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OPHTHALMOLOGY MADE EASY

DR VINEET SEHGAL
MBBS MD (AIIMS)
FELLOWSHIP IN GLAUCOMA
INCHARGE GLAUCOMA SUBSPECIALITY
SHARP SIGHT CENTRE
EX CONSULTANT- MEDANTA MEDCITY
ASSISTANT EDITOR- DJO
NTSE SCHOLAR
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Embryology
 Development starts from 3 weeks
 Choroidal fissure is formed due to differential growth
of optic vesicle.
 If this choroidal fissure does not fuse it becomes
typical colobomas
 Mesoderm forms the hyaline system of vessels

 INFERONASAL COLOBOMA
NEURAL ECTODERM NEURAL CREST MESODERM

•RETINA •CORNEAL ENDOTHELIUM •Muscle & vascular


•RPE endothelium
•TRABECULAR MESHWORK
•SPHINCTER & DILATOR PUPILLAE
•STROMA OF CORNEA, IRIS & CILIARY •EOM
•POSTERIOR IRIS EPITHELIUM
•CILIARY BODY EPITHELIUM BODY •CILLIARY MUSCLES
•OPTIC NERVE •CHOROID AND SCLERA
•CONNECTIVE TISSUE
•SMOOTH MUSCLE CELLS
•SECONDARY VITREOUS
•ZONULES

SURFACE ECTODERM

•CORNEAL & LACRIMAL


EPITHELIUM
•LENS
•LACRIMAL GLAND
•EYELID STRUCTURES
SURGERIES
KERATOCONUS - Collagen cross linking
- Corneal transplant
SIGNS IN KERATOCONUS - ALTK or DALK

• Munson Sign CONTACT LENSES


• Enlarged corneal nerves - Rigid Gas Permeable
• Oil droplet reflex (DDO) - Rose K lenses
• Rizutti Sign - Soper lenses
• Fleischer ring (Epithelium)
• Scissor reflex on retinoscopy

• On keratometry INTACS
- Steep cornea Intracorneal ring segments
- Bow tie pattern used to reduce corneal
- Paracentral thinning of cornea steepening, made of
Rizutti sign seen in PMMA.
keratoconus • Used in Pellucid Marginal
Acquired condition- VKC has Degeneration, post LASIK
high association. ectasia and keratoconus.
ANTERIOR SEGMENT DYSGENESIS SYNDROME

Peters anomaly
•Histopathologically, Endothelium & Descement”s is absent.
•There is central or paracentral corneal opacity.
• Peter 1 is without corneolenticular touch. Peter 2 has corneolenticular touch.
• Peter 2 having more systemic associations than Peter 1.
•Peter plus syndrome has many systemic malformations with it like, short stature, hearing defect, CVS
malformations etc. PAX 6 gene associated with it
Pterygium is a type of connective tissue degeneration. (Q)
• Probe test done to distinguish between pterygium &
pseudopterygium,
• In pseudopterygium it can pass, but not in pterygium.
(AIIMS)
• Stockers line is an evidence of iron deposition in
pterygium.

•KP ‘s are seen on endothelium.


Crescent-shaped ulceration with an
overhanging central edge &
vascularized base is seen temporally. It
by definition should NOT BE
ASSOCIATED WITH ANY SYSTEMIC
DISEASE and scleritis.
PERIPHERAL ULCERATIVE KERATITIS.....
Macular Dystrophy
Granular Dystrophy

• Initially by central ground glass


•B/L Small, discrete, sharply demarcated, haze superficially & small,
grayish-white opacities, multiple,gray-white, pleomorphic
•DROP, CRUMB, RING shaped. opacities. In later stages stroma is
diffusely involved, gray
•Initially stroma is clear between lesion with appearance of DESCEMET’s with
periphery remain free. rominent surface irregularities.
• Full thickness
•involves corneal periphery
Cogan Map Print epithelial
basement membrane dystrophy
Lattice Dystrophy Recurrent epithelial corneal
Apple green erosions are the
birefringence is seen in characteristic. Most
the lattice dystrophy common corneal dystrophy.
due to amyloid
deposition.
AdenoVIRUS may be
a bit slow in
presentation.
Normally it affects
cornea also, have tiny
white spots
WILSON DISEASE –
- KF ring is formed due to copper deposition in Descemet's membrane
- It is reversible ring. On treatment, it can disappear
- Sunflower Cataract
-

ASPERGILLUS COLONIES SUBCONJUNCTIVAL HEMORRHAGE

SPHEROIDAL DEGENERATION
SPECULAR MICROSCOPY
• Endothelial cell count done by specular microscopy.
• Based on the principle of specular reflection of light where
angle of reflection is equal to angle of incidence.
•Endothelium is usually made up of hexagonal, regular cells
which are uniform in shape.

ANKYLOBLEPHARON / SYMBLEPHARON
•Fusion of palpebral & bulbar conjunctiva symblepharon.
•Fusion of upper and lower palpbral conjunctiva
ankyloblepharon.
VERNAL KERATOCONJUNCTIVITIS

Antibiotics does not have any prominent role.


Steroids- Fluorometholone & loteprednolol
topical.
- DOC-Antihistaminics with Dual action
(Antihistaminics+Mast) cell stabilizers-
Olopatadine

Other Drugs
- Sodium Cromoglycate, Ketotifen & Epinastine.
- Refractory VKC-Cyclosporine (Topical),
Tacrolimus d. acetyl cysteine 0.5%
- SIGNS- Maxwell-Lyon sign, Horner Trantas
Spots
LASIK
• Principle: Flatten or steepen the Curvature of cornea & Change refractive power
Types
-Myopic
-Hyperopic both.

• Indication age > 18 yr, no viral keratitis, stability of power of spectacles for at least six months, no lattice with
hole, adequate thickness of cornea, CCT > 490 for I LASIK & 530 micrometer for conventional LASIK. (PGI TYPE)

• LASIK can't be done safely for > 10 D.

• Severe dryness, schirmer < 5 mm is also a contraindication. Pregancy & lactation relative contraindications

• Corneal ectatic condition like keratoconus, pellucid marginal degeneration are contraindications of doing
LASIK. There is no upper limit of age.

•corneal transplant is not an absolute contraindication for LASIK.

Note PRK is photorefractive keratectomy. That's not typical LASIK. That is superficial ablation done, followed by
laser application of laser
• SMILE- is small incision lenticular extraction, I lasik is bladeless lasik.
(Both I LASIK and SMILE use femtolaser)
• Pentacam: Now the investigative modality of choice to do any corneal topography, it may be
keratoconus, ectasia, LASIK.
• Conventional LASIK is microkeratome based that uses blade and excimer (193 micrometer) laser
•ARLTS LINE IN TRACHOMA
HERPES ZOSTER HERBERT’S PITS Can u see the
OPHTHALMICUS, opacified encirclation
Single dermatome ring near limbus.
involvement is Close differential is
there , so always arcus senilis that has
unilateral clear space between
limbus and cornea
Band shaped
keratopathy OPTICAL COHERENCE
PANNUS TOMOGRAPHY
Calcium deposition in Can you see angry vessels
on the cornea. It can be MEASURES Retinal
band shaped pattern. Nerve Fibre Layer Contour,
seen IN pterygium also but
Most common cause of the fleshy component Both macula and optic
BSK is post would be much more than nerve head can be
vitrectomized eye with the vascular component
evaluated
Silicon oil in situ
LID TARSORRAPHY HORNER TRANTAS SPOTS DENDRITIC ULCER: Seen
in Herpes Simplex Virus,
Pseudodendrites can be
seen in the other
modules like HZV and
acanthamoeba too
RING OF WESSLEY
- Acanthamoeba Keratitis
- Fungal corneal Ulcer
RETINA – ANATOMY & PHYSIOLOGY

Area of
Macula - 5.5 mm
Fovea - 1.5 mm
Foveola 0.35 mm. (Thinnest part of retina. No ganglion cells, only cones)

Signal transduction process is same in rods & cones though there number, color & intensity at
which it excites differ. (AIIMS Q)

Rods function – main fx in vision in dim light. Cones main fxn is color vision- blue, green & Red

Peak absorption at 500 nm, 120 million rods in retina, contrast to only 6.5 million cones (may be
imp in NEET & DNB)

Contains Rhodopsin pigment – OPSIN + RETINAL (Chromophore of VIT A Retinaldehyde)

No rods at foveola, max 20 deg of foveola, in contrast to cones that has highest concentration at
foveola
Cotton wool spots are present in nerve fibre layer.
 It is seen more commonly in hypertensive retinopathy
 Soft exudates or Cotton wool spots are small yellowish type,
irregular margins, due to axonal debris.
 Its due to axonal transport blockage.

Retinal Detachment (RD)

•RD is separation of neurosensory retina from retinal pigment epithelium

•RPE is the 1st layer of retina that contains single layer of cells attached to
bruch’s memberane of choroid. (imp in wet ARMD)

•On retinoscopy there is Grey Reflex

•Curtain falling over eyes & Flashes are typical presentations of RD.
Floaters can appear in both RD, pars planitis, CRVO & Vitreous Hemorrhage.
(VH)

•In Chronic RD, important signs are


- Watershed lines(q) PNEUMATIC RETINOPEXY JIPMER
- Proliferative vitreo-retinopathy •Air is also used for tamponade in pneumatic retinopexy.
- Retinal Cyst •Basically these gases provide tamponade for retinal detachment
surgery.
•Air is shortest acting, SF 6 is long acting and C3F8 is longest acting.
•Exudative retinal detachment occurs in toxemia of pregnancy.
• MC cause of Exudative RD- Malignant Melanoma
• Pilocarpine drug is associated with RD. So should be used
with caution in high myopics with glaucoma.
• Lattices (q), Retinal tears, High myopics(q), trauma are
known risk factors
• Shaffer sign - Pigments floating in anterior vitreous, sign of
retinal tear, that can lead to RD.
• Know the difference between tear and a hole: With tear
there is a traction that is not there in a hole.
RETINOPATHY OF PREMATURITY: (ROP)

ROP GUIDELINES: @
WHICH BABIES TO BE SCREENED GUIDELINES:
- Less than 1500gm
- Less than 32 weeks
-Pediatrician feels the necessity looking at the baby’s condition ,like mechanical ventilation,
sepsis, prolonged oxygen therapy & hemodynamic instability

When to screen: its four week after birth or at thirty one weeks whichever is later
•If the patient is LASERED ROP, then we have to follow him long.
•If patient has ROP, but its initial stage, then we can follow up till 40 weeks or when there is no
progression or change in three successive visits.
•If there is no ROP till 36 weeks, u can be safe.
ROP REQUIRING TREATMENT
•Zone I, any stage ROP with plus disease or
•Zone I, stage 3, with or without plus disease
•Zone II, stage 2 or 3 ROP, with plus disease

NOT TO TREAT
· Zone I, stage 1 or 2 with no plus disease or
· Zone II, stage 3 with no plus disease
NON PROLIFERATIVE DIABETIC RETINOPATHY WITH CLINICALLY
SIGNIFICANT MACULAR EDEMA
DIABETIC RETINOPATHY INVOLVES WHOLE OF FUNDUS. CAN U SEE EXUDATES ALL OVER THE FUNDUS , ALSO
SMALL HEMORRHAGES AND MICROANEURYSMS, ALSO ONE IMPORTANT THING TO NOTICE IS SOME YELLOWISH
DOTS NEAR MACULA , SO OUR DIAGNOSIS IS CSME
Central Serous Retinopathy (CSR)

A type of choroidoretinopathy, due to excessive leakage from choriocapillaries

CLINICAL SCENARIO (AIIMS/USMLE): Young anxious male coming to OPD with chief complaints of central
scotoma/blurred vision acute onset and says this happens quite often to him but resolves itself in few months.

Ink blot appearance (more common) & Honeycomb appearance is seen in CSR on
FA.
Also note CSR have
•Central scotoma @
•Type A personalities, males, it is more common
•Ask about use of Steroids from patient
• Hyperopic shift

Mx
- Wait and observe
- LASER the leaky areas
- PDT experimentally used
MICROBIOLOGY OF RETINA
• SYPHILLIS- salt and pepper retinopathy with extensive chorioretinal scarring.
• Leprosy affects cooler parts of the body. It affects all parts of eye. Retina is very rarely involved
and that two few here and there nodules.
• In tuberculosis, there are creamy coin shaped nodules in fundus.
• Toxoplasma has excavated scar in fundus, macula is its favorite site for toxoplasma. Also
headlight in fog appearance
TOXOPLASMA SCAR-
• CMV Retinitis- Pizza Pie appearance
Healed Toxoplasma

HEADLIGHT IN
FOG
APPEARANCE
FROSTED BRANCH ANGITIS -
CMV Retinitis Fundus Photo of Sarcoidosis
The florid translucent Placoid disc lesions in TB.
perivascular exudate is • Candle wax drippings- see exudates in
fundus, & near blood vessels, note these Diffferentiate it from
called 'frosted branch
angiitis' are just yellow lesions & these are not sarcoidosis lesions where it is
hard exudates as those are more distinct more exudates around the
margines. These are characteristic
findings of sarcoidosis
vessels
BERLINS EDEMA WITH CHERRY RED
SPOT- Red spot in midst of a pale retina (
c.f Bull’s eye retinopathy, where the red
glow of fundus is maintained)
CLINICAL SCENARIOS: Iritis with joint pain – Ankylosing spondylitis.
other Associations: Reiter & Psoariasis
Most common cause of arthritis involved with anterior uveitis- Ankylosing
Spondylitis

Heterochromic uveitis involve anterior part of uveitis. Fuchs heterochromic


iridocyclitis (FHI) is a chronic, unilateral iridocyclitis characterized by iris
heterochromia. Don’t have posterior synechia.
• Koeppe nodules are small nodules in inner margin of iris.
• Busaca nodules are seen in mid periphery
• Lisch Nodules of NF
• Brushfield spots in Downs Syndrome

Koeppe’s Nodules- On the BUSACA NODULE


LISCH NODULES margin of iris
Traumatic macular hole looks like Cherry Red spot. But its not red. More of
hyperpigmentation than redness.

Stem cells trial has been done for


macular hole closure
GYRATE ATROPHY

Arginine free diet is given.

 It's deficiency of ornithine aminotransferase


in gyrate atrophy.

Vit B 6 is also given.

.
•Neovascular glaucoma occurs when there is
abnormal proliferation as in DM, CRVO or OIS, in
open angle glaucoma there is no abnormal
proliferation normally.
•CRVO induced glaucoma called 90 day glaucoma.

BRANCH RETINAL VEIN


OCCLUSION, CAN U SEE ONLY
INFERIOR PART IS AFFECTED
INDOCYANIN GREEN ANGIOGRAPHY(ICG) @
NEW ADVANCEMENT:
Agiography technique to diagnose choroidopathies
Argus 2 retinal implants RP
like occult ARMD, CSR, polypoidal choroidopathy.
In ICG- the optic nerve head is shown
hypofluorescent. It is hyperfluorescent on FA.

Imdocyanin Green Fluorescein Angiography


Roths spot-
•Seen in bacterial endocarditis. Roth's spots are retinal hemorrhages with
white or pale centers.

•They can be composed of coagulated fibrin including platelets, focal ischemia,


inflammatory infiltrate, infectious organisms, or neoplastic cells.

• Caused by immune complex mediated vasculitis often resulting from


bacterial endocarditis.

•Roth's spots may be observed in leukemia, diabetes, subacute bacterial


endocarditis, pernicious anemia, ischemic events, hypertensive retinopathy and
rarely in HIV retinopathy.
•Usually they don’t contain BACTERIAS
COATS DISEASE

Can u see variety of exudates, some yellow, some whitish, some confluent.
These are characterastic of ongoing leakage. Its not diabetic retinopathy as you cant see hemorrhages. Compare
it with the photo of diabetes I have given, this is COATS DISEASE fundus photo. Features are
-1st decade of life
- Telengiectasia
- Characterisitic exudates all along vessels
- Leukocoria
BEST VITELLIFORM DYSTROPHY
CILIARY STAPHYLOMA
•Vitelliform dystrophy, or Best disease, is
hereditary retinal dystrophy involving RPE and • MYOPIA
leads yellow egg yolk appearance of the macula.
• TRAUMA
It present itself in childhood or early adulthood.
• SURGERY
•EOG is characteristically decreased • UVEITIS
RETINITIS PIGMENTOSA
 Centrocecal scotoma diagnostic of RP.
 X linked most severe.
 Bigenic inheritance pattern
 Most common inheritance pattern Autosomal
Recessive.
 Abetalipoproteinemia, or Bassen-Kornzweig
syndrome, AR rdisorder that interferes with the
normal absorption of fat and fat-soluble vitamins.
 NARP – neuropathy, Ataxia and RP, (
Abetalipoproteinemia, refsum disease are known
associations.)
 Bardet–Biedl syndrome (It is characterized
 High Dose VITAMIN A & ARGUS RETINAL IMPLANTS
by obesity, polydactyly, RP, hypogonadism,
and renal failure in some cases.
•PHPV associated with
microphthalmos.
Post operative endophthalmitis
•Delayed: MC cause- Propionobacterium acnes
•MC in total- Coagulase neg Staphylococci
•MC-Post traumatic- Bacillus Cereus
•MC fungal infection in eye in HIV - Candida

INVERSE HYPOPYON- SILICON OIL IN AC


• Tamoxifen & Travoprost is implicated in causation of macular edema.

FA PICTURE OF CYSTOID
MACULAR EDEMA
How to solve Fundus Based Questions
Now when u see a fundus, see the Optic nerve head and Macula first.
See any lesion or change in these two areas, and collaborate with options given

Remember these three Colors:


• Yellow
• Black
• Red
See the fundus and identify these three colours in disc and macula first, then in other
areas in the retina.
Collaborate with the options given. Mostly the answer correspond to the most
prominent of these colors
HOLLENHORST PLAQUE
Bull’s Eye Maculopathy
Foveal area is hyperpigmented, followed by the CAN U SEE WHITE PLAQUE IN
hypopigmented macular area. Like an eye, this is called SUPERIOR VESSEL). This question
Bull’s eye maculopathy. Please don’t confuse it with the was asked recently
Cherry Red Spot of the CRAO. That has pale fundus
surrounding it
MORNING GLORY SYNDROME Dark Adaptation Curve of Both Rods &
Blood vessels radiating like spikes from Cones
the optic nerve head. This is not a
glaucomatous disc. Glaucomatous disc
have more of cupping and yellowish pale
disc, with nasalization of vessels
DISC EDEMA
ANGIOID STREAKS NOTE: PAPPILEDEMA IS BILATERAL, MAY
BE ASSYMETRICAL, OPTIC NEURITIS CAN
These can be precursor of Choroidal BE UNILATERAL. ITS SUDDEN PAINLESS
Neovascular Membrane in some cases. LOSS OF VISION
SEA FAN
NEOVASCULARIZATION

SEEN IN SICKLE CELL


ANEMIA, less commonly
seen in Diabetic Retinopathy,
CRVO, Ocular Ischemic
Syndrome
WET ARMD
DRY ARMD
Can u see yellowish drusens near the macular area. These are typical of ARMD. A wet armd would have
red areas. A diabetic retinopathy would have yellowish exudates, red spots all over. In ARMD our lesions
are basically in macular areas
GLAUCOMA MADE EASY
Definition:
• Chronic optic neuropathy
• High IOP as one of the most preventable risk factor • 1-1.2 MILLION NEURONS
• Characteristic visual field defect. • Average dimensions of 1.76mm
horizontally by 1.92mm vertically
• DEVELOPS FROM THE OPTIC STALK

 TM outflow is 90-95%,Uveoscleral 10 %
 AQUEOUS OUTFLOW 2.7 MICROLITRE/MINUTE
 AH produced by non pigmented ciliary epithelium
 Trabecular meshwork outflow is pressure dependent ,
Uveoscleral outflow is pressure independent.
 High concentration of pyruvate, lactate & ascorbate &
low concentration of protein, urea, & glucose in aqueous
humor
🔸 Protein in aqueous humor is less than blood.
Tonopen- based on REBOUND TONOMETER
Mackay marg principle,
Goldmann Applanation used for determining iop
Tonometry in scarred cornea
Gold Standard and the Ix of
choice to measure IOP.
• Mackay marg tonometer is suited for irregular corneasIt is better suited for scarred and irregular corneas

• Malkalov tonometer - Principle of fixed force and variable area. Same is case of Halberg tonometer.

• Drager & Perkins are type of Goldman that can be used without slit lamp.
GLAUCOMA PROCEDURES

• All glaucoma procedures are done in dark room


• Peripheral iridectomy, trabeculoplasty, trabeculectomy is done in constricted pupil

GONIOSCOPE- VISAULIZATION OF ANGLE

 DIRECT GONIOSCOPE: Koeppe

 INDIRECT GONIOSCOPE: Zeiss, Goldman, Sussman.


AION: ALTITUDNAL
FIELD DEFECTS
RING SOCTOMA
SEEN IN RETINITIS
PIGMENTOSA
•Earliest field defect in glaucoma is isopter contraction followed by baring of blind spot
Glaucoma drainage implants that have been used extensively, include

•Non-restrictive/valved glaucoma drainage devices


•Molteno implant
•Baerveldt implant
•Schocket tube shunt

•Valved, restrictive drainage devices


•Krupin Denver Valve EXPRESS SHUNT
•Ahmed Glaucoma Valve – Silicone polymer

Indications
- Failed Pk
- NVG
- Uveitic Glaucoma
- Aphakic Glaucoma
AHMAD GLAUCOMA VALVE
PSEUDOEXFOLIATION SYNDROME

• Non dilating pupil


• Exfoliative material on pupil
• Bulls eye sign on lens
• Open angle that progress to closed angles
• Weakened zonules
• LOX L1 GENE ASSOCIATED
PEX syndrome: May be associated with amyloidosis or CVS
ABN
• Bulls eye sign on lens
Pigmentory glaucoma
- Krukenbergs spindles
- Transillumination defects in iris
- Deep AC
- Myopia
- Inc in IOP post exercise
- SLT RxOC
PRIMARY OPTIC ATROPHY GLAUCOMATOUS OPTIC ATROPHY
Embryology

- SURFACE ECTODERM
C LOOP IOL

MULTIFOCAL IOL ACIOL

CRYSTALENS
CALCIFICATION IS THE DIAGNOSTIC FEATURE.
IxOC is MRI HEAD & ORBIT WITH
FLEXER WINTERSTEINER LESIONS GALDOLINIUM CONTRAST
CHALAZION
o lipogranulomatous inflammation.
o Incision and curettage is done from
conjunctival side
o Horizontal incisions are avoided to minimize
damage to meibomian ducts.
o Recurrent chalazion and
blepharoconjunctivitis
o Adenocarcinoma and seb cell carcinoma
MC cause of u/l proptosis in children: Orbital
cellulitis
MC cause of b/l proptosis in children:
neuroblastoma
MC cause of u/l proptosis in adults: thyroid
ophthalmopathy
MC cause of b/l proptosis in children: thyroid

HERTELS EXOPHTHALMOMETER ophthalmopathy


 Ethmoidal sinuses are most commonly involved in
orbital cellulitis
Entropion Sebaceous cell Carcinoma

Goldenhar Syndrome with Limbal Dermoid Acute Dacryocystitis


Mitomycin-C has many uses in Ophthalmology-
- In trabeculectomy
- In recurrent pterygium
- in Ocular surface squamous neoplasia
- In Refreactive surgeries
GLC3B on 1p36 and GLC3C on 14q24.3 are genes implicated in
Congenital glaucoma
THYROID OPHTHALMOPATHY
LATTICE DEGENERATION
POTENTIAL AREA OF WEAKNESS
IN RETINA
MOLLUSCUM CONTAGIOSUM: ITS NOT
HERPES, LOOK THERE IS NO INFLAMMATION
Pin cushion effect seen in high power convex
glasses. Optical Coherence tomography- OCT
Showing macula. It is called optical biopsy. Shows
the layers of retina.
Kerrison bone punch
Used to make osteotomies in
DCR Surgery
SCHIRMER TEST
Evaluation of Dryness
- Less than 5 mm in 5 minutes indicate
severe dryness
PSEUDOPHAKIC BULLOUS KERATOPATHY

Its not viral keratitis, look at the scleral part, there is no inflammation at all. The PBK occurs
post intraocular surgery, due to loss of endothelial cells. The treatment is DSAEK, that is
descemnets stripping automated endothelial keratoplasty
OCULAR SURFACE
SQUAMOUS NEOPLASIA

CAN U SEE VESSELS GROWING OVER THE MASS. THIS IS NOT PTERYGIUM. PTERYGIUM FIRST OF ALL DOES NOT
HAVE THIS TYPE OF ELEVATED LESION, SECONDARILY THE VESSELS ARE NOT LIKE THIS ARBORIZING TYPE OF
PATTERN
CAPPILARY HEMANGIOMA
Port Wine Stain in Sturge weber syndrome
Propanolol is the new modality that is being used for
this lesion
ACUTE DACRYOCYSTITIS
MANAGEMENTIS ANTIBIOTICS, DON’T DO SYRINGING AND PROBING IN THIS
CHILD
MUNSON SIGN
Bulging of lower lid in Keratoconus
Don’t confuse it with the Mobius sign that is in thyroid ophthalmopathy that is loss of convergence
INCLUSION CYST

Most Common cyst of Conjunctiva


PLACIDO DISC KERATOSCOPE
USED FOR MEASURING
CURVATURE OF CORNEA
GONIOSCOPY IMAGE

Gonioscopy is the Investigative modality of choice to


diagnose angle closure glaucoma
PANDA EYES/
RACOON EYES
BIOMEDICAL WASTE
NON IONIZING RADIATTION
HAZARD

IONIZING RADIATION
IRIDODIALYSIS
This is not coloboma, this is post-traumatic
iridoialysis, iris is detached from its root
PERIPHERAL
IRIDOTOMY
Peripheral Iridotomy or Yag iridotomy
is the procedure of choice in primary
angle closure
SYNAPTOPHORE MADDOX ROD

It’s a misnomer. Its basically a lens that has been


V Important instrument, used in squint work up,
named as rod. Its principle is that it disassociates
diplopia charting, measuring interpupillary
two eyes and manifests the squint
distance.
Essential Infantile Esotropia
HESS CHART- Showing the action of Extra-ocular Muscles
S SHAPED PTOSIS : PLEXIFORM NEUROFIBROMATOSIS
Marcus Gunn Jaw Winking Phenomenon

Look that on opening the jaw the ptosis has improved, this is typically marcus
jaw winking phenomenon due to misinnervation of nerve.

Rx: Sling surgery has better results than LPS resection or Muller’s resection
BITOTS
SPOTS

POLIOSIS- Greying of
Eyelashes
Ultrasound B Scan
CT Head & Orbit Showing blow out fracture
Can you see this black and white image. It is
Ultrasound of eye B – Brightness . Showing posterior
segment of eye