OPHTHALMOLOGY
Cornea
Avascular
Corneal blink reflex:
Anesthesia:
Interstitial keratitis:
Corneal dystrophy
Inflammatory?
Progressive?
B/L?
Inherited?
Corneal investigations
Corneal infections
Hypopyon: Wesley’s ring Ring abscess Fluorescein + cobalt blue filter
Sterile, mobile- Satellite lesions H/o contact lens
Asterile, immobile- H/o trauma with misuse
vegetative matter
Pain:
2.5% phenylephrine:
Association:
Munson sign
Vogt’s striae
Fleischer ring
Rizutti sign Sclera
Oil droplet- Episclera
Tenon capsule
Scissoring- Conjunctiva
Extraconal space:
Intraconal space:
Keratoplasty
Kayes dots-Subepithelial
Khoda-daust line
KP
McCarey Kauffman medium
Visual field defects
Wernicke’s pupil
Light Reflex
Adie’s Tonic pupil Pharmacological
mydriasis
I/L Dilated pupil
Accommodation
0.125%
Pilocarpine
Optic atrophy
Sign Primary Secondary Consecutive
Multiple sclerosis
Previous swelling of No Preceded by long- No
Retrobulbar neuritis
the optic disc standing swelling of
the optic disc. Painful U/L LOV + No VFD
Disc colour Chalky white Grey Waxy pale Fundus normal
IOC:
Disc margins Distinct Blurred Normal, attenuated
arteries
Fibrosis (gliosis) of None Gliosis of the optic None
Papilledema
the disc nerve head
Cause • Compression of • Chronic • Chorioretinal Painless B/L
the optic nerve papilloedema disease e.g. VFD:
or chiasm • Papillitis retinitis
• Hereditary optic • Anterior pigmentosa
neuropathy ischemic optic • Central retinal
Altitudinal defects:
• Nutritional optic neuropathy artery occlusion
Glaucoma
atrophy
ON drusen
AION
Retina
Feature Direct Indirect (+20 Lens)
Magnification 14X 3X
Field diameter 2DD 9DD
Orientation of image Direct Inverted, reversed
View of periphery Limited Full
Stereopsis Absent Present
Blood supply:
Outer 4:
Inner 6:
Macular disorders
Photostress test Diagnosis-
Diagnosis- Layer-
R/F: Steroids / Type A personality Irvin Gass/ PG analogue/ DR / Uveitis/
RP/CRVO/ Niacin toxicity
BLOOD RETINAL BARRIER
OUTER : RPE (CSR)
INNER: CAPILLARY PERMEABILITY (CME)
Diabetic Retinopathy
Bevacizumab
Ranibizumab
Brolucizumab
ETDRS Aflibercept
MICROANEURYSM: Pegaptanib
Hemorrhages-Dot and bot:
HARD EXUDATES:
Flame shaped:
COTTON WOOL/ Soft exudates:
Screening-
Type 1
Type 2
Fundus spotters
SALU: S shaped deflection of veins
GUNN: Tapering of vein at either end
BONNET: Dilatation of vein at junction
Grade Mild generalized retinal arteriolar
1 narrowing
Grade Definite focal narrowing and
2 arteriovenous nipping
Grade Retinal hemorrhages, exudates and
3 cotton wool spots
Grade Severe grade 3 retinopathy plus
4 papilledema
AREDS2-
Vitamin C, E, Zn, Cu, Lutein,
Zeaxanthin
Rhegmatogeneous-
Trauma/myopia/surgery
“Curtain falling in front of eye”
Oguchi’s disease or congenital Exudative-
Docosahexanoic acid stationary night blindness:
decreased Mizuo-nakamura phenomenon Tractional-
Retinoblastoma
Sporadic: B/L-TOC:
Hereditary: CT VEC:
Familial Vincristine + Etoposide +
Non-familial Carboplatin
MC inheritance:
Gene:
Trilateral RB:
MC C/F-
IOC-
UVEITIS
Iris
Ciliary body-Pars plicata
Management:
Ciliary body-Pars plana
Choroid
Mutton fat-
Fine granular-
Pigmented- Amsler sign: Suiguira sign:
Stellate-
Conjunctiva
Toxins (e.g., Bacterial 5-14yrs boys
Limbus Stem cells
Apraclonidine) Allergic (e.g., Ropy discharge
ABCG2 , CD34
Viruses AKC, VKC) Cobblestone papilla
Deficiency:
COVID-19 Foreign Body Horner-Tranta dots
Chlamydia GPC Pseudogerontoxon
DOC:
NEONATAL CONJUNCTIVITIS
Type Onset age Treatment
Chemical <24 hr Eye lubricant
Gonococcal 2-5 days Ceftriaxone or cefotaxime
Angular conjunctivitis: Chlamydial 5-14 days Oral erythromycin
Trachoma
Surgery Antibiotics Facial Environmental
cleanliness change
Herbert pits:
Glaucoma
Angle Closure Glaucoma
AC:
Triad:
Glaucomflecken (anterior subcapsular opacity)
Iris atrophy
Pigment dispersion on endothelium
Management of ACG:
A
M
P
Surgery:
POAG:
Glaucoma-Instruments
Richardson/ Koeppe:
Earliest-
C: D ratio >0.3 Paracentral scotoma
Siedel’s scotoma
Bjerrum/ Arcute scotoma
Ring/Double arcuate
Roenne’s nasal step
Loss of central vision
Temporal crescent loss
Anti-Glaucoma Drugs
Decrease Aqueous Increase Trabecular Increase Uveoscleral
Production Outflow Outflow
Ocular Beta Blockers
Cholinomimetic Drugs PGF2∝ Analogues
1. Timolol
Pilocarpine 1. Lantanoprost
2. Betaxolol
2. Bimatoprost
3. Levobunolol
4. Carteolol
Nonselective Alpha Agonist Rho kinase inhibitor
Dipivefrine Netrasudil
Alpha-2 Agonist
1. Apraclonidine
2. Brimonidine
Carbonic Anhydrase Inhibitors
1. Acetazolamide
2. Brinzolamide
3. Dorzolamide
Cataract
Phacomorphic glaucoma
Polychromatic / Breadcrumb:
Phacolytic glaucoma
Glassblower’s cataract:
Phacotoxic glaucoma
Shield-like:
Phacoanaphylactic uveitis
Cataract
ECCE:
Conventional-
SICS-
Phacoemulsification-
MICS-
FLACS-
Intra-op:
1. Posterior capsular rupture +/- vitreous loss
2. UGH
3. Expulsive choroidal hemorrhage
4. Anterior capsule tear
Acute:
1. Iris prolapse
2. Endophthalmitis
3. TASS
Patellar fossa 4. Shallow AC
Refractive index-1.41 - 1.38- Chronic
Water soluble= crystallins 1. PCO
MC: Largest: 2. Irvin Gass syndrome
3. IOL displacement
HM1,2 – water soluble 4. Endophthalmitis: MCC early onset- Late onset-
INSTRUMENTS
Trypan blue:
Holladay / Hoffer Q/ SRKT
Myopic LASER: Haigis L
INSTRUMENTS
Lacrimal apparatus
Watering eye Tear film: Inner-
Middle-
Syringing and probing Outer-
Obstruction+ Obstruction- Dry eye
Hard stop: Jones dye test-1
Soft stop:
Opacify+ Opacify-
Jones dye
test-2
Opacify+ Opacify-
Congenital dacryocystitis: MCC:
Mx:
Trauma
Penetrating trauma-Ciliary
body
Granulomatous panuveitis Enucleation
Evisceration
Exenteration
Orbit
ORBITAL APEX SX CST
Proptosis:
NERVES
OPTHALMOPLEGIA
VISION LOSS
UL OR BL
Pulsatile:
Increases on bending/ Valsalva: CHEMOSIS,
Increases on crying: PROPTOSIS
Increases with URTI: ONSET
MCC of orbital mets:
Child-
Adult-
MC primary orbital tumor in child
Benign-
Malignant-
MC orbital tumor in adult
Benign-
Malignant-
EOM Actions
Muscle Nerve Supply Primary Action Secondary Tertiary Action
Action
MR - -
LR - -
SR
IR
SO
IO
SQUINT
HERRING:
SHERRINGTON:
Eso-
Exo-
Hyper-
Hypo-
2 > 1 deviation:
1= 2 deviation:
Ptosis + dilated pupil:
Ptosis + constricted pupil:
Ptosis + normal light reflex
Park 3 step test
“IGI and ITO”
Left hypertropia-Increases on right tilt and right gaze
Right hypotropia-Increases on left tilt and right gaze
Squint-Tests
REFRACTORY ERRORS
Axial length: Axial myopia:
AC: Curvature myopia:
Squint: Index myopia:
Positional myopia:
Axial length: Anisometropia:
AC: Tigroid appearance
Squint: Chorioretinal atrophy
Foster Fuch spots
Lacquer cracks
Rhegmatogenous RD
Post staphyloma
SNELLEN’S CHART:
Distance from chart-Nodal point:
Treatment : Angle subtended by topmost letter when viewed from 6m:
LASIK:
CI: <18yrs, unstable power, CT <450um
SMILE:
PRL:
ASTIGMATISM
180 90
-2cyl @180:
-1DS /-2DC @180
-3sph/ -4D cylindrical @90:
Community ophthalmology
School eye:
Done by:
Age:
Ratio:
Refer:
Miscellaneous
Blepharospasm
Lacrimation
Superotemporal: Photophobia
Inferonasal: Striae:
Microspherophakia: Corneal diameter>13mm Eye drop -> ointment
Clinical presentations-Localisation:
Gradual progressive painless DOV: GTCS
Sudden painful red eye + DOV:
Sudden painless DOV: Congenital ptosis:
Floaters: Poor LPS function-
Metamorphopsia: Good LPS function-
Absent lamina cribrosa
Retrodisplacement of
ON
Photocoagulation Photoablation Photodisruption Nd Glass (1053nm)
Double freq Nd-Yag (532nm) Argon fluoride Excimer Nd-Yag (1064nm)
Argon laser (193nm)
OPHTHAL PYQ
1. What is the most likely diagnosis in the image given
below?
A. Pterygium
B. Pinguecula
C. Dermoid
D. Dermolipoma
2. A 60-year-old female patient complaints of blurring of
vision and gives history of Diabetes for the past 10 years.
On examination findings as shown in image were seen. What
is the most likely diagnosis and treatment for the same.
A. Sunflower cataract with Lens
extraction
B. Rosette cataract with control of
blood sugar level
C. Immature cataract with
Phacoemulsification + IOL
implantation
D. Zonular Cataract with
Lensectomy
3. A patient has Bilateral right sided loss of vision. What is
the most likely site of lesion.
A. Left optic tract
B. Right optic tract
C. Optic chiasma
D. Optic radiation
4. What is the dye and filter used as seen in the image?
A. Fluorescein dye - visualised under
cobalt blue filter
B. Lissamine dye - green filter
C. Lissamine dye cobalt blue filter
D. Fluorescein dye - visualised under
green filter
5. A patient of HIV with low CD4 count presents with the
following finding. Which of the following is used in the treatment
of choice?
A. Acyclovir
B. Valacyclovir
C. Tenofovir
D. Ganciclovir
6. What dye is used in staining the anterior capsule of the
lens?
A. Fluorescein green
B. Trypan blue
C. Brilliant blue
D. Rose Bengal
7. In a patient presenting with recurrent chalazion, which
cancer is suspected?
A. Sebaceous cell carcinoma
B. Squamous cell carcinoma
C. Basal cell carcinoma
D. Kaposi’s sarcoma
8. What are the yoke muscles for levodepression?
A. R LR and LMR
B. R SR and LIR
C. R SO and LIR
D. R IO and LSO
9. A 60-year-old presents with chronic dacryocystitis.
What should be the treatment of choice?
A. Lacrimal sac massage
B. Syringing
C. Dacryocystorhinostomy
D. Probing
10. Which of the following type of cataract is seen in ocular blunt
trauma?
A. Toxic cataract
B. Metabolic cataract
C. Rosette cataract
D. Nuclear cataract
11. Shield ulcer is seen in:
A. Phlyctenular conjunctivitis
B. Spring catarrh
C. Atopic keratoconjunctivitis
D. Cataract
12. Curtain falling sign is indicative of: (FMGE JULY 2024)
A. Retinal detachment
B. Macular degeneration
C. Optic atrophy
D. Acute anterior uveitis
13. According to World Health Organization (WHO),
blindness is defined as: (FMGE JULY 2024)
A. VA < 3/60
B. VA < 6/60
C. VA > 3/60
D. VA > 6/60
14. Presence of different refractive powers (+5D in one eye and
+1D in the other eye) in a 10-year-old boy is suggestive of: (FMGE
JULY 2024)
A. Amblyopia
B. Anisometropic amblyopia
C. Malingering
D. Refractive errors
15. Local anesthesia used in cataract surgery is: (FMGE
JULY 2024)
A. Bupivacaine 0.5%
B. Lignocaine 2%
C. Prilocaine 0.5%
D. Ropivacaine 0.05%
16. A patient is prescribed a corrective lens with the following
prescription: -1D spherical, -2D cylinder at 180 degrees. What
type of refractive error is being corrected?
A. With the rule astigmatism
B. Against the rule astigmatism
C. Simple astigmatism
D. Mixed astigmatism
17. Which sequence of dyes is employed for ocular
surface examination and dry eye staining?
A. Fluorescein -Rose Bengal -Lisssamine green
B. Rose Bengal -Lisssamine green -Fluorescein
C. Lisssamine green -Rose Bengal -Fluorescein
D. Fluorescein -Lisssamine green -Rose Bengal
18. Which of these options are considered direct
gonioscopes?
1. Goldmann
2. Richardson
3. Zeis
4. Koeppe
A. 1, 3
B. 2, 4
C. 4
D. 1, 2, 3
19. Which of these statements is true regarding perimetry?
A. Kinetic perimetry is used in quantification and tracking of visual
changes in established glaucoma
B. In Static perimetry, stimulus intensity is held constant and moved
centrally with detection
C. Visual field defect to be classified as glaucoma, it should have the
corresponding optic nerve head abnormalities
D. Early signs include generalised constriction of isopters and
barring of blind spot
20. The vestibulo-ocular reflex (VOR) functions to stabilize
the image on the retina during head movement. What is the
ratio of eye velocity to head velocity, known as the VOR
gain?
A. 4
B. 2
C. 1
D. 3
21. Identify the condition given in the image.
A. Symblepharon
B. Ankyloblepharon
C. Congenital blepharophimosis
D. Congenital ptosis
22. Match the following:
1. Colour vision a. Applanation tonometer
2. Intraocular pressure b. Ishihara chart
3. Peripheral vision c. Tangent screen test
4. Central vision d. Perimetry
A. 1-d, 2-b, 3-a, 4-c
B. 1-a, 2-c, 3-d, 4-b
C. 1-b, 2-a, 3-d, 4-c
D. 1-d, 2-c, 3-a, 4-b
23. In which of the following is atropine contraindicated?
A. Acute congestive glaucoma
B. Acute anterior uveitis
C. Malignant glaucoma
D. Corneal ulcer
24. What event takes place when the retina is exposed to
light?
A. Hyperpolarization, increase in neurotransmitter release
B. Hyperpolarization, decrease in neurotransmitter release
C. Depolarization, decrease in neurotransmitter release
D. Depolarization, increase in neurotransmitter release
25. Which of the following is not a feature of keratoconus?
A. Haab's striae
B. Munson's sign
C. Irregular astigmatism
D. Scissoring reflex
26. A patient has presented for a routine eye evaluation. You
have checked his visual acuity using Snellen's chart and found it
to be 6/6. What is the minimum angle of resolution?
A. 15 minutes of arc
B. 5 minutes of arc
C. 10 minutes of arc
D. 20 minute of arc
27. Which of the following is not a feature of complicated
cataracts?
A. Krukenberg spindle
B. Polychromatic lusture
C. Occurs after uveitis
D. Breadcrumb appearance
28. Which of the following statement is incorrect about
Retinitis Pigmentosa? (INICET MAY 2024)
A. ERG shows decreased amplitude of a and b wave
B. Rod dystrophy > Cone dystrophy
C. Late presentation is loss of peripheral vision
D. Night blindness is a late feature
29. All the following are functions of the superior oblique
muscle except?
A. Adduction
B. Abduction
C. Depression
D. Intorsion
30. A patient presents with vision problem in his right eye.
On examination IOP of his right eye is 50 mmHg and left
eye is 16 mm Hg. Slit lamp examination shows presence of
flare cells in anterior chamber and cataractous lens in the
right eye. What is the diagnosis of this condition? (INICET
MAY 2024)
A. Phacolytic glaucoma
B. Malignant glaucoma
C. Fuch heterochromic iridocyclitis
D. Phacomorphic glaucoma
THANK YOU
