CET model answers: Systemic associations with the anterior eye and adnexa

Case 1

A 58-year-old man has a history of poor compliance with attendance for his diabetes check-ups

Question: If this eye is painful, what is the most appropriate management?

Answer: Suggest immediate referral to HES

Question: Which of the following is a likely underlying cause?

Answer: Proliferative diabetic retinopathy

This image clearly shows rubeosis iridis, the manifestation of severe proliferative retinopathy. This is typically found in poorly controlled late stage diabetes but also sometimes as a response to other causes of severe retinal ischaemia, such as an ischaemic central retinal vein occlusion. Management of proliferative disease might be best a direct referral to the consultant in charge of the disease rather than casualty (by whatever is the means locally available to do this, or if not sure, by phoning the local secondary care unit). In this case, pain is likely to indicate a secondary glaucoma and so immediate referral is appropriate.