Ophthamology Revision
- 1. Using the direct ophthalmoscope… You will find a word at each of the points indicated by the boxes…
- 2. A patient standing six metres from a standard Snellen Chart can only see the top line. How is this recorded in snellen notation?
- 3. E 5 minutes of arc: 6/6 acuity 10 minutes: 6/12 20 minutes: 6/24 30 minutes: 6/36 6 metres E 50 minutes of arc: 6/60 acuity The human eye is just able to discern separate objects if the angle between them is 30 seconds of arc.
- 4. 6 12 The test distance An average eye would see this line at 12 metres
- 5. Identify these refractive errors Myopia “Short sighted” Hypermetropia “long sighted”
- 6. What abnormality does this photo show, and what is the surgical procedure called which corrects it?
- 8. What is this abnormality called, and what is the main symptom it causes?
- 9. What stain has been used, and what abnormality is shown?
- 10. What abnormality is shown here? Suggest two important differential diagnoses Suggest two useful investigations
- 11. This patient suddenly lost all useful vision in her right eye a few hours before the photo was taken. What is the diagnosis? What tests would you perform What is the commonest accompanying systemic disease? What pupil abnormality would be present?
- 13. Name three abnormalities shown here Give the diagnosis Suggest a cause
- 14. Extra-ocular muscles Medial Rectus Third nerve Sixth nerve Third nerve Third nerve Fourth nerve Third nerve Lateral rectus Superior Rectus Inferior rectus Superior Oblique Inferior Oblique Muscle: Nerve supply:
- 15. 3 5 9 2 8
- 16. Humphrey Visual Field Analyser
- 17. Identify two abnormalities, and suggest a diagnosis
- 18. What is the diagnosis here?
- 19. What’s the diagnosis here?
- 20. What is the main abnormality shown here?
- 21. And here?
- 22. Which is the abnormal eye, and what word is used to describe the visual acuity deficit?
- 24. What is this condition called?
- 26. Different patients, same underlying diagnosis…
- 27. Laser treatment
- 33. Answers • Slide 2 - 6/60 • Slide 5 – Myopia “Short sighted” (top pic) and hypermetropia “long sighted” (bottom pic) • Slide 6 - Cataract – phaco-emulsification • Slide 8 - Entropion, where eye lash folds in towards eye. Main symptom: gritty scratchy “there’s something in my eye” kind of pain
- 34. Answers • Slide 9 - Fluoracin stain showing up corneal ulcer • Slide 10 - Abnormality: swollen, blurry optic disc edge (papilloedema). Differentials: Raised intracranial pressure, malignant hypertension, idiopathic intracranial hypertension. Investigations – blood pressure, CT scan
- 35. Answers • Slide 11 - Painless sudden loss of vision = central retinal artery occlusion/thrombosis. Tests – BP, cholesterol, glucose. Patient would be a vascularpath. Pupil abnormality is relative afferent pupillary defect, as retina not able to detect light • Slide 13 – Complete ptosis, “down & out” eye, dilated pupil = 3rd nerve palsy. Possible cause = posterior communicating artery aneurysm pressing on nerve, or vascualr occlusion along the length of the 3rd nerve.
- 36. Answers • Slide 15 – 2 – right eye loss of vision – 3 – bitemporal hemianopia “tunnel vision” – 5 – right homonymous hemianopia – 8 – right homonymous hemianopia – 9 – right homonymous hemianopia with central sparing • Slide 17 – Horners, see partial ptosis, constricted pupil & decreased sweating. Causes anything along the length of the sympathetic chain, e.g. tumour, vascular origin
- 37. Answers • Slide 18 – anterior uveitis, aka iritis • Slide 19 – glaucoma (see cupping of optic disc and increased intraocular pressure) • Slide 20 – leukochoria (white reflex/white pupil). Causes = retinoblastoma, cataract • Slide 21 – strabismus (“squint”) • Slide 22 – left eye abnormal. Amblyopia • Slide 23 - hypothryroidism
- 38. Answers • Slide 24 – central retinal vein occlusion, see multiple haemorrhages • Slide 25 – internal carotid artery atheroma and consequent embolus seen on retina • Slide 26 – diagnosis = diabetic retinopathy • Slide 28 – Stevens Johnson with decreased tear production & scarring
- 39. Answers • Slide 29 – areas of depigmentation of retina • Slide 30 – RA and see deterioration of the sclera called scleromalacia perforans • Slide 31 – sturge weber syndrome • Slide 32 – inverting eye lid with cotton bud
Editor's Notes
- #7: Answer: Cataract – phaco-emulsification
- #9: Answer: Entropion, where eye lash folds in towards eye. Main symptom is a gritty scratchy “there’s something in my eye” kind of pain
- #10: Answer: Fluoracin stain showing up corneal ulcer
- #11: Abnormality: swollen, blurry optic disc edge (papilloedema) Differentials: Raised intracranial pressure, malignant hypertension, idiopathic intracranial hypertension Investigations – blood pressure, CT scan
- #12: Painless sudden loss of vision = central retinal artery occlusion/thrombosis Tests – BP, cholesterol, glucose Patient would be a vascularpath Pupil abnormality is relative afferent pupillary defect, as retina not able to detect light
- #16: 2 – right eye loss of vision 3 – bitemporal hemianopia “tunnel vision” 5 – right homonymous hemianopia 8 – right homonymous hemianopia 9 – right homonymous hemianopia with central sparing