20-OPHTHALMOLOGY

cataract-ds
BrushfielD-Down synd

in
christmas tree-myotonic dystrophy
coronaRY-pubeRtY
cuneiform-cortical(polyopia)
cupuliform-post subcapsular(max vision loss)

s.
Elschnig pearl, ring of Soemmering-after(post capsule)
experimenTal-Tyr def
glassworker-infrared radiation
grey(soft), yellow, amber, red(cataracta rubra), brown(cataracta brunescence),
black(cat nigrans)(GYARBB)-nuclear(hard)
heat-ionising radiation iim
Membranous-HallerMan Streiff synd
morgagnian-hypermature senile
oildrop(revers)-galactossemia(G1PUT def)
post cortical/bread crumb/polychromatic lustre/rainbow-complicated
post polar-PHPV(persistent hyperplastic prim vitreous)
radiational-post subcapsular
4a
riders-zonular/lamellar(vitD def, hypoparathy)
roseTTe(ant cortex)-Trauma, concussion
shield-atopic dermatitis
snowstorm/flake-juvenile DM(aldose reductase def, T1>T2, sorbitol accumulat)
star-electrocution
sunflower/flower of petal-Wilson ds, chalcosis, penetrating trauma
m

syndermatotic-atopic ds
total-cong rubella
zonular-galactossemia(galactokinase def)

stage of cataract
Ai

lamellar separation
incipient/intumescence(freq change of glass)
immature
mature
hypermature
morgagnian
sclerotic
 lens layer
ant capsule
ant epithelium
lens fibre[66%H2O, 34%prot-aLp(Largest), Bet(most aBundant), γ(crystalline, soluble)]
nucleus
embryonic(0-3mthIUL)
fetal(3-8mthIUL)-Y shape(suture)
infantile(8mthIUL-puberty)

in
adult(>puberty)
cortex
post capsule
thinnest-post pole>ant pole
thickest, most active cell-equator

s.
vitA absent in lens
vitC tpt in lens by myoinositol
H2O tpt in lens by MIP26(Maj Intrinsic Prot26)

iim
dislocation(luxation)-complete outside patellar fossa(ant/post)
subluxation-partly displace in patellar fossa(shining golden crescent)
Marfan synd-suptemp subluxat
homocystinuria(b/l)-infnas subluxat
Weil Marchesani synd-antinf subluxat
hyperlysinemia, ED synd, sulfite oxidase def, Stickler synd, trauma
4a
cataract Sx
ECCE-6.5mm incision, post capsule, suture remove after 3w, near specs after 8w
SICS-3.5mm
phacoemulsification-2.75mm incision, hallow needle-titanium
phaconit-1.5mm
spectacle for-6w postSx
complicat-bld fr post ciliary vess
m

lens-made of
contact
hard-PMMA
Ai

soft-HEMA
semisoft-PMMA+silicon+CAB
rigid gas permeable-cellulose acetobutyrate
magnific d/t contact lens in aphakia=8%
intraocular
optic part
nonfoldable-PMMA(diam=5mm)
foldable-silicon, acrylic, hydrogel, collamer
 rollable-phaconit, hydrogel
implantable collomer
multifocal-pseudoaccomodation principle
haptic
polypropylene, PMMA, acrylic
phakic IOL=+12-–20D
biometry(IOL power calculat)
Sanders Retzlaff Kraff formula

in
P=A–2.5L–0.9K
A-contant for lens type
L-axial lth eyeball(A scan/USG eye)
K-mean corneal curvature(keratometry)

s.
struct-refractive index
air=1.000
aq humor, vitreous humor=1.336
cornea=1.376
lens=1.386-1.406

pupil-ds
iim
Argyl Robertson(Accomdat Refex+, light rxn–)-pretectal nucl inj, neurosyphilis,
dorsal midbrain synd, perinaud synd
D shape-iriDoDialysis
festoon, small irregul sluggish-a/c ant uveitis
4a
Holmes Adie(tonic dilate pupil)-ciliary ganglion inj, idiop, HSV
Marcus Gunn(relative affer pupil defect)-CNII neuritis, CNII compression
total affer pupil defect-CNII transection/avulsion
vertic oval, dilate, non reactive, fix-PACG

reflex
Marcus Gunn jaw winking-CNV CNIII synkinesis, LPS
m

Aschner Dagnini/oculocardiac reflex-aff-CNV1(ciliary ganglion), traction applied to

EOM→ eff-CNX, ↓HR,jn rhythm,asystole

app-condition
Ai

Amsler sign-Fuch heterochromic iridocyclitis

angioid streaks-pseudoxanthoma elasticum
arcus senilis-old age
asteroid hyalosis(body)-Ca, HTN, DM, lipid(cholesterol)
bld&thunder fundus, splashed tomato-CRVO
bony spicule pigmentat, ring scotoma, waxy pallor disc, arteriolar attenuation-retinitis
pigmentosa
bull eye maculopathy-chloroquine
 Busacca nodule-near collarette, large
candle wax Spot-Sarcoid
cattle tracking(fundus), box scarring(fluoresc angiography)-CRAO
cherry red spot(edem all over retina except foveola)
Cherry-CRAO
Tree-Trauma(Berlin edema)
Never-Neimann pick(sphingomyelina)
Grow-Gaucher ds(βglucosidase), GM1,GM2 ganglioside

in
Tall in-Tay sach ds(hexosaminidaseA)
Sand-Sandoff ds(hexosaminidaseB)
dendritic/geographic ulcer-HSV
dOT&fleck retinopathy, oil globule reflex(Ant lenticonus)-AlpOrT synd
double immune ring of Weseley-Acanthamoeba keratitis

s.
egg yolk(lipofuschin)-fundus dystrophy
egg yolk, scrambled egg, pseudohypopyon-Best ds
epibulbAR dermoid-GoldenhARs synd
Ferrys line-Filtering bleb
iim
Fleischer ring(Fe deposit), Munson sign, Vogt sign, oil Droplet reflex(DDopth),
SCissoring reflex(retinoSCopy), a/c corneal hydrops-keratoconus(Down synd)
flowerpetal(Henle layer)-DM macular edema, cystoid macular edema
Haabs striae-buphthalmos
headlight in fog, satellite lesion, Jenson juxtapapillary choroiditis-Toxoplasma
Hollenhorst plaque-amaurosis fugax
Hutchinson sign, nummular keratitis-HZV
4a
infectious crystalline keratopathy-Str viridans
interstitial keratitis, ground glass, Salmon patch-cong Syphilis
iris bombé, Arlts triangle-Ant uveitis
iris pearL-Leprotic uveitis
Kayser Fleischer ring(Descemet memb)-Wilson ds
Koeppe nodule-at pupillary bord, form post synechiae
Krukenberg spindle-pigm dispers synd, pigm glaucoma
m

lattice degeneration retina, tigroid fundus, annular crescent, Foxter Fuch spot(dark
area around fundus)-path myopia
macular scar configuration-neuroretinitis
memb conjunctivitis-C diphtheriae
Ai

morning glory-optic disc coloboma

mUlBERry-tUBERous sclerosis
multip cotton spot around disc-Puestur retinopathy(Pancreatitis, head trauma, chest
trauma, air/fat embolism)
mutton fat keratic ppt(lymphocyte), retrolental flare, Dalen Fuchs
nodule(subRPE)-panuveitis/sympathetic ophthalmitis
MuziO phenom-Oguchi ds(cong static night blindness)
Norrie ds-cong b/l blindn+pseudogliom
 oculodigital sign-Leber amaurosis
pizza fundus, tomato ketchup retinopathy, sauce cheese, brushfire vasculitis-CMV
retinitis
ring scotoma-retinitis pigmentosa, high myopia, POAG, aphakic spectacle correction,
panretinal photocoagulation
Roth spot-bact endocarditis
salt&pepper fundus-Toxoplasma, cong syphilis, rubella
scintillating scotoma-migraine

in
sclerosing keratitis-RA
Shafer sign-retinal detachment
smoke stag, enlarged inkblot-central serous retinopathy
snowball opacity-sarcoid, amyloid, Lyme ds, candidiasis
snowbanking, snowball-pars planitis

s.
Stocker line-pterygium
synchisis scintillans-liquefactive vitreous
tear drop sign-blunt trauma eye
tesellate fundus-myopia, retinitis pigmentosa
ulcus serPens-Str Pneumiim
VoSSius ring(ant capS lenS)-concuSSion inj
watered silk-hypermetropia

fungal corneal ulcer

We-Wessley sterile immune ring
Saw-Symptom<sign
4a
Vegetative-Vegetative material trauma
D-Dry looking ulcer
P-Pseudohypopyon(convex)
S-Satellite lesion
Film-Feathery finger like extension into stroma

seasonal allergic/spring catarrh/vernal keratoconjunctivitis

m

Ropy-Ropy discharge
Cobblestone-Cobble stone(eosinophil), pavement stone, papillary hypertrophy
Can-Cupid bow outline
Provide-Pseudogerontoxin
Ai

Maximum-Maxwel Lyon sign(eosinophil)

Shield in-Shield ulcer in cornea
Hot-Horner Tranta dot, T1HSR
Summer-Summer problem
type-palpebral(MC), bulbar, mixed
Rx-olopatadine drop

hypopyon-corneal ulcer, fungal ulcer(Aspergillus, Fusarium), Behcet ds(recur),

 endophthalmitis, panuveitis, panophthalmitis
pseudohypopyon-retinoblastoma, Best ds

a/c/epidem hgic conjunctivitis(PACESH)

Picornavirus
Adenovirus11(MC)
CoxsackievirusA24
Enterovirus70, Echovirus31

in
Str pneum
Haemophilus

blindness
WHO-ICD—visual acuity with best correction ction—NPCB, India(LESMA)

s.
catI=6/18-6/60-Low vision
catII=6/60-3/60-Economic/work blindness
catIII=3/60-1/60-Social/walk blindness
catIV=1/60-PL+-Manifest blindness
iim
catV=PL–-Absolute blindness

WHO-cataract, RE, childhood blindn, trachoma, onchocerciasis

NPCB-cataract, RE, childhood blindn, corneal blindn(trachoma), DM, HTN retinopathy

blindn
sudden
4a
painful-PACG, a/c iridocyclitis, chem&mech inj eyeball, endophthalmitis, optic
neuritis
painless-macular edema, CRAO, CRVO, CSR, retinal detachm, exudat ARMD,
vitreous& retinal hge, methyl alcoh amblyopia, subluxat/dislocat lens
gradual
painful-corneal ulcer, POAG(c/c simple glaucoma), c/c iridocyclitis
painless-progressive pterygium, corneal dystrophy, corneal degenerat, cataract,
m

chorioretinal degenerat, dry ARMD, DM retinopathy, RE, presbyopia, Leber heredit

optic neuropathy

tubular vision
Ai

retinitis pigmentosa
high myopia
POAG
CRAO with sparing of cilioretinal a

synd with ocular m palsy

Weber synd=i/l CNIII palsy+ c/l hemplegia(cerebral peduncle)
Nothnagel synd=i/l CNIII palsy+ c/l cerebellar ataxia(sup cerebellar peduncle)
 Benedict synd=i/l CNIII palsy+ c/l tremor/chorea/athetosis(red nucleus inj)
Claude synd=Benedict+Nothnagel
FOville synd=lat gaze palsy+ i/l CNVII palsy+ c/l hemiparesis(dOrsal pOntine inj)
Millard Gubler synd=c/l hemiplegia+ dysarthria+ i/l lat rect palsy+ i/l paresis of
upper&lower face(vent pont inj)

classif of trachoma-WHO(1987)(FITSO)
to be used for field worker

in
TF trach inflam follicular->5follicle(>0.5mm diam) on upper tarsal conjunctiva
TI trach inflam intense-inflam&papillary hypertrophy obscuring> ½of tarsal vess
TS trach scarring-scarring over upper tarsal conjunct, Arlts line
TT trach trichiasis-≥1trichiatic cilia rubbing globe/evidence of recent removal
CO corneal opacity extending over pupil

s.
MacCallan classif of trachoma
stage1(Incipient)-immature follicle on sup palpebral conjunctiva
stage2(Established)-mature follicle on sup palpebral conjunctiva
iim
stage3(Cicatrizing)-follicle/scarring over sup tarsus
stage4(Healed)-no follicle, extensive conjunctival scarring

trachom/Egyptian ophthalmia(A,B,Ba,C)
H-Herbert pit
A-Arlt line(follicular, papillary rxn)
L-Leber cell
4a
F-Follicle
S-SAFE strategy
P-Papillary hyperplasia&Pannus
City-Corneal ulcer
SAFE strategy
S-Sx
A-Antibiotic-Azithromycin 20mg/kgSD
m

F-Facial cleanliness
E-Environmental improvement
blanket therapy-2-9y>10% active trachoma-azithromycin SD 20mg/kg
complication-corneal ulcer
Ai

organism penetrating cornea

N meningitidis
N gonorrhoea(most virulent)
C diphtheriae
Acanthamoeba
Listeria monocytogenes
Hemophilus
 examination-instrument
angle(inf) of ant chamber-gonioscopy(refLected light-indirect-GoLdman, refracted
light-direct-Koeppe)-struct seen-Schwalbe line(post limit Descemet memb),
trabecular meshwork, scleral spur, ciliary body, root of iris
axial lth-USGA
binocular vision-synaptophore
caroticocavernous fistula-intra a DSA

in
colour blindness
classify-anomaloscope
quantify-FM100 hue test
screen-Ishihara chart
contrast sensitivity test-Pelli Robson chart, Regan chart, Standard Snellen type

s.
corneal curvature-kerat/ophthalmometer
corneal endothelium-specular microscopy(≥2500cell/mm²)
corneal stain-2%fluorescein stain-(brilliant green), bengal Rose1%-(Red-Dead epith)
corneal surface/topography-placido disc, keratoscopy
iim
corneal thickness-pachymeter
corneal thickn, curvature, surface-orbscan
differentiate b/n PACG& cataract-Fincham test
DM macular edema, cystoid macular edema, central serous retinopathy-fluorescein
angiography(antecubital v)
DM retinopathy-ETDRS(Early Treatment Diabetic Retinopathy Study)
field charting-campimeter, perimeter(fix at red light, respond to green light)
4a
IOP-tonometer
indentation-Schiotz, Baraquer
appLanation(best)-GoLdman[biprism, MC, Imbert Fick law-Pressure in sphere=W(
force)/A(area of flatten)], Perkin(hand held, children), noncontact(air
puff)-Drager(wide range IOP), Malkalor(variable area, MacKay Marg principle)
I/A-tonopen(irregular corneal surf), pneumotonometer
rebound phenom-I care(self tonometer)
m

dynamic contour-Pascal
macula-optical coherence tomography
macular fn-Amsler grid chart(central 10°), 2pt discrimination test, pinhole test,
Maddox rod test, Purkinje vess shadow, blue field entoptoscope flying corpuscle test,
Ai

potential visual acuity meter, laser inferometry, ERG, VER

n fibre layer-scanning laser polarimetry
occult choroidal NV-indocyanic green angiography
optic disc&macula-slitlamp biomicroscopy
outflow of aqueous(C value)-tonography
POAG-slit lamp biomicroscopy
contact on eye-Goldman(3mirror)
noncontact(front of eye)
 convex-+90,+78,+60D
concave(Hruby lens)-–58.6D
quantify optic disc change-scanning laser ophthalmoscopy
refractive error-retinoscopy/skiascopy/shadow test
1m dist-movement of image
same direction-hypermetropia, emmetropia, myopia<1D
no-myopia=1D
opp-myopia>1D

in
drug-subtract
atropin=1D, C=0.75D, H=0.5D, T=0.25D
retina layer-confocal microscope
squint-Hirschberg test, Krimsky prism bar test, cover-uncover test, alternate cover
test, Maddox rod/wing test, BSGT(Bagolini Striate Glass Test)

s.
subjective refining refraction
cylinder-Jackson cross cylinder, Astigmatic fan test
sphere-fogging techn, duochrome test, pinhole test
visual acuity(form sense)
iim
recognition-Snellen, E,C chart, Allen picture test
resolution-teller, VER, optokinetonystagmogram
detection-cardiff, dot visual acuity

transposition of equation
xS with yC at z°=(x+y)S with (–y)C at (90+z)°
spherical equivalent
4a
xS with yC at z°=(x+½y)S

angle of eye
Alpha-Visual axis& Optical axis(Voice Of America)
Kappa-Pupillary axis& Visual axis(Pakistan Versus Kashmir)
Gamma-Fixation axis& Optical axis(Fixation Of Gamma)
m

distant direct opthlm-25cm

Direct ophthalmoscope(vonHelmholts)(DO)-Erect, Virtual, 15time
magnification(DEV15)-2DD-close to eye
Indirect ophthalmoscope(IO)-Inverted, Real-4-5time
Ai

magnification(IIR4-5)-8DD-1m-condensing lens req, stereopsis present

field of vision(BYRG)
Blue>Yellow>Red>Green
sup(50°)<nas<(60°)<inf(70°)<tem(90°)

Purkinje image
1-ant cornea surf
 2-post cornea surf
3-ant surf lens
—erect&move in same direction
4-post surf lens
—inverted&move in opposite direction

nystagmus-lesion
uPbeat-Pons

in
downbeat-craniocervical jn
gaze evoke-cerebellum

aq humor flow through pupil(μl/min)

morn=3.0, after=2.4, night=1.5, total=2.0

s.
corneal opacity-corneal thickn
nebula<⅓(most vision disturb d/t diffraction)
macula=⅓-⅔
leucoma>⅔ iim
corneal epith inj→ corneal endoth rapidly regenerate

staphyloma
abnormal protrusion of uveal ts weak& thin portion of cornea/sclera
ant-corneal ulcer
4a
intercalary(limbus)-trauma, inf
ciliary-scleritis
equatorial-scleritis, degenerat myopia, c/c glaucoma
post-high myopia(>–6D)

exophthalmos-protrusion>18mm
proptosis-protrusion≤18mm
m

keratopathy(5 CAT N Fabryds)

Cu
Ca(band shape)-hypercalcemia, silicon oil, hypophosphatasia, sarcoid, phthisis bulbi
Ai

Chloroquine
Chlorpromazine
Cysteine
Amiodarone
Adrenalin(black cornea/adrenochrome)
NSAID
Fabry ds
Mx-EDTA chelation
 keratoplasty
Donor-endothelium, Descemet memb
host-epithelium, n, keratocyte
diam=7-8.5mm

Fuch endothelial epithelial dystrophy

stage

in
1-cornea guttata
2-edema/endoth decompensation
3-bullous keratopathy
4-scarring
Mx-edema-5%NaCl

s.
Bullous keratopathy-Bandage soft contact lens

struct-power
Lister reduce eye=+60D
cornea=+44D
lens=+16D
iim
amplitude accomodation=+10D
max tone ciliary m=+3D

peribulbar inj-periorbital space

4a
rod=120mill, cone=6.5mill
cell-response
rod, cone, horizontal cell-hyperpolarizat
bipolar cell-hyper/depolarizat
ganglion cell-depolarizat
amacrine cell-depolarizat, spike potential
m

optic cup:disc=0.3:1

cell-NT
rod,cone-glutamate
Ai

amacrine cell-8NT(GABA, Gly, dopamine, ACh, indolamine)

path of light
cornea→ aq humor→ lens→ vitreous→ retina[Inner limiting memb→ N fibre layer→
Ganglion cell layer→ Inner plexiform(secrete ACh)→ Inner nuclear→ Outer
plexiform(Henle layer)→ Outer nuclear→ External limiting memb→ Layer of
rod&cone→ retinal Pigmentary epith] outerside→ Bruch memb→
choroid[choriocapillary→ middle vasc(Salter)→ Large(HaLLer)]→ suprachoroid
 lamina→ sclera
foveola=ILM+ELM+cone
fovea=ILM+OPL+ELM+cone
neurosensory epith=retina–(LRC+RPE)
macula-GCL thickest
inner 6layer-central ret a-sup br-NFL, deep br-INL>OPL
outer 4layer-post ciliary a
bld retinal barrier

in
inner-wall of bld vess-DM retinopathy
outer-RPE+Bruch memb+choroid capillary-central serous retinopathy
laser photocoagulation-RPE
angioid streaks-crack in collagenous portion of Bruch memb-Paget ds,
pseudoxanthoma elasticum, Ehlers Danlos synd

s.
interphotoreceptor matrix
metalloproteinase
SialoProtein A/w Rod& Cone(SPARK)
Ts Inh of MetalloProteinase(TIMP)

methyl alcohol-GCL
iim
bld supply-central retinal a, retinal a, plexus of Haller& Zinn

visual acuity fn of-cone in fovea

suP retina(lower visual field)-Parietal lobe-lower quadrantanopia

inf retina(upper visual field)-temporal lobe-upper quadrantanopia
4a
sensory organ-photoreceptor(rod, cone)
1st order-axon of bipolar cell(retina)
2nd order-axon of ganglion cell(retina, optic disc, optic chiasma, optic tract)
3rd order-axon fr LGB(optic radiat)

Walds visual cycle

m

11 cis retinOl→All trAns retinAl

vitA regen-RPE
cis→trAns-RPE
OL→ AL-LRC
Ai

1st ord neur-INL(bipolar cell), amacrine-VA in changing light condition, horizontal

cell-connect 1cell to other
2ndON-GCL
3rdON-LGB(lat geniculate body)

retinoschisis-split retina in NFL-hypermetropia

retinal detachm-split RPE-myopia
cystoid macular edema-fluid b/n OPL-INL
 electroretinography(Photo le Bhai Phir)
change in resting potential of eye induced by flash of light
initial +ve deflect R1, f/b R2-Photochemical rxn(rod, cone) outer seg
large –ve a wave-Photoreceptor activity
large +ve B wave-response to Bipolar(Muller)cell
small +ve c wave-retinal Pigment epith

in
ERG-LRC
EOG-RPE-Ardens ratio=light peak/dark trough> 1.85-Best ds

Stargardt ds-loss central vision, ERG& EOG norm, no family hist

s.
angioid streak(Bruch memb dystrophy)(PEPSI)
Pseudoxanthoma elasticum
Ehlers Danlos synd
Pagets ds
Sickle cell anem iim
Incontinentia pigmenti, Idiopathic(MC)

DM retinopathy
MI risk fact-T2DM durat
T1DM-more retinopathy, IO after 5y
T2DM-immediate IO, f/b-after 1y
4a
mild NPDR-after 1y
mod NPDR-after 6mth
severe/very severe-after 2-3mth
NPDR
MIld-MIcroaneurysm
mod-FLam hge(NFL), dot/blot hge, hard exudate(OPL)
4:2:1rule-4-hard exudat, 2-v bld, 1-intraretinal microvasc abnorm
m

severe-⅓satisfied
very severe-⅔satisfied
PDR
neovasc-NVD(disc), NVI(iris), NVG(glaucoma), NVE(elsewhere)
Rx-panretinal photocoagulation NdYAG-532nm double freq laser)→ pars
Ai

planovitrectomy

preg-f/u-every 3mth

HTN retinopathy
Keith Wagner staging
I-diffuse arteriolar attenuation
 II-focal constriction
III-SE(NFL)>HE, hge
IV-b/l optic disc edema

DM ret-HE, dot blot hge, microaneurysm

HTN ret-SE, flame shape hge, macroaneurysm(>100μ)
isolated CNIII palsy+pupillary spare-DM

in
retinal detachm(NSR-RPE)
prim
rhegmatogenous-retinal break/hole-convex retina
Rx-vitreoretinal Sx
sec

s.
tractional-neovascularisation, pull of retina by fibrovasc(vitreoretinal) band-concave
exudative(solid)-choroid tm, CSR, post uveitis, preg, shifting fluid sign
Rx-Rx of underlying condition

central serous retinopathy

iim
CRVO-splash sauce app(multiple flame shape hge), 100d glaucoma(NVG)

ring reflex, young mal, self limited, steroid aggravat, smoke stack, enlarge ink
blot(fundoscopy), mushroom shape(fluorescein angiography)

vitreous attachm strongest-ora serrata(jn b/n retina& ciliary body)

4a
vitreous replacement
high surf tension
gas
air-not expose
SF6-2
C3F8-4
m

liquid
silicon oil-high density
perfluorocarbon liquid-high sp gravity
Ai

Whitnall tubercle(attached to lat wall orbit)

LPS
capsulopalpebral fascia
lat check lig
suspensory lig of Lockwood(prevent eyeball fall)

leukocoria(PREDICT)
PHPV
 Retinopathy of prematurity, Retinoblastoma
Endophthalmitis
Dysplasia of retina
Incontinentia pigmenti
Cong cataract, Coat ds(NORRIN gene)
Toxoplasma, Toxocara

retinopathy of prematurity(DR Fir PT)

in
temporal retina, <32w, <1500g, bld transfusion, 100%O2, VEGF→NV→RD+VH
zone I-radius=4DD, zone II, zone III
stage I-Demarcation line
stage II-Ridge
stage III-Fibrovasc prolifer

s.
stage IV-Partial RD, A-no fovea, B-fovea involve
stage V-Total RD
screen age=32-36w
Rx-stage I,II,III
iim
zone I,II-laser ablation of immature &avasc retina, III-w/w
stage IV,V-vitreoretinal Sx

retinoblastoma
70-75%-b/l, 25-30%-u/l
18mth, leukocoria-60%, squint-20%
sporadic-94%, Knudson 2hit hypothesis, 2hit afterbirth, 85%-u/l, 15%-b/l
4a
familial-6%, 1hit germcell, 1hit somatic, 85%-b/l, 15%-u/l, 40%-heritable
Flexner Wintersteiner rosette, Homer Wright rosette, pseudorosette, fleurette,
endophytic-cottage cheese app
Ix-1st-USGBscan-calcific, best-NCCT, CNII-MRI
spread-CNII→brain
International classific
A-<3mm(<2DD from fovea/1DD fr disc)-conservat-laser/cryo
m

B->3mm-CT→laser/cryo
C-localised vitreous-CT→laser/cryo
D-diffuse vitreous-CT→laser/cryo
E->½ eyeball(touching lens)-enucleation
Ai

RT-b/l, CNII involve, osteosarcoma, pinealoma

eyelid
skin
subcut ts
striated m
LPS
orbicularis occuli
 pretarsal-spont blink
RiOLan-Oppostion of UL-LL
HoRner-dRainage of teaRs
preseptal-voluntary blink
orbital-forceful blink
subm areolar ts
sm m-Muller/tarsal m(sympath-1-2mm eye elevat)
fibrous skeleton-tarsus, orbital septum

in
palpebral conjuct

ptosis
LPS action-norm>15mm, good=8-15mm, fair=4-8mm, poor<4mm
ptosis-mild=2mm(LPS plication), mod=3mm(LPS resection), severe≥4mm(LPS

s.
replace-frontalis/fascia lata sling)
Marcus Gunn jaw winking(u/l ptosis+ chewing) phenom
pterygoid→ LPS(CNV)
Mx-b/l LPS disinsertion
iim
Fasanella Servat-Horner synd
LPS plication-mild simple ptosis
LPS resection-mod simple ptosis
sling-severe simple ptosis
best material-fascia lata

Telecanthus-↑intercanthal dist, norm interpupillary dist, ↑sofT tissue

4a
Hypertelorism-↑intercanthal dist, ↑interpupillary dist, ↑Hard tissue

distichiasis-abnorm row of cilia taking place of Meibomian gld

madarosis-absent cilia-c/c blepharitis, leprosy, myxedema
poliosis-greying of cilia-old age, VKHds
trichiasis-misdirected cilia rub eyeball
m

entropion
senile(involutional)
cicatricial
spastic
Ai

cong
ectropion
senile
cicatricial
paralytic
mechanical
spastic
 direction of NLD(BLooD)-Backward, Lat, Downward

cong NLD obstr-Mx

<9mth-Criggler massage
9mth-4y-Bowman probing
>4y-DCR(middle meatus)
adult NLD obstr-Mx
a/c dacryocystitis-oral antibiotic, c/i-probing& irrigation

in
c/c dacryocystitis-DCR
TB, syphilis, leprosy, tm, sarcoid, fibrosed sac-dacryocystectomy
canalicular obstruction(<8mm fr punctum)
Mx-conjunct DCR-Pyrex Jones tube
block> 8mm fr punctum

s.
Mx-canaliculo DCR-intubation tube
tears lost-7% dehydration

lacrimal fistula-Mx-DCR
lacrimal fibrosis-Mx-DCT iim
Schirmer test-tear strip(5min)-<5mm-severe dry eye

LGB(3rdON)
6layer
1,4,6-c/l
4a
2,3,5-i/l
1,2-Magnocellular(Y)-Motion
3,4,5,6-paRvocellular(X)-colouR
pathologic myopia site of lesion-LGB

Colour vision pathway

Cone→ bipolar→ GCL→ X fibre→ CNII→ OC→ OT→ LGB(3,4,5,6)→ OR→ visual
m

cortex→ final visual centre→ V4 (fusiform gyrus)

Light reaction
retina→ CNII→ OC→ OT→ pretectal area→ dorsal midbrain→ b/l Eding Westphal
nucleus→ CNIII(n to inf oblique)→ ciliary ganglion→ short ciliary n→ constrictor
Ai

pupillae
Near pathway(trikinetic reflex)
b/l pupil constrict+ (convergence+ accomodation)-nucleus of Perlia
retina → ON→ OC→ OT→ cortex→ EW nucleus→ CNIII

extraocular m
4recti-insert on annulus of Zinn
2oblique-SO-body Sphenoid, IO-body maxilla
 origin(MILS)-dist from limbus(mm)
MR=5.5, IR=6.5, LR=7.0, SR=7.5
thinnest sclera-insertion of recti, thickest sclera-around CNII
shortest-IO, longest-SO, shortest rect-LR, longest rect-MR
Grave ophthalmopathy(IMSLO)-IR> MR> SR> LR> SO> IO
EOM with 2origin, embryologic 1st to develop, 2a for each m except-LR
Herring law of equal innervation-Yoke m
Sherrington law of reciprocal innervation-LR-MR, SR-IR, IO-SO

in
Rt eye(SLIIMS)
SR*IO
LR*MR
IR*SO
Beilchowsky sign-↑hypertropia on tilting head to same side-SO palsy

s.
step1-which eye hypertropic?
step2-hypertropia ↑on gaze to c/l side-SO palsy
step3-hypertropia ↑on i/l head tilt-SO palsy

iim
horiz gaze centre-Pontine Paramedian Reticular Formation(PPRF)
rt PPRF lesion-rt horizontal gaze palsy
rt MLF(med longitud fasciculus) lesion/internuclear ophthalmoplegia-rt MR palsy, lt
adb nystagm
rt PPRF+rt MLF lesion-1½synd
b/l MLF lesion(WEBINO-Wall Eye B/l Internuclear Ophthalmoplegia-b/l MR palsy
pseudostrabismus-visual axis parallel, eyes appear to have squint
4a
pseudoesotropia-apparent convergent squint
pseudoexotropia-apparent divergent squint
convergent(esotropia) squint-uncrossef diplopia
divergent(exotropia) squint-crossed diplopia
rt esotropia-lt LR palsy
vertical squint-hypertropia
heterophoria-latent squint
m

tropia-manifest squint
paralytic(incomitant) squint-sec>prim deviation
nonparalytic(concomitant) squint-sec=prim deviation
Ai

cong/infantile esotropia
large angle constant esotropia
IO overaction
Dissociate Vert Deviation(DVD)
latent nystagmus

Duane retraction synd

cong strabismus, fail developm CNVI
 type I(esotropic)-diff abduction(MC)
type II(exotropia)-diff adduction
type III-diff both
lt>rt

ophthalmoplegia
ext-only EOM palsy
int-only intrinsic m(ciliary m, iris) palsy

in
nuclear-EOM palsy d/t CNIII nucl lesion
ophthalmoplegic migraine/episodic ophthalmoplegia-recur attack of headache+
CNIII,IV,VI palsy
c/c progressive external ophthalmoplegia-mitochondr myopathy, b/l ptosis, no
diplopia

s.
Chandler stagin orbital cellulitis(POSIC)
I-Preseptal cellulitis
II-Orbital cellulitis
III-Subperiosteal abscess
IV-Intraorbital abscess
V-Cavernous sinus inf

aq humor
iim
form=secretion(70%)+ ultrafiltration(20%)+ diffusion(10%)
drain=trabecular(90%)+ uveoscleral(10%)+ uveovortex(min)
4a
PACG
stage
Prodromal
Intermittent-1064nm single wavelth NdYAG laser periph iridotomy
A/c angle closure-DOC-2%pilocarpine→ IV mannitol, oral acetazolamide, RxOC-laser
periph iridotomy
m

C/c angle closure-trabeculectomy

Absolute-retrobulbar Absolute alcohol inj, diode laser cyclophotocoagulation
Rx-1st line-IV mannitol
Ai

1-open angle
2-IOP>21mmHg
3-optic disc/visual field change
1+2+3=POAG, 1+2=ocular HTN, 1+3=norm tension glaucoma d/t hypoperfusion
cup:disc ratio>0.3
POAG-DOC-prostaglandin
earliest field def-Bjerrum area(central/paracaecal scotoma)
 cong glaucoma/buphthalmos
true-at birth, infantil-1-3y, juvenile(JOAG)>3y, ↑corneal diam(Haabs striae), aqueous
not drain as ant chamber covered by Barkan memb
DOC-acetazolamide
RxOC-trabeculectomy+ trabeculotomy> goniotomy
RxOC+corneal opacity-trabeculotomy
express shunt-stainless steel, Ahmed implant-silicone, Xen implant-gelatine, hydrous
implant-nitinol

in
sympathetic ophthalmitis
penetrating trauma→ exciting eye→ panuveitis→ sympathising eye
2w→lifetime
Rx-<2w-enucleate traumatic eye, >2w-pulse steroid(IV methylprednisolone)

s.
Eales ds/periphlebitis retinae(idiopathic vasculitis)
young mal with b/l recur vitreous hge (floater), NVE, sudden blurring of vision
Rx-w/w×3mth f/b pars plana vitrectomy
iim
Fuchs heterochromic iridocyclitis(iris stroma atrophy)
nongranulomatous ant uveitis, young mal with heterochromic iridum, hypochromia

tear film(LAMOMI)
Outer-Lipid-sebaceous gld-Meibomian gld, Zeiss gld
Middle-Aqueous-basal(accessory lacrimal-Krauss, Wolfring, mod sweat-Moll)
4a
Inner-Mucous-goblet cell-nasal conjuctiva

sweat gld
Moll-apocrine, next to eyelash, duct open-eyelash(hair) follicle
sebaceous gld
Zeiss-lid margin, duct open-eyelash follicle
Meibomian(tarsal)-rim of eyelid inside tarsal plate, duct open-lid margin
m

Meibomian gld-inf-internal hordeolum, noninf-chalazion(Meibomian cyst)

Zeiss, Moll gld-inf-external hordeolum(stye)
Ai

lacrimal gld secretion(SG²PZ)

Sup salivatory ganglion
Geniculate ganglion
Greater petrosal n
Pterygopalatine ganglion
Zygomaticotemporal n

alkali stage
 stage I-a/c ischemic necrosis
stage II-reparation
stage III-symblepharon

anat classif uveitis

ant-iris, pars plicata of ciliary body
iritis-iris
iridocyclitis-iris, pars plicata

in
cyclitis-pars plicata
intermed(pars planitis)-pars plana, retina, choroid
post(chorioretinitis)-choroid, retina
pan-whole uvea

s.
activity of ant uvelitis-no. of cell in ant chamber, flare

phthisis bulbi
final stage end result of c/c uveitis
iim
small, shrunken globe, thick sclera
retinal pigm epith→ metaplasia→ intraocular ossification

site of lesion-visual field defect

CNII-blindness
optic chiasma-bitemporal hemianopia
optic tract-incongruent homonymous hemianopia
4a
LGB-homonymous hemianopia
optic radiat(total)-homonymous hemianopia with macular sparing
optic radiation lower fibre(temporal lobe)-homonymous upper quadrantanopia
optic radiat upper fibre(parietal lobe)-homonymous lower quadrantanopia
visual cortex(ant occipital cortex)-homonymous hemianopia with macular sparing
occipital cortex tip-homonymous macular defect
m

prevalence criteria for determining xerophthalmia(CCBN)

Corneal xerosis>0.01%
Corneal ulcer>0.05%
Bitots spot>0.5%
Ai

Nightblindness>1%

WHO classification xerophthalmia

X1A-conjunctival xerosis
X1B-Bitot spot
X2-corneal xerosis
X3A-corneal ulceration<⅓ of cornea
X3B-corneal ulceration>⅓ of cornea
 XN-night blindness
XF-fundal change
XS-corneal scarring
1st sympt-night blindness
1st sign-conj xerosis
prevention-9dose
<6mth=50000IU oral, 6-12mth=1lac IU oral, >1y=2lac IU oral,
IM=½oral

in
Rx-D0,1,14/30mg double dose

NPCB
goal-0.3% by 2000
100%central sponsered scheme

s.
shift eye camp approach→fixed facility
conventional Sx→ IOL
↑coverage of eyecare service in tribal& underserved area

Cataract
Childhood blindness
Corneal blindness
iim
VISION 2020-Right to Sight(WHO, 1999)
ds(CCCDEFG)

DM retinopathy
refractive Error
4a
Focal trachoma
Glaucoma
pyramid
prim centre(20000 for 50000)
1ophthalm assistant
sec centre(2000 for 5lac)
2ophthalmologist+ 8paramedic(mid level ophthalm personnel)
m

training centre(200 for 50lac)

centre of excellency(20 for 5crore)

vitB2 def-conjunct hyperemia

Ai

vitB12 def+smoking+alc-prim optic atrophy(toxic amblyopia)

laser
193nm excimer-refractive Sx
532nm(double freq) NdYAG(colourless) -panretinal photocoagulation
1064nm(single freq)NdYAG-peripheral iridotomy, post capsulotomy
diode-vitreous hge, confocal scanning laser ophthalmoscope(670nm)
argon(488-514nm)-penetrating depth=1mm
 norm
vert curv>horiz curv-with the rule astigmat= 0.25D

pleomorph adenoma lacrimal gld-displacem eyeball inferolat

illuminat frenzel glasses(+20)-abolish fixation, reveal periph vestib nystagmus

in
nystagmus
central->1min
upbeat-↑on looking up
downbeat-↑on looking down
vertical-when subject rotated head tip sideway

s.
binocular vision
grade I-simultan percept
grade II-fusion
grade III-stereopsis

temporal cortex
iim
Pcell-project→ Parvocellular layer of LGB, control by bipolar cell, show linear
summation of response, more sensit to wavelth
Mcell-project to Magnocellular pathw, control by bipolar cell, show phasic nonlinear
response to complete stimulus, more sensitive to luminance
4a
Wcell-diffuse extensive receptive field, control by amacrine cell, respond poorly to
visual stimulus
b/l inftemp cortex(Pcell) less-cortic colour blindn(achromatopsia), inabilit to
recognise face of close relative(prosopagnosia)
middle temp& middle sup temp cortex-motion detect& control of eye movement

Abbreviations
m

a-artery, AA-amino acid, abtc-antibiotic, AI-autoimmune

bef-before, bel-below, b/l-bilateral, bld-blood, b/n-between, bn-benign, br-branch,
Bx-biopsy
ca-carcinoma, carb-carbohydrate, c/i-contraindication, c/l-contralateral,
conc-concentration, cong-congenital, Cx-cervix
Ai

d-day, def-deficient, ds-disease, d/t-due to, Dx-diagnosis

E-estrogen
fem-female, fr-from
gld-gland, glu-glucose
h-hormone
idiop-idiopathic, i/l-ipsilateral, inf-infection, inj-injury
lig-ligament, LL-lower limb, l/t-leading to
m-muscle, maj-major, mal-male, MC-most common, met-metastasis, min-minor,
mtx-methotrexate, Mx-management
n-nerve, norm-normal
 P-progesterone, pl-plasma, prot-protein, pt-patient
Rx-treatment
SCC-squamous cell carcinoma, sr-serum, Sx-surgery, sz-seizure
tm-tumour, ts-tissue
UL-upper limb, u/l-unilateral
vag-vagina, VC-vocal cord, vel-velocity, vert-vertebra, vit-vitamin, vol-volume
w-week, wt-weight
Xr-X ray
y-year

in
#-fracture
°-degree

THESE NOTES ARE ONLY FOR THE PURPOSE OF GUIDANCE AND HELP
TO PG ASPIRANTS, NOT FOR COMMERCIAL OR OTHER PURPOSE. REFERENCE

s.
HAS BEEN TAKEN FROM VARIOUS STANDARD TEXTBOOKS.

iim
4a
m
Ai