A 65 year old man presents to his optometrist in Kerry complaining of reduced visual acuity. The optometrist checks his aided visual acuity and finds that with the glasses he prescribed 2 years ago the man can now only see 6/12 best corrected where previously he could see 6/6.

A)    Have you been to one of the multiples for refractive surgery?

B)     Is the family history of eye disease?

C)    Do you have glaucoma?

B is a good question to ask it is general and enables the patient to contribute meaningfully if they have valuable knowledge about any family eye condition

Refraction demonstrates a marked increase of 4 dioptres of against the rule astigmatism in both eyes.

Management- usually these function well with glasses – if gets very thin can perforate from mild trauma

May require a lamellar tectonic graft or even a penetrating graft- it is always better if possible to avoid penetrating grafts.

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Lorem ipsum dolor sit amet, consectetur adipisicing elit, sed do eiusmod tempor incididunt ut labore et dolore magna aliqua. Ut enim ad minim veniam, quis nostrud exercitation ullamco laboris nisi ut aliquip ex ea commodo consequat. Duis aute irure dolor in reprehenderit in voluptate velit esse cillum dolore eu fugiat nulla pariatur. Excepteur sint occaecat cupidatat non proident, sunt in culpa qui officia deserunt mollit anim id est laborum.

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