical history includes well-controlled hypertension and osteoarthritis. She lives independently and does not drive at night due to poor vision.

Examination findings: Visual acuity is 6/18 (right) and 6/24 (left). Fundoscopy reveals yellow-white deposits in the macular area of both eyes with some pigmentary changes. There is no haemorrhage or exudate. Intraocular pressures are normal.

What is the most likely diagnosis and appropriate next steps? Select three (3) from the following list:

Samir D’Souza, aged 34, presents with a 2-day history of red, painful left eye and blurred vision. He describes seeing a grey patch in his peripheral vision and photophobia. He has no history of trauma, but reports that he has ankylosing spondylitis and has had similar episodes in the past. He is currently taking NSAIDs for joint symptoms and is otherwise well.

Examination findings: Visual acuity is 6/12 in the left eye and 6/6 in the right. The left pupil is small and irregular. Slit lamp exam reveals ciliary flush, keratic precipitates on the corneal endothelium, and cells and flare in the anterior chamber. No hypopyon is present. Fundoscopy is limited due to haze but no obvious retinal changes are seen. Intraocular pressures are normal.

What is the most likely diagnosis and appropriate next steps? Select three (3) from the following list:

William Kent, aged 61, presents with a 24-hour history of sudden, painless vision loss in his left eye. He describes it as a ‘black curtain’ that descended over his vision. He has a history of poorly controlled hypertension and type 2 diabetes. He denies trauma, headache, or eye pain. No previous ocular history.

Examination findings: Visual acuity is counting fingers in the left eye and 6/6 in the right. There is a relative afferent pupillary defect on the left. Fundoscopy reveals a pale retina with a cherry-red spot at the macula in the left eye. Intraocular pressure is normal bilaterally.

What is the most likely diagnosis and the appropriate immediate steps? Select three (3) from the following list:

Fatima El-Hassan, aged 7, is brought in by her father with a 3-day history of a red, swollen upper eyelid on the right side. She has mild discomfort and tearing but no visual changes or fever. She has no past ocular history and is otherwise well. Her father says she has been rubbing her eyes frequently due to hay fever.

Examination findings: Visual acuity is 6/6 in both eyes. There is a small, tender, localised swelling on the upper eyelid margin with surrounding mild erythema. The swelling is not fluctuant. There is no proptosis or restriction of eye movements. Conjunctiva is mildly injected. No discharge or corneal involvement is seen.

What is the most likely diagnosis and appropriate management? Select three (3) from the following list:

Peter Wallace, aged 73, presents with a two-day history of new onset double vision and drooping of his left eyelid. He reports that his left eye feels ‘heavy’ and that the double vision worsens when looking to the right. He denies trauma, headache, or eye pain. He has a history of type 2 diabetes and is otherwise well. There are no recent infections or neurological symptoms.

Examination findings: There is a left ptosis and the eye is deviated down and out at rest. He has restricted upward and medial movement of the left eye. Pupil size is equal and reactive bilaterally. No other cranial nerve deficits. Fundoscopy is normal.

What is the most likely diagnosis and appropriate management? Select three (3) from the following list:

Katherine Briggs, aged 26, presents with a painful right eye and photophobia following a night of welding without eye protection. She reports a gritty, burning sensation that started about 10 hours after exposure. There is no history of foreign body or trauma. Her vision is slightly blurred but she can still read with some discomfort.

Examination findings: Visual acuity is 6/9 in the right eye and 6/6 in the left. The right eye is red and watery. Fluorescein staining shows multiple punctate epithelial erosions on the cornea but no dendritic pattern. The pupil is reactive and intraocular pressure is normal. No foreign body is visible.

What is the most likely diagnosis and appropriate management? Select three (3) from the following list:

Richard Emery, aged 48, presents with a 5-day history of a painful red right eye, watery discharge, and a vesicular rash on his right forehead and eyelid. He describes photophobia and mild blurring of vision. He is otherwise well but notes that the rash appeared a day before the eye symptoms started. He has no history of contact lens use or trauma.

Examination findings: There is a vesicular rash in the distribution of the ophthalmic branch of the trigeminal nerve (V1), not crossing the midline. His right eyelid is mildly swollen. Slit lamp examination reveals conjunctival injection, punctate corneal staining with fluorescein, and small dendritic lesions. Visual acuity is 6/9 in the affected eye. Pupil and intraocular pressure are normal.

What is the most likely diagnosis and appropriate next steps? Select three (3) from the following list:

Angela Dimitriou, aged 52, presents with gradually worsening visual acuity, especially in dim lighting and when driving at night. She reports increasing glare sensitivity and halos around lights. She has no eye pain or redness. Her only medical history is well-controlled type 2 diabetes. She has not had an eye exam in over three years.

Examination findings: Visual acuity is 6/12 in both eyes. Red reflex is dull bilaterally. Fundoscopy is limited by lens opacity but shows no diabetic retinopathy. Slit lamp examination confirms nuclear sclerosis with lens opacification. Intraocular pressure is normal.

What is the most likely diagnosis and appropriate next steps? Select three (3) from the following list:

Michael Tran, aged 39, presents with redness, irritation, and a watery discharge from both eyes that began two days ago. He reports that his children recently had ‘sticky eyes’ and colds. He describes a gritty sensation but no photophobia or significant pain. He works as a primary school teacher.

Examination findings: Bilateral conjunctival injection, watery discharge, and mild eyelid swelling. No corneal staining on fluorescein exam. Visual acuity is 6/6 in both eyes. Pupils are equal and reactive. There is no preauricular lymphadenopathy and no evidence of corneal involvement.

What is the most likely diagnosis and appropriate management? Select three (3) from the following list:

Natalie Chandra, aged 32, presents with persistent dryness, foreign body sensation, and intermittent blurred vision in both eyes over the past four months. She works in an air-conditioned office and spends prolonged periods in front of a computer. She reports mild improvement with over-the-counter lubricating eye drops. She has no systemic illness or medications.

Examination findings: Visual acuity is 6/6 bilaterally. External eye examination is normal. Tear break-up time is reduced and there is punctate fluorescein staining over the inferior cornea bilaterally. There is no discharge, eyelid abnormality, or signs of infection. Schirmer’s test shows reduced tear production.

What is the most likely diagnosis and appropriate management? Select three (3) from the following list:

John Whitaker, aged 56, presents with gradual bilateral peripheral vision loss over the past several months. He describes bumping into objects and difficulty with night driving but no pain or redness. He has a family history of glaucoma. He has no significant past medical history and does not wear glasses. He has not had a recent eye check.

Examination findings: Visual acuity is 6/6 bilaterally. Pupils are equal and reactive. Intraocular pressure is elevated at 28 mmHg bilaterally. Fundoscopy reveals increased cup-to-disc ratio with cupping of the optic disc. Confrontation visual field testing suggests peripheral field loss.

What is the most likely diagnosis and appropriate next steps? Select three (3) from the following list:

Emily Watson, aged 23, presents with redness, itching, and watery discharge in both eyes that began yesterday. She also reports sneezing and nasal congestion. She has a history of hay fever and seasonal asthma. She is currently taking cetirizine and a salbutamol inhaler as needed.

Examination findings: Bilateral conjunctival injection, eyelid swelling, and stringy mucoid discharge. There is marked conjunctival chemosis. Corneal examination is normal. Visual acuity is 6/6 bilaterally.

What is the most likely diagnosis and appropriate management? Select three (3) from the following list:

Benjamin Liu, aged 62, presents with sudden onset of floaters and flashing lights in his right eye that started this morning. He now describes a shadow in the peripheral vision of the same eye that seems to be spreading centrally. He denies pain or redness. He is myopic and had cataract surgery in the right eye two years ago.

Examination findings: Visual acuity is 6/6 in the left eye and 6/18 in the right. Pupils are equal and reactive. Intraocular pressures are normal. Fundoscopy reveals an elevated, detached retina in the superotemporal quadrant of the right eye with visible folds. No haemorrhage or vitreous opacities noted.

What is the most likely diagnosis and appropriate management? Select three (3) from the following list:

Alana Edwards, aged 45, presents with sudden onset pain, redness, and blurred vision in her right eye. She reports no trauma or recent illness. She has a history of rheumatoid arthritis, currently managed with methotrexate. She describes a dull ache around the eye that worsens with eye movement. She denies photophobia or discharge.

Examination findings: Visual acuity is 6/12 in the right eye and 6/6 in the left. There is marked injection of the deep episcleral vessels (violaceous hue), tenderness on palpation, and no discharge. Pupil is normal and reactive. Fundoscopy is normal. Intraocular pressure is normal.

What is the most likely diagnosis and appropriate next steps? Select three (3) from the following list:

Leah Mitchell, aged 36, presents with a sensation of something in her right eye after gardening earlier today. She reports persistent irritation, tearing, and light sensitivity. She has flushed the eye with water at home but symptoms have not improved. She wears no contact lenses and is otherwise well.

Examination findings: Visual acuity is 6/6 bilaterally. The right eye shows mild conjunctival injection. Eversion of the right upper eyelid reveals a small metallic foreign body lodged on the palpebral conjunctiva. There is no corneal abrasion seen on fluorescein staining, and intraocular pressure is normal.

What is the most appropriate next step in management? Select three (3) from the following list:

Helen Roberts, aged 80, is brought in by her daughter who noticed that Helen’s left eye appears abnormally protruded over the past 24 hours. Helen reports mild discomfort but denies significant pain, double vision, or trauma. She has been treated for sinusitis twice in the last month. She has a history of hypertension and osteoarthritis.

Examination findings: Left eye proptosis is noted with mild conjunctival injection. Extraocular movements are mildly restricted on upward gaze. Visual acuity is 6/9 bilaterally. There is no afferent pupillary defect. The eye is not pulsatile and the overlying skin is normal. Intraocular pressure is mildly elevated in the left eye. Temperature is 37.5°C.

What is the most likely diagnosis and appropriate next steps? Select three (3) from the following list:

Sarah Milton, aged 29, presents with a two-day history of a painful, red left eye, blurred vision, and a photophobic sensation. She has a known history of recurrent cold sores. She denies trauma, discharge, or recent contact lens use.

Examination findings: Visual acuity is 6/6 in the right eye and 6/12 in the left. The left conjunctiva is injected. Fluorescein staining shows a branching dendritic ulcer on the cornea. Intraocular pressure is normal, and there is no hypopyon or anterior chamber cells visible on slit-lamp exam. Pupils are equal and reactive.

What is the most likely diagnosis and appropriate next steps? Select three (3) from the following list:

George Sanderson, aged 70, presents with gradual onset of monocular blurred vision and distortion of straight lines in his left eye. He reports difficulty reading and recognising faces on that side. He denies pain or photophobia. He has a history of hypertension and hyperlipidaemia, managed with perindopril and atorvastatin.

Examination findings: Visual acuity is 6/6 in the right eye and 6/24 in the left. Fundoscopy reveals subretinal haemorrhage and greyish discolouration at the macula. An Amsler grid test reveals metamorphopsia in the left eye.

What is the most likely diagnosis and appropriate next steps? Select three (3) from the following list:

Dominic Fraser, aged 40, presents after experiencing sudden-onset, painless monocular vision loss in his right eye lasting 15 minutes, which resolved spontaneously. He describes it as a ‘grey curtain’ descending over his vision. He has a history of hypertension and is a smoker. This is the first episode, and he currently has no visual symptoms.

Examination findings: Visual acuity is 6/6 bilaterally. Pupils are equal and reactive with no RAPD. Fundoscopy is normal. Neurological exam is unremarkable. Blood pressure is 152/96 mmHg.

What is the most likely diagnosis and appropriate next steps? Select three (3) from the following list:

Carla Nguyen, aged 19, presents with a red, watery right eye and a gritty sensation that developed overnight. She also reports tender swelling in front of her right ear and recent cold symptoms. Her flatmate had a similar eye issue last week. She denies pain, photophobia, or visual changes.

Examination findings: Visual acuity is 6/6 bilaterally. The right eye has diffuse conjunctival injection, watery discharge, and mild eyelid oedema. There is palpable preauricular lymphadenopathy. No corneal staining is seen on fluorescein exam. No hypopyon or anterior chamber reaction. Intraocular pressure is normal.

What is the most likely diagnosis and appropriate management? Select three (3) from the following list:

Daniela Russo, aged 64, presents with progressive, painless central visual blurring in both eyes over the past year. She describes trouble recognising faces and reading fine print, although peripheral vision remains intact. She denies floaters, photophobia, or visual distortion. She has a history of hypertension and is an ex-smoker. No known family history of eye disease.

Examination findings: Visual acuity is 6/18 in both eyes. Fundoscopy shows multiple soft drusen and pigmentary changes at the macula. There is no haemorrhage or subretinal fluid. Intraocular pressures are normal.

What is the most likely diagnosis and appropriate management? Select three (3) from the following list:

Omar Al-Karim, aged 50, presents with redness, pain, and photophobia in his right eye following minor trauma with a tree branch while gardening yesterday. He has a sensation of something in the eye and describes increased watering. He is otherwise well and has no history of contact lens use or eye disease.

Examination findings: Visual acuity is 6/6 bilaterally. The right eye is injected and watery. Fluorescein staining shows a linear area of uptake consistent with a corneal epithelial defect. There is no foreign body visible, no anterior chamber reaction, and intraocular pressure is normal. Pupil is round and reactive.

What is the most appropriate diagnosis and management? Select three (3) from the following list:

Grace Holloway, aged 58, presents with a 2-week history of a painful, red left eye with associated mucopurulent discharge and eyelid swelling. She reports crusting of the eyelashes in the morning and mild photophobia. She denies trauma or recent illness. She has type 2 diabetes and wears reading glasses.

Examination findings: Visual acuity is 6/6 bilaterally. The left eye shows conjunctival injection, mucopurulent discharge, and mild eyelid oedema. Cornea is clear with no fluorescein staining. Pupil is round and reactive. No preauricular lymphadenopathy. Intraocular pressure is normal.

What is the most likely diagnosis and appropriate management? Select three (3) from the following list:

Trent Wallace, aged 44, presents with a sensation of a foreign body in his left eye after mowing the lawn without eye protection. He reports tearing, discomfort, and mild photophobia. He denies any prior ocular issues or use of contact lenses.

Examination findings: Visual acuity is 6/6 bilaterally. The left conjunctiva is injected. Fluorescein staining reveals a small, circular epithelial defect on the inferior cornea. A small, rust-coloured lesion is seen on the corneal surface. No anterior chamber reaction. Pupil and intraocular pressure are normal.

What is the most appropriate diagnosis and initial management? Select three (3) from the following list:

Edward McKinnon, aged 66, presents with a one-day history of a painful, red left eye and blurry vision. He reports seeing halos around lights and feeling nauseated. He denies trauma. He has a history of hyperopia but no previous eye disease. Symptoms began suddenly in the evening while watching TV in a dimly lit room.

Examination findings: Visual acuity is 6/12 in the right eye and 6/36 in the left. The left conjunctiva is injected, and the cornea appears hazy. The pupil is mid-dilated and sluggishly reactive. Intraocular pressure is 48 mmHg in the left eye and 16 mmHg in the right. There is mild tenderness over the left globe.

What is the most likely diagnosis and appropriate next steps? Select three (3) from the following list:

Madeline Zhou, aged 22, presents with a red, gritty left eye that has worsened over the past 3 days. She wears soft contact lenses and admits to sleeping in them occasionally. She reports mild photophobia and blurred vision but no systemic symptoms. She is otherwise well and takes no regular medications.

Examination findings: Visual acuity is 6/6 in the right eye and 6/18 in the left. The left conjunctiva is injected. Fluorescein staining reveals a round epithelial defect with a hazy, whitish infiltrate at the centre of the cornea. There is no hypopyon. Intraocular pressure is normal.

What is the most likely diagnosis and appropriate next steps? Select three (3) from the following list:

Stephen Raj, aged 11, is brought in by his mother with a one-week history of persistent eyelid crusting, redness, and watery discharge in both eyes. He complains of itchy, gritty eyes and has been rubbing them frequently. His vision is unaffected. He has a background of eczema and allergic rhinitis.

Examination findings: Visual acuity is 6/6 in both eyes. There is bilateral eyelid margin erythema, scaling, and mild conjunctival injection. There is no corneal staining or discharge beyond mild watery tearing. No preauricular lymphadenopathy. No signs of systemic illness.

What is the most likely diagnosis and appropriate management? Select three (3) from the following list:

Jordan Matthews, aged 36, presents with mild bilateral visual disturbance and difficulty with colour perception over the past week. He has been on ethambutol for pulmonary tuberculosis for the past two months. He denies pain, photophobia, or discharge. He reports that both eyes feel ‘dull’ and that colours appear faded.

Examination findings: Visual acuity is 6/9 in both eyes. There is no conjunctival injection. Pupils are equal with a subtle relative afferent pupillary defect on the left. Fundoscopy reveals normal optic discs with no swelling. Colour vision testing reveals impaired red-green discrimination in both eyes.

What is the most likely diagnosis and appropriate next steps? Select three (3) from the following list:

Louise Kelly, aged 47, presents with redness and a dull ache in her right eye that has developed gradually over the past three days. She reports photophobia and blurred vision. She has a history of HLA-B27 positive ankylosing spondylitis. She denies trauma or discharge. This is her second episode with similar symptoms in the past year.

Examination findings: Visual acuity is 6/9 in the right eye and 6/6 in the left. The right pupil is miotic and sluggishly reactive. There is ciliary injection (limbal flush) and consensual photophobia. Slit lamp reveals anterior chamber cells and flare. Intraocular pressure is slightly reduced in the affected eye. Fundoscopy is normal.

What is the most likely diagnosis and appropriate management? Select three (3) from the following list:

Michelle Dean, aged 41, presents with gradual-onset drooping of her left upper eyelid over the past three months. She denies trauma, eye pain, visual changes, or systemic symptoms. She has no known neurological or endocrine conditions. She works as an office manager and does not wear contact lenses.

Examination findings: Visual acuity is 6/6 in both eyes. The left upper eyelid has mild ptosis, with the lid margin resting just over the superior limbus. Eye movements are full and symmetrical. Pupils are equal and reactive. No anisocoria, proptosis, or fatigue-related changes are noted. Neurological examination is normal.

What is the most likely diagnosis and appropriate next steps? Select three (3) from the following list:

Alisha Khan, aged 34, presents with redness and swelling of the right upper eyelid that has worsened over the last 48 hours. She reports tenderness, warmth over the lid, and mild discomfort when opening the eye. She denies systemic symptoms, visual changes, or eye pain. There is no trauma or contact lens use. She had a similar episode last year that resolved with warm compresses.

Examination findings: Visual acuity is 6/6 bilaterally. The right upper eyelid is erythematous and tender with a focal, raised swelling near the lid margin. The overlying skin is intact. The globe is non-tender, and there is no proptosis or restriction of eye movements. The conjunctiva is mildly injected. No fever or systemic signs.

What is the most likely diagnosis and appropriate management? Select three (3) from the following list:

Isabella Green, aged 3, is brought in by her parents due to a persistently watery and occasionally sticky right eye since birth. They report that her eye frequently appears teary, especially in cold weather or wind, and becomes mildly crusted in the mornings. There is no redness or discomfort. Her vision and general health appear normal for age.

Examination findings: The right eye has visible tearing and mild conjunctival injection. No photophobia or corneal haziness is noted. The pupil is round and reactive. Gentle pressure over the lacrimal sac produces reflux of mucoid fluid through the punctum. No swelling, erythema, or tenderness is noted over the lacrimal sac.

What is the most likely diagnosis and appropriate next steps? Select three (3) from the following list:

Jonathan Lees, aged 72, presents with a sudden, painless loss of vision in his right eye upon waking this morning. He describes it as a ‘blackout’ of vision with no associated headache, eye pain, or floaters. He has a history of hypertension and hyperlipidaemia, and takes perindopril and atorvastatin. He has no known history of atrial fibrillation or smoking.

Examination findings: Visual acuity is 6/6 in the left eye and hand movements only in the right. Relative afferent pupillary defect is present in the right eye. Fundoscopy reveals a pale retina with a cherry-red spot at the macula. Intraocular pressures are normal. No signs of temporal artery tenderness or jaw claudication are noted.

What is the most likely diagnosis and appropriate next steps? Select three (3) from the following list:

Samuel Boyd, aged 25, presents with a painful, red left eye and blurred vision that developed over the past 24 hours. He wears monthly contact lenses and admits to swimming while wearing them recently. He describes photophobia and a gritty sensation. He is otherwise well and not immunocompromised.

Examination findings: Visual acuity is 6/6 in the right eye and 6/18 in the left. The left eye has marked conjunctival injection. Fluorescein staining shows a paracentral dendritiform corneal ulcer with irregular borders. There is no hypopyon. Pupil is round and reactive. Intraocular pressure is normal.

What is the most likely diagnosis and appropriate next steps? Select three (3) from the following list:

Marcus El-Haddad, aged 60, presents with progressive eyelid swelling and discomfort in his right eye over the past 3 days. He reports feeling systemically unwell with a mild fever and headache. He denies trauma or visual changes but reports mild pain on eye movement. He has a history of chronic sinusitis.

Examination findings: Temperature is 37.8°C. The right upper eyelid is swollen, erythematous, and tender. There is mild proptosis and limited upward gaze of the right eye. Visual acuity is 6/6 bilaterally. The pupil is reactive and there is no RAPD. Intraocular pressure is normal. No signs of corneal or conjunctival involvement.

What is the most likely diagnosis and appropriate next steps? Select three (3) from the following list:

Nadia Clarke, aged 32, presents with a 2-week history of intermittent, painless episodes of double vision, particularly when looking to the sides. She also reports mild eyelid puffiness and a sensation of pressure behind both eyes. She denies trauma, visual loss, or photophobia. She has a 6-month history of recently diagnosed hyperthyroidism for which she is not yet on treatment.

Examination findings: Visual acuity is 6/6 bilaterally. There is mild bilateral proptosis and periorbital oedema. Extraocular movements are restricted, particularly on upward and lateral gaze. There is no RAPD. Pupils are equal and reactive. Fundoscopy is normal. No conjunctival injection or discharge.

What is the most likely diagnosis and appropriate management? Select three (3) from the following list:

William Tran, aged 27, presents with pain and redness in his right eye following a workplace welding incident without proper eye protection. He describes a gritty sensation, photophobia, and tearing that began several hours after exposure. He denies trauma or discharge. He works as a metal fabricator and is otherwise well.

Examination findings: Visual acuity is 6/6 bilaterally. The right eye is injected with significant photophobia. Fluorescein staining shows multiple small punctate areas of uptake across the cornea. No foreign body or abrasion is seen. Intraocular pressure is normal, and the pupil is round and reactive.

What is the most likely diagnosis and appropriate management? Select three (3) from the following list:

Rachel Kim, aged 38, presents with a gradually enlarging, painless lump on her right upper eyelid for the past 3 weeks. She describes it as initially tender, but it is now firm and non-tender. There is no associated redness, discharge, or visual disturbance. She has had similar lesions in the past that resolved spontaneously.

Examination findings: A firm, non-tender, round nodule is palpable within the tarsal plate of the right upper eyelid. The overlying skin is intact and mobile. There is no surrounding erythema or conjunctival involvement. Vision is unaffected.

What is the most likely diagnosis and appropriate management? Select three (3) from the following list:

David McCallum, aged 67, presents with a red, tender swelling at the medial canthus of his right eye. He reports associated tearing and discharge over the past 48 hours. The area has become progressively more painful and swollen. He denies trauma or systemic symptoms. He has no previous history of similar episodes.

Examination findings: There is a tender, erythematous swelling below the medial canthus of the right eye. Gentle pressure over the lacrimal sac produces purulent discharge from the punctum. The conjunctiva is mildly injected, but the cornea is clear and vision is unaffected. No proptosis or limitation of eye movement is noted.

What is the most likely diagnosis and appropriate next steps? Select three (3) from the following list:

Emily Foster, aged 30, presents with a 24-hour history of painful red eye, photophobia, and blurred vision in her right eye. She wears soft contact lenses and admits to poor compliance with cleaning routines. She denies trauma or systemic symptoms. She had a similar but milder episode six months ago which resolved spontaneously.

Examination findings: Visual acuity is 6/6 in the left eye and 6/18 in the right. The right eye shows diffuse conjunctival injection and a small central corneal ulcer with surrounding hazy infiltrate on fluorescein staining. No hypopyon is present. Intraocular pressure is normal.

What is the most likely diagnosis and appropriate next steps? Select three (3) from the following list:

Patricia Nolan, aged 75, presents with gradual onset of bilateral peripheral vision loss over several months. She denies eye pain, redness, or sudden changes in vision. She finds it increasingly difficult to navigate in dimly lit areas and has tripped over objects on her sides. She has a history of hypertension and type 2 diabetes.

Examination findings: Visual acuity is 6/6 in both eyes. Pupils are equal and reactive with no RAPD. Intraocular pressure is 26 mmHg in the right eye and 27 mmHg in the left. Fundoscopy reveals cupped optic discs with a cup-to-disc ratio of 0.7 bilaterally. Confrontation visual fields reveal peripheral field defects in both eyes.

What is the most likely diagnosis and appropriate next steps? Select three (3) from the following list:

Daniel O’Neill, aged 52, presents with a 3-day history of redness, discomfort, and watery discharge from his left eye. He reports mild photophobia but no significant pain. He recently recovered from an episode of shingles affecting the left forehead and scalp two weeks ago. He denies visual loss or trauma.

Examination findings: Visual acuity is 6/6 bilaterally. The left conjunctiva is injected, and there is a small area of epithelial staining on the cornea visible with fluorescein under cobalt blue light. The lesion appears branching with terminal bulbs. No hypopyon is seen. The pupil is reactive and intraocular pressure is normal.

What is the most likely diagnosis and appropriate next steps? Select three (3) from the following list:

Oliver Chan, aged 8, is brought in by his parents due to concerns about his right eye turning inward intermittently. They have noticed this over the past few months, particularly when he is tired or focusing on nearby objects. He has no complaints of double vision or headaches and is otherwise healthy. There is no family history of eye disease.

Examination findings: Visual acuity is 6/6 in both eyes with correction. Cover test reveals intermittent esotropia of the right eye at near. The corneal light reflex is slightly decentered on the right during convergence. Eye movements are full. No ptosis or pupil abnormality is seen. Fundoscopy is normal.

What is the most likely diagnosis and appropriate management? Select three (3) from the following list:

Helen Bradley, aged 59, presents with sudden onset of numerous floaters and flashing lights in her left eye that started earlier today. She now reports a shadow moving across her peripheral vision on the same side. She denies eye pain or systemic symptoms. She is moderately myopic and had uncomplicated cataract surgery in the left eye 1 year ago.

Examination findings: Visual acuity is 6/6 in the right eye and 6/9 in the left. Left pupil is reactive with no RAPD. Fundoscopy reveals a tear in the superior temporal retina and associated retinal detachment. No signs of vitreous haemorrhage or inflammation are noted.

What is the most likely diagnosis and appropriate next steps? Select three (3) from the following list: