20-OPHTHALMOLOGY

cataract-ds BrushfielD-Down synd christmas tree-myotonic dystrophy coronaRY-pubeRtY cuneiform-cortical(polyopia) cupuliform-post subcapsular(max vision loss) Elschnig pearl, ring of Soemmering-after(post capsule) experimenTal-Tyr def glassworker-infrared radiation grey(soft), yellow, amber, red(cataracta rubra), brown(cataracta brunescence), black(cat nigrans)(GYARBB)-nuclear(hard) heat-ionising radiation Membranous-HallerMan Streiff synd morgagnian-hypermature senile oildrop(revers)-galactossemia(G1PUT def) post cortical/bread crumb/polychromatic lustre/rainbow-complicated post polar-PHPV(persistent hyperplastic prim vitreous) radiational-post subcapsular riders-zonular/lamellar(vitD def, hypoparathy) roseTTe(ant cortex)-Trauma, concussion shield-atopic dermatitis snowstorm/flake-juvenile DM(aldose reductase def, T1>T2, sorbitol accumulat) star-electrocution sunflower/flower of petal-Wilson ds, chalcosis, penetrating trauma syndermatotic-atopic ds total-cong rubella zonular-galactossemia(galactokinase def)

stage of cataract lamellar separation incipient/intumescence(freq change of glass) immature mature hypermature morgagnian sclerotic

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lens layer ant capsule ant epithelium lens fibre[66%H2O, 34%prot-aLp(Largest), Bet(most aBundant), γ(crystalline, soluble)] nucleus embryonic(0-3mthIUL) fetal(3-8mthIUL)-Y shape(suture) infantile(8mthIUL-puberty) adult(>puberty)

cortex post capsule thinnest-post pole>ant pole thickest, most active cell-equator vitA absent in lens vitC tpt in lens by myoinositol H2O tpt in lens by MIP26(Maj Intrinsic Prot26)

dislocation(luxation)-complete outside patellar fossa(ant/post) subluxation-partly displace in patellar fossa(shining golden crescent) Marfan synd-suptemp subluxat homocystinuria(b/l)-infnas subluxat Weil Marchesani synd-antinf subluxat hyperlysinemia, ED synd, sulfite oxidase def, Stickler synd, trauma

cataract Sx ECCE-6.5mm incision, post capsule, suture remove after 3w, near specs after 8w SICS-3.5mm phacoemulsification-2.75mm incision, hallow needle-titanium phaconit-1.5mm spectacle for-6w postSx complicat-bld fr post ciliary vess

lens-made of contact hard-PMMA soft-HEMA semisoft-PMMA+silicon+CAB rigid gas permeable-cellulose acetobutyrate magnific d/t contact lens in aphakia=8%

intraocular optic part nonfoldable-PMMA(diam=5mm) foldable-silicon, acrylic, hydrogel, collamer

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rollable-phaconit, hydrogel implantable collomer multifocal-pseudoaccomodation principle

haptic polypropylene, PMMA, acrylic phakic IOL=+12-–20D biometry(IOL power calculat) Sanders Retzlaff Kraff formula P=A–2.5L–0.9K A-contant for lens type L-axial lth eyeball(A scan/USG eye) K-mean corneal curvature(keratometry)

struct-refractive index air=1.000 aq humor, vitreous humor=1.336 cornea=1.376 lens=1.386-1.406

pupil-ds Argyl Robertson(Accomdat Refex+, light rxn–)-pretectal nucl inj, neurosyphilis, dorsal midbrain synd, perinaud synd D shape-iriDoDialysis festoon, small irregul sluggish-a/c ant uveitis Holmes Adie(tonic dilate pupil)-ciliary ganglion inj, idiop, HSV Marcus Gunn(relative affer pupil defect)-CNII neuritis, CNII compression total affer pupil defect-CNII transection/avulsion vertic oval, dilate, non reactive, fix-PACG

reflex Marcus Gunn jaw winking-CNV CNIII synkinesis, LPS Aschner Dagnini/oculocardiac reflex-aff-CNV1(ciliary ganglion), traction applied to

→ ↓EOM eff-CNX, HR,jn rhythm,asystole

app-condition Amsler sign-Fuch heterochromic iridocyclitis angioid streaks-pseudoxanthoma elasticum arcus senilis-old age asteroid hyalosis(body)-Ca, HTN, DM, lipid(cholesterol) bld&thunder fundus, splashed tomato-CRVO bony spicule pigmentat, ring scotoma, waxy pallor disc, arteriolar attenuation-retinitis pigmentosa bull eye maculopathy-chloroquine

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Busacca nodule-near collarette, large candle wax Spot-Sarcoid cattle tracking(fundus), box scarring(fluoresc angiography)-CRAO cherry red spot(edem all over retina except foveola) Cherry-CRAO Tree-Trauma(Berlin edema) Never-Neimann pick(sphingomyelina) Grow-Gaucher ds(βglucosidase), GM1,GM2 ganglioside Tall in-Tay sach ds(hexosaminidaseA) Sand-Sandoff ds(hexosaminidaseB)

dendritic/geographic ulcer-HSV dOT&fleck retinopathy, oil globule reflex(Ant lenticonus)-AlpOrT synd double immune ring of Weseley-Acanthamoeba keratitis egg yolk(lipofuschin)-fundus dystrophy egg yolk, scrambled egg, pseudohypopyon-Best ds epibulbAR dermoid-GoldenhARs synd Ferrys line-Filtering bleb Fleischer ring(Fe deposit), Munson sign, Vogt sign, oil Droplet reflex(DDopth), SCissoring reflex(retinoSCopy), a/c corneal hydrops-keratoconus(Down synd) flowerpetal(Henle layer)-DM macular edema, cystoid macular edema Haabs striae-buphthalmos headlight in fog, satellite lesion, Jenson juxtapapillary choroiditis-Toxoplasma Hollenhorst plaque-amaurosis fugax Hutchinson sign, nummular keratitis-HZV infectious crystalline keratopathy-Str viridans interstitial keratitis, ground glass, Salmon patch-cong Syphilis iris bombé, Arlts triangle-Ant uveitis iris pearL-Leprotic uveitis Kayser Fleischer ring(Descemet memb)-Wilson ds Koeppe nodule-at pupillary bord, form post synechiae Krukenberg spindle-pigm dispers synd, pigm glaucoma lattice degeneration retina, tigroid fundus, annular crescent, Foxter Fuch spot(dark area around fundus)-path myopia macular scar configuration-neuroretinitis memb conjunctivitis-C diphtheriae morning glory-optic disc coloboma mUlBERry-tUBERous sclerosis multip cotton spot around disc-Puestur retinopathy(Pancreatitis, head trauma, chest trauma, air/fat embolism) mutton fat keratic ppt(lymphocyte), retrolental flare, Dalen Fuchs nodule(subRPE)-panuveitis/sympathetic ophthalmitis MuziO phenom-Oguchi ds(cong static night blindness) Norrie ds-cong b/l blindn+pseudogliom

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oculodigital sign-Leber amaurosis pizza fundus, tomato ketchup retinopathy, sauce cheese, brushfire vasculitis-CMV retinitis ring scotoma-retinitis pigmentosa, high myopia, POAG, aphakic spectacle correction, panretinal photocoagulation Roth spot-bact endocarditis salt&pepper fundus-Toxoplasma, cong syphilis, rubella scintillating scotoma-migraine sclerosing keratitis-RA Shafer sign-retinal detachment smoke stag, enlarged inkblot-central serous retinopathy snowball opacity-sarcoid, amyloid, Lyme ds, candidiasis snowbanking, snowball-pars planitis Stocker line-pterygium synchisis scintillans-liquefactive vitreous tear drop sign-blunt trauma eye tesellate fundus-myopia, retinitis pigmentosa ulcus serPens-Str Pneum VoSSius ring(ant capS lenS)-concuSSion inj watered silk-hypermetropia

fungal corneal ulcer We-Wessley sterile immune ring Saw-Symptom<sign Vegetative-Vegetative material trauma D-Dry looking ulcer P-Pseudohypopyon(convex) S-Satellite lesion Film-Feathery finger like extension into stroma

seasonal allergic/spring catarrh/vernal keratoconjunctivitis Ropy-Ropy discharge Cobblestone-Cobble stone(eosinophil), pavement stone, papillary hypertrophy Can-Cupid bow outline Provide-Pseudogerontoxin Maximum-Maxwel Lyon sign(eosinophil) Shield in-Shield ulcer in cornea Hot-Horner Tranta dot, T1HSR Summer-Summer problem type-palpebral(MC), bulbar, mixed

Rx-olopatadine drop

hypopyon-corneal ulcer, fungal ulcer(Aspergillus, Fusarium), Behcet ds(recur),

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endophthalmitis, panuveitis, panophthalmitis pseudohypopyon-retinoblastoma, Best ds

a/c/epidem hgic conjunctivitis(PACESH) Picornavirus Adenovirus11(MC) CoxsackievirusA24 Enterovirus70, Echovirus31 Str pneum Haemophilus

blindnessWHO-ICD—visual acuity with best correction ction—NPCB, India(LESMA) catI=6/18-6/60-Low vision catII=6/60-3/60-Economic/work blindness catIII=3/60-1/60-Social/walk blindness catIV=1/60-PL+-Manifest blindness catV=PL–-Absolute blindness

WHO-cataract, RE, childhood blindn, trachoma, onchocerciasis NPCB-cataract, RE, childhood blindn, corneal blindn(trachoma), DM, HTN retinopathy

blindn sudden painful-PACG, a/c iridocyclitis, chem&mech inj eyeball, endophthalmitis, optic neuritis painless-macular edema, CRAO, CRVO, CSR, retinal detachm, exudat ARMD, vitreous& retinal hge, methyl alcoh amblyopia, subluxat/dislocat lens gradual painful-corneal ulcer, POAG(c/c simple glaucoma), c/c iridocyclitis

painless-progressive pterygium, corneal dystrophy, corneal degenerat, cataract, chorioretinal degenerat, dry ARMD, DM retinopathy, RE, presbyopia, Leber heredit optic neuropathy

tubular vision retinitis pigmentosa high myopia POAG CRAO with sparing of cilioretinal a

synd with ocular m palsy Weber synd=i/l CNIII palsy+ c/l hemplegia(cerebral peduncle) Nothnagel synd=i/l CNIII palsy+ c/l cerebellar ataxia(sup cerebellar peduncle)

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Benedict synd=i/l CNIII palsy+ c/l tremor/chorea/athetosis(red nucleus inj) Claude synd=Benedict+Nothnagel FOville synd=lat gaze palsy+ i/l CNVII palsy+ c/l hemiparesis(dOrsal pOntine inj) Millard Gubler synd=c/l hemiplegia+ dysarthria+ i/l lat rect palsy+ i/l paresis of upper&lower face(vent pont inj)

classif of trachoma-WHO(1987)(FITSO) to be used for field worker TF trach inflam follicular->5follicle(>0.5mm diam) on upper tarsal conjunctiva TI trach inflam intense-inflam&papillary hypertrophy obscuring> ½of tarsal vess TS trach scarring-scarring over upper tarsal conjunct, Arlts line TT trach trichiasis-≥1trichiatic cilia rubbing globe/evidence of recent removal CO corneal opacity extending over pupil

MacCallan classif of trachoma stage1(Incipient)-immature follicle on sup palpebral conjunctiva stage2(Established)-mature follicle on sup palpebral conjunctiva stage3(Cicatrizing)-follicle/scarring over sup tarsus stage4(Healed)-no follicle, extensive conjunctival scarring

trachom/Egyptian ophthalmia(A,B,Ba,C) H-Herbert pit A-Arlt line(follicular, papillary rxn) L-Leber cell F-Follicle S-SAFE strategy P-Papillary hyperplasia&Pannus City-Corneal ulcer

SAFE strategy S-Sx A-Antibiotic-Azithromycin 20mg/kgSD F-Facial cleanliness E-Environmental improvement

blanket therapy-2-9y>10% active trachoma-azithromycin SD 20mg/kg complication-corneal ulcer

organism penetrating cornea N meningitidis N gonorrhoea(most virulent) C diphtheriae Acanthamoeba Listeria monocytogenes Hemophilus

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examination-instrument angle(inf) of ant chamber-gonioscopy(refLected light-indirect-GoLdman, refracted light-direct-Koeppe)-struct seen-Schwalbe line(post limit Descemet memb), trabecular meshwork, scleral spur, ciliary body, root of iris axial lth-USGA binocular vision-synaptophore caroticocavernous fistula-intra a DSA colour blindness classify-anomaloscope quantify-FM100 hue test screen-Ishihara chart

contrast sensitivity test-Pelli Robson chart, Regan chart, Standard Snellen type corneal curvature-kerat/ophthalmometer corneal endothelium-specular microscopy(≥2500cell/mm²) corneal stain-2%fluorescein stain-(brilliant green), bengal Rose1%-(Red-Dead epith) corneal surface/topography-placido disc, keratoscopy corneal thickness-pachymeter corneal thickn, curvature, surface-orbscan differentiate b/n PACG& cataract-Fincham test DM macular edema, cystoid macular edema, central serous retinopathy-fluorescein angiography(antecubital v) DM retinopathy-ETDRS(Early Treatment Diabetic Retinopathy Study) field charting-campimeter, perimeter(fix at red light, respond to green light) IOP-tonometer indentation-Schiotz, Baraquer

appLanation(best)-GoLdman[biprism, MC, Imbert Fick law-Pressure in sphere=W( force)/A(area of flatten)], Perkin(hand held, children), noncontact(air puff)-Drager(wide range IOP), Malkalor(variable area, MacKay Marg principle) I/A-tonopen(irregular corneal surf), pneumotonometer rebound phenom-I care(self tonometer) dynamic contour-Pascal

macula-optical coherence tomography macular fn-Amsler grid chart(central 10°), 2pt discrimination test, pinhole test, Maddox rod test, Purkinje vess shadow, blue field entoptoscope flying corpuscle test, potential visual acuity meter, laser inferometry, ERG, VER n fibre layer-scanning laser polarimetry occult choroidal NV-indocyanic green angiography optic disc&macula-slitlamp biomicroscopy outflow of aqueous(C value)-tonography POAG-slit lamp biomicroscopy contact on eye-Goldman(3mirror) noncontact(front of eye)

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convex-+90,+78,+60D concave(Hruby lens)-–58.6D quantify optic disc change-scanning laser ophthalmoscopy refractive error-retinoscopy/skiascopy/shadow test 1m dist-movement of image same direction-hypermetropia, emmetropia, myopia<1D no-myopia=1D opp-myopia>1D drug-subtract atropin=1D, C=0.75D, H=0.5D, T=0.25D

retina layer-confocal microscope squint-Hirschberg test, Krimsky prism bar test, cover-uncover test, alternate cover test, Maddox rod/wing test, BSGT(Bagolini Striate Glass Test) subjective refining refraction cylinder-Jackson cross cylinder, Astigmatic fan test

sphere-fogging techn, duochrome test, pinhole test visual acuity(form sense) recognition-Snellen, E,C chart, Allen picture test resolution-teller, VER, optokinetonystagmogram detection-cardiff, dot visual acuity

transposition of equation xS with yC at z°=(x+y)S with (–y)C at (90+z)°spherical equivalent xS with yC at z°=(x+½y)S

angle of eye Alpha-Visual axis& Optical axis(Voice Of America) Kappa-Pupillary axis& Visual axis(Pakistan Versus Kashmir) Gamma-Fixation axis& Optical axis(Fixation Of Gamma)

distant direct opthlm-25cm Direct ophthalmoscope(vonHelmholts)(DO)-Erect, Virtual, 15time magnification(DEV15)-2DD-close to eye Indirect ophthalmoscope(IO)-Inverted, Real-4-5time magnification(IIR4-5)-8DD-1m-condensing lens req, stereopsis present

field of vision(BYRG) Blue>Yellow>Red>Green sup(50°)<nas<(60°)<inf(70°)<tem(90°)

Purkinje image 1-ant cornea surf

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2-post cornea surf 3-ant surf lens —erect&move in same direction 4-post surf lens

—inverted&move in opposite direction

nystagmus-lesion uPbeat-Pons downbeat-craniocervical jn gaze evoke-cerebellum

aq humor flow through pupil(μl/min) morn=3.0, after=2.4, night=1.5, total=2.0

corneal opacity-corneal thickn⅓ nebula< (most vision disturb d/t diffraction)⅓ ⅔ macula= -⅔ leucoma>

→ corneal epith inj corneal endoth rapidly regenerate

staphyloma abnormal protrusion of uveal ts weak& thin portion of cornea/sclera ant-corneal ulcer intercalary(limbus)-trauma, inf ciliary-scleritis equatorial-scleritis, degenerat myopia, c/c glaucoma post-high myopia(>–6D)

exophthalmos-protrusion>18mmproptosis-protrusion≤18mm

keratopathy(5 CAT N Fabryds) Cu Ca(band shape)-hypercalcemia, silicon oil, hypophosphatasia, sarcoid, phthisis bulbi Chloroquine Chlorpromazine Cysteine Amiodarone Adrenalin(black cornea/adrenochrome) NSAID Fabry dsMx-EDTA chelation

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keratoplasty Donor-endothelium, Descemet memb host-epithelium, n, keratocyte diam=7-8.5mm

Fuch endothelial epithelial dystrophy stage 1-cornea guttata 2-edema/endoth decompensation 3-bullous keratopathy 4-scarringMx-edema-5%NaCl Bullous keratopathy-Bandage soft contact lens

struct-power Lister reduce eye=+60D cornea=+44D lens=+16D amplitude accomodation=+10D max tone ciliary m=+3D

peribulbar inj-periorbital space

rod=120mill, cone=6.5millcell-response rod, cone, horizontal cell-hyperpolarizat bipolar cell-hyper/depolarizat ganglion cell-depolarizat amacrine cell-depolarizat, spike potential

optic cup:disc=0.3:1

cell-NT rod,cone-glutamate amacrine cell-8NT(GABA, Gly, dopamine, ACh, indolamine)

path of light→ → → → → → cornea aq humor lens vitreous retina[Inner limiting memb N fibre layer

→ → →Ganglion cell layer Inner plexiform(secrete ACh) Inner nuclear Outer → → →plexiform(Henle layer) Outer nuclear External limiting memb Layer of

→ → →rod&cone retinal Pigmentary epith] outerside Bruch memb → → →choroid[choriocapillary middle vasc(Salter) Large(HaLLer)] suprachoroid

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→lamina sclera foveola=ILM+ELM+cone fovea=ILM+OPL+ELM+cone neurosensory epith=retina–(LRC+RPE) macula-GCL thickest inner 6layer-central ret a-sup br-NFL, deep br-INL>OPL outer 4layer-post ciliary a bld retinal barrier inner-wall of bld vess-DM retinopathy outer-RPE+Bruch memb+choroid capillary-central serous retinopathy

laser photocoagulation-RPE angioid streaks-crack in collagenous portion of Bruch memb-Paget ds, pseudoxanthoma elasticum, Ehlers Danlos synd interphotoreceptor matrix metalloproteinase SialoProtein A/w Rod& Cone(SPARK) Ts Inh of MetalloProteinase(TIMP)

bld supply-central retinal a, retinal a, plexus of Haller& Zinn methyl alcohol-GCL

visual acuity fn of-cone in fovea

suP retina(lower visual field)-Parietal lobe-lower quadrantanopia inf retina(upper visual field)-temporal lobe-upper quadrantanopia

sensory organ-photoreceptor(rod, cone) 1st order-axon of bipolar cell(retina) 2nd order-axon of ganglion cell(retina, optic disc, optic chiasma, optic tract) 3rd order-axon fr LGB(optic radiat)

Walds visual cycle→ 11 cis retinOl All trAns retinAl

vitA regen-RPE→ cis trAns-RPE→ OL AL-LRC

1st ord neur-INL(bipolar cell), amacrine-VA in changing light condition, horizontal cell-connect 1cell to other 2ndON-GCL 3rdON-LGB(lat geniculate body)

retinoschisis-split retina in NFL-hypermetropia retinal detachm-split RPE-myopia cystoid macular edema-fluid b/n OPL-INL

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electroretinography(Photo le Bhai Phir) change in resting potential of eye induced by flash of light initial +ve deflect R1, f/b R2-Photochemical rxn(rod, cone) outer seg large –ve a wave-Photoreceptor activity large +ve B wave-response to Bipolar(Muller)cell small +ve c wave-retinal Pigment epith

ERG-LRC EOG-RPE-Ardens ratio=light peak/dark trough> 1.85-Best ds

Stargardt ds-loss central vision, ERG& EOG norm, no family hist

angioid streak(Bruch memb dystrophy)(PEPSI) Pseudoxanthoma elasticum Ehlers Danlos synd Pagets ds Sickle cell anem Incontinentia pigmenti, Idiopathic(MC)

DM retinopathy MI risk fact-T2DM durat T1DM-more retinopathy, IO after 5y T2DM-immediate IO, f/b-after 1y mild NPDR-after 1y mod NPDR-after 6mth severe/very severe-after 2-3mth NPDR MIld-MIcroaneurysm mod-FLam hge(NFL), dot/blot hge, hard exudate(OPL) 4:2:1rule-4-hard exudat, 2-v bld, 1-intraretinal microvasc abnorm

⅓ severe- satisfied⅔ very severe- satisfied

PDR neovasc-NVD(disc), NVI(iris), NVG(glaucoma), NVE(elsewhere)

→Rx-panretinal photocoagulation NdYAG-532nm double freq laser) pars planovitrectomy

preg-f/u-every 3mth

HTN retinopathy Keith Wagner staging I-diffuse arteriolar attenuation

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II-focal constriction III-SE(NFL)>HE, hge IV-b/l optic disc edema

DM ret-HE, dot blot hge, microaneurysm HTN ret-SE, flame shape hge, macroaneurysm(>100μ) isolated CNIII palsy+pupillary spare-DM

retinal detachm(NSR-RPE) prim rhegmatogenous-retinal break/hole-convex retinaRx-vitreoretinal Sx sec tractional-neovascularisation, pull of retina by fibrovasc(vitreoretinal) band-concave

exudative(solid)-choroid tm, CSR, post uveitis, preg, shifting fluid signRx-Rx of underlying condition

CRVO-splash sauce app(multiple flame shape hge), 100d glaucoma(NVG)

central serous retinopathy ring reflex, young mal, self limited, steroid aggravat, smoke stack, enlarge ink blot(fundoscopy), mushroom shape(fluorescein angiography)

vitreous attachm strongest-ora serrata(jn b/n retina& ciliary body)

vitreous replacement high surf tension gas air-not expose SF6-2 C3F8-4

liquid silicon oil-high density perfluorocarbon liquid-high sp gravity

Whitnall tubercle(attached to lat wall orbit) LPS capsulopalpebral fascia lat check lig suspensory lig of Lockwood(prevent eyeball fall)

leukocoria(PREDICT) PHPV

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Retinopathy of prematurity, Retinoblastoma Endophthalmitis Dysplasia of retina Incontinentia pigmenti Cong cataract, Coat ds(NORRIN gene) Toxoplasma, Toxocara

retinopathy of prematurity(DR Fir PT)→ → temporal retina, <32w, <1500g, bld transfusion, 100%O2, VEGF NV RD+VH

zone I-radius=4DD, zone II, zone III stage I-Demarcation line stage II-Ridge stage III-Fibrovasc prolifer stage IV-Partial RD, A-no fovea, B-fovea involve stage V-Total RD screen age=32-36wRx-stage I,II,III

zone I,II-laser ablation of immature &avasc retina, III-w/w stage IV,V-vitreoretinal Sx

retinoblastoma 70-75%-b/l, 25-30%-u/l 18mth, leukocoria-60%, squint-20% sporadic-94%, Knudson 2hit hypothesis, 2hit afterbirth, 85%-u/l, 15%-b/l familial-6%, 1hit germcell, 1hit somatic, 85%-b/l, 15%-u/l, 40%-heritable Flexner Wintersteiner rosette, Homer Wright rosette, pseudorosette, fleurette, endophytic-cottage cheese app Ix-1st-USGBscan-calcific, best-NCCT, CNII-MRI

→ spread-CNII brain International classific A-<3mm(<2DD from fovea/1DD fr disc)-conservat-laser/cryo

→ B->3mm-CT laser/cryo→ C-localised vitreous-CT laser/cryo

→ D-diffuse vitreous-CT laser/cryo E->½ eyeball(touching lens)-enucleation RT-b/l, CNII involve, osteosarcoma, pinealoma

eyelid skin subcut ts striated m LPS orbicularis occuli

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pretarsal-spont blink RiOLan-Oppostion of UL-LL HoRner-dRainage of teaRs

preseptal-voluntary blink orbital-forceful blink subm areolar ts sm m-Muller/tarsal m(sympath-1-2mm eye elevat) fibrous skeleton-tarsus, orbital septum palpebral conjuct

ptosis LPS action-norm>15mm, good=8-15mm, fair=4-8mm, poor<4mm ptosis-mild=2mm(LPS plication), mod=3mm(LPS resection), severe≥4mm(LPS replace-frontalis/fascia lata sling) Marcus Gunn jaw winking(u/l ptosis+ chewing) phenom

→ pterygoid LPS(CNV)Mx-b/l LPS disinsertion Fasanella Servat-Horner synd LPS plication-mild simple ptosis LPS resection-mod simple ptosis sling-severe simple ptosis best material-fascia lata

↑ ↑ Telecanthus- intercanthal dist, norm interpupillary dist, sofT tissue↑ ↑ ↑ Hypertelorism- intercanthal dist, interpupillary dist, Hard tissue

distichiasis-abnorm row of cilia taking place of Meibomian gld madarosis-absent cilia-c/c blepharitis, leprosy, myxedema poliosis-greying of cilia-old age, VKHds trichiasis-misdirected cilia rub eyeball

entropion senile(involutional) cicatricial spastic congectropion senile cicatricial paralytic mechanical spastic

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direction of NLD(BLooD)-Backward, Lat, Downward

cong NLD obstr-Mx <9mth-Criggler massage 9mth-4y-Bowman probing >4y-DCR(middle meatus)adult NLD obstr-Mx a/c dacryocystitis-oral antibiotic, c/i-probing& irrigation c/c dacryocystitis-DCR TB, syphilis, leprosy, tm, sarcoid, fibrosed sac-dacryocystectomycanalicular obstruction(<8mm fr punctum) Mx-conjunct DCR-Pyrex Jones tubeblock> 8mm fr punctum Mx-canaliculo DCR-intubation tube tears lost-7% dehydration

lacrimal fistula-Mx-DCRlacrimal fibrosis-Mx-DCT

Schirmer test-tear strip(5min)-<5mm-severe dry eye

LGB(3rdON) 6layer 1,4,6-c/l 2,3,5-i/l 1,2-Magnocellular(Y)-Motion 3,4,5,6-paRvocellular(X)-colouR

pathologic myopia site of lesion-LGB

Colour vision pathway→ → → → → → → → → Cone bipolar GCL X fibre CNII OC OT LGB(3,4,5,6) OR visual → →cortex final visual centre V4 (fusiform gyrus)

Light reaction→ → → → → → retina CNII OC OT pretectal area dorsal midbrain b/l Eding Westphal → → → →nucleus CNIII(n to inf oblique) ciliary ganglion short ciliary n constrictor

pupillaeNear pathway(trikinetic reflex) b/l pupil constrict+ (convergence+ accomodation)-nucleus of Perlia

→ → → → → → retina ON OC OT cortex EW nucleus CNIII

extraocular m 4recti-insert on annulus of Zinn 2oblique-SO-body Sphenoid, IO-body maxilla

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origin(MILS)-dist from limbus(mm) MR=5.5, IR=6.5, LR=7.0, SR=7.5 thinnest sclera-insertion of recti, thickest sclera-around CNII shortest-IO, longest-SO, shortest rect-LR, longest rect-MR Grave ophthalmopathy(IMSLO)-IR> MR> SR> LR> SO> IO EOM with 2origin, embryologic 1st to develop, 2a for each m except-LR Herring law of equal innervation-Yoke m Sherrington law of reciprocal innervation-LR-MR, SR-IR, IO-SO Rt eye(SLIIMS) SR*IO LR*MR IR*SO

↑ Beilchowsky sign- hypertropia on tilting head to same side-SO palsy step1-which eye hypertropic?

↑ step2-hypertropia on gaze to c/l side-SO palsy↑ step3-hypertropia on i/l head tilt-SO palsy

horiz gaze centre-Pontine Paramedian Reticular Formation(PPRF) rt PPRF lesion-rt horizontal gaze palsy rt MLF(med longitud fasciculus) lesion/internuclear ophthalmoplegia-rt MR palsy, lt adb nystagm rt PPRF+rt MLF lesion-1½synd b/l MLF lesion(WEBINO-Wall Eye B/l Internuclear Ophthalmoplegia-b/l MR palsy pseudostrabismus-visual axis parallel, eyes appear to have squint pseudoesotropia-apparent convergent squint

pseudoexotropia-apparent divergent squint convergent(esotropia) squint-uncrossef diplopia divergent(exotropia) squint-crossed diplopia rt esotropia-lt LR palsy vertical squint-hypertropia heterophoria-latent squint tropia-manifest squint paralytic(incomitant) squint-sec>prim deviation nonparalytic(concomitant) squint-sec=prim deviation

cong/infantile esotropia large angle constant esotropia IO overaction Dissociate Vert Deviation(DVD) latent nystagmus

Duane retraction synd cong strabismus, fail developm CNVI

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type I(esotropic)-diff abduction(MC) type II(exotropia)-diff adduction type III-diff both lt>rt

ophthalmoplegia ext-only EOM palsy int-only intrinsic m(ciliary m, iris) palsy nuclear-EOM palsy d/t CNIII nucl lesion ophthalmoplegic migraine/episodic ophthalmoplegia-recur attack of headache+ CNIII,IV,VI palsy c/c progressive external ophthalmoplegia-mitochondr myopathy, b/l ptosis, no diplopia

Chandler stagin orbital cellulitis(POSIC) I-Preseptal cellulitis II-Orbital cellulitis III-Subperiosteal abscess IV-Intraorbital abscess V-Cavernous sinus inf

aq humor form=secretion(70%)+ ultrafiltration(20%)+ diffusion(10%) drain=trabecular(90%)+ uveoscleral(10%)+ uveovortex(min)

PACGstage Prodromal Intermittent-1064nm single wavelth NdYAG laser periph iridotomy

→ A/c angle closure-DOC-2%pilocarpine IV mannitol, oral acetazolamide, RxOC-laser periph iridotomy C/c angle closure-trabeculectomy Absolute-retrobulbar Absolute alcohol inj, diode laser cyclophotocoagulationRx-1st line-IV mannitol

1-open angle2-IOP>21mmHg3-optic disc/visual field change 1+2+3=POAG, 1+2=ocular HTN, 1+3=norm tension glaucoma d/t hypoperfusion cup:disc ratio>0.3 POAG-DOC-prostaglandin earliest field def-Bjerrum area(central/paracaecal scotoma)

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cong glaucoma/buphthalmos↑ true-at birth, infantil-1-3y, juvenile(JOAG)>3y, corneal diam(Haabs striae), aqueous

not drain as ant chamber covered by Barkan memb DOC-acetazolamide RxOC-trabeculectomy+ trabeculotomy> goniotomy RxOC+corneal opacity-trabeculotomy express shunt-stainless steel, Ahmed implant-silicone, Xen implant-gelatine, hydrous implant-nitinol

sympathetic ophthalmitis→ → → penetrating trauma exciting eye panuveitis sympathising eye

→ 2w lifetime Rx-<2w-enucleate traumatic eye, >2w-pulse steroid(IV methylprednisolone)

Eales ds/periphlebitis retinae(idiopathic vasculitis) young mal with b/l recur vitreous hge (floater), NVE, sudden blurring of visionRx-w/w×3mth f/b pars plana vitrectomy

Fuchs heterochromic iridocyclitis(iris stroma atrophy) nongranulomatous ant uveitis, young mal with heterochromic iridum, hypochromia

tear film(LAMOMI) Outer-Lipid-sebaceous gld-Meibomian gld, Zeiss gld Middle-Aqueous-basal(accessory lacrimal-Krauss, Wolfring, mod sweat-Moll) Inner-Mucous-goblet cell-nasal conjuctiva

sweat gld Moll-apocrine, next to eyelash, duct open-eyelash(hair) folliclesebaceous gld Zeiss-lid margin, duct open-eyelash follicle Meibomian(tarsal)-rim of eyelid inside tarsal plate, duct open-lid margin

Meibomian gld-inf-internal hordeolum, noninf-chalazion(Meibomian cyst) Zeiss, Moll gld-inf-external hordeolum(stye)

lacrimal gld secretion(SG²PZ) Sup salivatory ganglion Geniculate ganglion Greater petrosal n Pterygopalatine ganglion Zygomaticotemporal n

alkali stage

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stage I-a/c ischemic necrosis stage II-reparation stage III-symblepharon

anat classif uveitis ant-iris, pars plicata of ciliary body iritis-iris iridocyclitis-iris, pars plicata cyclitis-pars plicata

intermed(pars planitis)-pars plana, retina, choroid post(chorioretinitis)-choroid, retina pan-whole uvea

activity of ant uvelitis-no. of cell in ant chamber, flare

phthisis bulbi final stage end result of c/c uveitis small, shrunken globe, thick sclera

→ → retinal pigm epith metaplasia intraocular ossification

site of lesion-visual field defect CNII-blindness optic chiasma-bitemporal hemianopia optic tract-incongruent homonymous hemianopia LGB-homonymous hemianopia optic radiat(total)-homonymous hemianopia with macular sparing optic radiation lower fibre(temporal lobe)-homonymous upper quadrantanopia optic radiat upper fibre(parietal lobe)-homonymous lower quadrantanopia visual cortex(ant occipital cortex)-homonymous hemianopia with macular sparing occipital cortex tip-homonymous macular defect

prevalence criteria for determining xerophthalmia(CCBN) Corneal xerosis>0.01% Corneal ulcer>0.05% Bitots spot>0.5% Nightblindness>1%

WHO classification xerophthalmia X1A-conjunctival xerosis X1B-Bitot spot X2-corneal xerosis

⅓ X3A-corneal ulceration< of cornea⅓ X3B-corneal ulceration> of cornea

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XN-night blindness XF-fundal change XS-corneal scarring 1st sympt-night blindness 1st sign-conj xerosis prevention-9dose <6mth=50000IU oral, 6-12mth=1lac IU oral, >1y=2lac IU oral, IM=½oral Rx-D0,1,14/30mg double dose

NPCB goal-0.3% by 2000 100%central sponsered scheme

→ shift eye camp approach fixed facility → conventional Sx IOL

↑ coverage of eyecare service in tribal& underserved area

VISION 2020-Right to Sight(WHO, 1999) ds(CCCDEFG) Cataract Childhood blindness Corneal blindness DM retinopathy refractive Error Focal trachoma Glaucomapyramid prim centre(20000 for 50000) 1ophthalm assistant sec centre(2000 for 5lac) 2ophthalmologist+ 8paramedic(mid level ophthalm personnel) training centre(200 for 50lac) centre of excellency(20 for 5crore)

vitB2 def-conjunct hyperemia vitB12 def+smoking+alc-prim optic atrophy(toxic amblyopia)

laser 193nm excimer-refractive Sx 532nm(double freq) NdYAG(colourless) -panretinal photocoagulation 1064nm(single freq)NdYAG-peripheral iridotomy, post capsulotomy diode-vitreous hge, confocal scanning laser ophthalmoscope(670nm) argon(488-514nm)-penetrating depth=1mm

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norm vert curv>horiz curv-with the rule astigmat= 0.25D

pleomorph adenoma lacrimal gld-displacem eyeball inferolat

illuminat frenzel glasses(+20)-abolish fixation, reveal periph vestib nystagmus

nystagmus central->1min

↑ upbeat- on looking up↑ downbeat- on looking down

vertical-when subject rotated head tip sideway

binocular vision grade I-simultan percept grade II-fusion grade III-stereopsis

temporal cortex→ Pcell-project Parvocellular layer of LGB, control by bipolar cell, show linear

summation of response, more sensit to wavelth Mcell-project to Magnocellular pathw, control by bipolar cell, show phasic nonlinear response to complete stimulus, more sensitive to luminance Wcell-diffuse extensive receptive field, control by amacrine cell, respond poorly to visual stimulus b/l inftemp cortex(Pcell) less-cortic colour blindn(achromatopsia), inabilit to recognise face of close relative(prosopagnosia) middle temp& middle sup temp cortex-motion detect& control of eye movement

Abbreviations a-artery, AA-amino acid, abtc-antibiotic, AI-autoimmune bef-before, bel-below, b/l-bilateral, bld-blood, b/n-between, bn-benign, br-branch, Bx-biopsy ca-carcinoma, carb-carbohydrate, c/i-contraindication, c/l-contralateral, conc-concentration, cong-congenital, Cx-cervix d-day, def-deficient, ds-disease, d/t-due to, Dx-diagnosis E-estrogen fem-female, fr-from gld-gland, glu-glucose h-hormone idiop-idiopathic, i/l-ipsilateral, inf-infection, inj-injury lig-ligament, LL-lower limb, l/t-leading to m-muscle, maj-major, mal-male, MC-most common, met-metastasis, min-minor, mtx-methotrexate, Mx-management n-nerve, norm-normal

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P-progesterone, pl-plasma, prot-protein, pt-patient Rx-treatment SCC-squamous cell carcinoma, sr-serum, Sx-surgery, sz-seizure tm-tumour, ts-tissue UL-upper limb, u/l-unilateral vag-vagina, VC-vocal cord, vel-velocity, vert-vertebra, vit-vitamin, vol-volume w-week, wt-weight Xr-X ray y-year #-fracture °-degree

THESE NOTES ARE ONLY FOR THE PURPOSE OF GUIDANCE AND HELP TO PG ASPIRANTS, NOT FOR COMMERCIAL OR OTHER PURPOSE. REFERENCE HAS BEEN TAKEN FROM VARIOUS STANDARD TEXTBOOKS.

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