OPHTHALMOLOGY

LAYERS OR COATS OF EYEBALL

Outer fibrous Middle vascular Inner neural
Choroid
Cornea Iris
Retina
Ciiary body
Sclera

Segments of eyeball

Posterior chamber

Anterior segment Anterior chamber Posterior Segment

 Lens is placed in patellar fossa
(formed by Berger space)

Canal of Canal of
Hannover Petit
 2 LIVE RAPID REVISION

EMBRYO Clinical aspect

Failure to eyelid
Surface ectoderm
Failure to separate eyelids
develpoment

- S- Skin of eyelids/appendages
- L- Lens
- L- Lacrimal gland EYELID Coloboma
- E- Epithelium of cornea/conjunctiva  MCCx: exposure keratopathy

:Ankylo-blepharon

Failure of closure of embryonic fissure at 36 days:

Neuro ectoderm/ Optic cup eyeball coloboma (inferior)

- R - Retina Iris
- O- Optic stalk/optic nerve
- M- Muscles of iris (sphincter pupillae
dilator pupillae) Lens
- E- Epithelium of iris/ciliary body
- S- secondary and tertiary vitreous

Clinical aspect
Mesoderm Remnant of hyaloid vessel
- Muscles (Extraocular)
- Sclera (Temporal)
- Endothelium of Blood vessels
- Ocular primary vitreous
(hyaloid vessel)

Persistent Hyperplastic
Primary vitreous
Associated with:
Cataract
RD
Vitreous hemorrage
Micro-ophthalmous
 OPHTHALMOLOGY 3

INVESTIGATIONS
Early treatment of
Colour Diabetic Retinopathy Chart
sense
Ishihara Done from 4 m
Based on log MAR
Better for amblyopia
Light form
sense Vision sense

Perception of light Snellen

contrast 10 min 10*5= 50 min

sense
6 min 6*5= 30 min

1 min 1*5= 30 min

Pelli-Robson chart

INVESTIGATIONS
Teller chart Slit lamp

For viewing uptil ant 1/3rd of vitreous

If with lens: best for optic disc and

macula evaluation

Visual acuity in children

Direct Ophthalmoscopy Indirect Ophthalmoscopy

For viewing optic For viewing entire retina

disc and macula: through lenses (+20D/+30D)
but uniocular test
Doctor sees real inverted
image
Magnification= Magnification= Power of eye
Power of eye of of patient/power of lens
patient/4
4 LIVE RAPID REVISION

Visual pathway Lesion VISUAL FIELD DEFECTS

Right Optic nerve
Right anopia

Bitemporal
Chiasma
hemianopia
(Heteronymous)

Right optic tract Left honomymous

hemianopia

Right LGB Left homonymous keyhole defect

Visual pathway Lesion VISUAL FIELD DEFECTS

Right Temporal lobe Left homonymous

superior
quadrantanopia
(Pie in the sky defect)

Left homonymous
Right Parietal lobe inferior
quadrantanopia

(Pie on the floor defect)

Left honomymous
Hemianopia
with
Right Occipital lobe macular sparing
(Right Posterior Cerebral Artery  Key hole vision
occlusion)  As tip of occipital lobe has extra
supply by MCA
 OPHTHALMOLOGY 5

Light reflex pathway Clinical aspect

Complete optic Light shone in affected eye
nerve lesion Neither pupil
__________constrict
(No aniso-coria) Light shone in other eye
Both________
pupil constrict

_____
Optic nerve
3rd nerve lesion Light shone in affected eye
Affected side__________constrict
does not
_________
Oculomotor nerve
Light shone in other eye
Affected side__________constrict
does not

Pupil is dilated (aniso-coria)

 Same for ciliary ganglion lesion (Adie pupil)

pretectal
_________ except no squint/ptosis/loss of near reflex

Near reflex
Both pupil Accommodation
Convergence
constriction  Lens accommodates by increasing converging
power of eye
 Pretectal not involved
 During accommodation: anterior lens
curvature increase (radius decrease), lens
thickness decrease, anterior chamber becomes
 Pupil constrict by near, but not light is called shallow
light-near dissociation:
 With age, accommodation decrease: near
point goes away from eyes: Presbyopia
Argyll Roberston pupil (pretectal lesion): Miotic pupil
 Rx by near glasses (convex)

Also seen in Adie pupil (ciliary ganglion lesion): dilated pupil

Dilute Pilocarpine can constrict Adie pupil due to supersensitivity

6 LIVE RAPID REVISION

Clinical aspect
↓ Sympathetic
pathway

Dilates pupil Miosis

Muller muscle eyelid Partial ptosis
Elevation

Determine color of iris Heterochromia iridis

(in congenital Horner’s)
Sweating of face Anhydrosis

Loss of ciliospinal reflex

OPTICS

 Old patient with decreasing far vision but improvement in near vision: second sight due to index myopia in nuclear sclerosis
 Buphthalmous is axial myopia
 Keratoconus is curvatural myopia
 Anterior dislocation of lens is positional myopia

Types of
Astigmatism
 OPHTHALMOLOGY 7

 Sturm’s conoid is principle of astigmatism

Compound
Compound myopic
Simple Simple
hyperopic
hyperopic myopic
Mixed

 Here, vertical axis is focused before

horizontal: with the rule astigmatism

Q. After completion of retinoscopy, the Q. After completion of retinoscopy, the

retinoscopy values were: prescription of glasses obtained was
Refractive error: + 1 D S / -2 DC @ 90
Compond myopic with the rule Refractive error:
Mixed against the rule
8 LIVE RAPID REVISION

Anisometropia :Difference in refractive error of both eyes

Refractive surgeries

Create stromal flap: by LASIK

blade or femtolaser Eximer 193 laser Reposit flap
ablation

 LASIK can correct =4D to -12D

 Not done in thin cornea

 Flap related Cx: so, not done in severe dry eyes, contact sports

 Refractive lenticule extraction (SMILE) is flapless and no excimer laser is used (Femto laser is used)

 Readial keratotomy is absolute C/I in contact sports

 In phakic IOL, an IOL is placed along with natural lens. Eg: ICL (Implantable collamer lens)
 OPHTHALMOLOGY 9

LENS Clinical aspect

Subluxation of lens
Marfans  Mc Superotemporal

Aniridia

 Lens capsule thinnest at posterior pole, thickest at pre-equator Trauma

 Lens center is nucleus, periphery is cortex Hyperlysinemia

Homocystinuria  Mc Inferonasal
 Lens fibres are arranged in lamellar pattern
Stickler syndrome
Sulphite oxidase deficiency

 Lens is transparent due to avascularity/lamellar fibres, crystallins proteins, free radical scavengers (Vit C, E, glutathione)

 The opacification of lens fibres is called cataract

 Myotonic dystrophy:
Congenital Aquired
Christmas tree

 Atopic dermatitis:
shield
 Wilson/chalcosis:
sunflower
 Galactosemia:
 Blue dot: Most common oil droplet
no intervention
 DM type 1:
snowflake
 Complicated:
uveitis/any eye
pathology

 Blunt trauma:
 Senile:
rosette
Most common
 Zonular/lamellar:
Cataract sx asap
 10 LIVE RAPID REVISION

Senile Phaco-emulsification
Cortical Nuclear SRK formula for IOL calculation = A – 2.5L – 0.9K
A = constant L = axial length K = keratometry
(depends on material) (in mm) (in D)

1. Incision into anterior chamber from

(side port) (paracentesis)
6. Hydro- delination
2. Viscoelstics (to maintain AC) (water inside lens fibres)
 Immature
 Cuneiform (iris shadow seen) 3. Anterior capsulorhhexis 7. Phaco-emulsification
(trypan blue dye) (via piezo-electric crystals)
(Lens aspiration)

8. IOL implantation
(best in posterior chamber)
4. Enlarge Incision
(2.75-3.2 mm) 9. Visco removal
 Cupolliform  Hypermature 5. Hydro- dissection
(Posterior subcapsular) (Morgagnian: causes (water under lens capsule) 10. Wound hydrate
phacolytic glaucoma) Separate lens from capsule

Suprachoroid hemorrage
1. ____________

Shallow anterior misdirection

2. Acqueous __________ Pupil block glaucoma
3. __________
chamber and high IOP
(iris bombe)

Post Shallow anterior Wound leak

_______________ Siedel test to confirm)
(____________
chamber and low IOP
cataract
glare
↓ vision + __________
surgery
after
Post. Capsule opacification/__________
Elschnig pearls
cataract/ ______________

Nd-Yag
( Rx by ___________laser capsulotomy
_____________

Painful ↓vision, B scan shows vitreous exudates, cornea and sclera not affected
Acute endophthalmitis (Purulent panuveitis) (MC: S epidermidis)
______________________________

Intravitreal inj. of AB Vitrectomy

( Rx by ____________________________________________________
 OPHTHALMOLOGY 11

ORBIT Clinical aspect

Frontal
Lesser wing
Sphenoid
Ethmoid
Greater Lacrimal
wing
Palatine

Zygomatic Maxilla Blow-out #: Tear drop sign

 In blunt trauma
 IR muscle entrapped (restrictive
squint)

Clinical aspect
Superior orbital fissure Superior orbital fissure syndrome
(any etiology in apex of orbit)
Proptosis

Ophthalmoplegia

Loss of sensations of cornea

Optic canal

SOF + 2nd nerve

Orbital apex syndrome (decreased vision)

Cavernous sinus syndrome SOF + loss of cheek sensation

 12 LIVE RAPID REVISION

Lid lag, EOM belly enlargement, soft tissue signs –

Thyroid eye disease  MCC, HLA mediated, thyroxine level can be anything
 Sight loss due to 2nd nerve compression/corneal exposure

5-10 yr F, RAPD: optic

 Protrusion of eyeball: nerve glioma in NF1>2
Proptosis Painless axial, RAPD
 (Nafzigger view shown
here) gradual vision loss
Middle aged F,RAPD:
Pulsatile optic meningioma in
Ophthalmoplegia NF2
Loss of corneal
and cheek Painless axial, middle aged female
sensation Cavernous
hemangioma
Carotico-
Cavernous
fistula Non-axial
Bruit +ve Lacrimal gland tumour

Proptosis in a child
painful

yes
No
Trauma/sinus infection
Axial proptosis
yes No Yes No
Orbital cellulitis Round cell tumour
 If in front of orbital septum:
Preseptal
(no
proptosis/ophthalmoplegia/
decreased vision) echhymosis

Glioma Hard/ Capillary

desmin + hair follicle
Synaptophysin+ Neuroblastoma hemangioma
Rhabdo +nt
myosarcoma Retinoblastoma Dermoid
(any presentation)
 OPHTHALMOLOGY 13

Keratitis Uveitis Scleritis Episclerits Conjunctivitis

(infectious) (anterior) (anterior)
 Pain and redness in all
 Photophobia in keratitis and uveitis, minimal in conjunctivitis

 Discharge max in conjunctivitis

 Superficial redness in conjunctivitis and episcleritis, rest deep vessels. Superficial vessels blanched by topical phenyleprine
 Hypopyon in keratitis and ant uveitis

 Cells, flare, keratic precipitates with pupil small and irregular in ant. Uveitis. Rx by topical steroid,
adjuvant is cycloplegic (festooned pupil is seen after dilatation)

 Excruciating pain with history

of contact lens (tap water) with  Mild symptoms with history of
less signs (ring infitrates): trauma with Dry, rough texture,
Acanthamoeba keratitis: Rx by feathery margin ulcer: Fungal
topical biguanides+ keratitis: Rx by topical Natamycin
propamidine

 Recurrence
 Reduced corneal sensations
 Low immunity
 Dendritic ulcer: Herpes simplex:
Rx by ointment Aciclovir 5t/day
(Topical steroids are C/I)

 Topical steroids are given in

interstitial and disciform viral
keratitis
14 LIVE RAPID REVISION

 History of Rhematoid arthritis:

Anterior sclerits complicated by
scleromalacia perforans and
staphyloma (Intercalary/ciliary)

Staphyloma

: anterior in corneal ulcer

:Posterior in high myopia

Conjunctivitis

 If history of itching, in  If history of red watery eyes in

summers, ropy discharge with many members of family,  history of chemical
papillae with Horner Tranta conjunctival follicle, sub injury/Steven Johnson, severe
dots: Vernal epithelial infiltrates: Adeno viral dry eyes, symblepharon
keratoconjunctivitis keratoconjunctivitis
 Mucopurulent discharge, sticky  1st thing in chemical injury:
eyelid, lymph nodes + with wash eyes
history of STD: Gonorrhea
conjunctivitis
 Mucopurulent discharge, sticky
eyelid with history of STD:
 If history of sutures/contact Chlamydia conjunctivitis D-K
lens: Giant papillary (adult inclusion)
conjunctivitis  Chlamydia D-K in neonate:
Ophthalmia neonatorum MCC
 OPHTHALMOLOGY 15

Chlamydia Trachomitis Conjunctival degeneration (elastotic)

Trachoma A, B, Ab, C Pterygium

Follicle  > 5, each >0.5 mm  Head (has iron line: Stocker), neck
and body

Inflammation  > 50% vessels  Decreased vision due to astigmatism

Scarring  Arlt line  Mx by excision and autoconjunctival

graft (Mitomycin C as adjuant)

Trichiasis
 Both are more common in nasal (due to UV rays)
Opacity of cornea in center

 Rx: Surgery,
AB (Oral Azithro)  No symptoms
Facial cleaning
Environmental modification
Pingencula

Irregular astigmatism

1. Corneal opacity

• Young pt: painless decreased vision

2. Advanced keratoconus Fleisher ring • IOC: Pentacam

Astigmatism • Mx: Rigid contact lens

• C3R (collagen cross linking) for
Myopia/Munson sign progression
Oil droplet reflex • INTACS (Intra corneal ring segments)

U=Vogt stria

Scissor reflex
3. Advanced pterygium
 16 LIVE RAPID REVISION

Corneal depositions

Kayser Fleisher ring Band shaped keratopathy Corneal verticillata

Copper in Descemet membrane Calcium in Bowman membrane Drugs in epithelium
Wilson disease Silicone oil Amiodarone
Chalcosis Chronic eye disease NSAIDs
Cirrhosis Phthisis bulbi Chloroquine
• Starts at 6/12 clock • Ex by EDTA chelation Netarsudil
• Reversible
• 1st seen by gonioscopy • Reversible
• No vision loss

EYELID Clinical aspect

 Orbicularis closes eyes, supplied by 7th nerve:
Failure leads to lag-ophthalmous--- exposure keratitis
Levator muscle

 Levator (supplied by 3rd nerve) and Muller (sympathetic supply) elevates

Muller upper eyelid
muscle Horner syndrome: mild ptosis
3rd palsy: severe ptosis
MCC of ptosis: aponeurotic/senile
Tarsus
Orbicularis
oculi In congenital ptosis: levator maldeveloped: absence of lid crease, lid lag sign

Meibomian In complicated congenital ptosis: Marcus Gunn jaw winking phenomeon:

gland lateral pterygoids and 5th nerve are implied
 OPHTHALMOLOGY 17

 Misdirected eyelash: Trichiasis

 Extra layer of eyelash: Distichiasis
 Loss of eyelash: Madarosis
 Graying of eyelash: Poliosis
 Inward eyelid turning: Entropion
 Outward eyelid turning: Ectropion

Lacrimal apparatus and tear film

 Infection leads to acute dacryocystitis: mostly due to NLD

blockage- Mx by systemic antibiotics

 For chronic NLD blockage: Regurgitataion test +

 Mx: less than 9 months- Criggler massage
9 m to 4 yr: Bowman probing
more than 4 yrs: DCR (Dacryo-cysto-rhinostomy):
opening between medial orbit (maxilla and lacrimal
bone) and inferior meatus of nose

Tear film
Lipid Aqueous Mucin
 By Goblet cell : VitA is needed
 By Lacrimal gland and
 By Meibomian, Zeiss, hair follicle accessory lacrimal glands

 Meibomian gland block: Deficiency causes Dry eye

posterior eyelid swelling: (Keratoconjunctiva sicca)
Chalazion (lipogranulomatous
inflammation, more in upper
eyelid)

Rx by Incision and curettage

Infected chalazion: internal  Schirmer test: after 5 min,

hordeolum >15 mm is Normal, < 5mm- severe
Infection of Zeiss/hair follicle:
internal hordeolum/Stye  Vital staining: Vit A oral dose
 Fluoroscein
dye is used < 6 m: 50000
under 6m – 1 yr: 1L
Cobalt filter
> 1 yr: 2L
 Rx by topical lubricants (drops– gel---ointment in sequence)
 18 LIVE RAPID REVISION

RETINA AND NEURO-OPHTHAL

Right Visual field

Right retina S
Retinal vein
A:V ratio= 2:3

N T
Blind spot
(due to optic disc)
–ve scotoma
I

Patient’s view

:For central vision

:For nasal vision

:For temporal vision

Paracentral Siedel Arcuate/ Double

Scotoma: 1st defect Scotoma Bjerrum Arcuate/ Roenne Central Temporal
Scotoma ring nasal step defects defects:
scotoma Last

Visual field progression in glaucoma

 OPHTHALMOLOGY 19

Centro-caecal High myopia

Scotoma(In optic
neuropathy)
Tobacco, alcohol, ATT
Patient with lacquer cracks, Foster Fuch spots,

Posterior staphyloma
Patient with high CSF pressure : Papilledema
Bilateral blurred vision
Enlarged blind spot

Patient with optic neuritis MCC is demyelination

Peri papilla
myelinated
nerve fibres

RETINA

Right retina
Retinal vein
A:V ratio= 2:3

Fovea
(in temporal side)
Mealnin is max here

Optical coherence
tomography

Fovea has less layers, so there is a dip seen in

Normal OCT
 20 LIVE RAPID REVISION

Retina layers Inner limiting Retina vascular supply

Nerve fibre layer
Central
Ganglion cell
retinal
Inner plexiform
Vessels Forms
Inner nuclear
 Has bipolar/Muller/amacrine
(inner 6 inner blood
Retinal barrier
Outer plexiform layers)
Outer nuclear

Outer limiting

Rods/Cones segments
 Outer segment has discs)
Retinal Pigment Epithelium
Forms outer blood retinal barrier

Ganglion layer edema

Macula: all 10 layers, ganglion is multilayered History of RHD
CRAO /arrythmias
Fovea: 6 layers, ganglion is absent

Fovea is spared in
Cherry red spot Ganglion layer deposition

History of mental
retardation
Fovea is involved in Bulls maculopathy: MCC is Chloroquine GM Gangliosides No organomegaly
in Tay Sach
Sandoff

Separation of neurosensory retina (inner 9 layers) from RPE: Retinal detachment

A high myopic with floaters/flashes with curtain shadow falling from above: Rhegmatogenous RD

A high myopic with floaters followed by sudden decrease in vision with dark glow: Vitreous hemorrage
A 3rd trimester pregnant lady with bilateral decreased vision. Shifting fluid sign Exudative RD
was observed. (same scenario in Malignant Hypertension)
 OPHTHALMOLOGY 21

Outer barrier break: in young male

(stress/steroids)
Blurred vision with metamorphosia

Serous fluid from choroid enters subretinal

space: type of exudative retinal detachment Ink blot/smoke
stack on angio
Central serous retinopathy

Mx: wait 3 months

Inner barrier break: in Flower petal on angio

Diabetic/venous occlusion: due to VEGF
Uveitis/Irvine Gass
Drugs: adrenaline/PGs/Miotics/Niacin

Fluid in inner 6 layers (most in OPL)

Macula thickness increases with cystic spaces

Cystoid macular edema

Mx: depends on cause

Diabetic Retinopathy feature Sign Layer Stage

Loss of pericytes NFL/ Very mild NPDR

Proliferation of
ganglion
microvessels

Micro-
Aneurysm

Hyper dots on angio

Dot/blot
Hemorrages flame
NFL
in OPL hemorrages
Mild to moderate
non-proliferative
Hard diabetic retinpathy
exudates OPL
(NPDR)
NFL
Soft exudates
 22 LIVE RAPID REVISION

Diabetic Retinopathy feature Stage

4 quadrant hemorrages +
Severe NPDR Only one condition satisfied of 4 2 1 rule
1 quadrant venous beading

4 quadrant hemorrages +
1 quadrant venous beading + Very Severe NPDR 2 conditions satisfied of 4 2 1 rule
1 quadrant intra-retinal microvascular
abnormality

PDR

Or new vessels elsewhere in retina

/iris/glaucoma

Mx by Pan retinal photocoagulation

New vessels on disc

Or Tractional retinal detachment

Mx by vitreoretinal surgery
Or vitreous hemorrage

Central retinal vein occlusion Flame hemorrage

In Hypertension, A:V ratio is 1:3 Soft exudates

(arteriosclerosis can compress veins. It can lead to vein (cotton wool spot)
occlusion causing hemorrages/exudates all over retina like
splashed tomato (in central retinal vein occlusion) or part of
retina in (Branch RVO) with TORTUOS dilated veins

Mx by Pan retinal photocoagulation 100- day glaucoma

Old patient with

Metamorphosia
and decreased vision Pigment epithelial detachment
TYPES

Amsler Grid DRY WET

Drusen in Bruchs Mx by antioxidants If choroidal new vessels

Age related macular degeneration Mx by anti

VEGF/photodynamic therapy
 OPHTHALMOLOGY 23

Retinal dystrophy

Dark choroid on Autofluoroscence

Autofluoroscence
Angio Young patient came for routine check up
Young patient came with decreased vision Lipofuscin deposit in central retina at RPE (egg yolk)
Lipofuscin deposit all over retina at RPE (flecks)
Electrooculogram (Arden ratio) decreased
Electrooculogram (Arden ratio) decreased in later stages

Young patient with difficulty to see in night D/D of

Bony spicule in peripheral retina Ring sotoma/
Arteriolar attenuation and waxy disc pallor Tunnel vision
Retinitis pigmentosa
Electroretinogram a (early) and b wave decreased Pan-retinal photocoagulation
Vigabatrin/Quinine
Retinitis Pigmentosa Advanced glaucoma

Primary Glaucoma
Progressive optic neuropathy
 Risk factors: High IOP, Family history, Age
 IOP check best by Goldmann applanation tonometer  Fluoroscein dye is used under
Cobalt filter
 2 Prism form 2 semicircle

 IOP check in corneal opacity by Tonopen

 Self IOP check by rebound tonometer

 Angle of anterior chamber is seen by Gonioscopy: Direct gonioscope (Koeppe/Swan Jacob/Richardson) are preferred in surgery

 Optic disc changes: Thin neural rim

Nasalization of vessel
Bayonetting sign
Laminar dot sign

 Visual field changes: detected on Perimetry (static preferred in glaucoma, where stimulus intensity changes, stimulus does
not move)
 24 LIVE RAPID REVISION

Types and Management of glaucoma

Gonioscopy

Open angle Closed angle

IOP
IOP
Normal (<21 mm Hg) High (> 21) Normal High
Optic disc/Field Optic disc/Field Optic disc/Field Optic disc/Field
Changes Changes Normal
Normal Normal
Normal Changes
NTG POAG OHT PACS PAC PACG
Medical Mx (DOC: Prostaglandins) Laser iridotomy

Laser trabeculoplasty Medical Mx (DOC: Prostaglandins)

Surgical Mx Surgical Mx

Clinical scenarios
A hypermetropic patient after movie complain of painful blurred vision. Pupil was dilated. Acute angle closure
IOP was high.
Mannitol+Pilocarpine given
Rx of choice: laser iridotomy

A child with big blue eyes, photophobia, watering, Habb striae, deep AC, high IOP Congenital glaucoma
Mx by Goniotomy

MC sec. glaucoma
Pseudoexfoliation
_________________
Open/closed
 OPHTHALMOLOGY 25

SQUINT

 When the globe is abducted to 23°, the visual axis coincides with the line of pull of the SR and IR. In this
position SR can act only as an elevator and IR can act only as a depressor

 When the globe is adducted to 51°, the visual axis coincides with the line of pull of the SO and IO. In this
position SO can act only as a depressor and IO can act only as an elevator

Clinical aspect
 In paralytic squint,
diplopia is maximum
in direction of acting
muscle

 Ex: In Right SR palsy,

diplopia is max looking
up and right

 Ex: In Right SO palsy,

diplopia is max looking
down and right

 Ex: In Left LR palsy,

diplopia is max looking
left
26 LIVE RAPID REVISION

Sherrington law gives direction of eye in paralytic squint

(tells about antagonist muscle)

 Ex: In Left LR (6th nerve) palsy, Left MR is overaction: Left Esotropia

 Ex: In Left SO (4th nerve) palsy, Left elevators are

overacting: Left Hypertropia

 Ex: In Left 3rd nerve palsy, Left SO and LR are overacting:

Left Hyportropia and exotropia (down and out eye)
 Ptosis
 Pupil dilated

 Cover-uncover test: Here its Esophoria (latent squint): type of comitant squint (eye movements are normal)
 Manifests under cover when fusion breaks (like in cover/uncover test or in Worth 4 dot or in Maddox rod)

Both interpreted as patient view

Normal L suppression

R suppression

Normal

Uncrossed diplopia: Eso Crossed diplopia: Exo

Uncrossed diplopia: Eso Crossed diplopia: Exo
 OPHTHALMOLOGY 27

Tests for identification in squint

Hess/Lees chart: for incomitant squints

Prism bar cover
 For angle of
Titmus fly: for stereopsis
deviation

OCULAR INJURY
Chemical injury Radiation injury
 Alkali can penetrate in eye (more dangerous)
 UV rays causes cornea damage mostly:
 Most common is Lime (chuna particle)
Photokeratitis: snow blindness/welding
 Causes severe dry eyes
 IR rays causes rods/cones damage mostly:
 After history, 1st step is wash eyes
Photoretinitis: Solar eclipse
 Topical ascorbate/citrate strengthens cornea

Blunt trauma
Hyphema Irido-dialysis Vossius ring
Ecchymosis

Bilateral seen in:

# of anterior
___________ cranial fossa
(Racoon/Panda)
28 LIVE RAPID REVISION

Kayser Fleisher ring Chalcosis

__________________

sunflower cataract
_____________

Chisel
hammer Siderosis
__________________

Hyperpgmented iris
Fellow eye
Acute Pan-ophthalmitis
normal ____________________
Penetrating trauma
_______________ Painful vision loss, corneal
infiltrates, restricted eye
Fellow eye
movements
Dalen Fuch
nodules, Sympathetic ophthalmia
____________________
Mutton fat
KPs

Best wishes to all

Dr Sourabh Sharma
MBBS, MD (AIIMS), DNB, FICO, FRCS
Fellow - Singapore National eye Center and Research Institute
Faculty Ophthalmology - DAMS
Consultant – Bharti Eye Hospital, Delhi

Dr Sourabh Sharma page

DAMS exclusive club

t.me/DAMSOphthalmologySS