Dr/A.

K 2020 revision

1|Pa g e
Dr/A.K 2020 revision

2|Pa g e
Dr/A.K 2020 revision

3|Pa g e
Dr/A.K 2020 revision

Model answer June (2019)

1) Illustrate anatomy of EOM :

 Recti muscle
 Origin: at orbital apex from corresponding points of fibrous ring around optic foramen
"Annulus of Zinn"
 Course: they pass forward making a muscle cone and inserted with broad tendons
(10 mm width) into sclera
 Insertion : at sclera anterior to equator at variable distance from limbus
 M.R5.5 mm
 I.R  6.5 mm
 L.R  7 mm
 S.R 7.7 mm

 Oblique muscle
 Origin:
 S.O: from roof of orbital apex above and medial to annolus of zinn
 I.O: orbital floor lateral to opening of nasolacrimal bony canal
 Insertion:
 S.O :It passes forward and medially between roof and medial
wall until it reach trochlea
(Fibrous ring at angle) after reflection around the trochlea it
converted into a tendon and changes its direction to pass
backwards, downwards and laterally to be inserted behind
equator in upper lateral posterior quadrant of the sclera
 I.O : It passes backwards , upwards and laterally to be inserted in lower , lateral posterior
quadrant of eye

4|Pa g e
Dr/A.K 2020 revision

 Nerve supply :
 All extra-ocular muscles are supplied by 3rd " oculomotor " except :
a) 6th"abducent "lateral rectus
b) 4th "trochlear" superior oblique
 Blood supply : muscular branches of ophthalmic artery
 Action of E.O.M:

Muscle Main action ( primary action ) Secondary action Tertiary Action

M.R Adduction

L.R Abduction

S.R Elevation intortion Adduction

I.R Depression extortion Adduction

S.O intortion Depression Abduction

I.O Extortion Elevation Abduction

2) Define :
a) MRDI :distance between upper eye lid margin and centre of cornea normally 4.5 mm
b) Sunflower cataract : complicated cataract due to retention of intraocular FB cupper
(Chalcosis bulbi )
c) Phecomorphaic glaucoma : secondary angle closure glaucoma due to intumescent
cataract in which lens absorb aqueous and become swollen that push iris forward lead to
angle closure
d) Retinopathy :bilateral ,noninflammtory retinal affection due to systemic diseases chch
by retinal vessel changes, edema ,hemorrhage ,exudate

5|Pa g e
Dr/A.K 2020 revision

e) Giant retinal tear : retinal break more than 90 that may predispose to rhegmatogenous
retinal detachment
f) Papilledema : passive ,bilateral optic disc edema due to increase intracranial tension
(brain tumor )
g) Consecutive optic atrophy : abnormal yellowish discoloration of optic disc due to
retinal damage e.g. (central retinal artery occlusion ,retinitis pigmentosa ,…)
h) Irregular astigmatism: a condition of refraction in which parallel rays don’t come into
one focus on retina due to different power of meridian & irregular means highest and
lowest meridian not perpendicular to each other and change in between not gradual e.g.
keratoconus
i) Heteronymous diplopia : patient see two images (true &false ) by using both eyes
.false image is seen in front of normal eye due to medial rectus paralysis
j) Pseudo strabismus : false impression of ocular deviation despite of normally directed
visual axes

3) Uses of fluroscein in ophthalmology : ‫انظز التجميعات‬

4) Describe c/P:
a) Absolute glaucoma ‫انظز مذكزة الجلىكىما‬
Sym:
Sign:
b) Central retinal artery occlusion ‫انظز مذكزة الزيتنا‬
Cherry red spot ‫مهمه جداااا‬
5) DD of endophthalmitis :
‫ جدول المقارنه ف شابتز‬orbit +
6) Enumerate complications of :
a) Perforated corneal ulcer ‫انظز مذكزة الكىرنيا‬
b) Degenerative myopia ‫انظز مذكزة ال‬error

7) Cases : trachoma
‫انظز مذكزة المزاجعه شابتز ال‬conjunctiva

6|Pa g e
Dr/A.K 2020 revision

8) Cases : senile Hypermature cataract complicated with phacolytic glaucoma

‫انظز مذكزة الكيسز شابتز ال‬lens
9) cases : lime
a) lime damage eye by chemical effect due to formation of ca(oH)2
liquifictive necrosis & heat cause thermal damage
b) complications : ‫انظز‬chemical trauma
c) ttt :

10) casse : ‫طفل صغير بيدمع‬

a) Causes?
Most common causes:
 Congenital dacrocystitis
 Buphthalmous
 Ophthalmia neonatorum
 Corneal injury
- Lacrimation due to
1. Psychic condition :Sadness ,happiness
2. Physiological: associated to some reflexes e.g. yawining,coughing
3. Irritation of naso ciliary nerve endings :
 Corneal ulcer
 Foreign body
4. Topical eye drops : pilocarpine &serine stimulate accessory lacrimal gland
- Epiphora
 Physiological due to facial palsy
 Anatomical (punctual occlusion ,canalicular occlusion ,NLDO,nasal causes )
b) How to differentiate between them?
- Lacrimation : anterior segment examination
- Congenital dacrocystitis :positive regurge test, dye disappearance test ,probing
- Buphthalmous :
 -ve regurge test
 High I.O.P , Goniscopy( abnormal membrane ) ,
 fundus examination (late cupping )
 increase corneal diameter
- Ophthalmia neonatorum :
 Negative regurge test
 culture &sensitivity for discharge
 C/p of conjunctivitis ( lid edema ,chemosis ,conjunctival injection ,…)
- Corneal injury :
 Negative regurge test

7|Pa g e
Dr/A.K 2020 revision

 Positive fluorescein stain

 C/p of corneal ulcer (li edema, ciliary injection, loss of corneal luster,)
Mcq 5/ 2019

1-c
2-d
3-d
4-a
5-a
6-b
7-c
8-a
9-c
10-c
11-d
12-d
13-d
14-c
15-a
16-b
17-a
18-c
19-c
20-d
21-b
22-c
23-d
24-b
25-c

8|Pa g e