Ophthalmology

ANATOMY OF EYE  Schimer’s test is done for Dry eye.

 Maximum cones are seen in Fovea centralis.  Curvature of cornea – Keratometer.
 Superior oblique muscle is supplied by fourth cra-  Corneal thickness – Pachymeter.
nial nerve.  Corneal surface – Placido disc.
 Axial length of eye ball – Adult: 24 mm (Child: 16.5-  AC angles – Gonioscope.
17 mm).  Corneal sensation – Aesthesiometer.
 1 mm change in the axial length of the eyeball pro-  Refractive errors – Retinoscope.
duces a change in refractive index by 3 diopter.  Direct ophthalmoscope – Macula, fovea, optic disc.
 Blind sport of Mariotte is also known as Optic disc.  Indirect ophthalmoscope – Peripheral retina, cen-
 Depth of anterior chamber of the eye 2-3 mm. tral retina.
 Eye structure with maximum refractive power is  Indirect ophthalmoscopy – Real, Inverted and
Anterior surface of cornea. Magnified image (RIM).
 The normal pH of tears is 7.5.  Direct ophthalmoscopy – Virtual, erect and mag-
nified image (DEV).
 Power of normal eye is +60 D.
 Squint – Hirschberg test.
 Cranial nerves related to eye: 2,3,4,5,6,7.
 Distinguish between coloured halos of cataract and
 Thinnest part of eye is posterior part (also Thin- glaucoma – Fincham’s test.
nest part of lens is posterior).
 Distinguish between optical and organic defect –
 Attachment of vitreous is longest at ora serrata. Pinhole test.
 Latent squint – Cover/Uncover test.
PROCEDURES  Testing colour vision – Isochromatic charts
(Ishihara chart).
 Direct ophthalmoscope:
 Acuity for distant vision – Snellen chart.
— Magnification: 15 times
 Acuity for near vision – Jaeger type cards.
— Distance: 25 cm
 Field vision – Perimetry, Bjerum’s screen.
— Image: Erect
 IOP is best measured by Applanation tonometry
— Magnification is more than indirect (Goldmann).
 Most reliable provocative test for angle closure  Aqueous outflow is best measured by Tonogra-
glaucoma – Darkroom test. phy.

10.1
 PHARMACOLOGY  Trachoma: DOC – Azithromycin; Blanket therapy –
Tetracycline
 Not an antiglaucoma drug – Prednisolone.
H Herbert’s pit
 DOC for CMV retinitis in HIV patients – Gancyclovir.
 Tetracyclines can be used topically in eye. A Arlt’s line
 1% atropine is given in uveitis to cause mydrasis L Leber cell
and prevent formation of posterior synechiae.
F Follicles (Sago grain) [HALLMARK]
 Drug cannot be used in Malignant Glaucoma – Pilo-
carpine (can be used in POAG, AACG). S SAFE strategy (surgery, antibiotic, facial
cleanliness, environment improvement)
 Mydriatic does not have any cycloplegic effect is
Phenylephrine. P Papillary hyperplasia, pannus
 Shortest acting mydiatric – Tropicamide. City Corneal ulcers
 Cycloplegics are used for the treatment of Iridocy-  Seasonal allergic conjunctivitis/vernal keratocon-
clitis. junctivitis (spring catarrh):
 Single drug used for treatment of trachoma –
Cobble stone Cobble stone
Azithromycin.
 Drug used to avoid recurrence of pterygium – Mi- Can Cupid bow outline
tomycin C. Provide Pseudogerontoxon, Papillary
Ophtha

 RxOC for: hyperplasia

— Paralytic squint: Sx. Maximum Maxwell lyon sign (string or
— Amblyopia with unilateral strabismus: ropy discharge)
Conventional occlusion of normal eye. Shield Shield ulcer of cornea
— Accommodative squint: Correction of
In Hot Horner-tranta’s dots
refractive errors.
— Concomitant squint: Orthoptic exercises. Summer Summer problems
 Mydriatic used for refraction in infants – Atropine.  MCC of bilateral conjunctivitis in neonates
 Drug C/I in iridocyclitis – Pilocarpine. — 3 to 5 days – N. gonorrhoea
 Refractive error concerned MC with divergent stra- — After 7 days – C. trachomatis
bismus – Myopia. — At birth – Chemical.
 MCC of keratoconjunctivitis in contact lens users –
Pseudomonas, acanthamoeba (soft lens).
CONJUNCTIVA
 Herbert’s pit is seen in Chlamydial conjunctivitis.
 MCC of conjunctivitis – S. aureus.
 Xerosis is seen in Vitamin A deficiency.
 Membranous conjunctivitis – Corynebacterium
 Trachoma does not cause Enopthalmos.
Diphtheria.
 Epithelial lining of conjunctiva is stratified non-
 Pseudomembranous conjunctivitis – Strep.
keratinized.
Pyogenes.
 Arlt’s line is seen on Superior palpebral conjunc-
 Angular conjunctivitis – Moraxella Axenfeld.
tiva.
 Haemorrhagic conjunctivitis – Enterovirus 70.
 Pterygium:
 Epidemic keratoconjunctivitis – Adenovirus.
— Collagenous degeneration of conjunctiva

10.2
 OPHTHALMOLOGY

— Invasion of corneal epithelium  Treatment of band shaped keratopathy is EDTA.

— Destruction of stromal layer and Bowman’s  Part of cornea affected most in neuropathic
membrane. keratopathy – Inferior 3rd of cornea.
 Perforated corneal ulcer can lead to – Anterior cap-
sular cataract.
CORNEA  Organism which can penetrate normal cornea –
 Corneal nourishment – O2 directly from air and N.gonorrhoea.
glucose from aqueous humour.
 Keratoconus:
UVEAL TRACT AND GLAUCOMA
(a) Fleischer’s ring
 Anterior uveitis:
(b) Vogt’s striae
— First sign: aqueous flare
(c) Munson’s sign
— Most characteristic sign: Kps (Keratic
(d) High myopic astigmatism precipitates)
Rx – RGP contact lenses.  Definitive management in PACG – Laser iridotomy.
 Diagonostic test for corneal ulcer – Sodium fluo-  Most serious complication seen in other eye after
rescein dye. traumatic injury to one eye is Sympathetic oph-
 Interstitial keratitis is commonly seen in Congeni- thalmia.
tal syphilis.  Posterior staphyloma is seen in High Myopia.

Ophtha
 Dendritic ulcer is seen in Herpes simplex kerati-  Structures commonly involved in sympathetic
tis. ophthalmia are Iris and ciliary body.
 Corneal lesion seen in Hutchinson triad associated  In ACG: Obstruction to outflow of aqueous humour
with congenital syphilis is interstitial keratitis. is due to Trabecular meshwork.
 Moorens ulcer affects cornea.  MC form of glaucoma – Open angle glaucoma.
 Normal endothelial cell density (per mm square)  In iridodialysis, Iris is torn away from its ciliary at-
in cornea to maintain transparency is 500. tachment.
 Refractive index of cornea is 1.376.  Neovascular glaucoma is caused by CRVO, CRAO
and DM.
 Neurotrophic keratitis involves Trigeminal Nerve.
 APACG (acute primary angle closure glaucoma):
 Treatment for dendritic ulcer:
— Very high IOP
— Penetrating keratoplasty
— Vertically oval mid-dilated pupil
— Acyclovir
— Shallow anterior chamber.
— Debridement of the edges of the ulcer.
 Hundred day glaucoma – CRVO.
 Acute corneal hydrops is seen in Keratoconus.  Drug never used in glaucoma – Atropine.
 Nerve involved in exposure keratopathy is 7th cra-  Penetrating injury to ciliary body causes – Sympa-
nial nerve. thetic ophthalmitis.
 Initial treatment for perforated corneal ulcer is  In sympathetic ophthalmitis – Dalen Fuch’s nod-
Tissue adhesive glue. ules may be seen.
 Fungal corneal ulcer:  Pupil in acute congestive glaucoma:
— Convex hypopyon — Mid-dilated
— Hyphate margins — Vertically oval
— Satellite lesions. — Fixed.

10.3
  Management of choroiditis – Steroids.  MCC of blindness in India – Cataract.
 MC site of block to aqueous flow – Trabecular mesh-  MCC of cataract – Age related.
work.  MC type of congenital cataract – Blue dot cataract.
 Field defect in chronic simple glaucoma includes:  Most visually handicapped cataract – Posterior
— Paracentral scotoma subcapsular cataract.
— Arcuate scotoma  Second sight phenomenon – Nuclear cataract/Se-
— Seidel scotoma nile cataract.
(Except Central scotoma).  Diabetic cataract is due to accumulation of Sorbi-
tol.
 Ciliary staphyloma is a complication of – Scleritis.
 RxOC for aphakia – Intraoccular lens.
 Dangerous zone of eye – Ciliary body.
 Soft contact lens made up of HEMA.
 Hard contact lenses made up of PMMA.
LENS  Complicated cataracts and steroid induced cata-
 Lens is derived from surface ectoderm. racts are posterior subcapsular.
 Lens nourishment – Aqueous humour.  After cataract aka secondary cataract. It is of two
 Oldest lens fibres are located in nucleus. types:
 Stages of lens nucleus: Embryonic, Fetal, Infan- (a) Sommering’s
tile, Adult. (b) Elschnig’s Pearl.
Ophtha

 Processes involved in formation of aqueous  Laser used in the management of after cataracts –
humour from ciliary bodies: Nd-YAG.
— Active secretion 90%  Most important factor for refractive errors – Axial
— Ultrafiltration eyeball length
— Diffusion.  In Extra-Capsular Cataract Surgery (ECCEL) –
 Most common cause of visual morbidity – Refrac- Nucleus of the lens is excised.
tive error > Senile cataract
 Ideal site for intraocular lens implantation – Cap- RETINA
sular bag.
 Retina arises from neuroectoderm.
 Types of Cataract:
 Tractional retinal detachment is seen in DM retin-
Snow flake DM opathy.
Oil drop Galactosemia  Characteristic feature of diabetic retinopathy –
Microaneurysm.
Sunflower Chalcosis. Wilson’s  Roth’s spot are seen in SABE.
Nuclear Rubella  Cotton wool spots are commonly seen in HIV, Dia-
betes Mellitus and Hypertension.
Atopic Atopic dermatitis
 Earliest manifestation of retinal detachment –
Christmas tree Myotonia dystrophica Photopsia.
Rosette shaped Traumatic cataract  MC eye pathology in toxoplasma infection – Chori-
oretinitis.
Intumescent Phacomorphic glaucoma
 Retinal tear is associated with Lattice retinal de-
generation.

10.4
 OPHTHALMOLOGY

 Ring scotoma:  MC primary malignant tumour of orbit – Rhab-

— Pigmentation around the retinal veins domyosarcoma.
— Night blindness
— Tubular vision MISCELLANEOUS POINTS
— Bone corpuscular pigmentation of retina
 For a 1 year old child eye check up, which method
 Pale disc are seen in retinitis pigmentosa. of vision assessment will be used – Teller’s pref-
 Vision loss in HIV is commonly due to infection erential acuity charts.
with Cytomegalovirus.  Night blindness is characterized by – Increased dark
 Superficial retinal hemorrhage is seen in Nerve adaptation time.
fibre layer of retina.  Evisceration involves removal of which coats of
 Visual field defect in pituitary tumour with supra- the eyeball – Middle and inner layer.
cellular extension is Bitemporal hemianopia.  Which of the following is the feature of retinitis
 Most early feature of diabetic retinopathy – Dot pigmentosa – Arteriolar attenuation.
and blot haemorrhages.  A patient came to hospital with the complains of
 Neovascularization is characteristically associated loss of vision. On examination, fundus was found
with proliferative diabetic retinopathy. to be normal. Most probable diagnosis is – Ret-
 Enlargement of bilnd spots – Papilloedema. robulbar neuritis.
 Bitemporal hemianopia – Lesions in optic chiasma.  In Myopia – Rays fall anterior to retina.

Ophtha
 Homonemous hemianopia – Lesions in optic tract,  Contact lenses are better than normal glasses be-
LGB, optic radiations. cause – Prismatic effect is less.
 Macular sparing is seen in occipital cortex.  Treatment of mild congenital Ptosis – LP
 Centrocecal scotoma seen in toxic amblyopia. Sresection.
 CRAO – Cherry red spots, cattle track appearance,  Internal hordeolum is due to infection of – Mei-
hollenhorst plaque. bomian gland.
 CRVO – 100 day glaucoma.  Lacrimal gland is supplied through which parasym-
 Sudden painless loss of vision is seen in retinal pathetic ganglion – Pterygopalatine.
detachment, vitreous haemorrhage, CRAO, CRVO.  Phlyctenular conjunctivitis seen due to – Post tu-
berculoid.
 Scleritis is MC associated with Rheumatoid arthri-
OPHTHAL ONCOLOGY tis.
 Lisch nodules are seen in Neurofibromatosis.  Light reflex is carried through – Cranial nerve II.
 Malignant intraoccular tumour of children – Ret-  Lens used to treat astigmatism – Cylindrical lens.
inoblastoma.  Constriction of pupils is seen in light reflex and
 Retinoblastoma never cause proptosis. accommodation reflex.
 Flexner-Wintersteriner rosettes is seen in Retino-  Laser used in LASIK for correcting myopia –
blastoma. Excimer.
 Distant metastasis in retinoblastoma are common  Recurrent vitreous haemorrhage in young indi-
in brain. vidual indicates Eale’s disease.
 MC malignant eyelid tumour is Basal cell carci-  Jet-black spots in the retina are seen in Retinitis
noma. pigmentosa.
 Melanoma of choroid spreads most commonly to  Early occular sign of herpes zoster – Vesicles on
Liver. eyelids.

10.5
  Bitemporal hemianopia seen in pituitary ad-  Cystoid macular oedema develops commonly af-
enoma. ter – Intracapsular lens extraction.
 Lesion of Optic chiasma – Bitemporal hemiano-  World bank assistance to the National blindness
pia. control programme was provided for – Cataract.
 According to WHO, blindness is defined as Visual  MC part injured in orbital blow out # – Floor or
acuity of less than 3/60. inferior wall of orbit.
 Ankyloblepharon means Adhesions of the mar-  TOLOSA HUNT syndrome involves orbital apex.
gins of the two lids.  Pupil in acute anterior uveitis – Miotic.
 Power of IOL measured by SRK formula.  Normal intraocular pressure – 10-21 mm Hg.
 Argyll Roberson pupil (Prostitute pupil): Responds  Difference in image size – Aniseikonia.
to accommodation but light reflex is absent.  Maximum field of vision – Temporal.
 Inferior rectus is commonly affected in thyroid  Oculomotor nerve palsy presents as ptosis.
ophthalmopathy.
 Macular star is seen in papilledema.
 Angoid streaks are seen in Pseudoxanthoma
 Blowout fracture:
elasticum.
— Injury to eye ball
 Enucleation means removal of eyeball along with
— Visible hematoma
a portion of optic nerve.
— Emphysema of eyelid
 Peribulbar injection is given in Periorbital space.
— Diplopia
 Chronic, sterile inflammation of meibomian gland
Ophtha

is seen in Chalazion. — Enophthalmos

 Grave’s ophthalmopathy mostly presents as Prop- — Ptosis
tosis.  Sea saw nystagmus is seen in brainstem lesions.
 Multiple black floaters are due to particles in vit-  Management of anisometopia – Contact lens.
reous.  Management of choice for chronic dacryocystitis –
 Excessive accommodation may result in Dacryo-cysto-rhinostomy.
Pseudomyopia.  Subluxation of lens is associated with iridodone-
 Collection of blood in anterior chamber – sis.
Hyphaema.  MC complication of acute anterior uveitis is sec-
 Inability of completely close the palpebran aper- ondary glaucoma.
ture – Lagophthalmos.  DOC for retraction of hypermetropia in children
 Legal blindness – <3/60. <5 years – Atropine ointment.
 Economic blindness – <6/60.  Granulomatous uveitis:
 Red colour blindness – Protanopia. — Mutton fat keratic precipitates
 Green colour blindness – Deuteranopia. — Bussaca’s and Koeppe nodules.
 Blue colour blindness – Tritanopia.  Stocker’s line is seen in ptergyium.
 Attitudinal field defect is seen in anterior ischemic  Knudsons hypothesis is for retinoblastoma.
optic neuropathy.  Tear drop sign is seen in # of orbital floor.
 First nerve affected in cavernous sinus thrombo-  Axial proptosis is due to optic nerve glioma.
sis – 6th nerve.  Posterior limit of descemet’s membrane of cor-
 Plication of inferior lid retraction is indicated in – nea – Schwalbe’s line.
Senile entropion.  Lisch nodules are seen on iris in cases of neurofi-
 Lens used to correct myopia – Concave. bromatosis.

10.6