} 1 i ji \ 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 q ve 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.” § 4. Significance of this sign? ; 5. Treatment? Oral acyclovir 800 mg po five times daily for 7 to 10 days is the tandard 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 ipa pce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 bimic roscopy (with contact lens and without contact lens) 2.FFA (detects leaking areas and occlusion areas) 3.Q€T\(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) 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 wATaT > a E & i : ®& z 2 FELOPZD DEFPOTEC 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 senNormal sighted person should See at 60) 5. Usual distance between patient and chart? 6m or 20feet Station#06 Applanation tonometry: * Applanation tonometry: measures | IOP by providing force which flattens | the cornea, | * Variable force applanation | tonometers (Goldmann, Perkins, | Draeger, MacKay-Marg, and Tono- Pen and Pheumatonometer, * based on Imbert-Fick law: * Pete (P pressure ; _f- Force ; A- area) 1, Applanation tonome pressure within the ~~ cornea with a small 2. Use? Measures 1OP 3. Other devices used to tonometer,perkins tonomeStation#07: 1. Chalazion:chronic granulomatous inflammation of 2. Treatment? (Incision and curettage) 3. Treatment of recurrence? (Systemic antibiotics esp if associated with rosacea) 4. DD? (epidermoid cyst, dermoid cyst, sebaceous adenoma) 5. Pathogenesis? (Chronic, sterile lipogranuloma of mebomian glands)yaya Suryjoos sanis vonewauo ou'wed anpa1 0} Auoyewweyul jue pue soisagjeue’sdoup aha jeo1doy‘(u orxowe)sa101q!.Ue gqueuneel “y ejuownaud dauys‘snaune YydeysgASojo132 UOWUWOD ISOW *E siygsAoo.2eq ayndy gsisouseid *Z agueyosip Assnd yym ada jo snyqued jeipawu ye ssaupas pue Burjjams — gaunBy urejdxg “T go#uUonRSStation#09; ESOTROPIA 1. Manifest Squint — Esotropia 2. Associated refractive error? the constant or int i axis of one eye from point of fixation, which is seen with 3. Complication? An uncorrected squint can lead to amblyopia (lazy eye Inferior oblique overactivity may sometimes occur \ Dissociated vertical vi (not sure about 4. How is the angle of deviation measured? 5. Age group in which it com: age Station#10: Atropine Drops 1. Class to which it belongs? anticholinergic or ant (parasympatholytic) drug.More Precisely it is te since it antagonizes the muscarine-like esters.SHIEAN que'ds‘s99)n‘ewoone,|6 @AnseUOd = }! @SNed Jey} SUO!}IPUOD JejND0R;UI Z (P ueylxowe}‘}ouuNdoye‘sojoiu “spl0s9}S‘oulZewosdioyyo = asnes yey sBnup (9 ‘oyoqeyeu‘uoneipes‘abe ‘ewnes) = 90w (gun! sks'@SPasip BEYNS JPINDO'EWNER JEINDO'JEAM SUB] JIE}UOD = 10,SEH (e uofdodAy‘uoysebuco Arewpo'eausoo Azey‘uleys |2B8UlOD = 88S [1M nof yeym (qStation# 13 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 ¢) 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 lightnear dissociation = adie’s pupil, Argyll Robertson, 3° nerve regeneration, dorsal mid brain syndromeYysiuiwip + ( 216 a\do}9X5 ‘onoignue [Bodo | ‘(jeaowas yoaus) Juawepugeg *(@ulpLinxopi “SUIPIAYOINIL} “HAQ|OAOI 188} jebuag aso Jo js0} UIPISBINO|} %Z Sa} AIANISUaS [E@UOD= }sa3 (9 I'2.1 ASH = wsiueBio (g S@}PUap) 189) Jo soueieedde |Bo1bojoudio 2) JedAnue =xy (gq Aanisues jeausoo W =sisoubelp (yb) me: 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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) whento do surgery = if more than half of ant chamber is occupied (large/total hyphaemia) uncontrolled glaucoma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 @ retinoscope to shine light into the patient's eye and observes the reflection (reflex) off the patient's retina ¢) 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#f 19- Redeyedrops:Mydriatics /cycloplegics Forexample: Atropine -It's an anti muscarinic drug.ks M receptors. It belongs to class of "Parasympatholytic Drugs" AS for dilation of pupil) {it causes the paralysis of ciliary muscle) to relieve pain for pupillary dilation “4 It |s 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 A.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 4-which kind of drugs are these? ans: Mydriatics 2-name atleast three drugs of this class? ans: tropicamide atropine cocaine,adrenaline 3-whatare indications? ans: in ant uveitis to relieve pain , penalization, to treat cilliary block glaucoma 4-Whatisthe mode of action ofthe above drugs ans: Sympathetic stimulation of the adrenergic receptors causes the contraction of the radial muscle and subsequent dilation of the pupil.-Chalazion -Where located?upper eye lid ( more common jatol ) 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 23 Aight erOO MON jevyelaahens LATING war identify : ectropion , entropion -Causes :enttropion : 1. senile age related ( due to overriding of Pretarsal part of the orbicular is muscle atrophy of tarsus ) 2: cicatritial type ( scarring of palpebral conjunctiva ; cicatrizing c trachoma , Steven jhonsons syndrome , ocular cicatritial injuries ; lacerating injury.injury ; trauma, underlying tissu | i | cicatrizing chemical injuries , | conjunctivitis > tauma ( lacerating | trachoma , Steven injuries ), medications | jhonsons , ocular causing dermatitis cicatrizing | phemphigoid Due to atony of orbicular is ocull caused by 7" nerve palsy Spastic type | Paralytic in ectropion Spasm of orbicular Is ocull in patients with chronic irritating corneal condition Due to tumor of eyelid or proptosis Due to lack of support of eyelid occurs in ; phthisis bulbi, enophthaimos , enucleated Due to developmental | Due to developmental deformitybof tarsal deformity of eyelid plate | Mechanical type Congenital type Ls ‘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.sal hinge procedure ), ( severe cases > nctival tissue by mucous membrane graft ) oculi Meucicaly reat the underlying cause respect the abnormal portion Paralytic : artificial tears , lubricati Mechanical : prosthetic eye ( Congenital : surgical repair STATION24= 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.“4 -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 )-Signs and symptoms : signs : white pupillary reflex (eucocoria ) 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, a frequent change in eye glasses or contact lenses -Causes : rubella ( most common cause of congenital cataract ) , i 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. Corticosteroid , active smoking ‘Treatment: Extra copsular cataract extraction ~>conventional extracapsular cataract extraction , mention phacoemulsification Sere rerual ‘small incision cataract surgery )Wh identify: RET Diabetic Retinopatiny Diabetic Maculopathy (whole macula focused: STATION $1