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Eye OSPE compiled and solved.

Station#01

1. Diagnosis - Herpes Zoster Ophthalmicus


2. Organism – vzv
3. Hutchinson’s sign? Vesicles on the tip of the nose, or vesicles on the side of the
nose.. This occurs because the nasociliary branch of the trigeminal
nerve innervates both the cornea and the lateral dorsum of the nose as well as
the tip of the nose. This sign is named after Sir Jonathan Hutchinson.[2]
4. Significance of this sign?
5. Treatment? Oral acyclovir 800 mg po five times daily for 7 to 10 days is the
standard treatment. Alternatively, a provider could use famciclovir 500 mg po tid
or valacyclovir 1000mg po tid. If the systemic condition warrants or if the patient
is unable to tolerate food by mouth then acyclovir 5-10 mg/kg iv q8 for 5 days
may be utilized.
6. Complications? Common complications of herpes zoster infections include
acute pain, postherpetic neuralgia, persistent neuropathy, hemorrhage,
ulceration, necrosis, myonecrosis, necrosis of bone, and (uncommonly) secondary
bacterial infection

Station#02
Perform:
1. Extraocular movements – 3 components

2. Saccades: A quick simultaneous movement of both eyes between two or more


phases of fixation in the same direction.
3. Cover Uncover( used to determine if there is heterotropia or tropia which is a
manifest strabismus.The first eye is covered for approx 1 to 2 secs ,the uncovered
eye is observed for any shift in fixation. deviation).

Cross Cover Test(can’t find this)

Station#03

1. Diagnosis? diabetic maculopathy


2. Investigations?
1.FUNDUS EXAM with: (i)direct (ii)indirect opthalmoscope ansd (iii)slit lamp
bimicroscopy (with contact lens and without contact lens)

2.FFA (detects leaking areas and occlusion areas)

3.OCT(to assess retinal edema)

3. Treatment? From page no 185 and 186 JATOI


4. What do you see in the image?
5. Complications(vitreous hemorrhage,retinal detachment,glaucoma,blindness)

Station#04:

1. Diagnosis? Corneal ulcer + hypopyon


2. Causes of this according to figure? Page no 78 and 79 Jatoi
3. Other causes?
4. Treatment? Medical(Antiobioics,antifungal,antiviral eye drops are
thetreatment of choice or injection of medication near the eye)

Surgical(Corneal transplant)
5. Complications? chronic or recurrent viral infection open sores,corneal scarring
and swelling,temp or perm reduction in vision,blindness

Station#05:

1. Snellen’s Chart
2. Use? visual acuity
3. Angle that one letter makes? 5’ of an arc.
4. What does mean by visual acuity of 6/60?(patient could only see at 6m what a
normal sighted person should see at 60)
5. Usual distance between patient and chart? 6m or 20feet

Station#06

1. Applanation tonometer (anopthamologic instrument used to determine


pressure within the eye by measuring the force required to flatten an area of the
cornea with a small disc)
2. Use? Measures IOP
3. Other devices used to measure same thing? Schiotz tonometer,goldmann
tonometer,perkins tonometer,dynamic contour tonometry,rebound
tonometer,impression tonometer..
4. Area that it covers when placed in eye? 3.06mm
5. What principle does it work on? based on Imbert-Fick law
Station#07:

1. Chalazion:chronic granulomatous inflammation of meimobian gland.


2. Treatment? (Incision and curettage)
3. Treatment of recurrence? (Systemic antibiotics esp if associated with acne
rosacea)
4. DD? (epidermoid cyst, dermoid cyst, sebaceous adenoma)
5. Pathogenesis? (Chronic, sterile lipogranuloma of mebomian glands)
Station#08

1. Explain figure? – swelling and redness at medial canthus of eye with pussy
discharge
2. Diagnosis? Acute Dacrocystitis
3. Most common etiology?staph aureus,strep pneumonia
4. Treatment? antibiotics(amoxicillin),topical eye drops,analgesics and anti
inflammatory to reduce pain,hot fomentation gives soothing effect

5. Complications? orbital cellulitis,brain abcess,meningitis,death


Station#09:

1. Manifest Squint – Esotropia


2. Associated refractive error? the constant or intermittent deviation of visual
axis of one eye from point of fixation,which is seen with both eyes open
3. Complication? An uncorrected squint can lead to amblyopia (lazy eye

Inferior oblique overactivity may sometimes occur

Dissociated vertical vision (not sure about these complications.Kindly confirm)


4. How is the angle of deviation measured?
5. Age group in which it commonly occurs? Preschool age 3 years mostly

Station#10: Atropine Drops

1. Class to which it belongs? anticholinergic or antiparasympathetic


(parasympatholytic) drug. More precisely it is termed an antimuscarinic agent
since it antagonizes the muscarine-like actions of acetylcholine and other choline
esters.

2. Mechanism of action? muscle relaxant that inhibits nerve responses and for
dilating the pupil of the eye. atropine mechanism of action is classified as an
antiparasympathetic(parasympatholytic), or anticholinergic drug.
3. Uses? Cycloplegic,to paralyze accommodation reflex,as a mydriatic,
4.Ocular complications. Elevated IOP. With prolonged administration, local
irritation,photobia,blurred vision, hyperemia, edema, exudate, follicular
conjunctivitis, dermatitis.
5. Half life of atropine: 2 hours
Station#11
CATARACT:

B) mcc = trauma, age,radiation,metabolic,


c) drugs that cause = chlorpromazine,steroids,
miotics,allopurinol,tamoxifen
d) 2 intaocular conditions that cause it = Congestive
glaucoma,ulcer,rp,ant uveitis
e) Rx = ecce,phaco,iol,ice
Station#12
CORNEAL ULCER

b) what you will see = corneal stain,hazy cornea,cilliary


congestion,hypopyon
a) rfactor = contact lens wear,ocular trauma,ocular surface disease,sys
immune
Station#13
KERATOCONUS

a) diagnosis= Corneal topography and keratometry


b) sign = VA dec due to myopia and astigmatism , oil droplet reflex,
munson sign , irregular rings, scissor reflex , thinning and fwd bulging of
cornea, vogt’s line , fleischer’s eye
c) systemic d that cause it = down , marfan , ahlerdanson
d) best inv= dcorneal topography

Station#14
PUPILLARY REFLEXES

b) causes = optic neuritis, crvo


c) causes of light near dissociation = adie’s pupil, Argyll Robertson, 3 rd
nerve regeneration, dorsal mid brain syndrome
Station#15
DENDRITIC ULCER

A) diagnosis = Morphological appearance of ulcer (dendrites) + diminish


corneal sensitivity
B) organism = HSV I & II
C) test =Corneal sensitivity test, 2% flourescein test or rose Bengal test
D) Rx= antiviral (acyclovir, triflurothymidine, idoxuridine), Debridement
(mech removal),Topical antibiotic,Cycloplegic
Station#16
BASAL CELL CARCINOMA

a) it is on pic to diagnose :D
b) mc: eyelid tumour = BCC
c) ivg= skin biopsy and frozen sec study
d) rx = cryo, radiation,laser , chemo
e) DD =sebaceous hyperplasia, malignant melanoma, scc, scoliosis
Station#17
HYPHAEMIA

a) Diagnosis= slit lamp exam


b) Mcc = Ocular trauma/ blunt specially
c) 2 systemic to rule out before diagnosis = sicle cell anaemia. Basically
bleeding and vascular disorder
d) when to do surgery = if more than half of ant chamber is occupied
(large/total hyphaemia)
uncontrolled glaucoma
corneal blood staining
e) complication = rebleeding,glaucoma, corneal staining
Station#18
RETINOSCOPE

b) use = Retinoscopy. Retinoscopy (Ret) is a technique to obtain an objective


measurement of the refractive error of a patient's eyes. The examiner uses a
retinoscope to shine light into the patient's eye and observes the reflection (reflex)
off the patient's retina
c) classification of refractive error =myopia, hyper,astigmatism
d) cause of low red reflex = opacities, infection, cataract, vitreous haemorrhage,
e) reflex in myopia = red reflex

Station#19
Redeyedrops:Mydriatics/cycloplegics

Forexample: Atropine -It’s an anti muscarinic drug.


It blocks M receptors. –It belongs to class of "Parasympatholytic Drugs"
USES: In opthalmology: 1. As mydriatic (for dilation of pupil)

2.as cycloplegic (it causes the paralysis of ciliary muscle)


3.in anterior uveitis : to relieve pain ,for pupillary dilation
4 .It is used to widen the pupil before an eye exam: or eye surgery (ex:inECCE)
Systemic uses : 1.Antispasmodic 2.Antisecretory 3.Antidiarrheal
SEs: 1.DryEyes 2.Mydriasis 3.DryMouth 4.Tachycardia 5.Constipation
Over dose of Atropine results in 3'Cs 1.Convulsions 2.Cardiotoxicity 3.COMA
Other examples of mydriatics : homoatropine, cyclopentolate

Station#20

1-which kind of drugs are these?


ans: Mydriatics
2-name atleast three drugs of this class?
ans: tropicamide,atropine,cocaine,adrenaline
3-what are indications?
ans: in ant uveitis to relieve pain , penalization, to treat cilliary block
glaucoma
4- What is the mode of action of the above drugs
ans: Sympathetic stimulation of the adrenergic receptors causes the
contraction of the radial muscle and subsequent dilation of the pupil.
Conversely, parasympathetic stimulation causes contraction of the circular
muscle and constriction of the pupil.

Station#21

Q.identify the picture


ans: These coronal views reveal a fracture of the left

orbital floor (black arrow) The white arrow points to the

inferior rectus muscle protruding into the maxillary

sinus through the orbital floor fracture site.

Q.what is the treatment fortheabove condition?


ans:
STATION 22. EYELIDS:

-Basal Cell Carcinoma

A pic of rodent ulcer ( do check other form Goole )

Identify : basal cell carcinoma

.D/D : cyst , sebaceous hyperplasia , Bowens disease , seborrhoeic keratosis ,


wart , eczema / psoriasis.

.Signs and symptoms :

.Treatment? Surgical excision with microscopic evaluation of the marjins with


frozen section control is the best method

 Cryotherapy ( for lesions less than 10mm )


 Radiation therapy ( for small nodular ulcerative lesion )
 Laser microsurgery ( new method to remove well-circumscribed bcc ,
carbondioxide laser is used
 Chemotherapy ( used in recurrent invasive bcc of medial can thus
and orbit )
(doesn't metastasize, only infiltrates)
STATION 23

.Identify : ectropion , entropion

.Causes :enttropion : 1. senile age related ( due to overriding of preseptal over


pretarsal part of the orbicular is muscle atrophy of tarsus )

2: cicatritial type ( scarring of palpebral conjunctiva ; cicatrizing conjunctivitis (


trachoma , Steven jhonsons syndrome , ocular cicatritial phemphigoid ) ; chemical
injuries ; lacerating injury.

Causes Entropion Ectropion

Senile type By over ridding of pre Due to senile laxatity


septal over pre tarsal of the tissues of eye lid
part of orbicularis and loss of tone of
muscleatrophy of palpebral part of
tarsus and lower lid orbicularis oculi.
retraction
Cicatritial type Scaring of palpebral Due to scaring or
conjunctiva ; chemical contracture of skin and
injury ; trauma , underlying tissue ;
cicatrizing chemical injuries ,
conjunctivitis  tauma ( lacerating
trachoma , Steven injuries ) , medications
jhonsons , ocular causing dermatitis
cicatrizing
phemphigoid
Spastic type Spasm of orbicular is Due to atony of
Paralytic in ectropion oculi in patients with orbicular is oculi caused
chronic irritating by 7th nerve palsy
corneal condition
Mechanical type Due to tumor of eyelid Due to lack of support
or proptosis of eyelid occurs in ;
phthisis bulbi ,
enophthalmos ,
enucleated eye
Congenital type Due to developmental Due to developmental
deformitybof tarsal deformity of eyelid
plate

Signs and symptoms: symptoms of entropion : foreign body senstation ,


lacrimation , photophobia , punctate epithelial defects , conjunctival redness ,
corneal ulceration , secondary infection.

Signs : lid marijin in-turned and lashes rubbing the cornea and conjunctiva

Symptoms of ectropion : epiphora ( main symptom ) , chronic conjunctivitis ,


eczema , dermatitis

Complications : entropion : recurrent corneal abrasions , superficial corneal


opacities , corneal vascularization , non healing corneal ulcer.

Treatment?
Entropion : surgical ;
senile type ( horizontal resection of orbicular is muscle and tarsus procedure 
Weiss procedure , fox procedure , modified wheelers procedure.
Cicatrizing type ( mild cases  tarsal hinge procedure ) , ( severe cases 
replacement of contracted conjunctival tissue by mucous membrane graft )

Spastic type : taping the eyelid to the skin of cheek , eyelid everting sutures ,
denervation by alcohol injections and botulinum injections , remove a part of
orbicular is oculi surgically

Mechanical : treat the underlying cause

Congenital : respect the abnormal portion

Ectropion : senile type : medial conjuctivoplasty , horizontal lid shortening ,


modified kihnt-szymanowski procedure

Cicatritiql type : v-y operation , z-plasty , skin grafting

Paralytic : artificial tears , lubricating ointment , tarrsoraphy

Mechanical : prosthetic eye ( prevent rubbing of lashes )

Congenital : surgical repair

STATION 24
-Chalazion
.Where located?upper eye lid ( more common jatoi ) but can occur in lower ( se
pic from jatoi)

.Treatment? (surgery: incision and curettage) ; ( Medical : corticosteroid injection


, Triamcilone acetonide is injected through conjunctiva ) ; ( conservative
treatment : expression , hot fomentation , topical steroid antibiotic combination
drops , anti inflammatory drops
STATION 25

-Stye: (swelling at lid MARGIN, acute suppurative infection, reddish)

.Signs and symptoms : pain , eyelid red and edematous , tenderness ,

.Treatment? Systemic antibiotics , analgesics , topical antibiotics , warm


compresses , evacuation of pus
STATION 26

.Identify: ptosis

.Disorders related : third nerve palsy , Horner’s syndrome ,ysthenia gravis ,


myotonic dystrophy , amblyopia , ocular myopathy

.Types : congenital , myogenic , neurornic , aponeurotic , mechanical

.Treatment : fasanella servant operation , elevator resection , brow suspension


procedure ( sling procedure , aponeurotic strengthening.
STATION 27

-identify: Conjunctivitis

.Signs and symptoms : redness , discomfort , hperaemia chemosis , papillae


formation, membrane formation , subconjunctival hemorrhage , discharge (
purulent , muco purulent , mucoid , watery )

.Causes : infective : bacterial , viral , chlamydial , fungal

Non infective : allergic , autoimmune , chemical , toxic

.Pus discharge: gonnococal , acute sever bacterial infection


STATION 28

-identify: Dendritic Ulcer

.Causative agent : herpes simplex type 1 and 2

.Signs and symptoms : foreign body sensation , lacrimation , photophobia , pain


mild to moderate , reduction of vision.

Signs : ciliary congestion , corneal sensitivity diminished , corneal stain ( 2%


flourescein or rose Bengal ) shows ameboid shape ulcer

.Treatment? Topical antiviral drugs ( acycloguanosine , acyclovir ,


triflourothymidine , adenine arabinoside , idoxuridine ) , debriment , topical
antibiotics , cycloplegics ( 1% atropine drops for pain )
STATION 29

Identify:CATARACT

.Signs and symptoms : signs : white pupillary reflex ( leucocoria ) seen in mature
cataract , black coloured opacity seen against a red background ( on plane mirror
examinationdistance 1M ) , plane mirror examination distance 22cm shows
determine the exact position of opacity

Symptoms : cloudy blurred vision , faded colors , glare , halos , poor night vision ,
sunlight appear too bright , double vision or multiple vision seen In one eye ,
frequent change in eye glasses or contact lenses

.Causes : rubella ( most common cause of congenital cataract ) ,


eclampsia/preeclampsia , galactosemia , anirida , trisomy 21 , trauma ( forcep
delivery) ,ageing , excessive exposure to UV rays , diabetes , hypertension ,
obesity, high myopia , glaucoma , retinal detachment , long term or high dose of
corticosteroid , active smoking

.Treatment: Extra capsular cataract extraction conventional extracapsular


cataract extraction , mention phacoemulsification to examiner , manual small
incision cataract surgery )
-Intracapsular cataract extraction expression method , arrugas method ,
cryoextraction

-Parsplana lensectomy ( indicated in congenital cataract

STATION 30

Identify: RETINA:

-Diabetic Retinopathy

-Diabetic Maculopathy

(whole macula focused: diabetic retinopathy, only disc focused: papilledema)

STATION 31
.Slit Lamp (photo)
.Tonometer (Shiotz, applanation)

.Retinoscope (to check refraction)


Ophthalmoscope (to examine the fundus)

STATION 32

-Identify: SNELLEN'S CHART

.Basis (angle waali some definition)

.Procedure :

 The patient sits at a distance of 6 meters from a well a illuminated


vision testing chart( snellens )
 Occlude the left eye
 Ask the patient to read aloud each letter object and record the visual
acquity
 When the patient is unable to read the biggest letter from a distance
of 6meter ,then reduce the distance by moving the patient towards
the chart at a distance of 5 meter , 4 meter , 3 meter , 2 meter and 1
meter till he can read the biggest top letter and the vision will be
recorded as 5/60, 4/60 , 3/60 , 2/60 , 1/60
 When a patient cannot read the biggest letter from a distance of 1
meter then the visual acquity will be recorded as finger counting ,
hand movement, perception of light or no perception of light
 When the visual acquity is reduced , place a pin hole in front of eye ,
improvement in vision will indicate decreased vission due to refractive
error , further decrease indicate organic cause  cataract
 Repeat the steps 2&3 for the left eye
STATION 33
OSCE EYE EXAMINATIONS:
1. Direct Indirect Pupil Reflex:

(block the gap between patient's eyes for consensual light reflex, use high and low
power torches)

2. Swinging Torch test for RAPD:

(nerve completely damaged: APD, nerve partially damaged: RAPD)

STATION 34

Corneal Ulcer. ( A 20 year old med student with h/o contact lens wear)

Identify? Acanthameoba keratitis

Describe? Perineural infiltrates are seen ( pathognomonic sign ) Diffuse punctate


epitheliopathy and ring infiltrates seen
potentially blinding condition diagnosed via corneal scraping and identification of
an ameobic cyst on culture.

Causes? Contact lens wearers and ocular trauma

Investigation? Culture , indirect fluorescent antibody test ( IFAT ) ,

Approach? Thorough history ( contact lens wearing , blurred vissin , sever pain,
photophobia ) , examination ( diffuse punctate epitheliopathy , limbitis , ring
infiltrates , perineural infiltrates pathognomonic sign ) , diagnosis made on
corneal scrapings( non nutrient agar) culture ( visualizing the ameoba , ) , stain
used PAS and alcoflour white for ameobic cyst , and laminar corneal biopsy

Treatment?

STATION 35

Identify: Red capped and Green capped bottles. ( mydriatic and miotics
respectively ).

MOA?

Uses?

STATION 35

Identify?chalazion
Risk factors ( in elderly and young individuals separately )

signs and symptoms?

Effect on vision? Blurred vision due to astigmatism

Treatment? Conservative treatment  expression , hot fomentation , topical


steroid antibiotic combination drops anti inflammatory drops

Medical treatment  corticosteroid injection , triamicilone injection in to the


lesion through conjunctiva , systemic antibiotics

Surgical treatment  incision and curettage

Station 36

Identify:Hordeolum.

Most common cause? Staphylococcus aureus

Signs and Symptoms? Pain , eyelid red swollen and edematous , tenderness over
the lid marjin ,

Treatment? Systemic antibiotics , analgesics. Topical antibiotics , warm


compresses , evacuation of pus , treat the associated conditions

STATION 37

Identify? myopia

Causes? Increase curvature of cornea or lens , increase in axial length of eye ,


change in refractive index of lens ( nuclear sclerosis ) , due to anterior
displacement of crystalline lens

Definition? It is the form of refractive error in which parallel rays of light entering
the er are focused in front of retina with accommodation at rest
Complications? Posterior staphyloma , macular hemorrhage , retinal detachment
, glaucoma

Treatment? Non surgical  concave lens ( in childrens -> full correction for
constant use Is advised ) , ( in adults -> under correction -> 1-2D less is prescribed
)

STATION 38

Concave lenses

Surgical method  radical keratotomy , photo refractive keratectomy , laser


epithelial keratomileusis ( LASEK ) , laser in situ keratomileusis ( LASIK )

What is LASIK? Its done to correct myopia , hperopia , astigmatism

It corrects myopia up to 12 diopters and astigmatism up to 3 D

STATION 39

identify: Red Eye ( Scleritis)

Most common cause? Rheumatoid arthritis ( scleritis )

Other causes of red eye?conjunctivitis , keratitis , acute congestive glaucoma ,


acute iridocylitis , episcleritis , scleritis , subconjunctival hemorrhage , foreign
body in the cornea or conjunctiva

Symptoms of red eye? Decreased visual acquity ( inflamed cornea , iridocyclitis ,


acute glaucoma )

Pain ( keratitis , ulcer , iridocyclitis , acute glaucoma )

Photophobia ( ititis , conjunctivitis )

Colored halos ( acute glaucoma )


Discharge ( conjunctiva or lid inflammation , corneal ulcer , ) purulent/
mucopurulent : bacterial ; watery  viral ; scant , white , stringy  allergy , dry
eyes

Itiching ( allergy )

Treatment of this condition? Treat the associated condition , topical steroids ,


systemic Nsaids , systemic steroids , immunosuppressive , subconjunctival steroid
injections

STATION 40

identify: Acute dacrocystitis due to cong. NLD block?


Causes? Due to secondary infection after naso lacrimal duct obstruction ,
staphaureus , streptococcus , pneumococcus

Where does blockage occur? Blockage at lacrimal sac

Rx? Topical antibiotics , analgesics and anti inflammatory drugs , hot fomentation
, insicion and drainage of abscess

Route of antibiotics? Oral and topical drops

Names of abx? Acute dacrocystitis with orbital cellulitis give I/V antibiotics (
Ampicillin-sulbactam , ceftrixone , moxifloxacin

STATION 41
identify: Pterygium

Definition? Fibrovascular connective tissue overgrowth encroaching upon the


cornea from the conjunctiva in the interpalpebral region

Causes? Drying of interpalpaberal tearfilm most important initiating factor 


commonly occurs in people living in hot climates , damage due to UV rays
Symptoms? Asymptomatic in early stage but late cause detoriation of vision due
to astigmatism and mechanical obstruction

Rx? Surgical excision for cosmetic purpose

STATION 42
identify: Left eye convergent squint.

Another names of convergent squint? Esotropia (manifest squint)

Causes? Hypermetropia , myopia , astigmatism , abnormal ratio of


accommodative convergence to accomodation ( hyper activity leads to esotropia )

Nerve palsy causing this condtion? VI

Name of CN VI? Abducens nerve

VI nerve supplies which muscle? Lateral rectus muscle

Rx? Full correction of refractive error , amblyopia therapy ( patching ) , bifocal


convex glasses , resection , recession , orthoptic exercise ( to achieve binocular
vision )
Complications? Secondary vision loss due to amblyopia , pshycosocial effects (
hinder social interaction and self confidence )

STATION 43
identify: Direct ophthalmoscope.

Uses? Makes small aneurysms and small hemorrhages stand out , use to estimate
C/D ration , to examine fundus with small pupil , can differentiate b/w retinal and
choroidal lesion

STATION 44

What is this? exaphthalmos

Most common cause? Graves ophthalmopathy


What investigations would you perform? Hyperthyroidism serum TSH level ,
serum T3 and T4 level
ocular muscle enlargement ultrasonography , CTscan orbit , MRI

What are the ocular manifestation of this disease?


-slowly progressive disease Lacrimation , photophobia , retrobulbar discomfort ---
-rapidly progressive disease pain , proptosis

STATION 45
what is this? Aplanation tonometer

Principle on which this works? Based on imbert-fick principle which states that (
the pressure ‘p’ inside an ideal dry , thin walled sphere equals the force ‘f’
necessary to flatten its surface divided by the area of the flattening ‘A’ p=F/A

Area of cornea covered? Central part of cornea

Uses? Use to measure intra ocular pressure

What other instruments can be used? Schiotz tonomter , tonopen ,

STATION 46
keicher Fleischer ring.

-What disease is this? Wilson’s disease

-Whats the other name of this disease? Heoato lenticular degeneration

-What happens in this disease? Rare autosomal recessive inherited disorder


causes deposition of copper in the liver , brain , eye

-Investigations? Serum copper and aeruloplasmin , urrinary copper (increased


100-1000 micro gram) , liver biopsy , haemolysis and anemia , genetic analysis

-In what layer of cornea is this ring deposited? Decement membrane of cornea
close to endothelial surface
-In what other diseases would you see this ring? False positive in hepatitis ,
cholestasis , primary biliary cirrhosis

STATION 47

Eye.drop laminated pic of Timolol.

What group does this drug belong to? Beta blockers

Moa? Reduce the aqueous humor formation by blockage of beta receptor on the
ciliary epithelium

Systemic side effects? Bradycardia , arrhythmias ,heart failure , syncope ,


bronchospasm , airway obstruction

Ocular uses? Reduce high pressure inside the eye due to glaucoma ( open angle
type ) , ocular hypertension , decrese pressure to prevent blindness

Cardio selective drug of this group?atenolol metaprolol

STATION 48
Perform pupillary reflex.

What are your findings?

RAPD is found in What diseases? Optic neuritis , anterior ischaemic optic


neuropathy ,compressive optic neuropathy , glaucoma , optic nerve tumor ,
orbital disease , CRAO , CRVO , BRAO , BRAVO , cystoid macular edema , retinal
detachment , optic tract lesson

Why do we perform.consensual light reflex? To detect abnormal pupillary reflex


caused by oculomotor nerve damage , optic nerve damage , brain stem death

STATION 49

What's the.most probable diagnosis? NLD obstruction..johs dye in patient's eye


What are investigations? Jhons dye test , syringing ,
DD punctal atresia , conjunctivitis , congenital glaucoma ,

Complications if unresolved? Cutaneous scarring , injury to medial can thus ,


hemorrhage , cellulitis

treatment options.massage of lacrimal sac , antibiotics , spontanous patency ,


probing and syringing , DCR

STATION 50

What is this? pterigium

Risk factors of this. Hot dry climate , exposure to UV radiation and dryness

Symptoms. Burning , gritty feeling , itching , sensation of foreign body , blurred


vision

Treatment.non surgical tears , topical steroids , sunglasses

Surgical surgical excision due to cosmetic reasons

Waht would you do while performing surgery to prevent recurrence? Perform


conjunctival autograft and amniotic membrane transplantation , use Mytomycin C
at the time of surgery in topical form , radiation ( beta rays)

STATION 51

What's this? dendritic ulcer.

What's the most likely organism? Heroes simplex virus type 1 and 2

Tx topicgl atovirals ( acyvloguanosinr , acyclovir ) 5 times a day , triflurothymidine


( 1%drops ) , adenine arabinoside , idoxuridine ) debriment , topical antibiotics ,
cycloplegic

DD herpes zooster , healing corneal abrasion , acanthameoba keratitis


STATION 52

Disease? Central retinal artery occlusiin

Causes. Thrombosis , embolism , inflamation , periateritis , angiospasm , raised


intraocular pressure

Symptoms amaurosis fugox( monocular repeated transient episodes of decreased


vision or blindness , sudden painless severe loss of vission

DD for cherry red spot tayschs , GM 1 gangliosidosis , Neumann pick disease

STATION 53

What's this? Squint

At what age do children present? When the child is 3 years old

What refractive error is commonly associated ?amblyopia , myopia , hyperopia

Treatment options.surgical resection , recession orthoptic excersises