Clinical Ophthalmology
DJ :
Hussein Mnjbel
Slit lamp
Uses:
- Anterior segment examination
- indirect Fundoscopy (using condensing
lens)
- measure IOP ( using applation )
Direct ophthalmoscope
Use:
Fundoscopy (examination of retina )
Snellen chart
Use:
- To measure Visual acuity (VA)
Applanation tonometry
Use:
- To measure IOP ( used in
conjugation with slit lamp )
glues me 11 E g.
&
Trichiasis
( Posterior misdirected of eyelashes )
:
commonly used now
days .
B: 151
-
-
Eyelid disease
Chronic anterior blephritis Chronic posterior blephritis
Most important thing
Impetigo
Herpes simplex virus infection typically presents with
dendritic ulceration of the corneal epithelium
E
Herpes zoster ophthalmicus
②
Cause: varcilla zoster infection
•
Involvement of skin supplied by ophthalmic nerve+
Hutchinson sign ( external nasal nerve involvement)
•
Painful vesicles and pustules on erythematous base
Treatment: antiviral agent ( acyclovir )
Treatment: hot compress +topical
antibiotics (if infected, internal horedulum )
+ surgery if no improvement
Treatment: topical antibiotics + hot compress
always
Surged
+
Stye ( external horedulum )
Epilation
-94' id
under Abx cover
• FEW
Pinpoint painful whitish lesion on upper eyelid
: Cause: staphylococcal infection of eyelash follicle and its
associated gland of zeis
• Treatment: topical antibiotics + hot compress + epilation of hair follicles
&
Cellulitis skirts
between
to differentiate
Preseptal and
1- preseptal cellulitis orbital cellulitis
2- orbital cellulitis
.
2 3 4
5
PresPetal cellulitis →
so * A-
Treatment: Complications:
- Hospitalization - Exposure keratopathy
- IV + oral Antibiotics - Increased IOP
- 48 hrs if no improvement => Surgery - Endophthalmitis
- Meningitis, brain abscess
Treatment: simple excision
Ptosis
Types
:
1- congintal
2- A aired
Left eye ptosis
Treatment:
Mainly surgical,
or medical treatment for
the underlying cause (e.g.
Mysthenia gravis)
Right eye ptosis
i.
µ
-
Bacterial conjunctivitis
Associated with: pain, discharge, conjunctival redness
Treatment: broad spectrum topical antibiotics
Subconjunctival haemorrhage
Causes: Tretment :
- Idiopathic self -
limiting 5-7- days
- Trauma
- Hypertension
Red eye differential diagnosis?
1. Subconj. Haemorrhage
2. Conjunctivitis
3. Scleritis
4. Episcleritis
5. Uveitis
6. Keratitis
How to differentiate between Naevus and Melanoma?
- On examination, Naevus is mobile lesion, while Melanoma is fixed to the
eye globe.
↑
- most common risk factor .
Bacterial keratitis
Large Corneal
Stromal infltirate Stromal infltirate perforation =>
( supporation ) ( supporation ) stromal infiltrate
and hypopyon and hypopyon on corneal surface
Treatment:
- Hopitalization
- culture ( scrapings )
- Empirical antibiotic.
Bacterial keratitis ( Emergency )
Stromal infltirate ( supporation )
and hypopyon
→
→ Hypopyon ( intra-ocular fluid level
with pus) (in anterior chamber)
Treatment:
- Hopitalization
- culture ( scrapings )
- Empirical antibiotic.
Pterygium
%
( Abnormal growth of conjunctiva on the cornea )
Causes:
- UV light exposure
- Chronic surface dryness
Treatment:
1. Medical: artificial tear, topical steroid, sunglasses + Anti -
VEGF agent
2. Surgery : simple excision
Basal cell carcinoma
Rodent ulcer ( pathognomonic sign of basal cell carcinoma )
Treatment: surgery +- chemotherapy
Strabismus ( squint ) F-
-8 Righ side eye esotropia
→ Right side eye exotropia
Treatment:
- Glasses for mild cases
- Surgery for severe cases
common ﺷﻮﻓﻮھﻦ ﺑﺎﻟﮕﻮﮔﻞ ﻣﺎﺣﻄﯿﺘﮭﻦ ﻷن ﻣﻮ ھﻤﺎت وﻣﻮhypertropia وhypotropia اﻛﻮ ﺑﻌﺪ *
Occlusion therapy
Of amblyopia
Most common cause of amblyopia is SQUINT
Cataract
( opacification of crystalline lens )
Causes:
- Aging
- Diabetes mellitus
- Trauma
-
drugs ( steroid )
Treatment:
- Glasses for mild cases
- Surgery for severe cases
ink 3 G- I 1. ICCE
#
2. ECCE-
3. Phacoemulsification
Xanthelasma
Treatment: surgical excision
&
Leukocoria
- Most common cause : Cataract
- Most serious cause : Retinoblastoma
&
Lid retraction
(Bilateral)
Causes:
- Thyroid disease
Differential diagnosis:
- Restrictive myopathy
- Resection of superior
rectus muscle.
Nasolacrimal duct probing in congenital
nasolacrimal duct obstruction
Nasolacrimal duct obstruction presentation:
- Epiphora
- Matting of lashes Complication:
- Acute dacrocystitis
Hyphema
A hyphema is when blood collects inside the front of the eye. This happens between the cornea and
the iris.
Treatment:
Topical corticosteroids
if no
improvement →
Surgery .
Diabetic retinopathy
Signs: Treatment:
- Exudate Medical:
1- well glycemic control
- Haemorrhage 2- Anti-VEGF agents
- Oedema Surgical: PPV surgery
Stages of Diabetic retinopathy
Disc swelling
The most common cause is papillodema (bilateral disc
swelling) caused by increased ICP.
Iris prolapse
Cause: corneal perforation (or laceration) due to TRAUMA.
Treatment: Surgery
Ectopia lentis
dislocation or displacement of the natural crystalline lens.
Cause:
- Trauma
- Marfan syndrome
Treatment:
Surgery
Arcus senilis
Due to aging ?
Maybe associated with hyperlipidemia (cholesterol), and coronary
artery disease.
Keratoconus
Symptoms:
1. Refractive error
2. Diplopia
Treatment:
1. Glasses 2. Surgery
Exophthalmos ( thyroid eye disease )
:S # →
it
frontal view si
→
lid retraction of
lateral view s!@i 1%
Exophthalmos
!
ٮﺤﺎن/ٮﺎ ب اﻻﻣ0ٮ/ﺣ-ى ا+اﻟﺴﻼٮ &ﺪات ال
Direct Ophthalmoscope
ﻛﻞ، ﺳﻼﯾﺪات ﻛﻞ ﺳﻼﯾﺪ ﻣﻄﻠﺒﯿﻦ١٠ اﻻﻣﺘﺤﺎن
ﺤﺪام0ٮ/اﺳﻢ & اﺳ
ﻣﻄﻠﺐ ﻋﻠﯿﮫ درﺟﺔ ﺣﯿﻜﻮن اﻟﻤﺠﻤﻮع ﻋﺸﺮﯾﻦ درﺟﺔ
Applanation Tonometer
ﺤﺪام0ٮ/اﺳﻢ & اﺳ ٮﺎﻟﺴﻼٮ &ﺪات- ى+ح-/اﻫﻢ اﻟﻤواﺿيﻊ اﻟﲇ ٮ
Chalazion
Bilateral Lid Retraction Keratitis
ٮﺐ-اﺳﻢ & ﺳ Pterygium ٮﻪ-كﻠﺶ ٮ &ﺤ
Diabetic retinopathy
SCH
→ Sub conjunctival Haemorrhage Stye
Ddx 3 & ﺤ&ٮﺺ0ﺸ/ٮ Trichiasis
Cataract
Hyphema Glaucoma
ڡ&ٮﺮﺳﺖ ﻻٮ &ﻦ ﻋﻼج0 & اﺳﻢ Oribital cellulitis
Dendritic ulcer
Red eye
Cataract Congenital lacrimal duct obs
اﺳﻢ & ﻋﻼج
good
Ptosis
luck
ڡﺎل0ٮﻪ ﻣﺎل اﻻﻃ-ٮﺎ-اﺳﻢ & اﺳ
Pterygium
ٮﺐ-اﺳﻢ & اﻫﻢ ﺳ
Orbital Cellulitis
complications 3 & اﺳﻢ
Diabetic Retinopathy
.TW#WFmdosooPy
signs
+ seen in
stages & اﺳﻢ
ﻷن ﻣﺎ اﺣﺒﮭﻦentropian, ectropian ﻟﻸﻣﺎﻧﺔ اﻟﻤﻠﻒ ﻣﺎ ﺑﻲ
