OPTHALMOLOGY SHABRINA IYOOB MBBS

ANATOMY

Bony Orbit

Margins, walls, foramina, ducts, fissures Important structures pass orbit

OPTHALMOLOGY SHABRINA IYOOB MBBS

Cranial Nerves - 6 CNS innervate the eye and orbital adnexa (II-VII)

Optic Nerve: CN II

1.Intraocular part -- Optic disc /optic nerve head( which is where it begins in the
eyeball (globe) with fibers from the retina;
2.Orbital part -- (which is the part within the orbit).
3.Intracanicular part
(which is the part within a bony canal known as the optic canal)
4.Cranial part
(the part within the cranial cavity, which ends at the optic chiasm).

Oculomotor Nerve: CN III

OPTHALMOLOGY SHABRINA IYOOB MBBS

Trochlear Nerve: CN IV

Abducent Nerve: CN VI

Trigeminal Nerve: CN V

Facial Nerve: CN VII

OPTHALMOLOGY SHABRINA IYOOB MBBS

Ciliary Ganglion

Extraocular Muscles

Eyelid

Lacrimal Gland
OPTHALMOLOGY SHABRINA IYOOB MBBS

Topographical Anatomy of the Glob

Cornea
OPTHALMOLOGY SHABRINA IYOOB MBBS

Sclera

Anterior Chamber

Lens
OPTHALMOLOGY SHABRINA IYOOB MBBS

Uveal Tract

1.Iris

2.Ciliary Body

3.Choroid

Retina
OPTHALMOLOGY SHABRINA IYOOB MBBS

Macula

Vitreous

PHYSIOLOGY OF THE EYE

1.Ocular Blood Vessels

OPTHALMOLOGY SHABRINA IYOOB MBBS

2.Tear Film

3.Aqueous Humour

4.Intraocular Pressure

5.Accomodation
OPTHALMOLOGY SHABRINA IYOOB MBBS

PAEDIATRIC EYE DISEASE

1.Retinoblastoma

Definition -most common primary ocular malignancy of childhood

-tumours composed of retinoblast with large hyperchromatic nuclei & scanty cytoplasm
(rosettes)
Pathophysiolog -Arise from multipotential precursor cell (mutation in long arm of chromosome 13 band
y 13q14) that develop into almost any type of inner or outer retinal cell
-Exhibits -endophytic growth(vitreous seeding), exophytic growth(subretinal fluid
accumulation & retinal detachment), diffuse infiltrating growth
Clinical Features -Bilateral (1 yrs), Unilateral (2 yrs)
-Leukocoria (white pupillary reflex / cat’s eye reflex )-60%
-Strabismus
-Painful red eye with secondary glaucoma
-Poor vision
-Orbital inflammation, Orbital invasion
Investigation 1.Physical Examination
-Tonometry
-Anterior Chamber examination with hand held slit lamp
-Corneal diameter measurement
-Ophthalmoscopy (Red reflex testing)
2.B-scan Ultrasound
3.CT and MRI
Treatment 1.Chemotherapy
2.Focal therapy (cryotherapy, laser photocoagulation, transpupillary thermotherapy)
3.Brachytherapy
4.External beam radiotherapy
5. Enucleation

2.Strabismus

Definition Visual defect where eyes are misaligned, one/both eye not directed toward the object of
regard at same time
Classification Heterophoria-latent misalignment of both eye
Heterotropia-deviation persist even when both eyes are open (manifest)
Clinical Features -Asymptomatic
-Misaligned eyes
Investigation -General Inspection: Position of gaze (deviation of eye)
-Visual acuity presence/absence of amblyopia
-Ocular motility (if any muscle palsy-check for full range of movement)
-Measurement of deviation
-Testing of stereopsis
-Fundoscopy
-Hirschberg test
-Cover-Uncover test
-Prism cover test
Treatment 1.Wear spectacles if any refractive error
2.Occlusion of unaffected eye (Reverse amblyopia) and patching normal eye
3.Surgical correction of misalignment
OPTHALMOLOGY SHABRINA IYOOB MBBS

3.Retinopathy of Prematurity

Definition Vascular response of retina occurring predominantly in low-birthweight premature infants

exposed to oxygen therapy in early weeks of life
Pathophysiolog Failure of retinal vascularisation new vessel form extend to vitreous  traction detachment
y
Risk Factor -Gestation less than 32 weeks, Birthweight < 1.5 kg, Exposure to supplement O2
Clinical Feature -Commonly bilateral, avascular peripheral retina
-Leukocoria, vitreous haemorrhage, retinal detachment
-Increased tortuosity & dilatation of the retinal vessels
Treatment 1.Laser ablation of avascular peripheral retina
2.Intravitreal anti-VEGF agents

4.Congenital cataract

Definition Clouding/ Opacification of the lens of the eye that present at birth
Aetiology Metabolic Disorders: Galactosemia, Lowe syndrome
Chromosomal abnormalities: Down syndrome
Intrauterine Infection: Toxoplasmosis, Rubella, CMV, Herpes-Simplex, Syphilis
Clinical Feature Leukocoria, Lens opacity at birth, Nystagmus, strabismus, absent/asymmetric red pupillary
reflex, ambylopia
bilateral-children visually attentive (decreased vision)
In monocular cataract-the eye may be smaller
Examination 1.Visual acuity (<1mo-torchlight, <3mo-OKN drum, <1 yr-Kay Pictures)
2.Ophthalmoscope- Red reflex (absent-dense cataract) and fundus view
3.Pupillary light reflex (RAPD, leukocoria)
4.B-scan Ultrasound  dense cataract
Investigation 1.Screening for intrauterine infections ‘TORCH’
2.Urinalysis
3.Referal to paediatrician- chromosome analysis
Treatment 1.Lens aspiration with intraocular lens implant as soon as possible
-posterior capsulotomy (to prevent posterior capsule opacification)
2.Topical steroid and antibiotic
3.Patch normal eye, to encourage use of lazy eye  Ambylopia
4. Glasses for refractive error

5.Ptosis

Definition Drooping of upper eyelid

Aetiology Weak levator palpebrae superioris muscle eyelid lag on downgaze
-3rd nerve palsy, Myasthenia gravis, Horner’s Syndrome, Tumour
Clinical Feature Drooping eyelid, raise eyebrow and tilt head back in order to see, blocked vision, lid lag, fatigue
Investigation -Ach antibody myasthenia gravis
-CT orbit (trauma, palpable lid mass, orbital tumours)
Treatment 1.Surgery (shorten levator muscle-resection)
OPTHALMOLOGY SHABRINA IYOOB MBBS

GLAUCOMA

1.Primary Open Angle Glaucoma

2.Primary Acute Congestive Glaucoma

3.Secondary Glaucoma

Phacolytic Glaucoma
Trabecular meshwork obstruction due to high molecular weight lens protein

CATARACT

Definition Opacification of ocular lens

Aetiology Age-related cataract, diabetes mellitus, traumatic cataract
Pathophysiology -DM High glucose in aqueous humour  diffuse in lens
-Trauma Capsule ruptured
-Agingdenaturation of lens protein, slow sclerosis
Clinical Features -Gradual, painless blurring of vision, disturbance in colour vision (fading/yellowing of objects,
sensitivity to glare, coloured halos around lights
myopia (second sight of aged- assoc with nuclear sclerotic cataract)
Investigation 1.Red reflex test (opacities/ absent red reflex)
2.Fundus examination
3.Slit-lamp examination (type, location of cataract)
Treatment 1.Pre-op DM, HTN, B-scan ultrasoundto exclude retinal detachment ,Current refractive
status
2.Dilate the pupil with Tropicamide drops (dilate pupils to view periphery of lens and
diclofenac to prevent miosis intraoperatively
3. Before surgery Mydriatric + Phenylephrine
4. Conventional Extracapsular Cataract Extraction, Phacoemulsification with intraocular lens
implant
5.Post -op  Antibiotics
Intraoperative 1.Posterior Capsular Rupture
Complication 2.Drop Nucleus
3.Injury to cornea
4.Zonular dialysis
5. Suprachoroidal hemorrhage
Postoperative 1.Acute postoperative endophthalmitis
Complication 2. Delayed Onset Postoperative endophthalmitis
3.Suprachoroidal Hemorrhage
5.Posterior capsule opacification
6.Cystoid macular edema
7.Lens Dislocation
OPTHALMOLOGY SHABRINA IYOOB MBBS

1.Retinal Detachment

2.Central Retinal Arterial Occlusion

3.Central Retinal Vein Occlusion

4.Age-related Macular Degeneration

5.Diabetic Retinopathy

6.Hypertensive Retinopathy