Pearls of ophthalmology
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Pearls of ophthalmology

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lecture notes of Sir Idrees

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Pearls of ophthalmology Presentation Transcript

  • 1. Instructor Dr. Idrees sb Prep by: Abdul Wasay Baloch abdulwasay789@gmail.com OPHTALMOLOGY
  • 2. Vision System Units “Curiosity is gluttony. To see is to devour.” ― Victor Hugo, Les Misérables
  • 3.  Unit 1 - Protection :  Orbital Rim  Eye lids  Lacrimal glands  Unit 2 – Transmission of Light  Media  Cornea  Iris  Sclera  Pupil  Lens  Unit 3 – transformation of light  Macula – have only cones, fine vision  Rods – periphery of reitna , crude vision
  • 4.  Unit 4 – axons or nerve fibers  1 million axons in one retina  Optic pathway  Unit 5 – transformation  Takes place in visual cortex, Temporal region
  • 5. Basic Concept
  • 6. Refraction
  • 7. Convergence  FACTORS:  80% - Cornea  20% - lens taking constant  Length of eye ball  Refraction Errors: 1) Myopia 2) Hypermetropia 3) Astigmatism 4) Presbyopia
  • 8. Myopia  Rays fall short of Retina  Cornea more convex  Length of eyeball increase  Big eye  Disadvantages:  More chances of Retinal Detachment  Treatment:  Concave lens
  • 9. Hypermetropia  Small eyeball  Converging beyond the retina  Eye ball length may be decreased  Cornea less convex  Convex lens used for treatment  More chances of Acute Narrow Angle Glaucoma
  • 10. Astigmatism  Irregularity of eyeball  Cornea is irregularly irregular  Spherical lens may be used  Cylinderical no applied having Axis
  • 11. Presbyopia  Loss of accommodation with age  Usually above 40  Accommodation + convergence problems  Ciliary body contracts and lens relaxed  Ciliary body relaxes, zonules contracts – lens become convex  Degeneration of ciliary body, zonules cause loss of accommodation  Need of convex lens  Treatment:  Glasses  Contact Lens  Laser Treatment
  • 12.  Excimer Laser  Applied on Stroma  LASIK:  Cornea slicing  IOL implantation VISION  Uncorrected  Corrected  Pin hole
  • 13. Lacrimal Apparatus
  • 14.  Lacrimal gland – 90 %  Accessory glands – 10 %  Secretions may increase – wet eye  Secretions may decrease – dry eye  Causes  Congenital – underdeveloped drainage system. Self corrected  Old age  Any cause of irritation of eye – rubbing, infection, allergy
  • 15. Congenital Causes  Appears during first 6 months of life  Under developed  Massaging the duct 2-3 times  Treatment:  Recurrent infection of sack obstruction flow hinders. In case of bacterial infection, Mucoprulent discharge. Regurgitation test is positive  Treat actively  Treat the cause
  • 16. Old Age  Stenosis  Hardening of walls, Puncta and canalculi  Entropian – lids inward, Puncta is displaced  Clinical Feature  Blurring of vision  Chances of infection  Discomfort  Treatment:  Massage  Regurgitation for minor block  Puncta dilating  Dacryocystogram – dye injecting – x ray
  • 17.  Treatment:  DCR (Dacrycysto Renotomy)  Artificial passage at sac level, fluid is direct to middle meatus
  • 18. Dry Eye  Congential problems  Age related – secretion decrease  More common in females  Con tissue disorders Rheumatic dis, SLE  Chemical injuries  Dry eye – infection –  Bells phenomenon  Eye ball rubbing against upper eyelid – corneal ulcer – refraction problems – pain – irritation  Treatment:  Artificial tears  Blockage of Puncta
  • 19.  Conjectival grafting  Avoiding dry atmosphere  Humidifier  Avoiding direct under fan
  • 20. Dacryocystitis  Blockage of Lacrimal sac  Old age  Medial canthus swelling  Pain redness and tenderness  Regurgitation tes is positive  Complication  Infection  Cellulitis  Osteomyelitis  Treatment  Antibiotics  Removal of sac
  • 21. Cataract
  • 22.  Age related changes  Opacificaition of Lens  Congenital  Maternal disease  Trauma  Presentation:  Gradual decrease of vision  In children, white Pupillary Reflex (also RETINOBLASTOMA, Squint)  Pathogenesis:  Lens dehydration  Normally avascular  Media opacified due to metabolic disorders •Young cataract •Trauma •Steriods •Diabettes •Hypoparathyroidism
  • 23.  Treatment  Phacoemulsification with lens implant  Complication may be  Hydration due to rupture of endothelium  Rupture of post capsule with nucleus drop  Infection  Extracapsular Lens extraction  Manual compression and aspiration  Incision large  Heal time 2-6 months  Delayed recovery  Astigmatism  Trauma to Iris  LASER
  • 24. LIDS
  • 25. Diseases  Ptosis  Entropian  Ectropian  Swelling of lids  Stye  Chalazion  Tumor – BCC , SCC  Blephritis
  • 26. Swelling of Lids
  • 27. Stye  Inflammation on the margin of lid  Inflammation of hair follicle and Zeils Glands  Staph, strep, Pneumococci are responsible  Painful swelling  May press cornea – Astigmatism  Palpebral part of conjunctiva is red  Treatment  Medical – pain killer, anti inflammatory, antibiotics, warm compression, Hot Spoon or towel • Excision after local anesthesia
  • 28. Chalazion  Inflammation of Mobean gland  Swelling is usually not on lid margin  Non tender  Treatment:  Localized sterilized injection  Incision is vertical, half thickness after everting lid  Not extending upto lid margin  Scooping out
  • 29. Tumors  BCC  Sun exposed areas  Abnormal growth - ulcer , non healing – bleeding  Localized or may be spread  Treatment surgically  Excision  Radiation
  • 30. Entropian  Usually of lower lid  Cause :  Congenital  Trachoma  Old age  Trauma  Space occupying lesion  Adhesion of palperbral and Bulbar conjunctiva  Chemical injury  Mechanism  Imbalance between orbicularis occuli
  • 31. PTOSIS
  • 32.  Drooping of upper eye lid  Due to orbicularis occuli (closure of eye)  Or Levator Palpebral (open the eyelid)  Balance disturbed – Ptosis occur  Cause  Weakness of muscle  Nerve supply disturb  Old age  Trauma  Sympathetic problems – Horner syndrome  3rd nerve Palsy  Myasthenia Gravis  Squint •Features •In children •Vision problem •Cosmetic defect
  • 33.  Treatment:  Treat the cause  Medical – Botox injection(3-6 months)  Surgical – treated with replacement of fascia lata  Moderate resection – shortening of muscle •Test : •Ruler test above 6mm normal •Finger on frontalis muscle
  • 34.  Problems:  Exposure of conjunctiva – exposure Keratitis, ulceration, infection  Cosmetic disfigurement  Watery eyes  Treatment :  Essentially surgical  Cauterizing on palperbral Conjuvtiva of mild Entropian
  • 35. Blephritis  Dandruff cause  Mobean gland dysfunction MGD  Skin abonrmality – dryess – scales  Redness  Deposits onscales  Droping of scales into eyelids  Irritation of eye  Treatment:  Lid hygiene - clean with Na2CO3  Antibiotics oinment  Warm compression  Doxycycline for 3-6 months
  • 36. RED EYE
  • 37. Conjunctivitis  Conjuvtiva is red  Causes  Viral - adenovirus  Bacterial – staph , strep  Allergic  Adenovirus  No defect in epithelium (flouroscent stain)  Opacities on cornea ( Sick Epi – Rose bangol stain) •Features •No pain •No vision loss •Redness more on palperbral part •Discomfort due to chemosis
  • 38. Keratitis (Bacterial & Fungal)  Cause:  Trauma – epithelium breach – entry – infection  Fungal – vegetative injury  Features  Sensory nerve endings below epithelium – painful  Cicumcorneal congestion – limbal area  Treatment  Scrapping after local anaesthesia  Complication :  Infection – abscess  Corneal scarring  Perforation of cornea  Spread of infection to ant chamber – hypopean  Endophthalmitis •Hyphema : •Blood in anterior chamber •Blunt trauma •Bleeding disorders •Anticoagulants •Trauma •INR monitoring •Rest for five days – heal •Always examine the FUNDUS •Check IOP •Dialtion of pupil – rest •Steriods •Reexamine
  • 39. Herpes simplex H. Zoster  Big dendritic patterns  Cold sore of eye  Attack nerve  Red eye  Opacity on cornea  Fluorescent takes  Episcleritic scleritis may be caused  Treat by Acylovior  Loss of sensation of cornea  Small dendritic patterns  Hemi headache, hemi forehead  Vesicles – rash – papule – ulcer  Shingles  Numbness  Pain  Can involve any part of eye
  • 40.  Sterile Corneal Ulcer:  No involvement of org  Breach of epithelium  Treatment:  Antibiotic drops – prophylactic  Lubricants  Pain killers  Interstitial Keratitis  Notorious syphillis  Classical scaring  Saddle shape nose
  • 41. Keratoconus  Cone shaped cornea  10 -30 year  Cause:  Cogential weakness of cornea at that place  Aqous pressure rise  Asthama or allergy association  Consequences  Astigmatism  Perforation  Treatment  Glasses  Hard contact lens  Corneal ring with laser  Corneal graft •Complications •Acute hydrops •Perforation •Prevention •Avoid contact sports
  • 42. Trachoma
  • 43.  Leading cause of death  In between bacterial and viral  Due to unhygienic conditions  Pathology :  New blood vessel formation  And scarring  Limited to upper part of palpebral part of conjunctiva and cornea  Also cause Entropian of upper eyelid – eyelids rub and cause corneal ulcer  Also cause pits called HERBET PITS  Treatment :  Self limited  Erythomycin 1g state, repeat after six months  Tetracycline  3rg generation antibiotics  Entropian – surgical treatment  Scarring – corneal graft
  • 44. PTERIGIUM
  • 45.  Abnormal growth of fibrovascular tissue  Growth towards cornea  Commonly from Nose side  Hot climate  Dust climate  Sandy climate  Disadvantages:  Corneal pull – astigmatism  Pupillary area – vision problem  Treatment :  Surgical treatment  Excision with Mitomycin on limbal area  Excision with conjunvtival grafting
  • 46. Corneal graft  Removal of cornea and replaced with donor • Full thickness graft • Partial thickness graft • Test for donor: • Jacob test • Blood sample • Indication : • Scarring • Trachoma • Trauma • Abscess • Pterigium • Massive endothelial damage • Post cataract surgery
  • 47. UVEITIS
  • 48.  Uveal tissue  Most vascular part of eye  Nutrition  Systemic diseases effects  Common inflammation  Infection  Non infective – ankylsing spondyloisosis, HLA  Features  Red eye (congestion more Bulbar part of conjunctiva), Painful, Vision disturbed  Causes:  Corneal problems  Uveitis  Acute glaucomma Cicumcorneal Congestion
  • 49.  Examination  Vision  Redness  Corneal clarity  Pupil may be irregular or small, stick to lens POST Psynechia  Anterior chamber contain Iris cells that mat stick to endothelium of cornea – Keratopreicipitates  Cells visible on slit lamp – Flares  White grayish patches on retina along with blood vessels – Periphlebitis  Fluid oozes out from choroid into macula – Macular edema  Optic nerve inflammation  Retina may also have patches  Vitrous turbid
  • 50.  Causes  Any systemic infection, MS, T.B, Sarcoidosis, septecemia  Treated acc to cause  NON infective – steriods, cytotoxic drugs  INFECTIVE – treat the infection  Complication  Long standing – cataract  Glaucoma  Retinal detachment  Macular edema  Optic nerve dysfunction
  • 51. Iritis / Uveitis  In acute glaucoma  Perforation of gloe  Corneal propalsion  Penetrating injury  History  Viral (adenovirus)– watery discharge, glands usually involed
  • 52. Scleritis and Episclretis  Localized and diffused infection  Clinical Feature  Pain  Vision affected  May have systemic assosiation , Autoimmune disorders, Con tissue disorders ( ESR and CRP tests)  Hemiheadache  Nausea vomitting  DD – migraine
  • 53. Glaucoma
  • 54.  Types 1. Congenital 2. Closed angle glaucoma 3. Chronic open angle glaucoma 4. Secondary glaucoma  Pathogenesis  Ciliary body – lens – pupil – ant chamber – meshwork – canals of Shemn – episcleral vein  Angle between Iris and Cornea  Normal pressure is 10 – 20 mmHg, varies with age  Above 40 considered high
  • 55. Congenital Glaucoma  Trabecular meshwork or canals of shlemn not developed  Agenesis , disgenesis, fluid drain problem – pressure – BUPHTHALMOS  Due to elasticity – Big eye  Corneal fluid – hazy cornea  Refraction problem  Squint  Diagnosis  EUA  Check IOP  Refraction  Complete examination of eye including Optic Disc
  • 56.  Treatment  Medical  Antiglaucoma drops Dimox and Acetazolamide  Surgical  Modified trabeculectomy – placement of tube in ant chamber  Prognosis  Not very good
  • 57. Narrow Angle Glaucoma  Angle narrow or closed  Fluid obstruct  Back pressure buily  Precipitating factor is CATARACT  Small hypermetric eye  Middle to lat age presentation  Subacute attacks when pupil is Dilated  Hallows around the vision in Evening  Colorful vision  Hydration of cornea  Goneoscopy – examining lens of ant chamber , Gonolens
  • 58.  Treatment  Peripheral iriodotomy  Methods  Yag Laser  Making hole at limbal region  Clinical features at extreme conditons  Red  Pain assosiated with nausea vomitting  Pupil semidialted fixed  Cataract may be present  In acute attack, Nerve fibers may damage causing blindness in a day
  • 59. Treatment of Acute Attack  Maxillon inj for nusea  Acetazolamide 500 mg iv  Antiglaucoma drops Pilocarpine 4%  Beta blockerrs  Steriod drops – reducing swelling and congestion  Ultimate peripheral Iridotomy  And cataract surger ( precipitating factor)
  • 60. Chronic Open Angle Glaucoma  Resistance at trabeculated meshwork  Slowly progress,  Age 20 30 and old age  Pressure increase  Increase Blood Supply of axon  Pressure on axon  patient does not complaint unless get worsen in 60’s  Peripheral patchy field defect  Tunnel vision at end stage (also in Retina pigmentosum  Quality of vision loss  Screening program detection ususally •White Pupillary reflex •Cataract •Retinoblastoma •Retinopathy
  • 61. diagnosis  Screening program  IOP pilination Tononmeter  Examination of optic nerve  Check the field of vision  Perimetery  OCT of optic nerve  Nerve fiber analysis NFA  Family history of Diabettes  Diabetes  Hypertension  Glaucoma  Cholesterol increase Normal Tension Glaucoma •Pressure is normal •Any pressure damaging nerve of eye •Occular hyper discc
  • 62. SQUINT
  • 63.  Misalignment of two eye  Types  Paralytic ( CN 3 , 4, 6)  4th nerve damage – diagnosed by Head Tilt, Head Trauma  6th nerve – lateral rectus paralysed – inward eye  3rd and 6th are caused by old age, Diabetes, Hypertension and increase Cholestremia  Non paralytic  Investigations  Assessment  Causes  Clinical Feature  Ptosis  Outward or inward eye  Disfigurement  Double Vision due non fusion of both images in visual cortex •Aneurysm of PCA •Ptosis •3rd CN paralysis •Dilatation of pupil •painful
  • 64.  Treatment  Blockage of bad eye  Counseling to the patient  Recovery is 6 weeks to 3 months  Prolong one vision cause supression of bad eye  Field of vision loss  Diagnosis  2 feet examination  Eye movements  Botulin toxin in antagonist eye  Accommodating and Non accommodating squint  Squint goes away when covering the bad eye  Partial – half eye corrected •Monocular and Binocular •Steropsis •Depth of perception •3D imaging
  • 65. Non Accommodating Squint  Eye movements are not restricted  Common in children  Inward turning of eye – ESO  Tropia – when squint is always there  Phoria – when squint is sometime present  Causes  Refractive errors  Ptosis  Cataract  Clinical features  Focus problem  Vision reduced
  • 66.  Amblyopic eye – eye sight is normal but eye is tilt  Squint  In children – hypermetropia and ESO deviation  Examination  Preferential looking test  100 and 1000 test  Refraction  K test  Complete examination of eye including fundus  Torch corneal reflex  Two feet examination  Cover uncover test  Alternate test  Prism Cover Test  synaptophore
  • 67. Summary – Check List Examination  Refraction  Visual acquity  Check vision  Two feet examination and eye movements  Pupillary reflex  Coves uncover test  Prism cover test  Synatophore  Stereopsis •Ptosis complete •Corneal examination •Pupil reflex •Refraction •Cataract •Media for opacification •Retina examination •EUA for kids
  • 68. Management  Cosmetic and vision problem  Treat the cause  Refractive error  Ptosis  Corneal scarring  Cataract  Any congenital problem  Use glasses  Treat cataract  Corneal grafting  Emblopic Therapy : for certain day of time, Patch the good eye dilate the good eye Surgical treatment Recession of eye – weakening of muscle Resection – strongthe muscle
  • 69. Retinal Detachment
  • 70.  Retina is separated from Choroid  Pigment epithelium remain attached  Due to Fluid Push or Myopia  Types  Rigmatogenous – tear or hole, common in myopes  Non Rigmatogenous – in acute glaucoma, common in Hypermetropes
  • 71. Rigmatogenous RD  In myopes – BIG EYE - retina thin – more chances  Trauma  Vitrous degeneration  Problems (3F)  Field defect of that area  Retina dead due to low nourishment  Loss of central vision  Vitrous degenerated into pieces – FLOATERS  Retina pull – FLASHES  Bleeding via pulling of vessel  Decreased vision  Treatment –  seal hole or tear, (CRYO and LASER)  Approximate the retina – drainage of fluid OR ( Plomb Or BUCCAL) •CRYOBUCCAL PROCEDURE •Freezing -200 probe •Scar •Approximate •Plomb and buccal •VITRECTOMY •ENDOLASER •GAS OR SILICON OIL
  • 72. Non RG RD  Choroidal melanoma  Growth – pigmentation – ulceration – pain  Diabetic retinopathy  Usually upper temporal side defect and upper nasal  Treat the cause
  • 73. Vascular Problems
  • 74.  Retinal artery occlusion  Systemic  Diabetic retinopathy – ischemia – weak wall- pale – dead axon (cotton wool spots)  Retinal Vein occlusion – back pressure increase – fluid – edema  Hypertiension Retinopathy - pressure increased  New Blood vessel formation  Enothelial growth factors  New blood vessel formation  Fragile – tendency to bleed  Causes (inside wall – lumen reduced, Outside – mass occupying lesion)  Diabetes  Hypertension  Age factor  hypercholestrol
  • 75. Sudden Artery Occlusion  Sudden loss of vision  Afferent Pupillary pathway defect  Clinical Features:  Pupil – Blue in centre  Vision loss depends on area affected  HM +ve – because cilioretinal branch of ophthalmic division is spared  Retina – Pale ischemic Retina, thin arteries  Cherry Red Spots  Macular thin, choroidal blood vessels glow  After sometime, disc becomes pale  See the clots in blood vessels  Investigation  Carotid Bruit  Scan pulse feeble  Heart murmur •Treatment •Lower the IOP •No treatment satisfactory •Aspirin •Treat cause •Prognosis poor
  • 76. Hypertensive Retinopathy  Hyperemic swellen disc  Macular edema  Treatment  Treat the cause BP  Young hypertensive patien die due to Renal problems  Look for Renal problems
  • 77. Diabetic Retinopathy  Treat the cause  Argon Laser ( Never do it on Macula and Disc)  Macular edema  New b.v formation  Intravitreal injection of endothelial growth factor inhibitor  Vitrectomy with endolaser  Vein Occlusion  Back pressure – bleeding – SECTORIAL FIELD DEFEC  Central field defect  Treat the occlusion
  • 78.  Macular edema  Argon laser  Endothelial growth factor inhinitor  Antiplatelets  Screening of Diabetes  Macular edema  Heamorrhage  Vitrous bleed
  • 79. Age Related Macular Degeneration  Types  Dry ARMD  Wear and tear, Choroidal macula  Wet ARMD  Exudation – fluid – bleeding –  Clinical Feature  Distorsion of vision  O pain or rednes  AMSLER CHART  Complete examination  Investigation  Optic Coherence Tomography (OCT)  Layaer by layer examination  Macular fluid – push – macular detachment  Fundus Flourosent Angiography FFA  Leading cause of blindness •BLINDING CAUSES macular detachemnt •COAG ARMD •DRP •Myopic degenration •Trachoma
  • 80.  Treatment  Dry ARMD – no satisfactory treatment  Wet  Intravitreal growth factor inhibitor  Laser treatment  Prevention  Fresh green leafy vegetebles  Antioxidants  Multivitamin  UV light precuation
  • 81. DISC
  • 82.  Raise ICP – pupil edema  CSF incr  Head injury  Tumor  Cyst  Optic nerve pressure  Space occupying lesion  Choroditis  Uveitis  Optic nerve inflammation  Diabetes  DRUSEN – bolloid bodies  Venous occlusion Swelling of Disc
  • 83. Retina pigmentosa  Night blindness  Genetic disease  Rod Cones decreased  Retina destruction  Features ( Classic Triad)  Waxy pale disc  Thin attenuated blood vessels  Bony specules (black pigment around retina)  Macular edema  Cataract  Tunnel vision ( also in COAG)  no satisfactory treatment  Marriage counseling  Steropic glasses
  • 84. Retinoblastoma  Nerve tissue tumore  2-5 years age comon  White pupillary reflex  Squint , absent red reflex  Treatment  Complete removal of eyeball along with optic nerve  radiation and laser treatment at early stages  May spread to neural tissue  Optica chiasma
  • 85. Orbital Cellulitis  Inflammation of cellular tissue  Souces  Chalazion clamp  Sinuses  An infection  Clinical features  Sweeling, tenderness and apin  Redness of eye ball  Painful eye movements  Treatment  Local oral antibiotics if eye ball not involved otherwise IV
  • 86. Optic Nerve Function tests 1. Decreased vision 2. Decreased intensity of light 3. Decreased color vision 4. Field vision defects 5. Pupillary defect 1. Relative Afferent Pupil Defect
  • 87. Thyrotoxis – squint  Exophthalmus  Inflammatory tissue in retro orbital space  Eye movements restricted LID LAG PHENOMENON  Inflammatory tissue may compress optic nerve - Blindness  IOP raised  Treatment  Treat the cause  Routine management  In emergency – iv steroids and Acetazolamide  Surgery – ORBITAL DECOMPRESSION 1. Lateral canthectomy 2. Medial floor canthotomy 3. Tear drops 4. Treat squint
  • 88. Temporal Arteritis  Inflammatory cells affect medium and small sized arteries  Unknown etiology  Common in old age  Clinical feature  Jaw claudication  Tendeness on scalp  Retinal arteries blockage  Complication  Retinal artery occlusion  CN Palsy •ESR •TA •TB •MM •Autoimmune dis
  • 89.  Diagnosis  CRP  ESR v. high  Temporal artery biopsy  Slide – lumen blac  Treatment  Steroids high doses
  • 90. Melanoma  Pigment tumor  Iris may be involeved  Not Normal  Increase in size  Incr in growth  Incr in pain  Incr in ulceration  Accidental finding  Loss of vision  Complication  Locally invasive  Metastatise to liver
  • 91.  Treatment  Local resection  Radiation – palque attack of laser  Cryo Laser
  • 92. Central Serous Retinopathy  Usual age 30 to 40 years  Vision defect  Tense type personality  Blood vessels around macula – leak – fluid – blur vision – retina deachment – field defect  Self restoring about three months  Scarring  Recurrent conditions  Treatment not successful  Laser  IVGHI  Complication
  • 93.  Complication  Scarring  Reoccurrence  Fundus fluorescent angiography
  • 94. Sudden Loss of Vision  Vitrous haemorrhage  Diabetic retinopathy  Retinal detachment  Bitemporal hemianopia  Pituitary tumor  Nasal fibers representing temporal side after decussation
  • 95. Headache  Temporal arteritis  PCA aneurysm  Occipital headache in young  Disc swelling – ICP rise – headache  Tumors  Binign –  Intracranial hypertension  Morning sickness  Management  MRI scan  acetazolamide
  • 96. Nystagmus  Jerky movements of eyes  Constant vision  Visual pathway defect  Cataract may be one of cause
  • 97. Investigation of eye
  • 98.  Excimer Laser  Cornea refractive surgery  Argon Laser  Retinal problems – sealing  Glaucoma  Laser trabeculoplasty  YAG laser  For narrow angle glaucoma  Periperal ididectomy  Capluletomy – post  RUBIOSIS – blood vessels on Iris  Fundus Flurosent Angiography  Cornel topography for uneven cornea
  • 99.  OCT  Diabetes  ARMD  Corneal ulcer  Fluorescent dye  Rosebangol for sick epithelium  Pupillary reaction  ERG electroretinography  EOG – electro occular gram  Field defect test  Nerve Fiber analysis  Ophtalmoscope  Direct  Indirect – using lens
  • 100.  Refraction  Comp auto ref  Retinoscope  Scans  Alpha scan – length of eye ball  B scans – retina state observe  Cataract power of Lens  Keratometer  A scan