Ophtha Made Simple For NRE NLE Step 2 – BilalMD

In Ophthalmology OSCE stations, images of various eye diseases are shown, and candidates are asked to identify the disease and describe its treatment. The following are examples of common cases that may be presented:

1. Style (Hardeolum) and Chalazion
2. Ectropion and Entropion
3. Trachoma
4. Structure of Eye:
5. Conjunctivitis
6. Dacrocystitis
7. Endopthalmitis
8. Myopia and Hyperopia
9. Cataract
10. CRAO and CRVO
11. Orbital Cellulitis
12. Fundoscopic Finding in Diabetes Mellitus
13. STAGES OF DIABETIC RETINOPATHY

The Human eye consist of three layers.

1. Outer Layer: Sclera and cornea
2. Middle layer: Vascular in nature (choroid, iris)
3. Nervous Layer: Retina (Tod and cones)

Segments of Eye:

1. Anterial segment: Cornea to lens
2. Posterior segment: Behind lens

• Anterior segment further divided into two chambers.
• Anterior chamber = cornea to iris
• Posterior chamber = iris to lens

1. Style (Hardeolum) and Chalazion

2. Ectropion and Entropion

3. Trachoma

A disease of eye caused by Bacterial infection which result visual impairment and even blindness.

Causes:

1. Chlamydia Trachomatis
2. It is contagious in nature

Symptoms:

1. Mild itching and irritation in eye
2. Photophobia
3. Eyelid swelling
4. Eye redness
5. Vision loss

Who classification: (FISTO)

1. TF: (Trachoma Follicular)
   • Early infection heaving have more than five follicle.
   • Follicle contain lymphocytes
2. TI: (Trachoma Intense)
   • In this stage eye are highly contagious and become irritated.
3. TS (Trachoma Scarring)
   • Repeated infection result scarring of inner eyelid.
   • In this stage high chance of entropion
4. TT (Trachoma Trichiasis)
   • The scarred inner eyelid continue to deform and eventually turn inward (Entropion)
5. TO: (Trachoma Opacity)
   • In this stage clouding of cornea occur & result visual loss
6. Tx: A single dose of Azihromycin.

4. Conjunctivitis

Inflammation of conjunctive in the eye. It is also know pink eye. It is usually due to infection or allergies

Types:

1. Viral conjunctivitis (most common)
2. Bacterial conjunctivitis
3. Allergic conjunctivitis

Symptoms:

1. Redness in eye
2. Itchiness
3. Gritty feeling
4. Discharge (Purulent or watery)
5. Photophobia

Treatment:

1. Eye drop
2. Eye ointment
3. Anti-Allergic
4. Antibiotics

5. Dacrocystitis

Inflammation of lacrimal sac present in nasolacrimal duct

Causes:

1. Congenital
2. Bacterial infection (Staph Aerous)

Symptoms:

1. Swelling and near the medial canthus
2. Tenderness
3. Redness
4. Pus discharge
5. Fever

Diagnosis: Clinical diagnosis

Treatment:

1. Oral antibiotic (7-10 days)
2. DacryocystoRhinostomy (DCR)

6. Pterygium

1. A non cancenus abnormal tissue growth on conjunctiva
2. It usually grows toward cornea

Causes:

1. Idiopathic
2. Exposure to Uv-rays
3. M>F

Diagnosis: Clinical diagnosed

Treatment:

1. Follow up (cannot reach cornea)
2. Surgery

7. Endopthalmitis

A purulent inflammation of intraocular fluid (Acquoud vs vitnus) due to infection usually after ocular surgery

Causes:

1. Exogenous = Post-operative, Traumatic, Corneal Ulcer
2. Endogenous = Bacterial, Fungal

Symptoms:

1. Blurred Vision 94%
2. Redness in eye 82%
3. Pain in eye 74%
4. Swollen lid
5. Epiphora

O/E: Hypopyon

Note: Commonly occur after cataract surgery

Treatment:

1. Corticosteriod
2. Antibiotic
3. Topical antibiotic
4. Vitrectomy

8. Myopia and Hyperopia

9. Cataract

A condition in which the lens become opaque and cloudy. It is due to protein deposition during lens breakdown which result clouding.

Causes:

1. Older Age
2. D.M
3. Trauma
4. Ocular Injury
5. Family History (e.g Congenital)
6. Radiation

Types:

1. Senile Cataract
2. Nuclear Cataract
3. Cortical cataract
4. Posterior subcapsular cataract
5. Congenital cataract

Treatment:

1. Surgery ( IOL)
2. Phacoemulsification

10. CRAO and CRVO

11. Orbital Cellulitis

Infection of fats and muscles around the eye. It affect the eye lids, eyebrows and cheeks

Cause:

Bacteria (Staph Aerous)

Symptoms:

1. Proptosis
2. Chemosis
3. Pain with eye movement
4. Fever
5. Photophobia

Diagnosis:

Blood CP = Leukocytosis

Treatment:

Antibiotics, Corticosteroid

11. Fundoscopic Finding in Diabetes Mellitus

1. Micro-aneurysm
2. Cotton wool spot (Damage to nerve firbre)
3. Hard exudate (yellow white deposits of protein & lipid)
4. Retinal Hemorrhage
5. Neovascularization