5 th Grade clinical slide ophthalmology

1. Clinical for 5th Grade
students
Ahmed Osama Hashem
FRCS ophth
PhD,MD Ain Shams university
Associate Professor of ophthalmology
Head Of Vitreoretinal surgery unit KFS

2. Snellen chart- illiterate E –OR Landlot broken
C

3. Pinhole

4. Trial
• Trial frame ,, trial lenses

5. Phoropter

6. Test macula function (Amsler grid)

7. Age related Macular degeneration-Wet type
(CNV)with hemorrhage and scar

8. Test contrast sensitivity

9. Test color vision

10. Test VA in children
• Picture test

12. Test VA in children
• preferential looking

13. Test VA in children
• hundreds and thousand test sweet test

14. Anterior blepharitis

15. Squamous blepharitis (seborrheic)
• Greasy dandruff scales
• Dandruf like material –as sleeves around lashes
• Associated with dandruff of the scalp

16. Staphylococcus blepharitis
scales (hard and brittle)around base of lashes
collarettes (bleads on crust removal-ulcerative
lesion under the crust)
hyperemia and telangectasia of anterior lid margin
rosettes

17. Angular blepharitis

18. Stye

20. chalezion

22. Chalezion excesion

23. Chalezion excesion

24. Trichiatic lash trchiatic lash

27. Bilateral ptosis blepharophemosis

29. Levator function test

30. Lagophthalmos

31. Symblephron

32. Epicanthus

33. Complications of blepharitis(Madarosis –poliosis-
tylosis ……. Ectropion

34. Ectropion

35. Tylosis
• Thickening of the tarsal border of the eyelid

36. Loss of lashes

37. Poliosis

38. Eye lid edema
Eyelid edema is the medical term for swelling around the eyes
due to fluid retention. It can be caused by allergy,
inflammation, infection, or injury.
. Eyelid edema is usually a sign, not a condition

39. Dermoid cyst eyelid

40. Dermoid cyst eye lid
DD –lacrimal gland swelling i.e Dacyoadenitis

41. Eye lid coloboma

42. Dacryoadenitis

43. 5. Parasitic blepharitis
• Pubic louse& its ova(nits).
• Typically affects children with poor hyg.conditions.
• Itching.
Treatment - removal, destruction and delousing

44. Upper lid stye
• .

45. Madarosis ,Tylosis

46. chalezion

47. chalezion

48. stye

49. chalezion

50. Herpes simplex blepharitis vesicles

51. Lower lid ectropion

52. Marcus Gunn jaw-winking syndrome
• Accounts for about 5% of all cases of congenital ptosis
• Retraction or ‘wink’ of ptotic lid in conjunction with
stimulation of ipsilateral pterygoid muscles
Opening of mouth Contralateral movement of jaw

53. Blepharophimosis syndrome (Ptosis -….

54. Pseudomembranous
Pseudomembranes consist of coagulated
exudate adherent to the inflamed
conjunctival
epithelium. Characteristically, they can be
easily peeled off leaving the epithelium
intact.
Causes(1) severe adenoviral infection, (2)
Bacterial conjunctivitis and (3) autoimmune
conjunctivitis.

55. Follicular reaction
• Sub epithelial foci of hyperplastic of
lymphoid tissue with in stroma.
• More prominent in fornices.
• Multiple, discrete, slightly elevated,
lesions encircled by a tiny blood
vessel—small grains of rice.
• Size from 0.5 to 5 mm.
1. Viral.
2. Chlamydial.
3. Parinaud oculoglandular syndrome.
4. Hypersensitivity to topical
medications.

56. Papillae
bacterial conjunctivitis,
allergic conjunctivitis,
chronic blepharitis,
contact lens wear,
superior limbic keratoconjunctivitis floppy
eyelid syndrome.
elevated red dots as a result of
the central vascular channel,

57. Papillary reaction
• Hyperplastic conjunctival epithelium.
• Can develop in palpebral conjunctiva (firmly attached)
and limbus.
• Papilla may mask follicles.
• Giant papilla (confluence)
• Non-specific; (less diagnostic)
1. Chronic blephritis.
2. Allergic conjunctivitis.
3. Bacterial conjunctivitis.
4. Contact lens wears.
5. Superior limbic keratoconjunctivitis.
6. Floppy eyelid syndrome.

58. True membranes
True membranes form when the
inflammatory exudate permeates the
superficial layers
of the conjunctival epithelium. Attempts to
remove the membrane may be accompanied
by
tearing of the epithelium and bleeding.
Causes are infections from ß-haemolytic
streptococci and diphtheria.

59. Trachomatus Pannus

60. Limbal vernal
Trantas dots
Mucoid nodule

61. Phlycten

62. Limbal phlycten

63. Pinguecula

64. Pterygium

65. Pterygium

66. Limbal VKC

67. Trachomatous scar

68. PTCs Trachoma

69. Pterygium

70. lagophthalmos
• Definition: inability to close the palpebral fissure

71. Herpes zoster ophthalmicus

73. Lt lacrimal sac massage

74. Probing 1st punctum dilator

75. probing

76. Syringing

77. DCR

78. Rose Bengal staining of mucus, debris and
devitalized epithelial cells is observed in the
inferior cornea and bulbar conjunctiva

79. FL break up time test

80. Schirmer’s test

81. Schirmer’s test

83. Nebula

86. Leukoma

87. Desmatocele

88. Leukoma Adherant

89. Leukoma Adherant- Irregular pupil

91. Phlyectunular keratitis

92. Marginal corneal ulcer

93. Mooren’s corneal ulcer (Autoimmune)

94. Megalocornea

95. Microcornea

96. Posterior embryotoxin

97. White limbal girdle of vogt

98. Keratoglobus

99. Fleischer’s ring

100. Kayser Fleisher ring (Copper deposition
,Wilson disease)

101. Stocker line

102. Hudson stahli line

103. Band keratopathy

104. Granular corneal dystrophy

105. Arcus senilis

106. Intracorneal ring

107. Keratoconus

108. Cornea Plana

109. Penetrating keratoplasty

110. Anterior chamber flare

111. What you can see at the bottom of the cornea ?
What is the treatment ?
Mutton Fat keratic percepitates

112. Anterior uveitis if not treated probably may
lead to sever complications, what are they ?
Festooned pupil posterior synechia

113. What is your main finding?

114. Mention 3 abnormal findings ?
Mention the most common cause?

115. Rt Leukocoria

116. Cortical cataract (nearly complete cortical)

117. Nuclear cataract

118. Nuclear cataract
Increase in
refractive index
N=1.42
Red reflex
appears as a ring
around a nuclear
opacity

119. Nuclear cataract Vs Cortical cataract

120. Nuclear Brown Cataract

121. Hypermature cortical cataract
• A)Typical Hypermature.
• B)Morgagnian Type.

122. Morgagnian cataract

123. Focal blue dot Cataract
Extremely common and insignificant

124. Subluxated lens

125. Congenital or Developmental cataract

126. Morphological types
• Nuclear,,,, central,,,,+- Microcornea,Microphthalmia..

127. • Lamellar-Zonular
Opacity between clear Nucleus & Cortex

128. Sutural Cataract
• Follow Y sutures

129. Coronary cataract
• Opacity in deep cortex forming a crown like around the nucleus.

130. • Polar cataract:
-Anterior Polar:pyramidal projecting into AC,,,,
May accompany persistent pupillary membrane
Doesnot affect vision,,,,away from nodal point,,,

131. • Focal blue dot,,
Extremely common and insignificant

132. Subluxated lens

134. Intraocular Artificial lens

135. Complication of surgery
• PCO
• Posterior capsular opacification

136. IOL dislocated

137. Anterior Uveitis Keratic percepitate

138. Systemic diseases
• DM
-Presenile cataract ,,,senile in earlier stage
Good control of blood sugar,,ophthalm. Exam,surgery
-True diabetic cataract – relatively younger age-snow flake cataract.Ant
& Post flake like opacities.

139. • Hereditary. Retinitis pigmentosa,

140. Papilledema(optic disc edema)

141. 1- Intracranial causes:
A- Neoplasms 70 % are caused by brain tumors ,, Always
bilateral unless one nerve is atrophic,, (Foster kennedy
syndrome)
Frontal lobe
tumor
Optic disc edema on
one side and
primary optic
atrophy on the
other side

142. • Central retinal vein occlusion

143. Rt optic disc edema
Congested,tortous
retinal veins,,
Flame shaped He
Venous pulsation
disappear
Congested,tortous
retinal veins,,

144. Lt normal optic disc

145. • Post papilledemic optic atrophy

146. Glaucomatous optic atrophy

147. Glaucomatous optic atrophy

148. unilateral congenial severe ptosis

149. Rt leukocoria

150. Apparent squint

152. Cover uncover test

153. Synaptophore

154. Worth’s four dot test
five dots are seen, namely two red and three green in cases of
heterophoria.

155. Maddox rod and tangent scale test

156. The Maddox wing test

157. Cover test

158. Deviation of one eye Lt Exotropia( XT)

159. Rt 3rd N palsy

160. Lt 6th N palsy

161. Blow-out fractures of the orbit
• 1-(Periocular signs) include Black eye, edema and subcutaneous
emphysema.
• 2- Injury to the infraorbital nerve. This can cause hypoesthesia of the facial
skin of lower lid (Cheek anaesthesia).
• 3-Impingement of the inferior rectus can result in (Diplopia), The diplopia
typically occurs in both up-gaze and down-gaze (Vertical diplopia)
(Diplopia worse in upward gaze).
• 4- (Enophthalmos) is usually absent at the beginning because of associated
orbital edema or hemorrhage and, Enophthalmos may develop after 10
days as the edema subsides.
5- uncommon, Intraocular ocular damage (e.g. hyphema, angle recession,
retinal detachment) should be excluded

162. What is the diagnosis?
Mention 2 useful investigations?
Rt fracture orbital floor

163. What is the diagnosis?
The most common cause is ………

164. This CT scan shows fracture of the orbital floor and
opacification of the maxillary sinus.
Such a patient usually complain of …………

165. Eye lid hematoma
(black eye)

166. Eye lid laceration

167. Eye lid laceration

169. Ectropion

170. Lagophthalmos

171. coloboma

172. Vertical mattress suture for full thickness
eyelid injury repair

173. Why this injury needs urgent repair?
Lacrimal canalicular injury with nasolacrimal tube repair (Eagle Tube)

174. An injury like this should be done immediately
otherwise the patient will suffer from………..

175. Subconjunctival Hemorrhage
• Fragile vessels rupture from trauma,
Valsalva pressure spikes (sneezing,
coughing, retching),
hypertension,blood diseases, or
without obvious cause.

176. Subconjunctival Hemorrhage
• Cornea not involved.
• Resolves within 2 weeks.

177. But take care
You should exclude (Rupture globe) Scleral wound

178. And you should exclude fracture skull base
DD Local ocular trauma Fracture base of skull
onset immediate Delayed
Trauma To eye ,no proptosis To head + proptosis
consciousness Normal Loss of consciousness
site Temporal Fornices
shape Triangular,base to the cornea Tringular,,apex to cornea
color Bright red Dark red
Posterior limit definite Is not seen

181. Corneal Abrasion
• Corneal abrasions often worsened by
rubbing and scratching.
• Foreign body sensation common.

182. This photo took after an injury to the right Eye
Tell me the complications
Rupture globe with iris prolapse Corneal Limbal wound

183. Describe the finding in this picture

184. Angle recession glaucoma occurs after Blunt trauma

185. What is the diagnosis ?
Mention the most common underlying cause ?

186. What are the complications may follow this
trauma ?

187. Complication of hyphema
1-Secondary glaucoma (Open OR Close)
2-Blood stained cornea (5%) (need increase of IOP).
3-Decrease vision (due to cross pupil).
4-Recurrent hyphema (20%)(Secondary hyphema) within 3-5 days,
more common in Black people

188. How can you manage a case like this?

189. What are your findings?
Iridodyalysis D shaped pupil

191. Adie’s pupil,,ciliary ganglia lesion

192. Ultra sound
biomicroscopy

194. Voissous Ring

195. Characteristic stellate (star shape)
appearance of traumatic cataract

196. Lens subluxation (Sunset)

197. Rosette shape cataract

198. Commotio retinae is a complication of ……….

207. Retina Dyalisis from its Insertion

208. Choroidal rupture

209. Subretinal Hemorrhage-Suprachoroidal
hemorrhage

211. RT OPTIC DISC EDEMA AFTER TRAUAM

213. LT EYE COMPLETE OPTIC ATROPHY

214. This patient sustained trauma after ECCE,
describe the findings?

215. Perforating Injury
• Eye-threatening emergency requiring
emergency ophthalmologic surgical
intervention.
LT CORNEAL WOUND BY A KNIFE WITH
IRIS PROLAPSE

216. CORNEAL WOUND BY A KNIFE WITH
IRIS PROLAPSE
MY DEAR students please
notice the difference
between penetrating injury
and blunt one
Perforating injury

219. Corneal perforation repair

220. What are the complications?
Metallic FB
penetration

221. Corneal Foreign bodyy

222. What is your diagnosis ?
What is the treatment ?
Corneal FB over the limbus

223. Fb in sulcus subtarsalis –corneal abrasion by Fluoresceine

224. Rust ring after FB removal

225. 225
What is this test ?
What does it indicate ?
River sign
Penetratin FB
injury

226. What is your diagnosis ?
FB in the vitrous cavity

227. One of the
complications of
perforating eye injury
is endophthalmitis
with hypopyon

229. What is the diagnosis?
What is the treatment?
Lt FB intraocular by
Xray

230. Physical keratoconjunctivitis-phototoxicity-UV
photophthalmia
keratitis
+ve FL cobalt blue filter

231. True exfoliation :Infrared effect in ovens and
glassblowers
Pseudo exfoliation occur as a part of systemic
disease and lead to open angle glaucoma
Pseudoexf
oliation

232. Infrared (Glassblower Cataract)

233. Notice the effect of light energy over the photoreceptors in OCT

234. Vascularized cornel opacity

235. Vascularized cornel opacity

236. Cicatricial ectropion

237. Symblephron

238. What is the medical treatment of sever
chemical injury ?
Alkali burn more dangerous than acid burn.why?
Necrosis over
the limbus

239. Corneal
necrosis
after
chemica
burn

240. In chemical injury ,the first step is to irrigate the eye.
What next ?

241. Lid speculum

242. Autograft

243. Amniotic membrane graft

244. Lysis of symblepharon

245. Penetrating keratoplasty

246. Boston Keratoprothesis

247. Keratoconus

248. Myopic fundus with temporal crescent
•

249. Chorioretinal atrophy Fuch’s spot

253. CNV hemorrhage in myopic fundus

254. Giant retinal tear

255. Fuch’s spot in myopic fundus

256. Periperal retinal break surrounded by Argon
laser

257. Mucormycosis
Fungal infection
over lt orbit and lt
maxillary sinus

258. Cavernous hemangioma vs capillary
(Age)Commenest benign MCQ..

260. Commonest Adult tumor ,,(Orbital lymphoma,, ,,
Salmon patch---Lscrimal gland) Malignant

261. Rt Proptosis

262. Rt non axial proptosis

263. Bilateral lid retraction DD bilateral proptosis

264. Lt lid retraction Vs Lt proptosis

265. Lt Non-axial proptosis

266. RTl axial proptosis with exposure keratopathy

267. Preseptal cellulitis

268. Orbital cellulitis

270. Exophthalmometry(Hertel)

271. Preseptal vs Orbital cellulitis CT

272. Lt congenital Horner’s Syndrome with iris
heterochromia

273. Lt Horner’s syndrome (Ptosis –miosis -

275. Attenuation of arteries
Waxy disc pallor
Normal margin
Normal cup

277. Glaucomatous optic atrophy

278. Peripapillary atrophy in glaucoma.

280. Slit lamp + Gonio lens

281. 90 Diopter auxillary lens

282. Slit lamp + applanation tonometry

283. Applanation + FL

284. Digital method for IOP measurment

285. Tono pen

287. Confrontation test for the Lt eye

288. Visual field by projection

290. Rt diabetic retinopathy maculopathy

291. Rt diabetic retinopathy maculopathy

292. Lt diabetic maculopathy

293. Vitrous pre retinal hemorrhage

295. Lt Hypertensive retinopathy

296. What is your diagnosis ?
Mention the ttt briefly ?

297. Mention 3 abnormal findings ?
Mention the most common cause?

298. Band shaped keratopathy

299. Festooned pupil posterior synechia anterior uveitis

300. Iris naevus

302. Anterior uveitis if not treated probably may
lead to sever complications, what are they ?
- Rubeosis Iridis

303. Iridotomy

304. Iridectomy

305. Subluxated
lens

306. Subluxated Lens or Aphake
:Tremolous Iris

308. RT CRVO

309. Rt inferior temporal vein occlusion

310. Lt superior temporal vein occlusion

311. Retinal tear surrounded by Argon laser

312. Giant retinal break

313. Rt upper temporal artery occlusion

314. Lt retinal artery occlusion with macula sparing
(cilioretinal artery sparing

315. Lt cherry red spot DD ……

316. Thank You