Frcs Ophthalmology - Part 3

“Please examine this patient and discuss your findings,” the older examiner said.

Omar was called into a small, windowless room. Two examiners. One old, one younger. Neither smiled. frcs ophthalmology part 3

“Differential: Retinoblastoma, Coats’ disease, PHPV, Toxocara. But I note the OCT shows a solid, calcific mass. No exudation. My index of suspicion is Retinoblastoma. My immediate next step is not a biopsy—that risks extraocular spread. It is an EUA (Examination Under Anaesthesia) with B-scan, and referral to the specialist ocular oncology unit within 24 hours.” “Please examine this patient and discuss your findings,”

“I see a crystalline deposit on the endothelium,” Omar said. “Given the absence of inflammation, and the refractile nature, I suspect it is an isolated intraocular foreign body —likely metallic. I would ask about a history of hammering metal without eye protection. To confirm, I would perform a CT orbit to rule out scleral entry and check for a full-thickness scar on gonioscopy.” One old, one younger