ass.jpgUR NEXT POSTING – OPHTHALMOLOGY? 
1.Keep ur eyes healthy
# If u have red eyes or if there is pain – go to the health centre immediately
# Clean ur eyes with clean water daily
# Do not touch eyes with dirty hands
# Do not use eye drops without guidance from the doctor
#Eat vitamin A rich foods /fruits/vegetables
#Donot perform near works for long time, give rest to ur eyes
2. Must know
Anatomy of eyeball
Eye_Anatomy-Anat.jpg
Physiology of eyeball
Neurology ofeyeball
as.jpg 3. Clinical procedures u must be familiar with :
Visual acquity
Extraocular movements
Cover / Uncover test
Anterior chamber depth
Pupillary reflex
Visual field testing
Administration of drops
4. Observe the common ophthalmic conditions
Stye
Trichiasis
Ptosis
Chalazion
Entropion
Ectropion
Squint
Dacrocystitis
Bitots spot
Pinguecula
Pterygium
Conjunctivitis
Corneal ulcer
Cataract
Foreign body
5.Identify
Lenses
Pin hole
Occluder
Trial frame
Stenopic slit
Retinoscope
Direct/Indirect ophthalmoscope
Bjerrum’s spectrum
Perimetry
6. Ocular symptomatology a. Anomalies of ocular motility asthenopia: weakness or fatigue of eye, aching and burning sensation, heaviness of lid and headache
binocular diplopia:
causes – extra ocular muscle paresis, restrictive squint and displaced globe
b.Anomalies of ocular surface ocular irritation: sandy or gritty sensation plus burning sensation
causes - dry eye , trachoma, trichiasis
lacrimation: reflex increase in tear production:
causes- Lid disorders, conjunctivitis, scleritis, uveitis , corneal ulcer , dry eye , foreign bodies
Ephiphora: increased flow of tear due to obstruction to outflow of tear
Causes – punctate atresia, punctum block, canaliculitis
Photophobia: causes – keratitis, keratoconjunctivitis, corneal edema (in glaucoma)
Glare- excessive awareness of light
Cause: aniridia, ocular albinism, posterior subcapsular cataract
Redness- is a
final common response to the disease of the anterior segment Causes-conjunctivitis
Episcelritis
Dry eye
Subconjunctival hemorrhage
Pain- With red eye :
Corneal ulcer
Acute iridocyclitis
Primary angle closure glaucoma
Foreign body in cornea
Penetrating and perforating injury to eye
Scleritis
Without red eye OCULAR
Refractive error
Functional insufficiency
Squint
NON-OCULAR
Migraine
Tension
Trigeminal neuralgia
Hypertension
Raised intraocular pressure
c. Abnormalities associated with visual phenomenon Floaters Causes :
Vitreous degeneration- due to trauma, myopia, diabetes mellitus
Vitreos haemorrhage
Intermediate or posterior uveitis
Photophopsia Causes:
Posterior vitreous degeneration
Retinal detachment
Colour halo Causes :
Acute angle closure glaucoma
Cataract
Corneal edema
Visual hallucination Scotoma Uniocular diplopia Causes :
Early senile cataract
Subluxated lens
Astigmatism
Post surgical >1 eye
Keratoconus
Blurring of Vision Gradual:
Cataract
Diabetic retinopathy
Hypertension
Chronic uveitis-Glaucoma
Primary open angle glaucoma
Normotensive glaucoma
Corneal dystrophy
Macular degeneration
Sudden:
Corneal ulcer
Primary close angle glaucoma
Acute iridocyclitis
Endophthalmitis
Vitreous haemorrhage
Retinal detachment
Optic neuritis
Central retinal artery occlusion
Amblyopia-partial loss of sight
Amaurosis-complete loss of sight
Cause :
Papilloedema
Migraine
Raynaud’s disease
Night blindness
Vitamin A deficiency
Congenital
Pathological myopia
Colour blindness d. Other Proptosis Sudden-
Orbital cellulitis
Pseudotumor
Rhabdomyosarcoma
Metastatic lesions
Gradual-
Thyroid diseases ie.Thyrotoxicosis
Hemangioma
Optic nerve glioma
Neurofibromatosis
Lymphangioma
Orbitral varix
Lacrimal gland inflammation and tumor
Sinus mucocele (ethmoid, sphenoid, frontal)
Tumors of ethmoid, sphenoid , frontal
Maxillary tumor
Fibromas
Carotid cavernous fistula
Ptosis Congenital Acquired Neurogenic Myogenic Aponeurotic Mechanical Deviation of eyes
Squint
Restrictive myopathy
Paralytic
HISTORY TAKING 1. Particulars of patient
Name
Age/Sex
Address
Marital status
Occupation
2. Chief complaint 3. History of present illness 4. Past history 5. Personal history 6. Menstrual history 7. Family history 8. Socioeconomic history EXAMINATION GENERAL PHYSICAL EXAMINAITON
Pulse
Blood pressure
Respiratory rate
Pallor
Lymph nodes
Temperature
Cyanosis
Icterus
SYSTEMIC EXAMINATION A. Neurological examination
Gross
Cranial nerves
Pupillary reaction
Pain/ touch sensation
B. Cardiovascular examination
S1
S2
M
C. Respiratory examination
Breath sounds
D. Per –abdomen OCULAR EXAMINATION ALWAYS EXAMINE THE RIGHT EYE FIRST .
1.
Functional examination a. Cone function Visual acquity- for near and distance
Distance – with Snellens test types
d.jpg
: aided, unaided and with pin hole
E-chart
Landolt’s chart
Near - with Snellens test types or jaegers chart or Roman chart
Colour vision (foveal function)
With
Ishihara isochromatic chart
b. Rod function and peripheral retina function
Peripheral visual field examination-Confrontation test
2.Physical examination Facial symmetry Extraocular movement examination
Mono-ocular or duction
Binocular or version and vergence
Hirschberg’s test
Cover test
Head Posture
-head tilt
-face turn
-chin raised and chin depressed
Test for convergence
Eye brows Loss of eye brow
Myxedema
Leprosy
Certain uveitis
Whitening
poliosis
Lids
Blepharitis
Stye
Chalazion
Ptosis
Entropion
Ectropin
Dermatochalasis
Neoplasms
Trichiasis
Distichiasis
Lashes Loss of lashes
Myxedema
Leprosy
Certain uveitis
Whitening
Poliosis
Lacrimal drainage Lymph nodes Conjunctiva
Congestion
Secretion/discharge
Follicles/ papillae
Degenerative changes-pterygium, pinguecula
Cornea
Transparency
Smoothness
Diameter
Sensation
Anterior chamber Iris
Colour
Pattern
Nodules
Tumor
Aniridia
Coloboma
Polycoria
Persistent papillary membrane
Pupil
Size
Shape
Reflexes- light and accommodation reflex
position
Lens ANY OPACITY IN LENS IS KNOWN AS CATARACT KNOW IN NEPALI
TRACHOMA- khasre rog
GLAUCOMA- Jalbindu
CATARACT - motiabindu
Let us all help prevent blindness 
.
SUMAN PRASAD ADHIKARI
KMC
7th semester, 8th batch
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Ur Next Posting – Ophthalmology? -
03-07-2007, 12:02 AM
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