Girls work fromGirls work from
Dr.Sameer jamal lecturesDr.Sameer jamal lectures
Optic nerve swelling
Normal optic nerve (central
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.
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.
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
Angle-closure glaucoma: central corneal
oedema with an oval-shaped mid-dilated
used to see inside the fundus of the eye and other
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
•Used to objectively determine the refractive
power of the eye.
Finger Nail Abrasion Staining
Using 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
•To initially relieve double vision (diplopia) caused by an extra-ocular muscle palsy
•To protect injured eyes
• provides a high magnification view of
the front structures of the eye,
including the cornea, iris and lens,
• 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.
used to determine the intraoccular pressure
(IOP) - useful in glaucoma
Direct tonometer Indirect tonometer
used 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.
Management of traumatic eye
Corneal perforation Foreign body
Severe tear deficiency leads to breakdown of the
corneal epithelial layer.
Peripheral corneal ulceration Abrasion
Note the crescent-shaped destructive
inflammation of the juxtalimbal corne
When a patient come with eye trauma,
then you have to role out 4 conditions…
• Foreign body
• Corneal ulcer
بوكس ادالو احد او العين جوا دخلت لقصقة عدسة كان سواء
تسمى فكلها عينوا في
• The more serious the injury, the more pain the Pt.
will feel (perforation & ulcer are more painful than
• 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! تنسم !العين
Other non-pathognomonic signs of perforation-due-
• Bleeding (it could be a conjunctival trauma or an iris
trauma in case of bleeding from the perforation
• Irregular pupil
• Irregularity in AC depth
• Don’t put anything on the injury site, no antibiotics
or any drops. You might worsen the injury if you
• All you can do is just putting a shield on the eye to
protect the eye from further injury. NO PATCHING!
• العين فوق نحطها و نصين الورقية الكاسة نكسر الشيلد نسوي عشان
العين فوق نلصقها و
• Then, call an ophthalmologist and refer the case to
• 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
• 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
• REFER THE CASE TO AN OPHTHALMOLOGIST! It’s
not your job to treat the ulcer
• حأحولوا ماراح .. حأعالجو راح اذا بودي الفورين و اللسر
• No shield neither patch should be applied in case of
• حيتاخر المريض لوكان ال حيوي مضاد قطرة تحطي ما انك يفضل
من لمدة العيون لدكتور روحتوا في24الحالة دي ففي ساعة
النفيكشن تمنعي عشان حيوي مضاد قطرة تحطيلو
• If you suspect an ulcer, you need to give antibiotics
• عمل في بعدين حيتعب انو الحيوي المضاد قطرات في المشكلة
لللسر المسبب الميكروب لمعرفة كلتشر
• 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
• Refer the Pt. to an ophthalmologist for follow up.
The period for referral should not exceed 24 hours