Ophthalmology 2024

Festooned pupil

Festooned Pupil
Cause: Posterior Synechia (Iris+Ant Capsule of Lens)

In Rx of traumatic optic neuropathy, High dose IV METHYL not methylene * في تعديلات القسم

..

بقول للعيان يقلع العدسة لو بقيس IOP او بعمل flurosciene

بسيبها عادي لو fundus

high difference Anisometropia when corrected by glasses cause binocular dipopia

Mucous strand in tear film cause monocular dilopia

برضو الملون بس

pterygium , topical PG analogue may cause red eye

ان الconj معهاش photophobia و النظر كويس بس

الاسباب الي متعلم عليها بالالوان

life threatening condition :
✅ acute proptosis : may be cavernous sinus thrombosis or carotid cavernous fistula

✅Internal ophthalmoplegia : may be aneurysm

✅papilledema : ICP high
✅orbital cellulitis
✅leckckria: may be retinoblastoma

sight threatening :
Acute iritis and gonococcal conj
مش دول بس اكيد ده المنهج كله خطر بس بنقول الغريب بس انما هما كتير

حاجات غلط الناس فاكرها صح :::::::

❌Reading for prolonged periods can be harmful to the eyes.

❌Wearing glasses that are of the incorrect prescription can damage the eyes.
❌ Getting used to wearing glasses is harmful to the eyes *


❌If children sit too close to the television set, they may damage their eyes.

❌Crossing of the eyes will disappear when the child grows up.

❌Annual change of refraction in teenagers is a bad sign.

❌ A cataract can grow back after cataract surgery
مبقاش في عدسة اصلا

❌A cataract must be "ripe" before surgery can be done.

❌. In older people, a sign of healthy eyes is the ability to read the newspaper without glasses.

EXAMINATION Part 3

الحاجات الجديدة شوية في جزء ال DDx في الاول
From p 34 till the end
-دا الجديد بس انما البارت كله مهم -

opthalmoscope till p.33

IOP

pupil

جزء الcover
https://t.me/ophthalmology_24/5708

Examination Part 2 👇

EXAMINATION Part 1(from p.14 to 20)
النوتس المهمة خالص من اول ص 14 في الكتاب، الاناتومي خلصناه فوق✅:
(لا يغني عن الكتاب بس محاولة للتلخيص لو الوقت ضيق اوي)

✅tests MUST be done في كل الحالات:
Must ٤ حروف = 4 tests:
-Visual ACUITY, PUPILLARY reactions, EOM, FUNDUS
✅in fundus examination: Dilated or undilated , prefer UNdilated if محتاجين نشوف pupillary reactions
✅ADDITIONAL tests if indicated/ معانا وقت:
كل الباقي

✅tools: pen light- mydriatic- topical Anesthetics- direct ophthalmoscope- near vision card

✅Slit lamp = OFFICE instrument = mainly ANTERIOR segment, ممكن posterior if used lenses مساعدة
✅Portable slit lamp=
لحد مش هيعرف يتحرك
bedridden-children under general Anesthesia

1⃣Visual Acuity:
Def: measurement of smallest object pt can see at given distance compared to normal
=Testing distance (6m "standard")/ smallest line pt can see on VA chart
=distance at which test performed/ number written beside the line the pt could read

✅VA charts = SNELLEN- TUMBLING E-LANDLT C
✅6m distance= optical INFINITY
✅if pt wearing glasses= test VA with مرة , and without مرة
✅RIGHT eye tested first
نحن أهل اليمين
✅start with 6/6 line= اصغر واحد خالص تحت
ثم نطلع واحد واحد لحد فوق خالص أكبر واحد 6/60

✅ماننساش العين الشمال

✅PINHOLE TEST = if VA 6/12 or less
✅If VA improves with pinhole = refractive error= glasses
يلبس نضارة او لو لابسها ظبط القياسات

✅if can't see largest Snellen letter (6/60) = قرب المسافة =
5/60 وهكذا
ماشافش يبقى نقرب 1m كل شوية لحد 1/60

✅if مش شايف بردو at 1m (1/60)= use COUNTING FINGERS وقرب المسافة وسجلها=
CF (At distance اللي شاف عندها)
✅if no CF = Use HAND MOTION
✅if no HM = Use PL= LIGHT PERCEPTION
( Not projection= visual field)
✅If no PL = خلاص مش بيشوف

✅LEGAL blindness= WHO: Blindness at BEST-CORRECTED VA of 3/60 , in better seeing eye

✅Near VA testing =at 30-40 cm= if complaint of near vision/ bedridden= if pt wears glasses test with them

✅VA in non cooperative pts= there is vision if: change in facial expression- brisk pupillary response, except cortical blindness

✅VA in Newborns = can NOT be measured
اعمل التيستات التانية
✅VA in infants to 2 yrs= test for amblyopia
واتكلمنا بالتفصيل في ال Pediatric
✅NORMAL Visual function = CENTRAL, STEADY, MAINTAINED fixation , can be tested by ROTATING OPOKINETIC DRUM

✅VA in 2-3 yrs = use picture card
✅VA above 3 yrs= charts عادي + use adhesive patch for full occlusion of one eye
عشان الطفل ممكن يشيل ايده او يبص من وراها

✅if VA Normal = recheck ANNUALLY
✅uncooperative pt-malingering- examination difficult = use VEP/ERG

✅worldwide leading causes of vision impairment:
عشان ال all except:
Uncorrected refractive errors- cataract- glaucoma- AMD - DR- corneal opacity- trachoma
➖➖➖➖➖➖➖➖
2⃣Visual Field tests:
✅CONFRONTATION: If VA 1/60 or better
✅LIGHT PROJECTION (not perception ها) = if VA less than 1/60
✅Automated Perimetry= quantitative
✅Amsler grid= fieid defects in central 10 degrees
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3⃣Inspection
كل ال structures في العين عموما
الجديد
EVERSION of UPPER lid to search for Conjunctival FBs or Conjunctival signs
➖➖➖➖➖➖➖➖➖
4⃣depth of AC
✅normal iris= flat
✅if shallow AC= Iris bowed forwards
✅shallow AC = Angle closure glaucoma او هيحصله if pupil Dilatation = attack of ACG
✅in testing we look at nasal aspect if iris: if 2/3 or more of iris in shadow= shallow AC= Narrow angle

#Notes
جزء ال Examination في اول الكتاب
اهم اهم النوتس