Ophthalmology OSPE

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Dr.Sameer jamal lectures Dr.Sameer jamal lectures recordsrecords

20102010

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Optic nerve swelling Normal optic nerve (central

pinkish disk)Papillededema With severe swelling in addition to a

circumferential halo, the edema covers major blood vessels as they leave the optic disk and vessels on the disk .A subretinal hemorrhage is present at 7 o'clock.

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Acute visual loss

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papilledema

papilledema, characterized by 360 degree nerve elevation without obscuration of the vessels.

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Vitreous HemorrhageAcute Persistent Visual Loss: Vitreous Hemorrhage

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Vitreous detachment patient presenting with floaters and an acute

posterior vitreous detachment.

Blot hemorrhage on the optic nerve in a patient with an acute posterior vitreous detachment. This type of

hemorrhage can mimic a Drance hemorrhage.

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Retinal detachment

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Optic neuritis

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Ischemic optic neuropathy

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Orbital cellulititis

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Amblyopia

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Keratitis

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uveitisRed eye in patient with

anterior uveitis

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Central retinal artery occlusion

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Central retinal vein occlusion

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Branch occlusion

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ما لقيتلهم صور

CVA Temporal arteritis

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Acute angle closure glaucoma

Eye of a patient with acute angle closure glaucoma. Note the hazy cornea with semi-dilated and distorted pupil which are the common signs in this condition. In addition, digital palpation usually reveals that the affected eye is firmer than the

unaffected eye due to the high intraocular pressure

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Angle-closure glaucoma: central corneal oedema with an oval-shaped mid-dilated

pupil

Alkali burn

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Instruments

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Ophthalmoscopeused to see inside the fundus of the eye and other

structures

Direct Ophthalmoscope Indirect Ophthalmoscope

•It is crucial in determining the health of the retina and the vitreous humor.•It is used to detect and evaluate symptoms of retinal detachment or eye diseases such as glaucoma 21

Retinoscope

•Used to objectively determine the refractive power of the eye.

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Fluorescein dye

Finger Nail Abrasion StainingUsing Fluorescein Dye--Diffuse Illumination

•Used as a diagnostic tool, where topical fluorescein is used in the diagnosis of corneal abrasions, corneal ulcers and herpetic corneal infections. •It is also used in rigid gas permeable contact lens fitting to evaluate the tear layer under the lens.•to look at blood flow in the retina and choroid. 23

Patch & shield

Eye patch Eye shield

•Used in the management of children at risk of amblyopia, especially strabismic or anisometropic amblyopia.•To initially relieve double vision (diplopia) caused by an extra-ocular muscle palsy•To protect injured eyes

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Slit lamp• provides a high magnification view of

the front structures of the eye, including the cornea, iris and lens, and retina.

• It is used to detect tissue damage to the ocular surface including the cornea, conjunctiva and lids.

• It also can detect inflammation of the internal structures, cataract changes of the crystalline lens.

• It is used extensively for the fitting of contact lenses and is the instrument of choice for detecting contact lens related tissue changes to the cornea and surrounding tissues.

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Phoropter used in refraction testing

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Tonometers used to determine the intraoccular pressure

(IOP) - useful in glaucomaDirect tonometer Indirect tonometer

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Snellen's chartused to measure visual acuity

• 20/20 means a "normal" human being should be able to see when standing 20 feet away from an eye chart

• In metric, the standard is 6 meters and it's called 6/6 vision

• If you have (20/“X”) vision, it means that when you stand 20 feet away from the chart you can see what a normal human can see when standing “X” feet from the chart.

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Ishihara color test plate

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Management of traumatic eye

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Management of traumatic eye

Corneal perforation Foreign body

Severe tear deficiency leads to breakdown of the corneal epithelial layer.

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Peripheral corneal ulceration Abrasion

Note the crescent-shaped destructive inflammation of the juxtalimbal corne

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When a patient come with eye trauma, then you have to role out 4 conditions…

• Perforation • Abrasion • Foreign body • Corneal ulcer

سواء كان عدسة لقصقة دخلت جوا العين او احد ادالو بوكس في عينوا فكلها تسمى

Eye trauma

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Differences between abrasion & ulcer

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Management of perforated eye by GP

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• The more serious the injury, the more pain the Pt. will feel (perforation & ulcer are more painful than abrasion)

• First thing you have to do in eye trauma is to make sure that the Pt. does not have perforation

• Don’t touch the Pt. & don’t try to make the eye open by force if she/he has a perforation

• The pathognomonic feature that’s of trauma that causes perforation & can be seen by the physician by naked eye without touching the Pt. is flattening of the led & loss of led contour! العين تنسم!

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Other non-pathognomonic signs of perforation-due-to-trauma are:

• Bleeding (it could be a conjunctival trauma or an iris trauma in case of bleeding from the perforation site)

• Irregular pupil • Irregularity in AC depth

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• Don’t put anything on the injury site, no antibiotics or any drops. You might worsen the injury if you did.

• All you can do is just putting a shield on the eye to protect the eye from further injury. NO PATCHING!

• عشان نسوي الشيلد نكسر الكاسة الورقية نصين و نحطها فوق العين و نلصقها فوق العين

• Then, call an ophthalmologist and refer the case to him

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• Check the visual acuity when the Pt. comes to ER without touching him!

• In all trauma cases, you always have to document the amount and severity of trauma. And this is only after you role out perforation!. Don’t touch the Pt until you do that.

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Management of foreign body by GP

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• Look by your naked eyes with the help of pin light for any foreign body in the fornix &cornea and try to flip the eye led and see behind it

• See if there is any foreign body and remove it only by washing! This the only thing you’re allowed to do as a GP!

• If the foreign body could not be removed by washing, then it’s not your responsibility to remove it!

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Management of corneal ulcer by GP

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• REFER THE CASE TO AN OPHTHALMOLOGIST! It’s not your job to treat the ulcer

• اللسر و الفورين بودي اذا راح حأعالجو .. ماراح حأحولوا

• No shield neither patch should be applied in case of ulcers

• يفضل انك ما تحطي قطرة مضاد حيوي ال لوكان المريض حيتاخر ساعة ففي دي الحالة 24في روحتوا لدكتور العيون لمدة من

تحطيلو قطرة مضاد حيوي عشان تمنعي النفيكشن

• If you suspect an ulcer, you need to give antibiotics more frequently

• المشكلة في قطرات المضاد الحيوي انو حيتعب بعدين في عمل كلتشر لمعرفة الميكروب المسبب لللسر

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Management of corneal abrasionr by GP

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• It’s the job of GP to treat abrasions!• It’s the most common ocular emergency• The most important thing in TTT is double

horizontal PATCHING the eye! • Don’t forget to make the Pt. close his eye under the

patch. Otherwise, the abrasion will get worse.• You can apply antibiotic ointment on the eye if it

was available • Refer the Pt. to an ophthalmologist for follow up.

The period for referral should not exceed 24 hours

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