بسم الله الرحمن الرحيم
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Transcript of بسم الله الرحمن الرحيم
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These are the slides that dr.yasser al-faki revises every cycle, if you memorize & understand them, you will have no problem identifying & answering most of the O.S.C.E. Questions.The exam is formed of 20 stations , Each has 1 photo with 1 M.C.Q. that you have to Answer in 1 minute.Its not as hard as it sound if you give it the time to see these slide again & again.GOOD LUCK
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Lower Lid Ectropion (cicatrical) N.B. Involutional is the most common causeTx: Release the Scar or GraftComplication : Exposure Keratitis.Arcus Senalis
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Upper Lid Entropion & 2ry TrachiasisMost common cause is Trachoma (Cicatrical)Involutional Entropion Never Affects the Upper lidRx: Sugery
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Stye (External Hardiolum) : Inflamation of the Upper Lid With Pus Formation Tx: Antibiotics + Drainage + Remove eye lashes + Hot Compressors.
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Painless Swelling of the Lower Lid with pus formationChalazion (Meibomian Cyst)Common Tx: Surgical EvacuationNO ANTIBIOTICS (it is Sterile) If Recurrent : Think of Tumer of the GlandN.B. AcuteChalazion = Internal Hardiolum
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Painless Swelling for 1 year Then regressingCapillary Haemagioma No Tx unless there is obstruction of vision wich may lead to amblyopia (Give intralesional long acting steroid).
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Aggressive Tumer in a 70 y.o. patientMelanoma (Usually black color)Metastasize Early Tx: Ramoval or at least Debulk.
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Medial Rectus No
Superior Rectus No
Levator Palpepre Superioris No3rd Nerve Palsy (Occulomotor) Right Side Tx: if there is involvment of the introcular muscles Surgical Tx. -If not medical
Lareral Rectus YES Inferior Rectus No
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Bilateral Severe ptosis (With compensatory chin left) congenitalTx: Depends on the Levator Function : If ok then resect (shorten)If severe use a graft (Fascia lata)Time of Tx is after 1 year if bilatral but before 2 years to prevent C-spine deformety (becase of the constant chin lefting)If Unilatral Amblyopia
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Flurocena Dye (Green)Uses : 1- Corneal Abrasion/scar2- Tear film Lacrimal system assesment.3- I.O.P.4- Detect Leaking.?
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Dentritic Ulcer (Herpetc Keratits)Caused by HSV, HZV & TyrosinemiaTx: Antiviral (Acyclovir)NEVER GIVE STEROIDS (Sarhani notes page 91)
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Corneal Ulcer Stained by Flurocene + Entropion & 2ry Trichiasis Tx: Tx Entropion 1st Scraping the ulcer for a sample Embirical Broad spectrum Antibiotics (Cipro) (Topical) Because the cornea is avascular-NEVER GIVE STEROIDS in corneal Ulcer with infection
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Slit lamp examination showing very shallow anterior chamber. Iris touching the corneaAfter glucoma surgery? : TrabelectomyMesure I.O.P. : if low Leak or over drainageIf high Malignant Glucoma
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Rose Bengal Stain : Kerato conjectivitis Sicca = Dry Eye SyndromeWhy Not to use Flurocene?: Becaue it is hydrophilic & the epithelium will take hydrophobic (rose Bengal) so,-Dentritic : if infected rose Bengal ?-If desquamated Flurocene
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Swelling with tightly closed eye in a childDDx: Angiorretic edemaPreseptal cellulites Give Antibiotics.Cavernous Sinus Thrombosis (bilateral)Orbital CellulitisTx:AdmetionI.V. Broad spectrum antibiotics.Temperature Chart.CT Scan
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Orbital Cellulitis
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Orbital Cellulitis:??Signs:Connectival injection.Disharge seen near the lowr lid.Protrusion.
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Hx of: Fever , Sinusitis, Very ill patientRt. Orbital Cellulitis.
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Unilateral (Left) Proptosis & Lid Retraction (most common cause in adults is Dysthyroid)Tx: Treat the thryoid. Thyroid Function & CT are the most important investigations
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Exophthalmus
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Exophthalmometer
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In Any Retinal Slide , You have to see & comment on the following:Optic Disc : Atrophy?, Cupping?, New Vessels?.Is there any Exudate?The Macula : Is there any Lesion?The Retinal Background : Is There Any Hemorrhages?Veins : Congested?, A-V Crossing?Is there any Vitreous Hemorrhage? ( the wool picture would be blocked by it)
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Non-Prolifarative Diabetic Retinopathy (No New vascular Formation)Tx: Focal Laser (Not Sure?)Hard Exudate.Congested Veins. Heamorrages
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Proliferative Diabetic Retinopathy.Fan-shaped New Vascular Formation Around the DiscTx: P.R.P. (Pan Retinal Photocoagulation).
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Vitreous Heamorrage-Tx: Vetrotomy & P.R.P.-But In Type II DM ; we can wait for 3/12 because it may resolve spontaneously.
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Post-P.R.P.
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Disc Cupping: Chronic Open Angle Glaucoma. Most likely Primary.- In Closed angle Glaucoma: there is no time for cupping to develop.
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Optic Nerve Edema.Exudates.Cotton wool.Blurring of optic disc (you cant say where the disc ends & the Retina Starts).Flame-Shaped Hemorrhage.DDx:Optic Neuritis: ( Visual Acuity) Systemic Steroids? , HTN, I.C.P., Nutritional, Syphlis.Papilledema: BILATERAL, 2ry to I.C.P. With Enlarged Blinad Spot.
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Papilledema: Same Previous Picture but Bilateral.
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Optic Nerve Edema: (With Marked Venous Congestion).Hemorrhages.Cotton Wool.
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The Same patient of the previous picture; with E.S.R. & Hx of HeadacheGiant cell Arteritis (Temporal Arteritis).These Engorged Vessels are sign of poor prognosis.We must Give High Doses of Systemic Steroids to Preserve the other eye but not to treat this eye.
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Central Retinal Artery Occlusion.Severe Loss of Vesion, Poor Prognosis.Segmentation of the Blood Vessels & Marked Edema with Chari-red spotIschemia of the inner 2/3 of the retina (White/Yellow color)But the Fovia is preserveed (Supplied by the choroidal artery)
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Flame-Shaped Hemorrhage but without Cotton wool, no Exudate.HemiRetinal Vein occlusion (Branch).Tx: Observation & Medical Assesment.Complications: the most serious is New vessels formation Neovascular Glucoma.So, If anyNew Vessels = P.R.P.
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Robiosis Iridis. (new Vessels in the iris)Complicated by neovascular glaucoma.Tx: By Treating Retina Ischemia & P.R.P. if Any New Vessels.Cataract???????
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Regmatogenous Retinal Detachment.Because of the U-shaped (Horse-shoe) TearThe macula is still intact but may detach soon. (Emergency)
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25 y.o. female with depigmentation of the eye lashes, eye brow (poliosis) , vitiligo & Hearing lossV.K.H. diseaseShe will also have : Uveitis & Exudative Retinal detachment.
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Vitiligo
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Macroglossia Acromegally Pituitary Tumer Chiasmal Lesion Bitemporal Hemianopia
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Confrontation Test : Visual Field testing method.
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Pinhole Test : If improve Refractive error
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Regmatogenous Retinal Detachment- U-shaped Tear
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Optic Disc Atrophy: Milky white optic head ()
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ConjunctivaIdentify the area of maximum Injection.Usually starts Unilateral then become Bilateral.Conjunctivitis:Bacterial : Purulent or Mucoid Discharge.Viral Watery Discharge.Allergic: Watery then Mucoid, Asymptomatic or itching.Follicular conjunctivitis is Caused by: 1- Viral : Preauricular L.N. involvement.2- Active Trachoma : Most common.3- Medication side effect.
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Bacterial Conjunctivitis:- Red conjunctiva & Mucopurulent.
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Viral Conjunctivitis: - Watery & L.N.?
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Active Trachoma (Follicular Conjunctivitis).Tx: Oral erythromycinetc.Complications:Entropion , Corneal Scar/Ulcer.
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Injection Around the Limbus.DDx: Anterior Uveitis (Iritis)Keratitis.Acute Angle closure Glaucoma.
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Injection around the limbus.Iritis: Pain, photophobia, blurred vision, Redness.Tx: Topcal Steroids.If posterior uveitis : Systemic Steroids.Iritis =Iridocyclitis =Anterior Uveitis.
NOTE THE HYPOION (Pus or cells in the Ant. Chamber) Which requires Tx.In uveitis we will see in the Ant. Chamber: 1- Cells.2- Flare.3- Keratic precipitate.
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Slit lamp Examination Showing Keratic Precipitates in the posterior corneal surface. (UVEITIS).
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Hypopion + Marked Conjucival njection = CORNEAL ULCERFlurocene to confirm & Corneal Scrap (Sample).Tx: Antibiotics (Topical) + Cycloplegics & Patch (Dont patch without antibiotics)
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Hx of Trauma (Punch)Sub-conjuctival Hemorrhage.Asses visual acuity & eye movement. If ok Reassure the patients (Usually resolve in 2-3 weeks) If Visual acuity or eye movement not ok consider blow-out fracture
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Allergic Seasonal Conjunctivitis + Trantas Spots Vernal Keratoconjuctevitis.Itching, Watery then Mucoid.We used to give local steroids But now we give Antihistamines.
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Cobble-Stone Appearance (Giant Papilla): Severe Vernal K.C. (Papillary).If mild no Tx.If severe Short term steroids then Antihistamines + Mast cell Stabilizer
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Laser Iridotomy.In angle Closure Glaucoma.Note the ECLIPSE sign. ( Sign of a shallow Ant. Chamber) + .
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Episcleritis.
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Mansons Sign. KERATOCONUS.Mopes. Steep?Associated with V.K.C.& Atopic Dermatitis.Tx: Hard Contact lens or KERATOPLASTY.N.B. LASEK is CONTRAINDICATED.
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Deep Ant. Chamber.
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Mature Cataract. If the Age of Patient is 70 y.o. Senile If the age is 30 y.o. Presenile: DM, Steroids, Trauma, Atopic dermatitis.If 2 y.o. conjenital Cataract : TX as soon as possible to prevent Amblyopia.
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??
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Cataract + Atopic Dermatitis.
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Post-Iredectomy (Cataract)
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Sumluxated lens (SuperoTemporally) Marfans Syndrome
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Anterior Dislocated Lins.
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Leukocaria in a child.- It Should be Considered RETINOBLASTOMA until proven otherwise.
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Cataract.
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Buphthalmus (Rt.) = Congenital Glaucoma.
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Pseudostrapismus. (large epicanthal fold(
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Left esotropia.Exclude Retinoblastoma (20% presents with Strabismus)Tx: Surgery. Reset the medial rectus & resect the Lateral rectus.
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Right esotropia.
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?????????
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Accommodative Right Esotropia. Corrected by glasses.
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Left Exotropia.
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Right 4th Nerve palsy.
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If you Are Told that this Child Is looking Forward, Then the Dx Would Be:Alternating Strabismus.
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But if you Are told That she is trying to look to the left :Right 6th Nerve Palsy.
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Duan Syndrome?
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Iridectomy
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Posterior Synechia (Irregular Pupil)
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Hyphema (Blood in the Ant. Chamber)
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Ptyrigium.- Tx if Extending to the cornea (Excision)
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Acute Dacryocystitis.Tx: Antibiotic (Systemic & Local)DrainageDCR (Dacriocystorhinostomy) after elemination of the acute phase.
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Chronic Dacryocystitis. (Pus come out with pressure on the sac)
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Marcus-Gun Jaw Winking Syndrome.- Stimulation of the ptyregoid activates the lavator palp. Super. Of the same side.
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Posterior synechia.?
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Exophthalmus + Lid Retracion.Comlications: 1- Exposure Keratitis.2- Compression on the Optic Nerve.Examine Color vision, Visual Acuity, Pupellary Reflex, FundusInvestigations: TSH T3 & T4 + CT scan (to see the size of the Extra occular muscles).
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Ptosis.DDx: Horners Syndrome (mild Ptosis, Myosis & Anhydrosis)Mysthenia Gravis.Involutional3rd Nerve Palsy (Most Common)Pseudoptosis Due to Lack of support (Artificial eye)Trauma.
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Bilateral Senile Ptosis.
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Post-Peripheral Iridectomy.
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Basal cell Carcinoma (Rudent Ulcer)
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Ptergium with Corneal Involvement.Indications for Surgery:1- Decreased Vision.2- Cosmetic.3- May predispose to Keratopathy.4- Astigmatism.5- Decrease function of extraocular muscles.
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Unilateral Ptosis.
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Marcus-Gun Jaw Winking Syndrome.- Stimulation of the ptyregoid activates the lavator palp. Super. Of the same side.
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Morgagnian Cataract. (Liquefaction of the Cortex + Neucleus is down)
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Iridodialysis. (Trauma)Blurred VisionMono-ocular Diplopia? Cataract?
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Blow-out fracture
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Blow-out Fracture:Ptosis.Hematoma.Blurred vision.Dipopia on looking up (Due to Entrapment of the inferior Rectus)Enophthalmos.Tx: Systemic Antibiotics.& Surgery if Fracture more than 50% of orbital floor & Diplopia not improving or if enophthalmus more than 2mm.
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Corneal Ulcer : Marked conjuctival Injection & Hypopion. Exposure Keratitis.
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Dermoid Cyst.Tx: Intralesional steroids.
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Left Ptosis with contra lateral pseudo lid retraction (compensatory).
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Sub-conjuctival Hemorrhage.
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Left Exotropia
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Right Proptosis. Meningioma if the patient is an Adult & Glioma if child ???????
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Orbital Cellulitis.Admit , I.V. Antibiotics & if there is an abcess DrainCavernous sinus thrmbosis may give the same picture but bilateral.
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Ant. Dislocation of the lins.
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Capillary Heamangioma.Tx: Long-acting intralesional Steroids.
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Same Patient after steroid therapy.
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DDx:1- Heamangioma.2- Cyst.3- Chalazion.
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Port-Wine Stain. (Naevus Flammeus)Can Cause ipsilateral Glaucoma in 30%
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Entropion? + Arcus Senalis & Pseudoptosis.
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Non-proliferative Diabetic retinopathy.Tx: Focal Laser for macular edema.
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This patient presented with night blindnessRetinitis Pigmentosa.
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Corneal Scar.If the conjunctiva white inactive.If Red Active.Flurocene to conferm.
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DDx:1- Cellulitis.2- Angiorritic edema.Check slide 22
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Inferionasal coloboma of iris.
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Black red Reflex:Cataract.Vetrious hemorrhage.Corneal Opacity.
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Ptregium.
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Thats the end of the Revision Slides.The following were not covered by the DOCTOR, but are very important.
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Bilateral Eyelid Edema Due to Herpes Zoster Ophthalmicus
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Anterior Blepharitis with Localized folliclitis.
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Xanthelasma
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Acute Dacriocystitis 2ry to delayed canalization of Nasolacrimal Duct.
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Geographic Ulcer.Stained with Flurocin.Caused by HSV, HZV & TyrosinemiaTx: Antiviral (Acyclovir)NEVER GIVE STEROIDS (Sarhani notes page 91)
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Arcus Senilis.
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Shallow Ant. Chamber.
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Iridodialysis. (Traumatic)
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Optic Atrophy & Vascular Occlusion.End Stage Bahet Disease.
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Retinitis Pigmentosa.
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Bransh Retinal Artery Occlusion.
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Engorgement of Conjectival & Episcleral Blood Vessels in a patient with Carotid-Cavernous Communication.
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Left Dermoid Cyst.
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Bilateral Ectropion.
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Reg. Retinal Detachment.
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Primary Herpes Simplix Lesion. ??
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Poliosis + Vitiligo = V.K.H. Disease.
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Papilloma ????????
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The Same patient In Slide # 79.
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Thats All,,GOOD LUCK yassE.R.