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83 Cards in this Set
- Front
- Back
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CRVO
types? different presentation? cause of acute painless visual loss? other causes of visual loss? |
- ischemic and non ischemic
- ischemic: acute painless, non ischemic: asymptomatic painless - cause of visual loss: hhg/ neovascular - retinal detachment/ vitreous hhg / wet type AMD |
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NPDR
clinical features of mild? cause of visual loss? most imp diagnostic tool? recent imaging tool? drugs injected intravitreal? |
- microaneurysms/hard exudates/ dot hhgs
- macular edema - fluorescin angiography to differentiate between microaneurysm and dot hhg - OCT - anti VEGF/ Triamcenolone |
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PRP
indicaitons? type of laser? laser class? complications? recent alternative? |
- PDR/ ischemic CRVO
- argon/krypton/diode - photocoagulative - tubular vision - anti VEGF |
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CRAO
diagnostic criteria? symtpom? pathogenesis of cherry red spot? other causes of cherry red spot? |
- retinal whitening / cherry red spot
- sudden painless loss of vision - lateral displacement of inner retinal layers at the fovea - 1. tay sachs disease (amaurotic familial idiocy) 2. berlin edema (traumatic maculopathy) 3. quinine poisoning 4. macular hole |
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subhyaloid hemorrhage
diagnostic criteria? cause? treatment? other indication? |
- localized boat shape
- PDR - vitrectomy - tractional retinal detachment |
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retinal detachment
type? DD? visual field defect? other causes of altitudinal visual defect? treatment? |
- rhegmatogenous or exudative
- presence of a break - inferior -branch retinal artery occlusion - sclera buckle/ vitrectomy |
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retinitis pigmentosa
diagnostic symptoms? diagnostic signs? type of optic atrophy? other causes? investigations? |
- night blindness/ tubular vision
- bone spicule pigment / attenuated vessesl - consecutive - CRAO/ high myopia - dark adaptometry / perimetry ... ring scotoma |
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optic disc edema ( probably off)
causes? differences? cause of unilateral papilledema? cause of drug induced papilledema? |
- papilledema / papillitis
- laterality/ marcus gunn pupil - foster kennedy syndrome - steroids/ oral contraceptives / tetracycline |
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glaucomatous cupping
criteria? expected IOP? if normal IOP? diagnostic tests? |
- vertically oval / asymmetry / thin neural rim
- >21 mmHg - normal tension glaucoma - gonioscopy / perimetry |
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optic atrophy (probably off)
types? causes of 1ry? causes of 2ry? causes of consecutive? |
- 1ry/2ry/glaucomatous/consecutive
- multiple sclerosis (regular disc edges) - papilledema (blurred edges) - CRAO |
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causes of sudden loss of vision?
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optic nerve avulsion
CRAO hysteria and malingering (diagnosed by optokinetic drum and menace reflex) |
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causes of acute painful loss of vision?
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acute congestive glaucoma
corneal ulcer iritis acute optic neuritis |
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causes of acute painless loss of vision
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retinal detachment
vitreous hhg icshemic CRVO wet type of AMD |
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causes of gradual loss of vision?
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dry type AMD
diabetic maculopathy chronic optic neuritis senile cataract keratoconus primary open angle glaucoma retinitis pigmentosa |
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causes of regressive loss of vision?
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vitreous hhg
koch weeks conjunctivitis paralytic squint/ptosis |
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aggrivating and relieving factors of loss of vision
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1. pupillary dilation aggravates acute angle congestive glaucoma
2. day vision worsens with cupuliform cataract 3. defective night vision (tubular vision) caused by: - retinitis pigmentosa - ocular siderosis - vitamin A deficiency - primary open angle glaucoma - PRP - CRAO with patent cilioretinal artery - high myopia |
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examine levator function
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1. chin in primary position and down gaze
2. press firmly by 4 fingers on the side of the head and by thumb on brow 3. ask patient to look upwards and measure the lid elevation 4. normal: male 16-18 mm female 14-16 mm 5. abnormal: good 10-14 mm fair 6-10 poor <6 mm |
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test extraocular muscles
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1. monocular eye movment
2. position of gaze: 3 cardinal positions - primary position - looking straight up SR/IO - looking staright down IR/SO 6 cardinal positions: 1 prime mover 3. normal ductions with abnormal versions: medial longitudinal bundle defect eg multiple sclerosis 4. between each cardinal position return to primary position |
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regurge test
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1. pull lateral canthus outwards, palpate medial canthal tendon
2. press below tendon downwards and inwards & observe puncti 3. normally: negative regurge ANATOMICAL landmarks? lacrimal sac in lacrimal fossa ant to it lies ant lacrimal crest to which attaches medial canthal tendon post lies post lacrimal crest to which attaches horner muscle ABNORMAL results? postive regurge -mucous : obstruction w/o infection -mucopus: dacrocystitis - blood: TB/Tumor/membranous conj |
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test corneal reflex
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1. primary position
2. no local anesthesia 3. touch corneal periphery with a wisp of cotton - > blinking |
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causes of decreased corneal sensitivity?
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1. HSV and herpes zoster
2. syphilis and leprosy 3. destruction of trigeminal gnaglion in neuralgia 4. intracranial tumors/trauma |
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neural pathway of corneal reflex?
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afferent: long ciliary of nasociliary of ophtalmic of trigeminal
center: trigeminal nucleus in pons efferent: facial - > orbicularis --> blinking occulomotor --> superior rectus --> bell phenomenon |
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test anterior chamber depth
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shine light tangentially
look from the patient front view assess iris crescentic shadow normally: 0.5-1 mm if increased: shallow if decreased: deep |
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abnormal ac contents
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aq flare/cells
ant chamber IOL/Lens hyopyon ulcer hyphema iris pigment silicon foreign body |
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abnormal AC depth
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shallow: closed angle galucoma, corneal fistula, hypermetropia, intumescent cataract
deep: congenital glaucoma, keratoconus, myopia, aphakia |
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irregular AC depth
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lens subluxation
localized synechiae |
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causes of heterochromia of iris?
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heterochromia iridium:
- physiologic - naevus - melanoma heterochromia iridis: - phsyiologic - fuchs iritis - unilateral use of latanoprost |
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abnormalities of iris
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muddy iris
patches of iris atrophy rubeosis iridis |
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test light reflex pupil
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1. semidark room cuz if brightly illuminated -->baseline miosis
2. patient should fixate at a distant target to inhibit miosis by near response 3. shine light from bottom and swing the flashlight between both eyes to observe direct and consensual light reflexes |
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test near reflex
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1. semidark room because if brightly illuminated --> baseline miosis
2. patient should fixate at a distant target to inhibit miosis by near response 3. sudden appearance of a target in the midline brought gradually towards the patient until - it appears blurred or double: near point of accom - one eye loses fixation and turns out : near point of convergence |
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pathway of light reflex
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afferent: optic nerve
centre: edinger westphal nucleus in the midbrain.. subcortical efferent: occulomotor effector: sphincter pupillae |
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pathway of near reflex:
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afferent: optic nerve
center: cortical.. visual area in the occipital cortex efferent: occulomotor effector: sphincter pupillae --> miosis ciliary --> accomodation medial recti --> convergence |
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abnormalities in pupil
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1. marcus gunn pupil dt:
- total retinal detachment - optic neuritis - optic atrophy (NB marcus gunn jaw winking) 2. argyll robertson pupil (DM , syphillis) 3. absent near, intact light: any lesion from lat geniculate body to occipital cortex |
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pupil shape
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vertically oval: acute congestive glaucoma
festooned: iritis D shaped: irido dialysis pear shaped: leukoma adherent |
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polycoria
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iridectomy
iridodialysis patches of iris atrophy |
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dilated fixed pupil
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pharmacological
acute congestive glaucoma occulomotor injury 3rd stage of general anesthesia death |
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constricted fixed pupil
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horner syndrome
miotics corneal ulcer |
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purkinje images
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oblique illumination because vertical illumination produced superimposed images
1st: bright and erect 2nd: faint and erect 3rd: less bright than 1, inverted |
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uses of red reflex
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1. nuclear sclerosis vs cataract
2. mature vs immature 3. diagnosis of type of refractive error |
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cataract lens
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complicated <50
senile > 50 mature: - visual acuity HM - no red reflex - absent iris shadow if intumescent - white pupil Immature: - visual acuity: counting fingers - red reflex: dim - iris shadow present - pupil color grey |
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aphakia
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jet black pupil
absent 2nd, 3rd images |
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pseudophakia
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anterior chamber: possible visualization of lens edges + iridectomy
posterior chamber: bright 3rd image |
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test IOP digitally
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1. chin in the 1ry position + down gaze cuz
- if patient is looking straight ahead --> pressure on tarsus --> false high pressure - if patient closes his eye --> bells phenomenon --> pressure on the cornea --> false low pressure 2. rest 3 fingers of both hands on forehead and press by 1 index finger below the brow and feel the back wave 3. direction of pressure is downwards against orbital floor not backwards against fat |
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field of vision
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a. normal: according to visual acuity
- if more than 1/60 : normal by confrontation method - if less: normal by light projection |
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confrontation test
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1. patient and examiner are seated at the same level covering opposite eyes
2. patient and examiner should not wear spectacles to prevent field limitation 3. examiner moves his finger from the 4 fields of gaze to the midline until reported to be seen by the patient |
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light projection test
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ask the patient if he can determine direction of light
do not ask if he can see the light |
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chronic dacrocystitis
etiology predisposing factor complication treatment |
- pneumococci
- imperforate hasner valve - hypopyon ulcer /endophthalmitis - DCR |
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pterygium
symptom treatment 2 measures to prevent recurrence astigmatism dd pterygium vs pseudo? nature of pseudopterygium? |
- visual impairment / disfigurement
- surgical excision - MMC/ graft/ triple procedure - regular with the rule - hook - symblepharon |
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pingueculum
symptoms treatment ocular associations |
- asymptomatic
- surgical excision for cosmetic purposes - xanthelasma/ arcus |
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conjunctival hemorrhage
2 infective causees 2 non infective causes dd between conj and fracture skull base |
- pneumococci / EBV
- uncontrolled hypertension/ bleeding tendency - conjunctival: post limit seen fracture kull base: post limit not seen |
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conjunctival naevus
4 differences between neavus and melanoma |
melanoma: nodular, heavy pigmentation, large feeder vessel, metastasis, progressive growth
nevus: flat, minimal pigmentation and vascularity, no metastasis, stationary |
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symblepharon
2 etiologies 2 types 2 manifestations types of diplopia 2 other causes of binocular diplopia |
- trachoma/ chemical burn
- anterior/ posterior - lagophthalmos/diplopia - binocular - squint/anisometropia |
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pseudophakia
types IOL power calculation parameters energy used in phacoemulsification possible causes of decreased acuity |
- PCIOL/ACIOL
- biometry - axial length/ keratometry - ultrasound - corneal edema/ glaucoma/ wrong biometry |
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ACIOL
etiology contraindication complication how to avoid glaucoma why peripheral |
- post capsule loss during surgery
- shallow AC/ anterior synechiae - UGH syndrome - peripheral iridectomy - to avoid monocular diplopia |
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mature senile cataract
- expected vision - expected red reflex - other causes - 2 possible complications - surgery - when is sunset sign encountered |
- HM
- absent - diffuse corneal leukoma/ vitreous hhg - glaucoma/subluxation - ECCE if hard - morgagnian cataract |
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immature senile cataract
expected vision? expected red reflex? surgery? cupuliform cataract effect on vision? |
- > HM
- dim - phacoemulsification - decreased day/near |
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complicated cataract
possible local etiology? possible systemic etiology diabetic cataract: type of cataract induced? dd between congenital and acquired polar cataract? |
- corneal perforation
- DM - reversible snowflake / irreversible sorbitol - ant polar - congenital: bilateral/ clear cornea acquired: unilateral/ corneal fistula |
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blepharophimosis
components? 2 other lid anomalies? clinical significance? define ankyloblepharon? |
- ptosis/epicanthus/telecanthus
- coloboma/epicanthus - corneal ulcer / pseudoesotropia - upper and lower lid adhesion |
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chalazion
site of affection symptoms type of ptosis effect on lower lid type of astigmatism causes or recurrence |
- meibommian gland
- disfigurement / visual impairment - mechanical - ectropion - regular against the rule - DM/ uncorrected refractive error / meibommian gland adenocarcinoma |
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ptosis
ptosis with squint? ptosis with pupillary abnormalities? risk of congenital ptosis? surgery in poor levator function? |
- paralytic / myasthenic
- paralytic / sympathetic - amblyopia - hess (frontalis sling) |
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entropion
complication most common type most common cause surgery in the upper lid surgery in the lower lid |
- corneal ulcer
- cicatricial - trachoma - snellen - webster |
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ectropion
complication most common type surgery donor graft in cicatricial type |
- epiphora / lagophthalmos
- senile - medial canthoplasty - retroauricular / upper arm |
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lagophtalmos
nature? most common benign tumour? most common malignant tumour? complication most effective treatment |
- benign vascular tumor
- papilloma - BCC - amblyopia - intralesional steroids |
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BCC
incidence? most common benign lid tumour? most comon sites? most common type? treatment? investigations? |
- most common malignant lid tumour
- papilloma - lower lid/ medial canthus - noduloulcerative - mohs micrographic excision - not required/ locally malignant |
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Xanthelasma
symptom? treatment type of laser ocular associations incidence of recurrence? prevention? |
- asymptomatic
- surgical excision for cosmetic purposes/ CO2 laser - photoabblative (other lasers in this clase? excimer) - pinguaculum / arcus - common - reduction of blood lipids |
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keratoplasty
types? indications? contraindications? complications? diagnosis? donor preferred age? donor investigations? |
- penetrating/lamellar
- visual/ therapeutic - vascularization / chronic uveitis - graft rejection - graft edema dt endothelial dysfunction - young/good endothelial count - HIV/ hepatitis/ rabies |
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corneal opacity (nebula/leukoma)
causes? diff between nebula and leukoma? other complications of corneal ulcer? treatment? |
- corneal ulcer (infective/traumatic)
- iris visualization - vascularization / perforation - keratoplasty |
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arcus senilis
symptom? ocular associations? dd from pannus? laterality |
- asymptomatic
- pingueculum / xanthelasma - site and vogt lucid interval - bilateral except in ocular ischemic syndrome |
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hyphema
causes? grades? complications? treatment? |
- trauma / rubeosis iridis
- 0 - microscopic 1 - <1/3 2 - 1/3-1/2 3 - >1/2 4- total - red cell glaucoma / corneal blood staining - hospitalization /antiglaucoma |
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congenital glaucoma (buphthalmos)
most common cause? incidence? symptoms? signs? treatment? type of myopia? |
- barkan membrane
- male > females - lacrimation/ photophobia/ blepharospasm - corneal enlargement/ haab striae - goniotomy/ trab. / valve - axial |
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dilated fixed pupil
causes? light reflex? if absent direct and intact consensual? causes? |
- total 3rd nerve palsy/ closed angle glaucoma / atropine
- absent direct and consensual in the involved eye - marcus gunn pupil - optic neuritis / optic atrophy / total retinal detachment |
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schiotz indentation tonometer
normal iop? disadvantages? complementery tests? diagnostic triad of glaucoma? normal diurnal variation? |
- 10-21 mmhg (by this tonometer 12-23)
- inaccurate/ affected by corneoscleral rigidity - perimetry/pachymetry/gonioscopy - elevated IOP/ VF defects/ disc changes - 2-6 mmHG |
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maddox rod
uses principle diagnosis of vertical phorias other diagnostic tests |
- diagnosis of latent squint
- vertical red lien when held horizontally / dissimilar targets - hold the rod vertically - maddox wing/ worth 4 dots |
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worth 4 dot test
use? principle? other diagnostic tests? if patient sees 4 dots? if patient sees 5 dots? |
- diagnosis of latent squint
- dissimilar targets/ 2 red 3 green dots - maddox wing and rod - orthophoria / ARC - phoria |
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maddox wing
use? principle? other diagnostic test? advantage? |
- diagnosis of latent squint
- cross and arrows / dissimilar targets - maddox rod / worth 4 dots - quantitative |
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optokinetic drum
use? principle? other methods? causes of sudden visual loss? |
- pediatric visual assessment/ malingerer detection
- optokinetic nystagmus - allen figures / VEP - CRAO / optic nerve avulsion / hysteria and malingering |
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direct opthalmoscope
causes of cherry red spot other methods of retinal exam to diagnose peripheral retinal break? retinal break carrying poorest prognosis? |
- ?
-indirect ophtalmoscope. non contact lens - indirect ophthalmoscope - macular hole, giant retinal break, retinal dialysis |
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convex lens plus
use? types complications movement of red reflex |
- treatment of hyperopia/aphakia
- latent/manifest - closed angle glaucoma/esotropia - with |
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concave lens minus
uses types complications movement of red reflex |
- treatment of myopia
- simple/high - retinal detachment / exotropia - against |
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landolt broken ring chart
use other charts principle causes of acute painful loss of vision |
- assessment of visual acuity
- snellen / illiterate E - minimum visual angle 1 minute - acute congestive glaucoma/iritis |
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placido disc
use other test possible abnormality treatment |
- assessment of conreal surface regularity
- corneal topography - keratoconus - hard CL/ keratoplasty/ corneal rings |
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goldmann applanation tonometer
normal IOP disadvantages? complementary tests? diagnostic triad of glaucoma? normal diurnal variation? drugs that can induce increased IOP? |
- 10-21 mm HG
- affected by corneal thickness - perimetry / pachymetry - elevated IOP / VF defects/ disc changes - 2-6 mm Hg - steroids. vit A, oral contraceptives |
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pinhole
principle? conditions that are improved with pinhole? worsened? 2 examples of maculopathy? |
- blockage of peripheral light rays permitting only the passage of central undeviated rays
- refractive errors / peripheral cataract - maculopathy, central cataract - diabetic, age related |
