Q1. During an initial assessment of a 43-year-old who is interested in contact lenses for the first time, this image was taken by meibography of the lower lid. Which of the following best describes the findings?
Answer C. The meibography image clearly shows a central area where the bright meibum reflection of the infra-red is absent. This represents gland drop out. The other glands appear to be shorter in length than expected also.
Q2. Instillation of lissamine green dye resulted in the following appearance. What is represented by the black arrow?
Answer B. The black arrow represents the Marx line. This is the line of transition from the dry outer skin and the wetter palpebral conjunctiva. It is anterior to and histologically distinct from the lid wiper area.
Q3. Which of the following best represents the time of the first point of fluorescein tear break up?
Answer C. At five seconds on the video, the very first localised dark patch appears.
Q4. This is the data from a test of non-invasive break-up time for the right eye (figure 1). Work out which of the following statements can not be inferred from the printout?
Answer C. The orange and yellow patches represent break up and are clearly seen to be localised nasally and not temporally on this right eye.
Q5. Which of the following statements regarding the data shown is not true?
Answer A. This image showed the tear meniscus measurement using the IDRA system. As the two values measured were 0.21mm and 0.23mm, then this would suggest values just over the assumed average normal value of 0.2mm.
Q6. Prior to refitting a patient with new contact lenses, you review an image of the patient from a previous visit. Which of the following statements might be inferred?
Answer D. The larger and discrete nature of these deposits suggest lipid deposition and make it likely that the lens shown is a silicone hydrogel lens.
Q7. Based on this fluorescein appearance, which of the following is the most likely contact lens worn up until now?
Answer B. This image shows a superior epithelial arcuate lesion (SEAL) which is characteristic of wear with a high modulus contact lens.
Q8. This image is captured under white light using specular reflection at 40x magnification. What does the white arrow point to?
Answer D. The marmoreal patter, similar to motor oil on the surface of a puddle, is a representation of the thin lipid layer on the tear surface which has the effect of polarising reflected light.
Q9. This image was taken at 40 x magnification. Which of the following statements is false?
Answer D. This small ‘bubble-like’ lesion is found in the epithelium and seems to show reverse contrast – it is darker on the right-hand side compared with the adjacent corneal illumination, which is darker on the left. This confirms the lesion to be a microcyst and suggests early hypoxic stress. This is of clinical significance to the ECP.
Q10. Which of the following statements regarding the area denoted by the white arrow is true?
Answer D. The cell appearance of the endothelium here is very regular and there is no obvious variation in cell size or shape (pleomorphism).
Q11. Which statement regarding this topography plot is true?
Answer B. Warm colours, as hinted at by the scale on the left, reflect increased curvature. The steep dome here is characteristic of keratoconus.
Q12. Which of these four patterns best represents schematically a topography pattern resulting from regular astigmatism?
Answer B. Astigmatism would tend towards a bow-tie appearance and, if regular, would appear aligned along a single axis.