Ophthalmology Workbook PDF

Ophthalmology WHERE THE ART OF MEDICINE IS LOVED, THERE IS ALSO LOVE FOR HUMANITY. HIPPOCRATES DR. SUDHA SEETHARAM DR. SUDHA SEETHARAM FOLLOW ME ON TABLE OF CONTENTS Page No. Chapt...

Ophthalmology WHERE THE ART OF MEDICINE IS LOVED, THERE IS ALSO LOVE FOR HUMANITY. HIPPOCRATES DR. SUDHA SEETHARAM DR. SUDHA SEETHARAM FOLLOW ME ON TABLE OF CONTENTS Page No. Chapter 1: Coats and Contents of the Eyeball 1 Chapter 2: Clinical Examination 7 Chapter 3: Optics and Refraction 16 Chapter 4: Strabismus/ Squint 37 Chapter 5: Conjunctiva and Cornea 47 Chapter 6: Retina 66 Chapter 7: Neuro-Ophthalmology 84 Chapter 8: Crystalline Lens 97 Chapter 9: Glaucoma 112 Chpater 10: Adnexa 127 Chapter 11- UVEAL TRACT 144 Multiple Choice Questions (MCQ) 148 OPHTHALMOLOGY Chapter 1: Coats and Contents of the Eyeball COATS OF THE EYEBALL – Sclera – Cornea – Iris – Ciliary body – Choroid – Retina ARISE MEDICAL ACADEMY 1 OPHTHALMOLOGY OUTER FIBROUS COAT Cornea – Anterior 1/6th of the outer coat – Transparent – Function: Acts as an important refractive medium Posterior 5/6th of the outer coat Opaque Protection of intraocular contents Transmission of vessels and nerves Insertion of extraocular muscles MIDDLE VASCULAR COAT Iris – Circular disc shaped structure – Aperture at centre called pupil – Eye colour – Regulates the amount of light entering the eye by constriction and dilatation of the pupil ARISE MEDICAL ACADEMY 2 OPHTHALMOLOGY Ciliary body – Formation of aqueous humour – Attachment to the zonules which keep the crystalline lens in position – Accommodation Choroid – Vascular structure ARISE MEDICAL ACADEMY 3 OPHTHALMOLOGY INNER NERVOUS COAT Retina – Neural perception – CONTENTS OF THE EYEBALL Crystalline lens Aqueous humour Vitreous humour Lens – Biconvex structure, suspended by ciliary zonules – Divides the eyeball into anterior and posterior segment – Transparent structure: Acts as refractive medium – Accommodation ARISE MEDICAL ACADEMY 4 OPHTHALMOLOGY Aqueous humour – – Transparent: Acts as refracting medium – Produced from ciliary body and drained out mainly from the angle of anterior chamber – Maintains intraocular pressure – Provides nutrition and removes excretory substances Vitreous humour – – Transparent: Acts as refractive medium – Maintains shape and contour of eyeball – Maintains intraocular pressure ARISE MEDICAL ACADEMY 5 OPHTHALMOLOGY ARISE MEDICAL ACADEMY 6 OPHTHALMOLOGY Visual Assessment Visual Acuity Contrast Sensitivity Colour Vision Field of Vision ARISE MEDICAL ACADEMY 7 OPHTHALMOLOGY ARISE MEDICAL ACADEMY 8 OPHTHALMOLOGY Pelli Robson Chart ARISE MEDICAL ACADEMY 9 OPHTHALMOLOGY art Humphrey Perimeter ARISE MEDICAL ACADEMY 10 OPHTHALMOLOGY Anterior Segment Evaluation Slit Lamp Biomicroscope ARISE MEDICAL ACADEMY 11 OPHTHALMOLOGY Posterior Segment Evaluation Slit Lamp Biomicroscope with 90D Lens Indirect Ophthalmoscope Direct Ophthalmoscope ARISE MEDICAL ACADEMY 12 OPHTHALMOLOGY OPHTHALMOSCOPE Direct Ophthalmoscope Indirect Ophthalmoscope ARISE MEDICAL ACADEMY 13 OPHTHALMOLOGY Blindness WHO criteria for blindness Presenting visual acuity in the better eye less than 3/60 Criteria for visual impairment Presenting visual acuity less than 6/12 in the better eye – Mild Presenting visual acuity less than 6/18 in the better eye – Moderate Presenting visual acuity less than 6/60 in the better eye – Severe Economic Blindness Social Blindness Manifest Blindness Absolute Blindness Avoidable Blindness Preventable blindness Curable blindness ARISE MEDICAL ACADEMY 14 OPHTHALMOLOGY ARISE MEDICAL ACADEMY 15 OPHTHALMOLOGY Cornea: 44D Aqueous humour Crystalline lens: 16D Vitreous humour ARISE MEDICAL ACADEMY 16 OPHTHALMOLOGY Increase in the refractive power of the eye, usually to bring a near object to focus Contraction of the ciliary body Relaxation of the zonules Increase in the curvature of the crystalline lens Presbyopia Physiological decrease in the amplitude of accommodation with age Usual onset at the age of 40 years Convex lens for near work ARISE MEDICAL ACADEMY 17 OPHTHALMOLOGY Myopia Hypermetropia Astigmatism Myopia Hypermetropia ARISE MEDICAL ACADEMY 18 OPHTHALMOLOGY Astigmatism meridians of the eye Types of Astigmatism ARISE MEDICAL ACADEMY 19 OPHTHALMOLOGY ARISE MEDICAL ACADEMY 20 OPHTHALMOLOGY Sturm’s Conoid Myopia Parallel rays of light /distanct rays after refraction are brought to focus in front of the retina Types of myopia ARISE MEDICAL ACADEMY 21 OPHTHALMOLOGY Pseudoproptosis Exotropia/Divergent Squint Thin Cornea Deep Anterior Chamber Lens changes Subluxation Complicated Cataract Vitreous changes Vitreous liquefaction/degeneration Posterior vitreous detachment Fundus changes Lattice degeneration Myopic crescent Lacquer cracks Retinal tears Retinal detachment Posterior staphyloma Foster Fuch’s spots Normal Retina ARISE MEDICAL ACADEMY 22 OPHTHALMOLOGY Hypermetropia ARISE MEDICAL ACADEMY 23 OPHTHALMOLOGY Parallel rays of light/ Distant rays after refraction are brought to focus behind the retina Distance vision may become normal by use of accommodation Types of Hypermetropia Esotropia/Convergent squint Shallow anterior chamber Angle closure glaucoma Crowding on the disc/ Pseudopapilloedema Silk retina ARISE MEDICAL ACADEMY 24 OPHTHALMOLOGY ARISE MEDICAL ACADEMY 25 OPHTHALMOLOGY ARISE MEDICAL ACADEMY 26 OPHTHALMOLOGY Irregular Astigmatism Seen in Corneal scar, Keratoconus The two meridians are not perpendicular to each other Lack of any predictable pattern Does not improve with glasses Rigid gas permeable contact lens are given ARISE MEDICAL ACADEMY 27 OPHTHALMOLOGY Autorefractometer/ Retinoscope Subjective refraction Auto-Refractometer Retinoscope ARISE MEDICAL ACADEMY 28 OPHTHALMOLOGY Dilator Cylcoplegics Drugs Used in Refraction Atropine (1% eye ointment) – Longest acting – Duration of action 10-14 days – Slowest acting – Used in children 8 kg or > 1 year 2 lakh IU orally on days 0,1,14 For children 50 years Types Nuclear cataract Cortical cataract Posterior subcapsular cataract Mature intumescent cataract Hypermature Morgagnian cataract ARISE MEDICAL ACADEMY 99 OPHTHALMOLOGY ARISE MEDICAL ACADEMY 100 OPHTHALMOLOGY Diabetes Mellitus – – Caused by accumulation of sorbitol Galactosemia – Oil droplet cataract – Reversible cataract Wilson’s disease – Lowe’s syndrome – Oculocerebrorenal syndrome – Cataract associated with posterior lenticonus ARISE MEDICAL ACADEMY 101 OPHTHALMOLOGY Steroids Amiodarone Anti-cholinesterase Busulphan Chloroquine Chlorpromazine Ethambutol INH Causes – Chronic uveitis – High myopia – Retinitis pigmentosa – Angle closure glaucoma: – Tumours ARISE MEDICAL ACADEMY 102 OPHTHALMOLOGY Penetrating injury Blunt injury – Electrical injury Radiation injury Myotonic dystrophy – Atopic dermatitis Down’s syndrome ARISE MEDICAL ACADEMY 103 OPHTHALMOLOGY Intracapsular cataract extraction (ICCE) Extracapsular cataract extraction (ECCE) Small incision cataract surgery (SICS) Femtosecond laser assisted cataract surgery (FLACS) Incision: Main port and side ports Capsulorrhexis Hydrodissection Irrigation and aspiration IOL insertion and dialing Hydration of ports ARISE MEDICAL ACADEMY 104 OPHTHALMOLOGY Incision: Main port and side ports ARISE MEDICAL ACADEMY 105 OPHTHALMOLOGY Capsulorrhexis ARISE MEDICAL ACADEMY 106 OPHTHALMOLOGY Hydrodissection Nucleus management ARISE MEDICAL ACADEMY 107 OPHTHALMOLOGY Irrigation and aspiration IOL insertion ARISE MEDICAL ACADEMY 108 OPHTHALMOLOGY Types of IOL Monofocal IOL Multifocal IOL ARISE MEDICAL ACADEMY 109 OPHTHALMOLOGY Most common late complication of cataract surgery Proliferation of the residual lens epithelial cells in the capsular bag Previously called After cataract May present months or years after cataract surgery with gradually progressive decrease in vision Laser capsulotomy with Nd: YAG laser ARISE MEDICAL ACADEMY 110 OPHTHALMOLOGY ARISE MEDICAL ACADEMY 111 OPHTHALMOLOGY It is an optic neuropathy caused by increased intraocular pressure resulting Aqueous Humour Dynamics Site of production: Pars plicata of the ciliary body Conventional pathway Uveoscleral pathway ARISE MEDICAL ACADEMY 112 OPHTHALMOLOGY Evaluation of a patient of glaucoma Tonometry Gonioscopy Evaluation of optic disc Perimetry ARISE MEDICAL ACADEMY 113 OPHTHALMOLOGY Tonometry Goldman Applanation Tonometer Tonopen Rebound Tonometer Non contact Tonometer ARISE MEDICAL ACADEMY 114 OPHTHALMOLOGY Schwalbe’s Line Trabecular Meshwork Scleral Spur Ciliary body Band ARISE MEDICAL ACADEMY 115 OPHTHALMOLOGY ation Enlargement of the optic cup Increase in Cup: Disc Ratio Thinning of the neuroretinal rim Nasal shifting of vessels ARISE MEDICAL ACADEMY 116 OPHTHALMOLOGY Perimetry Paracentral scotoma Seidel’s scotoma Roenne’s nasal step Arcuate scotoma Double arcuate scotoma Total scotoma ARISE MEDICAL ACADEMY 117 OPHTHALMOLOGY ARISE MEDICAL ACADEMY 118 OPHTHALMOLOGY Anomaly of angle of anterior chamber: Trabeculodysgenesis Symptoms: Triad Lacrimation Photophobia Blepharospasm Corneal oedema due to failure of the endothelial pump Signs Buphthalmos Large cornea Cloudy cornea Haab’s striae Deep anterior chamber Optic nerve damage IOP: 40-60mmHg Treatment-Trabeculotomy and Trabeculectomy ARISE MEDICAL ACADEMY 119 OPHTHALMOLOGY Predisposing factors Shallow anterior chamber- Age>65 years, Female Small eyes- High Hypermetropes Nanophthalmos Microcornea Thick lens Acute Angle Closure Glaucoma Symptoms Sudden onset severe pain, redness and decrease in vision Nausea, vomiting Headache ARISE MEDICAL ACADEMY 120 OPHTHALMOLOGY Signs Congestion Hazy cornea IOP is high (60-70mm) Hg Treatment Intravenous Mannitol Pilocarpine eye drops Laser peripheral iridotomy: Nd: YAG laser Family history Myopia DM Nocturnal hypotension Hypothyroid Symptoms Early stage: Asymptomatic Criteria for diagnosis- Open angles on gonioscopy IOP > 21mm hg or Diurnal Variation>8mm Hg Optic disc changes suggestive of glaucoma ARISE MEDICAL ACADEMY 121 OPHTHALMOLOGY Variants of POAG Treatment Medical management Laser trabeculoplasty: Double frequency Nd: YAG laser Trabeculectomy B-Blocker Alpha Receptor Agonist Carbonic Anhydrase Inhibitors Prostaglandin Analogues Miotics Hyperosmotics ARISE MEDICAL ACADEMY 122 OPHTHALMOLOGY B- Blocker Timolol(0.5%) Alpha Receptor Agonist Brimonidine (0.2%,0.1%), Apraclonidine (0.5%) ARISE MEDICAL ACADEMY 123 OPHTHALMOLOGY Carbonic Anhydrase Inhibitors Topical-Dorzolamide (2%), Brinzolamide (1%) Systemic- Acetazolamide Prostaglandin Analogues Latanoprost (0.005%), Travoprost (0.004%), Bimatoprost (0.03%, 0.01%) ARISE MEDICAL ACADEMY 124 OPHTHALMOLOGY Miotics Pilocarpine (1%,2%) Hyperosmotic Drugs Mannitol (10 %, 20%), Glycerol ARISE MEDICAL ACADEMY 125 OPHTHALMOLOGY ARISE MEDICAL ACADEMY 126 OPHTHALMOLOGY GLANDS OF EYELIDS Meibomian glands Located in the tarsus but ducts open at the lid margin Gland of Zeis Located at the base of eyelash Gland of Moll Located between two eyelashes ARISE MEDICAL ACADEMY 127 OPHTHALMOLOGY INFLAMMATION OF LID GLANDS External hordeolum/ Stye Internal hordeolum ARISE MEDICAL ACADEMY 128 OPHTHALMOLOGY Chalazion ARISE MEDICAL ACADEMY 129 OPHTHALMOLOGY ANOMALIES OF LID POSITION Entropion Inward turning of lid margin Causes: Senile Cicatricial Burns: Chemical, thermal Steven Johnson syndrome Trachoma Herpes Zoster ARISE MEDICAL ACADEMY 130 OPHTHALMOLOGY Ectropion Outward turning of lid margin Causes: Senile Paralytic: Facial nerve palsy ARISE MEDICAL ACADEMY 131 OPHTHALMOLOGY Ptosis ARISE MEDICAL ACADEMY 132 OPHTHALMOLOGY Anomalies of Eyelashes Trichiasis Misdirection of the eyelashes Causes Treatment Epilation Electrolysis Distichiasis Presence of second row of eyelashes Usually congenital and asymptomatic Cryotherapy (if symptomatic) ARISE MEDICAL ACADEMY 133 OPHTHALMOLOGY Anatomy of Orbit Volume:30cc Weakest wall: Medial Thickest wall: Lateral Blow out fracture: Floor Bones in the walls of the Orbit Roof Floor Frontal Maxilla Lesser wing of sphenoid Palatine bone Lateral wall Medial wall Zygomatic Frontal process of maxilla Greater wing of sphenoid Lacrimal bone Ethmoid Body of sphenoid Proptosis ARISE MEDICAL ACADEMY 134 OPHTHALMOLOGY Orbital Cellulitis Most common cause of unilateral proptosis in children Clinical features Fever Pain, redness and swelling of the eye Proptosis Lid oedema Conjunctival congestion and chemosis Loss of ocular movements Tortuous blood vessels and congestion on the optic disc ARISE MEDICAL ACADEMY 135 OPHTHALMOLOGY Thyroid Ophthalmopathy Generally associated with Graves’ disease Most common cause of unilateral or bilateral proptosis in adults Pathophysiology Increase in the synthesis of glysominoglycans Clinical features Lid retraction Lid lag in downgaze Proptosis Infrequent blinking Staring/Frightened look Restriction of ocular movements ARISE MEDICAL ACADEMY 136 OPHTHALMOLOGY Blow Out Fracture of Orbit Sudden increase in intraorbital pressure Clinical features Periocular ecchymosis Infraorbital anesthesia Subcutaneous emphysema Enophthalmos Diplopia- Double Diplopia ARISE MEDICAL ACADEMY 137 OPHTHALMOLOGY Lacrimal system has 2 parts Lacrimal glands Lacrimal drainage pathway Lacrimal gland Main gland Accessory glands- Glands of Krause and Wolfring in fornix and infra-orbital region ARISE MEDICAL ACADEMY 138 OPHTHALMOLOGY ARISE MEDICAL ACADEMY 139 OPHTHALMOLOGY Schirmer’s Test Tear Film Break Up Time (TBUT) ARISE MEDICAL ACADEMY 140 OPHTHALMOLOGY Congenital Dacryocystitis Commonest site of obstruction is Valve of Hasner Clinical features Epiphora and discharge Matting of eyelashes Regurgitation Test is Positive Treatment Sac massage Syringing and probing – generally at 1yr Dacryocystorhinostomy (DCR)- at 3 years ARISE MEDICAL ACADEMY 141 OPHTHALMOLOGY Acute Dacryocystitis Acute suppurative infection of the lacrimal sac secondary to obstruction of the NLD Clinical features Pain, redness and swelling close to the medial canthus Fever Tender swelling over the lacrimal sac Chronic Dacryocystitis obstruction of the NLD Clinical features Watering and discharge Painless swelling close to the medial canthus Regurgitation test positive Non-tender swelling in the region of the lacrimal sac ARISE MEDICAL ACADEMY 142 OPHTHALMOLOGY ARISE MEDICAL ACADEMY 143 OPHTHALMOLOGY Chapter 11- UVEAL TRACT Uveitis Anterior Uveitis- Intermediate Uveitis- Pars planitis Posterior Uveitis- Chorioretinitis Granulomatous Uveitis Non-granulomatous Uveitis Tuberculosis Idiopathic Leprosy Juvenile Rheumatoid Arthritis Syphilis Ankylosing spondylitis Herpes Fuch’s heterochromic Sarcoidosis iridocyclitis Vogt Koyanagi Harada’s disease Sympathetic Ophthalmitis Lens induced uveitis Foreign body uveitis ARISE MEDICAL ACADEMY 144 OPHTHALMOLOGY Anterior Uveitis Symptoms: Pain, redness, photophobia, decrease in vision Signs Circumciliary congestion Miosed pupil Complications Festooned pupil Glaucoma Cataract ARISE MEDICAL ACADEMY 145 OPHTHALMOLOGY Intermediate Uveitis Floaters Whitish vitreous exudates in the region of the pars plana Snow Banking Posterior Uveitis Pain, redness Decrease in vision Vitritis Patches of choroiditis Treatment Drug of choice: Steroids Topical steroids Periocular steroid injection Systemic steroids Adjuvant Cycloplegic like atropine ARISE MEDICAL ACADEMY 146 OPHTHALMOLOGY Important One-Liners Headlight in fog appearance: Toxoplasma retinochoroiditis Sauce and cheese retinopathy: CMV retinitis Pizza pie retinopathy: CMV retinitis Candle wax dripping retinopathy: Sarcoidosis Dalen Fuch’s nodules: Sympathetic ophthalmitis Sunset glow fundus: Vogt Koyanagi Harada disease Bilateral granulomatous uveitis with Vitiligo and tinnitus: VKH disease Recurrent anterior uveitis with low back pain: Ankylosing spondylitis ARISE MEDICAL ACADEMY 147 OPHTHALMOLOGY 1. small print. What is the likely diagnosis? 2. Myopia 3. Hypermetropia 4. Presbyopia 5. Astigmatism 2. 1. Myopia 2. Hypermetropia 3. Regular astigmatism 4. Irregular astigmatism 1. Simple myopia 2. Compound myopic astigmatism 3. Simple myopic astigmatism 4. Mixed astigmatism 5. ARISE MEDICAL ACADEMY 148 OPHTHALMOLOGY 1. Simple hypermetropia 2. Compound hypermetropic astigmatism 3. Mixed astigmatism 4. Simple myopia 5. Diagnosis 1. Simple myopia 2. Simple myopic astigmatism 3. Simple hypermetropic astigmatism 4. Mixed astigmatism 6. 1. Simple myopic astigmatism 2. Compound myopic astigmatism 3. Mixed astigmatism 4. Simple myopia 7 1. Simple myopia 2. Simple myopic astigmatism 3. Simple hypermetropic astigmatism 4. Mixed astigmatism ARISE MEDICAL ACADEMY 149 OPHTHALMOLOGY 1. Simple myopia 2. Simple hypermetropia 3. Simple myopic astigmatism 4. Simple hypermetropic astigmatism 9. Identify the 1. Simple myopia 2. Simple hypermetropia 3. Simple myopic astigmatism 4. Mixed astigmatism 1. Observe for 6 months 2. Behavioral therapy 3. Assess for refractive error 4. Prescribe lubricating eye drops ARISE MEDICAL ACADEMY 150 OPHTHALMOLOGY 1. +2 DS/+1DC *90 2. +2 DS/+1DC * 180 3. +4DS/+1DC *90 4. +4DS/+1DC *180 Glass pres 1. -2 DS/-1DC *90 2. -2DS/-1DC * 180 3. -4DS/-1DC *90 4. -4DS/-1DC *180 iption ARISE MEDICAL ACADEMY 151 OPHTHALMOLOGY 1. -2 DS/-2DC *90 2. -2DS/-2DC * 180 3. -3DS/-2DC *90 4. -3DS/-2DC *180 14. A 25-year-old patient presented to the OPD with a known history of myopia. He is using glasses of -2 D in left eye and -3 D in the right eye. He is A. It moves in the same direction of the retinoscope B. It moves in the opposite direction of the retinoscope C. D. 15. Identify the 1. CMA ATR 2. SMA ATR 3. CMA WTR 4. SMA WTR Squint/Strabismus 1. 1. RIO+LSR 2. RSR+LIO 3. RSR+RIO 4. LSR+LIO ARISE MEDICAL ACADEMY 152 OPHTHALMOLOGY 2. 1. LIR+RSO 2. LSO+RIR 3. LIR+LSO 4. RIR+RSO 3. 1. RLR+LMR 2. LLR+RMR 3. LLR+LMR 4. RLR+RMR 4. entify the diagnosis a. LE esotropia 45 degrees b. LE esotropia 15 degrees c. LE exotropia 15 degrees d. LE exotropia 45 degrees 5. a. Mydriasis b. Eyeball is deviated upwards and outwards c. Ptosis d. Loss of accommodation ARISE MEDICAL ACADEMY 153 OPHTHALMOLOGY 6. wearing glasses. Diagnosis? 1. Congenital esotropia 2. Accommodative esotropia 3. Infantile esotropia 4. Cyclical esotropia 7. 1. Adduction 2. Abduction 3. Elevation 4. Extorsion 8. hypertropia in RE and slight head tilt to the left. Possible diagnosis? 1. Right LR palsy 2. Right SO palsy 3. Right IO palsy 4. Left SO palsy 9. 1. Facial nerve 2. Third nerve 3. Sixth nerve 4. Fourth nerve ARISE MEDICAL ACADEMY 154 OPHTHALMOLOGY 10. 1. Medial rectus 2. Superior oblique 3. Superior rectus 4. Inferior rectus 1. A patient presents with pain redness and watering in the right eye. On 2. Bacterial ulcer 3. Acanthamoeba keratitis 4. Viral keratitis 5. Fungal ulcer 2. A patient presents with mild redness and foreign body sensation in the 1. Viral keratitis 2. Bacterial ulcer 3. Fungal ulcer 4. Acanthamoeba keratitis 1. Bacterial ulcer 2. Fungal ulcer 3. Herpes simplex keratitis 4. Acanthamoeba keratitis likely diagnosis? ARISE MEDICAL ACADEMY 155 OPHTHALMOLOGY 1. Phlyctenular conjunctivitis 2. Vernal Kerato conjunctivitis 3. Adenoviral conjunctivitis 4. Xerophthalmia 5. 1. It is a Type IV hypersensitivity 2. The most common cause in worldwide is Tuberculosis 3. Fascicular ulcer may be seen 4. Nodule is seen close to the limbus 1.Causes myopia 2. Associated with UV exposure 3. More common nasally 4. Recurrence is common after excision 1. Perimetry 2. Specular microscopy 3. Corneal topography 4. Corneal scraping 1. Keratoconus 2. Perforated corneal ulcer 3. Neurotrophic keratopathy 4. Total corneal opacity ARISE MEDICAL ACADEMY 156 OPHTHALMOLOGY 1. 2 lakh IU Vitamin A orally on days 0,1,14 2. 1 lakh IU Vitamin A orally on days 0, 1,14 3. Lubricating eye drops 4. 1. Death from rabies 2.Death due to septicaemia 3.Death from meningitis 4.Death from unexplained cause 11. 1. Munson’s sign is seen 2. 3. Irregular myopic astigmatism is seen 4. Thinning of the cornea is seen 12.Diagnosis 1. Entropion 2. Keratoconus 3. Scleromalacia perforans 4. Keratomalacia ARISE MEDICAL ACADEMY 157 OPHTHALMOLOGY 1. Atenolol 2. Atorvastatin 3. Amiodarone 4. Rifampicin Lens 1. Possible diagnosis? 2. Marfan syndrome 3. Homocystinuria 4. 5. Weil-Marchesani syndrome 1. Phacomorphic glaucoma 2. Phacolytic glaucoma 3. Retinal detachment 4. Vitreous haemorrhage diagnosis? ARISE MEDICAL ACADEMY 158 OPHTHALMOLOGY 1. Mature cataract 2. Hypermature cataract 3. Posterior subcapsular cataract 4. Nuclear cataract 1. Blunt trauma 2. Myotonic dystrophy 3. Diabetes mellitus 4. Galactosemia 1. Posterior subcapsular cataract 2. Mature cataract 3. Nuclear cataract 4. Morgagnian cataract 1. Methotrexate 2. Prednisolone ARISE MEDICAL ACADEMY 159 OPHTHALMOLOGY 3. Cyclosporine 4. Hydroxychloroquine 1. Monofocal IOL 2. Multifocal IOL 3. No IOL is implanted 4. Toric IOL surgery? 1. Capsulorrhexis 2. Sclerocorneal tunnel 3. Irrigation and aspiration 4. Foldable IOL implantation 9. Best site for IOL implantation is 1. Anterior chamber 2. Capsular bag 3. 4. 1. Femtosecond laser 2. Nd:YAG laser 3. Argon laser 4. Picosecond laser ARISE MEDICAL ACADEMY 160 OPHTHALMOLOGY 1. Repeat cataract surgery 2. Glasses 3. Nd: YAG Capsulotomy 4. Wait and watch 1. Hydrodissection 2. Nucleus management 3. Capsulorrhexis 4. IOL insertion 13.The instrument i 1. Lens 2. Anterior chamber 3. Posterior chamber 4. Sclera 1. Incision 2. Hydrodissection 3. 4. IOL insertion ARISE MEDICAL ACADEMY 161 OPHTHALMOLOGY 1. A 60 year old woman presents with sudden onset of severe pain and A. Primary open angle glaucoma B. Conjunctivitis C. Acute angle closure glaucoma D. Acute anterior uveitis 1.Photophobia is a common symptom 2.Haab’s striae are seen 3.Thin sclera may be seen 4.Anterior chamber is shallow 1.Timolol 2.Brimonidine 3.Acetazolamide 4.Latanoprost 1.Acetazolamide 2.Latanoprost 3.Brimonidine 4.Timolol ARISE MEDICAL ACADEMY 162 OPHTHALMOLOGY 1.Timolol 2.Latanoprost 3.Brimonidine 4.Dorzolamide 1.Timolol 2.Latanoprost 3.Brimonidine 4.Dorzolamide 1.Timolol 2.Latanoprost 3.Brimonidine 4.Dorzolamide the diagnosis? 1. Phacolytic glaucoma 2. Phacomorphic glaucoma 3. Primary angle closure glaucoma 4. Primary open angle glaucoma diagnosis? 1. Phacolytic glaucoma 2. Phacomorphic glaucoma 3. Primary angle closure glaucoma 4. Primary open angle glaucoma ARISE MEDICAL ACADEMY 163 OPHTHALMOLOGY of the following tonometers should be used? 1. Goldman Applanation Tonometer 2. Schiotz Tonometer 3. Tonopen 4. Rebound Tonometer 1. Arcuate scotoma 2. Nasal step 3. Seidel scotoma 4. Centrocaecal scotoma 1. Enlargement of the cup 2. Decrease in Cup: Disc ratio 3. Nasal shifting of the blood vessels on the disc 4. Thinning of the neuroretinal rim 12. 1. Laser trabeculoplasty 2. Laser peripheral iridotomy iridotomy 3. Trabeculotomy 4. Trabeculectomy 13. ARISE MEDICAL ACADEMY 164 OPHTHALMOLOGY 1. Laser iridotomy 2. Laser trabeculoplasty 3. Trabeculotomy 4. Trabeculectomy Retina 1.It has the lowest threshold for light 2.Contains only rods 3.Located on the optic nerve 4.It is associated with minimum visual acuity 2. 1.Convex lens is used 2.Image is virtual and erect 4.Useful in hazy media due to bright illumination 3. 1. 2. 3. It is associated with high myopia 4. Surgery is the treatment 4.A patient who uses -7D and -10D glasses in both eyes presents to the 1. Reassure the patient and send him home 2. Retinoscopy ARISE MEDICAL ACADEMY 165 OPHTHALMOLOGY 3. Direct Ophthalmoscopy 4. Indirect Ophthalmoscopy 5. A 60-year-old patient with history of heart disease presents with sudden is the treatment? 1. Wait and watch 2. Intravitreal steroids 3. Ocular massage and Immediate paracentesis 4. Intravitreal anti-VEGF 6.Diagnosis: 1. Central retinal artery occlusion (CRAO) 2. Branch retinal artery occlusion (BRAO) 3. Central retinal vein occlusion (CRVO) 4. Branch retinal vein occlusion 1. It may have X-linked inheritance 2. Early detection and treatment prevent progression of the disease 3. Visual acuity may be preserved even in the advanced stages of the disease 4. It may be associated with systemic abnormalities a. NSAIDs b. Steroids c. Atropine d. Pilocarpine ARISE MEDICAL ACADEMY 166 OPHTHALMOLOGY 9.A patient is diagnosed with high-risk PDR in both eyes. What should be the 1. Pars plana vitrectomy 2. Intravitreal anti-VEGF 3. Panretinal photocoagulation 4. No ocular treatment. Only glycemic control 10.A patient is diagnosed with moderate NPDR in both eyes. What should be 1. Pars plana vitrectomy 2. Intravitreal anti-VEGF 3. Panretinal photocoagulation 4. No ocular treatment. Only glycemic control 11. Fundus photo of a patient presenting with sudden painless loss of vision. Diagnosis 1. BRVO 2. BRAO 3. CRVO 4. CRAO 12. Spot diagnosis a. Retinitis pigmentosa b. Best’s disease c. Oguchi’s disease d. Stargardt’s disease ARISE MEDICAL ACADEMY 167 OPHTHALMOLOGY A. Coats’ Disease B. Retinoblastoma C. Toxocariasis D. Retinal tuberculoma diameter. Management? 1. Enucleation of both eyes 2. Chemotherapy 3. Enucleation of right eye and focal therapy of left eye 4. Radiotherapy 1. FFA 2. USG B-Scan 3. USG A -Scan 4. ERG 16.Diagnosis ARISE MEDICAL ACADEMY 168 OPHTHALMOLOGY 1. Vitreous haemorrhage 2. Normal retina and vitreous 3. Retinal detachment 4. Retinoblastoma Neuro-ophthalmology 1. 2. Edinger Westphal nucleus 3. Medial geniculate body 4. Pretectal nucleus 5. Ciliary ganglion 1. 2. 3. Seen in Neurosyphilis 4. Lesion in the optic tract 3. a. Optic chiasma b. Optic tract c. Occipital cortex d. Meyers’s loop 4. ARISE MEDICAL ACADEMY 169 OPHTHALMOLOGY a. Third nerve palsy b. Sixth nerve palsy c. Fourth nerve palsy d. Horner syndrome 5. 1. Perimetry 2. OCT Macula 3. MRI Brain 4. USG B-Scan 6. 1. OCT Macula 2. Perimetry and VEP 3. USG B-Scan 4. CT Scan of orbit 7. 1. Rifampicin 2. Ethambutol 3. INH 4. Pyrazinamide 8. Diagnosis a. Right LR palsy b. Left LR palsy c. Right MR palsy d. Left MR palsy ARISE MEDICAL ACADEMY 170 OPHTHALMOLOGY 9. a. Horner’s syndrome b. Fourth nerve palsy c. Senile ptosis d. Third nerve palsy a. Decreased visual acuity b. Blurring of disc margins c. Associated with raised ICT d. Peripapillary haemorrhages may be present 1. 2. Ethmoid bone 3. Sphenoid bone 4. Lacrimal bone 5. Frontal bone 1. Subcutaneous emphysema is seen 2. Tear drop sign is seen on X-Ray 3. Diplopia is horizontal 4. Enophthalmos is seen 3. eye. Management? 1. Dacryocystorhinostomy 2. Sac massage 3. Probing 4. Balloon dacryocystoplasty ARISE MEDICAL ACADEMY 171 OPHTHALMOLOGY Management: 1. Sac massage 2. DCR 3. Dacryocystoplasty 4. Probing 5. 1. Eye speculum 2. Chalazion clamp 3. Chalazion scoop 4. Bone punch movements in the left eye. Diagnosis: ARISE MEDICAL ACADEMY 172 OPHTHALMOLOGY 1. Conjunctivitis 2. Preseptal cellulitis 3. Orbital cellulitis 4. Acute dacryocystitis 1. CT Scan orbit 2. 3. USG B-Scan 4. Carotid doppler 1. 2. It involves the gland of Zeis 3. Presents with painless lid swelling 4. Incision and curettage is the treatment eyelid on jaw movements. What is the diagnosis? 1. Abducens palsy 2. Misdirected third nerve 3. Duanne’s retraction syndrome 4. Marcus Gunn jaw-winking syndrome : 1. Increased number of eyelashes 2. Misdirected eyelashes 3. Second row of eyelashes 4. Depigmented eyelashes ARISE MEDICAL ACADEMY 173 OPHTHALMOLOGY 1. Acute congestive glaucoma 2. Acute anterior uveitis 3. Acute conjunctivitis 4. Infective keratitis 2.A 25-year-old man presents with non-granulomatous anterior uveitis in the right eye. He has no history of similar episodes in the past. He has no history 1. Mantoux test and Chest X-ray 2. HLA B-27 3. No investigations to be done. Only management for uveitis to be given 4. CT Scan orbit 3.A 25-year-old man presents with severe non-granulomatous anterior uveitis in the right eye. He has history of similar episodes in both eyes in the past. line of management? 1. Mantoux test and Chest X-ray 2. HLA B-27 3. No investigations to be done. Only management for uveitis to be given 4. CT Scan orbit 4.A 25-year-old man presents with granulomatous uveitis in the right eye. He has history of similar episodes in both eyes in the past. He has no history of 1. HLA B-27 2. Blood investigations/ Mantoux test/Chest X-ray 3. No investigations to be done. Only management for uveitis to be given 4. CT Scan orbit ARISE MEDICAL ACADEMY 174 OPHTHALMOLOGY Images ARISE MEDICAL ACADEMY 175 OPHTHALMOLOGY ARISE MEDICAL ACADEMY 176 OPHTHALMOLOGY ARISE MEDICAL ACADEMY 177 OPHTHALMOLOGY ARISE MEDICAL ACADEMY 178  THE FUTURE BELONGS TO THOSE WHO BELIEVE IN THE BEAUTY OF THEIR DREAMS. 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