@ bellum enc Ceret SECTION 1: ANATOMY AND DEVELOPMENT ‘Ad 16.51rm amen Hypermetropia +2 to +3 Comea arm Umm Lens —spherloat 2zones of nucteus Biconvex 4 zones of nucieus Pupl sat ‘Anterior chamber shallow Orbit are alvergent 45 degree Ascegee Macuia undifterentiated | 4- 6 month) ‘Atler 4 month of bith Loctimal gland not functional Functional atter a month Fixation starts at 1 month. poor fixation Completed by 6 montts Binocularity at 3 montis By 5-6 years of age 6/6 Visual acuity poor 4/60 y muscle ene > Ciliary muscle and accommodation #7 joe pelo pecormee MOce Changes during accommodation jveye tne semen, ON aur — kurace ) merosis a > INTRAVITREAL INJECTION i fe pee Pa 4mm jem Unbos@ Cerebellum eteener ape > Coloboma in eye Normally when the eyeball is developing , 2 canal ( hyaleid canals claquet’s canal ) runs inferiorly through a fissure ( hyaloid fissure) in the neuroepithelium from back of lens to optic disc ‘* Through this canal hyaloid vessels pass which provide nourishment to the developing eve. Later this defect closes at around 6 to 7" week af gestation and canal disappear Persistence of the fissure- leads to coloboma ra ry Microphthalmos ( NEET PG 2019) not te RUBELLA Amoll ob Cryptophthalmos fuotd S . ™ ayCerebellum etter SECTION 2 LENS AND CATARACT » Morphological types ‘SNOWFLAKE | DM type 1 and 2, sorbitol accumulates in lens . aldose | reductase enzyme mediates (iL DROPLET | Galactosemia ( MC and early in GALT deficiency J, galactitol | accumulates . Only reversible cataract CHRISTMAS TREE | Myotonic dystrophy ROSETTE | Blunt trauma SUNFLOWER | Wilson disease and chiacosis ‘SHEILD LIKE [Atopic dermatitis RADIATIONAL (GLASS Infra red rays BLOWER) POLY CHROMATIC LUSTRE, So. cataract. Causes — uveitis (MC), tumour of eye , BREAD CRUMB | dergenerations in retina Mostly subcapsular Howe GLAUCOMFLECKEN | After Angle closure glaucoma attack > Kaiser Fleisher ring Cu accumulation in DM of cornea, Starts at superior part Vision normal. Disappear after treatment ‘Other causes of KF rings are cholestasis, primary biliary cirrhosis and “cryptogenic” cirrhosis .Ceruloplasmin is decreased in 85-90% of individuals, 24-hour urinary copper and free copper will show increased copper level. Seen under slit lamp, gonioscopy for early diagnosisCerebellum Steen > Hypermature senile morgagnian cataract Cortex liquifies and the nucleus settles down giving a BAG of MILK appearance. Micro leaks develops in the capsule from which lens proteins leak out and get deposited in angle Pdecreased drainage of aqueous > secondary open angle glaucoma PHALOLYTIC pene » MANAGEMENT / WORK UP tolformuia CP K IL A- ASEH O° 9K ome eS IL Feraharvoreaie EE a POST LASIK ( AIMS 2020)- Hal wan ~ for nreet Aetina. » 4 how nature onaay * KERATONE TER, > SURGERIES plcwLe 1, Small Incision Cataract Surgery (SICS) Self-sealing scleral tunnel, 5.5 mm_2. Phacoemulsification * Titanium needle is used with piezoelectric crystals rotating 40000 He - ultrasonic power to cut and emulsify the nucleus. © Self-sealing incision of 3.2 mm made at limbus, ar done in anterior lens capsule (I . rocedure done to separate capsule from cortex and nucleus ‘* Phaco power used to cut nucleus into smaller pieces and emulsify. ‘© Cortical cleaning done and !OL put in the bag. 3. Robotic surgery = Femto Laser Assisted Cataract Surgery ( FLACS) jo-'S , 1053 nm muttiocst — OM Fhe Aisouce caereck ef scomaton = oe MAO WK perword z h » Complications in cataract surgery M Ic U f Hyphema , glaucoma, uveitis, cystoid macular ed ‘endophthalmit fibrous downgrowth, retinal detachmentEndophthalmitis ( NEET PG 2018) : very severe inflammation of inner contents of eyeball with vitritis: _ Pp acne cary SIADH ZPIDEANIOIS ine fungus ‘Symptoms PVR after cataract surgery ¢ gown wisi Reduces Sins anterior chamber reaction, vin, rpopvon PLY.S tn AC R, - dubroc real tie PPV __ Posterior capsular opacification (PCO) AIMS ~ al * entooact auecr iy eoek Opes. enkaaacr fr type fy - ol YA ntete >» SUBLUXATION 4 cf "d Gp = unioudber Aaplep (BPL ME H S H) Below Poverty Line ME Hum Subluxate Hue oT Buphthalmos, Pseudoesfolition, hypertysenemi{ Martath weil mye syndrome , Ehler Danlos syndrome, Homocysteinuria, Sulphite oxidase deficiency, HMSC 1 tin Gable pron Mitgo SPHERDPHARIA WAVASE oo,g cerebelvPTioNn 3: CONJUNCTIVA > To see upper fornix dlesweseee Lid Hebacter > D/D of subconjunctival hemorrhage Hemorthagic=__, P A c . © RECOV = FO™ Preorna alamo Lexoekue 1 to 3 weeks take to resolve < 1A > > Ophthal ia neonatorum Come Girl Out Hove Coffee © Chemical (crede’ s method silver nitrate) 0-1 D G Gonococcus { NEET PG 2018) ©- Other bacterias H Herpes. C. Trachomatis D TO K > 7 DAY ( INICET 2021) > Vernal keratoconjunctivitis (VKC) Fores eelscetocomrs Boys Have Special Sense Of Care, KEEP Relaxed , Smiling , Dream for Money Boys , Homer tranta, Summer, Shield ulcer 1, Cobble stone papillae, Kerataconus , IgE, Exogenous, Pseudogerontoxon , Ropy discharge’ Dennie morgan fold , Maxwel Iyon sign frracete seeps > Giant papillary conjunctivitis ( NEET PG 2021) > Pterygium ( NEET PG 2019) ‘Wing shaped fold of conjunctiva encroaching on cornea stocker’s ine Indications of treatment: mainly cosmetic, decrease in vision - — wi, Treatment — excision ( bare sclera — 60 % recurrence} Excision + autograft PERFECT surgery ~ pterygium extended resection followed by extended conjunctival transplantation Methodstodecresse recurrence <= MMC, SPU, Awl f > XEROPHTHALMIA ( NET PG 2021 and 2022) xn ‘Night Blindness® ( 1* symptom) tia Conjunctival xerosis® ( 1" sign ) (as Bitot spot { metaplasia of epithelium : keratin +C. xerosis_) 2 Corneal xerosis ( acute dryness ) xa Keratomalacia < 1/3 cornea involved (small punched out ulcer) 88 Keratomalacia > 1/3 cornea involved ( ophthalmic emergency) xs Corneal scarring X Xerophthaimic fundus ( white retinal flecks)gy Cerebellum pense SECTION 4: OPTICS / REFRACTIVE ERRORS » Vision and its recording Taw | distewe g@ puso Each letter subtend an angle of 5 minute of an arc at nidal point of eye from that respective distance ( AIMS 2018) 50 A— forms 5 min at 60 meter, letters in 6/6 line at 6 meter ETDRS / LOG MAR/ BAILEY AND LOVIE chart D> Records minimal angle of resolution (MAR). 6/6 equals to MAR of 1 minute of arc = 0 , 6/12 equates to 2 minutes of arc D> Each line has 5 letters spacing between them and each row is related to width and height of letters respectively. Every letter has been a different score of 0.02 and hence EachlineO.1 HV ZDS NCVKD ozs ee ae Org syar ge, AGQ ier DINROLE Imm hole henspetenm More frequency of degenerations like lattice, snow flake More chances of Retinal detachments Choroidal hemorrhage in macula: foster fuch’s spot Lacquer cracks: breaks in bruch’s membrane Myopic crescent: disparity b/t sclera (globe enlarges) and RPE Posterior staphyloma: ectasia of sclera Large disc, large disc cup ratio Visibility of choroidal vessels, RPE thinning Tilted disc: dragging of retina nasally over disc Regular astigmatism can be classified into the —< Four types a With The Rule ( WTR) ea 5 “topes b. Against The Rule (ATR) — F ameuidan oe + Qo L1e0 Wihieg xuowadtine WEL Oblique astigmatism lout not A, Simp monic 8 Sees meme OO 6 «a © Compound nyremavopec eo © 10@ Cerebellum eteener ape Types according to prescription ~ ( NEET PG 2018) Simple hyperopic astigmatism (+0.5 DC at 90) —Ih8Cer ab Simple myopic astigmatism = = ‘Compound hyperopic astigmatism Compound myopic astigmatism —~ | ES ¢ | -10 Cot.aro Mixed astigmatism Direct ophthaimascope Findirect ophthalmoscope Magnification 15 times | upto 5 times Image virtual erect Image inverted , real, mirror image Only central retina seen Periphery seen too 2D image formed 3.0 image formed When media haze , no View of retina Retina can be partially seen if media haze ” yy a i Retinoscopy PRESCRIPTION OF GLASSES FROM RETINOSCOPIC VALUE es. u@ Cerebellum eteener ape Transposing lenses Transpose a lens power of +1,00 -3.00 at 90 degree {jn minus-cylinder form) to plus-cylinder form. ser | -3 = =AhS sor +3 _ -gas|43dcer step3 1g = 180 Spherical equivalent Take half the value of the cylinder, add it to sphere power. ( NEET PG 2022) In other words, asa formula the spherical equivalent Spherical Equivalent = Sphere + (Cylinder)/2 DUOCHROME TEST For subjective verification of refractive correction If the letters of the green side are clearer +0.25 D sphere is added If the letters on the red side are clearer -0.25 D sphere is added,Cerebellum eteener ape SECTION 5: CORNEA » LAYERS OF CORNEA A Epithelium : multi-layered , wing shaped cells, regenerate basal membrane has stem cells 8- Bowman : Type | collagen No regeneration (A/IMS 2020) G- Stroma: type 1, 3, 5 collagen , keratin sulphate (NEET PG 2022) D- Dua (6-10 micron) : Predescemet layer - lamellar keratoplasty done at this level ( named by Dr Harminder Dua) , Most resistant layer D-Descemet ( 10 micron): Type IV and Vil collagen E~Endothelium (5 micron) oon ah q horon qt & ¥ Endothelial eatleount(Ece) _ > CHO Colle specular MIER LOPE >» Thickness __ 52.0 pum cc » Sensations ( NEET PG 2022) TRIGEMINAL NERVE Decreased corneal sensation ‘ (ERBRRMBicer, surgery, tumour, Multiple Sclerosis, : coe ?@ =e > Fungal corneal ulcer (AlIMS 2018) Yo trauma by vegetative material, steroid usage . MC aspergillus ss ig ag a = Sanmundlegical 29 4 Witicleg - fa L unsteite lypepysn > "Retembtl neeandin Y- Sf notomyin + Map’ > Viral keratitis a. Herpes simplex keratitis — dean ducted Ruratiuak - Tue : hwobs G) Fluorescein dye ~ AAAI, EE vs Colon, Rose Bengal dye = btn edges pak Topical steroid are C/I ( AIMS 2019) be Merpeszoster aap — Herpes zoster ophthalmicus( HZO) aes |Cerebellum teins Pe octarivolvernent is frequent it side/ tp of nose presents with vesicular lesions (because of nasociliary nerve ~ common nerve supply to tip of nose and cornea) Menerveinvolved = = FrewRbw > Acanthamoeba ulcer Contac tens misusage / bathing in ety water Most paintutuicer PLO WAL uratovrentitis Difficult to diagnose vesimes = PHMQ ( Biquaside) ® Neuroparalytic (INICET 2022) _ id HAT Nwe J P q 4 aa Causes of lagophthaimos 7” nerve palsy, bell's palsy, acoustic neuroma, leprosy, severe scinpion, soe pnts NOE scarf Bacco \y- you Lappin i ent ) > Cornea verticillata: _ beeen SUK ful occultation FiTness CARD Fabry’ seas, indomethacin SRBRAEEoruine,Corpromacne (phencthiacn) (@ New) 16_ cubation. 6, wineaTe Hunning, > Keratoconus fai dtevnic Etiology : Defective cross linking in stromal lamellae Keratoconus OF MR VANSH (0 - Oil droplet reftex oon A [(€] R- Rizutt’s sign V- Vogt striae ‘Ac Applanation ( pulsating mires) N- Nerve prominent S- Scissoring reflex 4 Hydrops Associations Ectopia lenis, congenital can wot dermatitis Marfan, Ehler Danlos syndrome, jalve prolapse pracido disc ~ QUAN” CARA OARAL ee 4 pion 7™ SECTION 6; GLAUCOMA > Information on gonioscopy: | Can See Till Schwalbe’s Line 1 KK is iv way Ch Sued Ty » Van Herrick grading > Goldman applanation Tonometer ( GAT) Fixed area 3.04 mm /7.02 mm? Anaesthetize cornea with proparacaing; stain with fluorescein > under cobalt blue filter of sit lamp biprism advanced towards comea -> touches apex-> 2 semicircles observed > end point © RISK FACTORS FOR POAG ( INICET 2022) ("! ' a 7? , Ba, 5 i 6a i speech, POE .» ISNT RULE + Quim Deooduat ‘ % > Signs of glaucomatous cupping ange cup : dise ratio > 0.7 Disc haemorrhage Notching Laminar dot sign Asymmerty Bayonetting Baring of circumlinear vessles Bean pot cupping ypexuaneaw » Visual field defects 1. Isopteric contraction ( VIGABATRIN- AlIMS 2020) 2. Baring of blind spot 3. Wing shaped paracentral scotom: 4, Seidel’s scotoma = derringer’s scotoma 5. Arcuate (Bjerrum) scotoma 6. Double arcuate Peripheral nasal st 8. Only temporal island left ( NEET PG 2018) ual contraction of fields in centre 19> Angle closure glaucoma om gona Classification of PACG given by American Academy of Ophthalmology 1. Primary angle closure suspect pacs): LIC Ot 2. Primary angle closure (PAC) Le. tT 40 N 3. Primary angle closure glaucoma (pac): PAC VF difete omoge TCs on gonioscopy contact between peripheral iris and scleral spur, if posterior TM not seen on manipulation ‘Symptoms of angle closure glaucoma PVR , beadache UL newaea vowing ~ pednsen, ne: el aati ent sototii Vogt’ triad: (iiemonie Pi) (INCE 2022) de Management of angle closure glaucoma { NEET PG 201! 1, Systemic agents (hyperosmotics) a. 1/V 20 % Mannitol 1-2. gm/ kg BW Acatarslimide;> oh AANA... oot nen-abatic) 1:2 Ke OE 3. Pilecarpine 2% :......910. oe altpek, 4. Assess the angle by gonioscopy HPAS<180degree MTPAS > 180 degree y papa siege ae Peripheral Iridoplastyrtm cacamy « feitila. by os pet 41H ting Oo selral bebe > Congenital glaucoma (NEET PG 2021) Etiology... TAB ECLLLD pyS. GENES. Genetic : GLC 3 locus (cyt P1B1 gene) Clinical features Lasiumalior TRIAD ( BPL Mnemonic) AlIMS 2018 § peepiboce Comea bull aa an agent Blue “nT - ‘or alae kosge aS ese Refractive Status OPI a Woodson = oniowdel sebuee Lunt m (D/D — vertical striae after ferteps delivery) 21> Pigmentary glaucoma or Pigment dispersion syndrome (PDS) an yma. ’ Reverse pupillary ei nae ea asa valve resulting in 1OP higher in : eral posterior bowing of the iris oe sammiamneelain wk endotrelue [R) ‘Sampaolest' s line » Pseudoexfoliation jucoma ( PXF) Bull's eye or target sign ( NEETPG 2022) OV the Sampaolesi’s line can be seen Poymentea sohwalbcs Live Drugs important points PG jlogues — increase uveoscleral outflow bo iprost, bimatoprost, unoprost , tafluprast sest for PONG, NITY maximum decrease from bane set LWA, a 5 Dd Mis mut PAP ( PG associated periorbitopathy) — He peak eects, pLPRUOL , CMEg Cerebellum etter —- 2 Beta (NET PG 2019, 2021) : timolol and betaxolol ~ decrease production Uno spasny uf afco bol Bimodal action , cross 888 swe - Sedation 4. Carbonic anhydrase inhibitors : acetazolamide, dorzolamide, brinzolamide Decrease production of aqueous s/t = taste, tingling, renal stones -metabolic acidosis, cardiac overload Saline et oe SR eS, like nitric oxide, work primarily by enhancing trabeculat meshwork outflow. Inhibition of the norepinephrine transporter system, which leads to decreased production AH 6 can cm “ Pho kinae ina + tae 23ene SECTION 7: STRABISMUS > Extraocular muscles (EOM)- —Z- » CLINICAL DIAGRAM FOR MUSCLES sR 10 0 SR Ree bate Re Dome Dow Lr Lun 0 so R To check SO muscle {INICET 2022): LoD OL HOSE YOKE MUSCLE FOR Rt MR (NEET PG 2018) t te » TESTS FOR SQUINT 1, Bruckner’s test Normal red glow. Crescent | ~ MRED Lighter reflex bse 2. Cover— uncover test : for heterophoria ( NEET PG 2019) 3,. Tests for stereopsis ( AIIMS 2019) - Tit mus ~ 3 d booklet of 2 pages , one has fly and one has circles and animals , seen through polaroid 4, Tests for sensory anomalies: Worth 4 dot test =U 2red - 3green/ 2 red - beptepim 24@ Corebelien : 5. Maddox rod test (NEET PG 2019) _ OXLOUES @ ta Cmepere Eas 7 Sesnts - _ ao Tee oe t siege ae oy Esotropia (AIIMS 2019) Accommodative- A, Refractive ; patient has high hypermetropia +2D to +8 D. Treated by convex glasses . ce O.Nonretrective = pe hae sr eg A Ronis [AC/A Ratio = accommodative convergence/ accommodation ratio. s Treated by bifocals (AIMS 2018) = Cx ecultive Third nerve palsy ( AlIMS 2018) Structure supplied | Normal action | Features when paralysed ] LPs Elevation of eyelid Procis i} “em ‘adduction obductin ] a | Deprusaci 10 Elevation ww R Depression Up eye | but this action is ne | hs = elevators are paralysed) Sphincter Pupiliae Neloscee wy BR wu Caumuce Ottonodalut - Losr “OUT kbOWH eye "IXTH NERVE PALSY Eg Rt sided 6" nerve : diplopia more off ight To avoid diplopia face turn on ight. FOURTH NERVE PALSY Eg Right sided a © rep re Go bpp q Wot "ae pte pp te Jo Une, veal waucedee — Park, “8? oe ft Right. SOP Step 1 which side is hypertropic Step 2 hypertropia inereasing on which gaze Step 3 hypertropia increase on which head tilt Q. A patient 35 year old presented with Rt. hypertropia which increases on right gare and on tilting head on right shoulder, What is the muscle involved (AIMS 2020) Ba aa pup hata muscle sh so 2 Shp 2- felcr @ sold @ musele ee ee da a #, aN Qe Aeber ED 20 De ™ © pe,Cerebellum etter Duane retraction syndrome Absent or limited abduction , retraction of globe on attempted adduction Anomalous innervation of lateral rectus by 3" nerve agy Cerebellum Demers SECTION 8 : VITREOUS AND RETINA Lig er ing seine ewe tet taver angen eer tar pesto ape kant ue psc ee (au arp ayer of Rens and Coes ein pagent epeetie NFL: Has axons of ganglion cells, GCL : Nucleus of ganglion cells PL. : Synapse of axons of bipolar and ganglion cells INL: Bipotar cells / horizontal cells {interconnecting eurons\/ amacrine cells (nite synapses - axons bipolar ONL: nucleus of photoreceptors, ELM: limits outer segment Photoreceptors: only outer seg of photoreceptors, . ree opukts «= ORB Np funcbin © eae ees one. Pub Teer, Myopia, trauma and surgery of eye hou tous shoe dged How™ a and bucking - ep feanal seduol buckis ™ 4 q uaile , beau fund trou te Her « = fu Rede weaeble H04 b. PPV with tamponading agents / vitreous ae | => je ARD ali aa Silicone oil in AC Exudative Retinal detachment: SHIFTING FLUID SIGN IN EXUDATIVE RO ~~ vere wh athe NORMAL FFA Foveal avascular zone (FAZ) ® ~3s0 - 400 p HYPER ON FFA ( White areas) [ HYPO ON FFA ( Black areas) ] Microaneurysm, leakin neowascvlarisation [ Hard exudates, soft exudates, haemorrhage | 29@ Cerebellum eteener ape Diabetic retinopathy Classification of diabetic retinopathy mainly into non proliferative and proliferative retinopathy (ETDRS) (AlIMS 2019 ) Mild non proliferative diabetic retinopathy (NPDR) Moderate non proliferative diabetic retinopathy(NPDR) Severe non proliferative diabetic retinopathy(NPOR} Very severe non proliferative diabetic retinopathy| NDR) Proliferative diabetic retinopathy (PDR) : 1+2+3+4 + Neovascularisation vee Mild POR : any NVD or NVE High Risk PR (HR POR) : NVD > 1/3 disc area , NVD with VH, NVE > % disc area with VH typed ‘Screening ( AlIMS 2019) | ti= Treatment ~ PRP (* POR 53 ee “ur Pan retinal photocoagulation ( NEET PG 2022) ‘Anti VEGF 3. Bevacizumab is # humanized full length anti-VEGF antibody designed to block all VEGF \soforms b nized anti-VEGF recombinant Fab fragment (49 kDa) It binds with VEGFR-binding domain of all biologically active isoforms of VEGF-A. ¢. Pegaptanib (Macugen) is an RNA aptamer that binds and neutralizes VEGF 165 d._Aflibercept is a recombinant fusion protein consisting of VEGF-binding portions from the extracellular domains of human VEGF receptors 1 and 2, that are fused to the Fc portion of the human IgGi immunoglobulin a molecular mass of 26 KOA. Only FDA approved for wet ARMDCerebellum eteener ape HYPERTENSIVE RETINOPATHY Grade 1: arteriolar narrowing, + Grade 2: AV grade changes Grade 3: hemorrhage and exudates Grade 4: papilledema eee ee eke /. Central Retinal Arterial Occlusion (CRAO) ote techemia a OCL 4. Retinal whitening becomes normal in 4 to 6 weeks [ vision doesn’t improve} be chenysed sot = feta. oe vO Gc, po fscheme , poihitens Cattle track appearance temerity btord coery Pet or rorn sate aga + C= CRAO , CO poisoning T- Tay Sach disease N- Neiman Pick G- Generalised Gangliosidosis (GMI type 2) T-Trauma M- Metachromatic leukodystrophy, Methanol poisoning + S-Sandoff’s disease Central Retinal Venous Occlusion (CRVO) Dilated tortuous veins , haemorrhage and exudates , disc edema +/- CME Ischemic variety: less common ‘Thunder storm / splashed tomato appearance 100 day glaucoma (NEET PG 2018). Bratt qe caAVvO R w ME Bey CELE + Branch Retinal Vascular Occlusion 31Cystoid macular edema + DRIP Ur Nose p OR ta RP, . me ererrmarst —ANMS 2019 = fa CME Central serous retinopathy( CSR) s feret Moclet spudadiire Letoeb ment FFA: ink blot pattern / mushroom = smoke stack = umbrella appearance Mc ~% Mow Np oye Patkeer Which aver affected RPE CHOROLD pup fie Which layers elevated SK Fluid collected where gyn Stab Aptian Apne. Age related macular degeneration (ARMD) Etiopathogenesis: Sheetlike deposits basal laminar deposits ( ANIMS 2018) DRY ARMD (90%) ¥ Early ARMD Intermediate ARMD g yey ¥ Late AMRD - Geographical atrophy ~ pe poquests , RPE, platovupCerebellum Wet ARMD ‘Amsler grid 400 Squares, Centralvisualfeld “20 VF pe She meow T payee Retinitis pigmentosa (RP) * MC hereditary dystrophy + wvemance sporadic 7 AR? AD > K ‘+ Signs ~ Classically a triad is seen in retina ( Mnemonic - + lal igi re Pale dite P} Posterior subcapsular cataracts, CME, and refractive errors Associations of RP® (Associations of RP (BLACK URN ) Gardet Beidel syndrome, Laurence Moon Beidel syndrome, Abetalipoproteinemia ( Bassen Kornzweig syndrome), Cocayne syndrome | ataxia, deafness), Kearn Sayre syndrome 14 i irewcotn ae Fundus flavimaculatus and Stargardt disease (MC) (MC) Autosomal Recessive , progressive loss of central vision , begins in late first or second decade, Bull's eye maculopathy and Fishtail flecks at macula 3@ Best vitelliform macular dystrophy : dysfunction of protein bestrophin on chr 11. Lipofuschin accumulates at macula + Stage (Prevtetitorm): Ae(®) 204, Wo “ep? + Stage | (Vitelliform): classic “egg-yolk" lesion, A: + Stage Il! (Pseudohypopyon): layering of ipofuschin + Stage IV {Vitelleruptive): breakup of material gives 404 < 150 Oguchi’s disease or congenital stationary night blindness Non progressive night blindness in young person with normal day vision Golden-yellow metallic sheen Mizuo-Nakamura phenomenon > ae } ow BULL'S EYE MACULOPATHY: D/D Cone Dystrophy, Stargardt’s disea {Age Related Macular Degeneration, Central areolar choroidal dystrophy Benign Concentric Annular Macular Dystrophy, Fenestrated Sheen Macular Dystrophy Leber’s Congenital Amauosis, Chronic macular hole, Inverse Retinitis pigmentosa, Batten disease Bardet Biedl Syndrome, Clofazimine ToxicityCerebellum SECTION 9: OCULOPLASTY > Thyroid associated ophthalmopathy (TAO) Avicimmune (type 2), increase in fat or connective tissue volume. Deposition of GAG pm OC weageafe! ‘OALRY MAPLE RETRACTION OF UL VON GRAEte uu ‘GRUFEETH LOWER UID LAG ON UPGAZE eNROTH FULLNESS OF EYELIDS STELWAG WNFREQUENT BUNKING Giron (OVFFICULTY IN EVERSION OF UL mosis CONVERGENCE WEAKNESS, Jorrnor [LACK OF WRINKLING OW FOREWEAD ON UPGAZE {seLINKE'S ABNORMAL PIGMENTATION Coca-Cola bottle sign ‘on imaging Pe AC LI PN WU ormusete ve r- ——— » Cavernous sinus thrombosis BIL pe (te fected lal odictise lnowsp ud 36Cerebellum eteener ape > Destructive surgeries of eye 1. Evisceration (ida, bane upateukz \ , eyeoull ( hy @0M eal Indications: Panophthalmitis, expulsive choroidal hemorrhage, Bleeding anterior pital Contraindications TF 4 Syedoall ; damp thehe 1pm i" Be Indications : sympathetic ophthalmia, tumours of eye Z.Exenteration — fysoalk + aye Yy_ Bone (Removed Indications a eeoneaees > Rios caueepua 5 we bal '* Marcus Gunn jaw winking phenomenon (MGIW) RG ey met icgnnsl LPS Uy ptessaad musak LPS resection é eae ~~ a Sling surgery/ brow suspension (NEET PG 2019) ~ CLEVE BlL sere eG pra é piws URS detion sfoocce Inka mued as a 8ce aoe 'b. Chalazion/ tarsal cyst/ meibomain cyst ( AllMS 2019) Chronic painless lipogranulomatous inflammation of meibomian gland ‘Treatment by Incision and curettage ~ MISDIRECIED SAELASH + Trichiasis Distichiasis — rir eg eto tow 4 Madarosis — ee ‘Causes - Biepharitis, ae epromatoustepront mvaedera: pil, tumours, generalised alopecia, abel Poliosis «= oh netrmal Causes : blepharitis, VKH syndrome , Waardenbur ® Tylosis ; thickening of lid margin ( AlIMS 2018) + smtprn . odlhtaion belles sai + Ankyloblepharon — ‘ pyslid revsge j on » Retinoblastoma ay tae “wale ee France TRIP to COR bad rte Fungal endophthalmitis, Toxocariasis, ROP , Inflammatory cyclitic membrane PHPV, Congenital cataract , coloboma, Dysplasia of retina, Retinoblastorna hep btraluctic proprsals + eT ial ssfatapaotese “ Diagnosis ( NEET PG 2023) tora (we INEET PG Uaseaplon y ec VINCELC Tine — > Chronic dacryocys PE ; Regurgitation yo. | ~ ROPLAS +ve_ Syringing Interpretation Same canaliuls block ~ feo Ste = Common canals block Obstruction distal to sac / NLD meal? —* > Probing Spee: SPD > Tear film Break UpTirws ( BUT) S10see- fo > Schirmer test Sih » Phenol red thread test { aa pH dence | , srt aed Ey@ =e H8ZOSN SECTION 10 : NEUROPHTHALMOLOGY > PELLI ROBSON CHART Each group has 3 letters of the same contrast level. Score based on the contrast of the last group in which two or three letters were correctly read. Isa measure of the subject's log contrast sensitivity » Anomalies of disc Morning glory syndrome Mesodermal scleral defect, Absence of lamina cribrosa, Large excavated disc Vessels indistinguished ~ radiating like morning glory flow Drusen: calcified material on disc , Autofluorescence Hypoplasia ~ small optic dise , double ring sign Complete absence of the septum pellucidum , , Hypoplastic pituitary stalk Symptoms Ophthalmoscopic Findings 1. Nasal margia blue 2. Venous tortuosity 3. Enlarged dise 4. Macular star 5. Paton’s line ~ Un pekine Visual field OTHER D/O PX aCerebellum eteener ape >» OPTIC NEURITIS ( INICET 2022) Types : papilltis / retrobulbar neuritis / neuroretinitis Papillitis: UL sudden loss of vision , disc edema , RAPD Retrobulbar neuritis: Sudden loss of vision , retina normal , RAPD +. MRI to diagnose Neuroretinitis : papilltis + macular star formation > Optic atrophy Primary- Tuma /Toxja /T rOumMA /NuantHowed /H. ay Secondary ~ O46 pp i popuedigs: i 65208800, 6508600!> Lesions of visual pathway @ AvoPe Lesion at Lt optie nerve b. Lesion at optic chiasma = Br Central INICET 2021) ® he ints re Temporal hdres DB ea pin Lesion at It optic tract ( NEET PG 2021) , OS @ Ooreepin d. Lesion at it LGB Lesion at It optic radiation 4 < oo f. Lesion at it visual cortex Lesion at Lt proximal optic nerve - Pre fixed and post fixed chaisma lesions Envetue-d \e w&* he Trot 1 eek cr = tacoma ee} Opi tract Qa Qe = ey fle dapecte ee Oe sings sets @ @& ~ fae mmpint ag Cerebellum etter > Pupillary pathway ‘Normal pupil: constriction of pupil to light and accommodation ‘Pod Leye Vi Ree 1, Marcus gunn pupil = Relative Afferent Pupillary defect Test relative defects of afferent nerve for pupillary pathway ic te Optic nerve eg in Optic neuritis, Tested by swinging flash light test Pupillary escape phenomenon- abnormal dilatation of both pupils when light is withdrawn from normal eve and shown to — Lined Argyll Robertson pupil eh — ! Pha Shia pe ‘Tonie pupil : slow to react, UL large pupil, vermiform pupillary contraction hypersensitive tocholinergicagent = un vntty to orasy- piouresive |. Wemicke hemianopic pupil : Normal pupillary constriction when normal hemiretina is stimulated — in optic tract lesions Horner's pupil ( AIIMS 2020) : UL small pupil. Anisocoria { increase in dark ) 43Cerebellum eter HORNER’ S SYNDROME Hil PAMELA HI: Heterochromia iridium P= ptosis Ac anhidrosis M: meiosis E: enophthalmos Leloss of ciliospinat reflex A; anisocoria » Supranuclear control of visual system Vertical gaze centre- Interstitial Nucleus of Cajal / posterior commisure / Rostral interstitial nucleus ‘of the medial longitudinal fasciculus Hertzontaigaecentre = FEF ! PRA ‘The pathway for horizontal gaze ( AlIMS 2028) Fed) eX Nv ant ne, "R ay _, Qe uecen I page 2 Lesion of Rt PPRF ® cae A 3. Lesion of Rt MLF and Rt PPRF/6" nerve nucleus - | pen = Obs duchin 5 Oye Pps pase only “— _ - > Myasthenia gravis waren - depavinted GPR OO Gavel 4 Ue 45Cerebellum eteener ape SECTION 11: REFRACTIVE SURGERIES Re! vs LASIK - loud freetron swig = brwadl Puce Stovas omic a” io trkd INTACS : intracorneal ring segments ( NEET PG2022) ee pnsorted, 0 ICL: IMPLANTABLE COLLAMER LENS ( NET PG 2023), cj ) % | ate p RO ge }% Cerebellum SECTION 12: MISCELLANEOUS TOPICS TRAUMA 4 » "Petapeeed RRR ape eyelid haematoma seen in basal___— s fossa fracture * Blow out fracture ( NET PG 2018}: Fracture of floor orbit, Loss of sensation on half of face , enophthaimos Tear drop sign ( NEET PG 2019) wow ent nto 4 pceta ge revi * Anterior chamber. tris , lens > Sympathetic Ophthalmla: 8] severe granulomatous non suppurative paunuveltis after penetrating injury to ciliary body of one eye ( NEET PG 2022) 2wcehsyearsaterinty a Symptom = dp MAL Ft Sa debra Omkat cele % [ore Dalen fuch nodule *: yellow spots throughout retina (ageregation of epitheloid cells on RPE) Treatment — LyeRoips 3 abe vexpromnns —— — antuctentner | FAA ot > ronmensoor-ioc = «CT Siam 7 Uy BELO 7 a7Cerebellum etter 2 CHEMICAL INJURIES OF EYE Comeal epithelial and stromal damage by collagenase enzyme . Limbal ischaemia, ‘conjuctivalisation, ulceration and perforation. Treatment ~ wogde (* 30 mum | fecal sero, Tear supplement, Cycloplegic, Antiglaucoma drugs Sodiurn citrate , ascorbate , Vitamin A and C ) at Tetracycline Boston K Pro - The Boston Keratoprosthesis is a callar button design keratoprosthesis Repeat graft failure and aniridia multiple graft failures, Stevens-lohnson syndrome (SIS) , ‘ocular cicatricial pemphigoid, other autoimmune diseases, ocular burns@ Cerebellum eteener ape San eee Economic < 6/60 Manifest <1/60 Social veo Rene vor ‘Curable beeen it managed in time: Preventable Preventabeby appropriate prophylaxis Xerophthaimia, trachoma . glaucoma Avoidable preventable + ; Cdoble > Rastriya Bal Suraksha Karyakram - 30 selected health conditions, From birth tll 18 years * Wea det, Congest catargAUBBN Won pire » Fuch’s heterochromiciridocyclitis “i tesa Bagenentises Signs Classleal trad $@itaract( 50%), Geterochromialfi! , Bs mo (20%), Nodules, hsyniechia | Amsier's sign : aracentesis results in filiform haemorrhage » SCLEROMALACIA PERFORANS (NEET PG 2022) [eee necrotizing scleritis without inflammation elderly women with long-standing rheumatoid arthritis. SLE, PAN, granulomatosis with polyangitti Behcet disease, herpes-zoster are also associated 43> POSTERIOR SCLERITIS ~Uneepl d T SIGN in USG B scan eo rv wis tim vetledion UM » STAPHYLOMA | Ectasia of outer coat of eye with incarceration of uveal tissue behind it SOTerTy ‘ANTERIOR INTERCALARY Within 3 mm to limbus, MC cause : Peripheral Underiying root of iis Ulcerative Keratitis traumatic perforation After 3. mm from limbus, MC cause : Scleritis » Underlying ciliary body Perforation > Absolute Glaucoma At equator of eyeball, MC cause: Scleritis > Underlying choroid Myopia Behind equator, MC cause : Pathologie posterior pole Myopia 50@ Cerebellum enc » TOXOPLASMOSIS Active - Headlight in fog appearance Chronic ; macular scar / punch out 5.