aL ‘a? Describe its various treatment options. What is myopi MYOPIA: a ; ] Myopia or short-sightedness is a type of rofractive error in which parallel rays of light coming og infinity are focused in front of the retina when accommodation is at rest | ‘TREATMENT: : : | Spectacles—Myopia is treated by prescribing suitable correcting spherical c me lenses for crn use : 3 aa Hygiene of eyes—Proper position, good illumination and correct distance from the-book (aboitt 25. while reading is essential : | Operative pte, ha E: 3) Bpikeratophakia 4) Kéraomileusié 5). LASIK 1) Radial keratotomy 2) Excimer laser’ What is hypopyon corneal ijlcer? How will you manage batter eee ae HYPOPYON CORNEAL ULCER: Hypopyon ulcer is a comeal ulcer associated as a result of iridocyclitis. It is important to nd the toxins and not by actual invasion of the‘ba MANAGEMEN’ Admit the patient if necessary. Identify the predisposing facto 1) Contact lens wear 2) Ocul Investigations should be c: Routine investigations are!“ *: 1) Blood CP 2) BSR 3) Blood siigar-4) Urine DIR Microbiological investigations: °) : The material is obtained by'scfiping\the base and margins of ulcer under topical anaesthesia by kins} spatula or bent tip of 20 Gauge hypodermic needle, The scraping is used for: 1) Gram & Giemsaistaining for identification of the infecting organism 2) 10% potassium hydrox (KOH) for identification of fingal hyphae 3) Culture and sensitivity. “Giprile pus in the anterior chamber, F nyponyonte, tat hypopyon iGisterile as the leucocytosis is duc to ries Mi i ime 3)Occier Sur fore the Use of antibacterial therapy. What is glaucoina? Write down the clinical features of and management of acute congestive glaucoma/acute arigle closure glaucoma. GLAUCOMA: Glaucoma is a progressive optic neuropathy with characteristic appearance of the‘optic disc & spe pattern of visual field defects, inay or may not be associated with increased IOP. CLINICAL FEATURES: : 1) Edema of the lids & conjunctiva 2) Marked conjunctival & ciliary congestion 3) Comes is insensitive 4) Anterior chamber is very shallow 5) Iris pattem is lost & may be discoloured 6) P! ee dilated & vertically oval 7) Severe unilateral headache, nausea, vomiting & prostration! Marked ace oa 9) Redness, lacrimation & photophobia 10) Halos around light. Control of the acute attack: i Ds ‘Systemic therapy is carried out to 1) Reduce the raised 1OP 2) Decrease the comeal ed in the its sabecotuzolamide VV decteaées the aqueous secretion by 40-60%, Hyperosmotic agents increase the blood osmolality which creates an osmotic gradient between the blood and the vitreous humor, drawing water from the vitreous cavity and reducing IOP. The fryperosmotic ngents are: ts 1) Mannitol (1/V) 2) Glycerol (Orally) , ‘Analgesic are used to relief the pain, © Aitiemetics are used fo control the vomiting, . \ Be ‘opieal thorapy: . 1) Pilocarpine 2) Beta blockers e.g. Timolol 3) Alpha-2 agonist 4) Topical carbonic anhydrase sjnhibitor 5) Topical steroids pl 3) Alpla.2 agonist 4) Topical car yydrase ' Prevention of the future attack: in the’same eyes : sot iridotomy 2) Trabeculectomy , Prevention of the attnelc in the fellow eyes To prevent the attack in fellow eye, prophylactic laser iridotomy or surgical iridectomy may be performed, , f elegl aripotomy may What is cataract? How will you manage s case of senile cata CATARACT: : ‘Any opacity in the Jens or its capsule whether developmen MANAGEMENT OF SENILE CATARACT: ts No medical treatment is‘effective once opacities have dey/eloped: Non-surgical treatment: . 3 Spectacles => For the correction of refractive dios Dark glasses => To decrease the constrictidn‘ok pubil, Pupillary dilatation with mydriatic => mfijsimproyen (nuclear or posterior subcapsular ac cleat portion of the lens. Surgical Treatment The modem trend is in favoiit This reduces the iticidencd of In the modein age ECCES The type of operation depeitd be removed by thé 1) ICCE 2) ECGE, PTERYGIUM: eS Ibis a degenerative Condition of the conjunctiva in which theres triangular fibrovascular connective tissue overgrowth from conjunctiva to the cornea in the interpalpebral region. CLINICAL FEATURES: , i — 1) Usually symptomless 2) Cosmetic disfigurement 3) Impaired vision 4) Rarely diplopia 5) Numerous small opacities, ie. deposits of iron 6) Limited inward ocular movements 7) Triangular encroachment of the conjunctiva on the cornea from the inner canthus in the palpebral aperture. ‘TREATMENT: Non-surgical: Tearg substitute to control the dryness of comea. Topical steroids for inflammation Sunglasses to reduce ultraviolet light exposure.B. Surgic > i. ii, 6. A > > > B. > > > > > > > 8. a i emetic reason, and in stage Treatment of pterygium is surgical excision indicated in stage 1 for cosmetic reason, and in stage, 7 {ot prevention of vision deterioration. Procedure: : — a Simple excision (bare scl technique) is associated wit a high rate af ecurnts nd Simple conjunctival flap-excision and covering of bare area with con} Describe the clinical features and treatment of acute dacryocystitis. e ACUTE DACRYOCYSTITIS: Itis the acute suppurative inflammation of the isriml a. 7 CLINICAL FEARURES OF ACUTE DACRYOCYS : — fall . i ith epiphora 2) Swelling 1) Subacute onset ofa painful redness & swelling a the medial cant wi no ieee ee the medial canthus, avhich is reddish and (ender on touch 3) Kegurgitation Mucopurulent or purulent discharge 5) Abscess formation s TREATMENT: . Conservative: Antibiotic systemic or topical are used to control the infection. *. Congenital rubella is proBiblytie iavst fr >: Intrautering hypoxia/placeiital fi > Maternal exposure to ionizing > Drugs e.g. Cortigdsftnoids & > > ¢.g, Preeclampsia and eclampsia aie. stich as X-rays, gamma and beta rays. : Endocrine dist S severe placental haémorthage, eg. placenta praevia. oF thé’ foetus or infant like galactosaentia, galactokinase deficiency, emia, fiypddalcaemia and lowe syndrome. " Chromosomal absiotimaliies, e.g: as in Down syndrome (t 7 i isoiny 21) > Ooular anomalies'e.g, aniridia, persistent hyperplastic primary vitreous. >, Trauma due to forceps delivery. ©. Unknown cause: 5 > In sporadic cataract, etiology is unknown and constitutes 35-55% of cases. 7 10. What are’ the causes of hypopyon corsieal'uleer? How will you treat bacterial corneal ulcers? ' HYPOPYON CORNEAL ULCER: | Hypopyon ulcer is a corneal ulcer associated with hypopyon, 1.6, sterile pus in the anterior chamber, 48 aresult of iridocyelitis CAUSES OF HYPOPYON CORNEAL ULCER: Microbial keratitis (Infective causes): Bacteria: Gram, Positive anc organism - % 83] Page AlVVVVVVVVV' VY pv vvE PS vvVVYDVV'ivyYvVYVY! ~ What is conjunctivitis? How will you treat allergic conjunctivitis? Viruses: Herpes simplex and Herpes zoster virus Fungi: Aspergillus fumigatus'dhd candida albicans Protozoa: Acanthamoeba spp Chlamydia trachomatis : Non-microbial keratitis (Non infective causes: Hypersensitivity ce Autoimmune diseases (Mooren ulcer/ peripheral ulcers) Neuroparalytic (1 nerve palsy) Neurotrophic ulcer (ophthalmic division of trigeminal nerve lesions) : ” Exposure keratopathy (proptosis) Nutritional deficiency (vitamin A/ Protein) Tear film abnormality (keratoconjunctivitis sicea/ xerophthalmia) Chemical burns (Acid burns/Alkali burns) Eyelid abnormalities (Trichiasis/Entropion) CONJUNCTIVITIS: Itis the inflammation of conjindtiva. Itis allergic when it is charactetiged by itching and redngss allergens or antigens, Fe Acute allergic conjunctivitis: 1) Cold compresses 2) Topical antihistamine, Seasonal & perennial allergic conjunctiviti Avoid exposure to allergens, cold com cromoglycate/lodoxamide) Steroids are rarely indicated &. Vernal keratoconjunctivitis & Topical therapy: ee Se Avoid exposure to allergens; cold compressés are effective Mast cell stabilizers are effédtive (Soditih cromoglycate/Lodoxamide) ‘Antihistamines control itching:(Emedastine/Epinastine) NSAIDS block non-histamife mediators (Ketorolac/Diclofenac) Combined Antihistaminé & Mast cell stabilizers (Azelastine ketotifen olopatadine) Topical steroids (Fligrofriie{holone/Prednisolone) Mucolytic agerit (Acelyiéysteine) & Topical Cyclosporin Supratarsal stéroid'injection (Dexamethasone/Triamcinolone) Systemic therapy: Immunosuppressive agents (Steroid & Azathioprine) : Oral antihistamine is helpful to reduce itching : Phlyetenular keratoconjunctivitis (Phlyctenulosis): Topical steroid drops are usually very effective Topical antibiotic is used to prevent secondary infection Treat the source of antigens such as chronic staphylococcal blepharitis, worm infestation or tuberculosis sratokonjunctivitis: “‘Keopic: . What is entropion? How will you classify the entropion? ENTROPION: Itis the condition in which the eyelid margin is turned towards the eyeball(CATION OF ENTROPION: fi ae , ASEM g classified into: | = 7 Batet genital Batropion 2) Acquired Entropion ae penital Enropion: ea rare condition : ie aniged by developmental deformity ofthe tarsal plate ised Entropion: I is further classified into: " Sef qavolutional) Entropion: . Sie most common te and aflecs only lower eyelid in elderly people used by overriding of preseptal over the pretarsal part ofthe orbiulars muse a le, as a result of we eye tis ca sp ale of the tarsus and lower lid retractors, Cicatricial Entropion: ; {ris also common type, usually involves the upper eyelid. Tris caused by scarring of the palpebral conjunctiva, whi . : is eases are a ich pulls the lid matgin towards the globe’ == Cicatrizii = pemphigoid. Chemical injuries such as Face burn, Lacerating injuries such as Trauma. ii t. Spastic Entropion: } Ttresults from excessive contraction of orbicularis ooy! sinrecognized atrophy of the lower eyelid retractor ijward rotation of the eyelid margin. . ) Its causes include: : i... Ocular irritation from chronic conjunet Mi jatients who have mild or ‘icularis oculi muscle causes 13, What is diabetic retinopathy? Clas itedowit:the features of pre-proliferative diabetic retinopathy. 4 Itis a non-inflammatory disease of the retina; characterized by progressive dysfunction of the retinal vasculature secondary fo f » CLASSIFICATION OF DIABETIC RETINOPATHY: jabetic retindpithy (BDR) 2) Pre-proliferative diabetic retinopathy (PPDR) 3) ‘tingpathy (PDR) 4) Diabetic maculopathy 5) Advanced/complicated diabetic retinopathy.(ADRY, Bent out diabetic retinopathy. ' FEATURESOE PRES ROLIFERATIVE DIABETIC RETINOPATHY: «_ Itis the iSoliginitistage-gharacterized by following features: i 1ge8-cotfist of generalized dilatation and tortuos aiid satisage liké's¢gmentation. ¥ Coiton wool spoté’also called soft exudates. 1) They present the area of nerve fiber layer int 2) They are caused'by swelling of the nerve fibers, leading t with indistinct margin. Intraretinal microvascular abnormality (IRMA) are art arterioles 16 venules, thus bypass the capillary bed. They appeat fine (lines) that run from arterioles to venules, without erossing major blood vessels. of veins along with bleading, looping farots resulting from occlusion of precapillary arterioles 0 characteristics whitish fluffy appeerance eriovenous shunt vessels that run from retinal irregular, red intraretinal vessels |. What are the features of vitamin A deficiency? How will you treat it? i VITAMIN A DEFICIENCY (BYPOVITAMINOSIS) ency. Xerophthalmia ig a spectrum of ocular manifestations ‘caused by vitamin A deficiens>«FEATURES OF VITAMIN A DEXICTENCY: , 7 Night blindness is the earligst symptom 2) Ocular foreign body sensation due to dryness Conjuneti Xerosis is the wrinkling and pigmentation. os, . a Bitot spots are grey triangular patches of foamy keratinized epithelium in intet Palpebral area. g consist of keratinized epithelium, inflammatory cells, debris and corynebacterium xeross, ip associated with conjunctival ty dryness of thejgoniunetiva. Typigalis & may be ve v Xerosis: Gives a lusterless appearance to comes. Punctuate epithelial erosions. In the inter palpebral area. Corneal ulceration : . Keratomalacia: Sterile comeal melting by liquefective necrosis that may lead to perforation, Reti Yellow white dots in peripherg! fundus. Electroretinogram amplitude is reduced ‘TREATMENT: ‘Topical (reatment: 1) Artificial tears 2) Topical retinoic acid 3) Treatment of comnealile vvvy' ovve - Systemic treatment: 1) Oral administcation of Vitagnin A 2) Intramuscular injection.s)Rrotel * PTOSIS: It is an abnormal drooping of the upper ¢} © CLASSIFICATION OF PTOSIS: , ‘A. Congenital ptosis: 2 Itis caused by maldevelopment in the following forms: 1) Simple congenital ptosis Blepharophimosis syndroh B. Acquired ptosis a) Neurogenie ptosis = Itoccurs due to.lesion of th 1) Third nerve palsy 2) Hoi b) Myogenic ptosis: | | ' * It is due to defect of muselé Or myoneural junction. Its types are: 1) Myasthenia gravis 2).Geular thyropathy 3) Myotenic dystrophy ©) Aponeurotic.ptosi Itoccurs due to‘dehiscence, disinsertion or stretching of the levator aponeurosis. Its types are: ic 2) Traumatic disinsertion of levator aponeufosis 3) Postoperative due tod 8 &tendén or nerve supply of levator muscle. It oc AN sys Giga JavE Winking Ptosis (Congenital Synkinetic Ptoss) ee iivos.supplying the upper eyelid. syndrome 1) Involutional or ser action on aponéurosis. d) Mechanical ptosis: Itoccurs due to increased weight of the upper eyelid caused by lesion. 1) Eyelid tumors e.g. neurofibromatosis 2) Inflammation: Large chalazion/derniatochalasis .? Deseribe its various treatments. 16. What is hypermetro} + HYPERMETROPIA: Itis the type of refractive error, where parallel rays of light entering the eye are focused pehind retina, while accommodation is at rest,—_— ee cent OF HPERMETROVIA: : Yon-surBical? i None Tenses plus ee re . «Cans hildrea, when the refractive error is more than 3-5 diopt > a correction. pters or convergent squint is present it ildren, full correction of hypermetropi: stent wit nee eri o tropia consistent with good vision is advi: Stang aduls,Bypermeropia Less than 3 diopters and good vision without sy —- iene . symptoms rarely needs , Surgleae ye Keratestomy (PRK, i Photoreftactive Keratectomy (PRK), in which anterior surfa i is therefore center becomes steeper. It corrects 2 diopters of es ne meee Laser in situ keratomileusis (LASIK) corrects up to 4 diopters. ° Conductive keratoplasty, it involves application of radiofr c x nase ketosis iofrequency energy to comeal stroma, to correct, power lenses vw ve > > + HYPERMETROPIA: Inis the type of refractive ‘error, whére parallel rays of light retina, while accommodation is at rest. « TYPES OF HYPERMETROPIA: 1) Axial hypermetropia 2) Curvature hypermetropia 3) hypermetropia 5) Aphakia veyyy z E z g B é EB} 2 ‘After.7 years of age w! error becomes myopic. Severity of HypéFinetro Low => Refrative érfor less than Moderate, elragtive: ror greater than +2.diopters up to +5 diopters. ive'éiror greater than +5 dioptets. veo v _ 18. What are thie @andég of corneal ulcer? What are the diagnipstic methods of ulcer? -% » CORNEAL ULCER: There is a'loss in the continuity necrosis. ‘ » CAUSES: The common causative bacterial organisms of corneal ulcer afe as follows: > Gram-positive cocci—Staphylococous aureus, S. albus, Streptococcus hemolyticus, S. pn' (Pneumococcus). > Gram-negative cocci: Neisseria gonorrho > Gram-positive bacilli: Nocardia asteroides, Cory > Gram-negative bacilli—Pseudomonas aeruginosa, Escherichia coli, etc. > Mycobacteria— Mycobacterium tuberculosis, M: leprae. > Three pathogens can invade normal intact epithelium... = of the corneal epithelium associated with tissue infiltration and yeumoniae des (meningocorets) a (diplobacilli). Moraxella, Hemophilus, ea (gonococcus), N. meningit bacterium diphtheri Proteus, Klebsiella,1) Neisseria gonorrhoeae 2) Neisseria meningitides 3) Corynetecterium diphtheri * DIAGNOSTIC METHODS: + Staining of the cornea by fluorescein stain: > Superficial staining: it staing.the margin of the ulcer bright brilliant green. > Method: A drop of fluorescein is instilled in the conjunctival sec. Alternatively, disposable st > 2 fluorescein stain may be used. After few seconds, excess dye is washed off with normal saline’ “! Deep staining: It stains the stromal infiltration defect grass green and the endothelium yellow j,, colour respectively. Method: After instillation of fluorescein dye in the conjinctival sac, the lids are kept closed for i, minutes. Excess dye is washed off with normal saline. 19. What are the types of cataract? Define merits and demerits of phacosurgery- © Types of cataract: - On'the basis of age: oY 1) Congenital cataract 2) Infantile cataract » Juvenile cataract 4) Adil cata 6) Senile cataract ee, '~ On the basis of location of opacity in the lens: 1) Capsular cataract 2) Subcapsillar cataract 3) Cortical cataract 4). Supra Jear cataract 5) Nucle: cataract 6) Total cataract t = - On the basis of degree of opacity: 1) Incipient cataract 2) Immature cataract 3) Intume cataract (Calcified, Morgagnian) - Cataract ean be classified as: '5) Presenile catirs Demyetinating disorder, inflammation of the myelin sheath Infections associated with ¥ zoster virus, syphilis, lyme disease, cat scratch fever. Parainfectious associdited ‘with measles, mumps and chicken pox related infections. It is also associ with post immunization. Contagious inflammation Intraocular inflamniation Systemic autoiinmune diseases such as: 1) Systemic lupus 2) Systemic polyarthritis TREATMENT: Corticosteroid therapy Oral prednisolone alone is contraindicated When MRI brain supports multiple sclerosis the regimen is as follows: W methylprednisolone sodium suecinate followed by oral prednisolone YM interferon beta Vitamin B1, B6 and B12 injections are given. associated with meninges, orbit and sinus associated with uveitis, endophithamitis.21. Define glaucoma. Enumerate the clinical feature and di glaucoma. “agnostic methods of pri Primary open angle + GLAUCOMA: ; Glaucoma is a progtessive optic ne » pattern of visual field defects, ma +; CLINICAL FEATURES OF P: 3 sion 2) Night bi both eyes 3) Intraocular pressure is aed 4) Gini g és ie disc + DIAGNOSTIC METHODS, - ‘on (diurnal variation) ix JOP, loration of vision inone or anges are present $) Visual Medical treatmen ae > Prostaglandins (Latanoprosi/ Travoprost/ Bi; ‘ : > Beta blockers (Timolol maleate/ Torsha ee ie! i: > Alpha 2 agonists (Brimonidine/ Apraclonidiny areal > Carbonic anhydrase inhibitors @orzolamide) > Adrenergic drugs (Bpinephrine! Dipivettin) > Combined drugs: : 1) Xalacom (Timolol+Latanoprost é me : CinaisreE aaa eae (ibibo (@e) 3) Combigan Laser Trabeeuloplasty: : : 1) Argon laser trabeculoplasty (ALT) 2) Sel Surgical treatment: ; ; 1) Trabeculectomy 2) Non-penetrating glatigoma Sargery (Deep sclerotomy) é 22, What are the clinical features an + ACUTE RWDOCYC It is an acute inflamma * CLINICAL FEATURES ig (ifitis) and the ciliary body (cyclitis). SLE YRDOCYCLITIS: keratié. precipitates (KPs cells) 6) Anterior chamber shows (Aqueous 1ous exudates/ Hypopyon) 7) Iris is muddy in appearance 8) Constricted rsVnechiaé gives irregular shape to pupil 10) Anterior vitreous shows 2d reflex may be poor but fundus is psually normal 12) Tenderness of eyeball The aim is to relieve the patient's symptoms, treat the underlying cause and prevent complications The drugs used are: ; Mydriatic & Cycloplegic drugs (Atropine sulphate, Homatropine, Cyclopentolate) Steroids (Prednisolone, Dexamethasone) . Systemic NSAIDS Systemic steroids (Prednisolone) Antimetabolites (Azathioprine, Methotrexate) Cyclosporin” Antibiotics ; on Intraocular, steroid (Intravitreal triamcinolone acetoni———— ~ atures of Congenital Nasolacrimal Duet block and its treatment, 23, What are the clinical fe UCT OBSTRUCTION/BLOCK: SONGENTTAL NASOLACRIMAL D _ CONGENITAL NA se enomaly eaused by non-canalization of the meu, Itis the common congenitalfjgorimal drainas the lower end of the nasolacrital duct. + CLINICAL FEATURES: ; . co 1) toceut it about 5% of full erm new born 2) It may be unilateral or bilateral. Bilateral involy is more common 3) Watery eyes 4) Sticky mucoid 5) Mueopurul Ient'discharge 6) Positive repurpi + Conservative: ee 1) Spontaneous patency 2) Massage of the lacrimal sac 3) Topical & systemic antibiotics - Surgical: 1) Probing 2) Syringing (irrigation) > Others 1) Intubation with silastic tube 2) Balloon catheter dilatation of nas > Dacryocystorhinostomy (DCR) . ; - It - It is caused by herpes simplex virus type 1 and type 2.’ * CLINICAL FEATURES: ye 1) Foreign body sensation 2) Lacrimation 3) Ph 5) Reduction of corneal sensitivity 6) Gilli Rose Bengal shows dendritic or geggrapliical * TREATMENT: Eh * + Topical antiviral drugs (Acyloguandsiti -. Debridement: After topica! SI 2mm beyond the edge of - ‘Topical-antibiotices “si - Cycloplegics (Atropine droj - .Oral antiviral therapy; (Ac | \ | | | test. ; 1 + TREATMENT: | 25. What are the clinical + CLINICAL FEATURES: 1) Leucocoria 2) Convergent squint 3) Nystagmus 4) Severe pain 5) Enlargement of the globe wit protrusion of the eyeball 6) Multiple polypoid masses in the fundus 7) Pseudohypopyon with esol"? (convergent squint). + TREATMENT OF RETINOBLASTOMA: ; 1) Enucleation is the treatment of choice in clinical stage 1 and stage 2 2) Exenteration of the of") Radiation and chemotherapy 4) Cryotherapy 5) Photocoagulation by argon laser or diode lase"' 0 SS SS | a ee 26: What are the clinical features and treating - ‘ut of Vernal Kerato. ivi -conjunctivitis VC? «VERNAL KERATOCONyUNG . _ Itisa recurrent, Vilaterlsteoon eae an . exogenous allergen. It occurs due to hype is O°eur and dust. It is mediated by Igz, Tsensitivity rea : a FEATURES: 1) Itching 2) Thick, white, ro, a , Photophebia 5) Lacrimation or wate, 888° 3) Burning & foreign body sensation 4) + TREATMENT: - - Topical corticosteroids _Acetyleysteine drops * Disodium cromoglycate 2% drops : Lodoxamide 0.1% drops : a4 Cryotherapy-of the-nodule may be-effective- - ‘Tinted glasses provide considerable comfort and relief. - Non-steroidal anti * srbiorone tia, es Leta pear terir) drugs (NSAIDs), e.g. flurbiproféni jiidoniethacin, diclofenac 0.1%, - Supratarsal injection of steroid is very effective - Topical cyclosporine 1% + Surgical management includes: 1) Debridement 2) Lamellar keratéctomy ing With the onset of hot weather) caused by ction to exogenous allergen such as pollens * ering @examethasone/Betamethasone) 27. What are the clinical features and treatme « CONGENITAL GLAUCOMA: ~ It is defined as-glaucoma appearing petwesu Birth tension present since birth, it is duéito c < Which i + CLINICAL FEATURES: 1) Lacrimation 2) Photo} ‘abnstmality at the angle of anterior chamber in ; Sytiea. Hazy. Caria 4) Enlargement of comea 5) Corneal oedema & ‘flattened & displaced backwards 8) Sclera becomes thin & bluish A. Medical treai > Systemigiatétas the intrdgehla B, Surgical o iridic angld is i i s Nec up the blockage of the comeoiridic angle by the persistent embryonic tissue Feeney elie i repcated on the other side also. Its often difficult to loalise the Schlomm's sone e a ncret iis useful in cases where goniotomy hes failed or witen the angle isnot visible due to anal, iid mannitol IV along with local beta blockers, e.g timolol maleate control ‘operatively G 7 neers my: If all forms of trabeculotomy fail then a trabecilectomy, a type of filtering operation, ‘rabeculectomy: inay be considered 8. Define-astiginatism. What are the types of astigmatism and how will you manage regular ‘ \. Define ‘astigm: - 7 . . astigmatism? aor eMariaes son in which 2 point of light cannot be made to produce @ punctate image » Itis that condition of refraction pon the vetina by any spherical correcting lens (astigmatism = a point). . ~~» girsVV VOV VV OVE > |. Sclerit TYPES OF ASTIGMATISM: Regular astigmatism = : 1) Simple 2) Compound 3) Mixed . | | Irregular astigmatism & MANAGEMENT & TREATMENT OF ASTIGMATISM: | Non-surgical: 7 1) Cylindrical lens 2) Spherocylindrical lens 3)-Hand contact lens . Surgical: ) Photorefractive keratectomy (corrects up to 3 dioprg i 1) Astigmatic keratotomy 2) Extra sutures 3 r LASEK (corrects up to 3 diopters) 5) LASIK (corrects up to 5 diopters) What is esotropia? How will you treat accommodative esotropia? ESOTROPIA: Esotropia is a form of strabismus in which onc or both eyes turns inward, TREATMENT OF ACCOMMODATIVE ESOTROPIA: Refractive accommodative esotropia: : Fully accommodative esotropia ‘Hypermetropic correction-esotropia is fully corrested with glassé: Partial accommodative esotropia * Hypermetropic correction-esotropia is partially corrected. Amblyopia therapy-after correction of refractive ei Surgery for residual deviation ; Non-refractive accommodative esotropia: Executive bifocal glasses Amblyopia therapy-after correction of refractive ertor. . Surgery to correct the deviation and impiove binge ig single vision. Discuss the causes of painful res CAUSES OF RED EYE: ainfuil):3) Acute congestive glaucoma (painful) 4) Acute .ss) 6) Scleritis (painful) 7) Subconjunctival hemorthages a or cornea (painful) CAUSES OF PAINFUL RED.EVE: | . ynsei of pain 2) Mild to severe deterioration of vision & photophe! Keratitis: 1) Moderate to severeian; 3) Watery or mucopurileitt dischaf'ge 4) Circumcomeal congestion 5) Corneal staining with 2% fluorescein dye is positive’6) Hypopyon may be present in anterior chamber 7) It is usually unilater Acute congestive ghiie jitia! 1) Moderate to severe onset of pain with tenderness 2) Mild to severe deterioratioft of Vision: ven up to No Perception of Light (NPP) 3) Watery discharge 4) Deep ei congestion 5)'Hazy cornea due fo edema, corneal staining is negative 6) Anterior chamber is shallo 7) Pupil is mild dilated & iris may show atrophic patéhes 8) 1OF is above 4SmmHg to 7ommbg anc History of halos. Acute iridocyclitis: 1) Moderate to severe onset of pain with marked tenderness 2) Mild to mode. deterioration of vision 3) Watery discharge 4) Circumcortieal congestion 5) Anterior chamber is normal in depth and shows flare and cells 6) Cornea shows keratic precipitates 7) Pupil is constricted/miosed and iris is muddy in appearance 8) May be unilateral o bilateral 9) IOP is nor or raised due to secondary glaucoma : 1) Gradual onset-& pain is usually severe, deep & boring in character 2) Normal vision} Deep purple congestion 4) Sclera keralitis 5) Collagen disorders eoee eee in conjunetiva or, cornea: 1) Sudden onset with history of fall of foreign bot i! in is usually mild to moderate 3) Foreign body sensation, lacrimation along with coM or ciliary congestion