ophthamology revision
TRANSCRIPT
![Page 1: Ophthamology Revision](https://reader034.vdocument.in/reader034/viewer/2022051520/586fcb361a28aba24c8b6c29/html5/thumbnails/1.jpg)
Using the direct ophthalmoscope…
You will find a word at each of the points indicated by the boxes…
![Page 2: Ophthamology Revision](https://reader034.vdocument.in/reader034/viewer/2022051520/586fcb361a28aba24c8b6c29/html5/thumbnails/2.jpg)
A patient standing six metres from a standard Snellen Chart can only see the top line. How is this recorded in snellen notation?
![Page 3: Ophthamology Revision](https://reader034.vdocument.in/reader034/viewer/2022051520/586fcb361a28aba24c8b6c29/html5/thumbnails/3.jpg)
E5 minutes of arc: 6/6 acuity
10 minutes: 6/12
20 minutes: 6/24
30 minutes: 6/36
6 metres
E50 minutes of arc: 6/60 acuity
The human eye is just able to discern separate objects if the angle between them is 30 seconds of arc.
![Page 4: Ophthamology Revision](https://reader034.vdocument.in/reader034/viewer/2022051520/586fcb361a28aba24c8b6c29/html5/thumbnails/4.jpg)
6
12
The test distance
An average eye would see this line at 12 metres
![Page 5: Ophthamology Revision](https://reader034.vdocument.in/reader034/viewer/2022051520/586fcb361a28aba24c8b6c29/html5/thumbnails/5.jpg)
Identify these refractive errors
Myopia
“Short sighted”
Hypermetropia
“long sighted”
![Page 6: Ophthamology Revision](https://reader034.vdocument.in/reader034/viewer/2022051520/586fcb361a28aba24c8b6c29/html5/thumbnails/6.jpg)
What abnormality does this photo show, and what is the surgical procedure called which corrects it?
![Page 7: Ophthamology Revision](https://reader034.vdocument.in/reader034/viewer/2022051520/586fcb361a28aba24c8b6c29/html5/thumbnails/7.jpg)
![Page 8: Ophthamology Revision](https://reader034.vdocument.in/reader034/viewer/2022051520/586fcb361a28aba24c8b6c29/html5/thumbnails/8.jpg)
What is this abnormality called, and what is the main symptom it causes?
![Page 9: Ophthamology Revision](https://reader034.vdocument.in/reader034/viewer/2022051520/586fcb361a28aba24c8b6c29/html5/thumbnails/9.jpg)
What stain has been used, and what abnormality is shown?
![Page 10: Ophthamology Revision](https://reader034.vdocument.in/reader034/viewer/2022051520/586fcb361a28aba24c8b6c29/html5/thumbnails/10.jpg)
What abnormality is shown here?
Suggest two important differential diagnoses
Suggest two useful investigations
![Page 11: Ophthamology Revision](https://reader034.vdocument.in/reader034/viewer/2022051520/586fcb361a28aba24c8b6c29/html5/thumbnails/11.jpg)
This patient suddenly lost all useful vision in her right eye a few hours before the photo was taken.
What is the diagnosis?
What tests would you perform
What is the commonest accompanying systemic disease?
What pupil abnormality would be present?
![Page 12: Ophthamology Revision](https://reader034.vdocument.in/reader034/viewer/2022051520/586fcb361a28aba24c8b6c29/html5/thumbnails/12.jpg)
![Page 13: Ophthamology Revision](https://reader034.vdocument.in/reader034/viewer/2022051520/586fcb361a28aba24c8b6c29/html5/thumbnails/13.jpg)
Name three abnormalities shown here
Give the diagnosis
Suggest a cause
![Page 14: Ophthamology Revision](https://reader034.vdocument.in/reader034/viewer/2022051520/586fcb361a28aba24c8b6c29/html5/thumbnails/14.jpg)
Extra-ocular muscles
Medial Rectus Third nerve
Sixth nerve
Third nerve
Third nerve
Fourth nerve
Third nerve
Lateral rectus
Superior RectusInferior rectus
Superior Oblique
Inferior Oblique
Muscle: Nerve supply:
![Page 15: Ophthamology Revision](https://reader034.vdocument.in/reader034/viewer/2022051520/586fcb361a28aba24c8b6c29/html5/thumbnails/15.jpg)
3
5
9
2
8
![Page 16: Ophthamology Revision](https://reader034.vdocument.in/reader034/viewer/2022051520/586fcb361a28aba24c8b6c29/html5/thumbnails/16.jpg)
Humphrey Visual Field Analyser
![Page 17: Ophthamology Revision](https://reader034.vdocument.in/reader034/viewer/2022051520/586fcb361a28aba24c8b6c29/html5/thumbnails/17.jpg)
Identify two abnormalities, and suggest a diagnosis
![Page 18: Ophthamology Revision](https://reader034.vdocument.in/reader034/viewer/2022051520/586fcb361a28aba24c8b6c29/html5/thumbnails/18.jpg)
What is the diagnosis here?
![Page 19: Ophthamology Revision](https://reader034.vdocument.in/reader034/viewer/2022051520/586fcb361a28aba24c8b6c29/html5/thumbnails/19.jpg)
What’s the diagnosis here?
![Page 20: Ophthamology Revision](https://reader034.vdocument.in/reader034/viewer/2022051520/586fcb361a28aba24c8b6c29/html5/thumbnails/20.jpg)
What is the main abnormality shown here?
![Page 21: Ophthamology Revision](https://reader034.vdocument.in/reader034/viewer/2022051520/586fcb361a28aba24c8b6c29/html5/thumbnails/21.jpg)
And here?
![Page 22: Ophthamology Revision](https://reader034.vdocument.in/reader034/viewer/2022051520/586fcb361a28aba24c8b6c29/html5/thumbnails/22.jpg)
Which is the abnormal eye, and what word is used to describe the visual acuity deficit?
![Page 23: Ophthamology Revision](https://reader034.vdocument.in/reader034/viewer/2022051520/586fcb361a28aba24c8b6c29/html5/thumbnails/23.jpg)
Before After
Diagnosis?
![Page 24: Ophthamology Revision](https://reader034.vdocument.in/reader034/viewer/2022051520/586fcb361a28aba24c8b6c29/html5/thumbnails/24.jpg)
What is this condition called?
![Page 25: Ophthamology Revision](https://reader034.vdocument.in/reader034/viewer/2022051520/586fcb361a28aba24c8b6c29/html5/thumbnails/25.jpg)
What’s the link..?
![Page 26: Ophthamology Revision](https://reader034.vdocument.in/reader034/viewer/2022051520/586fcb361a28aba24c8b6c29/html5/thumbnails/26.jpg)
Different patients, same underlying diagnosis…
![Page 27: Ophthamology Revision](https://reader034.vdocument.in/reader034/viewer/2022051520/586fcb361a28aba24c8b6c29/html5/thumbnails/27.jpg)
Laser treatment
![Page 28: Ophthamology Revision](https://reader034.vdocument.in/reader034/viewer/2022051520/586fcb361a28aba24c8b6c29/html5/thumbnails/28.jpg)
![Page 29: Ophthamology Revision](https://reader034.vdocument.in/reader034/viewer/2022051520/586fcb361a28aba24c8b6c29/html5/thumbnails/29.jpg)
![Page 30: Ophthamology Revision](https://reader034.vdocument.in/reader034/viewer/2022051520/586fcb361a28aba24c8b6c29/html5/thumbnails/30.jpg)
![Page 31: Ophthamology Revision](https://reader034.vdocument.in/reader034/viewer/2022051520/586fcb361a28aba24c8b6c29/html5/thumbnails/31.jpg)
![Page 32: Ophthamology Revision](https://reader034.vdocument.in/reader034/viewer/2022051520/586fcb361a28aba24c8b6c29/html5/thumbnails/32.jpg)
![Page 33: Ophthamology Revision](https://reader034.vdocument.in/reader034/viewer/2022051520/586fcb361a28aba24c8b6c29/html5/thumbnails/33.jpg)
Answers
• Slide 2 - 6/60• Slide 5 – Myopia “Short sighted” (top pic)
and hypermetropia “long sighted” (bottom pic)
• Slide 6 - Cataract – phaco-emulsification• Slide 8 - Entropion, where eye lash folds in
towards eye. Main symptom: gritty scratchy “there’s something in my eye” kind of pain
![Page 34: Ophthamology Revision](https://reader034.vdocument.in/reader034/viewer/2022051520/586fcb361a28aba24c8b6c29/html5/thumbnails/34.jpg)
Answers
• Slide 9 - Fluoracin stain showing up corneal ulcer
• Slide 10 - Abnormality: swollen, blurry optic disc edge (papilloedema). Differentials: Raised intracranial pressure, malignant hypertension, idiopathic intracranial hypertension. Investigations – blood pressure, CT scan
![Page 35: Ophthamology Revision](https://reader034.vdocument.in/reader034/viewer/2022051520/586fcb361a28aba24c8b6c29/html5/thumbnails/35.jpg)
Answers• Slide 11 - Painless sudden loss of vision =
central retinal artery occlusion/thrombosis. Tests – BP, cholesterol, glucose. Patient would be a vascularpath. Pupil abnormality is relative afferent pupillary defect, as retina not able to detect light
• Slide 13 – Complete ptosis, “down & out” eye, dilated pupil = 3rd nerve palsy. Possible cause = posterior communicating artery aneurysm pressing on nerve, or vascualr occlusion along the length of the 3rd nerve.
![Page 36: Ophthamology Revision](https://reader034.vdocument.in/reader034/viewer/2022051520/586fcb361a28aba24c8b6c29/html5/thumbnails/36.jpg)
Answers• Slide 15
– 2 – right eye loss of vision– 3 – bitemporal hemianopia “tunnel vision”– 5 – right homonymous hemianopia– 8 – right homonymous hemianopia– 9 – right homonymous hemianopia with central
sparing• Slide 17 – Horners, see partial ptosis,
constricted pupil & decreased sweating. Causes anything along the length of the sympathetic chain, e.g. tumour, vascular origin
![Page 37: Ophthamology Revision](https://reader034.vdocument.in/reader034/viewer/2022051520/586fcb361a28aba24c8b6c29/html5/thumbnails/37.jpg)
Answers
• Slide 18 – anterior uveitis, aka iritis• Slide 19 – glaucoma (see cupping of optic
disc and increased intraocular pressure)• Slide 20 – leukochoria (white reflex/white
pupil). Causes = retinoblastoma, cataract• Slide 21 – strabismus (“squint”)• Slide 22 – left eye abnormal. Amblyopia• Slide 23 - hypothryroidism
![Page 38: Ophthamology Revision](https://reader034.vdocument.in/reader034/viewer/2022051520/586fcb361a28aba24c8b6c29/html5/thumbnails/38.jpg)
Answers
• Slide 24 – central retinal vein occlusion, see multiple haemorrhages
• Slide 25 – internal carotid artery atheroma and consequent embolus seen on retina
• Slide 26 – diagnosis = diabetic retinopathy• Slide 28 – Stevens Johnson with
decreased tear production & scarring
![Page 39: Ophthamology Revision](https://reader034.vdocument.in/reader034/viewer/2022051520/586fcb361a28aba24c8b6c29/html5/thumbnails/39.jpg)
Answers
• Slide 29 – areas of depigmentation of retina
• Slide 30 – RA and see deterioration of the sclera called scleromalacia perforans
• Slide 31 – sturge weber syndrome• Slide 32 – inverting eye lid with cotton bud