Ophthalmology OSCE

Prince Matthew
Things to Note
• All images used here are “similar” images, variations of the ones that
were projected
• Remember to specify which eye the defect is in (left or right), which
eyelid (upper or lower (specify whether right upper, right lower, etc.)),
etc, for all structures that are paired.
• Specify what kind of antibiotic, steroid, antifungal, antiviral, etc is
used, for questions where it is indicated. Have an example in your
mind.
• For questions which require causes of a disease, if the causes can be
grouped under large headings (eg: for ptosis; neurogenic, myogenic,
congenital, aponeurotic, etc) use the large headings and give
examples under them.
Slide 1
1. What procedure is being performed in
the video?
• Goldmann Applanatory Tonometry

2. What is the normal range?

• 10 to 21mmHg

3. Name a drug each that can be used to

increase it and to decrease it.
• Increase it: Dexamethasone / Prednisone
• Decrease it: Timolol / Benzolamide
 Slide 2
1. Describe in your own words, the visual
pathway up to the lateral geniculate
nucleus
• The left visual field of the left eye, and the right
visual field of the right eye sends rays to the nasal
retina which travels contralateral across the optic
chiasm to the lateral geniculate nucleus
• The right visual field of the left eye, and the left
visual field of the right eye send light rays to the
temporal retina which travels ipsilateral along the
optic nerve to the lateral geniculate nucleus

2. What type of visual field defect will be seen

when there is damage to the optic chiasm?
• Bitemporal hemianopias
 Slide 3
1. State the extraocular muscles, their
functions and their innervation.
• Superior Rectus (CN III)
• Elevate and medially rotate the eyeball
• Inferior Rectus (CN III)
• Depresses and laterally rotate the eyeball
• Medial Rectus (CN III)
• Adduct the eyeball
• Lateral Rectus (CN VI)
• Abduct the eyeball
• Superior Oblique (CN IV)
• Depress and medially rotate the eyeball
• Inferior Oblique (CN III)
• Elevate and laterally rotate the eyeball
• Levator Palpebrae superioris
• Elevate the eyelids
This Photo by Unknown Author is licensed under CC BY-SA-NC
Slide 4
1. Name two diagnostic drugs used in
the clinic
• Fluorescein dye, Mitotic mydriatic drugs

2. State what one of the drugs

mentioned in (1) above is used for.
• it is used to assess for corneal ulceration,
integrity if corneal epithelium
Slide 5
A pregnant woman in her third trimester
presents with gradual reduction in vision
A. What are 3 causes of the reduced vision
based on her condition?
• Reduced corneal sensitivity
• Decreased IOP
• Dry eyes, Refractive error

B. She wants to change her glasses on referral,

what will be your next line of action?
Slide 6
A. Label the parts 1, 2, 3, 4, 5, 9, 10, and
11

B. Mention the parts of the uveal tract

• Iris, Choroid, Ciliary body

C. State two functions of the part labelled

3 (lens)
• Refracts light rays
• Focuses light rays unto the retina
 Slide 7
1. List 3 signs you see.
• Mid dilated pupil
• Conjuctival reddening, cloudy lense
• Irregular pupil
2. Mention 2 causes.
• Cataract, hyphema, trauma
3. State 2 complications
• Glare and Halos, Potential loss of
vision

Note the dilation of the pupil even

with the light in the eye
Slide 8
1. What is the device?
• Ophthalmoscope

2. State 3 uses.
• Examining the retina, Inspect the fundus or back of the
eye, Checking for optic nerve damage, detecting eye
disease,

3. Mention 2 causes of an absent red reflex

• Cataracts, Retinal abnormalities
Slide 9
1. What is the green glowing
substance on the image?
• Flourescein dye

2. State 2 uses it has in eyecare.

• Assess integrity of the corneal
epithelium
• Assess vessel abnormalities

3. What 2 signs can you see on the

cornea?
• Corneal ulcer, corneal perforation
 Slide 10
1. What is the most likely diagnosis.
• Stye of the right eye

2. State one differential diagnosis.

• Chalazion

3. What is the mode of management

of the condition?
• Warm compress,
• Removal of offending eyelash
• Topical antibiotic ointment
Slide 11
1. What do you see on the left
eye?
• Ptosis – drooling of the left upper
eyelid
• Reduced palpebrae fissure height
2. What are 4 causes?
• Myasthemia gravis, Nerve damage,
hea injury or eye tauma

3. What is likely to happen if the

condition is not treated in
childhood or infancy?
• Amblyopia, Strabismus,
Astigmatism
 Slide 12
1. Visual acuity testing is the most
objective test of visual function.
What are 4 other tests of visual
function?
• Colour vision
• Dark adaptation
• Contrast sensitivity
• Visual field
Slide 13
A woman presented to the eye clinic. After visual acuity testing, these
were her results
VR:6/18 VL:6/12+2
With pinhole VR:6/60 VL:6/6
1. Explain her unaided visual acuity test results
2. What could be the reason for her poor near sight(??)
3. Why did her left eye vision improve with the pinhole?
 Slide 14
1. Identify the conditions in a and b
• a = Entropion
• b = Ectropion

2. List 3 complications of b
• Corneal ulcers
• Corneal abrasions
• Drying of the eye
• Impaired vision
• Permanent blindness
 Slide 14
1. Identify the conditions in a and b
• a = Entropion
• b = Ectropion

2. List 3 complications of a
• Corneal and conjunctival damage
• Corneal stromal abrasion,
• Corneal scarring
• Corneal thinning
• Corneal neovascularization
Slide 15
What is the correct way of administering eyedrops?
1. Wash your hands with soap and water
2. Invert the bottle two to three times to mix the contents
3. Tilt your head back and look up
4. Use one hand to pull your lower eyelid away from your
eyeball
5. With the other hand, hold the bottle upside down with
the tip just above the pocket
6. Gently squeeze the bottle to let the drop fall into the
pocket
7. Close your eyes and press your finger lightly on your tear
duct for at least one minute
8. Blink the drops in
Slide 15
1. What is the condition above?
• Ischaemic central retinal vein
occlusion
2. State 3 causes
• Blood clott in the central retinal vein
• Trauma
• Uncontrolled DM
• Uncontrolled HTN
3. State 2 complications
• Macula edema
• Neovascularisation
• Vitreous haemorrhage
• Retinal traction
 Slide 16
1. What is the diagnosis?
2. State 3 causes of the condition.
Slide 17
1. What can you identify on the image
• leukocoria
2. State 4 differential diagnoses for
this
• Cataract (commonest differential)
• Retinoblastoma
• Persistent fetal vasculature
• Retinal detachment
• Retinopathy of prematurity
• Optic disc coloboma
• Toxocariasis
• Coats disease This Photo by Unknown Author is licensed under CC BY-SA
Slide 18
1. What do you see on the
image?
• Dendritic Ulcer
2. What is the diagnosis?
• Herpes simplex virus
3. What is the mode of
treatment?
• topical antiviral such as acyclovir
Slide 19
The man presented with a large
nodule on the anterior neck
• What is the diagnosis?
• Exophthalmos, Proptosis – Thyroid eye
disease
• What are 3 possible causes of the
condition?
• Graves disease, Overactive thyroid
gland, Tumours, Orbital inflammatory
syndrome
• What biochemical test can you
perform to confirm the diagnosis?
• Thyroid function tests
Slide 20
1. What is the condition shown in the
image?
• Ectropion of the left lower eyelid
• Entropion of the left upper eyelid

2. Mention two causes

• Trauma, Senile, Bells’s palsy, pRevious
eye surgery, facial nerve palsy

3. Mention two complications

• Foreign body sensation
• Ulceration
• Exposure keratitis
 Slide 21
1. What is the condition shown in the
image?
• Pterygium
2. Mention 3 differential diagnoses
• Pseudo-pterygium
• Pinguecula
• Limb al dermoid
• Squamous cell carcinoma
3. What signs can you identify in people
with this?
• Foreign body sensation, Dry eye, impaired
vision,
Slide: These also came in some form
• Anterior uveitis
• Cataract
• Poor bell’s phenomenon