Contents

Basic Anatomy of the Eye  1

Cornea and Sclera  4

Neuro-ophthalmology  12

Squint  23

Lens  32

Glaucoma  42

Optics and Refraction  50

om
Retina  58

l.c
ai
gm
Eyelids and Orbit  69
@
60

Conjunctiva and Community Ophthalmology  73

23
ik
hv
rit
|
w
ro
ar
M
©
©
M
ar
ro
w
|
rit
hv
ik
23
60
@
gm
ai
l.c
om
 Basic Anatomy of the Eye 1

BASIC ANATOMY OF EYE ----- Active space -----

General Features 00:01:23

Shape : Aspherical (Oblate spheroid).

Volume : 6 mL.
Location : Orbit 4 walls.
• Thinnest wall : Medial.
• Weakest wall : Floor.
- M/c orbital fracture : Blow out fracture. Tear drop sign

om
Blow out fracture

l.c
ai
gm
Orbital Anatomy :
@
60

Base
23

(Quadrangular)
ik
hv
rit
|

Lateral wall
w

Medial
ro

wall
ar

Cone of muscle
M
©

Annulus of Zinn :
• Common tendinous ring
• Origin of EOM 45˚

90˚ Apex (Conical)

Routes of local anaesthesia :

• Retrobulbar : Intraconal space
• Peribulbar : Extraconal space
(↓Complications).

Ophthalmology Revision • v4.0 • Marrow 8.0 • 2024

 2 Ophthalmology

----- Active space ----- Layers of the Eyeball 00:07:20

Outermost :
1. Cornea :
• Transparent.
• Anterior 1/6th.
• Convex (Refracts light).
2. Sclera :
• Opaque (White).
• Posterior 5/6th.
• Covered by conjunctiva.
3. Limbus :
• Corneoscleral junction.
• Contains stem cells :

om
- Specific marker : ABCG2.

l.c
- Universal marker : CD34.
ai
gm
Middle : Uvea (Vascular).
@
60

1. Iris :
23
ik

- Sphincter pupillae : Miosis (Constriction).

hv

- Dilator pupillae : Mydriasis (Dilatation).

rit
|

2. Ciliary body :
w
ro

- Pars plicata (Anterior) :

ar
M

• Ciliary projections : Secrete aqueous.

©

- Pars plana (Posterior) :

• Relatively avascular (Point of entry into fundus).
3. Choroid :
- Posteriormost.
- ↑vascularity.
Inner : Retina (Neurosensory).
• Converts sensory impulses into neural signals.

Limbus

Sclera
Iris
Seen posterior
to cornea Pupil

Ophthalmology Revision • v4.0 • Marrow 8.0 • 2024

 Basic Anatomy of the Eye 3

Cross-section of Eyeball : ----- Active space -----

Pars plana
Choroid
Sclera (Uvea)
Ciliary body (Uvea) Retina Fovea :
Pars plicata • Max. no. of cones
(Centre of visual field)
Zonules • Best image
• Foveal fixation develops
Cornea by 3-4 months.
Iris (Uvea)
Pupil Optic nerve Neuroretinal rim
(Peripheral)
Optic cup (Central)
Aqueous (Anterior
segment)
Lens

om
Central artery & vein of retina

l.c
Vitreous
ai
(Posterior segment) Optic disc
gm
(Blind spot, no photoreceptors)
@
60
23

Note : Pars plana gives the site of entry into vitreous.

ik
hv
rit
|

Limbal Pathologies :
w
ro

1. Limbal dermoid :
ar
M

- Benign, congenital tumour.

©

- Choriostomatous tissue + (Bone, cilia, hair follicles etc).

2. Pterygium :
- Limbal stem cell deficiency.
- Conjunctiva grows over cornea Limbal dermoid
(Normally, conjunctiva only covers the sclera).

Ophthalmology Revision • v4.0 • Marrow 8.0 • 2024

 4

----- Active space ----- CORNEA AND SCLERA

Anatomy Of Cornea 00:01:00

Layers Of Cornea : Anterior

(Outermost)

Can
regenerate

Thickest

om
l.c
ai
gm
Strongest
@
60
23

Can
ik

regenerate Posterior
hv

Most metabolically
rit

active (Innermost)
Layers of cornea
|
w
ro

1. Epithelium :
ar
M

• Non-keratinized stratified squamous epithelium.

©

• Layers :
- Superficial : Squamous (Microvili + Adhesion of tear film).
- Basal : Columnar (Mitosis + Regeneration).

2. Bowman’s layer :
• False basement membrane (PAS -ve).
• Acellular
(No regeneration Heals by scar formation Corneal opacity LOV).
Corneal opacities :
Pupillary margin Iris details Depth of involvement
Nebular (Faintest) Visible Visible Bowman’s & superficial stroma
Macular Visible ≤ 1/2 stroma
Not seen
Leucoma (Most opaque) Not seen Not seen ≥ 1/2 stroma
Nebular opacity : Maximum discomfort (Induces irregular astigmatism).
Leucoma : Maximum visual loss.
Ophthalmology Revision • v4.0 • Marrow 8.0 • 2024
 Cornea and Sclera 5

3. Stroma : Made of collagen (M/c Type 1) & GAGs (M/c keratan sulphate). ----- Active space -----

4. Dua’s layer : Strongest corneal layer.

5. Descemet’s Membrane (DM) :

• Previously called the strongest layer.
• Regeneration + .
• Schwalbes line : Peripheral termination of DM.

6. Endothelium :
• Metabolism + .
• Maintains corneal transparency.
No. of endothelial cells (Cells/mm2) Significance
2400-3000 Normal
<2400 Corneal compensation

om
<500 (Critical point) Corneal decompensation Edema Hazy cornea

l.c
ai
gm
Note : Counted using specular microscopy
@
60

Nerve Supply (Sensory) :

23
ik

TON : Trigeminal Ophthalmic Nasociliary

hv
rit

Test for corneal sensations :

|
w

Cotton wisp Touch cornea CN V (Afferent) Brain CN VII (Efferent)

ro
ar
M

Orbicularis oculi
©

Blink No blinking

Normal Corneal anaesthesia

(M/c cause : Herpes)

General Properties of Cornea :

Corneal shape : Convex (Converging)
Curvature ∝ Power
Corneal power : +43D to +44D
Corneal colour : Transparent (Appears black)

Ophthalmology Revision • v4.0 • Marrow 8.0 • 2024

 6 Ophthalmology

----- Active space ----- Special Investigations for the Cornea 00:15:59

1. Pachymetry :
• Measures corneal thickness (CT).
• Normal CT ~ 540 microns/0.54 mm.

2. Keratometry :
• Measures corneal curvature.
• Astigmatism : Vertical curvature ≠ Horizontal curvature.

Positioning of
keratometric
mires
Keratometer Incorrect Incorrect Correct

om
l.c
ai
3. Topography : gm
Examination of corneal surface using Placido disc.
@
60
23

4. Staining :
ik
hv

a. Fluorescein dye :
rit

• Stains areas of broken epithelium • Other uses :

|
w

(Ulcer base). - Goldmann’s applanation

ro
ar

tonometry.
M
©

Areas of - Seidel’s test (To locate site

broken
of perforation).
Viewed under epithelium
- Tear film break up test (To
Cobalt blue filter
detect dry eyes).
Orange dye used Green fluorescence

b. Rose Bengal dye :

Stains areas of necrotic tissue
(Ulcer margins)
Necrotic
tissue (Red)
c. Lissamine green dye :
• Stains both cornea + conjunctiva.
• Used in dry eyes > Corneal ulcer.
• Does not destroy normal tissue
(Non-toxic).

Ophthalmology Revision • v4.0 • Marrow 8.0 • 2024

 Cornea and Sclera 7

Corneal Ulcer 00:26:45 ----- Active space -----

Loss of epithelium + Necrosis of underlying tissue

W/o necrosis Epithelium

Abrasion. Stroma
(Regenerates)
Corneal ulcer

BACTERIAL CORNEAL ULCER

Pneumococcus/S. pneumoniae :
• M/c cause (India).
• Ulcus serpens : Snake shaped ulcer.
• Hypopyon : Mobile & sterile collection of
pus in anterior chamber. Hypopyon

om
l.c
Nocardia :
ai
gm
• Seen in traumatic cases.
@

• Wreath/pin head pattern ulcer

60
23
ik

Note :
hv
rit

Pseudomonas :
|
w

M/c cause of corneal ulcer in contact lens users. Wreath/Pin head pattern ulcer
ro
ar
M

Organisms that can penetrate intact cornea :

©

Mnemonic : High Level CNS

• Haemophilus aegyptius
• Listeria
• Corynebacterium diptheriae
• Neisseria gonorrhoeae
• Neisseria meningitidis
• Shigella
Management :
Mnemonic : 5S
1. Scrape base of ulcer using blunt edge of 15 no. blade.
2. Gram staining & culture.
3. Start fortified antibiotics.
4. Supportive therapy : Atropine Cycloplegia relieves pain.
5. Avoid steroids.

Ophthalmology Revision • v4.0 • Marrow 8.0 • 2024

 8 Ophthalmology

----- Active space ----- FUNGAL CORNEAL ULCER

• M/c cause : Aspergillus (Filamentous, septate).
• H/o : Trauma with
vegetative material.
Symptoms : Mild pain & Satellite lesion
redness.
Signs : Feathery margin
Wessley immune ring
• Dry ulcer.
• Feathery margins.
• Satellite lesions. Fungal corneal ulcer
• Wessley immune ring (Ag-Ab reaction).
• Hypopyon : Immobile & unsterile.
Treatment :

om
• DOC : 5% Natamycin eye drops.

l.c
ai
• Rest of the management is similar to bacterial corneal ulcers.
gm
@

HERPETIC KERATITIS
60
23

Disease Progression :
ik
hv
rit
|
w
ro

If If
ar
M

untreated untreated
©

Superficial punctate keratitis Dendritic ulcer Geographic ulcer

Treatment :
• 3% Acyclovir eye ointment.
• Steroids contraindicated.
Other Lesions d/t Herpes :
• Necrotising stromal keratitis
Rx : Topical steroids (Intact epithelium) + Oral acyclovir
• Disciform keratitis/endothelitis
• Metaherpetic keratitis/neutrophic ulcer : CN V atrophy/palsy Corneal anaesthesia.

Note :
1. Neuroparalytic ulcer (Not d/t herpes) : CN VII palsy Loss of blinking
(Lagophthalmos) Exposure keratitis Neuroparalytic ulcer.
2. Lagophthalmos seen in Leprosy & Bell’s palsy.

Ophthalmology Revision • v4.0 • Marrow 8.0 • 2024

 Cornea and Sclera 9

ACANTHAMOEBA KERATITIS ----- Active space -----

Contact lens users + Dirty water (Swimming/cleaning lens with tap water).

Symptoms : Severe pain d/t nerve inflammation. (Radial keratoneuritis)

Signs :
• Radial keratoneuritis. Pseudo dendrites
• Ring abscess.
• Pseudodendrites. Ring abscess

Culture :
Non-nutrient agar enriched with E.coli.
(Pseudopods seen)

Treatment :
• PHMB 0.02% (DOC)

om
l.c
• Chlorhexidine 0.1.%
Accessible
ai
gm
• Propamidine
@
60
23

Corneal Dystrophies 00:51:30

ik
hv

• B/L, non-inflammatory opacifying disorder.

rit
|

• Autosomal dominant.
w
ro
ar

Types :
M
©

Dystrophy Site Features

Cogan’s epithelial basement membrane dystrophy M/c type
Epithelial
Meesman’s epithelial dystrophy Keratin gene mutation
(Mnemonic : CML)
Lisch epithelial dystrophy Autosomal dominant > X-linked dominant
Reis Buckler’s dystrophy Fish net
Bowman layer
Schnyder central crystalline dystrophy Corneal lipid metabolism disorder
(Mnemonic : RST)
Thiel Behnke dystrophy Honeycomb pattern opacities
Lattice corneal dystrophy Amyloid deposit (Stained by Congo red)
Hyaline deposits
Granular corneal dystrophy Stromal
(Stained by Masson trichrome)
Macular corneal dystrophy Least common, Autosomal Recessive (AR)
Cornea guttata :
Fuch’s endothelial dystrophy
Wart like excrescences on posterior cornea
Endothelial
Posterior polymorphous corneal dystrophy
AR inheritance, perinatal onset
Congenital hereditary endothelial dystrophy

Ophthalmology Revision • v4.0 • Marrow 8.0 • 2024

 10 Ophthalmology

----- Active space -----

Granular corneal dystrophy

Keratoconus 00:54:45

Cone-shaped cornea.
Signs :

om
l.c
ai
gm
@
60
23
ik

1. Munson’s sign : 3. Rizzuti’s sign :

hv
rit

V-shaped lower lid Light thrown from one side refracts to form
|

an arrowhead shape facing the opposite side.

w
ro
ar

2. Irregular astigmatism (Myopic).

M

Note :
©

3. Vogt’s striae (D/t stretching of cornea).

Kayser fleischer ring : D/t Cu
4. Fleischer’s ring : D/t iron deposition.
deposition in Wilson’s disease.
5. Oil droplet reflex : On ophthalmoscopy.
6. Scissoring reflex : On retinoscopy.
Investigation :
Topography (10C).

Treatment :
• INTACS’s surgery : Intracorneal stromal ring
segments.
• Rigid contact lens.
• Keratoplasty : Corneal transplantation (Cadaveric
donor). INTACS Sx :
• Corneal collagen cross linking with riboflavin & UVA Ring stretches the cornea
radiation
(C3R) : Best initial treatment.
Ophthalmology Revision • v4.0 • Marrow 8.0 • 2024
 Cornea and Sclera 11

Note : ----- Active space -----

Band shaped Keratopathy

Band shaped Ca2+ deposition

in Bowman’s layer

Treatment : Chelation with EDTA.

Sclera 00:59:45

Episcleritis vs. Scleritis :

Episcleritis Scleritis
Inflammation of Superficial vessels Deep vessels

om
Hue Reddish Bluish/violaceous

l.c
ai
Pain Mild gm Deep seated, chronic
Response to phenylephrine Redness disappears Redness persists
@
60

(Vasoconstrictor) (Blanching) (No blanching)

23
ik
hv
rit
|
w
ro
ar
M
©

Before After
Episcleritis : Phenylephrine test

Nodular episcleritis Scleritis (Longstanding)

Bluish discoloration
Note :
Scleromalacia perforans :
• Anterior necrotising scleritis without inflammation.
• No redness/pain Progressive atrophy Scleral perforation.
• M/c in women with rheumatoid arthritis.

Ophthalmology Revision • v4.0 • Marrow 8.0 • 2024

 12

----- Active space ----- NEURO - OPHTHALMOLOGY

Visual Pathway 00:01:29

Retina :
• Covers posterior part of eye till ora serrata.
• Deficient anteriorly.
Left Right

Nasal (N)
visual field

om
Temporal Temporal (T) Nasal visual field → Temporal fibers

l.c
visual visual field Temporal visual field → Nasal fibers

ai
field
gm
@
60

Temporal
23

Temporal
fibers
ik

fibers Nasal
hv

1 fibers Optic nerve (ON) I/L Temporal + I/L Nasal fibers

rit

3 2 Crossing over of nasal fibers : Contains

Optic chiasm (OC)
|

4 4 B/L nasal fibers

w

5
ro

Optic tract (OT)

ar

8
M
©

Lateral geniculate
6 body (LGB)
Relay centre I/L Temporal & C/L Nasal fibers
9
Superior fibres 7
Inferior fibres Optic radiations
(OR)

Visual cortex (VC)

10

Note : FOF
Field loss is opposite to loss of fibres. (Temporal fibres injured Nasal field lost.)

Ophthalmology Revision • v4.0 • Marrow 8.0 • 2024

 Neuro - Ophthalmology 13

Visual Field Defects 00:07:10 ----- Active space -----

Left sided lesions are described below :

Fibres affected Visual field defects (VFD)

T N N T
L R

1. Optic nerve : I/L temporal + 1/L nasal

I/L anopia (Blindness)

2. Optic chiasma : B/L nasal T N

L N T R
Anterior
communicating
Artery(ACA)

om
Optic chiasm

l.c
under ACA Bitemporal/Heteronymous

ai
gm Hemianopia
@

3. Junction of ON & OC (Proximal ON) :

60
23

Anterior knee of von Willebrand

ik
hv
rit

L R
|
w
ro
ar

L T N N T R
M
©

Junctional scotoma
T : Temporal
SN : Superonasal
IN : Inferonasal
M/c cause : Meningioma

L T N N T R
4. Lateral optic chiasma :
- B/L temporal (Always B/L)
- Very rare
Binasal hemianopia

Ophthalmology Revision • v4.0 • Marrow 8.0 • 2024

 14 Ophthalmology

----- Active space ----- Fibres affected Visual field defects

T N N T
5. OT L R
6. LGB I/L temporal
7. OR +
10. VC (Rare) C/L nasal
C/L homonymous hemianopia
L R
8. Inferior OR : Meyer’s loop
Inferior I/L temporal + C/L nasal
T N N T

P C/L homonymous
F 9 superior quadrantanopia,
LGB AKA “Pie in the sky.”
Mnemonic : TIPS
VC

om
(Temporal inferior pie in the sky)
T 8

l.c
L R

ai
gm T N N T
9. Superior OR : Baum’s loop
@

Superior I/L temporal + C/L nasal

60
23
ik

F : Frontal lobe T : Temporal lobe C/L homonymous Inferior

hv

P : Parietal cortex VC : Visual cortex

rit

quadrantanopia,
|

AKA “Pie on the floor.”

w
ro

10. Occipital lobe lesion :

ar

a. Tip of cortex lesion : Macular representation L R

M

T N N T
©

I/L temporal + C/L nasal

Middle cerebral artery

C/L homonymous
macular defect

T N N T
L R

Posterior cerebral artery

b. Visual cortex except tip :

I/L temporal + C/L nasal except C/L homonymous hemianopia
macular representation with macular sparing.

Ophthalmology Revision • v4.0 • Marrow 8.0 • 2024

 Neuro - Ophthalmology 15

Causes for bitemporal hemianopia : 3PC & AC ----- Active space -----
1. 3rd ventricular CSF blockage Ventricular dilatation O ptic chiasma
glioma compression.
2. Pituitary macroadenoma (>10 mm/1 cm).
3. Craniopharyngioma.
4. Anterior communicating artery aneurysm.
5. Caverous sinus thrombosis.

Difference b/w lesions at 5, 6, and 7 :

OT Lesion LGB Lesion OR Lesion
(5) (6) (7)
Abnormal :
Pupil Normal Normal
Wernicke’s pupil
Absent

om
Optic
Present bilaterally Present (Optic radiations are

l.c
atrophy
ai
gm post ganglionic : 4th order)
@

Congruity Incongruous Incongruous Congruous

60
23
ik

Pupillary Reflex 
hv

00:34:04
rit
|

Pupillary Light Reflex :

w
ro

Light Pupil Constrict/dilate

ar
M

Types : Direct and consensual.

©

Light stimulus

Direct light reflex Consensual light reflex

Ophthalmology Revision • v4.0 • Marrow 8.0 • 2024

 16 Ophthalmology

----- Active space ----- Pupillary Pathway :

Efferent (B/L) Afferent (I/L)
I/L direct PLR

C/L consensual Pupils

PLR
7. B/L sphincter pupillae Light on one eye
constriction (Stimulus)

(L) (R)
B/L short
ciliary nerve
1. Optic nerve
6. B/L ciliary
ganglion

om
5. B/L CN III

l.c
2. Optic tract
(Inferior fibres of
ai
gm
inferior oblique Pupillomotor fibres exit from optic
@

muscle) tract before reaching LGB

60
23
ik
hv
rit

4. B/L EWN (Accessory

|
w

nucleus for CN III)

ro
ar
M

Note :
©

• ON, OC, OT are common to both

PLR pathway & visual pathway.
Internuncial neuron (IN) 3. Centre of light reflex : • EWN : Edinger-Westphal Nucleus.
Responsible for Pretectal nucleus
Consensual light reflex

Lesions of Pupillary Light Reflex  00:39:14

Afferent pathway lesions Efferent pathway lesion :

• AAPD : Absolute/total Afferent • ARP : Argyll Robertson Pupil

Pathway Defect • Tonic pupil
On lesion.
• RAPD : Relative Afferent Pathway • Pharmacological mydriasis
Defect/Marcus Gunn pupil
• Wernicke’s pupil OT lesion.
Ophthalmology Revision • v4.0 • Marrow 8.0 • 2024
 Neuro - Ophthalmology 17

Afferent Pathway Lesions : ----- Active space -----

AAPD RAPD

Light stimulus on
Light stimulus on N eye :
B/L pupils constrict
N eye :
B/L pupils constrict

Findings Light stimulus on

Light stimulus on lesion lesion side :
side : B/L pupils dilate
B/L pupils do not constrict

Swinging flashlight test Partial on lesion

om
Paradoxical dilatation Nerve fatigue

l.c
of pupils

ai
gm
Pupils size Isocoria : Both pupils equal in size
@
60

Efferent Pathway Lesion :

23

ARP : Mnemonic ARP-PRA

ik
hv

• Accommodation Reflex Present Pupillary Reflex Absent.

rit
|

• Cause : Neurosyphilis.
w
ro
ar

Tonic/Adie’s Pupil Pharmacological Mydriasis

M

Cause Lesion at ciliary ganglion/short ciliary nerve Drugs : Atropine

©

Eg : Lesion/mydriatic application at right eye

Light on normal side

Light reflex
I/L pupil does not constrict
(AKA tonic pupil)
Light on lesion side

Pupil size Anisocoria : Both pupils unequal in size

Ophthalmology Revision • v4.0 • Marrow 8.0 • 2024

 18 Ophthalmology

----- Active space -----

Tonic/Adie’s Pupil Pharmacological Mydriasis
Absent
MOA : Cycloplegic action
Accommodation
Normal
reflex Relaxation of cilliary muslce

Loss of accomodation.
Constricts d/t denervation hypersensitivity
MOA : Sphincter pupillae denervated
Diluted
Does not constrict
Pilocarpine
Over-expression of receptors (Even with 1% pilocarpine)
(0.125%)

Hyperreactive to stimuli.

om
Muscles of Iris 00:51:36

l.c
ai
gm
Sphincter pupillae Dilator pupillae
@

Function Miosis (constriction of pupil) Mydriasis (dilatation of pupil)

60
23

Autonomic Parasympathetic control

ik
hv

Nerve Supply (Inhibitory) Sympathetic control

rit

via (Excitatory)
|

Via
w
ro

Oculomotor nerve (CN III) Hypothalamus

ar

1˚neuron
M
©

Ciliospinal bulge (C8-T1)

Crosses over
Inferior branch 2˚ neuron Lesion at any
lung parenchyma
(To inferior oblique muscle) point
Superior cervical ganglion
Through cavernous
sinus Oculosympathetic
Short ciliary nerve Long ciliary nerve palsy.
Final nerve
(Post ganglion)
supply

Ophthalmology Revision • v4.0 • Marrow 8.0 • 2024

 Neuro - Ophthalmology 19

Course and Lesions of Sympathetic Supply to the Iris : ----- Active space -----

Ophthalmic division of
trigeminal nerve
Hypothalamus
Long ciliary nerve

To sweat glands of forehead

Internal carotid artery
To smooth muscle of eyelid
To pupil

To sweat glands of face

First order
neuron (Central) C2 Third order neuron Ascends to cavernous sinus and
Hypothalamus to (Post ganglionic) supply pupillae via long ciliary nerve
ciliospinal bulge (C2-T1) Superior cervical Causes :

om
Causes : ganglion • Cluster headache

l.c
• Brain stem lesions T1 • Internal carotid artery dissection
ai
(Tumor, etc)
gm • Otitis media
Second order neuron • Cavernous sinus mass
@

• Syringomyelia
60

• Diabetic autonomic (Pre ganglionic)

23

neuropathy Ciliospinal bulge to superior

ik

Spinal cord
hv

• Wallenberg syndrome cervical ganglion in neck

rit
|

Causes :
w

• Pancoast tumor
ro
ar

• Carotid and aortic aneurysm

M

• Neck lesions
©

Horner’s Syndrome/Oculosympathetic Palsy 00:53:41

Paralysis of sympathetic pathway of dilator pupillae.

Clinical features : (Mnemonic : HIMAPLE)

• Heterochromia iridis : Hypochromic affected eye (Only in congenital cases).
• Inferior eyelid elevation.
• Miosis : Paralysis of dilator pupillae Unopposed sphincter pupillae.
• Anhydrosis : I/L absence of sweating.
• Ptosis : Drooping of upper eyelid d/t Muller’s muscle paralysis.
• Loss of ciliospinal reflex.
• Enophthalmos (Sunken eyes).

Ophthalmology Revision • v4.0 • Marrow 8.0 • 2024

 20 Ophthalmology

----- Active space ----- Diagnosis :

1. Identification of Horner’s syndrome

4% cocaine test 1% apraclonidine test

Blocks NE reuptake Pupil dilates

d/t denervation hypersensitivity of
α1 receptor
Pupil dilate Pupil does not dilate
(↑NE in postsynaptic cleft) (No NE in postsynaptic cleft)

Normal pupil. Horner’s syndrome

2. Localisation

1 % amphetamine test

om
Pupil dilates Pupil does not dilate

l.c
ai
gm Post ganglionic lesion.
Pre ganglionic lesion.
@
60

Optic Atrophy 00:59:33

23
ik
hv
rit
|

Primary ( 1o ) Secondary (2o) Consecutive

w
ro

Optic atrophy without antecedent Optic atrophy after optic disc Optic atrophy due to disease of
ar

Definition
optic disc swelling swelling inner retina and its blood supply
M
©

Disc Chalky white, well defined Dirty gray-white,

Waxy pallor of disc
appearance margins ill-defined margins

Optic cup -

Chalky white Ill defined margins of OD

• Optic neuritis Retinal diseases :

• Tumors • Retinitis seen
• Trauma • Papilledema • CRAO/CRVO
Causes
• Hereditary : LEBER’s disease • Papillitis • Healed vasculitis
(Mitochondrial inheritance) • Panretinal photocoagulation
• Toxic : Ethambutol • Retinitis pigmentosa

Ophthalmology Revision • v4.0 • Marrow 8.0 • 2024

 Neuro - Ophthalmology 21

Optic Neuritis 01:02:50 ----- Active space -----

Inflammation of optic nerve.

Cause : Multiple Sclerosis (M/c).
Clinical features :
Mnemonic : 2 CUP mar.
• Central scotoma. • Pulfrich sign : Tachtokinetic dissociation.
• Color blindness of red & green. • Pain in eye on ocular movements.
• U/L loss of vision. • Marcus Gunn pupil (RAPD).
• Uhthoff sign : Worsening of symptoms on ↑body temperature (Eg : Exercise).

Treatment :
• Steroids : Anti-inflammatory for Rx of multiple sclerosis IV f/b oral.
• Interferons
Papilledema

om
01:04:52

l.c
Signs :
ai
gm
• Blurring of disc margins : Earliest.
@
60

• Normal vision.
23

• Amaurosis fugax : Transient loss of vision.

ik
hv

↑ICP
rit

Edematous OD :
|
w

D/t ↑ICP
ro

Temporary block in conduction of impulses

ar
M
©

Transient blindness
• Visual field defects : Enlargement of blind spot.
• Paton’s lines : Retinochoroidal folds around OD d/t
fluid accumulation.
Treatment : Control ICP. Paton’s lines

Myelinated Nerve Fibres :

• Myelination of OD & nerve fibres of retina.
• No loss of vision.
• Myelination : ↑Speed of conduction.
Myelinated nerve fibres

Colour Blindness 01:09:10

1° colors :
• Red : Prota. • Green : Deutra. • Blue : Trita.

Ophthalmology Revision • v4.0 • Marrow 8.0 • 2024

 22 Ophthalmology

----- Active space ----- Etiology :

a. Acquired : b. Congenital :
Colors affected Etiology X-linked recessive (M > F)
• Retinal diseases :
- CSR Females are carriers.
Blue-yellow
- Macular edema
• Primary Open Angle Glaucoma (POAG)
Optic nerve lesions :
Red-green • Optic neuritis
• LHON
Blue Old age
Types :
Dyschromatopsia (Defective) Achromatopsia (Absent)
Dichromatic Trichromatic anomalous Rod monochromat Cone monochromat

om
• Perception of 2 Only rod + One type of
• Perception of all 3 colors + cone +

l.c
colors

ai
Features • Perception is defective
• Blindness for 1 gm Total color blind
(Anomalous)
color (Anopia)
@

(Black & white vision) 1 cone perception

60

• Protanopia • Protanomaly
23

Clinical Hemaralopia
ik

• Deuteranopia • Deuteranomaly -
hv

conditions (Day blindness)

• Tritanopia • Tritanomaly
rit
|

Tests :
w
ro

Ishihara chart Hardy Rand Ritter

ar
M
©

Chart

Numbers
Shapes

• M/c used
Features Used to test pediatric age group
• Disadv. : Cannot detect tritan defects

Farnsworth Munsell 100 hue test Farnsworth Munsell 15 hue test

Chart

Features Most sensitive Differentiates between congenital & acquired

Ophthalmology Revision • v4.0 • Marrow 8.0 • 2024

 Squint 23

SQUINT ----- Active space -----

Extraocular Muscles (EOM) 00:01:45

6 EOMs act on eyeball & I EOM acts on eyelid (Levator palpabrae superioris).

Muscles Acting on the Eyeball :

Action only in I˚ gaze :
• Medial Rectus (MR) : Adduction.
• Lateral Rectus (LR) : Abduction.

Action in 1˚, 2˚ & 3˚ gaze : (Cyclical action)

om
Actions

l.c
Muscle

ai
1˚ (Predominates in abduction) 2˚ (Predominates in adduction)
gm 3˚
Superior Rectus (SR) Elevation Intorsion
@

Adduction
60

Inferior Rectus (IR) Depression Extorsion

23

Superior Oblique (SO) Intorsion Depression

ik
hv

Abduction
Inferior Oblique (IO) Extorsion Elevation
rit
|
w
ro

Nerve supply :
ar
M

• LR6 : Lateral rectus supplied by Abducent N. (CN 6)

©

• SO4 : Superior oblique is supplied by Trochlear N. (CN 4)

• Others : CN 3
Elevation

Adduction Abduction
Intorsion Extorsion

Depression
Anatomical action of EOM Clinical action of EOM

Note : Superior oblique function can be confirmed by asking the pt. to look at the
tip of their nose.

Ophthalmology Revision • v4.0 • Marrow 8.0 • 2024

 24 Ophthalmology

----- Active space ----- Terminology related to EOM :

Terminology Action of the muscles Examples
Antagonist Opposite action is same eye Rt. LR & Rt. MR
Agonists Same action in same eye Rt. SR & Rt. IO
Yoke muscles/ One muscle from each eye; helps to look in
Rt. MR & Lt. LR
Contralateral synergists the same direction. (Version movement)

1˚ gaze
2˚ gaze
3˚ gaze

om
l.c
ai
gm
@
60

Yoke muscles in different gazes

23

Mechanisms of binocular vision :

ik
hv

• Hering’s law : Equal innervation to yoke muscles.

rit
|

• Sherrington’s law : Reciprocal inhibition to antagonist (Relaxes).

w
ro

• A defect in these mechanisms lead to squint.

ar
M
©

Types Of Squint 00:14:03

Pseudo strabismus True strabismus

Appears deviated,
but no squint present. Tropia Phoria
(Manifest squint) • Latent squint
• Only manifests
Comitant Incomitant when under stress.
(Constant deviation) (Variable deviation)
• 1˚ < 2˚ deviation

Paralytic (FDT-ve) Restrictive (FDT +ve)

• CN palsy • Spasm of EOM
Forced Duction Test (FDT) is diagnostic only for restrictive squint.
Ophthalmology Revision • v4.0 • Marrow 8.0 • 2024
 Squint 25

Directions of deviation : ----- Active space -----

All deviations of the right eye in below examples.
1. Esotropia 2. Exotropia

Inward deviation Outward deviation

3. Hypertropia 4. Hypotropia

Upward/Hyperdeviation Downward/Hypodeviation

om
5. Incyclotropia 6. Excyclotropia

l.c
ai
gm
@
60
23
ik

Inward rotation Outward rotation

hv
rit

Note :
|
w

Incyclotropia and excyclotropia are clinically not visible. Dx : Double Maddox rod
ro
ar

test.
M
©

Investigations 00:19:06

1. Ocular movement examination : In all directions of gaze.

2. Calculate refractory error : To rule out hypermetropia (Esotropia seen in Hypermetropia).
3. Measure fusional vergence :
• Extra power needed to prevent Esophoria.
• Dx : RAF ruler.
4. Measure ocular deviation :
a. Hirschberg’s test. c. Maddox rod.
b. Cover-Uncover test. d. PBCT (Prism Bar Cover Test).
5. Measurement of diplopia :
e. Hess chart (M/c) f. Lee’s screen.
6. Tests for sensory anomalies :
g. Worth 4 dot test (M/c). h. Bagolini striated glass.
Ophthalmology Revision • v4.0 • Marrow 8.0 • 2024
 26 Ophthalmology

----- Active space ----- MEASUREMENT OF OCULAR DEVIATION

1. Hirschberg’s Test :
Interpretation :
a. Direction of deviation b. Degree of deviation :

1. Normal : 0˚
Reflection 2. At pupillary margin : 15˚
Reflection nasal at centre
to centre 1 2 3 4 4. At limbus : 45˚
3. B/w 2 & 4 : 30˚
DOOR : Deviation
Opposite Of Reflection Position of corneal reflection
Note :
Temporal deviation. • 1 prism dioptre = 0.5 degree.
(AKA : Exotropia) • 1 mm deviation = 7˚ of squint.

om
l.c
ai
gm
2. Cover & Uncover Test :
@

• Cover test Tropia.

60
23

• Uncover test Phoria.

ik
hv

Doom : Deviation Opposite Of Movement.

rit
|

a. Cover test : b. Uncover test:

w
ro
ar
M
©

At presentation :
At presentation :

Normal eye covered : On covering RE :

LE moves inwards to Normal eye does
compensate. not move.

RE Exophoria

Moves inward, hence

deviation is outward
Normal eye uncovered :
LE returns to its original position. RE returns to initial position on uncovering

Ophthalmology Revision • v4.0 • Marrow 8.0 • 2024

 Squint 27

3. Maddox Rod Test : ----- Active space -----

Uses :
• Diagnose phoria at far fixation.
• Macular function test.
• Cyclotropia measurement with double
maddox rod test. Maddox rod test

4. Prism Bar Cover Test :

• Most accurate test to measure degree of tropia.
• Base of prism : Placed opposite to direction of deviation.

MEASUREMENT OF DIPLOPIA Prism bar

5. Hess Chart :

om
l.c
Concave lines
ai
gm Note :
Amsler’s grid has straight lines,
@
60

not concave.
23
ik
hv
rit
|
w

6. Worth 4 Dot Test :

ro
ar

Equipment :
M

4 dots :
©

• I Red Over LE Over RE

• 2 Green
• I white

Interpretation :

Normal binoular single vision : Non-hormonious RE suppression LE suppression

Harmonious ARC ARC (Diplopia)

Note : ARC Anomalous Retinal Correspondence.

Ophthalmology Revision • v4.0 • Marrow 8.0 • 2024

 28 Ophthalmology

----- Active space ----- Paralytic Squint 00:35:49

• C/f : Opposite direction

To action of paralysed EOM
• Head tilt : Same direction
Muscles Action Palsy Other C/F Mx
LPS Elevation of lid Ptosis
SR, IO Elevation Hypotropia Wait and watch.
3rd CN (CN III regenerates
MR Adduction Exotropia Crossed diplopia
Palsy as it is covered by
Sphincter pupillae Miosis Mydriasis neurilemma)
Ciliary muscle Accomodation Loss of accomodation
Intorsion (1˚) Encyclotropia
4th CN Depression (2˚) Hypertropia • Chin depression. Confirmation of Dx :
Superior oblique
Palsy Depression in ↑Hypertropia on • C/L Head tilt. Park’s 3 step test.
adduction adduction/opposite gaze

om
6 CN
th
• Uncrossed diplopia.
Lateral rectus Abduction Esotropia -

l.c
Palsy • I/L face turn.

ai
gm
@

3rd nerve palsy :

60
23
ik
hv
rit
|

Down & Ptosis

w
ro

out pupil
ar
M
©

4th nerve palsy : Park’s 3-step test.

RE LE

LE hypertropia

↑↑Hypertropia
(Worse on opposile gazes)

Right gaze Left gaze

Improved hypertropia
(Better on opposite tilt)

Right tilt Left tilt

Ophthalmology Revision • v4.0 • Marrow 8.0 • 2024

 Squint 29

6th nerve palsy : ----- Active space -----

RE LE
Normal Absent LE
right gaze abduction
LE esotropia Right gaze Left gaze

Horizontal Gaze (Left Eye) 00:46:18

C/L gaze palsy Right Left Left horizontal gaze :

X
1. Initiation C/L FEF • LE : LR
• RE : MR

MR LR
Afferent
Efferent

om
l.c
ai
gm
3rd
@
60
23
ik
hv
rit

Internuclear
|

X
w

ophthalmoplegia : 3. C/L MLF

ro

2. I/L PPRF Centre

C/L gaze defect
ar

X
M

I/L gaze palsy

©

PPRF : Parapontine Reticular Formation

MLF : Medial Longitudinal Fasciculus
FEF : Frontal Eye Field 6th Nucleus
Pathway of left gaze

RE LE RE LE

Normal 1˚ gaze Normal 1˚ gaze

Normal right gaze Normal right gaze

I/L adduction -

C/L abduction +
Left gaze palsy : Left gaze defect :
Lt. PPRF/Rt. FEF lesions Rt. MLF lesion

Ophthalmology Revision • v4.0 • Marrow 8.0 • 2024

 30 Ophthalmology

----- Active space ----- Restrictive Squint 00:52:30

Duane’s retraction syndrome :

Limitation of movements Palpebral fissure closure (+) Retraction of globe
Type 1 Abduction Adduction
Type 2 Adduction
Type 3 Abduction + adduction
Dx : Forced duction test.

Concomitant Squint  00:53:49

Esotropia/Crossed-eyes :
M/c presentation of concomitant squint.
1. Accomodative : (Role of accomodation + )

om
Refractive Non-refractive

l.c
ai
Hypermetropia D/t high accomodative
Cause gm
(SO HYPER) convergence/accomodation ratio
@
60

Esotropia Distant > Near Near > Distant

23

Bifocal spectacles
ik

Rx Convex spectacles
hv

Miotics : Echothiophate
rit

2. Non-accomodative : (Role of accomodation - )

|
w
ro

• AKA essential infantile esotropia.

ar

• 4-6 months of age.

M
©

• MoA : Large angle squint (>15˚) 2 eyes focus on different objects

Suppression of deviated eye

Amblyopia (Lazy eye) of deviated eye :

Loss of vision without organic cause.
• No treatment.
• Prevention : Occlusion therapy (Until 6 yrs of age)

Patch normal eye for ‘X’ days

(X = Age of child)
F/b
Patch deviated eye for I day.

Ophthalmology Revision • v4.0 • Marrow 8.0 • 2024

 Squint 31

Myasthenia Gravis  01:00:07 ----- Active space -----

Defective function of EOM.

Clinical Features :
• Ptosis :
- B/L
- Worsens as day progresses (D/t ↓ ACh Fatigue)
• Diplopia
• Cogan lid twitch sign : Upper eyelid shoots up on switching from downward
gaze to upward gaze.

Diagnosis :
Tensilon test : Definitive test.

om
l.c
ai
gm
Inj Edrophonium
@
60
23

Rt. Ptosis Improvement of ptosis

ik
hv
rit
|
w
ro
ar
M
©

Ophthalmology Revision • v4.0 • Marrow 8.0 • 2024

 32

----- Active space ----- LENS

Lens Anatomy & Classification of Cataract  00:01:19

Anatomy :

om
l.c
ai
gm
@

Oldest lens fibres

60
23
ik
hv
rit
|
w
ro
ar
M

Shape : Biconvex. Layers :

©

Power : + 16D to + 19D. • Capsule

Superficial
Colour : Transparent. • Anterior epithelium
to
Embryological development : Starts on Day 27. • Cortex
Deep
• Nucleus
Lens Proteins :
Proteins

Water soluble (80%) Water insoluble (20%)

a Crystallins b Crystallins g Crystallins Urea soluble Urea insoluble

• Largest crystallins Major portion (55%) Cytoskeletal proteins MIP 26/Aquaporin 0

(600 kDa)
• Found in lens epithelium Vimentin Filensin Phakinin Maintains
• Heat shock proteins transparency of lens
Beaded filament

Disruption leads to cataract formation

Ophthalmology Revision • v4.0 • Marrow 8.0 • 2024
 Lens 33

Lens Metabolism : ----- Active space -----

• Lens is avascular.
• Diffusion of glucose occurs via Aqueous (90%); Vitreous (10%).

Metabolic Pathways :
• Anaerobic glycolysis (>80%).
• Kreb’s cycle & HMP shunt (~ 15%). Polyol
• Sorbitol pathway (<5%) : Glucose Aldose Sorbitol Fructose.
Reductase dehydrogenase
Accumulate in lens
- Normally inactive.
Cataract
- Activated by hyperglycemia (DM & galactosemia).
Cataract :
• Gradual & painless loss of vision.
• M/c cause of blindness in India.

om
l.c
Classification :
ai
gm
@

Acquired Congenital
60
23

Metabolic Infantile
ik

Traumatic
hv

Developmental
rit

Complicated
|
w

Senile/age related
ro
ar

Metabolic Cataract
M

00:11:37
©

1. Parathyroid tetany :
Children : Lamellar cataract.
Hypocalcemia
Adults : Anterior & posterior subcapsular cataract.
Snowflake cataract
2. Snowflake cataract :
DM (Type 1 > Type 2) Carbamylation of crystallins Cortical cataract.

3. Oil droplet cataract :

• Galactosemia Accumulation of metabolite & substrate  Posterior
subcapsular cataract.
• Only reversible cataract. Oil droplet cataract

4. Sunflower cataract : D/t Wilson’s disease.

5. Christmas tree cataract :

Myotonic dystrophy Posterior subcapsular cataract.
Christmas tree cataract Sunflower cataract
Ophthalmology Revision • v4.0 • Marrow 8.0 • 2024
 34 Ophthalmology

Note :
----- Active space -----
1. Kayser Fleischer ring : A/w Wilson’s disease
- Golden-brown Cu2+ deposition in the Descemet’s membrane near the limbus.
- Progression : Superior Inferior Lateral Circumferential.
- All cases with neurological manifestation and 50% cases with only hepatic
manifestation.
2. Fleischer’s ring : A/w keratoconus.
Kayser Fleischer ring 3. Pseudo-fleischer’s ring : A/w hypermetropia.

Traumatic Cataract 00:18:38

Noxious stimulus Effect Cataract

IR rays True exfoliation of lens capsule Glassblower’s cataract
Lightning/Electric shock Anterior capsular opacities Unnamed

om
BLUNT TRAUMA

l.c
Contusion injury Posterior subcapsular cataract.
ai
gm
(Tennis ball/Fist injury) (Rosette shaped cataract)
@
60
23

Signs :
ik
hv

1. Hyphema (M/c) : Rosette shaped cataract

rit
|

Bleeding from major arterial circle of iris Collection of blood in Anterior

w
ro

Chamber (AC).
ar
M

2. Iris signs :
©

• Iridodonesis : Trembling iris.

• Iridodialysis : Detachment of root of iris from
ciliary body.
- D shaped pupil.
Iridodialysis Hyphema
- Diplopia d/t 2nd pupil.
3. Lens signs :
• Phacodonesis : Trembling lens.
• Rosette shaped cataract.
• Vossius ring : Ring of pigment (D/t
pupil striking the lens).
Vossius ring Ectopia Lentis
• Ectopia lentis : Subluxation of lens.
4. Fundus/retinal signs :
• Cherry red spot at macula : Fluid accumulation in all of retina except macula in
trauma (Berlin’s edema).

Ophthalmology Revision • v4.0 • Marrow 8.0 • 2024

 Lens 35

• Retinal Detachment (RD) : M/c rhegmatogenous RD. ----- Active space -----
• Commotio retinae : Pale fundus.
• Traumatic optic neuropathy : Causes 1° optic atrophy.
• Vitreous hemorrhage : M/c cause in young adults.
5. 2° open angle glaucoma:
• Angle recession glaucoma. • Ghost cell glaucoma.
Note :
Cherry red spot at macula
Mnemonic : Cherry Trees Never Grow Tall in Sand, Mud & Grime
• Central retinal artery occlusion (CRAO)
• Trauma (Blunt)
• Niemann-Pick disease
• GM1 gangliosidoses
• Tay-Sachs disease

om
• Sandhoff’s disease

l.c
• Metachromatic leukodystrophy

ai
• Multiple sulfatase deficiency gm
• Gaucher’s disease (Type 2 only) : Least common
@
60
23

Blunt Trauma to Orbit :

ik
hv
rit
|
w
ro
ar
M

Tear drop sign

©

Blowout fracture
Complicated Cataract 00:30:15

Causes : mnemonic UMAR.

• Uveitis (m/c). • Angle closure glaucoma.
• Myopia. • Retinitis pigmentosa.
Appearance : Breadcrumb + Polychromatic lustre.
Site : Posterior subcapsular cataract.

Senile Cataract 00:31:50

Age group : 50-70 years.

Types (Based on location) :
a. Nuclear c. Posterior subcapsular
b. Cortical d. Anterior subcapsular
Ophthalmology Revision • v4.0 • Marrow 8.0 • 2024
 36 Ophthalmology

----- Active space ----- Nuclear Cataract :

Opacified nucleus
Nucleus
Cataract +

Transparent lens N Nuclear cataract

Slit lamp oblique illumination
Pathogenesis : Sclerosis of lens ↑Refractive index.

Clinical Features :
• Induced myopia (Near-sightedness).
• Second sight phenomenon : Improved near vision.
• LOV : Day > Night (D/t central location; Pupil dilates in low light).

om
• Xanthopsia : Yellow colored vision d/t discolored lens.

l.c
ai
gm
Cortical Cataract :
@
60

Pathogenesis :
23
ik
hv

Hydration of lens
rit
|
w

Formation of water clefts & vacuoles

ro
ar

(Earliest change)
M

Intumescent cataract
©

Coalescence Cuneiform cataract M/c complication :

Separation of lens fibers M/c inferonasally Phacomorphic glaucoma
(2° AC glaucoma)
(Lamellar separation)

Wedge-shaped opacities
Liquified cortex
(Cuneiform cataract) Sunken Nucleus
Persistent hydration
Swollen lens
(Intumescent cataract)
Morgagnian/Hypermature cataract Argentinian flag sign
M/c complication : d/t puncturing of
Cortex liquefied. Phacolytic glaucoma swollen lens during CCC
(Morgagnian cataract) (2° OA glaucoma)

Ophthalmology Revision • v4.0 • Marrow 8.0 • 2024

 Lens 37

Posterior Subcapsular Cataract : ----- Active space -----

Causes : Mnemonic MNC Repay GST.
• Myotonic dystrophy • Galactosemia
• Neurofibromatosis • Steroids (Systemic)
• Complicated cataract • Trauma (Blunt)
• X-Rays

Clinical Features :
• Glare Difficulty in driving at night (M/c).
• Max. LOV (Near > Far; Day > Night).

Note : Topical steroids Glaucoma.

Anterior Subcapsular Cataract :
Rarest type.

om
Causes : AACG

l.c
• Amiodarone • Chlorpromazine
ai
gm
• Atopic dermatitis • Gold deposits
@
60
23

Surgical Management of Cataract 00:44:45

ik
hv
rit

Surgical Methods:
|

• ICCE : whole lens removed (No longer used).

w
ro

• ECCE : Lens removed, capsule retained.

ar
M
©

Techniques of ECCE :
Site of Incision Size of Incision
1. Conventional ECCE Limbus 8–10 mm
2. Small Incision Cataract Surgery (SICS) Sclera (Sclera-corneal tunnel) 5–7 mm
3. Phacoemulsification Clear corneal 2.2–3.2 mm

4. FLACS (Femtosecond Laser Assisted Cataract Surgery) :

• Latest technique.
• Femtosecond :
10-15 sec. CCC
Nuclear Laser
fragmentation used for
2 steps

Nd : Glass Laser
Principle Photodisruption
Ophthalmology Revision • v4.0 • Marrow 8.0 • 2024
 38 Ophthalmology

----- Active space ----- Phacoemulsification :

Principle :
Piezoelectric crystal at tip of phacotopeConverts Ultrasonic energy to Mechanical
energy (To & fro motion).
Steps:

1. Side port incision 2. Staining the capsule + CCC 3. Main incision

Using MVR/15° blade Dye : Trypan blue

6. Irrigation & aspiration

7. IOL implantation

om
l.c
ai
gm
@
60

4. Hydrodissection 5. Nuclear fragmentation

23

Separation of cortex & capsule

ik
hv

Note : CCC Continuous Curvilinear Capsulorhexis.

rit
|
w

Intra-ocular lens (IOL) :

ro
ar

Types of IOL :
M
©

C shaped haptic

Optic

S shaped haptic

PCIOL ACIOL
(Posterior chamber IOL) (Anterior chamber IOL)
• Implanted in the capsular bag.
• Better choice.

Biometry : Calculations of power of IOL to be implanted

1. Keratometry : Corneal curvature.

Ophthalmology Revision • v4.0 • Marrow 8.0 • 2024

 Lens 39

2. A-scan USG : Axial length/AP diameter of eye ( N AL ~ 24 mm). ----- Active space -----

Axial Length

3. IOL power calculation using SRK-T formula.

Complications of Cataract Surgery 00:38:54

Operative :
• Posterior Capsular Rupture (PCR).

om
• Uveitis-Glaucoma-Hyphema (UGH) Syndrome d/t ACIOL.

l.c
• Vitreous loss.
ai
gm
• Expulsive choroidal hemorrhage : Bleeding from choroidal artery.
@
60

• Descemet membrane detachment : Reattached by injecting air bubble

23

or gas in AC Descemetopexy.
ik
hv
rit

Postoperative :
|
w

• Posterior capsular opacification (M/c) :

ro
ar

- Occurs 6-12 months postop.

M

- Types
©

Elschnig’s pearls (90%)

Sommering’s ring (10%)
• Retinal detachment.
• Irvine Gass/Vitreous wick syndrome : Elschnig’s pearls
- 6-10 weeks postop. Rx
- Cystoid macular edema + bullous keratopathy d/t vitreous touch.
• Displacement of IOL :
- Sunset syndrome : Inferior subluxation.
- Sunrise syndrome : Superior subluxation.
- Lost lens syndrome : Complete dislocation.
• Toxic Anterior Segment Syndrome (TASS).
Nd YAG laser posterior
• Flat/shallow AC : capsulotomy
- Wound leak.
- Ciliary choroidal detachment.
- Pupillary block glaucoma.
- Malignant glaucoma.
Ophthalmology Revision • v4.0 • Marrow 8.0 • 2024
 40 Ophthalmology

----- Active space ----- Endophthalmitis (Starts intra-op, extends post-op) :

• Suppurative inflammation of all structures except sclera.
• Causes :
Type M/c Pathogen Congestion
Early postop (<7 days) CoNS (Staphylococcus epidermidis)
Hazy Cornea
Late postop(>6 weeks) Propionibacterium
Traumatic B. cereus Hypopyon
Endogenous Klebsiella, Candida
Presentation of endophthalmitis
• C/f : Pain, redness, LOV + vitritis.
• Rx :
Assess Visual Acuity

If no perception of light If perception of light only If hand motion or

om
better vision

l.c
Evisceration Immediate pars plana

ai
(Removal of all vitrectomy
gm Vitreous tap
structures but sclera) +
@
60

Intravitreal antibiotics Culture

23

+
ik

Topical fortified antibiotics Intravitreal antibiotics

hv
rit

Note : Systemic antibiotics have no role.

|
w
ro

Congenital Cataract
ar

01:03:00
M
©

Types :

Infantile cataract Developmental cataract

Age at presentation < 1y > 1y
LOV Severe Minimal
Lamellar/zonular cataract

Blue dot/punctate
m/c type Riders cataract
Opacity
(Spoke like (A/w Downs syndrome)
in fetal
opacities)
nucleus

Rx Immediate surgery -

Ophthalmology Revision • v4.0 • Marrow 8.0 • 2024

 Lens 41

----- Active space -----

Cornea
Cortex
Aqueous Opacity at the centre
of posterior capsule
Anterior capsule

Posterior Polar Cataract

• Onion ring/whorled appearance.
• A/w Mittendorf dots.
(Remnants of hyaloid artery).

Miscellaneous 01:05:50

Ectopia Lentis : Golden red crescent in

Subluxation of lens d/t breakage pupillary area

om
l.c
of zonules.
ai
gm
Inferiorly displaced lens
Causes :
@
60

• Blunt trauma (M/c).

23
ik

• Marfan’s syndrome (Superotemporal subluxation).

hv

• Homocystinuria (Inferonasal subluxation).

rit
|

• Weill-Marchesani syndrome (Anterior subluxation).

w
ro
ar

Clinical features : Diplopia d/t differential refractive power.

M
©

Lenticonus :

Cornea
Aqueous
Anterior lens surface

Anterior Lenticonus Posterior Lenticonus

Causes : Spina bifida, Alport syndrome, Cause : Lowe syndrome
Waardenburg syndrome

Ophthalmology Revision • v4.0 • Marrow 8.0 • 2024

 42

----- Active space ----- GLAUCOMA

Pathophysiology and Types  00:00:20

PATHOPHYSIOLOGY
Optic neuropathy :
• Optic disc changes : Progressive, characteristic.
• Visual field defects : Irreversible.
• IOP : Normal/raised (Normal : 11-21 mmHg).
Glaucoma can occur by either ↑production or ↓clearance of aqueous.

Flow of Aqueous :

om
Trabecular and uveoscleral outflow.

l.c
ai
Trabecular outflow : gm
@

Trabecular meshwork
60
23

(Secretes aqueous)
ik
hv
rit

Schlemm’s canal
|
w
ro
ar

Aqueous vein
M
©

Ciliary processes Angle of AC : Iridocorneal

Episcleral vein. angle (Site of outflow)

Open Angle Glaucoma (OAG) Angle Closure Glaucoma (ACG)

Angle b/w iris & cornea Wide Narrow

Pathology Defective trabecular meshwork Anterior displacement of iris
Anterior chamber Deep Shallow
• Trabeculoplasty • Iridectomy
Rx
• Trabeculectomy • Iridotomy

Ophthalmology Revision • v4.0 • Marrow 8.0 • 2024

 Glaucoma 43

Investigations 00:05:37 ----- Active space -----

Optic Disc Examination :

Direct ophthalmoscopy :
• Magnification : 15 times.
• Visualizes central fundus.
• Disadvantage : No binocular vision
(No depth perception).

Slit lamp biomicroscopy :

Magnification : + 90 D lens

Visual field examination : 90D Examination

Perimetry :

om
l.c
1. Kinetic (Moving targets) : Not preferred.
ai
gm Superior
2. Static (Idle targets) :
@

Eg : Humphrey Field Analyzer (HFA).

60

Fovea
23

Nasal Temporal
ik
hv

Normal visual field :

rit

Blind spot
• Horizontally oval with an infero-nasal notch.
|
w

• Superior : Minimum.
ro

Inferior
ar

• Temporal : Maximum.
M
©

Humphrey Field Analyzer :

Area of ↓sensitivity

Fovea
Output
Blind-spot

HFA Machine

Ophthalmology Revision • v4.0 • Marrow 8.0 • 2024

 44 Ophthalmology

----- Active space ----- IOP Measurement/Tonometry :

1. Indentation tonometry :

Schiotz tonometer Rebound tonometer

Not preferred d/t variability Choice for self-monitoring
2. Non-contact tonometry : Choice for screening in camps.
3. Transpalpebral tonometry (Diaton, Proview) : Visualized through eyelid (Not

om
commonly used).

l.c
4. Applanation tonometry : M/c done.
ai
gm
Principle : Imbert Fick law Pressure =
@

Force/Area.
60
23

Touches the cornea

Types : Fixed force (Not used) and fixed
ik
hv

area.
rit
|

Fixed area tonometers :

w
ro

1. Goldmann’s : Gold standard Inner margins of

ar

superior & inferior

M

- Corneal stain : Fluorescein dye. rings should touch

©

- Cobalt blue light.

2. Mackey marg : AT rings/mires
Choice of tonometry in edematous irregular cornea.
Examination of Angle of Anterior Chamber :
1. Van Herick’s Method :
• Comparison of peripheral anterior chamber depth (PACD) & corneal thickness
• Performed in slit lamp. (CT).
• PACD = CT Open angle.
• PACD < 1/4 CT : Shallow AC Closed/closing angle.

: CT
: PACD

Ophthalmology Revision • v4.0 • Marrow 8.0 • 2024

 Glaucoma 45

2. Oblique Flashlight Test : ----- Active space -----

Nasal Temporal Nasal Temporal

Shadow
over
nasal iris

Temporal Temporal iris

& nasal iris illumination
Open Angle illumination Shallow AC Angle closure glaucoma

3. Gonioscopy : Best.
Principle : Overcomes total internal reflection.

om
C/I : Dilated pupil.

l.c
Structures seen :
ai
gm
Mnemonic : Can’t see this stuff.
@

Posterior • Ciliary body.

60
23

• Scleral spur.
ik

4 mirror Gonioscope
hv

• Trabecular meshwork.
rit

Anterior • Schwalbe’s line (Peripheral termination of Descemet’s membrane).

|
w
ro
ar

Primary Open Angle Glaucoma (POAG) 00:18:24

M
©

• Chronic disease. • Family history + .

• Age : >50 yrs. • Genes : WDR 36, optineurin, myocilin.
Symptoms :
• Headache. Double
• Delayed dark adaptation. angulation
• Frequent change in presbyopic spectacles. of blood
vessel
Signs :
IOP : >21 mmHg OR >5 mmHg difference b/w both eyes.
Bayonetting sign Normal disc
OD Changes : (c/d ratio = 0.3)
1. Loss of neuroretinal rim (Inferior).
2. Vertical cupping (c/d ratio >0.5).
3. Bayonetting sign.
4. Laminar dot sign. a zone : Specific.
5. Peripapillary atrophy. b zone : Also seen in myopia
(As temporal myopic crescents). Glaucomatous changes
Ophthalmology Revision • v4.0 • Marrow 8.0 • 2024
 46 Ophthalmology

----- Active space ----- Visual Field Changes :

Earliest Sign Isopter contraction
(Constriction of peripheral VF)

Baring of blind-spot

Paracentral scotoma
(Earliest clinically visible manifestation)
Occur in Connects with blind spot
Bjerrum’s Seidel’s scotoma : Paracentral scotoma Seidel’s scotoma
area Comma shaped Roenne’s
affecting Arches to opposite side nasal
arcuate Bjerrum/Arcuate scotoma step
nerve fibres.
Ring/Double arcuate scotoma Central
vision
Roenne’s central/peripheral nasal step spared
( D/t unequal contraction of upper &

om
Bjerrum/Arcuate Ring/Double
lower hemispheres)

l.c
scotoma arcuate scotoma

ai
gm
Loss of central vision
@
60

Loss of temporal island vision.

23

(Last to be lost)
ik
hv

Treatment :
rit
|

Medical Mx : Topical drugs.

w
ro
ar

Drug MOA S/E

M

• Hypertrichosis (↑Growth of eyelashes)

©

Prostaglandin F2a (PGF2a)

• Hyperpigmentation of iris
Latanoprost (DOC) : OD ↑Uveoscleral outflow • Cystoid macular edema
dosage
• Uveitis
b blockers : • Corneal anesthesia
Timolol (Non-selective b ↓Aqueous production • Nasolacrimal duct (NLD) blockage
blockers) • Blepharoconjunctivitis
↓Aqueous production • Eyelid retraction
a-agonists :
+ • Mydriasis
Apraclonidine
↑Trabecular outflow • Follicular conjunctivitis
CNS Suppression d/t crossing of BBB
• Drowsiness
Brimonidine ↓Aqueous production • Apnea
• Depression
Carbonic anhydrase
inhibitors : Acetazolamide
- Emergency drug

↓Aqueous production
Rho kinase inhibitors :
Netarsudil + -
↑Trabecular outflow
Ophthalmology Revision • v4.0 • Marrow 8.0 • 2024
 Glaucoma 47

Surgical Mx : ↑Trabecular outflow. ----- Active space -----

1. Laser trabeculoplasty :
- Photocoagulation with argon laser.
- TOC for prophylaxis in other eye.
2. Trabeculectomy : Best Sx.
3. Non-penetrating Sx
- Viscocanalostomy.
- Deep sclerectomy.
4. Seton Sx/Drainage devices :
In resistant cases
- Express mini shunt.
- Maltena devices.
5. MIGS (Minimally Invasive Glaucoma Sx).

om
Primary Angle Closure Glaucoma 00:29:00

l.c
ai
gm
Acute disease.
@
60

Pathogenesis :
23
ik

Relative pupillary block (A)

hv

(D/t pupillary margin touching the lens)

rit
|
w

No flow of aqueous
ro
ar

(Posterior Anterior chamber)

M
©

Iris pushed forward : Iris bombe (B)

Irido-trabeculo-corneal contact (C)

Peripheral anterior synechiae formation

PACG
Clinical Features :
• Headache.
• Severe eye pain : IOP >40 mmHg (Rock hard eye in digital tonometry).
• High IOP disrupts the endothelium Corneal edema.
• Distorted vision : D/t hazy cornea.
• Redness of eye.
• Vomiting.
• Halos around lights : Prismatic dispersion d/t corneal edema.

Ophthalmology Revision • v4.0 • Marrow 8.0 • 2024

 48 Ophthalmology

----- Active space ----- Signs :

• Eclipse sign : Shadow over nasal iris. (Oblique flashlight Peripheral
Posterior
test) anterior
synechiae
synechiae
• Vogt’s triad :
- Iris atrophy.
- Posterior synechiae (Adhesion b/w pupillary margin &
lens).
- Vertically oval mid-dilated pupil (D/t iris atrophy),
which is fixed.
Note : ACG is precipitated in dark places (Eg : Movie halls).
Treatment :
Initial Rx :
• IV Mannitol (DOC)
↓IOP

om
• Oral acetazolamide

l.c
• Pilocarpine eyedrops (Miotic) : Given after ↓IOP; Pulls iris to center and open
ai
gm
angle.
@
60

Definitive Rx :
23
ik

Laser iridotomy : TOC.

hv
rit

• Nd-YAG Laser.
|

• B/w 11 o’clock & 1 o’clock.

w
ro

Equalizes pressure.
ar
M

Laser iridotomy
©

Congenital Glaucoma 00:37:10

Signs :
1. Buphthalmos :
Enlarged eyeballs:
• Deep AC.
• ↑Axial length Myopia.
• Corneal diameter >13 mm.
• Blue sclera. Blue sclera
2. Haab’s striae
3. Hazy cornea : Earliest sign.

Symptoms :
• Blepharospasm
• Photophobia
• Lacrimation Haab’s striae
Ophthalmology Revision • v4.0 • Marrow 8.0 • 2024
 Glaucoma 49

Treatment : ----- Active space -----

• Trabeculectomy + trabeculotomy : TOC
• Goniotomy : If cornea is clear.

Secondary Glaucoma 00:39:25

TYPES
1. Lens Induced :
• Phacomorphic : Intumescent cataract.
• Phacolytic : Morgagnian cataract.

2. Pigmentary :
• Presents as 2° open angle glaucoma.
• Krukenberg spindles : Characteristic.
Target sign

om
3. Pseudoexfoliation :

l.c
M/c cause of 2° open angle glaucoma.
ai
gm
@

Characteristic Signs :
60
23

Target sign : Deposit of exfoliative

ik
hv

material on lens.
rit

Fnocks : Deposit of pseudoexfoliative material

|
w

on pupillary margin.
ro
ar

Fnocks
M

Neovascularization of Iris/Rubeosis Iridis :

©

Causes :
• Proliferative Diabetic Retinopathy (PDR).
• Ischemic CRVO.

Progression :
Hyphema 2° OAG (AKA neovascular glaucoma).

Ophthalmology Revision • v4.0 • Marrow 8.0 • 2024

 50

----- Active space ----- OPTICS AND REFRACTION

Tests for Vision  00:01:04

TESTS FOR FAR VISION

60 Meters from which
1. Snellen’s Chart : a normal eye can
• Distance of examination : 6 metres. read the letter
• Normal : 6/5, 6/6. 36
• Least vision : 1/60. 24
Minimum of 7
- 1/6 Finger counting (FC) Hand 18 lines of letters
movement (HM) Perception of 12

om
light (PL) 9
6

l.c
ai
gm Snellen’s chart
Principle :
@

Each letter subtends an angle of 5 minutes of arc at nodal point of eye when
60
23

viewed from its respective distance.

ik
hv

2. Bailey-Lovie/Log chart 3. Landolt C-Ring 4. Snellen’s E-Chart

rit
|

Not used in India. If pt. is illiterate

w
ro
ar

5 letters in
M

each row
©

Tests Used in Infants :

1. Optokinetic nystagmus : 2. Preferential looking test :

OKN drum Catford drum Teller acuity cards Keeler gratings

The child normally focuses on The child prefers to look at the
alternating light & dark bands patterned areas
Ophthalmology Revision • v4.0 • Marrow 8.0 • 2024
 Optics and Refraction 51

3. Blink reflex : 5. Cardiff Acuity Test ----- Active space -----

• Blinks on exposing eye to light.
• Present since birth.

4. Menace reflex :
• Any object brought close to the child’s
eye Child moves away.
• Develops at 4 to 6 months of age.

TESTS FOR NEAR VISION :

Distance of examination : 30 to 35 cms.

1. Snellen’s Near Chart :

• Best near vision : N6.
• Worst near vision : N36.

om
M/c used.

l.c
ai
gm
2. Jaeger’s Chart : Snellen’s near chart
@

J1 to J7 vision.
60
23
ik

TEST FOR CONTRAST SENSITIVITY :

hv

Pelli Robson Chart :

rit
|

Used in case of cataract,

w
ro

where contrast vision is lost early.

ar
M
©

Normal Optics of Eye 00:09:05

Visual axis F
A E N R
a B Pupillary axis Optical axis
k
O
(Object)

Axes : Angles :
1. Anatomical axis : ANR. 1. Kappa (k) : B/w pupillary and
2. Visual axis : OENF. visual axes.
3. Pupillary axis : BE (Axis to the centre 2. Alpha (a) : B/w anatomical and
of the pupil). visual axes.

Ophthalmology Revision • v4.0 • Marrow 8.0 • 2024

 52 Ophthalmology

----- Active space ----- Gullstrand’s Schematic Eye :

Purkinje images :
4 refractory surfaces in the eye based on the reflections of light.
Purkinje Surfaces I II III IV
Cornea Lens
Site
Anterior Posterior Anterior Posterior
Power +48.8 D (Max) -5.88 D +19 D

Listing’s Reduced Eye :

• All elements measured from anterior
corneal surface.
• Power of eye : 58.6 D.

Factors determining power :

om
Principal point : Nodal point : Focal point :
• Curvature of anterior corneal

l.c
1.35 mm 7.08 mm 24.13 mm

ai
surface. gm
Distance from anterior corneal surface
@

• Length of eyeball.
60
23
ik

Refractory Error
hv

00:12:09
rit
|

Types :
w
ro
ar
M
©

Monocular Binocular
(Visual defect in 1 eye) (Visual defect in 2 eyes)
Correctable with

Spherical lens Cylindrical lens

(Anterior & posterior surface of (Anterior & posterior surface of
the same power) different powers)

Myopia Hypermetropia Astigmatism

Ophthalmology Revision • v4.0 • Marrow 8.0 • 2024

 Optics and Refraction 53

Myopia Hypermetropia ----- Active space -----

More Less
Power
(Image in front of retina) (Image behind the retina)
Corrective lens ‘-’/Concave (Diverging) ‘+’/Convex (Converging)
Axial length ↑(Buphthalmos) ↓
Curvature ↑ ↓
Refractory index ↑(Nuclear cataract) ↓
Anterior
Position of lens Posterior
(Weill Marchesani syndrome)
Note : 1 mm ↑ in axial length = 3D myopia.
Myopia 00:15:40

Fundus signs : Only seen in pathological myopia (>6D).

om
• Temporal myopic crescent : Choroidal & retinal atrophy.

l.c
• Posterior staphyloma.
ai
gm
• Lacquer cracks : Break in Bruch’s membrane.
@

• Foster-Fuch’s spots : Bleeding at the macula.

60
23

• Vitreous hemorrhage.
ik
hv

• Retinal detachment : Pathological myopia is the m/c cause of rhegmatogenous

rit
|

retinal detachment.
w
ro
ar
M
©

Posterior
staphyloma
(Gutter-like)
OD
Temporal myopic crescent Lacquer cracks Foster fuch spots

Surgical correction of myopia :

• Radial keratotomy (PRK) :
Multiple peripheral corneal incisions given Stretches and flattens the
cornea ↓Converging power.
• LASIK : Excimer laser Argon (Ar) & fluoride (F).
• SMILE (Small Incision Lenticule Extraction) : Nd:Glass laser.
• ICL (Implantable Collamer Lens) :
- If power >8D.
- Site of implantation : Sulcus (Space between iris & posterior chamber).
• INTACS (Intracorneal stromal ring segment).

Ophthalmology Revision • v4.0 • Marrow 8.0 • 2024

 54 Ophthalmology

----- Active space ----- Astigmatism 00:21:00

Regular Irregular

2 principal meridians 2 principal meridians not

perpendicular to each other perpendicular to each other

D/t corneal/retinal scarring

With the rule Against the rule Oblique
No Rx
Vertical meridian Horizontal meridian 2 perpendicular meridians
is more curved is more curved not vertical/horizontal
Treatment : Cylindrical glasses/toric contact lens.
Axis determination :

om
l.c
180° 90°
ai
gm
With the rule Concave (-) Convex (+)
@
60

Against the rule Convex (+) Concave (-)

23
ik

Mnemonic : With CV, against VC.

hv
rit

Sturm’s conoid :
|
w
ro

Configuration of light rays when refracted from a toric surface.

ar
M

Vc : Vertical curvature
©

Hc : Horizontal curvature
Vp : Vertical power
Hp : Horizontal power

Vc > Hc

Vp > Hp
A B C D E F G
Vertical rays Circle of least Horizontal
focused diffusion rays focused

Convergence of horizontal rays

= Divergence of vertical rays

Ophthalmology Revision • v4.0 • Marrow 8.0 • 2024

 Optics and Refraction 55

Correction of Refractory Errors 00:26:10 ----- Active space -----

Prescription of Spectacles :
Lens Use
- Spherical Myopia
+ Spherical Hypermetropia
- Cylinder Simple myopic astigmatism
+ Cylinder Simple hypermetropic astigmatism
- Spherical/ - Cylinder Compound myopic astigmatism
+ Spherical/ + Cylinder Compound hypermetropic astigmatism
- Spherical/ + Cylinder
OR Mixed astigmatism
+ Spherical/ - Cylinder

Determination of refractory errors :

om
l.c
ai
gm
Objective (1st test) Subjective
@
60
23

Retinoscopy • Trial & error method

ik
hv

• Refinement of refraction :
rit

- Cylinder
|

Manual Automated Refractometer

w
ro

a. Jackson’s cross cylinder test

ar

b. Astigmatic fan test

M
©

- Sphere
i. Duochrome test
ii. Pinhole test

Reflecting mirror Priestley-Smith Self illuminated

retinoscope retinoscope STREAK retinoscope

Streak Retinoscope :
• M/c used. Trial & error method
• Light produced in vertical/horizontal beams.
• Distance of examination : 1 mt.
• Method : Comparing movement of red streak to movement of retinoscope.

Ophthalmology Revision • v4.0 • Marrow 8.0 • 2024

 56 Ophthalmology

----- Active space -----

Against No movement With

Power >1 D myopia 1 D myopia <1 D myopia Can also be either
Retinoscopy emmetropia/hypermetropia.
Variable Zero Variable
Value
Retinoscopy values :
Cycloplegics C2
Correction factors (C) :
Atropine 1
1. Distance (d) of examination : C1 = 1/d.
2. Tonus allowance of cycloplegic drug Cyclopentolate 0.75
(To neutralize accommodation power) : Homatropine 0.50

Corrected retinoscopic value (RF) : RF - C1 - C2.

om
SUBJECTIVE ASSESSMENT :

l.c
Refinement for Cylindrical Lenses :
ai
gm
a. Jackson Cross Cylinder (JCC) test :
Jackson's Cross Cylinder
@

• - 0.5 D sph/+ 1.0 cyl

60

Combinations used
23

• - 0.25 D sph/+ 0.5 cyl

ik
hv
rit

b. Astigmatic fan : Power refined till pt. can see

|

all the axes well.

w
ro

Astigmatic Fan
ar

Refinement of Spherical Lenses:

M
©

1. Duochrome test :

Residual Better vision Better vision Residual

myopia hypermetropia

2. Pinhole test :
Eliminates peripheral light rays,
allows central light rays
Placed in front of eye
Visual acuity Size of hole :
1 mm in diameter
Improves Decreases
Residual refractory Macular disease.
error.
Ophthalmology Revision • v4.0 • Marrow 8.0 • 2024
 Optics and Refraction 57

Accomodation  00:37:34 ----- Active space -----

Helps near vision (Power needs to ↑).

Far vision : Near vision :
Ciliary muscles Ciliary muscles
(Relaxed) (Contracted)
Ciliary zonules Ciliary zonules
(Tense) (Slack)

A P Lens (Thin, with A P Lens (Thick, with

flatter anterior anterior surface
surface) more curved)
(↓Power) (↑Power)

om
l.c
ai
gm
@

Presbyopia :
60
23

• Physiological insufficiency of accommodation (Difficulty in near vision).

ik

• Age : >40 yrs.

hv
rit

Treatment : Convex spectacle (+) (At 45y + 1 D power)

|
w
ro

Spasm of Accommodation :
ar
M

• AKA Pseudomyopia.
©

• Issue with distant vision (D/t spasm of ciliary muscles).

Treatment : Cycloplegics Atropine (Relaxes ciliary muscle).
Newborn :
At Birth :
• Axial Length (AL) : ~17 mm (Smaller than normal).
• Refractory error : 2-3 D hypermetropia.
• Becomes emmetropic by 5-6 yrs.

Ophthalmology Revision • v4.0 • Marrow 8.0 • 2024

 58

----- Active space ----- RETINA

Anatomy 00:00:42

Arc-like vessels
Macula (Appears avascular & temporal to optic discs)
Neuroretinal rim Optic disc
Optic cup
• Diameter : 1.5 mm
• Shape : Vertical oval
• c ratio : 0.3
d

om
Fundus : Ora serrata :

l.c
• Vitreous • Anterior termination of retina.
ai
Transparent gm
• Retina • Site of intravitreal injection : Anterior to ora serrata
@
60

• Choroid : Red or 3-4 mm posterior to limbus. (Pierces sclera & pars

23

plana)
ik
hv

Layers of retina (Inside to outside) : Mnemonic ING (IOP)2

rit
|
w
ro

Internal limiting membrane

ar
M

Nerve fibre layer

©

(Fibres collect to form optic N.) Ganglion cell layer

Inner plexiform layer Inner nuclear layer

(Bipolar cells)
Outer plexiform layer Outer nuclear layer

Photoreceptors Pigment epithelium

(Rods & cones) (Outer blood-retinal barrier)
External limiting membrane
Key : (Not visualized)
1st order neurons
2nd order neurons
3rd order neurons

Note : Subretinal space Space b/w inner 9 layers & pigment epithelium.

Ophthalmology Revision • v4.0 • Marrow 8.0 • 2024

 Retina 59

Investigations 00:09:18 ----- Active space -----

Ophthalmoscopy : To visualise fundus & retina (1st investigation).

Direct ophthalmoscope Indirect ophthalmoscope

Appearance

Operation Hand-held Worn around the head

External lens No Yes (Power : +20 D)
Distance of examination As close to patient’s eye as possible Arm’s length
Image Virtual & erect Real & inverted

om
• +20 D lens : 3X
Magnification 15X

l.c
• + 14D lens : 5X

ai
Small : gm Large :
• Central fundus • Peripheral fundus
@

Area visualised
60

• Optic disc & macula • Ora serrata

23
ik

Field of view 10o 45o with +20 D lens

hv

Area viewed 2 DD 8 DD
rit
|
w
ro

Fundus Fluorescein Angiography (FFA) :

ar
M

• Visualises fluorescent blood vessels.

©

• Diagnoses :
Dark
- Vascular disorders. Macula
- Macular disorders :
Normal macula appears dark.
Normal FFA

Leakage from blood vessels Blocked blood vessels Macular disorder

Ophthalmology Revision • v4.0 • Marrow 8.0 • 2024

 60 Ophthalmology

----- Active space ----- Indocyanine Green Angiography (ICGA) :

To visualise choroidal vasculature.

Optical Coherence Tomography (OCT) :

To visualise retinal layers.

om
• RPE : Always red. • Fovea : Depressed contour.

l.c
ai
B (Brightness) Scan USG : gm
Structures observed :
@
60

• Vitreous (Black/hypoechoic).
23
ik

• Retina
hv

White/hyperechoic
rit

• Choroid
|
w
ro
ar

Pathologies on B-scan :
M
©

Collar stud/
mushroom
appearance

Choroidal melanoma Retinal detachment

Vitreous Hemorrhage (VH) :

• M/c cause of VH :
- Diabetic retinopathy.
- Blunt trauma(Young adults).
- Eales disease (Recurrent)
• C/f : Blurring of vision/LOV.
• O/E : Pale fundus (Red glow obscured by
hemorrhage).
Ophthalmology Revision • v4.0 • Marrow 8.0 • 2024
 Retina 61

Electroretinography (ERG) : b ----- Active space -----

• Records retinal action potential.
• Detects photoreceptor pathology.
c
Interpretation :
• a wave : Photoreceptors activity.
• b wave : Bipolar & Muller’s cells activity. a
• c wave : Metabolic activity of pigment epithelium.

Electrooculography (EOG) :
• Records retinal standing potential from outer retina.
(Photoreceptors + Pigment epithelium)
• Measurement : Arden’s ratio = Light peak (Normal > 185%)
Dark trough
• Detects photoreceptor pathology.

om
l.c
ai
Retinoblastoma gm 00:23:20
@
60

Types :
23

• Non-hereditary (60%) : Always U/L.

ik
hv

• Hereditary : Non-familial (33%) and familial (7%).

rit
|

• Sporadic (M/c) : Non-hereditary + Non-familial (93%).

w
ro
ar

Genetics :
M
©

• M/c inheritance : Autosomal Dominant (AD).

• Gene : RB on Chr. 13q14.
Knudsons 2 hit hypothesis : Tumor presents only on loss of heterozygosity.

Malignancy :
• M/c malignancy : PNET/pineoblastoma.
• M/c 2o malignancy : Osteosarcoma.

Clinical Features : Leukocoria

• Leukocoria (M/c)

White pupillary reflex

• Squint (2nd M/c).
• 2o glaucoma + Buphthalmos (3rd M/c)
M/c causes :
Spread : Direct through optic nerve. Retinoblastoma (U/L) and Cataract (B/L)

Ophthalmology Revision • v4.0 • Marrow 8.0 • 2024

 62 Ophthalmology

----- Active space ----- Investigations :

CT scan (IOC)
Calcified tumor
(M/c cause of
intraocular calcification)

Biopsy (Gold standard) :

• Sample : Optic nerve.
• Findings :

om
a. Homer wright rosettes (Pseudo-rosettes).

l.c
b. Fleurettes c. Flexner wintersteiner rosette
ai
gm
• Empty central lumen.
@

• Surrounding cells with

60
23

nucleus pointing centrally.

ik

Treatment :
hv
rit

Enucleation (TOC) : Removal of eyeball + optic nerve.

|
w
ro

Macular Disorders
ar

00:29:25
M
©

Macula : Responsible for central vision (D/t fovea).

Tests :
1. Amsler’s grid : Patient asked to look at the central dot.

Normal test : Straight lines Macular disorder: Wavy lines

2. Photostress test :
• ↑Photostress recovery time in macular disorder.
• To differentiate macular with optic nerve disorders :
Normal photostress recovery time + LOV Optic nerve disease.
Ophthalmology Revision • v4.0 • Marrow 8.0 • 2024
 Retina 63

MACULAR DISORDERS ----- Active space -----

Central Serous Retinopathy :
• Damage to Retinal Pigment Epithelium (RPE).
• Fluid in subretinal space.

Risk factors :
• Steroids • H. pylori infection.
• Cushing’s syndrome. • Type A personality.

Treatment :
• Self resolving, treat risk factor.
• Photodynamic therapy with Verteporfin. Not routinely done.
• Laser photocoagulation.
• Steroids C/I.

om
Investigations :

l.c
ai
gm
@
60
23
ik

Subretinal
hv
rit

fluid
|

collection
w
ro

FFA : Umbrella/smoke FFA : Ink blot appearance OCT

ar
M

stack appearance
©

Cystoid Macular Edema :

Fluid in outer plexiform layer.
Risk factors : Mnemonic RUN PRIDE.
• Retinitis pigmentosa.
• Uveitis
• Niacin/nicotine.
• Prostaglandin analogues.
• Retinal vein occlusion.
• Irvine-Gass syndrome (Post-op cataract complication).
• Diabetic retinopathy.
• Epinephrine in aphakia.

Ophthalmology Revision • v4.0 • Marrow 8.0 • 2024

 64 Ophthalmology

----- Active space ----- Investigations :

FFA : Flower petal appearance OCT : Cystic spaces

Treatment : Intravitreal steroids.
Age Related Macular Degeneration (ARMD) :
a. Dry/Non-neovascular/Non-exudative b. Wet/Neovascular/Exudative :
Stages : Signs :
• Early Drusen + (Yellowish • RPE detachment.
• Intermediate eosinophilic deposits) • Choroidal neovascularisation.

om
• Late Geographic atrophy of RPE + . Rx : Intravitreal anti-VEGF drugs.

l.c
ai
Rx : Antioxidants @
gm
60
23
ik
hv
rit
|
w
ro
ar
M
©

Drusens RPE detachment Choroidal neovascularisation

Fundus Dystrophies 00:39:54

Retinitis Pigmentosa :
• Rod-cone dystrophy (Rods > cones).
• M/c inheritance : Autosomal recessive.
(M/c hereditary fundus dystrophy)
Clinical Features :
• Nyctalopia, ring/donut scotoma/
tunnel vision (Rods affected).
• Bony spicule pigmentation.
• Waxy, pale optic disc. Bony spicule pigmentation
• Systemic association : Lawrence-Moon-Biedl syndrome
• Arteriolar attenuation.
Ophthalmology Revision • v4.0 • Marrow 8.0 • 2024
 Retina 65

10C : ERG (a wave absent). ----- Active space -----

Treatment : Genetic counselling (No Rx).

Best’s Macular Dystrophy :

• Cone dystrophy Hemaralopia (Day blindness), central scotoma.
• Autosomal dominant.

Egg yolk/Vitelliform lesion

Breaks
Pseudohypopyon/Vitelliruptive
lesion (Collection in AC)

IOC : EOG (ERG normal, Arden’s ratio <150%)

om
Stargardt Disease :

l.c
ai
M/c cause of juvenile hereditary macular dystrophy. gm
@
60
23
ik
hv
rit
|
w
ro
ar
M
©

Bull’s eye maculopathy FFA : Dark/silent choroid sign

Note : Bull’s eye maculopathy also seen in chloroquine toxicity.

Vascular Disorders 00:46:33

Diabetic Retinopathy :
Risk factor : Duration of DM.
Screening : TI DM : 5 years after Dx.
T2 DM : Immediately on Dx.

Ophthalmology Revision • v4.0 • Marrow 8.0 • 2024

 66 Ophthalmology

----- Active space ----- Early Treatment Diabetic Retinopatly Study (ETDRS) classification :
Proliferative DR (PDR) Non-proliferative DR (NPDR)
Neovascularisation : a. Micro-aneurysms (Earliest).
• NVD : At disc. b. Hemorrhages (Flame shaped, dot & blot).
• NVE : Elsewhere c. Exudates : Lipid deposits.
d. Cotton wool spots : Neuronal debris.

Tuft of vessels
c.
(Neovascularisation) d.
Signs

Straight vessels
b.
NVD
• Requires treatment d/t leaky newly formed
vessels.

om
Rx : Panretinal photocoagulation > Anti-VEGF drugs Glycemic control

l.c
Note : Lasers in ophthalmology
ai
gm
@

Treatment modality Laser used

60
23

Photocoagulations Argon green

ik
hv

Photodisruption Nd-YAG/Nd-glass
rit

Photoablation Excimer
|
w

Hypertensive Retinopathy :
ro
ar

Keith Wagner classification :

M
©

Grade Retinal findings

Arteriolar attenuation A : V ratio = 1 : 3
1
(Normal = 2 : 3)
2 Salu’s sign
• Bonnet sign/Gunn’s sign.
3 • Flame shaped hemorrhage (White arrow).
• Cotton wool spots (Black arrow).
• Papilledema
4
• Silver wiring.
Note : Salu’s sign and Bonnet/Gunn sign are both A-V changes.

CRAO :
Causes : Atherosclerosis (M/c).
Symptoms : Sudden LOV (Emergency).
Fundus signs :
• Pale. (Retinal edema).
• Cattle tracking. (D/t blocked arteries). Cherry red spot at macula
Ophthalmology Revision • v4.0 • Marrow 8.0 • 2024
 Retina 67

Treatment : ----- Active space -----

• Ocular massage. (Dislodges emboli.)
• Sublingual isosorbide nitrate. (Vasodilation.)
• IV mannitol. Cilioretinal vessels
• Aspiration of (↓IOP) (Supply macula)
aqueous.

CRVO : FFA : Blocked blood vessels

Non-ischemic Ischemic
Stasis
Complete loss of blood supply
Pathogenesis Vasodilation
Cell death
↑Vascular permeability

om
Severe flame-shaped hemorrhages

l.c
C/F Macular edema (Tomato splash fundus)

ai
gm
Rubeosis iridis (Iris NV) 100 day glaucoma
@
60

Rx Intravitreal triamcinolone Panretinal photocoagulation

23

BRVO :
ik
hv

• Branch Retinal Vein Occlusion

rit
|

• M/c affects superotemporal quadrant.

w
ro
ar
M
©

BRVO : Sectoral involvement Tomato splash fundus

Retinopathy Of Prematurity (ROP) :

Risk factors :
• Preterm infants <34 Wks.
• Birth weight <1750 grams.
• Preterm infants 34-36 W0G + risk factors (RDS).

Screening of infants :
• Born ≥28wks and ≥1200g : Screen after 4 wks of birth.
• Born <28wks or <1200g : Screen within 2-3 wks of birth.

Ophthalmology Revision • v4.0 • Marrow 8.0 • 2024

 68 Ophthalmology

----- Active space ----- Treatment :

• Laser photocoagulation using diode red laser (For NV).
• Lens sparing pars plana vitrectomy (For tractional retinal detachment).

Retinal Detachment 01:02:59

Separation of neurosensory retina from retinal pigment epithelium d/t fluid

collection in subretinal space.

Types :
Rhegmatogenous Tractional Exudative
M/c cause Pathological myopia Diabetic retinopathy Choroidal melanoma
Retinal break + - -
Syneresis (Vitreous liquefaction) + - -

om
Vitreo-retinal traction + + -

l.c
ai
Photopsia + gm - -
@

+ - -
60

Floaters
23

+ + +
ik

Curtain falling before eye

hv
rit

Retinal surface Convex Concave -

|

Retinal mobility Mobile Immobile, taut -

w
ro

• Retinal atrophy.
ar
M

Signs of chronicity • High watermarks. Demarcation lines

©

• Intraretinal cysts.
Shaffer’s sign
Other signs - Shifting fluid
(Tobacco dust appearance)
RAPD/Marcus Gunn pupil + + +

Investigations :
10C : Indirect ophthalmoscopy.

Grey detached
retina
Normal attached
SRF retina

OCT : Subretinal fluid collection Fundoscopy

Ophthalmology Revision • v4.0 • Marrow 8.0 • 2024

 Eyelids And Orbit 69

EYELIDS AND ORBIT ----- Active space -----

Anatomy of Eyelids 00:00:15

Eyelids
Divided by ‘Grey line’

Anterior laminae Posterior laminae

• Skin • Tarsal plate (Fibrous tissue ; not cartilaginous)
• SC tissue • Palpebral conjunctiva
• Muscles • Glands
- Meibomian
Modified sebaceous glands.

om
- Zeis

l.c
- Moll : Sweat gland
ai
gm
Muscles of eyelid :
@
60

Muscle Nerve Supply Action Effect of Injury

23
ik

Levator palpebrae superioris CN III

hv

Elevation of upper eyelid Ptosis

rit

Muller's muscle Sympathetic fibers

|
w

Orbicularis oculi CN VII Closure of eyelids Lagophthalmos

ro
ar
M

Eyelid Pathologies 00:03:18

©

Chalazion vs. Stye/External Hordeolum :

Chalazion Stye/External hordeolum
Lipogranulomatous inflammation of Suppurative (S. aureus) inflammation
Pathology
Meibomian gland of Zeiss gland
Painless localized (Nodular) swelling Painful generalized swelling

C/f

Rx Incision & drainage/curettage Hot compressions

Ophthalmology Revision • v4.0 • Marrow 8.0 • 2024

 70 Ophthalmology

----- Active space ----- Eyelash Pathologies 00:06:30

Trichiasis Distichiasis Madarosis

Additional posterior row
Pathology Misdirection of cilia Absent eyelashes
of eyelashes

Appearance

Epilation (To prevent corneal

Rx - -
abrasion & opacity)

om
Lid Margin Pathologies 00:08:06

l.c
ai
gm
Ectropion Entropion
@
60
23

Pathology Eversion of lid margin Inversion of lid margin

ik
hv
rit
|
w
ro

Appearance
ar
M
©

Tylosis : Thickening of lid margin.

Ankyloblepharon : Fusion of upper & lower lid margins.

Note :
Symblepharon (Conjunctival disorder) : Fusion of bulbar & palpebral conjunctiva.

Congenital Ptosis :
Pathology : LPS malinsertion.

Clinical Features : Lid lag

Absent upper
eyelid crease

Left eye congenital ptosis

Ophthalmology Revision • v4.0 • Marrow 8.0 • 2024
 Eyelids And Orbit 71

Treatment : ----- Active space -----

Severity Surgery
Mild ptosis and good levator function Fasanella servat operation
Moderate ptosis and fair levator function Levator resection surgery
Severe ptosis and poor levator function Frontalis sling surgery
Surgery is done around 5 years of age.
Orbital Pathologies 00:13:38

Proptosis/Exophthalmos :
Eyeball protrusion >21 mm from lateral orbital rim.
Assessment :

om
l.c
ai
gm
@

Hertel’s exophthalmometer : Better option Luedde’s exophthalmometer : Easier to use (Used in children)
60
23

Cause of proptosis Feature

ik
hv

• ↑On bending forward/Valsalva manoeuvre

rit

Orbital varices
• U/L phleboliths on MRI
|
w
ro

Orbital lymphangioma ↑D/t URTI

ar
M

Capillary hemangioma (Child)

↑On crying
©

Encephalocele (Infant)
• B/L, pulsatile
• 75% cases : Traumatic
Carotid cavernous fistula
• CN VI : Earliest affected nerve
• IOC : Digital Subtraction Carotid Angiography (DSCA)

Cavernous sinus thrombosis Orbital apex syndrome Orbital cellulitis

Laterality U/L B/L U/L U/L
CN affected III, IV, VI (earliest), V1, V2 II, III, IV, VI, V1 II, III, IV, VI
a. Ophthalmoplegia Complete (Sequential) Complete (Concurrent) Complete
LOV No Yes (D/t CN II involvement)
Corneal sensations Lost (D/t V1 involvement) Lost (D/t V1 involvement) Intact
b. Chemosis, proptosis,
Marked Minimal Marked
fever, headache
Mastoid edema Present Absent
Chronology of symptoms a=b a b b a
VI : Ophthalmic n. V2 : Maxillary n.
Ophthalmology Revision • v4.0 • Marrow 8.0 • 2024
 72 Ophthalmology

----- Active space ----- M/c causes :

Adults Children
U/L Thyroid associated ophthalmopathy Orbital cellulitis
B/L (Grave's disease) AML (Chloroma), neuroblastoma

M/c Associations with Orbit :

• M/c cystic orbital lesions : Ductal cysts of lacrimal gland.
• M/c cystic orbital tumour : Epidermoid and dermoid.
• M/c orbital neoplasm (Paediatric age) : Epidermoid and dermoid.
• M/c orbital malignant tumor (Paediatric age) : Rhabdomyosarcoma.
• M/c orbital and periorbital tumor in children : Capillary hemangioma.
• M/c benign orbital tumour (Adults) : Cavernous hemangioma.
• M/c malignant orbital tumour (Adults) : B cell NHL (Lymphoma).

om
• M/c intrinsic lacrimal gland lesion/lacrimal gland epithelial neoplasm :

l.c
Pleomorphic adenoma.
ai
gm
• M/c orbital metastasis (Paediatric age) : Neuroblastoma.
@
60

• M/c peripheral neural tumour of the orbit : Plexiform neurofibroma.

23

• M/c primary source of orbital Metastases :

ik
hv

- Breast : 42%.
rit
|

- Lung : 11% (Most deaths).

w
ro

- Neuroblastoma (Paediatric age).

ar
M
©

Ophthalmology Revision • v4.0 • Marrow 8.0 • 2024

 Conjunctiva and Community Ophthalmology 73

CONJUNCTIVA AND COMMUNITY ----- Active space -----

OPHTHALMOLOGY

Anatomy of Conjunctiva :
Types :
• Bulbar : Lines sclera. Bulbar
• Palpebral : Lines eyelids. Forniceal
• Forniceal : Between bulbar & palpebral conjunctiva. Palpebral
Histology :
Goblet cells :
• Present in conjunctival epithelium.

om
• Secretes mucin Forms innermost layer of tear film.

l.c
ai
Lymphatic drainage : gm
@

• Medially Submandibular lymph nodes.

60

• Laterally
23

Preauricular lymph nodes.

ik
hv

Conjunctivitis/Eye Flu
rit

00:02:27
|
w

Clinical Features :
ro
ar

• Redness, watering.
M
©

• Stickiness, irritation.
• Foreign body sensation.
• No loss of vision.
• No pain.

Signs :
1. Discharge :
• Sticking together of eyelids in the morning. Discharge
• Colored halos. Hypertrophied vascular cores
• Types :
- Watery : Allergies.
- Mucopurulent : Bacterial & chlamydial conditions.
2. Papillae :
Seen in allergies & bacterial infections.

Ophthalmology Revision • v4.0 • Marrow 8.0 • 2024

 74 Ophthalmology

----- Active space ----- 3. Follicles : 4. Hyperemia/congestion : Redness.

Seen in chlamydial & viral infections.

Yellowish colored
lymphoid aggregates

5. Subconjunctival hemorrhage 6. Chemosis : Edema of bulbar conjunctiva

om
l.c
ai
gm
@
60
23

Symptom Groups and Etiologies :

ik
hv
rit

Papillae Follicles
|
w

Mucopurulent discharge Bacterial Chlamydia

ro
ar

Watery discharge Allergic Viral

M
©

Bacterial & Chlamydial Conjunctivitis 00:05:27

Bacterial conjunctivitis :
Type Characteristics
Acute mucopurulent Staph. aureus (M/c)
• Neisseria gonorrhoeae
Acute/hyperacute purulent/
• Overhanging eyelids + copious discharge
blennorrhea
• Pre-auricular lymphadenopathy
Acute membranous Bleeds on removal
Acute pseudomembranous Does not bleed on removal
Acute pseudomembranous type • Moraxella axenfeld
Angular/Diplobacillary • Affects lateral canthi
• Rx : Tetracyclin, zinc boric acid drops

Ophthalmology Revision • v4.0 • Marrow 8.0 • 2024

 Conjunctiva and Community Ophthalmology 75

Chlamydial Conjunctivitis 00:07:21 ----- Active space -----

Etiology :
Disease Chlamydia serovar
Adult inclusion conjunctivitis D-K
Trachoma A, B, Ba , C
Ophthalmia neonatorum D-K serovars, other causes

Trachoma/Egyptian Ophthalmia :
Spread : Finger, fly, fomites.

Signs :
1. Sago grain follicles + papillae.
2. Arlt’s line : Line of cicatrization (D/t concurrent inflammation & healing).
3. Herbert’s pits at limbus.

om
l.c
4. Pannus : Vascularization of cornea.
ai
gm
@
60
23
ik
hv
rit
|
w
ro
ar

Arlt’s line Herbert’s pits Pannus

M
©

Diagnosis : Halberstaedter–Prowazek bodies (Cytoplasmic inclusion bodies).

Treatment : SAFE strategy.

• Surgery.
• Antibiotics : Azithromycin 1 gm single dose (Stat).
• Facial cleanliness.
• Environment changes.
Complication : Blindness
Infections Inflammation Scarring of Trichiasis : Corneal
eyelids Irritation of cornea opacity.
by eyelashes

Ophthalmology Revision • v4.0 • Marrow 8.0 • 2024

 76 Ophthalmology

----- Active space ----- Ophthalmia Neonatorum :

Onset (Hours after birth) Cause
Within first 6 hours Chemical (Silver nitrate) conjunctivitis
24–48 hours (Most severe) Neisseria gonorrhoeae
>1 week (M/C) Chlamydia trachomatis (D-K)

Prevention :
• Erythromycin eye ointment : First 2 hrs.
• Crede’s method : Obsolete (Used silver nitrate).

Viral & Allergic Conjunctivitis 00:10:56

Viral Conjunctivitis :
Etiology & types :
• Adenoviral.

om
l.c
- Epidemic keratoconjunctivitis (EKC).
ai
gm
- Pharyngoconjunctival fever (PCF).
@

• Acute hemorrhagic/Apollo conjunctivitis : (PACE)

60
23

- Picornavirus.
ik
hv

- Adenovirus.
rit

- Coxsackie A24.
|
w

- Enterovirus type 70.

ro
ar

• HSV.
M
©

• Molluscum contagiosum conjunctivitis.

Allergic Conjunctivitis :
Seasonal.

Types :
• Vernal keratoconjunctivitis (VKC)/Spring catarrh.
• Atopic keratoconjunctivitis : Like VKC in adults.
• Giant papillary conjunctivitis :
D/t mechanical irritation : Contact lens, protruding sutures,
ill-fitting prosthesis
• Phlyctenular conjunctivitis.

VKC/Spring catarrh :
• M/c in boys of 5–15 yrs.
• Hypersensitivity : Type 1 > 2.
• Ropy discharge : Maxwell-Lyon sign.
Ophthalmology Revision • v4.0 • Marrow 8.0 • 2024
 Conjunctiva and Community Ophthalmology 77

Signs : ----- Active space -----

Eosinophilic deposits at limbus

White ring
around
the limbus

Cobblestone papilla Horner-Trantas dots Pseudogerontoxon

Rx :
Olopatadine (DOC) : Antihistamine + mast cell stabilizer.
+
Topical steroids : For immediate relief/acute exacerbations.

om
Pterygium 00:14:43

l.c
ai
gm
Triangular growth of conjunctiva over cornea.
@
60

Causes :
23
ik

• Limbal stem cell deficiency.

hv

• UV, dust, heat.

rit
|
w

Progression :
ro
ar
M
©

Over pupil Not over pupil

Obstruction of visual axis Visual defect d/t astigmatism

Treatment :
Excision.

Prevention of recurrence : Mitomycin C, autograft.

Ophthalmology Revision • v4.0 • Marrow 8.0 • 2024

 78 Ophthalmology

----- Active space ----- Community Ophthalmology 00:17:01

National Programme for Control of Blindness & Visual Impairment (NPCBVI) :

Definition of blindness :
Visual acuity <3/60 in the better eye.
OR
Visual field <10 degrees.

Goal :
↓Prevalence of avoidable blindness to <0.25% by 2025
(National blindness & visual impairment survey : 2015-2019).

Causes :
Blindness Visual Impairment <6/18
• Cataract (M/c) • Cataract (M/c)

om
≥50 yrs
• Corneal opacity • Refractive error

l.c
ai
• Corneal opacity (M/c)
gm • Refractive error (M/c)
0-49 yrs
• Amblyopia • Cataract
@
60
23

Rashtriya Bal Swasthya Karyakram (RBSK) :

ik
hv

Target group : Birth to 18 yrs.

rit
|

Screening : 4Ds
w
ro

Covers 32 diseases under 4 categories :

ar
M

• Defects at birth. • Diseases of childhood.

©

• Deficiencies. • Developmental delays.

Target group Screened by
Birth - 6 wks Born at public health facilities Mobile health team
6 wks - 6 yrs Rural areas, urban slum ANM
6 yrs - 18 yrs School children Questionnaire by district hospitals

Ophthalmology Revision • v4.0 • Marrow 8.0 • 2024

©
M
ar
ro
w
|
rit
hv
ik
23
60
@
gm
ai
l.c
om
©
M
ar
ro
w
|
rit
hv
ik
23
60
@
gm
ai
l.c
om