ONE SHOT OPHTHALMOLOGY

By Dr. Niha Aggarwal

Compiled by
Rohan Hake
Seth GS Medical college &
KEM hospital, Mumbai
9561983020
DISCLAIMER

The images mentioned in the file may be taken from open internet network
available like google, youtube, linkedin etc and in no way anyone is
claiming these to be my original patients. These are solely taken up from
internet for the purpose of academics and to explain common conditions
to the students.

This work will be purely utilised only for academics explanation of the
content and in no way it is a commercial activity.
INDEX
1. Visual Acuity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

2. Lens . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

3. Glaucoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27

4. Retina . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49

5. Cornea . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81

6. Sclera. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93

7. Trauma. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99

8. Previous Years Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 113

 BOOK
VISuAL ACuITY
[Link]

Chapter
Visual Acuity
01
Mc used - Snellen’s chart
Normal visual acvity = 6/6

Patient stands at 6 meters or 20 feet

7
6& Patient is standing at a distance of 6 meters
60T

Distance from which normal can read this letter

1
60 Minimum visual acvity recorded by snellen’s chart
V

Finger counting at 1 meter

Finger counting near face

Hand movement

Perception of light

Positive Negative
W ~

Check projection of rays Absolutely blind

Superior

Nasal Temporal

Inferior

Arc of 1 minute

Vo Arc of 5 minutes MAR Minimum angle of resulution

-(
Nodal point
6 meter testing distance

Each letter substends angle of 5 minutes of the arc at the respective distance

Eg : 6/60 = this will make an angle of 5 minutes at 60 meters

6/36 = this will make an angle of 5 minutes at 36 meters

What is angle substended by top most letter at 6 meters

Ans : 5 minutes at 60 meters
Superior oblique
hence 5 x 10 = 50 minutes of the arc at 6 meters
muscle (IV) [Intorsion
and depression in
Trochea adduction]

Tendon of superior oblique

Trick : Divide by 6 and multiply by 5
Superior rectus
muscle (Ⅲ)
[Elevation] Lateral
rectus muscle

5
(VI) [Abduction]

Medial NEET PG / INI-CET WORKBOOK BY DR. NIHA AGGARWAL

rectus muscle (Ⅲ)
[Adduction]

Inferior rectus
muscle III (Depression)
ONE SHOT OPHTHALMOLOGY
[Link]

For illiterates
E chart or C chart

Landott’s C chart / broken wheel chart

Superior oblique
muscle (IV) [Intorsion
and depression in
Trochea adduction]

Tendon of superior oblique

Superior rectus
muscle (Ⅲ)
[Elevation] Lateral
rectus muscle

6
(VI) [Abduction]

NEET PG / INI-CET WORKBOOK BY DR. NIHA AGGARWAL Medial

rectus muscle (Ⅲ)
[Adduction]

Inferior rectus
muscle III (Depression)
 BOOK
VISuAL ACuITY
[Link]

E EE E E

Simple picture chart

t For 2-5 yrs of child

Eye all
t

Optokinetic nystagmus drum

For 1-2 yrs child

If child has vision

W

Induce physiological nystagmus

If child is < 1 yr : we use ERG (Electroretinography)

Superior oblique
muscle (IV) [Intorsion
and depression in
Trochea adduction]

Tendon of superior oblique

Superior rectus
muscle (Ⅲ)
[Elevation] Lateral
rectus muscle

7
(VI) [Abduction]

Medial NEET PG / INI-CET WORKBOOK BY DR. NIHA AGGARWAL

rectus muscle (Ⅲ)
[Adduction]

Inferior rectus
muscle III (Depression)
NOTES
 BOOK
LENS
[Link]

Chapter
Lens
02
Avascularity
Anterior capsule
Lens gets nutrition from Aqueous humor
Anterior epithelium
But no posterior epithelium
Biconvex shape
RI : 1.39 C
Cortex Bioconvex in adults But Spherical at birth

Adult
Nucleus

Infantile
Crystalline nature
oetal

Embryonic
Crystallins : It contains sequestered antigens

RI : 1.42

....
Alpha Beta Gamma
Largest size MC = 55%
Concentric
lamellar layers
Diamond shape
Relatively dehydrated state
MIP 26 : for transperancy

Congenital cataract

Mc Blue dot cataract /

Punctate cataract

Not visually significant

Superior oblique
muscle (IV) [Intorsion
and depression in
Trochea adduction]

Tendon of superior oblique

Superior rectus
muscle (Ⅲ)
[Elevation] Lateral
rectus muscle

9
(VI) [Abduction]

Medial NEET PG / INI-CET WORKBOOK BY DR. NIHA AGGARWAL

rectus muscle (Ⅲ)
[Adduction]

Inferior rectus
muscle III (Depression)
 ONE SHOT OPHTHALMOLOGY
[Link]

Zonular / Lamellar cataract

MC congenital cataract which is visually significant

Etiology &
Autosomal dominant
>
Hypocalcemia / def of Vit D
>
Meternal Rubella especially in 7-8th week of gestation

S
Resemble spokes of wheel known as Riders

Congenital Rubella syndrome TRIAD

~ ~ ~

Eye Heart Ear

W S

1. Congenital cataract Sensory neural hearing loss

L
MC : PDA
(MC - Nuclear pearly ) Ventricular septal defect
2. Salt & paper retinitis Pulmonic stenosis
3. Microphthalmos ASD is not seen

Anterior Slit lamp

1

>
Posterior Onion peel / ring appearance
C
O Posterior polar cataract
R
Posterior
Lens

N >

E pole
A ↑

Superior oblique
muscle (IV) [Intorsion
and depression in
Trochea adduction]

Tendon of superior oblique

Superior rectus
muscle (Ⅲ)
[Elevation] Lateral
rectus muscle

10
(VI) [Abduction]

NEET PG / INI-CET WORKBOOK BY DR. NIHA AGGARWAL Medial

rectus muscle (Ⅲ)
[Adduction]

Inferior rectus
muscle III (Depression)
 BOOK
LENS
[Link]

Mature senile cataract

Pearly white cataract
No irish shadow

Leucocoria (D/D)

Stages of maturation of cortical cataract

1. Lamellar separation
2. Early cataract :- Uniocular polyopia
3. IMSC : Irish shadow & Greish white colour
4. MSC :- DOV & Prearly white colour
5. Hyper MSC : chalky white colour

&
Immature senile cataract
Irish shadow present
Greyish white cataract
Irish shadow present

Patient can have Phacomorphic glaucoma

S
Oblique light

C I ~
--
-- Formation of iris shadow
& - V

Shadow of iris on IMSC seen through clear cortex

Swollen lens in IMSC

Trochea
Superior oblique
!
In
Normal outflow
muscle (IV) [Intorsion
and depression in
un
Swollen Lens due to continuous overhydration

W
W

Obstruction in aqueous outflow

Increase in intraocular pressure

Symptoms
• Coloured haloes
• Frequent change of glasses
Coloured halos : D/D
• IMSC
• ACG
• Acute mucopurulent conjuctivitis
adduction]

Tendon of superior oblique

V

Phaco morphic glaucoma Aka Intumescent cataract

Superior rectus

Lens
L
muscle (Ⅲ)
[Elevation] Lateral
S
Morphology
rectus muscle

11
(VI) [Abduction]

Medial NEET PG / INI-CET WORKBOOK BY DR. NIHA AGGARWAL

rectus muscle (Ⅲ)
[Adduction]

Inferior rectus
muscle III (Depression)
ONE SHOT OPHTHALMOLOGY
[Link]

Cuneiform cataract
~MC in senile cataract
Form periphery towards centre

Mostly peripheral part is involved

N ~

Night blindness

Golden brown pigment in nucleus

M

Nuclear sclerosis

Cornea
-

( -
Lense >
Golden brown colour
pigment deposition

Nuclear sclerosis

MC presenting feature : Frequent change of distant glasses

Increase in Refractive Index in nuclear sclerosis: Myopia

Cortical cataract : over hydration > Softening

~

Decrease in Refractive Index

V

Hypermetropia Superior oblique

muscle (IV) [Intorsion
and depression in
Trochea adduction]

Tendon of superior oblique

Myopia - - Hypermetropia [
Superior rectus
muscle (Ⅲ)
[Elevation] Lateral
rectus muscle

12
(VI) [Abduction]

NEET PG / INI-CET WORKBOOK BY DR. NIHA AGGARWAL Medial

rectus muscle (Ⅲ)
[Adduction]

Inferior rectus
muscle III (Depression)
 BOOK
LENS
[Link]
Morgagnian
. Morgagnian Sclerotic hyper mature senile cataract
Proteins

Proteins
Nucleus

Nucleus

Hyper mature senile cataract

Chalky white or milky white

W W

Morgagnian Sclerotic

·
Lysis of cortex proteins with intact capsule
.
Trabecular meshwork Passing through the capsule into aqueous humor
ing

90% outflow
ak

V
Le

Blocking trabecular meshwork

Anterior chamber

Posterior chamber

Decrease in aqueous outflow

Phaco lytic glaucoma or lens protein glaucoma

Sclerotic hyper mature senile cataract

Disintegration of cortex ( fluid comes out )

Shrinkage of lens

Degeneration of ciliary zonules

Subluxation of lens ( partial displacement )

> Also known as Phacodonesis ( trembling of lens )
W V

Anterior subluxation Posterior subluxation

V ~

Displace into anti chamber Dissolve into vitreous cavity

~ ~

Block aqueous outflow No glaucoma

Superior oblique
muscle (IV) [Intorsion
and depression in
Trochea adduction] ~

Tendon of superior oblique

Glaucoma known as Phaco topic Glaucoma
Superior rectus
muscle (Ⅲ)
[Elevation] Lateral
Lens E >
Position
rectus muscle

13
(VI) [Abduction]

Medial NEET PG / INI-CET WORKBOOK BY DR. NIHA AGGARWAL

rectus muscle (Ⅲ)
[Adduction]

Inferior rectus
muscle III (Depression)
ONE SHOT OPHTHALMOLOGY
[Link]

Causes of osterior Complicated cataract

subcapsular cataract 1. Bread crumb app
I ot A SC 2. Seen after Chronic Anterior uveitis
3. Polychromatic lustre
loni in radiation
lass blo er s cataract Due to infra Red radiation Christamas tree cataract
Atopic dermatitis Shield cataract 1. Found in myotonic dystrophy
usulfan 2. Frontal baldness
Steroids 3. Heart conduction defect
Chloroquine 4. Hatchet facies : Atrophy of temporal muscles
Complicated cataract 5. Bitemporal bossing
Christmas tree cataract 6. Gynaecomstia
7. Percussion myotonic reaction

Plaque like opacity Cupuliform cataract

MC in other acquired cataract
W Posterior subcapsular cataract
Starting from centre of posterior
cortex towards equator

N ⑪
~

Central part is affected

L
W

- Day blindness
- Early loss of vision

Superior oblique
muscle (IV) [Intorsion
and depression in
Trochea adduction]

Tendon of superior oblique

Superior rectus
muscle (Ⅲ)
[Elevation] Lateral
rectus muscle

14
(VI) [Abduction]

NEET PG / INI-CET WORKBOOK BY DR. NIHA AGGARWAL Medial

rectus muscle (Ⅲ)
[Adduction]

Inferior rectus
muscle III (Depression)
 BOOK
LENS
[Link]

Rosette cataract
• Star shaped cataract
• MCC : blunt trauma

Sunflower cataract
• MCC : Penetrating trauma
• Wilson’s disease
• Chalcosis due to Cu deposition

Superior oblique
muscle (IV) [Intorsion
and depression in
Trochea adduction]

Tendon of superior oblique

Superior rectus
muscle (Ⅲ)
[Elevation] Lateral
rectus muscle

15
(VI) [Abduction]

Medial NEET PG / INI-CET WORKBOOK BY DR. NIHA AGGARWAL

rectus muscle (Ⅲ)
[Adduction]

Inferior rectus
muscle III (Depression)
 ONE SHOT OPHTHALMOLOGY
[Link]

&
S
First occurs in superior and inferior
quadrants and later forms ring

Associated with patients having neurological involvement : 95-100 %

Also associated with hepatic involvement : 65%
Only reversible cataract : Galactocemic cataract
> Sunflower cataract is not reversible but K F ring is reversible

Wilson’s disease
Inborn error of copper metabolism : deficiency of ceruloplasmin
Associated with hepato lenticular degeneration
Low levels of ceruloplasmin which then lead to Charcosis ( copper deposition in alloy form )
v

Sunflower cataract

MC ocular feature of Wilson’s disease : K F ring (Kayser Fleicher ring)

Deposition in descements membrane of cornea
Golden brown in colour seen through cobalt blue filter ( slit lamp)
Reversible on treatment with D- pencillamine

Snow flake cataract

Premature senile cataract
• Myotonic dystrophy
• Atopic dermatitis
• DM

Gradual painless progressive diminution of vision

• Cataract
• POAG

Diabetic cataract
-

W
W

Pre senile : MC True metabolic ( rate but specific )

W
W

Senile cataract at younger age ( 50 years ) Due to enzyme : Aldol reductase

V
S
Etiology DM - glycemic and products > Sorbitol pathway
=
>
Diabetic V

> Atopic dermatitis Snow flake cataract

> Myotonica dystrophica
Superior oblique

MC symptom : Fluctuations of refraction errors due to changes in muscle (IV) [Intorsion

and depression in
Trochea adduction]

glycemic index of patient within 24 hrs Tendon of superior oblique

Myopia HRM Superior rectus

muscle (Ⅲ)
[Elevation] Lateral
rectus muscle

16
(VI) [Abduction]

NEET PG / INI-CET WORKBOOK BY DR. NIHA AGGARWAL Medial

rectus muscle (Ⅲ)
[Adduction]

Inferior rectus
muscle III (Depression)
 BOOK
LENS
[Link]

Classical galactocemia

Due to deficiency of Gal-1-phosphate uridyl transferase

Oil droplets cataract

+
Systemic features
>
Due to cerebral hypoglycaemia
W

Leucocoria with convulsions, diarrhea, vomiting

( intolerance ), failure to thrive, hepatospleenomegaly
Bilateral Cataract + Convulsions

Non classical Galactocemia

Oil droplet cataract W

Due to deficiency of Galactokinase

↓
Only reversible cataract W

Lamellar cataract

Leucocoria + Seizures (D/D)

• Congenital Toxoplasma
• Lowe’s syndrome

Iridodialysis
-
> D shaped pupil
Iris L
Detachment from its root

Root of iris
>
W

>
Margins of iris

I
Ca

Iridodialysis
• Injury to Iris
• Complication of cataract surgery

Superior oblique
muscle (IV) [Intorsion
and depression in
Trochea adduction]

Tendon of superior oblique

Superior rectus
muscle (Ⅲ)
[Elevation] Lateral
rectus muscle

17
(VI) [Abduction]

Medial NEET PG / INI-CET WORKBOOK BY DR. NIHA AGGARWAL

rectus muscle (Ⅲ)
[Adduction]

Inferior rectus
muscle III (Depression)
 ONE SHOT OPHTHALMOLOGY
[Link]

Hypopyon
Pus in Anterior chamber

Seen in
• Bacterial ulcer
• Fungal ulcer
• Bacterial enophthalmitis

Hooks M

aptics aptics

IOL
Best site : Posterior capsule
Refractive
Optic one Optic one
Surface Power of IOL
• Calculated byBiometer
• SRK Formula
• Axial length : A scan
• Corneal curvature : Keratometer

Cornea Sclera
L L

h
7 Calculated by keratometer

1. SRK formula P = A - 2.5L - 0.9K Corneal curvature

7

Power L >
Axial length
-
IOL constant
Calculated by A Scan ultrasound M

J
Amplitude (1-D USG )

Superior oblique
muscle (IV) [Intorsion
and depression in

2. SRK II formula for very high axial length Trochea adduction]

Tendon of superior oblique

Superior rectus
muscle (Ⅲ)
[Elevation] Lateral
rectus muscle

18
(VI) [Abduction]

NEET PG / INI-CET WORKBOOK BY DR. NIHA AGGARWAL Medial

rectus muscle (Ⅲ)
[Adduction]

Inferior rectus
muscle III (Depression)
 BOOK
LENS
[Link]

Iris prolapse due to high Intra ocular pressure

Change the shape of pupil

W
Peaked pupil

Normal IOP : 11-21 mmHg

W

To reduce the complication anti glaucoma drugs are given

Eg : Acetazolamide : DIMOX
250mg x 2 H/S
2 tablet x morning

Anterior capsulectomy > Trypan blue dye is used

v V

Circular curvilinear capsulorrhexis

Can opener technique
O Preferred

Superior oblique
muscle (IV) [Intorsion
and depression in
Trochea adduction]

Tendon of superior oblique

Superior rectus
muscle (Ⅲ)
[Elevation] Lateral
rectus muscle

19
(VI) [Abduction]

Medial NEET PG / INI-CET WORKBOOK BY DR. NIHA AGGARWAL

rectus muscle (Ⅲ)
[Adduction]

Inferior rectus
muscle III (Depression)
 ONE SHOT OPHTHALMOLOGY
[Link]

Can opener technique

ACTION RIMAR SECONDAR TERTIAR

MR ADD CTION
LR A D CTION
SR ELEVATION INTORSION ADD CTION
IR DE RESSION E TORSION ADD CTION
SO INTORSION DE RESSION A D CTION
IO E TORSION ELEVATION A D CTION
Hyphema
rom face
Blood in Anterior chamber

rom retina

Strea re ex ith movement A ainst movement

Superior oblique
muscle (IV) [Intorsion
and depression in
Trochea adduction]

Tendon of superior oblique

Superior rectus
muscle (Ⅲ)
[Elevation] Lateral
rectus muscle

20
(VI) [Abduction]

NEET PG / INI-CET WORKBOOK BY DR. NIHA AGGARWAL Medial

rectus muscle (Ⅲ)
[Adduction]

Inferior rectus
muscle III (Depression)
 BOOK
LENS
[Link]

Elschnig Pearls cataract PCO : Posterior Capsular Opacification

Vacuolated cells present due to proliferation of LEC ( lens epithelial cells )
( equatorial cells of anterior epithelium.

"
Diminution of vision

Therefore know as after cataract or secondary cataract

Treatment is same - laser posterior capsulectomy

Opening in posterior capsule
Nd:YAG
1064 nm
MOA : Photo disruption

PCO : Posterior Capsular Opacification

Treatment

:
Sommering’s Ring cataract Elschnig Pearls cataract
Soemmering’s Ring cataract

Opening
Vacuolated cells

Elschnig Pearls cataract

Sommering’s Ring cataract

Sommering’s Ring cataract

Superior oblique
muscle (IV) [Intorsion
and depression in
Trochea adduction]

Tendon of superior oblique

Superior rectus
muscle (Ⅲ)
[Elevation] Lateral
rectus muscle

21
(VI) [Abduction]

Medial NEET PG / INI-CET WORKBOOK BY DR. NIHA AGGARWAL

rectus muscle (Ⅲ)
[Adduction]

Inferior rectus
muscle III (Depression)
ONE SHOT OPHTHALMOLOGY
[Link]

Ectopia Lentis
• Abnormal position of Lens
• MCC : Trauma
• MC congenial Anomaly : Marfans’s syndrome

A. Marfan’s syndrome (AD) : fibrillin gene defect

• Superio temporal subluxation
• Aortic regurgitation

B. Homocysteinuria (AR )
• Inferionasal subluxation
• Due to deficiency of Cystathione synthase enzyme
• Rx : Vit B6

C. Ehler- Danlos syndrome

• Subluxation
• Blue sclera

D. Weil- Marchesani syndrome

• Anterior + inferior
• Micro sphero Phacia (Small spherical lens)
• Short and stout fingers (Brachyductyly)
• Short stature

Christmas tree cataract

• Polychromatic needle crystals
• Posterior subcapsular cataract

Christamas tree cataract

1. Found in myotonic dystrophy
2. Frontal baldness
3. Heart conduction defect
4. Hatchet facies : Atrophy of temporal muscles
5. Bitemporal bossing
6. Gynaecomstia
7. Percussion myotonic reaction

Superior oblique
muscle (IV) [Intorsion
and depression in
Trochea adduction]

Tendon of superior oblique

Superior rectus
muscle (Ⅲ)
[Elevation] Lateral
rectus muscle

22
(VI) [Abduction]

NEET PG / INI-CET WORKBOOK BY DR. NIHA AGGARWAL Medial

rectus muscle (Ⅲ)
[Adduction]

Inferior rectus
muscle III (Depression)
 BOOK
LENS
[Link]

Endophthalmitis
Chec the visual acuity and then plan treatment accordin ly

If vision is MC If vision is only L

proceed for vitreous then patient should be If no li ht perception then
samplin by tap for ta en up for vitrectomy no sur ical intervention or
microbiolo y and ith IV antibiotics evisceration of developin
intracanithal in ection panophthalmitis
of antibiotics

After hours chec the vision and if there is no improvement proceed for repeat
vitreous tap for infection

If there is no improvement after intravitreal in ections proceed for vitrectomy

Shield cataract

Shield cataract
Atopic dermatitis

Shield ulcer Shield ulcer

VKC / Spring cataract

Superior oblique
muscle (IV) [Intorsion
and depression in
Trochea adduction]

Tendon of superior oblique

Superior rectus
muscle (Ⅲ)
[Elevation] Lateral
rectus muscle

23
(VI) [Abduction]

Medial NEET PG / INI-CET WORKBOOK BY DR. NIHA AGGARWAL

rectus muscle (Ⅲ)
[Adduction]

Inferior rectus
muscle III (Depression)
ONE SHOT OPHTHALMOLOGY
[Link]

Anterior Surface of lens Anterior polar cataract

" C
O
R
Anterior polar cataract
N
E
A

Anterior Surface Anterior lenticonus

Alport syndrome

&
C
O
R
N
E
A

Superior oblique
muscle (IV) [Intorsion
and depression in
Trochea adduction]

Tendon of superior oblique

Superior rectus
muscle (Ⅲ)
[Elevation] Lateral
rectus muscle

24
(VI) [Abduction]

NEET PG / INI-CET WORKBOOK BY DR. NIHA AGGARWAL Medial

rectus muscle (Ⅲ)
[Adduction]

Inferior rectus
muscle III (Depression)
 BOOK
LENS
[Link]

Posterior lenticonus
• Lowe’s syndrome
-
Posterior Surface

Superior oblique
muscle (IV) [Intorsion
and depression in
Trochea adduction]

Tendon of superior oblique

Superior rectus
muscle (Ⅲ)
[Elevation] Lateral
rectus muscle

25
(VI) [Abduction]

Medial NEET PG / INI-CET WORKBOOK BY DR. NIHA AGGARWAL

rectus muscle (Ⅲ)
[Adduction]

Inferior rectus
muscle III (Depression)
NOTES
 BOOK
GLAuComA
[Link]

Chapter
Glaucoma
03
roup of Eye Diseases
inside the eye OD changes
Nerve fibre layer of retina
INTRAOC LAR
Optic atrophy : Ganglionic cell death
ERTENSION Optic Nerve
Dama ed hence irreversible vision loss
>21 mmHg

lindness

V Ds

Visual field defects

Angle of Anterior chamber

5 structures
1. Root of Iris
2. Ciliary body band
3. Scrotal scleral spur
4. Trabecular meshwork
VI
III
II I
5. Schwalbe’s line
SL
TM
Angle is visualised by Gonioscope (slit lamp)
SS

C If all structures are visible on gonioscopy

ROI Open angle : Open angle glaucoma

If no structures are visible on Gonioscopy

Closed angle : Angle closure glaucoma

Shaffer’s classification ( based on gonioscopic findings )

Grades No of structures visible

IV 4 - CCB, SS, TM, SL - Open angle

III 3 - SS, TM, SL - Mild closure

II 2 - TM & SL - moderate closure

Superior oblique
muscle (IV) [Intorsion I 1 - SL only - Severe closure
and depression in
Trochea adduction]

Tendon of superior oblique

0 No structures visible - Total closure

Superior rectus
muscle (Ⅲ)
[Elevation] Lateral
rectus muscle

27
(VI) [Abduction]

Medial NEET PG / INI-CET WORKBOOK BY DR. NIHA AGGARWAL

rectus muscle (Ⅲ)
[Adduction]

Inferior rectus
muscle III (Depression)
 ONE SHOT OPHTHALMOLOGY
[Link]
p n n l la oma ost ommon
Trabecular meshwork block radual ressure
Slo Clo in Increase rain

Optic
Nerve

Initially
Outer Rim Atrophy 3 Rods 3
Night blindness

eripheral Vision
An le Open
Loss

Risk factors for POAG

1. Age >60 years, male = female
Association of POAG
2. Hereditary, Genes 3
Optineurin Chromosome no 1 1. High myopia (deeper AC)
> Myocillin -

2. Retinitis Pigmentosa
3. Diabetes, hypertension, thyrotoxicosis 3. Fuch’s Endothelial dystrophy
4. Myopia ( deeper anterior chamber ) 4. CRVD
5. Cigarette smoking 5. Primary retinal detachment
6. Retinal vascular diseases
7. Steroid responders

Buphthalmos
Male child
Blepharospasm
Photophobia
Lacrimation
Hazy cornea : Frosted glass appearance
Blue sclera
Megalocornea : >13 mm
Axial myopia : Anisometric amblyopia
Habb’s striae : Horizontal

Superior oblique
muscle (IV) [Intorsion
and depression in
Trochea adduction]

Tendon of superior oblique

Superior rectus
muscle (Ⅲ)
[Elevation] Lateral
rectus muscle

28
(VI) [Abduction]

NEET PG / INI-CET WORKBOOK BY DR. NIHA AGGARWAL Medial

rectus muscle (Ⅲ)
[Adduction]

Inferior rectus
muscle III (Depression)
 BOOK
GLAuComA
[Link]

Habb’s striae

oli ati
oli ati
ia tiia ti
tinopath
tinopath

no mal
no mal
ss ls ss ls

Vogt's Striae & Haab's Striae

o t s o t tias t iaaa s aat ias t ia

o t s o t tias t ia aa s aat ias t ia

Seen in keratoconus

Vogt’s striae : Vertical

Habb’s striae : Horizontal

Superior oblique
muscle (IV) [Intorsion
and depression in
o t s o t tias t ia
Trochea adduction]

Tendon of superior oblique OccurOccur

centrally
centrally
in in
a patient
a patient
ith ith
Superior rectus
muscle (Ⅲ) eratoconus
eratoconus
[Elevation] Lateral

Vertical
Vertical
stromal
stromal
rectus muscle

29
(VI) [Abduction]

Medial NEET PG / INI-CET WORKBOOK

Descemet sBY DR.
Descemet s NIHA AGGARWAL
rectus muscle (Ⅲ)
[Adduction]
membrane
membrane
lines lines
Inferior rectus StressStress
lines due
linestodue to
muscle III (Depression)
stretchin
stretchin
and and
ONE SHOT OPHTHALMOLOGY
[Link]

Buphthalmos
Male child
Blepharospasm
Photophobia
Lacrimation
Hazy cornea : Frosted glass appearance
Blue sclera
Megalocornea : >13 mm
Axial myopia : Anisometric amblyopia
Habb’s striae : Horizontal

E E

Constriction of peripheral visual field : Tunnel vision

Superior oblique
muscle (IV) [Intorsion
and depression in
Trochea adduction]

Tendon of superior oblique

Superior rectus
muscle (Ⅲ)
[Elevation] Lateral
rectus muscle

30
(VI) [Abduction]

NEET PG / INI-CET WORKBOOK BY DR. NIHA AGGARWAL Medial

rectus muscle (Ⅲ)
[Adduction]

Inferior rectus
muscle III (Depression)
 BOOK
GLAuComA
[Link]

Schiotz indentation tonometer (mc)

Probe of Goldman’s Applanation Tonometer

Superior oblique
muscle (IV) [Intorsion
and depression in
Trochea adduction]

Tendon of superior oblique

Superior rectus
muscle (Ⅲ)
[Elevation] Lateral
rectus muscle

31
(VI) [Abduction]

Medial NEET PG / INI-CET WORKBOOK BY DR. NIHA AGGARWAL

rectus muscle (Ⅲ)
[Adduction]

Inferior rectus
muscle III (Depression)
 ONE SHOT OPHTHALMOLOGY
[Link]

Goldman’s Applanation Tonometer

Principle of GAT
Probe
IMBERT FICK’s law

Force
Pressure =
Area

Fixed area tonometer

> 3.06 mm diameter of cornea
mm
Diameter or variable force tonometer
Circle of contact
Optical Endpoint .. P X
F
or P = F x 10 = IOP
Mires & Touching inner ends
mm of Hg L S
In grams
11 -T
S 0.2-0.3 mm

Stain : Fluorocein stain with

cobalt blue filter
Superior oblique
muscle (IV) [Intorsion
and depression in
Trochea adduction]

Dial reading greater Dial reading less than Dial reading equals Tendon of superior oblique

than pressure of globe pressure of globe to pressure of globe

Superior rectus
muscle (Ⅲ)
[Elevation] Lateral
rectus muscle

32
(VI) [Abduction]

NEET PG / INI-CET WORKBOOK BY DR. NIHA AGGARWAL Medial

rectus muscle (Ⅲ)
[Adduction]

Inferior rectus
muscle III (Depression)
 BOOK
GLAuComA
. [Link]

Mires > Touching inner ends

I I -T

S 0.2-0.3 mm

Dial reading greater Dial reading less than Dial reading equals
than pressure of globe pressure of globe to pressure of globe

Circum Corneal Con unctival - Deeper inflammation in acute red eye

Con estion In
veitis AC laucoma

Acute red eye

• Uveitis
• Acute congestive glaucoma

Superior oblique
muscle (IV) [Intorsion
and depression in
Trochea adduction]

Tendon of superior oblique

Superior rectus
muscle (Ⅲ)
[Elevation] Lateral
rectus muscle

33
(VI) [Abduction]

Medial NEET PG / INI-CET WORKBOOK BY DR. NIHA AGGARWAL

rectus muscle (Ⅲ)
[Adduction]

Inferior rectus
muscle III (Depression)
 ONE SHOT OPHTHALMOLOGY
[Link]

Ahmed glaucoma valve

Made up of Latex
Seton surgery

Glaucoma drainage device

h E E ini la oma h nt

Spur ac plate
revents revents
device device
extrusion intrusion Glaucoma drainage device
eveled Tip Made up of stainless steel
Enables precise and
controlled insertion

Relief ort
Allo s uninterrupted
aqueous human o

Total span mm

Superior oblique
muscle (IV) [Intorsion
and depression in
Trochea adduction]

Tendon of superior oblique

Superior rectus
muscle (Ⅲ)
[Elevation] Lateral
rectus muscle

34
(VI) [Abduction]

NEET PG / INI-CET WORKBOOK BY DR. NIHA AGGARWAL Medial

rectus muscle (Ⅲ)
[Adduction]

Inferior rectus
muscle III (Depression)
 BOOK
GLAuComA
[Link]

Acute congestive glaucoma

• Mid dilated pupil
• Hazy cornea

Vogt’s triad
1. Patches of iris atrophy
2. Glaucoma flackens (anterior
subcapsular cataract)
3. Pigments on corneal epithelium

Surgical peripheral iridectomy

Superior oblique
muscle (IV) [Intorsion
and depression in
Trochea adduction]

Tendon of superior oblique

Superior rectus
muscle (Ⅲ)
[Elevation] Lateral
rectus muscle

35
(VI) [Abduction]

Medial NEET PG / INI-CET WORKBOOK BY DR. NIHA AGGARWAL

rectus muscle (Ⅲ)
[Adduction]

Inferior rectus
muscle III (Depression)
ONE SHOT OPHTHALMOLOGY
[Link]

Laser iridotomy

Rubeosis iriditis
Neovascular glaucoma
Secondary ACG
AKA 100 day glaucoma in CRVO

Superior oblique
muscle (IV) [Intorsion
and depression in
Trochea adduction]

Tendon of superior oblique

Superior rectus
muscle (Ⅲ)
[Elevation] Lateral
rectus muscle

36
(VI) [Abduction]

NEET PG / INI-CET WORKBOOK BY DR. NIHA AGGARWAL Medial

rectus muscle (Ⅲ)
[Adduction]

Inferior rectus
muscle III (Depression)
 BOOK
GLAuComA
[Link]

Pseudo Exfoliation syndrome

Dandruff like debris in trabecular meshwork

MC secondary open angle glaucoma

Pseudo Exfoliation syndrome

Dandruff like debris in trabecular meshwork

MC secondary open angle glaucoma

Superior oblique
muscle (IV) [Intorsion
and depression in
Trochea adduction]

Tendon of superior oblique

Superior rectus
muscle (Ⅲ)
[Elevation] Lateral
rectus muscle

37
(VI) [Abduction]

Medial NEET PG / INI-CET WORKBOOK BY DR. NIHA AGGARWAL

rectus muscle (Ⅲ)
[Adduction]

Inferior rectus
muscle III (Depression)
 ONE SHOT OPHTHALMOLOGY
[Link]

Pigmentory glaucoma
Krukenburg spindles
Secondary open angle glaucoma

UVEITIS
ars plana sclera choroid retina

Eyelids

Comea Optic
nerve
Ins
Lens
pupil

Anterior chamber
osterior chamber

Ciliary body
vitreous

Con uctiva

Anterior Intermediate osterior

Pan uveitis : while uveal tract is involved

- W
-
Iris + pars plicata Pars plana choroid + retina
Superior oblique
muscle (IV) [Intorsion
~ V
~ and depression in
Trochea adduction]

Iridocyclitis Pars planitis Chorioretinitis Tendon of superior oblique

Superior rectus
muscle (Ⅲ)
[Elevation] Lateral
rectus muscle

38
(VI) [Abduction]

NEET PG / INI-CET WORKBOOK BY DR. NIHA AGGARWAL Medial

rectus muscle (Ⅲ)
[Adduction]

Inferior rectus
muscle III (Depression)
 BOOK
GLAuComA
[Link]

upillary mar in iris

Parts of CB
asal
(peripheral) iris
Cornea
ectinate
li aments
Anterior chamber

osterior
chamber Sclerociliary
cleft

onules

ars plicata ciliaris Rough Anterior part : 2 mm

ars plana ciliaris Smooth posterior part : 4 mm

Ora ciliaris retinae

Structure : collaratte pattern

( resemble spokes of wheel appearance ) [
Normal colour: Dark brown

Collarette
-

Iris

IL ( mm)

upillary one

Ciliary one

Superior oblique
muscle (IV) [Intorsion
and depression in
Trochea adduction]

Tendon of superior oblique

Superior rectus
muscle (Ⅲ)
[Elevation] Lateral
rectus muscle

39
(VI) [Abduction]

Medial NEET PG / INI-CET WORKBOOK BY DR. NIHA AGGARWAL

rectus muscle (Ⅲ)
[Adduction]

Inferior rectus
muscle III (Depression)
 ONE SHOT OPHTHALMOLOGY
[Link]

Anterior ciliary art

Sclera erichoroidal
space
Blood supply

Lon
posterior

·
W

Major arterial circle Minor arterial circle

ciliary art
Iris
W W

Present at root of iris Present at pupillary border

E

Ma or MC source of bleeding in
arterial Traumatic hyphema
circle
Choroid

Minor arterial circle

Arterial supply of iris

o s p io ot ins op n into s p io
ophthalmi in
W

o in io o t in op n into in io Cavernous sinus

ophthalmi in ↑

Supra obital vein Superior ophthalmic vein

W W

Venous vorticose Centre Lateral wall

W W

VI III
ICA IV
V1
V2

An ular vein
Infenar
Inferior ophthalmic vein ophthalmic vein
Infra orbital vein

Superior oblique
muscle (IV) [Intorsion
and depression in
Trochea adduction]

Tendon of superior oblique

Superior rectus
muscle (Ⅲ)
[Elevation] Lateral
rectus muscle

40
(VI) [Abduction]

NEET PG / INI-CET WORKBOOK BY DR. NIHA AGGARWAL Medial

rectus muscle (Ⅲ)
[Adduction]

Inferior rectus
muscle III (Depression)
 BOOK
GLAuComA
[Link]
Circum Corneal Con unctival
Con estion In

veitis AC laucoma

oeppe s and usacca s in nodules

usacca s nodules oeppe s nodules

on the surface of iris at pupillary mar in
A re ates of epithelioid cells mononuclear cells

D/D 1. Lisch nodules — NF-1 ( Iris hamartoma )

2. Iris pearls — leprosy
3. Brushfield spots — Down’s syndrome
4. Dalen Fuch’s nodules — Symphthetic ophthalmia

Superior oblique
muscle (IV) [Intorsion
and depression in
Trochea adduction]

Tendon of superior oblique

Superior rectus
muscle (Ⅲ)
[Elevation] Lateral
rectus muscle

41
(VI) [Abduction]

Medial NEET PG / INI-CET WORKBOOK BY DR. NIHA AGGARWAL

rectus muscle (Ⅲ)
[Adduction]

Inferior rectus
muscle III (Depression)
ONE SHOT OPHTHALMOLOGY
[Link]

Angular/ Ring synechiae

I
Pupillary margin

Posterior chamber
Aqueous
collection
Annular osterior synechine Total posterior synechiae behind the iris

chamber
Anterior
E

Posterior chamber
·

Posterior chamber Push the iris anteriorly

Anterior
I
chamber

Le
E
- V

ft un Iris bombe formation

Posterior chamber
tre
Posterior chamber F

ate
- d

Anterior chamber
v

Peripheral anterior synechiae

Posterior chamber
W

Adhesion between iris and cornea F

-V
W

Synechial angle closure glaucoma - Iridiocorneal contact

W

Known as Chronic congestive glaucoma W

Sudden closure of angle of anterior chamber

Show banking W
Acute congestive glaucoma
DOC : Dipevefine
CI in systemic HTN

D/D of snow banking

Candidiasis
Sarcoidosis >
Candle wax drippings
Ocular toxocariasis
Multiple sclerosis

Snow ball opacities & snow banking S

W
-

& D
Clumps of Settled at periphery due
to gravity
L

exudates in
L
vitreous cavity

Superior oblique
muscle (IV) [Intorsion
and depression in
Trochea adduction]

Tendon of superior oblique

Superior rectus
muscle (Ⅲ)
[Elevation] Lateral
rectus muscle

42
(VI) [Abduction]

NEET PG / INI-CET WORKBOOK BY DR. NIHA AGGARWAL Medial

rectus muscle (Ⅲ)
[Adduction]

Inferior rectus
muscle III (Depression)
 BOOK
GLAuComA
[Link]

Snow ball opacities

Snow ball opacities

lashes of li ht photopsia

Flashes of light/photopsia
• RRD
• Retinitis (posterior uveitis)

Photopsia + floaters : Unique to RRD

d t Retinitis

Superior oblique
muscle (IV) [Intorsion
and depression in
Trochea adduction]

Tendon of superior oblique

Superior rectus
muscle (Ⅲ)
[Elevation] Lateral
rectus muscle

43
(VI) [Abduction]

Medial NEET PG / INI-CET WORKBOOK BY DR. NIHA AGGARWAL

rectus muscle (Ⅲ)
[Adduction]

Inferior rectus
muscle III (Depression)
ONE SHOT OPHTHALMOLOGY
[Link]

Amsler grid test ( macular function test )

Positive scotoma
E

E Fixation point

400 squares

5 mm x 5 mm

Systemic associations of Uveitis

Aphthous ulcer in Uveitis

Behçet’s disease
Granulomatous pan uveitis
A/w HLAB5
Anterior Uveitis
Recurrent hypopyon

Triad
1. Oral ulcers : very painful
2. Genital ulcers
3. Uveitis

Superior oblique
muscle (IV) [Intorsion
and depression in
Trochea adduction]

Tendon of superior oblique

Superior rectus
muscle (Ⅲ)
[Elevation] Lateral
rectus muscle

44
(VI) [Abduction]

NEET PG / INI-CET WORKBOOK BY DR. NIHA AGGARWAL Medial

rectus muscle (Ⅲ)
[Adduction]

Inferior rectus
muscle III (Depression)
 BOOK
GLAuComA
[Link]

VKH syndrome

Vitiligo

Poliosis : Greying of eyelashes

VKH syndrome — Vigo Koyanagi Horada

4 organs involved

V W W z

C O N E
W W W W

Cutaneous Ocular Neurological Ear

~ z Uveitis Y Meningitis > Sensory neural hearing loss

Hyper pigmentation Hypo pigmentation > Neuropathies Tinnitus

Vitiligo

Sarcoidosis
Snow ball opacities in Sarcoidosis
Granulomatous, pan uveitis
W

Candle wax dripping Snow banking

Etiology : Retinal periphlebitis

Peripheral[ 3 Inflammation of veins

Pouring of exudates in vitreous cavity

Known as candle wax drippings

W

Pre retinal nodules

( Lander’s sign )

Superior oblique
muscle (IV) [Intorsion
and depression in
Trochea adduction]

Tendon of superior oblique

Superior rectus
muscle (Ⅲ)
[Elevation] Lateral
rectus muscle

45
(VI) [Abduction]

Medial NEET PG / INI-CET WORKBOOK BY DR. NIHA AGGARWAL

rectus muscle (Ⅲ)
[Adduction]

Inferior rectus
muscle III (Depression)
 ONE SHOT OPHTHALMOLOGY
[Link]

Headlight in fog appearance

Toxoplasmosis Granulomatous pan uveitis

i
Congenital Acquired

Triad Hydrocephalus ( convulsions ) Typical appearance in posterior uveitis

Chorioretinitis
Intra cranial calcification Head light in fog appearance

Patch of choroiditis Vitritis

Early macular involvement : early diminition of vision

Headlight in the fog appearance
Most common cause of posterior uveitis in India

FUS ( Fuch uveitis Syndrome )

Female, unilateral — Lighter colour of Iris

Grey, stellate ( star shaped ), KP’s, Mild Anterior uveitis
Rubiosis iridis >
Vessels may bleed in angle of AC : Amsler sign
Patches of iris atropy
Secondary glaucoma ( inflammatory )
Complicated cataract
Posterior synechiae always absent

Treatment : Steroids

hs h t o h omi litis
An idiopathic disorder of the eye ith heterochromia uveitis of the
li hter coloured eye iridocyclitis eratitic precipitates and often
cataract

Superior oblique
muscle (IV) [Intorsion
and depression in
Trochea adduction]

Tendon of superior oblique

Superior rectus
muscle (Ⅲ)
[Elevation] Lateral
rectus muscle

46
(VI) [Abduction]

NEET PG / INI-CET WORKBOOK BY DR. NIHA AGGARWAL Medial

rectus muscle (Ⅲ)
[Adduction]

Inferior rectus
muscle III (Depression)
 BOOK
GLAuComA
[Link]

Coloboma

Defect in closure of embryonic fissure

Absence of tissue
-

W W

Mc inferionasal quadrant Other 3 quadrants

W ~

Typical Coloboma Atypical Coloboma

W

ST SN

&
·
IT IN

Symphthetic ophthalmitis
Bilateral granulomatous pan uveitis
due to trauma ( penetrating/ perforating ) of ciliary body ( knowns as dangerous area of eye )
• Penetrating wound : only entry wound present
• Perforating wound : Entry + exit wound present

MC etiology : Allergic origin > Uncovering of the hidden antigens

-

Formation of immune complexes

Inflammation of eye

7
Sympathising eye
M

ks
wee
4-8
Trauma eye
Known as Other eye
>
Exciting eye

Symptoms : Earliest >

Photophobia
> Transient weakening of accommodation ( ciliary muscles )
Superior oblique
muscle (IV) [Intorsion

Trochea
and depression in
adduction] Signs : Earliest >
Retro lental flare
Tendon of superior oblique

Most imp >

Dalen Fuch Nodules
Superior rectus
muscle (Ⅲ)
[Elevation] Lateral
rectus muscle

47
(VI) [Abduction]

Medial NEET PG / INI-CET WORKBOOK BY DR. NIHA AGGARWAL

rectus muscle (Ⅲ)
[Adduction]

Inferior rectus
muscle III (Depression)
 NOTES

Treatment
It is rare but serious
1. Meticulous repair of perforation
2. Steroids ( contraindicated in perforations) - DOC
3. Assess visual acuity in exciting eye
W

Hope of useful vision

v W

No Yes

W W

Enucleation Continue medical treatment

Within 2 weeks
W

Removal of the eyeball + part of optic nerve

 BOOK
RETINA
[Link]

Chapter
Retina
04
Normal Fundus
o mal nd s

Macula

o mal nd s

Optic Disc

hysiolo ical Cup

Macula Optic disc

Vein

Artery

Fovea

.
Macula

O
Macula: 5.5 mm 2 DD = 2 x 1.5 = 3 mm
M <

&
Temporal Nasal

-O Optic
S

Optic disc >

1.5 mm
Fovea centralis
1.5 mm disc
w

Blind spot on temporal side

L

Foveola
0.35 mm
w
·

Sharpest image is formed Foveolar reflex

Densely packed with cones; no rods

>
Floor Thinnest part of Retina
ovea
>

Which side of eye is this ?

Fovea centralis
Ans : If macula is present on right side then it is right eye
> Rim 3
Thickest part of Retina If macula is present in left side then it is left eye
So it is right eye
Overall thinnest part - Orra serrata

Superior oblique
muscle (IV) [Intorsion
and depression in
Trochea adduction]

Tendon of superior oblique

Superior rectus
muscle (Ⅲ)
[Elevation] Lateral
rectus muscle

49
(VI) [Abduction]

Medial NEET PG / INI-CET WORKBOOK BY DR. NIHA AGGARWAL

rectus muscle (Ⅲ)
[Adduction]

Inferior rectus
muscle III (Depression)
ONE SHOT OPHTHALMOLOGY
[Link]

Indirect ophthalmoscope
+20 D lens

Direct ophthalmoscope Indirect ophthalmoscope

Used to see central fundus Used to see periphery
Area seen : 2 DD Area seen : 8 DD
Image formed : Virtual, Erect, Magnified Image formed: Real, inverted, magnified
Magnification : 15 times Magnification : 5 times

Direct ophthalmoscope

Superior oblique
muscle (IV) [Intorsion
and depression in
Trochea adduction]

Tendon of superior oblique

Superior rectus
muscle (Ⅲ)
[Elevation] Lateral
rectus muscle

50
(VI) [Abduction]

NEET PG / INI-CET WORKBOOK BY DR. NIHA AGGARWAL Medial

rectus muscle (Ⅲ)
[Adduction]

Inferior rectus
muscle III (Depression)
 BOOK
RETINA
[Link]
tinal a s lls

Inner limitin
Nerve ber layer membrane
Axons at surface of
retina passin via
an lion cell
optic nerve chiasm
layer
and tract to lateral
eniculate body
Inner plexiform an lion cell
layer
Muller cell
Inner nuclear (supportin lial cell)
layer
bipolar cell
Amarcine cell
Outer plexiform
layer ori ontal cell
Rod
Cone
Outer nuclear
layer

hotoreceptor i ment cells

layer of choroid
i ment tion
epithelium th o h tina

ILM
N L Internal
CL >

I L

&
[
This is on internal
7
side — Internal Nuclear layer
&
INL

O L Dark layers are nuclear layer

ONL &
>
This is on external
7
side — External nuclear layer

OLM &

L 3
External

R E
Superior oblique
muscle (IV) [Intorsion
and depression in
Trochea adduction]

Tendon of superior oblique

Superior rectus
muscle (Ⅲ)
[Elevation] Lateral
rectus muscle

51
(VI) [Abduction]

Medial NEET PG / INI-CET WORKBOOK BY DR. NIHA AGGARWAL

rectus muscle (Ⅲ)
[Adduction]

Inferior rectus
muscle III (Depression)
1. RPE - Retinal Pigment Epithelium
>
Melanin
Bruch’s membrane of choroid

:
Sub retinal space Contains sub retinal fluid

2. Layers of rod and cones (Photoreceptors) >

First order neurons >
Contains outer segment and inner segment

3. External limiting membrane Outer segment

>
-

Layer of rods and cones

4. Outer Nuclear layer - Nuclei of rod and cones Inner segment

External limiting membrane
⑳ Outer Nuclear layer

5. Outer plexiform layer - synaptic cleft and Rods and cones 2) Outer plexiform layer
1

>
Synaptic cleft

6. Inner nuclear layer - Contains nuclei of bipolar cells ( II order ) > amacrine, horizontal, muller cells

7. Inner plexiform layer - Synapse between ganglionic cells ( III order ) and bipolar cells

8. Ganglion cell layer - contains dendrites of Ganglionic cells

9. Nerve fibre layer - contains axons of Ganglion cells

Continues to form optic nerve
In optic neuropathy - Ganglion cell death

10. Internal limiting membrane

Choroid
RPE
Retina Sub retinal space Neurosensory retina
Neurosensory retina ( 9 layers )
RPE
Vitreous
Transparent/ colourless
Sub retinal space

Red glow from choroid

1. The layer Most resistant to radiation : RPE > GCL

2. The layer Most sensitive to radiation : Layer of rods and cones
3. Optic nerve : NFL
4. Layer Most prone to pathology : OPL & INL
5. Macula- contains all 10 layers

Fovea Foveola centralis

5 layers 6 layers

1. RPE 1. RPE
2. Layer of cones 2. Layer of cones
3. OLM ( ELM ) 3. OLM ( ELM )
4. ONL 4. ONL
5. ILM 5. ILM
6. ILM
ONE SHOT OPHTHALMOLOGY
[Link]

Roth spots

Present in the SABE

Roth spot Y Multiple superficial hemorrhages

ith
W
L

White dot >

Fibrin clot

Etiology : Retinal Hypoxia

Blood in vitreous cavity

Clinical features: • Sudden painless diminition of vision

(Posterior segment pathology)
• Floaters due to climbing in vitreous gel
• Absence of the fundal glow ( no red glow )

Etiology : mc cause of vitreous haemorrhage- spontaneous > trauma

mc cause of recurrent vitreous hemorrhages

z v

Young Elderly

v
v

Eale’s disease PDR ( proliferative diabetic retinopathy )

~ reaction to TB patients
Due to hyper sensitivity
Trochea
Superior oblique
muscle (IV) [Intorsion
and depression in
adduction]

Tendon of superior oblique

V

TOC : Steroids + ATT Superior rectus

muscle (Ⅲ)
[Elevation] Lateral
rectus muscle

52
(VI) [Abduction]

NEET PG / INI-CET WORKBOOK BY DR. NIHA AGGARWAL Medial

rectus muscle (Ⅲ)
[Adduction]

Inferior rectus
muscle III (Depression)
 BOOK
RETINA
[Link]

CRAO CRAO ( Central Retinal Arteriolar Occlusion )

Ophthalmic emergency

Due to
V

Central Retinal artery - 4 end arteries - No collaterals

More common in males of >50 years

MC cause : Thrombosis (80%) > Embolism (20%)

Occur due to Cholesterol crystals known as

Hollen Horst plaques
Retinal hypoxia time 60-90 mins
MC site : Lamina cribrosa

Clinical features : Sudden painless loss of vision

RAPD present ( due to optic nerve disease )

Signs Cherry red spot

:
Cattle track appearance Segmentation of blood column in veins

CRAO — pale retina

Milky white in colour due to exudate collection in ganglionic cell layer

Absent in fovea centralis

Fovea centralis Ganglionic cell layer absent

Supplied by choriocapillaries

Cherry red spot : only area through which choroid continues to shine

D/D of cherry red spot Treatment of CRAO

1. Immediate lowering of Intra ocular pressure to dislodge the the thrombus
Niemann pick disease Sand hoff disease
M

...
Cherry Trees Never Grows Tall in Sand and Mud IV Mannitol
Acetazolamide
CRAO
L

Tay Sach disease Metachromatic leucodystrophy Ocular massage

Paracentesis ( aspiration of anterior chamber )
Blunt trauma
Gangliosidosis and Gucher disease Macular edema
(Berlin’s edema) 2. Carbol mixture : 95% O2 + 5% CO2 = for vasodilation
Pseudo cherry red spot
To maintain respiratory drive
( if 100% O2 given : Respiratory depression )
CRVO
3. IV > Steroids
& Anti coagulants > Streptokinase, urokinase, tPA
>
Embolysis

Complication : Consecutive optic atrophy

CRVO ( Central retinal venous Occlusion )

Less severe but more common than CRAO

Types
-

V V

Ischemic Non ischemic

Splashed tomato appearance Severe changes >

Edema
Mild changes
> Hemorrhages
3
Tortuosity W

Hemorrhages
Newly formed vessles are fragile V Edema
T

Ischemia
Tortuosity
V
W

Treatment : Laser photo coagulation [ Vitreous hemorrhage V

No treatment required
VEGF release

Splashed tomato appearance V

Blood thunder appearance Neovascularisation

Superior oblique
muscle (IV) [Intorsion ~
and depression in W
Neovascular glaucoma ( 100 day glaucoma )
Neovascular Glaucoma
Trochea adduction]

Tendon of superior oblique It is complication of CRVO

100 day / 90 day Glaucoma
Superior rectus
muscle (Ⅲ)
[Elevation] Lateral
rectus muscle

53
(VI) [Abduction]

Medial NEET PG / INI-CET WORKBOOK BY DR. NIHA AGGARWAL

rectus muscle (Ⅲ)
[Adduction]

Inferior rectus
muscle III (Depression)
 ONE SHOT OPHTHALMOLOGY
[Link]

5. Hypertension retinopathy

1. Earliest sign : Nasal angiospasm : thinning of blood vessels in nasal quadrant

Directly proportional to severity of hypertension

2. Arteriosclerosis : increase in total peripheral resistance

1

Increase in diastolic B.P.

Vicious cycle More angiospasm

~

Directly proportional to duration of hypertension

3. Increased vascular permeability

- Flame shaped hemorrhages

v W
V

Flame shaped hemorrhages Cotton wool spots Retinal edema

V

- Superficial hemorrhages Soft exudates

,

Due to retinal hypoxia

J

Present in nerve fibre layer of retina

↑

Axostasis

Keith, Wagner, Barker — Stages of hypertension retinopathy

I — Mild angiospasm ( A:V from 2:3 to 1:3 )
II — Moderate angiospasm + Salu’s sign
III —Copper writing of f arterioles + grade II changes + Gunn sign and bonnet sign
IV — Silver wiring of arterioles + grade III changes + papilloedema ( marker of stage IV hypertension )

Spasm >
Change in colour in blood vessles
Bright red
. Normal Capillaries Acellular Capillaries ericyte host Microaneurysm
V

Dark red

Copper coloured > Grade III

No blood >
Silver wiring 2 Grade IV

Tapering/ deflection of f veins W.R.T. AV crossings

1. At AV crossing : Salu’s sign
2. Distal to AV crossing : Bonnet sign
3. Perpendicular to AV crossing : Gunn sign

Mc cause of diminition of vision in hypertension retinopathy — Maculopathy ( Not papilloedema )

Normal capillaries Acellular capillaries Pericyte Ghost Micro Aneurysm Superior oblique
muscle (IV) [Intorsion
and depression in
Trochea adduction]
~

Hall Mark of DR : Micro aneurysms D/t Loss of pericytes

Tendon of superior oblique

Superior rectus
muscle (Ⅲ)
[Elevation] Lateral
rectus muscle

54
(VI) [Abduction]

NEET PG / INI-CET WORKBOOK BY DR. NIHA AGGARWAL Medial

rectus muscle (Ⅲ)
[Adduction]

Inferior rectus
muscle III (Depression)
 BOOK
RETINA

. [Link]

Stage of Diabetic Retinopathy — 4

1. NPDR ( Non Proliferative Diabetic Retinopathy ) or Background DR — Earliest stage &

.
7 Earliest sign — Micro aneurysms > Pin point hemorrhages

v
Due to loss of pericytes from the capillary walls
Present in Inner Nuclear layer of retina
Deep hemorrhages — called as Dot- blot hemorrhages
-

Hard exudates are present in Outer Plexiform Layer

3 Lipids and lipoprotein deposits
Micro aneurysms

i Circinate retinopathy
00
Og
AV shunt
&

IRMA : Intra Retinal Micro Vascular Abnormality

Eg : venous changes Bleeding
Loops
Eg : AV shunts ( Arterio- Venous shunts )
Retinal edema

Severity of NPDR : 4-2-1 Rule

Criteria >
1. All 4 quadrants have micro aneurysms
> 2. Venous changes in at least 2 quadrants
>
3. IRMA ( AV shunts ) in at least 1 quadrant

If any 1 criteria present : Severe NPDR

If any 2 criteria present : very severe NPDR

Larger : Soft exudates

Smaller : Hard exudates

Neovascularisation Micro aneurysms

2. PDR ( Proliferative Diabetic Retinopathy ) — Always occurs after NODR

0.
~

Neovascularisation ( Hallmark )

V V

NVE NVD

88 :
V

Elsewhere Disc
W

Along major blood vessles

Superior oblique
muscle (IV) [Intorsion
Optic Disc
and depression in
↓
Trochea adduction]

Tendon of superior oblique

Superior rectus
muscle (Ⅲ)
[Elevation] Lateral
rectus muscle

55
(VI) [Abduction]

Medial NEET PG / INI-CET WORKBOOK BY DR. NIHA AGGARWAL

rectus muscle (Ⅲ)
[Adduction]

Inferior rectus
muscle III (Depression)
ONE SHOT OPHTHALMOLOGY
[Link]

3. Diabetic Maculopathy — Macular involvement

CSME - Clinically Significant Macular Edema

1. At macula > Edema

& Exudates

or, 2. Within 500um from centre of macula

with 3. Increased retinal thickening atleast 1 DD ( due to edema )

ARD E
Maculopathy can occur after DATE
>NPDR
> PDR

4. Advanced Diabetic Eye Disease — Complications

Neovascular glaucoma (NVG), Tractional Retinal Detachment (TRD),

Screening of Diabetic Retinopathy Follow up

IDDM/ Type I NIDDM / Type II NPDR — Mild : Yearly

Moderate : 6 monthly
W ~

Start within 5 years of diagnosis Immediately/ ASAP Severely : 3 monthly

PDR — 2 monthly
>
Early onset so duration is less Adult onset so duration is less [

Diminition of vision in Diabetic Retinopathy

W W

Sudden Gradual 7 Cataract

> Tractional Retinal Detachment (TRD)
W ~

NPDR PDR > Diabetic retinopathy

V V

MCC : Maculopathy MCC: Recurrent vitreous haemorrhage

Most important test to see changes in Diabetic Retinopathy

↓
~

Breakdown of Inner Blood Renal Barrier

Fluorescein Angiography
~

Fluorescein dye is injected in Anti cubital vein

Superior oblique
muscle (IV) [Intorsion
and depression in
Trochea adduction]

Tendon of superior oblique

Superior rectus
muscle (Ⅲ)
[Elevation] Lateral
rectus muscle

56
(VI) [Abduction]

NEET PG / INI-CET WORKBOOK BY DR. NIHA AGGARWAL Medial

rectus muscle (Ⅲ)
[Adduction]

Inferior rectus
muscle III (Depression)
 BOOK
RETINA
[Link]
IRMA

FFA is IOC
• Grey : Choroid
• White : Retinal hemorrhages
• Black : Ischemia
• Larger white : Neovascularisation

oli ati ia ti
tinopath

• Neovascularisation
Hallmark of PDR

• Microaneurysms
Hallmark of NPDR

no mal ss ls

o t s t ia aa s t ia
Superior oblique
muscle (IV) [Intorsion
and depression in
Trochea adduction]

o t s t ia
Tendon of superior oblique
aa s t ia
Superior rectus
muscle (Ⅲ)
[Elevation] Lateral
rectus muscle

57
(VI) [Abduction]

Medial NEET PG / INI-CET WORKBOOK BY DR. NIHA AGGARWAL

rectus muscle (Ⅲ)
[Adduction]

Inferior rectus
muscle III (Depression)
ONE SHOT OPHTHALMOLOGY
[Link]

Intra vitreal steriod injection

CME (Diabetic maculoathy)

—MCC of Diminition of vision in NPDR

anretinal hotocoa ulation

PRP ( Pan Retinal Photo coagulation ) — Laser

Whole Retina : 2000-3000 Laser spots
Each laser spot : 500 um foot 0.1 second
Distance between 2 spots : 500 um
Started from periphery to centre leaving macular area (FAZ = Foveal Avascular Zone)

> Blind spot

Total area = Ring scotoma

Superior oblique
muscle (IV) [Intorsion
and depression in
Trochea adduction]

Tendon of superior oblique

Diminition of vision in Diabetic Retinopathy is irreversible

PRP is done to prevent complications Superior rectus
muscle (Ⅲ)
[Elevation] Lateral
rectus muscle

58
(VI) [Abduction]

NEET PG / INI-CET WORKBOOK BY DR. NIHA AGGARWAL Medial

rectus muscle (Ⅲ)
[Adduction]

Inferior rectus
muscle III (Depression)
 BOOK
RETINA
[Link]
tinopath o p mat it

ta on ta t o ta th
Optic nerve
Lens
<28 weeks - Period of gestation
<1.7 kg - Birth weight
V

Exposed to high [O2]

Prone to obliteration because of immature retinal vasculature

↓
Demarcation line Demarcation line Ne blood
Retina
idens and thic ens vessel ro th
W

Due to release of VEGF

formin a rid e

Intense fibrovascular proliferation especially behind the lens

ta o ta v

Hence called Retrolental fibroplasia

Leucocoria

artial detached retina Detached retina

Stages of ROP - 5
Leucocoria d/d
1. Dermarcation of line: Between the vascular and avascular retina
[Link]
2. Ridge : permanent line 2. Congenital cataract
3. Ridge with fibro vascular proliferation 3. Retinoblastoma
4. Subtotal RD ( TRD )
5. Total RD

on
Cloc ours
one III one III

one II one II

one I one I
ovea

Optic Nerve

one I one II one III

Concentric circle centered Concentric annular area Temporal crescent from
on optic nerve from outer border of one I outer border of one Il to
Radius x distance from to the ora nasally and ust temporal ora serrata
nerve to fovea beyond equator temporally

Superior oblique
muscle (IV) [Intorsion
and depression in
Trochea adduction]

Tendon of superior oblique

Superior rectus
muscle (Ⅲ)
[Elevation] Lateral
rectus muscle

59
(VI) [Abduction]

Medial NEET PG / INI-CET WORKBOOK BY DR. NIHA AGGARWAL

rectus muscle (Ⅲ)
[Adduction]

Inferior rectus
muscle III (Depression)
ONE SHOT OPHTHALMOLOGY
[Link]
E E

.
ROP — Plus Disease

Tortuous arteries
TAVE
Engorged veins

Threshold Disease
↓
5 contiguous areas or 8 non contiguous areas in stage 3 + Zone I/II with plus Disease

Retinitis pigmentosa

MC hereditary pigmentory (Involve RPE)

dystrophy (Degenerative) of Retina affecting
Photo receptors ( rods >> cones )

More common in males

Bilateral
Symmetrical

Inheritance : MC - sporadic (35%) > familial

Most common
L V

AR>AD>XR &

Best prognosis [

Worst prognosis &

Symptoms : 1. Rods >Cones

Earlist sign : night blindness

2. Delay dark adaptation

3. Tunnel vision or Tubular vision

Signs : Triad
1. Pale yellow wavy optic disc
Superior oblique

2. Pigmentory spicules : Ring scotoma

muscle (IV) [Intorsion
and depression in
Trochea adduction]

3. Attenuation of retinal arterioles

Tendon of superior oblique

Superior rectus
muscle (Ⅲ)
[Elevation] Lateral
rectus muscle

60
(VI) [Abduction]

NEET PG / INI-CET WORKBOOK BY DR. NIHA AGGARWAL Medial

rectus muscle (Ⅲ)
[Adduction]

Inferior rectus
muscle III (Depression)
 BOOK
RETINA
[Link]

RETINITIS I MENTOSA

J
O ONADISM MENTAL VESTI LO
RETARDATION CERE ELLAR
MENTAL ERI ERAL
RETARDATION IN ANTILE NE RO AT
DEA NESS LA R INT INE CON ENITAL
CERE ELLAR DEA NESS Ptosis
DEA NESS
O ESIT D AR ISM
N STA M S MENTAL
OL DACT L DE ICIENC

LA RENCE Kearns-Sayre
COC A NE RE S M S ER ALL REN
OON IEDL
S NDROME S NDROME S NDROME S NDROME syndrome
S NDROME

Acanthocytes
+
Retinitis pigmentosa
V

Bassen Kornzweig syndrome

Superior oblique
muscle (IV) [Intorsion
and depression in
Trochea adduction]

Tendon of superior oblique

Superior rectus
muscle (Ⅲ)
[Elevation] Lateral
rectus muscle

61
(VI) [Abduction]

Medial NEET PG / INI-CET WORKBOOK BY DR. NIHA AGGARWAL

rectus muscle (Ⅲ)
[Adduction]

Inferior rectus
muscle III (Depression)
ONE SHOT OPHTHALMOLOGY
[Link]

Salt pepper retinitis

• No triad
• Black and white flecks
• Congenital Rubella
• Congenital syphilis
• Phenothiazine toxicity

ll s E a lopath

atient presents ith

fundus A ndin s

atient ta in
m day Bull’s eye maculopathy
hydroxychloroqine • Irreversible
• CQ / HCQ Toxicity
hat is the dia nosis
pro nosis for this
patient

Superior oblique
muscle (IV) [Intorsion
and depression in
Trochea adduction]

Tendon of superior oblique

Superior rectus
muscle (Ⅲ)
[Elevation] Lateral
rectus muscle

62
(VI) [Abduction]

NEET PG / INI-CET WORKBOOK BY DR. NIHA AGGARWAL Medial

rectus muscle (Ⅲ)
[Adduction]

Inferior rectus
muscle III (Depression)
 BOOK
RETINA
[Link]

Best Vitelliform macular dystrophy/ Best disease

2nd mc macular dystrophy
Autosomal dominant
Mutation of Bestrophin gene
Localised deposition of lipofuschin in RPE of macula —

Egg yolk appearance

Age : Children and young

Best test for Best disease : EOG

Abnormal EOG with relatively Normal ERG

:
EOG : measures resting potential ERG : a wave : Rods and cones : Normal
Macular dystrophy : affects -ve charge of macula b wave : Bipolar cells : Normal
Hence abnormal EOG is obtained c wave : RPE : Abnormal
Only decreased c wave

Stargardt’s disease ( Fundus flavimaculatus )

Autosomal recessive : ABCA-4 Gene mutation

Diffuse deposition of lipofuschin (Golden brown

pigment) in RPE of macula

Beaten bronze appearance

FFA - fluoroscein dye — Auto fluorescence

Lipofuschin covers fluorescence

Silent choroid or Dark choroid

Subnormal / Normal ERG

Age : young (8-14yr)

Gradual impairment of vision : central vision

Superior oblique
muscle (IV) [Intorsion
and depression in
Trochea adduction]

Tendon of superior oblique

Superior rectus
muscle (Ⅲ)
[Elevation] Lateral
rectus muscle

63
(VI) [Abduction]

Medial NEET PG / INI-CET WORKBOOK BY DR. NIHA AGGARWAL

rectus muscle (Ⅲ)
[Adduction]

Inferior rectus
muscle III (Depression)
ONE SHOT OPHTHALMOLOGY
[Link]

Silent choroid or Dark choroid

EOG
IOC in Best disease

Arden Index is taken in EOG

Arden Index = Max spike / Min spike
• Normal : >185
• Borderline : 150-180
• Subnormal : <150
• Flat : <125

Superior oblique
muscle (IV) [Intorsion
and depression in
Trochea adduction]

Tendon of superior oblique

Superior rectus
muscle (Ⅲ)
[Elevation] Lateral
rectus muscle

64
(VI) [Abduction]

NEET PG / INI-CET WORKBOOK BY DR. NIHA AGGARWAL Medial

rectus muscle (Ⅲ)
[Adduction]

Inferior rectus
muscle III (Depression)
 BOOK
RETINA
[Link]

ERG
IOC in Retinitis Pigmentosa
• a wave : Rods and cones : Normal
• b wave : Bipolar cells : Normal
• c wave : RPE : Abnormal

Macular disease
Distorted images : Metamorphopsia

Superior oblique
muscle (IV) [Intorsion
and depression in
Trochea adduction]

Tendon of superior oblique

Superior rectus
muscle (Ⅲ)
[Elevation] Lateral
rectus muscle

65
(VI) [Abduction]

Medial NEET PG / INI-CET WORKBOOK BY DR. NIHA AGGARWAL

rectus muscle (Ⅲ)
[Adduction]

Inferior rectus
muscle III (Depression)
 ONE SHOT OPHTHALMOLOGY
[Link]
Foveal depression : 6 layers Nerve ber layer
Vitreous
ovea
Neurosensory Retina ~

Subretinal space
-

RPE
-

Retinal i ment Epithelium Choroid

OCT : Optical Coherance Tomography

Foveal depression = absent INL & GCL

1
[ Neurosensory retina
Sub Retinal space
- RPE

Circular ring sign seen in CSR

Slit lamp Bio-microscopy or Direct ophthalmoscopy

> Better W

Circular ring sign

Superior oblique
muscle (IV) [Intorsion
and depression in
Trochea adduction]

Tendon of superior oblique

Superior rectus
muscle (Ⅲ)
[Elevation] Lateral
rectus muscle

66
(VI) [Abduction]

NEET PG / INI-CET WORKBOOK BY DR. NIHA AGGARWAL Medial

rectus muscle (Ⅲ)
[Adduction]

Inferior rectus
muscle III (Depression)
 BOOK
RETINA
[Link]

Neurons sensory retina Foveal depression More common in males

L
20-50 years
> Type A personality 7
Hurry
> Worry
1 SRF 3
Curry
Stress, Smoking, Steroids
RPE
T N

CSR (Central Serous Retinopathy)

-T
Macula SRF Collection
Spontaneous detachment of neurosensory retina from RPE in macular area = collection of SRF
Foveal depression = absent INL & GCL

1
[
Neurosensory retina
Sub Retinal space
CSR - RPE

Mushroom pattern/
Umbrella pattern/
Smoke stack pattern

FFA ( Fundus Fluoroscein Angiography )

W V

Mushroom pattern/ Ink Blot pattern/

Umbrella pattern/ Enlarging dot sign
Smoke stack pattern
Superior oblique
muscle (IV) [Intorsion
and depression in
Trochea adduction]

Tendon of superior oblique

Superior rectus
muscle (Ⅲ)
[Elevation] Lateral
rectus muscle

67
(VI) [Abduction]

Medial NEET PG / INI-CET WORKBOOK BY DR. NIHA AGGARWAL

rectus muscle (Ⅲ)
[Adduction]

Inferior rectus
muscle III (Depression)
ONE SHOT OPHTHALMOLOGY
[Link]

Ink Blot pattern/

Enlarging dot sign

CSR : Breakdown of outer blood retinal barrier

Self limiting

Treatment : Just wait and watch for spontaneous resolution ( usually self limiting : 4-12 weeks )
Treatment: Steroids + Causative treatment

Honeycomb apprearance

CME : Cystoid Macular edema

Cyst like spaces in macula due to collection of fluid in
• Outer flexiform (Henle’s layer) (Petalloid fibres)
• INL

Treatment: Steroids + Causative treatment

Superior oblique
muscle (IV) [Intorsion
and depression in
Trochea adduction]

Tendon of superior oblique

Superior rectus
muscle (Ⅲ)
[Elevation] Lateral
rectus muscle

68
(VI) [Abduction]

NEET PG / INI-CET WORKBOOK BY DR. NIHA AGGARWAL Medial

rectus muscle (Ⅲ)
[Adduction]

Inferior rectus
muscle III (Depression)
 BOOK
RETINA
[Link]

FFA : confirmation : Flower petal appearance

Due to radial/ petalloid arrangement of the fibres in the Henle’s layer (outer plexiform layer)

OCT of CME

Superior oblique
muscle (IV) [Intorsion
and depression in
Trochea adduction]

Tendon of superior oblique

Superior rectus
muscle (Ⅲ)
[Elevation] Lateral
rectus muscle

69
(VI) [Abduction]

Medial NEET PG / INI-CET WORKBOOK BY DR. NIHA AGGARWAL

rectus muscle (Ⅲ)
[Adduction]

Inferior rectus
muscle III (Depression)
ONE SHOT OPHTHALMOLOGY
[Link]

Amsler grid test

Macular function test

Used to differentiate between

• Macular diseases
• Optic nerve diseases

Macular diseases
• Distorted pattern
• Blue and yellow colourblindness

Superior oblique
muscle (IV) [Intorsion
and depression in
Trochea adduction]

Tendon of superior oblique

Superior rectus
muscle (Ⅲ)
[Elevation] Lateral
rectus muscle

70
(VI) [Abduction]

NEET PG / INI-CET WORKBOOK BY DR. NIHA AGGARWAL Medial

rectus muscle (Ⅲ)
[Adduction]

Inferior rectus
muscle III (Depression)
 BOOK
RETINA
[Link]

Optic nerve diseases

• Missing lines
• Red and green colourblindness

Drusen
[

E W
Bruch’s membrane

Choroid

Superior oblique
muscle (IV) [Intorsion
and depression in
Trochea adduction]

Tendon of superior oblique

Superior rectus
muscle (Ⅲ)
[Elevation] Lateral
rectus muscle

71
(VI) [Abduction]

Medial NEET PG / INI-CET WORKBOOK BY DR. NIHA AGGARWAL

rectus muscle (Ⅲ)
[Adduction]

Inferior rectus
muscle III (Depression)
 ONE SHOT OPHTHALMOLOGY
[Link]

ARMD (Age Related Macular Degeneration)

• >60 years
• Males = Females
• Bilateral
• Symmetrical

MC cause of irreversible diminition of vision

in developed countries

Drusen ello spots

I
-

I
ARMD

V
V

Dry/ Geographic (90%) Wet (10%)

-
Main lesson : Drusens
I
Choroidal neovascularisation After thickening of Bruch’s membrane

Extra cellular eosinophilic deposition between the Bruch’s membrane and RPE Dysfunctional Bruch’s membrane
+
Atrophic areas in retina
+
Irregular pigmentation RPE
Choroid

Mild or no diminition of vision ~

Treatment: No treatment
Multivitamins + anti oxidants -
RPE PED
Choroid
-

"
I
Pigment epithelial detachment

CNVM
(Choroidal Neovascular Membrane)

Cholesterol crystals in Synchysis Scintillans

Shower of Golden rain

Superior oblique
muscle (IV) [Intorsion
and depression in
Trochea adduction]

Tendon of superior oblique

Superior rectus
muscle (Ⅲ)
[Elevation] Lateral
rectus muscle

72
(VI) [Abduction]

NEET PG / INI-CET WORKBOOK BY DR. NIHA AGGARWAL Medial

rectus muscle (Ⅲ)
[Adduction]

Inferior rectus
muscle III (Depression)
 BOOK
RETINA
[Link]

Asteroid hyalosis
Starry sky appearance
Calcium deposition

Pizza pie appearance

HIV Retinopathy
CD4 count : <50

MC ocular infection : CMV Retinitis

Pizza pie appearance

Superior oblique
muscle (IV) [Intorsion
and depression in
Trochea adduction]

Tendon of superior oblique

Superior rectus
muscle (Ⅲ)
[Elevation] Lateral
rectus muscle

73
(VI) [Abduction]

Medial NEET PG / INI-CET WORKBOOK BY DR. NIHA AGGARWAL

rectus muscle (Ⅲ)
[Adduction]

Inferior rectus
muscle III (Depression)
ONE SHOT OPHTHALMOLOGY
[Link]

HIV Retinopathy
CD4 count : <50

Most specific : Brush fire apprearance

RETINAL Retinal detachment

TEAR
Misnomer : It is actually separation of RPE from
RETINAL
neurosensory retina
DETAC MENT
MC : Rhegmatogenous
Retinal hole : most imp risk factor

Superior oblique
muscle (IV) [Intorsion
and depression in
Trochea adduction]

Tendon of superior oblique

Superior rectus
muscle (Ⅲ)
[Elevation] Lateral
rectus muscle

74
(VI) [Abduction]

NEET PG / INI-CET WORKBOOK BY DR. NIHA AGGARWAL Medial

rectus muscle (Ⅲ)
[Adduction]

Inferior rectus
muscle III (Depression)
 BOOK
RETINA
[Link]

B scan USG in RRD

W

Funnel shaped RD

ain d
TV d mm
Sens V
ase d
E ain

Medial rectus muscle

Treatment
1. Sealing of retinal hole by lesser Photo coagulation
Scleral buc le 2. Scleral buckling/ encirclage operation >
Most imp step

Silicon patch

!
Encircling sclera
Fix the retina

Suturing

Lateral rectus muscle

Superior oblique
muscle (IV) [Intorsion
and depression in
Trochea adduction]

Tendon of superior oblique

Superior rectus
muscle (Ⅲ)
[Elevation] Lateral
rectus muscle

75
(VI) [Abduction]

Medial NEET PG / INI-CET WORKBOOK BY DR. NIHA AGGARWAL

rectus muscle (Ⅲ)
[Adduction]

Inferior rectus
muscle III (Depression)
 ONE SHOT OPHTHALMOLOGY
[Link]

Inverse hypopyon

Internal temponade
>
Inverse hypopyon
Silicon oil
or
Heavy gases : SF6 gas

Remove within 3 months

S because of ADR
Eg: Oil granuloma

Tent li e TRD Table top TRD

Concave RD / Fractional RD
Treatment
Occurs due to pulling of retina towards vitreous cavity
due to dense fibro vascular tissue (due to Old vitreous 1. Laser photo coagulation
hemorrhages) in vitreous cavity W

to stop vitreous hemorrhages

D
TRD

Concave / tent shaped 2. PPV : pars plana vitrectomy

Vitreous aspiration of fibro vascular tissue

Superior oblique
muscle (IV) [Intorsion
and depression in
Trochea adduction]

Only RD which causes Gradual painless DOV 3. RD surgery Tendon of superior oblique

Superior rectus
muscle (Ⅲ)
[Elevation] Lateral
rectus muscle

76
(VI) [Abduction]

NEET PG / INI-CET WORKBOOK BY DR. NIHA AGGARWAL Medial

rectus muscle (Ⅲ)
[Adduction]

Inferior rectus
muscle III (Depression)
 BOOK
RETINA
[Link]

Exudative RD
Smooth convex RD

Due to pushing of retina towards vitreous cavity

by collection of exudates/ fluids / tumor cells

· [
Smooth convex RD

Sclera
Choroid
RPE
Neurosensory retina

Retinoblastoma
• Leucocoria (1st sign)

• 2nd MC : Squint (convergent)

• Nystagmus, poor vision, ERD

1.5 year baby with leucocoria

1st d/d should be Retinoblastoma

• MC tumor associated with Retinoblastoma : Pinealoblastoma

• MC secondary tumor ( patient is disease free ) : Osteosarcoma

Treatment :1. Unilateral, <10 mm — tumor destruction by laser photo coagulation or cryotherapy
2. Unilateral, >10 mm — TOC : Enucleation
Superior oblique
3. Bilateral, metastasis present : TOC — chemo VEC regimen
-
muscle (IV) [Intorsion
and depression in
Trochea adduction]

Tendon of superior oblique

Vincristine, Etoposide, Carboplatin + life long surveillance

Superior rectus
muscle (Ⅲ)
[Elevation] Lateral
rectus muscle

77
(VI) [Abduction]

Medial NEET PG / INI-CET WORKBOOK BY DR. NIHA AGGARWAL

rectus muscle (Ⅲ)
[Adduction]

Inferior rectus
muscle III (Depression)
ONE SHOT OPHTHALMOLOGY
[Link]

↓ W

Proptosis
Tumour cells in Anterior
chamber

• Local spread - MC Optic nerve

• Distant metastasis > Direct route
> Lymphatic
> Blood route ( most severe )
Liver : MCC death

Empty lumen
W

Flexner Wintersteiner rosette

Superior oblique
muscle (IV) [Intorsion
and depression in
Trochea adduction]

Tendon of superior oblique

Superior rectus
muscle (Ⅲ)
[Elevation] Lateral
rectus muscle

78
(VI) [Abduction]

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rectus muscle (Ⅲ)
[Adduction]

Inferior rectus
muscle III (Depression)
 BOOK
RETINA
[Link]

No lumen seen
W

Homer Wright Pseudo Rosette

s an o tino lastoma sho in solid post io

int ao la mass ontains st on pa ti lat tions
att i ta l to int al sional al i ation

B Scan USG
W

Intralesional calcifications

Superior oblique
muscle (IV) [Intorsion
and depression in
Trochea adduction]

Tendon of superior oblique

Superior rectus
muscle (Ⅲ)
[Elevation] Lateral
rectus muscle

79
(VI) [Abduction]

Medial NEET PG / INI-CET WORKBOOK BY DR. NIHA AGGARWAL

rectus muscle (Ⅲ)
[Adduction]

Inferior rectus
muscle III (Depression)
ONE SHOT OPHTHALMOLOGY
[Link]

CT - scan
• Calcification seen
• Not preferred in children

IOC : MRI
• MRI - better to see calcification
• It will also show optic nerve involvement

Plasma LDH levels : Not diagnostic, only prognostic value

Malignant melanoma
W

Leading to ERD

Superior oblique
muscle (IV) [Intorsion
and depression in
Trochea adduction]

Tendon of superior oblique

Superior rectus
muscle (Ⅲ)
[Elevation] Lateral
rectus muscle

80
(VI) [Abduction]

NEET PG / INI-CET WORKBOOK BY DR. NIHA AGGARWAL Medial

rectus muscle (Ⅲ)
[Adduction]

Inferior rectus
muscle III (Depression)
 BOOK
CoRNEA
[Link]

Chapter
Cornea
05
Epithelium Tear lm

Squamous
A : Anterior epithelium :
• Non keratinised stratified epithelium
o man s oly onal

asal
B : Bowman’s Layer
Stroma • Acellular, Avascular, can’t regenerate

Colla en ibrils
eratocytes C : Connective tissues Stroma
• Thickest
Descemet s
D : Descements membrane
• Toughest
Endothelium

E : Endothelium
• Metabolically most active

CAUSES OF CORNEAL OPACITY CORNEAL APPEARANCE

Edema Blue "cobblestoned" appearance

Inflammatory cell infiltration Yellow, green, or tan corneal stromal opacity

Lipid/mineral deposition Silvery white, crystalline, sparkly opacities; sometimes coalescing

creamy or shiny opacities

Fibrosis Grayish white, sometimes feathery or wispy opacity

Melanosis Dark brown to black, variable density, often with blood vessels

Vascularization Variably perfused blood vessels extending from comeoscleral

limbus

Superior oblique
muscle (IV) [Intorsion
and depression in
Trochea adduction]

Tendon of superior oblique

Superior rectus
muscle (Ⅲ)
[Elevation] Lateral
rectus muscle

81
(VI) [Abduction]

Medial NEET PG / INI-CET WORKBOOK BY DR. NIHA AGGARWAL

rectus muscle (Ⅲ)
[Adduction]

Inferior rectus
muscle III (Depression)
 ONE SHOT OPHTHALMOLOGY

Corneal Topography & Pentacam Corneal Surface

[Link]

• A non-invasive medical imaging technique for mapping the surface curvature of the cornea.

• The corneal topography and color coded maps derived from quantitative analysis of numerous surface points.

• Physicians interpret the color coded images to diagnose & treat patients with eye refracting

Eg : Keratoconus

Congenital cloudy cornea "STUMPED”

• Sclerocornea

• Tears in Descmet's membrane

• Uterine infections

• Metabolic conditions

• Peter's anomaly

• Endothelial dystrophy

• Dermoid

Superior oblique
muscle (IV) [Intorsion
and depression in
Trochea adduction]

Tendon of superior oblique

Superior rectus
muscle (Ⅲ)
[Elevation] Lateral
rectus muscle

82
(VI) [Abduction]

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rectus muscle (Ⅲ)
[Adduction]

Inferior rectus
muscle III (Depression)
 BOOK
CoRNEA
[Link]

Bacterial keratitis
Bacterial corneal ulcer
Single ulcer • MC World — Staph aureus
(Cause no hyphae)
! India — Streptococcus pneumonae
• Some bacteria can penetrate intact cornea
C. diphtheriae
N. meningitidis
N. gonorrhoea
Hemophillus
Hypopyon
Listeria
(Sterile, mobile)
Shigella
But not pseudomonas

Stages : 1. Polymorphonuclear infiltration Clinical features : Photophobia

2. Active ulceration Sudden painful loss of vision
3. Impending perforation / Descematocele Acute red eye
4. Perforation Vascularisation

... Iridocyclitis Anterior uveitis

Descements membrane

Epithelium
~

Hypopyon >
Purulent uveitis
( Pus in anterior chamber )

I Descematocele > Impending perforation

Adherent leucoma
• Very small perforation

Superior oblique
muscle (IV) [Intorsion
and depression in
Trochea adduction]

Tendon of superior oblique

Superior rectus
muscle (Ⅲ)
[Elevation] Lateral
rectus muscle

83
(VI) [Abduction]

Medial NEET PG / INI-CET WORKBOOK BY DR. NIHA AGGARWAL

rectus muscle (Ⅲ)
[Adduction]

Inferior rectus
muscle III (Depression)
ONE SHOT OPHTHALMOLOGY
[Link]

Iris prolapse
• Small perforation

Anterior staphyloma
• Total perforation

Superior oblique
muscle (IV) [Intorsion
and depression in
Trochea adduction]

Tendon of superior oblique

Superior rectus
muscle (Ⅲ)
[Elevation] Lateral
rectus muscle

84
(VI) [Abduction]

NEET PG / INI-CET WORKBOOK BY DR. NIHA AGGARWAL Medial

rectus muscle (Ⅲ)
[Adduction]

Inferior rectus
muscle III (Depression)
 BOOK
CoRNEA
[Link]

Fungal keratitis
Dry/greyish ulcer
with elevated • H/o Vegetative trauma
margins • Signs >> Symptoms

Fungal ulcer

Hypopyon
(non sterile, non mobile)
T
Filamentous

Aspergillus fusarium
> Yeast like

• Candida
• Cryptococcus
Satellite lessions ~

Natamycin
↓
Signs : Dry looking, greyish white, elevated margins Amphotericin B +
Finger like extensions Nystatin
Multiple satellites like lesions
Immune ring of Wesseley
Big hypopyon
Perforation is rare
Vascularisation is away absent

Feathery margins

Superior oblique
muscle (IV) [Intorsion
and depression in
Trochea adduction]

Tendon of superior oblique

Superior rectus
muscle (Ⅲ)
[Elevation] Lateral
rectus muscle

85
(VI) [Abduction]

Medial NEET PG / INI-CET WORKBOOK BY DR. NIHA AGGARWAL

rectus muscle (Ⅲ)
[Adduction]

Inferior rectus
muscle III (Depression)
ONE SHOT OPHTHALMOLOGY
[Link]

Viral corneal ulcer

• Decreased corneal sensation
• Keratic precipitates
(MC seen in anterior uveitis )

Herpes simplex

-
Primary lesions Recurrent lesions
Super cial punctate eratitis
W
~

Blepharitis Dendritic pattern

Follicular conjunctivitis
Superficial punctuate keratitis
Multiple dot like lesions in epithelium

Dendritic pattern

Steroids are contraindicated

Amoebic ulcer/ Geographical ulcer

Knobs are present

L

Rose Bengal stain

see
7
arf
2

&
Floor — Fluoroscein stain
Knob — Rose Bengal stain

Treatment : 3% Acyclovir eye ointment 5 times daily

Superior oblique

Topical steroids are contraindicated as they can hasten formation of Geographical ulcer
muscle (IV) [Intorsion
and depression in
Trochea adduction]

Tendon of superior oblique

Superior rectus
muscle (Ⅲ)
[Elevation] Lateral
rectus muscle

86
(VI) [Abduction]

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rectus muscle (Ⅲ)
[Adduction]

Inferior rectus
muscle III (Depression)
 BOOK
CoRNEA
[Link]

Herpes zoster ophthalmicus

W W

Primary lesion Gasserian Recurrent

Ganglion lesions

Ophthalmic division of Trigeminal nerve involved

Frontal -
Lacrimal Nasociliary

Strict distribution on one side of forehead

Hutchinson’s rule :
Tip of nose lesions shows more chances of ocular involvement

Clinical features : intense Trigeminal fever + Neuralgia

I
Skin eruptions

Ocular features

Superior oblique
muscle (IV) [Intorsion
and depression in
Trochea adduction]

Tendon of superior oblique

Superior rectus
muscle (Ⅲ)
[Elevation] Lateral
rectus muscle

87
(VI) [Abduction]

Medial NEET PG / INI-CET WORKBOOK BY DR. NIHA AGGARWAL

rectus muscle (Ⅲ)
[Adduction]

Inferior rectus
muscle III (Depression)
ONE SHOT OPHTHALMOLOGY
[Link]

Nummular keratitis
Treatment of HZO
1. Tab. Acyclovir 800mg
2. 3% Acyclovir
3. Topical antibiotic - Steroids ointment
4. Systemic steroids — Post herpatic neuralgia
5. Amitryptilline — Depession
6. 6. Antihistaminics

Nummular keratitis >

Characteristic
> Granular deposits surrounded by stromal haziness

Acanthamoeba
• Free living Amoeba present in soil
• Infection is mc in contact lens users, trauma with vegetative matter, swimming pool, immunocompramised

* Radial kerato neuritis

Out of proportion pain

• Typical reticular pattern
Superior oblique
• History of contact lens muscle (IV) [Intorsion
and depression in
Trochea
• Pseudo dendrites ( confused with H. simplex )
adduction]

Tendon of superior oblique

• Trophozoites ( Mistaken with macrophages ) Diagnosis : Culture on non nutrient agar enriched with E. coli
Superior rectus
muscle (Ⅲ)
[Elevation] Lateral
rectus muscle

88
(VI) [Abduction]

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rectus muscle (Ⅲ)
[Adduction]

Inferior rectus
muscle III (Depression)
 BOOK
CoRNEA
[Link]

o t s t ia
Occur centrally in
a patient ith
eratoconus
Vertical stromal
Descemet s
membrane lines
Stress lines due to
stretchin and
thinnin
Disappear ith lobe
pressure
E o nds o

Vertex keratopathy

Epithelial deposits by drugs

• P : Phenothiazine
• I : Indomethacin
• C : Chloroquine
• A : Amiodarone
• N : Nitarsudil

Superior oblique • MC infection in contact Lens users : Pseudomonas

muscle (IV) [Intorsion
and depression in
Trochea adduction]

Tendon of superior oblique

Superior rectus
muscle (Ⅲ)
[Elevation] Lateral
rectus muscle

89
(VI) [Abduction]

Medial NEET PG / INI-CET WORKBOOK BY DR. NIHA AGGARWAL

rectus muscle (Ⅲ)
[Adduction]

Inferior rectus
muscle III (Depression)
ONE SHOT OPHTHALMOLOGY
[Link]

Munson’s sign
• Vogt’s striae : Vertical
• Scissors reflex due to astigmatism

Keratoconus
Non inflammatory, bilateral conical ectasia of cornea associated with progressive
Myopia and irregular astigmatism

Signs : 1. Oil drop reflex on direct ophthalmoscope

2. Fleischer’s ring at the base of cone due to iron deposition
3. Munson’s sign : Localised bulging of lower eyelids when patient looks in downward gaze

Complications : Acute hydrops due to rupture of descements membrane

Treatment : 1. Rigid contact lenses

2. Penetrating keratoplasty
3. Collagen cross lining by Riboflavin and UVA to arrest progression

Superior oblique
muscle (IV) [Intorsion
and depression in
Trochea adduction]

Tendon of superior oblique

Superior rectus
muscle (Ⅲ)
[Elevation] Lateral
rectus muscle

90
(VI) [Abduction]

NEET PG / INI-CET WORKBOOK BY DR. NIHA AGGARWAL Medial

rectus muscle (Ⅲ)
[Adduction]

Inferior rectus
muscle III (Depression)
 BOOK
CoRNEA
[Link]

Band shaped keratopathy

Degenerative disease occurring due to Calcium deposition in
Bowman’s membrane

Etiology :
Hypercalcemia, chronic uveitis, JRA, Sarcoidosis, still’s
disease, Chronic glaucoma, vitamin D toxicity, ocular
trauma, phthisis bulbi, Chronic keratitis, hyperparathyroidism

Treatment : EDTA ( Chelating agent )

Systemic Associations of Keratoconus

ABCDEF

Atopy

Bones (osteogenesis imperfecta)

Crouzon's syndrome

Down's syndrome

Ehler's Danlos syndrome

Fingers (Marfan's)

Lipodermoid
Swelling at lateral canthus

Superior oblique
muscle (IV) [Intorsion
and depression in
Trochea adduction]

Tendon of superior oblique

Superior rectus
muscle (Ⅲ)
[Elevation] Lateral
rectus muscle

91
(VI) [Abduction]

Medial NEET PG / INI-CET WORKBOOK BY DR. NIHA AGGARWAL

rectus muscle (Ⅲ)
[Adduction]

Inferior rectus
muscle III (Depression)
ONE SHOT OPHTHALMOLOGY
[Link]

Limbal dermoid

Symblepharon
Adhesion between palpebral and
bulbar conjunctiva

Superior oblique
muscle (IV) [Intorsion
and depression in
Trochea adduction]

Tendon of superior oblique

Superior rectus
muscle (Ⅲ)
[Elevation] Lateral
rectus muscle

92
(VI) [Abduction]

NEET PG / INI-CET WORKBOOK BY DR. NIHA AGGARWAL Medial

rectus muscle (Ⅲ)
[Adduction]

Inferior rectus
muscle III (Depression)
 BOOK
SCLERA
[Link]

Chapter
Sclera
06

EPISCLERITIS VS SCLERITIS

• No pain comes to doctor due to red color • VERY Painful.. Deep Boring (drilling?) wakes up early due to
pain.. Cant move eye DANGEROUS

• Affects episclera • Affects sclera

• Types-diffuse, nodular • Types-anterior, posterior

• Bright red in color • Anterior - diffuse, nodular, necrotizing (with inflammation Can
burst, without inflammation - can perforate, scleromalacia,
perforans)

• No scleral edema • Posterior-cant see the color, tenderness, proptosis, visual loss,
Ultra sound B Scan -T sign. Treat with Systemic Steroids.

• No treatment needed, resolves sponta- • Violet blue in color

neously, Idiopathic, other causes could
gout, hypersensitivity etc topical NSAIDS

• By 10% phenylephrine drops vessels • Scleral edema

undergo blanching white

• Associated with AUTOIMMUNE disorders RA, SLE etc

• Treatment Oral NSAIDS, 2 step- Systemic Steroids, 3 step-

immunomodulators - cyclophosphomide

• By 10% phenylephrine drops vessies do not blanch (deep blood

vessels)

Superior oblique
muscle (IV) [Intorsion
and depression in
Trochea adduction]

Tendon of superior oblique

Superior rectus
muscle (Ⅲ)
[Elevation] Lateral
rectus muscle

93
(VI) [Abduction]

Medial NEET PG / INI-CET WORKBOOK BY DR. NIHA AGGARWAL

rectus muscle (Ⅲ)
[Adduction]

Inferior rectus
muscle III (Depression)
 ONE SHOT OPHTHALMOLOGY

HOPES Belief [Link]

Blue Sclera
High myopia

Osteogenesis imperfecta

Pseudoxanthoma elasticum

Ehlers-danlos syndrome

Scleritis

Bupthalmos

Diffuse episcleritis

Superior oblique
muscle (IV) [Intorsion
and depression in
Trochea adduction]

Tendon of superior oblique

Superior rectus
muscle (Ⅲ)
[Elevation] Lateral
rectus muscle

94
(VI) [Abduction]

NEET PG / INI-CET WORKBOOK BY DR. NIHA AGGARWAL Medial

rectus muscle (Ⅲ)
[Adduction]

Inferior rectus
muscle III (Depression)
 BOOK
SCLERA
[Link]

Diffuse Scleritis

Scleromalasia perforans

Superior oblique
muscle (IV) [Intorsion
and depression in
Trochea adduction]

Tendon of superior oblique

Superior rectus
muscle (Ⅲ)
[Elevation] Lateral
rectus muscle

95
(VI) [Abduction]

Medial NEET PG / INI-CET WORKBOOK BY DR. NIHA AGGARWAL

rectus muscle (Ⅲ)
[Adduction]

Inferior rectus
muscle III (Depression)
ONE SHOT OPHTHALMOLOGY
[Link]

Posterior scleritis
T sign on B scan USG

Ciliary staphyloma
4 mm behind limbus

Superior oblique
muscle (IV) [Intorsion
and depression in
Trochea adduction]

Tendon of superior oblique

Superior rectus
muscle (Ⅲ)
[Elevation] Lateral
rectus muscle

96
(VI) [Abduction]

NEET PG / INI-CET WORKBOOK BY DR. NIHA AGGARWAL Medial

rectus muscle (Ⅲ)
[Adduction]

Inferior rectus
muscle III (Depression)
 BOOK
SCLERA
[Link]

Scleromalasia perforans

Intercalary
Equatorial
Staphyloma
Bunch of grapes like appearance

Anterior lens
osterior

Ciliary

Superior oblique
muscle (IV) [Intorsion
and depression in
Trochea adduction]

Tendon of superior oblique

Superior rectus
muscle (Ⅲ)
[Elevation] Lateral
rectus muscle

97
(VI) [Abduction]

Medial NEET PG / INI-CET WORKBOOK BY DR. NIHA AGGARWAL

rectus muscle (Ⅲ)
[Adduction]

Inferior rectus
muscle III (Depression)
ONE SHOT OPHTHALMOLOGY
[Link]

Intercalary staphyloma

Anterior staphyloma

Superior oblique
muscle (IV) [Intorsion
and depression in
Trochea adduction]

Tendon of superior oblique

Superior rectus
muscle (Ⅲ)
[Elevation] Lateral
rectus muscle

98
(VI) [Abduction]

NEET PG / INI-CET WORKBOOK BY DR. NIHA AGGARWAL Medial

rectus muscle (Ⅲ)
[Adduction]

Inferior rectus
muscle III (Depression)
 BOOK
TRAumA
[Link]

Chapter
Trauma
07

Blunt trauma
Subconjunctival Haemorrhage

Raccoon sign / Panda sign

Superior oblique
muscle (IV) [Intorsion
and depression in
Trochea adduction]

Tendon of superior oblique

Superior rectus
muscle (Ⅲ)
[Elevation] Lateral
rectus muscle

99
(VI) [Abduction]

Medial NEET PG / INI-CET WORKBOOK BY DR. NIHA AGGARWAL

rectus muscle (Ⅲ)
[Adduction]

Inferior rectus
muscle III (Depression)
ONE SHOT OPHTHALMOLOGY
[Link]

Hyphema
D/t blunt trauma
MC source is major arterial circle

Irido dialysis
+
D shaped pupil

Superior oblique
muscle (IV) [Intorsion
and depression in
Trochea adduction]

Tendon of superior oblique

Superior rectus
muscle (Ⅲ)
[Elevation] Lateral
rectus muscle

100
(VI) [Abduction]

NEET PG / INI-CET WORKBOOK BY DR. NIHA AGGARWAL Medial

rectus muscle (Ⅲ)
[Adduction]

Inferior rectus
muscle III (Depression)
 BOOK
TRAumA
[Link]

Tear drop sign

Blow out fracture
IOC : Xray water’s view

Rosette cataract

Superior oblique
muscle (IV) [Intorsion
and depression in
Trochea adduction]

Tendon of superior oblique

Superior rectus
muscle (Ⅲ)
[Elevation] Lateral
rectus muscle

101
(VI) [Abduction]

Medial NEET PG / INI-CET WORKBOOK BY DR. NIHA AGGARWAL

rectus muscle (Ⅲ)
[Adduction]

Inferior rectus
muscle III (Depression)
ONE SHOT OPHTHALMOLOGY
[Link]

Vossious ring

Penetrating trauma
Intraocular foreign body
MC : Iron
MRI is contraindicated

Superior oblique
muscle (IV) [Intorsion
and depression in
Trochea adduction]

Tendon of superior oblique

Superior rectus
muscle (Ⅲ)
[Elevation] Lateral
rectus muscle

102
(VI) [Abduction]

NEET PG / INI-CET WORKBOOK BY DR. NIHA AGGARWAL Medial

rectus muscle (Ⅲ)
[Adduction]

Inferior rectus
muscle III (Depression)
 BOOK
TRAumA

Salient Features of Common Cycloplegic and Mydriatic Drugs

[Link]

SL. NAME AGE OF DOSAGE OF PEAK TIME OF DURA- PERIOD OF TONUS

NO OF THE THE PA- INSTILLA- EF- PERFORM- TION POSTCYCLO- ALLOW-
DRUG TIENT TION FECT ING RETI- OF AC- PLEGIC ANCE
WHEN IN- NOSCOPY TION TEST
DICATED

1. Atropine < 5 years TDS x 3 days 2-3 4th day 10-20 After 3 weeks of 1D Strongest
sulphate days days retinoscopy Longest
(1% oint- acting
ment)

2. Homa- 5-8 years One drop 60-90 After 90 min. 48-72 After 3 days of 0.5D
trophie every 10 min min of instillation hours retinoscopy
hydrohro- for 6 times of first drop
mied (2%
drops)

3. Cyclo- 8-20 years One drop 80-90 After 90 min. 6-18 After 3 days of 0.75D
pentolate every 15 min. min of instillation hours retinoscopy
hydrochlo- for 3 times of first drop
ride (1%
drops)

4. Tropi- Not used as One drop 20-40 4-6 hours

camide cycloplegic every 15 min. min.
(0.5%, for retinos- for 3 to 4 Shortest
1% drops) copy; used times acting
only as
mydriatic

5. Phenyl- Used only One drop 30-40 4-6 hours

ephrine as mydriatic every 15 min. min.
(5%, 10% alone or in for 3 to 4
drops) combination times
with tropi-
camide

Superior oblique
muscle (IV) [Intorsion
and depression in
Trochea adduction]

Tendon of superior oblique

Superior rectus
muscle (Ⅲ)
[Elevation] Lateral
rectus muscle

103
(VI) [Abduction]

Medial NEET PG / INI-CET WORKBOOK BY DR. NIHA AGGARWAL

rectus muscle (Ⅲ)
[Adduction]

Inferior rectus
muscle III (Depression)
 ONE SHOT OPHTHALMOLOGY

Lasers Used in Ophthalmology [Link]

SL. TYPE OF LASER WAVELENGTH (NM) ATOMIC ENVIRONMENT USED EFFECTS

NO PRODUCED

1. Argon 488 (Blue) Argon gas Photocoagulation

514 (Green)

2. Krypton 647 Krypton gas Photocoagulation

3. Diode 810 Diode crystal Photocoagulation

4. Diode Frequency doubled 577 (green) Diode and Nd:YAG Photocoagulation

neodymium FD-YAG crystals

5. Nd:YAG 1064 (near infrared) A liquid by or a solid compound Photodisruption

of yttrium-aluminium garnet and
neodymium

6. Excimer 193 (ultraviolet) Helium and flourine gas Photoablation

7. Femtosecond 1053 (near infrared) Neodymium-glass Phtotodisruption

8. Helium neon 633 (red) Used as low power

Superior oblique
muscle (IV) [Intorsion
and depression in
Trochea adduction]

Tendon of superior oblique

Superior rectus
muscle (Ⅲ)
[Elevation] Lateral
rectus muscle

104
(VI) [Abduction]

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rectus muscle (Ⅲ)
[Adduction]

Inferior rectus
muscle III (Depression)
 BOOK
TRAumA
[Link]
BETTER EYE BEST WORSE EYE BEST PERCENT DISABILITY
CORRECTED CORRECTED IMPAIRMENT CATEGORY

6/6 to 6/18 6/6 to 6/18 0% 0

6/24 to 6/60 10% 0

Less than 6/60 to 3/60 20% I

Less than 3/60 no light 30% II (one eyed person)

perception

6/24 to 6/60 6/24 to 6/60 40% III a (low vision)

Or
Visual field less than 40 up to 20 Less than 6/60 to 3/60 50% III b (low vision)
degrees around centre of fixation
or hemianopia involving macula Less than 3/60 to no light 60% III c (low vision)
perception

Less than 6/60 to 3/60 Less than 6/60 to 3/60 70% III d (low vision)
Or
Visual field less than 20 up to 10 Less than 3/60 to no light 80% III e (low vision)
degrees around centre of fixation perception

Less than 3/60 to 1/60 Less than 3/60 to no light 90% IV a (blindness)
Or perception
Visual field less than 10 degrees
around centre of fixation

Only HMCF Only HMCF 100% IV b (blindness)

Only light perception, Only light perception,
No light perception No light perception
Note: Vision assessment should be done after best possible correction (medical, surgical or usual/conventional
spectacles)

Superior oblique
muscle (IV) [Intorsion
and depression in
Trochea adduction]

Tendon of superior oblique

Superior rectus
muscle (Ⅲ)
[Elevation] Lateral
rectus muscle

105
(VI) [Abduction]

Medial NEET PG / INI-CET WORKBOOK BY DR. NIHA AGGARWAL

rectus muscle (Ⅲ)
[Adduction]

Inferior rectus
muscle III (Depression)
 ONE SHOT OPHTHALMOLOGY
Name of the Different Types of Lasers and their Mechanism of Action. [Link]

TYPE OF LASER MECHANISM OF ACTION

Argon Photocoagulation

Krypton Photocoagulation

Didoe Photocoagulation

Frequency doubled Photocoagulation

Nd-YAG Photocoagulation

Nd-YAG Photoablation

Excimer Photoablation

Superior oblique
muscle (IV) [Intorsion
and depression in
Trochea adduction]

Tendon of superior oblique

Superior rectus
muscle (Ⅲ)
[Elevation] Lateral
rectus muscle

106
(VI) [Abduction]

NEET PG / INI-CET WORKBOOK BY DR. NIHA AGGARWAL Medial

rectus muscle (Ⅲ)
[Adduction]

Inferior rectus
muscle III (Depression)
 BOOK
TRAumA

Darkroom procedures (DRPs) form an essential part of examination and evaluation of the eyes in modern
[Link]

ophthalmic practice. Consequently, this section has been given a special slot in the undergraduate as
well as postgraduate examinations. Most of the darkroom procedures have been described vividly with
the support of self-explanatory illustrations. Common darkroom procedures are:

• Oblique illumination examination

• Loupe and lens examination

• Slit-lamp biomicroscopy

• Gonioscopy

• Transillumination

• Retinoscopy

• Ophthalmoscopy

Superior oblique
muscle (IV) [Intorsion
and depression in
Trochea adduction]

Tendon of superior oblique

Superior rectus
muscle (Ⅲ)
[Elevation] Lateral
rectus muscle

107
(VI) [Abduction]

Medial NEET PG / INI-CET WORKBOOK BY DR. NIHA AGGARWAL

rectus muscle (Ⅲ)
[Adduction]

Inferior rectus
muscle III (Depression)
 ONE SHOT OPHTHALMOLOGY

Ocular and Systemic Features of Immunological Disorders: [Link]

SYSTEMIC DIAGNOSIS SYSTEMIC FEATURES EXTRAOCULAR INTRAOCULAR

FEATURES FEATURES

Rheumatoid arthritis Arthritis-hand, wrist and 'Dry eye', episcleritis, Iridocyclitis, corneal
foot, skin nodules, Felty scleritis melting, cataract
syndrome

Systemic lupus Butterfly rash, pleuritis, Episcleritis Iritis, retionpathy

erythematosus pericarditis Raynaud phe-
nomenon

Giant cell arterirtis Temporal arteritis, cephal- Extraocular muscle palsies Anterior ischaemic optic
gia, jaw claudication neuropathy

Sarcoidosis Granuloma of the lymph Enlargement of the lacri- Iridocyclitis, retinal peri-
nodes, lungs, CNS, ery- mal glands phlebitis or sarcoid nodule
thema nodosum

Reiter syndrome Arthritis, urethritis, plan- Conjunctivitis Uveitis, retinal vasculitis

tar rash

Periarteritis nodosa Pyrexia of unknown ori- Episcleritis, extraocular Uveitis, retinal haemor-
gin, myalgia, arthralagia, muscle palsy rhage, papilloedema
skin nodules, renal and
cardiac failure

Vogt-Koyanagi-Harada Meningitis, encephalop- Poliosis Uveitis, choroiditis, exu-

syndrome athy, dysacusis, vitiligo, dative retinal detachment
alopecia

Multiple endocrine Medullary carcinoma of Mucosal neuromas of the Medullated nerve fibres in
neoplasia (MEN IIb) thyroid, phaeochromolcy- lid and conjunctiva the comea
toma

Ocular and Systemic Features of Haematological Diseases

SYSTEMIC DIAGNOSIS SYSTEMIC FEATURES EXTRAOCULAR INTRAOCULAR

FEATURES FEATURES

Lymphocytic leukaemia Lymphadenopathy, hepa- Proptosis Iris nodules, retinal

tosplenom eagly, anae- oedema, haemorrhages,
mia, leucopenia leukaemic infitrates, Roth
spots

Myeloid leukaemia Hepatosplenomegaly, Orbital chloroma Retinal oedema, haemor-

bleeding, thrombosis rhages, peripheral retinal
neovascularization

Lymphomas Fever, lymphadenopathy Lid/orbital deposits Uveitis

Sickle cell anaemia Transient aplastic crisis, Dilated conjunctival Retinal capillary occlusion,
stroke, leg ulcers, jaun- vessels neovascularization, cho-
dice, anaemia rioretinal scars

Superior oblique
muscle (IV) [Intorsion
and depression in
Trochea adduction]

Tendon of superior oblique

Superior rectus
muscle (Ⅲ)
[Elevation] Lateral
rectus muscle

108
(VI) [Abduction]

NEET PG / INI-CET WORKBOOK BY DR. NIHA AGGARWAL Medial

rectus muscle (Ⅲ)
[Adduction]

Inferior rectus
muscle III (Depression)
 BOOK
TRAumA

Ocular and Systemic Features of Infectious Diseases

[Link]

SYSTEMIC SYSTEMIC FEATURES EXTRAOCULAR INTRAOCULAR

DIAGNOSIS FEATURES FEATURES

Viral

Herpes simplex Blisters and sores around Vesicles on the lids Dendritic keratitis, uveitis,
the mouth and genital acute retinal necrosis
area

Congenital rubella Cogenital heart disease, Microphthalmos, cataract,

sensorineural deafness, glaucoma, chorioretinitis
mental retardation

Measels Rash, diarrhoea, middle Keratoconjunctivitis, pre- Optic neuritis

ear infection, encephalitis, cipitates xerophthalmia
precipitates malnutrition

Infectious Fever, malaise, rash, Conjunctivitis Uveitis, retinal phlebitis,

mononucleosis lymphadenopathy, spleno- papillitis
meagly

Cytomegalovirus Immunocompromised Microphthalmos Necrotizing chorioretinitis,

adults and newborns-fe- optic atrophy
ver, hepatitis, pneumoni-
tis, encephalitis

Acquired immune Immunocompromised in- Kaposi sarcoma (Fig) Cotton-wool spots on ret-
deficiency syndrome dividuals, Kaposi sarcoma ina, cytomegalovirus reti-
nitis

Fungal

Candida Oral and genital 'thrush’ Conjunctivitis Keratitis, retinitis, endoph-

thalmitis

Cryptococcus Immunocompromised Papilloedema, optic atro-

adults, pneumonia, men- phy
ingitis

Bacterial

Tuberculosis Fever, malaise, granulo- Phlyctenular conjunctivi- Granulomatous uveitis,

mas (lung, lymph node) tis juxtapapillary choroiditis

Leprosy Thickened peripheral Facial palsy, madarosis Iritis, secondary glauco-

nerves, hypaesthetic skin ma, cataract
lesions, weakness of pe-
ripheral muscles

Superior oblique
muscle (IV) [Intorsion
and depression in
Trochea adduction]

Tendon of superior oblique

Superior rectus
muscle (Ⅲ)
[Elevation] Lateral
rectus muscle

109
(VI) [Abduction]

Medial NEET PG / INI-CET WORKBOOK BY DR. NIHA AGGARWAL

rectus muscle (Ⅲ)
[Adduction]

Inferior rectus
muscle III (Depression)
 ONE SHOT OPHTHALMOLOGY

Ocular and Systemic Features of Muscular Disorders [Link]

SYSTEMIC DIAGNOSIS SYSTEMIC FEATURES EXTRAOCULAR INTRAOCULAR

FEATURES FEATURES

Myasthenia gravis Fluctuating voluntary Ptosis, diplopia

muscle weakness affecting
speech, swallowing
breathing

Muscular dystrophy Progressive muscle weak- Ptosis, exophthalmoplegia Cataract, pigmentary

ness of dry eye retinopathy

Ocular and Systemic Features of Inherited Disorders

SYSTEMIC DIAGNOSIS SYSTEMIC FEATURES EXTRAOCULAR INTRAOCULAR
FEATURES FEATURES

Down syndrome Mental retardation, Mongoloid slant of Cataract, iris spots

muscle hypotonia, eyes, epicanthic folds,
congenital heart disease keratoconus

Sturge-Weber syndrome Facial port-wine strain, Arteriovenous malforma- Choroidal haemangioma,

angiomas tions of episclera glaucoma

Neurofibromatosis Café au lait spots, subcu- Prosis, pulsating Optic nerve gloma, neu-
taneous neurofibromas exophthalmos ro?bromas of the iris,
retina and choroid

Albinism Hypopigmented skin and Nystagmus Translucent iris, albinotic

hair fundus, foveal hypoplasia

Marfan syndrome Tall, arachnodactyly, aortic Subluxation of the lens,

aneurysm, cardiac valvu- myopia, retinal detach-
lar anomalies ment

von Hippel-Lindau disease Angimatosis of the central Retinal angiomas

nervous system and kid-
neys

Superior oblique
muscle (IV) [Intorsion
and depression in
Trochea adduction]

Tendon of superior oblique

Superior rectus
muscle (Ⅲ)
[Elevation] Lateral
rectus muscle

110
(VI) [Abduction]

NEET PG / INI-CET WORKBOOK BY DR. NIHA AGGARWAL Medial

rectus muscle (Ⅲ)
[Adduction]

Inferior rectus
muscle III (Depression)
 BOOK
TRAumA

Ocular and Systemic Features of Parasitic Diseases

[Link]

SYSTEMIC SYSTEMIC FEATURES EXTRAOCULAR INTRAOCULAR

DIAGNOSIS FEATURES FEATURES

Toxoplasmosis Congenital-mental retardation, Macular scarring,

deafness Immune deficient retinochoroiditis, vitritis
patient-encephalitis

Toxocariasis Congenital-mental retardation, Vitritis, choroiditis, vitreo-

deafness Immune deficient pa- retinal granuloma
tient-encephalitis

Cysticerosis Cysticerci-subcutaneous, Subconjunctival cysticerci Subretinal or vitreous

brain, spine, heart cysticerci

Onchocerciasis Subcutaneous onchoceromas Sclerosing keratitis, uve-

itis, cataract

Ocular and Systemic Features of Endocrine Disorders and Disorders of Metabolism

SYSTEMIC DIAGNOSIS SYSTEMIC FEATURES EXTRAOCULAR INTRAOCULAR
FEATURES FEATURES

Homocystinuria Mental retardation, Subluxation of the lens

tall, arachnodactyly,
thromboembolic episodes

Mucopoly accharidoses Dysmorphia, behavioural Corneal opacification Pigmentary retinopathy,

disorders, cardiac anom- glaucoma, optic atrophy
alies

Wilson disease Extrapyramidal signs, Kayser-Fleischer ring Sunflower cataract

cirrhosis

Diabetes mellitus Peripheral neuropathy, Xanthelsma, extraocular Cataract, iris neovascu-

glomerulosclerosis muscle palsies, infections larization, retinopathy,
vitreous haemorrhage,
tractional retinal detach-
ment, optic neuropathy

Hyperthyroidism Tachycardia, tremors of Exophthalmos, lid Superior limbic keratitis

the hand retraction, lid lag disc oedema

Hypoparathyroidism Tetany, seizures Fasciculation Cataract, disc oedema

Superior oblique
muscle (IV) [Intorsion
and depression in
Trochea adduction]

Tendon of superior oblique

Superior rectus
muscle (Ⅲ)
[Elevation] Lateral
rectus muscle

111
(VI) [Abduction]

Medial NEET PG / INI-CET WORKBOOK BY DR. NIHA AGGARWAL

rectus muscle (Ⅲ)
[Adduction]

Inferior rectus
muscle III (Depression)
 ONE SHOT OPHTHALMOLOGY

Classification of Visual Impairment and Blindness [Link]

CATEGORY OF VISUAL BEST CORRECTED VISUAL ACUITY (BCVA)

IMPAIRMENT* IN THE BETTER EYE

0 'Normal’ 6/6 to 6/18, i.e. can see 6/18 or better

1 'Visual impairment’ <6/18 to 6/18, i.e. cannot see 6/18 or better

2 'Severe visual impairment' (Economic)’ <6/60 to 3/60, i.e. cannot see 6/60, can see 3/60

3 'Blind' (Social)’ <3/60 to 1/60, i.e. cannot see 3/60, can see 1/60

4 'Blind' (Legal) <1/60 to only light perception, i.e. cannot see 3/60, can see light

5 'Blind' (Total) No light perception, i.e. cannot see light

9 'Undetermined or unspecified
*Adapted from International Statistical Classification of Diseases and Related Health Problems, tenth revision,
Geneva, World Health Organization, 1992.

Superior oblique
muscle (IV) [Intorsion
and depression in
Trochea adduction]

Tendon of superior oblique

Superior rectus
muscle (Ⅲ)
[Elevation] Lateral
rectus muscle

112
(VI) [Abduction]

NEET PG / INI-CET WORKBOOK BY DR. NIHA AGGARWAL Medial

rectus muscle (Ⅲ)
[Adduction]

Inferior rectus
muscle III (Depression)
 BOOK
PREVIouS YEARS QuESTIoNS
[Link]

Chapter
Previous Years Questions
08
PAGE NO - 1
(AIIMS & NEET – Memory Based Questions)

1. A child came in due to complaints of

diminished vision in dim light along with
dry eyes and rough corneal surface. Which
deficiency is associated?

PAGE NO - 1
a. Iron b. Protein
a. Buphthalmos
c. Niacin d. Retinoic acid
b. Cataract
2. A boy came with thin built, lens subluxation
c. MPS
and long fingers, shows deficiency of
cystathione synthase. Which AA should be d. Hurler syndrome
supplemented?
7. A female comes with history of contact lens
a. Serine b. Tyrosine

c. Methionine d. Cysteine
PAGE NO - 1
use comes with following. Diagnosis is:

3. A 15 year old girl, who is a case of myopic

astigmatism is non-compliant for myopic
PAGE NO - 2
glasses, what can be prescribed?

a. Lasik

b. Femtolasik

c. ICL a. Trachoma
d. Spherical alternative correction b. PAGE NO - 2
GPC

4. A 33 yr. female with complaints of c. Spring Cataract

diminishing vision on right halves of both
DR
eyes. Probable diagnosis? d. Acute follicular conjunctivitis

a. Left optic tract 8. An elderly

ES female with gradual painless
PAGE NO - 2
DOV fundus image:-

PAGE NO - 4
b. Right occipital lobe

c. Optic chiasma

d. Right optic nerve

DR
5. A child with whitish pupillary reflex has
undergone enucleation & shows Flexner ES
winter Steiner rosette. Diagnosis is?

a. Retinoblastoma
DR
PAGE NO - 4
b. Rhabdomyosarcoma
ES
c. Medulloblastoma

d. Astrocytoma a.
PAGE NO - 4
Hard exudates in DR

b. Flame Hemorrhages in HTN

6. A one month baby comes with watering and
Superior oblique
muscle (IV) [Intorsion
and depression in
Trochea adduction]
megalocornea, diagnosis is: c. Soft exudates in HTN
Tendon of superior oblique

Superior rectus d. CRVO

muscle (Ⅲ)
[Elevation] Lateral
rectus muscle

113
(VI) [Abduction]

Medial NEET PG / INI-CET WORKBOOK BY DR. NIHA AGGARWAL

rectus muscle (Ⅲ)
[Adduction]

Inferior rectus
muscle III (Depression)
 ONE DRSHOT OPHTHALMOLOGY
PAGE NO -
ES
9. The given defect is most likely associated a. Optic chiasma [Link]

PAGE NO - 4
with which complication?
b. Left occipital lobe

c. Left LGB

d. Right occipital lobe

14. Most common Lacrimal gland tumor:

a. Pleomorphic adenoma
ATTERN ATTERN
DEVIATON DEVIATON
b. Mucoepidermoid CA

c. Adeno cystic CA
a. Cataract
d. Non-Hodgkin lymphoma
b. Exposure keratitis A
15. Identify the condition in the given image:
c.

d.
Difficulty in eye movement

Glaucoma
PAGE NO -
10. There is history of trauma with chisel and
hammer and patient states that foreign body
enters the eye. Which of the investigation
will be detrimental?

a. MRI orbit b. X ray orbit

c. CT scan d. B scan

11. Retinoblastoma most commonly spread via:

a.

[Link]
ATTERN
PAGE NO -
Oculomotor nerve palsy

Trochlear nerve palsy

ATTERN
DEVIATON
a. Lymphatic spread
c. Abducens nerve palsy
b. Hematogenous spread
d. Medial rectum palsy
c. Direct spread

d. Optic nerve invasion 16. SAFE

A strategy for trachoma includes all
except:
12. There is a Proptosis in a child with desmin
positive tumor. What is the probable a. Surgery for trichiasis
diagnosis? b. Antibiotics
a. Embryonal rhabdomyosarcoma
c. Facial cleanliness
b. Leukemia
d. Evaluation of program
c. Lymphoma
17. Identify the structure located at the level
d. Ewing’s sarcoma of nucleus supplying the muscle marked in

PAGE NO - this [Link] NO -

PAGE NO -
13. Identify the site of the lesion:

ATTERN ATTERN
DEVIATON DEVIATON

Superior oblique
muscle (IV) [Intorsion
and depression in
Trochea adduction]

Tendon of superior oblique

A
Superior rectus

PAGE NO -
muscle (Ⅲ)
[Elevation] Lateral
rectus muscle

114
(VI) [Abduction]

NEET PG / INI-CET WORKBOOK BY DR. NIHA AGGARWAL Medial

rectus muscle (Ⅲ)
[Adduction]

Inferior rectus
muscle III (Depression)
 BOOK
PREVIouS YEARS QuESTIoNS

a. Red nucleus
[Link]
b. Pyramid 25. Esotropia is most commonly associate with:

c. Olive d. Facial colliculus [Link] Hyperopia ATTERN b. Myopia

DEVIATON DEVIATON

18. Characteristic finding of fungal ulcer: c. Emmetropic d. Astigmatism

a. Satellite lesions 26. Photostress test is used to differentiate:

b. Dendritic ulcer a.
A Cataract & Glaucoma

c. Ring abscess b. Cornea & lens diseases

d. White hypopyon c. Macular & optic nerve

19. Which vitamin in supra physiologic dose d. Vitreous & retina

cause macular oedema and macular cyst:
27. Lesion producing incongruous homonymous
a. Vitamin A b. Vitamin D hemianopia with Wernicke’s hemianopia
pupil. Site of lesion is:
c. Vitamin E d. NIACIN

PAGE NOd. -
a. Optic tract b. Visual cortex
20. Pre requisite for sympathetic ophthalmitis
is due to: c. Optic radiations Optic Nerve

a. Penetrating trauma to eye 28. A 65-year old male with history of diabetes
and hypertension presents to the OPD
b. Blunt ocular trauma with complaints of diplopia and squint.
c. Uveitis due to sarcoidosis in one eye On examination secondary deviation is
seen to be more than primary deviation.
d. Urinary tract infection Which of the following is the most probable
diagnosis?
21. Which layer of cornea helps in maintaining
hydration of stroma of cornea: a. Paralytic squint

a. Descemet’s membrane b. Concomitant squint

b. Endothelium c. Restrictive squint

c. Epithelium d. Pseudo squint

d. Stroma 29.
PAGE NO -
The movement is lost in:

22. Presence of extra layer of cilia posterior to

grey line is:

a. Tylosis b. Madarosis

c. Distichiasis d. Trichiasis

23. Unilateral proptosis with Bilateral Sixth a. Third nerve palsy

Nerve Palsy is seen in:
b. Trochlear palsy
a. Cavernous sinus thrombosis
c. Sixth nerve palsy
b. Thyroid ophthalmopathy
d. Facial palsy
c. Retinoblastoma
30. Middle aged women with b/l proptosis,
d. Orbital pseudotumor
with restricted ocular movements, and
chemosis, is euthyroid. What is the probable
24. Shifting fluid sign in:
diagnosis?
a. Exudative Retinal Detachment
a. Orbital cellulites
b. Tractional RD
b. Thyroid ophthalmopathy
c.
Superior oblique Rhegmatogenous RD
muscle (IV) [Intorsion
and depression in
c. Pseudotumor of Orbit
Trochea

d. Retinal dialysis
adduction]

d. Orbital lymphoma
Tendon of superior oblique

Superior rectus
muscle (Ⅲ)
[Elevation] Lateral
rectus muscle

115
(VI) [Abduction]

Medial NEET PG / INI-CET WORKBOOK BY DR. NIHA AGGARWAL

rectus muscle (Ⅲ)
[Adduction]

Inferior rectus
muscle III (Depression)
 ONE SHOT OPHTHALMOLOGY

31. True statement regarding KF ring: 34. How to differentiate the causes of a dilated
[Link]

pupil?
1. Seen in all patients with neurological
involvement 1. 1% Phenylephrine

2. Is pathognomonic for Wilson’s disease 2. 1% Pilocarpine

3. Resolves with treatment 3. 0.25% Pilocarpine

4. Seen in all patients with hepatic 4. 4% Cocaine

involvement
5. Epinephrine
5. Starts first in superior and inferior
quadrant
Select the correct answer from the given
below code:
Select the correct answer from the given
below code: a. 1, 2, 3, 4 and 5

a. 1 and 5 only b. 2 and 3 only

b. 1, 2, 3 and 5 only c. 1, 4 and 5 only

c. 1, 2, 3, 4 and 5 d. 1, 3 and 4

d. 2, 3, 4 and 5
35. All the following used to control raised IOP
except:
32. Iritis is seen in all except?
a. Dexamethasone
1. Rheumatoid arthritis
b. Methazolamide
2. Behcet’s disease
c. Mannitol
3. Ulcerative colitis
d. Clonidine
4. SLE

5. Psoriatic arthritis 36. A patient with diabetes, fundus Image

is give, visual acuity is decreased due to
which lesion in fundus?
Select the correct answer from the given
below code: PAGE NO -
a. 2, 3 and 5 b. 1 and 4

c. 1, 3 and 4 d. 1, 2, 3, 4 and 5

33. True regarding POAG.

1. Abnormality of trabecular meshwork is

seen on gonioscopy

2. First degree relatives have more chances

of developing steroid induced glaucoma

3. Dilatation of pupil is associated with

exacerbation of IOP
a.
PAGE NO - 11
Premacular hemorrhage
4. First degree relatives are at 1% increased No Li ht
risk of POAG b. Submacular hemorrhage
Normal
5. Visual field defect can exist with normal c. Ischemic
Response Hemorrhage
C:D ratio to Li ht

d. Diabetic Macular edema

ositive
Select the correct answer from the given RA D of
below code: 37. Topiramate
Ri ht Eye causes which type of glaucoma:

a. 1, 2, 4 and 5 a. PAGE
POAG NO - 12
b. 1, 2 and 3 b. Primary angle closure
Superior oblique

c. 2 and 5 only c. Secondary open angle muscle (IV) [Intorsion

and depression in
Trochea adduction]

d. Secondary angle closure

Tendon of superior oblique

d. 1, 3 and 4
Superior rectus
muscle (Ⅲ)
[Elevation] Lateral
rectus muscle

116
(VI) [Abduction]

NEET PG / INI-CET WORKBOOK BY DR. NIHA AGGARWAL Medial

rectus muscle (Ⅲ)
[Adduction]

Inferior rectus
muscle III (Depression)
 BOOK
PREVIouS YEARS QuESTIoNS

38. For the following question, there is an

[Link]
42. ETDRS study was related to?
Assertion - (A) and Reasoning - (R)
statement. Mark the correct/True option as a. Central retinal artery occlusion
per the following direction: b. Diabetic macular edema
Assertion – (A): Topical steroids are contraindi- c. Primary open angle glaucoma
cated in viral corneal ulcers
d. Non-infectious Uveitis
Reason – (R): Topical steroids can cause
increased IOP
43. What is the first step in the management of
Select one of the following: an 18 month old child whose both eyes are
deviated medially:
a. Both Assertion and Reasons are
independently true / correct statements a. Forced ductions test
and the Reason is the true / correct
explanation for the Assertion b. Examination under anaesthesia

b. Both Assertion and Reasons are c. Refractive error testing and fundus
independently true / correct statements, examination
but the Reason is not the true / correct
explanation for the Assertion d. Cover uncover test

c. Assertion is independently a true / 44. After cataract surgery; intraocular lens put
correct statement, but the Reasons is uneventfully in a young patient what should
independently a false / incorrect statement
be done then?
d. Assertion is independently a false /
a. IOL replaced every 10 years
incorrect statement, but the Reasons is
independently a true / correct statement
b. Never replaced
e. Both Assertion and Reasons are
independently incorrect statements c. Replaced when secondary cataract
develops
39. All of the following are causes for expanding d. Replaced when presbyopia develops
blind spot; except:
45. Match the following ocular drugs with
a. Hypoplasia of optic disc
respect to their side effects [Column – (A)
b. POAG with Column – (B)].

c. Papilledema Column – (A) Column – (B)

d. Medullated nerve fibres a. Amiodarone 1. Optic neuritis

b. Digoxin 2. Cataract
40. True or False regarding Chalazion:
c. Systemic steroids 3. Yellow vision
a. Can affect both upper and lower lids T
d. Hydroxychloroquine 4. Retinopathy
b. Painful F
5. Angle closure
c. Inflammation of hair follicle F Glaucoma

d. Inflammation of meibomian glands T 6. Blepharoconjunctivitis

e. Treated with Antibiotics and Hot 7. Corneal micro

fomentation F deposits

41. True or false on glaucoma: 8. Maculopathy

a. Topiramate causes glaucoma T Select the correct answer using the code
below:
b. Topical steroids are C/I in viral
conjunctivitis due to risk of glaucoma with a. a=7/b=2/c=3/d=1
it T
b. a=7/b=3/c=2/d=4
c. Latanoprost cannot be used in patient
with asthma F c. a=5/b=2/c=4/d=1
Superior oblique

d.
muscle (IV) [Intorsion
and depression in IOP decrease in pregnancy T d. a=3/b=5/c=2/d=1
Trochea adduction]

Tendon of superior oblique

Superior rectus
muscle (Ⅲ)
[Elevation] Lateral
rectus muscle

117
(VI) [Abduction]

Medial NEET PG / INI-CET WORKBOOK BY DR. NIHA AGGARWAL

rectus muscle (Ⅲ)
[Adduction]

Inferior rectus
muscle III (Depression)
 ONE SHOT OPHTHALMOLOGY

46. When should Fundus examination be [Link]

PAGE NO -
done in a 45 years old female with newly
diagnosed diabetes mellitus with no visual
symptoms?

a. After 2 years

b. After 5 years

c. At the time of diagnosis

d. Doesn’t require fundus examination

47. Which of the following is correct regarding

PAGE NO - 11
the image given below:

a. Ocular deviation
No Li ht
b. Stereopsis test

c. Refractive errors
Normal
Response d. Sensory anomalies
to Li ht
50. Which anti-glaucoma drug causes ocular
PAGE NO - 11
ositive
RA D of
hypotension with apnea in an infant?

Ri ht Eye a. Latanoprost b. Timolol

No Li ht
c. Brimonidine d. Dorzolamide

PAGE NO - 12
a. It is called as Argyll Robertson pupil
Normal
51. Chemotherapy agents for retinoblastoma:
b. Response
This test is named after famous scientist
to Li ht gun, a physician of US.
a. Vincristine, carboplatin and etoposide
Marcus
b. Vinblastine, etoposide and bleomycin
c. The vision is normal in right eye
ositive c. Vinblastine, vincristine and etoposide
d. RA
SeenD ofin optic neuritis, the pupil can
Ri ht Eye
paradoxically dilate in both eyes in the d. Vinblastine, vincristine and cisplatin
presence of flash light.

48.
PAGE NO - 12
What is not to done in the given below case:
52. Which of the Parameter is Decreased in
Retinitis Pigmentosa?

a. Arachidonic Acid

b. Trielonic Acid

c. Thromboxane

d. Docosahexanoic acid

53. Drug used in acute congestive glaucoma

are:

a. Atropine

a. Remove the foreign body b. Pilocarpine

b. Check for visual acuity c. Acetazolamide

c. Give antibiotics d. Both b and c

d. Do primary survey 54. A 3-year-old child is presenting with

drooping of upper lid since birth. On
49. The test given below in the image is used examination, the palpebral aperture height
for: is 6 mm and with poor levator palpebrae Superior oblique
muscle (IV) [Intorsion

superioris function. What is the procedure

and depression in
Trochea adduction]

recommended?
Tendon of superior oblique

Superior rectus
muscle (Ⅲ)
[Elevation] Lateral
rectus muscle

118
(VI) [Abduction]

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rectus muscle (Ⅲ)
[Adduction]

Inferior rectus
muscle III (Depression)
 BOOK
PREVIouS YEARS QuESTIoNS

a. Levator muscle resection

[Link]
a. Cover-uncover test

b. Mullerectomy b. Maddox rod test

c. Fasanella Servat operation c. PAGE NO - 1

Occlusion test

d. Frontalis sling surgery d. None of the above

55. Which is the most common ocular finding in 59. Esotropia is commonly seen in which type
myasthenia gravis? of refractive error?

a. Ptosis b. Lagophthalmos a. Myopia b. Hypermetropia

c. Proptosis d. Enophthalmos c. Astigmatism d. Presbyopia

56. Visual disturbance in the following condition 60. Which of the following is an example
is due to: PAGE NO - 1 of compound myopic, against the rule
astigmatism:

a.

b.
PAGE NO - 14
–2D Sph - 2Dcyl at 180

–2D Sph - 1Dcyl at 90

PAGE NO - 1
c. +2D Sph - 2Dcyl at 90

d. –2 Dcyl at 90

61. The most common cause of proptosis in

PAGE NO - 1 adults is:

a.
PAGE NO - 14
Lesion occluding pupil a. Orbital cellulitis

b. Astigmatism b. Preseptal cellulitis

c. Thyroid eye disease

c. Cataract
d. Capillary hemangioma
d. Myopia
62. Which one of the procedure involves using
57. Identify the instrument:
PAGE NO - 14 glaucoma drainage device?

a. Seton operation

b. Deep sclerectomy

PAGE NO - 14 c. Viscocanalostomy

d. Trabeculectomy

63. A 2-year-old child presents with watering

of eyes with bilateral proptosis and
PAGE NO - 1
a. Maddox rod b. Maddox wing
photophobia. What may be the diagnosis?
c. Maddox glass d. Red glass

58. Identify the test shown in the Image:

PAGE NO - 1

a. Congenital glaucoma

Superior oblique
PAGE NO - 1 b. Retinoblastoma
muscle (IV) [Intorsion
and depression in

c. Megalocornea
Trochea adduction]

Tendon of superior oblique

Superior rectus d. Congenital endothelial dystrophy

PAGE NO -/ 1
muscle (Ⅲ)
[Elevation] Lateral
rectus muscle

119
(VI) [Abduction]

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rectus muscle (Ⅲ)
[Adduction]

Inferior rectus
muscle III (Depression)
 ONE SHOT OPHTHALMOLOGY

64. The pair of spectacles shown in the picture a. Oculomotor nerve palsy [Link]

below are used in:

b. Trochlear nerve palsy

c. Internuclear ophthalmoplegia

d. Lateral rectus paralysis

69. Identify the marked layer in the given

histology section:

a. Bifocals for adult aphakia

b. Bifocal glasses for presbyopia

c. Progressive glasses for presbyopia

d. Bifocals for pediatric pseudophakia

65. What is the angle subtended by the topmost

letter of Snellen’s chart at the nodal point
of eye?

a. 5 min b. 20 min

c. 50 min d. 30 min

66. What is the most common eye manifestation

in Sturge–Weber syndrome?

a.

b.
Glaucoma

Keratitis
PAGE NO - 1
a. Outer plexiform layer

b. Inner plexiform layer

c. Uveitis
c. Outer limiting membrane
d. Retinitis pigmentosa
d. Inner limiting membrane
67. A patient came to AIIMS OPD with acute
70. Tylosis refers to:
pain and watering from eye for 3 days.
There was 3 x 2 mm ulcer on the cornea a. Hypertrophy and drooping of eyelid
with ROLLED OUT margins and feathery
and finger-like projections with minimal b. Inversion of eyelid
hypopyon. What is the diagnosis?
c. Senile eversion of eyelid
a. Bacterial b. Fungal
d. Distortion of cilia
c. Acanthamoeba d. HSV II
71. A 21-year-old female patient presented
68. Below image signifies which of the following with glaucoma with bulging cornea. What is

PAGE NO - 1
condition? the most probable diagnosis of this case?

a. Keratoconus

b. Keratomalacia

c. Staphyloma

d. Granular dystrophy

72. Identify the pathology in the below

histopathology picture of retinal pigment
epithelium?

Superior oblique
muscle (IV) [Intorsion
and depression in
Trochea adduction]

Tendon of superior oblique

Superior rectus
muscle (Ⅲ)
[Elevation] Lateral
rectus muscle

120
(VI) [Abduction]

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rectus muscle (Ⅲ)
[Adduction]

Inferior rectus
muscle III (Depression)
 BOOK
PAGE NO - 1 PREVIouS YEARS QuESTIoNS
[Link]
He had underwent cataract surgery 1 year
back. The best corrected visual acuity is RE
- 6/12 and LE - 6/9 No improvement with
pinhole. What is the probable diagnosis?

a. Cystoid macular edema

b. Pseudophakic bullous keratopathy

c. ARMD

d. Posterior capsular opacification

78. A 5-year-old boy was brought with the

complains of protrusion of the right eye–
10 days with no h/o fever. CT-scan showed
well-defined mass in the orbit with irregular
a. Drusen border and adjacent bony destruction. Biopsy
showed small, round cells which is positive
b. Bipolar cells
for Desmin in immunohistochemistry. What
c. Basement membrane. is the probable diagnosis?

d. Phagosome a. Retinoblastoma

b. Cavernous Hemangioma
73. Stenopic slit is used for all except-
c. Orbital cellulitis
a. Fincham’s test
d. Rhabdomyosarcoma
b. Determine the axis of cylinder

c. Corneal tattooing 79. In 3rd nerve palsy all seen except?

d. Iridectomy a. Pupil dilation

b. Ptosis
74. Which of the following is used as an
adjuvant therapy for fungal corneal ulcer? c. Outward upward rolling of pupil

a. Atropine eye drops d. Impaired pupillary reflex

b. Pilocarpine eye drops

80. A patient is taking drugs for rheumatoid
c. Dexamethasone arthritis and has a history of cataract
surgery 1 year back, the patient presented
d. Lidocaine
PAGE NO - 1
with sudden painless loss of vision, probable
diagnosis is?
75. Which of the following is not an ocular
manifestation of Dengue virus infection?

a. Cataract

b. Maculopathy

c. Optic neuritis

d. Vitreous hemorrhage

76. Which of the following is the site of lesion

of internuclear ophthalmoplegia?

a. Medial longitudinal fasciculus

b. 6th nerve nucleus

PAGE NO - 1
a. CME
c. Pontine paramedian reticular formation b. Macular hole
d. A and C c. Chloroquine toxicity
Superior oblique
muscle (IV) [Intorsion
and depression in
Trochea
77.
adduction]
A 55-year-old male patient came to OPD with d. Chronic choroiditis
Tendon of superior oblique

the complaints of gIare during night drive.

Superior rectus
muscle (Ⅲ)
[Elevation] Lateral
rectus muscle

121
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Medial NEET PG / INI-CET WORKBOOK BY DR. NIHA AGGARWAL

rectus muscle (Ⅲ)
[Adduction]

Inferior rectus
muscle III (Depression)
 PAGE NO - 1
ONE SHOT OPHTHALMOLOGY

81. A 15-year-old boy presented with headache b. Intact light reflex, accommodation
[Link]
is
and blurring of vision. On examination there absent
was diplopia on looking towards left in the
c. Both light and accommodation reflex is
right eye. What is your diagnosis? absent
a. Tb meningitis d. Both are normal
b. lnternuclear ophthalmoplegia
87. 100-day glaucoma is seen in?
c. Cranial neuritis
a. Central retinal vein occlusion (CRVO)

82.
d. Demyelination

A 70 years old lady 2 days following cataract

b.
PAGE NO - 1
Central retinal artery occlusion (CRAO)

c. Diabetic retinopathy
surgery presents with eye complaints
as shown in the image. Next step in its d. After injury

PAGE NO - 1
management is?
88. What is the most serious cause of
conjunctivitis that cause blindness in
children?

a. N. gonococcus

b. Streptococus

c. Staphylococcus

d. Chlamydia

89. Most common wall of orbit involved in a

PAGE NO - 1
blowout fracture is:

a. PAGE NO - 2
Intravitreal antibiotic a. Medial b. Floor

b. Intravitreal steroids c. Lateral d. Roof

c. Eye patch and dressing 90. Most common cause of neonatal eye
infection is?
d. Intravitreal mannitol
a. Staphylococcus
83. Yoke muscle for right lateral rectus in
dextroversion movement of eye is: b. Streptococus

a. Left medial rectus c. N. Gonorrhoeae

b. Left superior rectus d. Chlamydia

c. Left superior oblique 91. PAGE NO - 2

Cause of given retina image is:

d. Left inferior oblique

84. Last vision to go in glaucoma is:

a. Temporal b. Superior

c. Inferior d. Nasal

85. A 50-year-old emmetropic patient,

presbyopic correction needed is?

a. +2D b. +4D

c. +3D d. +t D a. Acute leukemia

86. 3rd nerve palsy in diabetes mellitus b. Sickle cell anemia

characteristically shows?
c. Beta thalassemia
Superior oblique
muscle (IV) [Intorsion

a. Absent light reflex, accommodation is and depression in

d. Uveal melanoma Trochea adduction]

present Tendon of superior oblique

Superior rectus
muscle (Ⅲ)
[Elevation] Lateral
rectus muscle

122
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rectus muscle (Ⅲ)
[Adduction]

Inferior rectus
muscle III (Depression)
 BOOK
PREVIouS YEARS QuESTIoNS

92. Which PAGE NO - 2

is an example of the simple myopic
[Link]

astigmatism among the prescriptions given

96. A patient of glaucoma presents with bulging
cornea. The most likely diagnosis is :
below?
a. Keratoconus
a. Treatment with (+) spherical lens
b. Keratomalacia
b. Treatment will be cylindrical/plano (–)
lens c. Staphyloma

c. Treatment will be (–) spherical lens d. Granular dystrophy

d. (–) (+) (+) (–) on both 90 and 180-degree 97. A 60-year-old diabetic male presents with
axis a history of decreased vision. Fluorescein

93. Identify the refractive error: PAGENO

PAGE NO-- 22
21
angiography showed the following image.
What is the most likely diagnosis?

a. Myopia b. Presbyopia

c. Hypermetropia d. Astigmatism

PAGE NO - 21
94. Following picture exhibit which cranial
nerve palsy?

a. Mild non-proliferative diabetic retinopathy

b. Severe non-proliferative diabetic

c.
PAGE NO - 22
retinopathy

Bird shot choroidopathy

d. Proliferative diabetic retinopathy

98. A patient presents with endophthalmitis

after 5 days of cataract surgery. All the
treatment regimens can be followed except?

a. Intravitreal injection

b. Intravenous steroids

c. Pars plana vitrectomy

d. Topical Antibiotics

PAGE NO - 22
a. Oculomotor nerve

b. Abducent nerve 99. Identify the given condition:

c. Trochlear nerve

d. Facial nerve

95. Which is the most common epithelial

lacrimal gland tumor?

a. Adenoid cystic carcinoma

b.
Superior oblique
Pleomorphic adenoma
muscle (IV) [Intorsion
and depression in

c. Mucoepidermoid carcinoma
Trochea adduction]

Tendon of superior oblique

Superior rectus
muscle (Ⅲ)
d. Malignant mixed tumor
[Elevation] Lateral
rectus muscle

123
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rectus muscle (Ⅲ)
[Adduction]

Inferior rectus
muscle III (Depression)
 ONE SHOT OPHTHALMOLOGY

a. Pinguecula 103. Identify the below finding: [Link]

b. Pterygium

c. Chemical Burn

d. Thermal Burn

PAGE NO - 2
100. Identify the test shown below:

a.

b.
PAGE NO - 24
Ptosis of right eye

Entropion of right eye

c. Lagophthalmos right eye

d. Ectropion left eye

a. Tonometry 104. Visual pathway defect at the level of optic

b. PAGE NO - 2
Laser interferometry
chiasma will result in:

a. Binasal hemianopia
c. Pachymetry
b. Bitemporal hemianopia
d. Refractometer
c. Central scotoma

101. A 60-year-old with cataract surgery, post d. Bilateral hemianopia

1 year came with complaints of diminished
vision. And shows the following finding. 105. Which of the following will not cause
Diagnosis? hypotonic maculopathy?

a. Suprachoroidal hemorrhage

b. Cyclodialysis of uvea

c. Corneal perforation

d. Filtration site leak

106. Which of the following is false about corneal

epithelium?

a. Bowman membrane can regenerate

PAGE NO - 24 b. Limbus have stem cells

c. Lined by stratified epithelium

a. Irvine-Gass syndrome d. Apical cells have microvilli

b. After cataract 107. A patient is prescribed on eye ointment

and eye drop by a nurse. What should she
c. UGH syndrome advice about putting them?

d. Endophthalmitis a. Eye drops followed by ointment

b. Ointment flowed by drops

102. “Silent choroid” on FFA is feature of:
c. Eye drops applied first , wait 15 minutes,
a.
PAGE NO - 24
Best’s disease then apply ointment

b. Age related macular degeneration d. Eye ointment applied first, wait 15

minutes, then apply eye drops
Superior oblique

c. Stargardt’s disease
muscle (IV) [Intorsion
and depression in
Trochea adduction]

Tendon of superior oblique

d. Cystoid macular edema

Superior rectus
muscle (Ⅲ)
[Elevation] Lateral
rectus muscle

124
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rectus muscle (Ⅲ)
[Adduction]

Inferior rectus
muscle III (Depression)
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108. A 55 year old man has undergone LASIK for

[Link]
111. A patient having left sided based tilt. In
myopia. What is the best method to check examination there is right sided hypotropia
for power? increase on dextroversion and right head
tilt. What is the diagnosis?
a. SRK-1 b. SRK-2
a. RSO
c. HAIGIS d. Hoffer Q
b. LSO
109. If the numerical aperture of objective lens
is increased, what is the change in the c. RIO
Image observed?
d. RSR
a. Increased magnification

b. Increased Contrast

c. Increased resolution

d. Increased field

110. A small pupil, which remains the same in

dark is seen in the condition of:

a. Argyll Roberson’s Pupil

b. Blind pupil

c. Horner’s Pupil

d. Adie’s Pupil

Superior oblique
muscle (IV) [Intorsion
and depression in
Trochea adduction]

Tendon of superior oblique

Superior rectus
muscle (Ⅲ)
[Elevation] Lateral
rectus muscle

125
(VI) [Abduction]

Medial NEET PG / INI-CET WORKBOOK BY DR. NIHA AGGARWAL

rectus muscle (Ⅲ)
[Adduction]

Inferior rectus
muscle III (Depression)
NOTES