Past Years Ophthalmology q&As

8/4/2019 Past Years Ophthalmology q&As

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PAST YEARS OPHTHALMOLOGY QsShort form : CP (clinical picture), Mx (management), Rx (treatment) ,DD (diff diagnosis),Dx (diagnosis)

1. Anatomy of the eye-anatomy upper eye lid***

-draw a labelled section of cornea****(disclaimer: bukan saya yg lukis. amik kt google je)

so basically cornea has 5 strata (superficial to deep):1) epithelium2) Bowmans layer3) Stroma4) Descements membrane5) Endothelium

-draw a labelled diagram of eye globe**

-labelled diagram of lacrimal apparatus

(disclaimer lagi: bukan saya yg lukis. google je)lacrimal apparatus is divided to 2 parts: secretory and excretory part1. secretory part

1) Reflex: main lacrimal gland middle aqueous layer2) Basic:

i) accessory lacrimal gland (Wolfring and Krause) middle aqueous layerii) Meibomian gland and Zeiss gland superficial oily layer


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iii) Goblet cells deep mucus gland2. excretory part:

1) puncti2) upper and lower canaliculi3) lacrimal sac4) nasolacrimal duct

-gonioscopic structure of angle of anterior chamber

(tak perlu lukis pun, tapi senang skit nk nampak kalau ada gambar)

from behind forwards are:1. root of the iris.2. anterior surface of ciliary body3. scleral spur.4. trabecular meshwork5. schwalbles line6. posterior surface of cornea.

-anatomy extra-ocular muscles2. Visual and pupillary pathways

-discuss acute loss of visioncrvo (ischemic type)

crao - sudden LOV,not acutepapillitisvitreous hge

-causes of yellow papillary reflex [rasanya ni sama dgn white pupillaryreflex/leukocoria]a) retinoblastomab) endophthalmitis

-3 causes dilated fixed pupila

optic neuritis/ optic atrophy (yg ni bukan marcus gunn pupil ke?) > [MG kalau

partial, kalau full affection causes permanent dilatation kan] > erm xsure 3rd nerve palsy effector(iris/muscle) affection , eg: atropine traumatic mydriasis (blunt trauma to iris) acute congestive glaucoma (dilated oval)


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-components of near reflex

accommodation miosis convergence

-causes of unilateral dilate fixed pupil[ni tak same ke dgn soalan atas] > same je-mydriatic?- 3rd nerve palsy

3. Eye lids-causes & CP entropion

Congenital Spastic Senile (involutional) Cicatricial (both lids may be affected)

CP: due to mechanical irritation and injury to cornea; Irritation, pain, congestion,lacrimation and photophobia

-causes & Rx of ectropion**causes:

1.paralytic : facial palsy2. senile3. cicatricial : extensive chemical/heat burn on the face/ contraction of skin as ineczema etc4. mechanical5. congenital (cong eNtropion >> cong eCtropion)

Rx: Rx the cause

Rx of cicatricial ectropion1. if mild: release tension of linear scar2. if severe: scar revision and excision and its replacement by pedicle flap or free

grafting (inner side of arm, behind ear or clavicular area)

Ps- care shud be taken on the cornea till cause of ectropion is treated

-types, CP,& Rx of blepharitisTypes : ant(seborrheic,ulcerative) . post(MGD) . allergic . parasitic . angular .CP

1. Burning itching eye strain worse in morning2. Photophobia


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3. FB sensation4. Lid margin ; dry,red,thick,hyperemia,greasy in seborrheic type,ulcerated instaph5. Scales : brittle,crusting,colarette6. Lashes : matted (ulcerative type )

Rx1. Eye lid hygiene n hot foment (Na HCO3 or diluted baby shampoo)(triple dye)* eyelid massage n expression of meibomian glnd 2-4x/d2. Top or syst Ab (tetraC doxyC erythroM-child n pregnant)3. Artificial tears for dry eye4. Topical steroid for ass keratitis5. Rx ass scalp seborrhea w antidandruff shampoo

-causes & rx of trichiasis-causes of trichiasis:

1. following diseases that cause scarring of the eyelid margin eg. ulcerativeblepharitis

2. any condition that causes entropion eg. trachomatous cicatricial entropion andspastic entropion

3. distichiasis

treatment of trichiasis:

1. if few and focal: destroy the follicles by laser, electrolysis, diathermy orcryocoagulation

2. if general: operate(split lid n grey line insert mm graft) . .the so called VanMellingans operation

3. if due to entropion: operate to reconstruct the lid margin

-complications of ulcerative blepharitis

1. madarosis2. trichiasis3. permanent reddening of eye lid4. recurrent styes5. eczema----ectropion6. chronic conjunctivitis

7. keratitis

-define districhiasisThe lashes and lid margin are normal but an extra row of lashes arises from tarsalgland orifices behind the grey line

-causes of ptosis**


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a) Congenital - abnormal development.b) Paralysis - destructive lesion of the occulomotor nerve/nucleus.c) Sympathetic - Mullers muscle affection in Horners syndrome.d) Myogenic - disease of the muscle itself, famous example: myasthenia gravis.e) Aponeurotic - defect in function caused by senile degenerative process orfollowing cataract or retinal surgery 2ry to manipulation.

f) Mechanical - increased weight.g) Traumatic - to the muscle or nerve.

-CP & Mx of ptosis***CPUpper eyelid cover cornea more than 2mm in 1ry gazeBilateral n pupil cover : raised eyebrow , wrinkling skin forehead , throw head backwardUnilateral congenital pupil cover : diminish visionCP of the causes (eg : myasthenia muscle weakness, horner anhydrosis,miosis)Mx

1. Rx of the cause (eg: myasthenia anticholinesterase, mechanical Rx causeof heaviness)2. Surgery (depend on degree of ptosis)mild : fasanella servant operation (tarsomullerctomy)severe : (depend on levator function)

good fx : levator resectionx fx : frontalis sling operation (hess operation)

-causes & complications of lagophthalmos1) physiological: during sleep2) mechanical:-enlargement/protusion eyes (buphthalmos, proptosis, staphyloma)

-structural lid loss: coloboma-impair normal mvmt lid (severe ectropion)

3) paralytic: orbicularis oculi(facial palsy)

4) spastic: spasm levator of Mullers muscle(endocrine exophtalmopathy)5) functional: extreme debility, unconciousness, general anaesthesia.complication: 1) cornea: dry/xerotic and exposure keratopathy

(lead to corneal opacity, ulceration, perforation, loss eye)2) conjunctiva: exposed, dry, xerotic

-define: symblepharoncicatrical adhesions between the palpebral conjuctiva and bulbar conjuctiva orcornea.

4. Errors of refraction-discuss hypermetropia**

(tak masuk kot soalan camni. blh baca sendiri kot dari definition hinggalahtreatment) > eh mana tau xleh kire jugak sbb pernah masuk

-CP & types of hypermetropiaCP:-symptoms:1. accomodative asthenopia2. defective near vision3. early presbyopia


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-signs:1. small eyeball2. small cornea3. relatively shallow anterior chamber4. fundus shows a greater brightness of light from the retinal surface (watered silk

appearance)5. optic disc: less defined edges with torturous retinal vessels

TYPES of HYPERMETROPIA:1. Total2. Latent3. Manifest4. Facultative5. Absolute

-types of myopia & complications of high myopia** types - simple myopia (most common, puberty till 25-30years,


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-define: facultative hypermetropia**part of manifest hypermetropia that is corrected by accomodation

-define: astigmatism with rule,regular astigmatismAstigmatism- state of refraction of eye in which there is difference in the refraction ofthe different meridians of the eye, parallel rays of light will not focus in a point, but in

a line.

Regular- fulfill 2 criteria:

(a) meridian of maximum and minimum powers are at right angle to each other(b) there is gradual changes of power between meridian maximum to minimum

With rule- verical meridian is more curved (more myopic) than the horizontal

-define: myopiaThe state of refraction of the eye in which parallel rays of light focus on a point infront of the retina while accommodation is at rest

5. Lacrimal Apparatus-Rx of acute dacryocystitismedical:

-antibiotic(local/systemic)-analgesic and hot fermentation-Vasoconstictor nasal drop

surgical-abscess-- incision and drainage-lacrimal fistula--fistulectomy & dacryocystectomy

-causes of watery eye**1. Lacrimation

o psychic conditions

o reflex watering (due to foreign body of cornea and conjunctiva)

2. Epiphora

o eversion of lower punctum

o occlusion of puncti

o occlusion of canaliculio chronic dacryocystitis

o stricture or obstruction of naso-lacrimal duct

-2 lesions treated by dacryocystectomy


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1. Long standing chronic dacryocystitis with destruction of the sac structure andatrophic rhinitis

2. tuberculosis of the lacrimal sac

Other answers:

a. Primary neoplasms of the sacb. presence of hypopyon corneal ulcerc. If the patient is going to undergo an intraocular operation in the near

future

6. Squint-Mx concomitant squint in 5y old child

accomodative esotropia - GOOS(Glasses,Occlusion of stronger eye,orthoptic

,Surgery) congenital esotropia -recession of both medial recti sensory esotropia - surgical after rx the cause consecutive eso - surgery b4 4 years old to avoid compllications primary exotropia - correction of refractive error (myopia full corre ,hyperopia

under corre)

- orthoptic -eliminate amblopia-anti suppression ecxesrcise,increased

fusional amplitude- base in prism

-surgery (bilateral LR / unilateral LR+MR recession)

heterophoria??

-method of detection of heterophoria

alternate cover test maddox rod maddox wing worth 4 dot test

synotophore

-2 muscles causing intortion

Sup.oblique sup.rectus


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-2 causes of uniocular diplopia

iridodialysis subluxated lens irregular astigmatism early cataract

-CP paralytic squint

limited ocular mov in direction of paralysed muscle binocular diplopia manifest squint 2ry angle>1ry angle of deviation nausea,vomitting,vertigo w unstable gait abn. head posture false projection

7. Conjunctiva-DD red eyes**1. Conjunctival injection: conjutvts2. Ciliary injection-acute angle-closure glaucoma-keratitis-iridocylitis

3. subconjunctival hge

(blepharitis,Uveitis,corneal ulcer,allergic) --> (tak pasti yg ni nk letak kt bahagianmana)

-clinical stages of trachoma

Stage

T1 Immature follicle-greyish,non expressible, no necrotic tissue,non raised

1. Cornea: Trachomatous pannus

Sx: - sandy gritty sensation ; mucous discharge

T2 T2a: mature follicle ( yellowish,expressible,raised , necrotic tissue)T2b: Raised projected papillae.Cornea: Marked pannusSx: -Abundant discharge, heavy upper lid

T3 Stage of cicatrisation.Sign of active trachoma ( follicle n papillae )


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Scarring on upper tarsal : star shape,radiate,white line ; Artls linePTC n PTD may appear on this stage.

T4 Healed trachoma.No active inflammationOnly scar tissue are present

-stages of active trachoma , CP, RxStage RX: MEDICAL RX:SURGICAL

T1 Immature follicle-greyish,non expressible, nonecrotic tissue,non raisedCornea: Trachomatous pannusSx: - sandy gritty sensation ;mucous discharge

a)LOCAL-Terramycin 6w-Sulphacetamide

b)SYSTEMICChild:Erythromycin 2wAdult:Doxycyclin 2wNew rx: AzitromycinKeyword:TSEDA

T2 T2a: mature follicle

( yellowish,expressible,raised ,necrotic tissue)T2b: Raised projected papillae.Cornea: Marked pannusSx: -Abundant discharge,heavy upper lid

Same above T2a:

Expression follicleby Graddys forcepsT2b:Scraped by sharpspoon after lideversion.

T3 Stage of cicatrisation.Sign of active trachoma( follicle n papillae )Scarring on upper tarsal : starshape,radiate,white line ; ArtlslinePTC n PTD may appear on thisstage.

Same Above T3:Pick up the PTC nPTD by sharpscalpel blade.

T4 Healed trachoma.No active inflammationOnly scar tissue are present

N/B: THIS IS NOT ANACTIVE STAGE...UCAN OMIT IT= )

(soalan: T4 ni dah tak kira sebagai active dah kan?) : Exactly...T4 bkn activestage...xpayah tulis xpe.


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-complications of trachoma****a) Lid - trichiasis, entropion (circatricial), ptosis.b) Conjunctiva - xerosis, symblepharon, hyaline degeneration.c) Cornea - corneal scars ----> irregular astigmatism, xerosis.

d) Lacrimal - chronic dacryocystitis, chronic dacryoadenitis.

-CP vernal keratoconjunctivitisSymptoms:

o Intense itching, lacrimation, photophobia, and ropy discharge (rich in

eosinophils)

Signs:

o

Palpebral type : Affection of upper palpebral conjunctiva; Flat topped,multiple, cobble stone pattern of papillae. They are red in color and largerin size than those of trachoma.

o Bulbar type : Limbal gelatinous elevation with localised limbal conjunctival

injection. White spots called Tranta spots can appear within the limballesion.

o Mixed type : Both palpebral and bulbar manifestations

o Corneal affection (rare): Punctate epithelial keratitis (keratitis superficialis

vernalis) & Epithelial macro-erosions (Shield ulcer) + corneal opacity(pseudo-gerontoxon)

-corneal manifestations & complications of trachoma

corneal ulcer -linear w horizontal linear axis

-lower border of pannus-superficial

pannus (cellular infiltration + superficial vascularization on upper pt of corneal)

-clinical types,CP of purulent conjunctivitisclinical type: epidemic, genital, ophtalmia neonatorum, metastatic gonococcalconjuctivitisCP: (a)incubation period: few hours to 3days

(b) infiltration stage: 2-3 days. conjuctiva red,chemotic, lid edema. no discharge.mild fever,preauricular lymph node enlarged and tender.


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(c)discharge: 2-3 weeks. lid swolen, conjuctiva red, chemotis. pus- form falsemembrane.(d) chronic- papillary thickening.

-type of allergic conjunctivitis,details about CP of spring catarrh

1) hypersensitivity to EXOgenous allergen-vernal keratoconjunctivitis

-atopic keratoconjunctivitis-giant papillary conjunctivitis-hay fever keratoconjunctivitis

2) hypersensitivity to ENDOgenous allergen-phlyctenular keratoconjunctivitis

CP spring catarrhsymptoms: intense itching, lacrimation, photophobia, ropy dischargesigns: 1) palpebral type(upper)- PAPILLAE-flat-topped

-multiple-cobble stone appearance-dark red-larger than trachoma-associated hyperemia and chemosis

2) bulbar/limbal type- limbal gelatinous elevation- localized limbal conjuctival injection- tranta spot

3) mixed type4) rare cornea affection

-3 causes of follicular conjunctivitisa) adenoviral conjunctivitisb) acute hemorrhagic conjunctivitisc) acute herpetic conjunctivitishny

8. Cornea-CP of hypopyon ulcer****a) Symptoms: Pain, lacrimation, photophobia, blepharospasm and severediminution of vision.b) Signs: mild to moderate lid oedema, ciliary and conjunctival injection, theulcer itself (disc like greyish or yellowish area of stromal infiltration, near thecenter of the cornea), positive fluoroscin stain, corneal oedema, perforation,anterior chamber involvement with hypopyon and pupillary constriction.

-classify keratitis, give Rx for hypopyon ulcerRx -top antibioticcombination to cover g-ve & g+ve (gentamycin&ciprofloxacin)promote re-epi -eye closure,lub,CL,corneal grafting

-complications of hypopyon ulcerCases without perforation


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Corneal opacity (usually vascularized)Irregular astigmatism (facet)KeratectasiaDescematocele

Cases with perforation

Depends on siteCentral lost AC PAS fistula 2ary glaucoma corneal staphylomaPeripheral iris prolapse leukoma adherentCorneal fistulaCentral perforation with epithelialization of the walls of the ulcerIntraocular infection (endophthalmitis)Intraocular hemorrhage

-Rx of ophthalmia neonatorum

-Rx & Cp of herpetic ulcer

-pathognomonic of herpetic keratitis

a. dendritiform ulcer b. history of recurrent ulcerationsc. hyposthesia of cornead. absence of corneal vascularization

- 2 corneal manifestations of phlycten

-corneal phlycten-fascicular ulcer-phlyctenular pannus

-predisposing factors for corneal ulcer

dryness(xerosis) exposure (lagopthalmus) decrease sensation-neuroparalysis/herpetis keratitis decrease resistant- DM,decrease vit A epithelial corneal edema eyelid malposition

contact lens wearer

-3 different signs between superficial & deep corneal vascularisation

Superficial Deep


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Origin traced over the limbus fromconjunctiva

ends at the limbus

branch arborescent fashion run parallel and branch at oneangle brush like

Characteristic bright red, well defined grayish or bluish red, ill defined

-indications keratoplasty,brief surgical techniquesIndications :

optical/visualo central corneal opacities : ulcers, degenerations, trauma, dystrophies,

keratoconuso corneal edema : keratoconus with corneal hydrops, pseudophakic bullou

keratopathy therapeutic : resistant corneal ulcer, corneal fistula structural : after treatment of pterygium cosmetic : blind eyes w corneal opacities

9. Lens-discuss congenital cataract**

-CP of lamellar cataract*Most common type ; usually bilateral*involving foetal nucleus

*arcuate opacities often straddle the equator of the lamellar catarct. ( so calledRiders )*viewed from front: disc-shaped configurationCauses:- Transient toxic during embyrogenesis- Calcium and Vit D deficiency during pregnancy

-types of developmental cataract & shortly about treatment**Types:a) Polar* Ant. polar: Less affect Visual* Post polarb) Lamellar

c) Completed) Coronary - Less affect Visuale) Blue dots - Less affect Visualf) Nuclearg) Sutural - Less affect Visualh) Membranous

Treatment:a) Non surgical treatment:


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- if no visual impairment like blue dot, sutural cataract- Optical treatment : in non dense cataract if can improve the vision to >6/18

b) Surgical treatment:- Anterior capsulorhexxis with irrigation and aspiration, posterior. capsulotomy, andant. vitrectomy

- Lansectomy thru pars plana / pars plicata

-3 causes of complicated cataractLocal: i-PCRIridocylitisPerforated corneal ulcer - central will lead to ant.polar cataract ( unilateral and central cornealopacity )Chronic glaucomaRetina and choroid disease ( Retinitis pigmentosa, long standing Retinal detachment,Intraocular tumour ( retinoblastoma, malignant melanoma )GENERAL DISEASE:Metabolic : DM, GALACTOSEMIAEndocrinal : hypothyroid / hypoparathyroidismSevere anaemia

-complications of cataract extraction** (intra & post-operative)Intraoperative:a) Vitreous prolapse may occur during intra/extracapsular C.Extractionb) Expulsive haemorrhage ( most serious ) - occur in old age with ATH + High IOP -----> usuallyloss of the eye.

Postoperative:a) Endophtalmitisb) Corneal edemac) Wound distortiond) Glaucomae) IOL dislocated

f) Uveitisg) Retinal detachmenth) Cystoid macular edema

-Mx of unilateral aphakia A. unilateral aphakia with good vision of the other eye

i. Secondary implantation of IOL-posterior chamber IOL (if there is intact post capsule)-anterior chamber IOL (if no post capsule)-scleral fixation (if no post capsule, and disturbed ant chamber

anatomy)ii. Contact lenses

B. unilateral aphakia with NO useful vision in the other eyei. corrected with glasses only

10. Glaucoma-CP of buphtalmos (congenital glaucoma) ox eye A. Symptoms

a) triad: watering, photophobia, blepharospasmB. Signs

a) cornea:i. corneal edema


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ii. corneal enlargement (buphthalmos)iii. widening of limbusiv. corneal clouding (tears of Descemet membrane)

b) blue sclerac) deep anterior chamberd) subluxated lens (late)

e) optic disc; glaucomatous cupf) refractive state of eye: axial myopia dt globe enlargementg)increase IOP

-CP of acute stage angle closure glaucoma**Symptoms:

a. Severe unilateral headache, nausea, vomiting and abdominal pain (that may givethe wrong diagnosis of acute abdomen)

b. Unilateral ocular pain radiating along the branches of trigeminal nervec. Marked diminution of vision down to HM or PLd. Redness, lacrimation and photophobia

Signs:

a. Lid and conjunctival oedemab. Ciliary congestionc. Corneal oedemad. Shallow ACe. Loss of iris patternf. Pupil is dilated, oval with absent reflexesg. Marked rise of IOPh. Difficult fundus examination due to corneal edemai. Gonioscopy shows abnormally closed angle

-Rx of acute congestive glaucoma***-patient must be hospitalized-Medical treatment:(a) sedatives- lumunal, largactil,morphine(b) dehydrating measures: IV hyperosmolar therapy (manitol,urea), oral glycerin,magnesium sulphate enema(c) pilocarpine drops

(d)Carbonic anhydrase inhibitor- acetazolamide(e) topical steroid drop- Not continued medical treatment beyond 24hours. Wait until eye is quiet beforeoperating.-operation:(a) iridectomy (if perip ant synaechiae not extensive)(b) filtration surgery such as trabeculectomy (If extensive)(c)other eye- prophylactic peripheral iridectomy


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-causes & Rx neovascular glaucoma A. causes: proliferative diabetic retinopathy, CRVO, carotid artery insufficiency

B. Rxi. Medical

a)beta-blockerb)carbonic anhydrase inhibitor

c)atropine and steroid (comfort)ii. surgica

a)laser photocoagulation to-retinal hypoxic area-neovascular fronds in the angle

b)filtering surgeryc)cyclodestructive

-causes of 2ry glaucoma (page 170 buku tebal :)

-2ry glaucoma due to corneal disease

1. Corneal fistula2. Corneal staphylomata

-field changes in chronic simple glaucoma**

-lense induce glaucoma1) intumescence cataract (phacomorphic glaucoma)-take up fluid and swell-pupillary block

2) lens dislocation (ant/post)-pupillary block, damage TM, vitreous plug, 2ry uveitis, angle recession

3) phacolytic glaucoma- lens ptn seep out obstruct angle directly or engulf by macrophage andmacrophage obstruct angle

4) phacoanaphylactic glaucoma-desensitization of lens ptn--granulomatous uveitis--edema TM

-define: scotoma11. Uveal diseases

-CP acute iridocyclitis**

symptoms

1. pain2. photophobia3. lacrimation4. dimunition of vision


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signs

1. ciliary injection2. keratic percipitate3. aqueous cell4. aqueous flare

5. loss of iris pattern(muddy iris)6. small irregular and sluggishly reacting pupil7. intraocular pressure change

acute cyclitis-lower IOP thick fibrinous exudation-increase IOP

-sequalae of acute iridocyclitis/complications**

1. posterior synechiae2. seclusio pupillae3. occlusio papillae4. total posterior synechiae5. peripheral anterior synechiae6. secondary glaucoma7. complicated cataract8. corneal degeneration9. cyclitic membrane and tractional retinal detachment10. band shaped keratopathy.11. atrophia bulbi

Easy to recall by remembering:a) SYNECHIAE : Posterior Syn. / Total Posterior Syn. / Anterior synechiaeb) PAPILLAE : Occlusio papillae / secclusio papillae.

-DD & main line of Rx of iridocyclitis**

DDx of red eye:o acute iridocyclitis.

o acute conjunctivitis

o acute closed angle glaucoma

o corneal ulcer

main Rx:o mydriatic cycloplegics - pain relief and prevention of synechiae.

o steroids - mainstay of treatment, local or systemic.

o cytotoxic agents - only in special types of severe uveitis.

o cyclosporin - only in special types of severe uveitis.

o other - hot fomentation, NSAID, treatment of the cause, treatment of the

complications.


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- define:iridocyclitisiridocyclitis is inflammation of the iris and anterior part of the ciliary body

-3 signs of acute iritis ( Q#....acute iritis ni same ngn acute iridocyclitis ke? Iritisis another name for anterior uveitis which is also known as iridocyclitis, basedon maklumat kat tenet la.)

12. Retina

-differences between rhegmatogenous & non rheg retinal detachment

Rhegmatogenous Tractional Exudation

Break Present Absent Absent

Configuration Concave Concave Convex

Mobility Freely REduce Fixed

-fundus picture in diabetic retinopathy**

mild-moderate non proliferative DR

1. microaneurysm - showing small dots 12-100um , early detec in DR,2. intraretinal hge- showing Dots and blot in the compact middle layer

retina,flame shape haemorrhage follow the nerve course

3. hard exudate - it is yellowish waxy appearance have affinity tomacula,composed of lipoprotein n distributed in circinate pattern.

severe non proliferative DR

1. large retinal hge2. cotton wool exudate3. venous changes-beading,dilated,saucer shape

4. IRMA(intra retinal microvascular abn)5. retinal ischaemia

proliferative DR

1. neovascularization


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2. pre retinal hge3. tractional retinal detachment

-short account on treatment diabetic retinopathy

1) Good metabolic control can delayprogression of diabetic retinopathy

2.1 Mild non proliferative - refer to ophthalmologist is essential for early detection- Retinopathy = Follow up every 6m- Macular edema = Laser rx can be done

2.2 Severe non proliferative - Follow up every 3m- Laser rx should be done in case* PATIENT = Lack compliance, one eyed patient* MEDICAL CONDITION = Pregnant ; Renal failure

2.3 Proliferaive retinopathy - Pan retinal photocoagulation- if new vessel is persist another session

photocoagulation or peripheral retinal cryotherapy-LASER THERAPY USED in:a) Diabetic macular edemab) Proliferative-VITRECTOMY :a) persistent intravitreous hgeb) tractional detachment-INTRAVITREAL INJECTIONa) Triamcilonb) Anti VEGF

-etiology & CP of CRVO

Incitin factor: Trombus formation and inflammationPredisposing factor: Diabetic, hypertension, Open angle glaucoma.CLINICAL PICTURE:

Non ischemic Ischemic

Symptom discover during routin fundusexam.

Sudden drop n cloudiness of visionafter awake

Sign:Vessel

Dilated tortuous vessel Marked dilated tortuousENgorge retinal vein

Vision 20/20 20/200 or worse

Haemorrhage Scattered all over retina extensively

Rx

-ophthalmic manifestation of retinitis pigmentosa**Fundus examination showing pigmentary black spot.LAter on it will increase and spread.Vessel are attenuated and thread likeOptic disc : pale waxy yellowish colour


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Later stage,post cortical cataract appear and turn out to complete opacity.

13. Ocular tumours-causes of yellow papillary reflexa) retinoblastomab) endophthalmitis

14. Ocular trauma-complications of retained intraocular foreign body1) mechanical- direct injury ocular structures2) infective: endophthalmitis3) specific reaction: siderosis(iron), chalosis(copper)4) immunonlogical: symphathetic ophthalmia

-Rx of extraocular foreign body

-CP lens changes after blunt trauma

dislocation or subluxation contusion cataract vossious ring

-Effects of blunt trauma on iris

traumatic miosis traumatic mydriasis iridodialysis traumatic iritis iris atrophy traumatic aniridia

-blunt trauma to lens1. Dislocations/subluxations:

o dt. complete/partial disruption of zonules

o can be compicated by pupillary block glaucoma

2. Traumatic cataract

o rosette-shaped cataract (usually in post. cortex, sometimes in ant. or

both)o may be complicated by lens-induced glaucoma, either:

lens-particle glaucoma (dt. liberated lens proteins) phacolytic glaucoma (dt. macrophages that engulf denatured lens

proteins)


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3. Vossious ring

o a circular ring of pigmented stippled opacity seen on the ant. lens capsule

dt. impression of the pupillary border of iris

-Rx of chemical burn of eye**15. Optic nerve

-3 different signs to differentiate papilledema & papillitis

papilloedema Papillitis

symptoms Increase ICP(headache, vomiting, blurredvision)visual acuity N

Marked visual deterioration

pupils N sluggish unsustained reaction onaffected side.(relative afferentpupillary defect)

fundus disc swelling & elevation ismore.no vitreous opacity

disc swelling & elevation is less.vitreous dusty opacity

field N in early cases. later itshows enlarged blind spot.latest it shows contraction.

central scotoma for red & green.

16. Orbit-causes,CP,DD of orbital cellulitiscauses: staph or strepCP: sudden onset of unilateral chemosis, pain, lid oedema, reduction of ocularmovement, proptosis(frequently laterally & downward)DD:tenositis, cavernous sinus thrombosis, orbital periostitis

-Rx orbital cellulitis

adult: high IV dose of penicillin (200 000 unit) alternating with penicillin resistantantibioticchildren


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1) congenital: dermoid cyst, meningio-encephalocele, developmental anomaliesskull and orbit.2) traumatic: surgical emphysema, retrobulbar hge, carotid-cavernousfistula(pulsating)3) inflammatory:-acute: orbital cellulitis, CST, orbital periosteitis, tenonitis

-chronic: inflammatory pseudotmor, TB, syphilis

4) endocrinal: thyroid ophthalmopathy5) neoplastic:-1ry: dermoid, vascular tumor, rhabdomyosarcoma, neuroma

- extension from surrounding- metastatic: neuroblasoma(children), breast cancer, lung cancer

-enumerate endocrinal causes of exophthalmos

-CP & complications of thyroid exophthalmos-Exposure keratopathy?-Optic nerve atrophy?

17. Diseases of the sclera.18. Ophthalmic lasers.( E.L)

-4 treatment modalities using laser

refractive error:PTK,PRK & LASIK acute n open angle glaucoma diabetic macular oedema cataract surgery:post capsulotomy n for cataract extraction subretinal neovascular membrane proliferative diabetic retinopathy early m.choroidal melanoma

-indications of argon laser photocoagulation

argon laser trabeculoplasty laser peripheral iridectomy laser cyclophotocoagulation diabetic macular oedema Rx of early m.choroidal melanoma n retinoblastoma

19. Others-ocular manifestation in patient with Diabetes Mellitus***a) Eyelid - xanthelasmata.b) Increased liability to conjucntivitis and keratitis.c) Increased liability for iritis and iridis rubeosis.d) Lens - temporary refractive changes, early presbyopia and diabetic cataract.e) diabetic retinopathy.f) intraocular haemorrhages - hyphaemia, vitreous hemorrhage.g) Acute papillitis or retrobulbar neuritis.


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h) Extraocular muscles palsy due to ischaemic neuropathy.

-ocular manifestation in hypertensive patient

-Vit A deficiency eye manifestation & short treatment

Early: Loss of corneal lustre with dryness and hyposthesiaLate: Rapidly progress to corneal ulceration and meltingNo inflammatory signs are seen & perforation can occur

Treatment: Vitamin supplementation and treatment of protein deficiencymalnutrition

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Past Years Ophthalmology q&As

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