(BQ) Part 2 book Exam preparatory manual for undergraduates ophthalmology has contents: Lacrimal apparatus, injuries to the eye, neuro ophthalmology, ocular manifestations of systemic diseases, community ophthalmology, clinical examination, instruments and lenses,... and other contents.
CHAPTER 15 Lids What are the layers of eyelids? •• •• •• •• •• •• •• Fig 15.1: From the front to back Cutaneous layer (skin) Areolar layer (loose areolar tissue) Muscular layer (orbicularis oculi) Sub Muscular areolar tissue Fibrous layer (tarsal plate) Layer of smooth muscle (Muller’s muscle) Conjunctival layer (mucous layer) −− Grey line separates fibrous layer from muscular layer mebooksfree.com Lids 257 Write short notes on blepharitis: Chronic inflammation of lid margin Types •• •• •• •• Squamous Ulcerative Posterior blepharitis or meibomitis Parasitic blepharitis – due to Demodex folliculorum and Phthiriasis palpebrarum Squamous blepharitis Fig 15.2: Squamous blepharitis •• •• •• •• •• Due to seborrheic dermatitis Usually associated with dandruff of scalp White coloured scales accumulate among lashes Eyelashes fall out but are replaced without distortion On removal of scales, the underlying surface is red Ulcerative blepharitis Fig 15.3: Ulcerative blepharitis •• Yellow scales glue the lashes together •• Hyperemia, telangiectasia and scaling •• On removing of the crusts, small ulcers are seen around base of the lashes These ulcers bleed Lashes fall and replaced by misdirected ones mebooksfree.com 258 Exam Preparatory Manual for Undergraduates Ophthalmology •• Caused by staphylococcal aureus and epidermidis •• Secondary changes caused by hypersensitivity to staphylococcus exotoxins are: −− Mild papillary conjunctivitis −− Marginal keratitis Symptoms •• •• •• •• •• •• Itching Redness Soreness Lacrimation Mild photophobia Lid crusting Sequela •• •• •• •• •• •• Trichiasis Tylosis (thickening of lid margin) Madarosis ( loss of eye lashes) Poliosis (whitening of eye lashes) Ectropion Stye −− Usually secondary to poor ocular hygiene, frequent rubbing of eyes, exposure to smoke and pollutants and asthenopia Differences between squamous and ulcerative blepharitis Features Squamous Ulcerative Etiology Seborrhea Staphylococcus Deposits on eyelashes Shiny waxy Brittle scales/ulcers Removal of deposits leaves Hyperaemic zone Bleeding ulcers Hair follicles Not destroyed Destroyed Meibomian secretion Vicarious Normal Eyelashes Normal Trichiasis, Madarosis and Poliosis Lid margin may present Chalazion Stye Conjunctiva Mild conjunctivitis Severe conjunctivitis Dryness Absent Present Corneal complications •• Punctate epithelial erosions •• Marginal ulcers May be seen Absent Commonly seen Present Treatment Local •• Removal of scales, crusts and diseased lashes •• Cleaning lid margin with 3% NaHCO₃, betadine, or baby shampoo and artificial tears mebooksfree.com Lids 259 Specific: Antibiotic eye ointment, betadine lotion applied for 2–3 weeks General: Improvement of general health and personal hygiene Dandruff of scalp: Selenium sulphide 2.5% shampoo twice weekly Posterior blebharitis: Systemic tetracycline or doxycycline or erythromycin and antibiotic steroid eye ointment at the lid margin •• Parasitic blepharitis – Removal of nits by forceps and antibiotic ointment to lid margin •• Delousing of patient and family members Write short notes on Hordeolum externum (Stye): Fig 15.4: Zeis gland Fig 15.5: Stye Acute suppurative inflammation of Zeis or Moll’s glands mebooksfree.com 260 Exam Preparatory Manual for Undergraduates Ophthalmology Etiology Due to staphylococcal infection associated with boils, acne, common in children and young adults Also seen in immuno compromised person Symptoms Acute pain along the lid margin Signs Tender, hard swelling seen near lid margin An abscess may form pointing near base of lashes Pain subsides if it gets ruptured There are two stages: •• Stage of cellulitis •• Stage of abscess Treatment Hot fomentation in early stage: •• Systemic – broad spectrum antibiotic •• Analgesics and anti-inflammatory drugs •• Removal of pus by pulling or epilating the involved lash or incision and drainage •• In case of recurrent stye, diabetes and refractive errors have to be ruled out Write short notes on chalazion: Fig 15.6: Tarsal or meibomian cyst Chronic granulomatous inflammation of meibomian gland Etiology Due to chronic irritation caused by an organism of low virulence: •• Small nontender hard swelling in the lid, slightly away from lid margin •• Cosmetic problem •• May cause astigmatism against rule due to pressure on cornea Sequela •• Spontaneous resolution •• Contents may extrude through conjunctiva to resemble fungating mass mebooksfree.com Lids 261 •• •• •• •• Calcification Meibomian cell carcinoma May get secondary infection and form Hordeolum internum Marginal chalazionoccurs in ducts of meibomian gland The granulation tissue projects as a reddish grey nodule on the intermarginal strip Treatment •• Incision and curettage: The lid is everted and vertical incision is made with 11 blade and mucoid material scooped out and the cavity curetted Vertical incision is made to avoid damage to adjacent meibomian glands •• Intralesional injection of Triamcinolone may help in smaller chalazion Write short notes on Hordeolum internum: Acute suppurative inflammation of meibomian gland •• Occurs due to secondary infection of chalazion •• Symptoms are more than in stye because the gland is larger and is embedded deeply in dense fibrous tissue Treatment: Broad spectrum antibiotics and anti-inflammatory drugs to control pain Latter incision and curettage as for chalazion What is Molluscum contagiosum? It is a viral infection of the lids, commonly affecting children It is caused by poxvirus Clinical features: They are multiple, pale, waxy, umblicated swellings around the lid margin Complications: Chronic follicular conjunctivitis and superficial keratitis Treatment: They should be incised and expressed and the interior touched with 5% povidone iodine or pure carbolic acid Write short notes on trichiasis: Fig 15.7: Eyelashes are misdirected backwards and rub against cornea Etiology •• Stage IV Trachoma •• Spastic entropion in elderly person mebooksfree.com 262 Exam Preparatory Manual for Undergraduates Ophthalmology •• Tight bandaging •• Ulcerative blepharitis •• Scars of lid Symptoms •• Foreign body sensation and photophobia •• Redness of conjunctiva and lacrimation Signs •• Misdirected cilia touching the cornea •• Blepharospasm and photophobia if cornea is involved •• Superficial corneal opacities Complications •• Chronic conjunctivitis •• Recurrent corneal abrasions •• Nonhealing corneal ulcer Treatment •• If single or few cilia are involved, epilation or electrolysis at root of hair follicle •• When many cilia are misdirected, surgical correction similar to cicatrical entropion is advised Write short notes on entropion: Fig 15.8: Lid margin rolls inwards Types •• Senile or involutional: Affects only lower lid •• Spastic: Due to spasm of orbicularis oculi of lower lid due to tight bandaging Occurs in lower lid of old people mebooksfree.com Lids 263 •• Cicatrical: Due to contraction of palpebral conjunctiva involves both lids It occurs in trachoma stage IV, ulcerative blepharitis, Burns, Steven Jhonson syndrome, diphtheritic membranous conjunctivitis and pemphigus (pemphigoid) •• Congenital entropion rare: Due to deformity of tarsal plate It involves lower lid only •• Mechanical: Due to lack of support provided by eyeball—seen in phthisis bulbi or enucleated or eviscerated eyes Symptoms and Signs Same as for Trichiasis and those of disturbances of stability of tear film They are foreign body sensation, irritation, abrasion and corneal ulcer Three grades Mild: Posterior border of lid inturned Moderate: Intermarginal strip rotates inwards Severe: Entire lid margin rolls inwards Senile entropion: Seen in old age Usually above 60 years Etiology •• Overriding of preseptal part of orbicularis over pretarsal part with atrophy of subcutaneous tissue with ageing •• Inturning of lower lid tarsus due to weak lower lid retractors and laxity of medial and lateral ligaments •• Loss of posterior support in enophthalmos due to atrophy of orbital fat Treatment Aim of surgery: To restore vertical and horizontal tautness of lid: •• Reattach retractors to tarsal plate •• Shortening of horizontal width of tarsal plate •• Forming a cicatrix between pretarsal and preseptal parts of orbicularis: −− Short term relief: By sticking an adhesive tape to pull lower lid outwards −− Everting sutures: 5–0 vicryl chromic catgut from conjunctiva to skin of lid adjacent to inferior border of tarsus creates cicatrical barrier that maintains eyelid in everted position −− Modified Wheeler operation: Skin incision—parallel to lower lid Orbicularis is dissected and 3mm strip of muscle is double breasted and stitched together with an excision of base down triangle of tarsus Redundant (excess) skin is excised −− Quickert’s procedure: Transverse lid split + everting sutures + horizontal lid shortening −− Modified Jones procedure: Inferior lid retractors are plicated or attached to the tarsus Spastic entropion Due to spasm of Orbicularis oculi: •• Evert the lid by pulling it with adhesive plaster •• Botulinum toxin injected into pretarsal orbicularis to prevent it from overriding mebooksfree.com 264 Exam Preparatory Manual for Undergraduates Ophthalmology Cicatrical Entropion Treatment: Mild to moderate cases with thickened tarsus is treated with wedge resection of tarsus If tarsus is not thickened, Modified Burrow’s operation or Tarsal fracture is done Very extensive scarring may necessitate the replacement of conjunctiva by a mucous membrane graft and a distorted tarsal plate by cartilage graft Congenital Entropion abnormal tarsal plate is resected Abnormal skin fold is excised Write short notes on Ectropion: Fig 15.9: Outward turning of eyelid margin Types •• •• •• •• •• •• Senile or Involutional Spastic Cicatrical Mechanical Paralytic Congenital •• Senile ectropion occurs only in lower lid due to horizontal laxity of eyelid, medial canthal or lateral canthal laxity •• Spastic: Due to blepharospasm when lids are well supported by globe Occurs in children and young adults •• Cicatrical: Due to scarring of skin by chronic conjunctivitis, blepharitis, injuries, burns, ulcers, etc •• Mechanical: Due to dragging of lid tumor with its weight •• Paralytic: Paralysis in orbicularis as in facial palsy - affecting lower lid •• Congenital: Due to deficient eyelid skin - skin grafting to be done Symptoms Epiphora and constant watering of the eyes Signs •• Conjunctiva becomes dry and thickened •• Chronic conjunctivitis due to exposure, exposure keratitis mebooksfree.com Lids 265 Three grades Mild: Only punctum is everted Moderate: Palpebral conjunctiva is visible Severe: Lower fornix is exposed Treatment •• Spastic: Underlying cause of blepharospasm is treated •• Cicatricial: Free lid margin from scar tissue and restore lid to normal position Mild cases Fig 15.10: V-Y operation V shaped incision is made in the skin of lower lid which includes the scar Skin is excised and wound is sutured in Y shaped pattern thus correcting ectropion Extensive scarring: Excision of scar tissue and application of skin graft Split skin graft or full thickness grafts are taken from upper lid, behind the ear, inner side of upper arm or thigh Senile ectropion: Depending on severity the following operations are done −− Mild to moderate cases, a horizontal spindle shaped piece of conjunctiva subconjunctival tissue is removed mm from the punctum and margins are sutured −− For severe cases in mid portion of lower lid, full thickness shortening of lid is done Fig 15.11: Bryon Smith modification of Kuhnt Szymanowski’s procedure Full thickness inverted house (pentagon) shaped excision at least mm away from punctum is done and margins are sutured −− Bryon Smith modification of Kuhnt Szymanowski’s procedure: for severe ectropion which is more marked in the lateral half of lid A base up pentagonal full thickness excision from the lateral third of lid is combined with triangular excision of skin from the area just lateral to lateral canthus to elevate the lid −− Medial ectropion is corrected by modified lazy T operation in which medial vertical pentagon of full thickness lid is excised mm lateral to lower punctum Paralytic ectropion: It occurs due to paralysis of facial nerve, in Bell’s palsy, parotid surgeries, trauma and tumors such as an acoustic neuroma mebooksfree.com Index 411 Exotropia 333 External lacrimal fistula, stage of 275f Extorsion 335 Extracapsular cataract extraction, conventional 161 Extraocular extension, stage of 254 Extraocular muscles actions of 8, 335 anatomy of 7f Exudative detachment, treatment of 237 Eye anatomy of bank 119 care education 360 cytoarchitecture of 113 development of 10 drops 38, 82 emmetropic 49, 55f examination of 159 fixation 332 hypermetropic 56f itching of 367 lashes loss of 258 whitening of 258 myopic 50f nerve supply of physiology of 13 watering of 366 Eyeball 369, 378 size of 113 Eyelid drooping of 113 function 280 glands of layer of 8, 256 margin, outward turning of 264f F Facial block 403 Facial nerve 10 palsy 101 Farnsworth Munsell 100 hue test 19, 206 Ferry’s line 113, 400 Fetal nucleus Fever eruptive 355 pharyngoconjunctival 69 Fibrocytes 196 Fibroplasia, retrolental 250 Fleischer’s ring 109, 113, 248, 400 Flexner-Wintersteiner rosettes 248 Fluorescein 398 angiography 125, 142, 255, 398 dye disappearance test 285 Fluorophotometry 398 Follicular conjunctivitis 72 causes of 72 Forced duction test 345 Foreign body granuloma 79, 83 sensation 290, 367 Foster Fuch’s spot 49 Foster Kennedy syndrome 321, 321f Fovea Frisby stereo test 19 Fuch’s endothelial dystrophies 115 Fuch’s spot 48 Fundus 183 contact lens 255 fluorescein angiography 241, 323 xerophthalmic 87 Fungal corneal ulcer, treatment of 95 Fusion 19 G Galactosemia 164 Ganglion cell layer ciliary 312 Gaucher’s disease 227 Geniculate body, lateral 20, 22, 313 Giemsa stain 94 Glands of Krause 9, 67 Glaucoma 36, 37, 166, 171, 192, 196, 206, 209, 347, 353-356, 361, 362, 368 acute 283 classification of 171 mebooksfree.com 412 Exam Preparatory Manual for Undergraduates Ophthalmology congenital 72, 171, 179 Flecken 188 ghost cell 197 infantile 179 juvenile 179 malignant 193, 374 phacolytic 161, 188, 190 phacomorphic 161, 188, 190 pigmentary 191 pseudoexfoliation 192 secondary 96, 111, 112, 119, 121, 139, 163, 168, 171, 332 steroid induced 192 treatment of 184 Glaucomatocyclitic crisis, 188 Goblet cells 67 Goldmann applanation tonometer 174f Goldmann bowel perimetry 177 Gomori’s methamine silver stain 94 Gonioscopic lenses, types of 175 Gonioscopy 175, 183 Goniotomy 181 Gram stain 94 Grave’s disease, signs of 303 Grave’s ophthalmopathy 303 Gunn’s sign 221, 224 Gyrate atrophy 239 H Haab’s striae 400 Haemophilus influenzae 149 Haller’s layer Harada’s disease 124, 231 Headache causes of, 367 mild 187 ophthalmic causes of 367 Heidenberg retinal tomography 184 Hemangioma 83, 247, 270, 308 Hemianopia 30 bitemporal 35, 35f, 36 geniculate 32 heteronymous 34 homonymous 30, 31f, 34f, 36 occipital lobe 33 types of 30 Hemibranch retinal artery 36 Hemiretinal vein occlusion 225, 227, 230 Hemorrhage 212f, 351 choroidal 255, 295 deep 224 expulsive 390 flame shaped 221 intraocular 96, 193 massive vitreous 366 nonclearing vitreous 217 orbital 308 petechial 84 placental 166 pontine 375 retinal 208, 211 retrobulbar 162, 308 severe 327 splinter 330 subarachnoid 321 subconjunctival 84, 292, 292f superficial 224 suprachoroidal 162 vitreous 194, 196, 227, 369 Hemorrhagic conjunctivitis, acute 69 Hemosiderosis bulbi 197 Herbert’s pits 74, 75 Hereditary endothelial dystrophy, congenital 115, 180 Herpes simplex 71, 92 keratitis 104 virus 71 Herpes zoster 122, 317, 367 ophthalmicus 106, 348 Herring’s law 335 Hess chart 345 Heterophoria 331 High plus reading glasses 352 Hirschberg’s test 332, 336, 337, 337f HIV retinopathy 348, 349 Holmgren wool test 206 Homer-Wright rosettes 248 Homocystinuria 166 Hordeolum externum 259 Hordeolum internum 261 Horner Trantas spots 77 mebooksfree.com Index 413 Horner’s syndrome 315, 375 congenital 315 Horseshoe tear 233f Hospital cornea retrieval programme 363 Host cornea, excision of 118 Hruby lens 391 Hudson Stahli line 113, 400 Human immunodeficiency virus 347 Human resource development strategies 363 Hutchinson’s pupil 315 Hutchinson’s rule 107 Hutchinson’s triad 103 Hyalocytes 196 Hydrops, corneal 109 Hyperemia 69 conjunctival 77 Hyperfluorescence 399 Hyperhomocysteinemia 228 Hyperlacrimation causes of 283 central 284 Hyperlipidemia 228 Hyperlysinemia 166 Hypermetropia 46, 54, 53, 66, 367, 374 absolute 54 components of 54 facultative 54 latent 54 total 54 Hypermetropic astigmatism, compound 57f Hyperphoria 331, 395 Hypertelorism 331 Hypertension 39, 84, 209, 228 malignant 321, 324 ocular 228 severity of 224 Hyperviscosity 228 Hyphema 162, 293f traumatic 293 Hypogenitalism 239 Hypopyon 97, 135 contents of 99 inverse 98 mechanism of 97 ulcer, mycotic 99 Hypovitaminosis A 280 Hysteria 227 I Indirect fluorescein antibody test 141 Infarction, occipital lobe 227 Infection control of 95 mode of 149, 305 orbital 348, 350 viral 145 Infiltration, stage of 73 Inflammation 317 orbital 124, 304 Influenza 317 Injuries acidic 289 alkaline 288 chemical 288 Internal carotids, atheroma of 34f Intracorneal ring segments 110 Intracranial pressure 321f Intraocular lenses parts of 169 posterior chamber 163 types of 168 Intraocular pressure, 17, 147, 159, 380 Intravitreal injection 38, 235 Iridectomy, surgical peripheral 187 Iridis, heterochromia 315 Iridocyclitis 107, 165, 375 acute 83, 132, 140, 188, 366, 374 granulomatous 133 herpetic 105 late sequela of 113 severe 98 toxic 96 Iridodialysis 293, 293f, 368 Iris 5f, 12, 126f, 247, 293, 350, 374, 380 anterior surface of 5f, 127f atrophic patches 188 atrophy 139 bombe 139, 374 damage 316 epithelial layer of 12 mebooksfree.com 414 Exam Preparatory Manual for Undergraduates Ophthalmology layer of 127 malignant melanoma of 247 neovascularization of 137, 146 nevus of 247 nodules 135, 136f pearls 400, 402 prolapse of 96, 97f, 162, 297 radial tears of 293 root of shadow 157f, 376 signs 133, 135 stroma structure of tubercles, conglomerate 350 Irvin Gass syndrome 244 Ischemia choroidal 399 retinal 399 Ischemic attacks, transient 225 Ischemic optic neuropathy, anterior 223, 320 Ishihara pseudoisochromatic charts 206 Ishihara pseudoisochromatic plate test 18 J Jones dye tests 286, 286f, 287 K Kaposi’s sarcoma 348 Kayser Fleischer ring 113, 400 Kearns-Sayre syndrome 239 Keith Wagner Barkar classification 220 Keratectomy, phototherapeutic 114 Keratitis 83 classification of 92 disciform 92, 104, 107 exposure 93, 101, 351 fascicular 350 fungal 100 healed 115 interstitial 92, 102, 350, 351 marginal 258 neurotrophic 93, 101, 351 nonpurulent 92 nummular 107 purulent 92 sclerosing 92, 138 stromal 104 superficial 74, 92 trophic 105 types of 92 ulcerative 98 viral 100 Keratocele 112 Keratoconjunctivitis epidemic 69 phlyctenular 350 Keratoconus 109, 113, 118, 166, 368, 374 Keratoglobus 109, 110, 180 Keratomalacia 86, 87f, 93, 351 corneal 87 Keratome 384f Keratometry 77, 109, 139, 160 band shaped 113, 114, 138, 139f Keratophakia 63 Keratoplasty 117, 280, 356 lamellar 114, 115 penetrating 110, 115 therapeutic 101 Keratotomy photorefractive 51, 51f radial 51f Khodadoust line 400 Kochweek’s bacillus 69 Koeppe’s lens 175 Koeppe’s nodule 136, 402 Krimsky’s test 336, 338 uses of 338 Kruckenberg’s spindle 113 Kuhnt Szymanowski’s procedure 265, 265f L Lacquer cracks 48, 49 Lacrimal abscess, stage of 275 Lacrimal apparatus 272, 272f, 273, 379 anatomy of 272 epithelium of 12 Lacrimal artery, recurrent 300 Lacrimal gland 10, 12, 272 accessory 67, 282 mebooksfree.com Index 415 Lacrimal sac 272, 284, 369 tumors of 279 Lacrimal system 351 Lacrimation 102, 132, 290, 399 reflex 132 Laevodepression 334 Laevoelevation 334 Laevoversion 334 Lagophthalmos 269, 280, 351 Lamellar keratoplasty, deep anterior 110 Lang’s two pencil test 19 Lantern test 206 Laser iridotomy 187 Laser therapy 185 LASIK 52, 52f surgery 280 Latanoprost 45 Laurence Moon Bardet Biedl syndrome 239 Lead amblyopia 329 Lead poisoning 26 Leber’s disease 317 Leber’s hereditary optic atrophy 325 Lenses 133, 138, 156, 294, 347, 375, 380 anatomy of 156 aspirate 196 astigmatic 60f capsule 156 crystalline 12 curvature of 156 dialer 386 diameter of 156 dimensions of dislocated 96 epithelium 156 fibers 156 foldable 169 fragmentation of 162 hard 64 hook 385, 385f induced uveitis 166 intraocular 168 material of 169 microscopic 352 soft 65 spatula 387 structure of subluxation 162, 166, 198 telescopic 352 thickness 156 transparency See also concave lens and convex lens Leprosy 102, 144, 347 Leukemia 208, 321 Leukocoria, causes of 250 Leukoma, adherent 97, 116, 374 Lids 75, 256, 347, 350, 351, 370 ecchymosis of 291f ectropion, lower 351 edema 133, 303, 307 epidermis of 12 lag 303 margin 369 chronic inflammation of 257 thickening of 258 ulceration of 350 retraction 303, 316 stickiness of 69 swelling of 69, 70 tumors 270 Light reflex 312, 315 corneal 337 pathway 313f Limbic conjunctivitis, superior 76 Limbic keratopathy, superior 303 Limbus 371, 379 Lipid deficiency 280 dry eye 280 Lisch nodule 402 Lister’s perimeter 24, 176f Low vision 352, 361 aids 216, 352, 365 Lowe’s syndrome 164, 165 Lymphangioma 270, 271 Lymphoma 308 Lymphosarcoma 308 M MacCallan’s classification 75 Macrodacryocystography, substraction 278 Macroglobulinemia 228 mebooksfree.com 416 Exam Preparatory Manual for Undergraduates Ophthalmology Macula 116, 323, 330 disciform degeneration of 26 lutea Macular degeneration, age related 240, 361 Macular edema cystoid 163, 168, 244 persistent 217 Macular function tests 159, 160 Macular hole 26, 207, 227 Macular retinal detachment 26 Macular star 220, 221, 222f Madarosis 258, 350, 351 Maddox rod 336, 394, 394f test 340, 340f Maddox wing 336, 340 test 341 Malnutrition 355 Manz, glands of 67 Marchessani syndrome 166 Marcus Gunn jaw winking phenomenon 268 Marcus Gunn pupil 314, 318, 375 Marfan’s syndrome 166 Marginal reflex distance 267 Masquerade syndrome 149 Mast cell stabilizers 39 Maxillary sinus 300 McPherson lens holding forceps 385 McReynolds method 82 Measles 317 Medial orbital wall, fracture of 308 Megalocornea 180f, 181 Meibomian cyst 260f Meibomian glands 8, 85 congenital absence of 280 Meibomitis, chronic 280 Melanocytoma 247 Melanoma benign 255 epithelioid cell 254 malignant 147, 154, 247 necrotic 254 Meningitis 153, 302, 321 Mental retardation 239 Mesencephalic root 313 Messman corneal dystrophies 115 Metabolic diseases 131 Metamorphopsia 233, 241 Metastasis 147 stage of 254 Methotrexate 144 Methyl alcohol amblyopia 329 Methyl alcohol poisoning 227 Microvascular diseases 84 Microvascular leakage 209, 210 Microvascular occlusion 209, 210 Migraine 31, 368 Miosis 315, 351, 375 traumatic 293 unilateral triad of 315 Mitomycin 82, 148 Mitral valve emboli 31 Moll’s glands 9, 259, 270 Molluscum contagiosum 261, 348 Mooren’s ulcer 92, 93, 108, 108f Morphine poisoning 375 Motor nerves 10 Mucin deficiency 280 Mucin secreting glands 67 Mucocele, lacrimal 277f Mucopolysaccharidosis 180 Mucopurulent conjunctivitis, acute 68, 69, 79 Mucormycosis 305, 350 Muller’s lacrimal speculum 388, 388f Muller’s muscle 256, 268 paralysis 315 Multifocal deep retinal lesion 349 Mumps 317 Munson’s sign 109, 109f Muscles action of 377f ciliary 128, 313 extraocular 7, 12, 155f, 334, 334f insertion of 335 pair of 336 palsy, extraocular 345 paralysis, dilator 315 weakness 39 Mycobacterial infection 349, 350 Mycotic infections 305 Mydriasis, traumatic 293 Mydriatic test 187 mebooksfree.com Index 417 Mydriatic, use of 186 Myelinated nerve fibers 37, 327 Myopia 46, 66, 374 congenital 47 high 26, 165, 166, 209 lenticular 166 pathological 47, 326, 368 simple 47 Myopic astigmatism compound 57f, 392 simple 57f, 392 Myopic disc 37 Myotonia dystrophy 165 N Nagel anomaloscope 206 Nasociliary nerve 300 Nasolacrimal duct 272, 273, 285 patency of 159 National Programme for Control of Blindness 358 Near reflex 313 Near vision 15 Necrosis 94 Necrotizing scleritis, anterior 123, 124 Neisseria gonorrhea 69, 71, 73, 93 Neisseria meningitidis 93 Neostigmine test 268 Neovascular glaucoma 146, 191, 191, 214 Neovascularization 210, 220 Nerve abducent 301 autonomic 10 cranial 347, 350 fiber layer 7, 183 frontal 300 lacrimal 300 oculomotor 313 palsy 314, 346 cranial 350 short ciliary 312 trigeminal 10 trochlear 300 Nervous system, central 10 Neuritis, retrobulbar 317, 318, 351 Neuroblastoma 308 Neurofibromatosis 271 Neuromyelitis optica 317 Neuro-ophthalmic infections 350 Neuro-ophthalmic lesions 348 Neuro-ophthalmology 312 Neuroprotective drugs 185 Neuroretinal rim, pallor of 181 Neuroretinitis 317, 319f, 350 Nevus 247, 270 Nicotinic acid maculopathy 244 Niemann Pick disease 227 Night blindness 87, 351, 367, 368 congenital 368 Nonsteroidal anti-inflammatory drugs 38, 39 Non-striated muscle fibers, layer of Nuclear hardness, grades of 161 Nyctalopia 368 Nystagmus 396 O Obesity 239 Occipital cortex 20 Occipital lobe, striate cortex of 313 Occipito mesencephalic tract 313 Ocular disease 69 Ocular motility, laws of 335 Ocular motor nerve palsy 223 Ocular movement, restriction of 307 Oguchi’s disease 239 Oil droplet reflex 110f Ombraine’s method 82 Opaque nerve fibers 26 Ophthalmia neonatorum 69, 71, 355 Ophthalmic surgeries, anesthesia in 402 Ophthalmic vein inferior superior 9, 300 Ophthalmitis, sympathetic 144, 145 Ophthalmology dye in 398 lasers in 396 nodules in 402 pearls in 400 rings in 400 mebooksfree.com 418 Exam Preparatory Manual for Undergraduates Ophthalmology role of miotics in 40 striae in 400 triangle in 400 Ophthalmoplegia, internal 314 Ophthalmoscopy, indirect 197, 232, 255 Optic atrophy 36, 209, 226, 321f, 324, 326, 327, 350 consecutive 324, 325, 325f fundus of 325 glaucomatous 327 postneuritic 324, 326 postpapilledemic 324 primary 324, 325f secondary 326, 326f vascular 327 Optic canal 300, 301 Optic chiasma 20 Optic disc coloboma of 26 drusen 36 edema 146 Optic foramen 9, 300 Optic nerve 20, 22, 23, 36, 252, 296, 312, 313, 321f, 325, 347, 350, 354 blood flow measurement 184 coloboma 36, 37 dimensions of drusen 37, 327 enucleation 155f fibers of 12 glioma of 271 head analysis 171 drusen of 324 hypoplasia 327 inflammation of 317 lesions 20 traumatic avulsion of 23 Optic neuritis 23, 36, 107, 124, 317, 330, 350 Optic neuropathy, ischemic 36, 324 Optic radiation 20, 313 anterior loop of 24 hemianopia 32 middle of 23 posterior part of 23 upper part of 23, 24 Optic tract 20, 21, 23, 36, 312, 313 Optical coherence tomography 172, 176, 184 Optical distortion 166 Optical iridectomy 117 Ora serrata 48 Oral contraceptives 330 Orbicularis oculi 10, 256 reflex spasm of 132 Orbit 300, 347, 350, 369, 378 anatomy of 9, 300 blowout fractures of 311 surgical spaces of 301 tumors of 308 Orbital fissure inferior 300, 301 superior 300 Orbital foramen inferior superior Orbital inflammations 305 Orbital mass 124 Orbital periostitis 305 Orthophoria 331, 337, 341f, 395 Osteitis deformans 308 Osteomyelitis 350 Osteoperiostitis, orbital 305 Osteoporosis 39 P Palpebral fissure 370 Pannus 76, 351 trachomatous 74 Panophthalmitis 97, 151, 152, 153f, 283, 390 sequela of 113 Panretinal photocoagulation 191, 368 bilateral 37 Papilla 80f cobblestone arrangement of 77 Papillary conjunctivitis, mild 258 Papilledema 26, 37, 208, 320, 321f, 350 early 322, 322f established 322, 322f pathogenesis of 321 stage of 323f mebooksfree.com Index 419 Papillitis 139, 151, 208, 317, 318, 324 Papilloma 83 Paracentral scotoma 29, 29f, 182f Paranasal sinuses 142 mucocele of 308 Parietal lobe lesion 24, 37 Parinaud’s dorsal midbrain syndrome 316f Parinaud’s syndrome 316 Pars plana vitrectomy 198, 217, 235, 236 Pars planitis 144, 244, 350 Paton’s line 323 Pemphigus, ocular 266 Periarteritis 225, 226 Perilacrimal tissue, infection of 276 Perimetry 176, 183 Periostitis 350 Peripapillary atrophy 182 Persistent hyperplastic primary vitreous 194, 196, 198, 250, 251 Peter’s anomaly 180 Phacoemulsification 161, 162 principles of 162 Phenylephrine 40 uses of 40 Phoria, types of 395 Photoablation 396 Photocoagulation 396 Photodynamic therapy 242, 396 Photophobia 146, 102, 132, 290, 367, 368 Photophthalmia 290 Photopsia 233, 368 Photoretinitis 245 Phthiriasis palpebrarum 257 Phthisis bulbi 72, 97, 111, 112, 140, 151, 153 causes of 112 Picorna viruses 69 Pigment dispersion causes of 113 syndrome 113 Pilocarpine 40 Pinguecula 81, 81f, 82 Placido disc 109, 372f, 373f Plaque brachytherapy 252 Plaque formation 77 Plastic iridocyclitis, acute 146 Plastic iritis 350 Plexiform neuroma 271 Pneumatic retinopexy 235 Pneumotonometer 174 Polar cataract, anterior 97, 167 Poliosis 258 Polyarteritis nodosa 122 Polychondritis 122 Polychromatic luster 138, 165 Polycythemia 228, 321 Polygonal cells 248 Polymethyl methacrylate 169 Polymorphous dystrophy, posterior 115 Precapillary arterioles, obstruction of 221 Presbyopia 61, 66 Prism 393 cover test 336, 338, 339, 339f neutralization 345 over fixing eye 338f Progressive infiltration, stage of 93, 94 Progressive outer retinal necrosis 348, 349 Prone test 187 Proptosis 307, 350 axial 307 bilateral 308 intermittent, causes of 308 treatment of 307 unilateral 307 Prostaglandin analogs 45, 185 Protanopia 19 Protein calorie malnutrition 93 Provocative tests 187 Pseudo Foster Kennedy syndrome 402 Pseudo von Grafe’s sign 402 Pseudo-argyll Robertson pupil 402 Pseudocornea 96, 97, 112, 401 Pseudoesotropia 331, 401 Pseudoexfoliation 192f, 401 Pseudogerontoxon 402 Pseudoglioma 250, 401 Pseudohypopyon 98, 401 Pseudomembrane 402 Pseudomonas 149 Pseudomyopia 401 Pseudoneuritis 318, 324, 402 mebooksfree.com 420 Exam Preparatory Manual for Undergraduates Ophthalmology Pseudopapilledema 401 Pseudophakia 400 Pseudoproptosis 401 Pseudopterygium 82, 401 Pseudoptosis 402 Pseudoretinitis pigmentosa 402 Pseudostrabismus 331, 401 Pseudotumor cerebri 321, 401 Psychosensory reflex 312, 313 Pterygium 81, 81f, 82, 113 cystic 83 Ptosis 267, 315 mild 268 overcorrection of 101 severe loss of 268 Pump failure 287 Pump mechanism, lacrimal 283f Puncta, lacrimal 272 Punctate epithelial erosion 77 Punctate keratitis epithelial 104, 105 subepithelial 107 superficial 107, 367 Pupil 350, 351, 375, 380 constriction of 375 double 368 Pupillary abnormalities 350 Pupillary block 163 Pupillary capture 163 Pupillary paralysis 23 Pupillary reaction 138, 159, 375 abnormal 314 Pupillary reflex 24, 312 Pupillary signs 133, 137 Pupillary tuck 163 Pupillary zone 127 Purkinje-Sanson images 376, 376f conjunctivitis, purulent, acute 69, 70 Q Quadrantanopia, inferior 32 Quiescent stage 249, 254 Quinine amblyopia 329 Quinine poisoning 327 Quinine toxicity 227 R Recipient cornea, excision of 118 Rectus inferior lateral superior Reflection tests, corneal 336 Reflex convergence 312 hyperlacrimation 283 Refractive errors 46, 353, 356, 361, 367 Refractive index Refsum syndrome 239 Regurgitation test 285 Retina 6, 12, 247, 295, 347, 350, 355 functions of nerve fiber pattern of 27f pigmentary dystrophies of 206 structure of 6f See also retinal Retinal artery occlusion 224 central 37, 147, 191, 224, 225, 327, 366 Retinal break 232, 296 Retinal complications 139 Retinal detachment 124, 163, 165, 198, 227, 230, 235, 366, 368 exudative 139, 224 tractional 197, 214 treatment of 217 types of 237 Retinal disease 37, 161 bitemporal 36 severe loss of 314 Retinal function 205 Retinal hemorrhage, deep 208 Retinal necrosis, acute 348, 349 Retinal nerve fiber layer 171 methods of 205, 207 Retinal pigment epithelium 6, 196 Retinal thickening 214f Retinal vascular lesions 20 Retinal vein occlusion 225, 227, 229 central 146, 191, 225, 227, 324 types of 227 Retinal vein, central mebooksfree.com Index 421 Retinal vessels, obstruction of 224 Retinitis 368 necrotizing 349 pigmentosa 165, 209, 237, 239, 244, 326, 361, 368 punctata albescence 239 viral, treatment of 349 Retinoblastoma 147, 154, 247, 248 exophytic 231 Retinochoroiditis, toxoplasmic 349 Retinopathy background 210 diabetic 197, 208, 217, 218, 361, 362, 366 duration of 362 hypertensive 208, 218, 221f, 223f phases of 219 pigmentary 330 preproliferative 210, 211 screening, diabetic 218 stage of 224 study, diabetic 216 vitrectomy study, diabetic 216 Retinoschisis, senile 234 Retinoscopy 63, 109 Retrobulbar block 403 Retrobulbar injection 38 Retrobulbar neuritis, idiopathic 325 Retrolental floaters 146 Rhegmatogenous detachment 231, 255 mechanism of 232, 232f signs of 233 Rheumatoid arthritis 122, 280 Rhinitis, atrophic 279 Rhinosporidiosis 279 Rickets 308 Riddoch’s phenomenon 35, 319 Riley day syndrome 280316 Rings scotoma 238f Rodent ulcer 108, 271 Rods and cones, layer of Ronne’s nasal step 182 Rose Bengal staining 281 Rubella, congenital 355 Rubeosis iridis 139, 146, 148f, 226 Choroidal rupture 294, 295, 295f S Sacroiliac joints 142 Salus sign 222f, 224 Salzmann nodular degeneration 113, 114 Sampaolesi’s line 400 Sandhoff’s disease 227 Sarcoidosis 131, 144, 228 Sattler’s layer Scalp, dandruff of 259 Scheie classification 220 Schilder’s disease 317 Schiotz indentation tonometer 173f Schirmer’s test 268, 281 School Eye Screening Programme 360, 364 Schwalbe’s line 2, 400 Scintillography, lacrimal 287 Sclera 12, 107, 120, 293, 347, 350, 351, 371, 379 functions of 120 inflammation of 120 thickness of See also entries under scleral Scleral buckling 235, 236 types of 236f Scleral spur Scleritis 83, 84, 107, 120-121, 122, 122f, 350, 351 anterior 123 necrotizing 123 non-necrotizing 123 posterior 123, 124, 231 Sclerocornea 180 Sclerosis disseminated 131 multiple 317, 325 stage of 224 Scotoma 26, 27 absolute 26 central 26-28, 28f, 36, 329, 330 junctional 27, 30, 30f types of 26, 27f Sebaceous cyst, inflamed 276 Sebaceous gland, modified Seidel’s scotoma 29, 29f Seidel’s sign 182, 182f Seidel’s test 398 Senile cataract, types of 156 mebooksfree.com 422 Exam Preparatory Manual for Undergraduates Ophthalmology Serpiginous ulcer acute 93 chronic 93, 108 Serum viscosity 141 Shaffer’s grading 175 Sherrington’s law 335 Sickle cell retinopathy 197, 231 Siderosis 113 bulbi 298, 369 Silver nitrate 71 Simcoe irrigation aspiration cannula 385, 385f Sinskey hook 386 Sinusitis 276 Sjögren’s syndrome primary 280 secondary 280 Skin 8, 104, 271 diseases 131 test 141 Skull, developmental anomalies of 308 Slaty-Gray pigmentation in retina 253f Slit lamp 94 appearance 190 biomicroscopy 255 examination 98, 109, 380 Small incision cataract surgery 161, 383 Smear, conjunctival 159 Smooth muscle, layer of 256 Snellen distant visual acuity chart 14f Soemmering’s ring 163, 400 Spaeth’s grading 175 Spherophakia 166 Sphincter pupilla 127, 312, 313 Spindle cell melanoma 254 Sponge circumferential 236 radial 236 Spontaneous regression 270 Squamous cell carcinoma 270, 271 Squint 331, 353 comitant 332 convergent 333, 338f divergent 49, 333 incidence of 331 incomitant 332 latent 331 types of 333f St Martin forceps 386, 386f Staphylococcus aureus 69, 73, 93, 149 Staphylococcus epidermidis 149 Staphyloma 125, 351 anterior 72, 97, 108, 111, 112 ciliary 83 posterior 48f, 49 treatment of 125 State Blindness Control Society 358 State Health Societies 358 State Ophthalmic Cell 358 Stenopaic slit 394, 394f Stereopsis 19 tests for 342 Sterilization 170 Steven Johnson syndrome 266, 280 Stocker’s line 113, 400 Strabismus fixus 332 Streptococcus hemolyticus 73 Streptococcus pneumonia 71, 73, 93 Stress, emotional 186 Striate keratitis 162 Striated muscle, layer of Stroma 3, 91, 127, 128, 129 corneal 12 liquefaction, corneal 86 parts of 127 Stromal necrotic keratitis, diffuse 104 Subcapsular cataract, posterior 159 Subcapsular opacities, posterior 138 Subconjunctival injections 38 Subperiosteal space Subretinal fluid, drainage of 235 Subretinal neovascular membrane, removal of 217 Subretinal neovascularization 231 SubTenon injections 38 Sunrise syndrome 163 Sunset syndrome 163 Suppurative dacryocystitis, acute 274 Suppurative inflammation, acute 259 Suppurative pericystitis, acute 274 Suprachoroidal lamina 5, 129 mebooksfree.com Index 423 Supraciliary lamina 128 Supraorbital fissure syndrome 367 Supraseller aneurysm 23 Sweat gland, modified Swinging flash light test 314 Swollen disc 330 Swollen eyelids 71 Symblepharon 75, 266, 280, 350 Synchysis 194 scintillans 195 Synechia annular posterior 137f posterior 136, 136f, 139 Synoptophore 339f, 340f, 342 evaluation 345 test 332 Syphilis 141, 144, 305, 347 acquired 102 congenital 102 Systemic diseases noninfectious 131 ocular manifestations of 347 Systemic lupus erythematosus 122 Systemic steroids 319 Systemic therapy 144 T Tabes dorsalis 325 Tacrolimus 144 Tarsal fracture 264 Tarsal plate 256 Tarsorrhaphy 101, 282 Taut posterior hyaloid 217 Tay Sach’s disease 227 T-cell inhibitors 144 T-cell mediated disease 145 Tears elimination of 282 film assessment 398 film osmolarity 281 lysozyme 281 secretion of 282 Tenon’s space Tendonitis 305 Teratoma, orbital 307 Terrien marginal degeneration 113, 114 Thrombophilic disorders acquired 228 inherited 228 Thrombophlebitis 276 Titmus fly test 19 Tolosa hunt syndrome 305 Tonometry, types of 172 Topical drug allergy 367 Topical fortified antibiotics 151 Topical steroids 104, 143, 293 Toxocariasis 144 Toxoplasma antibodies 141 Toxoplasmosis 144 Trabecular meshwork Trabeculectomy 148, 186 Trachoma 69, 72, 74, 78, 85, 280, 353 Trachomatous follicular inflammation 75 Trachomatous intense inflammation 75 Transillumination test 255 Translucid scotoma 27 Triamcinolone, intravitreal injection of 216 Trichiasis 258, 261, 351, 367 trachomatous 75 Tuberculoma 321 Tuberculosis 102, 144, 279, 305, 347, 350 Tumors 308 choroidal 124, 231 intraocular 161, 191, 247 orbital 310 pituitary 23, 325 primary 24 secondary 24 stage of 254 Tunnel blade 383 U Ulcer 78, 180, 266 amoeboid 105 atheromatous 93 corneal 72, 87, 87f, 92, 93, 363 dendritic 93, 104, 105, 105f fascicular 93 fungal 99 geographic 104, 106f mebooksfree.com 424 Exam Preparatory Manual for Undergraduates Ophthalmology hypopyon 93, 98, 98f, 276 irregular margins of 94 marginal 92 peptic 39 shield 78 stage of 93 Uncover test 337 United Kingdom Prospective Diabetes Study 216 Usher’s syndrome 239 Uvea 126, 350, 351 anatomy and blood supply of 126 Uveitis 130, 131 anterior 162, 368 chronic 147, 191 classification of 130 fibrinous 168 glaucoma hyphema syndrome 163 granulomatous 140, 351 granulomatous anterior 350 hypersensitivity 131 idiopathic 132 infective 130 infective, types of 131 intermediate 144 nongranulomatous 140 posterior 369 sight threatening 144 toxic 131 traumatic 131 Uveoscleral outflow 16, 16f, 17 V Valvular shunts 148 van Herick’s sign 172 van Herick’s slit lamp grading 172, 172f Vancomycin 151 Vanna’s scissors 383, 383f Vascular tissue, atrophy of 399 Vasculitis, retinal 350 Vein occlusion central 208 retinal 197, 223, 225 Veins 226 Vertigo 102, 367 Virus, DNA of 43 Vision binocular 19 color 330 complete loss of 224 defective 116, 132 dimensions of 197 double 367, 368 gradual loss of 366 island of 24f neurology of 20 physiology of 17 reduction of 361 severe loss of 241 sudden loss of 366 sudden painless loss of 227 tests binocular 341 color 18, 205, 206 transient blurring of 187 tubular 182, 183f Visual field defects 182 Visual loss, causes of 215 Visual system 20f Vitamin A 88, 88f, 166, 239, 351, 356 deficiency 84, 85, 87, 88, 101, 206, 239, 351, 355, 363, 368 foods rich in 88 B1 351 B2 351 deficiency 166 B6 239 C 166, 351 D 166, 351 Vitrectomy 151, 152, 196, 197 anterior 197, 198 core 197 Vitreomacular traction 217 Vitreous 133, 138, 194 294, 347 anatomy of 194 aspiration 142 definitive 12 degeneration of 194, 197 detachment, posterior 196, 197, 232, 368, 369 diseases of 194 mebooksfree.com Index 425 floaters 146 fluid 49 haze 132 hemorrhage, recurrent 197 liquefaction 49, 194 loss 162 membrane 198 opacities of 194 touch syndrome 198 traction 207, 232 Vogt Koyanagi Harada syndrome 144 Vogt’s striae 109, 400 von Recklinghausen disease 271 Vortex veins, compression of 254 V-Y operation 265f W Water drinking test 183 Wegener’s granulomatosis 122, 308 Weil Marchesani syndrome 166 Weiss ring 400 Wernicke’s encephalopathy 351 Wernicke’s hemianopic pupil 31, 314, 315 Wessely’s ring 400 Whooping cough 84 Wilson’s disease 113, 164 Window reflex 109 Wire speculum 381, 381f Wolfring, glands of 9, 67 Worth dot test 19, 342, 342f X Xanthelasma 270 Xanthoma 270 Xerophthalmia 84, 353 types of 85 Xerophthalmic scar 87 Xerosis 75, 85, 85f, 93, 351 conjunctival 87 corneal 87 profuse growth 85 Xylocaine allergy 162 Y Yoke muscle 336 Z Zeis gland 8, 259, 259f Zeiss four mirror 175 Zonular cataract 351 Zonular degeneration, acquired 166 mebooksfree.com ... entropion in elderly person mebooksfree.com 26 2 Exam Preparatory Manual for Undergraduates Ophthalmology •• Tight bandaging •• Ulcerative blepharitis •• Scars of lid Symptoms •• Foreign body sensation... abrasion •• Counter coup – damage due to pressure waves Fig 17 .2: Ecchymosis of lids mebooksfree.com 29 2 Exam Preparatory Manual for Undergraduates Ophthalmology Conjunctiva: Subconjunctival Hemorrhage... •• Lower lid ectropion - surgery •• Orbital decompression for thyroid ophthalmopathy mebooksfree.com 27 0 Exam Preparatory Manual for Undergraduates Ophthalmology •• Lateral tarsorrhaphy •• Treat