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Optical- Anisometropia, unilateral aphakia, myopia, low astigmatism Therapeutic- corneal scar, iris abnormalities, post keratoplasty, microbial keratitis, amblyopia ( opaque lens) glaucoma etc. Cosmetic- corneal scar, phthsis bulbi Occupational- sportsman, pilots, actors
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Dark room tests in ophthalmology
Dark Room Procedures for undergraduates(MB,BS) in the field of Ophthalmology are explained in simple terms in this presentation. Series of lectures taken at Central Park Medical College Lahore Pakistan.
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This document describes various instruments used in ophthalmic examinations including retinoscopes, trial frames, Placido's disc, Maddox wing and rod, lenses, occluders, pin holes, and stenopic slits. It provides details on how each instrument is constructed and its purpose in examining patients, determining refractive error, and testing for conditions like keratoconus and heterophoria.
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The trial case contains spherical and cylindrical lenses of known power ranging from +0.12D to -20.00D for spherical lenses and +0.25D to -6.00D for cylindrical lenses. It also includes prisms up to 10 prism diopters, trial frames, occluders, pinholes, filters, and other accessories used to perform refraction tests and examinations.
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Dark room tests in ophthalmology
Dark Room Procedures for undergraduates(MB,BS) in the field of Ophthalmology are explained in simple terms in this presentation. Series of lectures taken at Central Park Medical College Lahore Pakistan.
Dark room
This document describes various instruments used in ophthalmic examinations including retinoscopes, trial frames, Placido's disc, Maddox wing and rod, lenses, occluders, pin holes, and stenopic slits. It provides details on how each instrument is constructed and its purpose in examining patients, determining refractive error, and testing for conditions like keratoconus and heterophoria.
Trial set
The trial case contains spherical and cylindrical lenses of known power ranging from +0.12D to -20.00D for spherical lenses and +0.25D to -6.00D for cylindrical lenses. It also includes prisms up to 10 prism diopters, trial frames, occluders, pinholes, filters, and other accessories used to perform refraction tests and examinations.
Indirect ophthalmoscopy
Indirect ophthalmoscopy has evolved since its introduction in the 1850s to become an indispensable tool for examining the retina. It allows examination of the peripheral retina through the use of a condensing lens held close to the eye. The observer views an enlarged, inverted image of the retina. Several advantages include the ability to compensate for a patient's refractive error, good illumination, and use with scleral indentation to examine the far periphery. Adjustments of the lens diopter and observation distance allow viewing different areas of the retina with varying magnification and field of view. Proper technique involves adjusting the headband-mounted binocular scope and positioning the condensing lens.
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The document describes the components and uses of a trial box, which is a set of lenses, frames, and accessories used to test vision. It contains trial frames that hold spherical, cylindrical, and prismatic lenses in various diopters for refraction testing. Accessories include occluders, filters, charts, and tools like Maddox rods and cross cylinders. The trial box is used for objective and subjective refraction, diagnosing conditions like squint, and assessing binocular vision.
Retinoscopy
Retinoscopy is a technique used to objectively determine a patient's refractive error without their input. It involves using a retinoscope to observe the light reflex in the pupil when it is illuminated. The observer notes whether the reflex moves with or against the motion of the retinoscope, indicating whether plus or minus lenses are needed to neutralize the reflex. Additional steps are taken to determine any cylindrical error by observing the reflex in different meridians and neutralizing them with spherical and cylindrical trial lenses. The objective refraction obtained via retinoscopy provides a starting point for subjective refraction to obtain the patient's best-corrected vision.
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This document provides an overview of direct ophthalmoscopy. It discusses the introduction, types of ophthalmoscopy including direct ophthalmoscopy, indications for use, optics, image characteristics, instrumentation including the illumination and viewing systems, examination procedure for a normal fundus, recording findings both normal and pathological, common errors, advantages and disadvantages of direct ophthalmoscopy, different models available and references. The document serves as a guide for optometry students on how to perform and interpret findings from a direct ophthalmoscopic exam.
Binocular Indirect OPHTHALMOSCOPY
This document provides a history of the development of the ophthalmoscope and techniques for indirect ophthalmoscopy. It discusses key developments such as Mery making the first ophthalmoscopic observations in 1704, Cumming and Brucke explaining the principles in 1846, and Helmholtz describing the basic principles in 1852. Later sections cover the design of monocular and binocular indirect ophthalmoscopes, use of scleral depressors, techniques for peripheral examination, and diagnostic uses of indentation. The document presents information on indirect ophthalmoscopy in a detailed but structured manner.
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Retinoscopy is an objective refraction technique used to estimate the refractive error of the eye. It involves using a retinoscope to observe the movement and characteristics of the pupil reflex when trial lenses are placed in front of the eye. The examiner finds the lens that causes the pupil reflex to become neutral, indicating the refractive error. Sources of error include incorrect working distance, mirror position, or patient fixation. Retinoscopy requires dim lighting and takes practice to become proficient in techniques like identifying astigmatism or difficult patient types.
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normal fundus , the retina how it works & how it is visualised is described here.
the procedure of direct ophthalmoscopy how the image is seen.
Abnormalities of retina how are they seen.
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1. The document describes the technique of direct ophthalmoscopy, providing details on its history, modern instrumentation, use, and what can be observed through examination of the retina.
2. Key aspects covered include how the examiner is able to view the retina by aligning their eye with the light source entering the patient's eye, and modern ophthalmoscopes using mirrors to reflect light at a 90 degree angle.
3. The summary also notes what can be seen through direct ophthalmoscopy like the optic disc, macula, blood vessels, and various pathological features.
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Indirect ophthalmoscopy provides binocular visualization of the retina using an illuminated, inverted image located between the examiner and patient. There are two main types:
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2. Direct ophthalmoscopy provides a monocular view with high magnification but limited field of view and issues with reflections. It is better for viewing small pupils or the retinal nerve fiber layer.
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The document summarizes different techniques used to examine the fundus of the eye, including:
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2. Slit lamp biomicroscopy provides a 30-40 degree inverted view at higher magnifications up to 16x using a +78D lens.
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1. Direct ophthalmoscopy allows for a magnified but erect virtual image of the fundus using a light source and lenses.
2. It provides the highest magnification of fundus examination techniques but has a limited field of view and is monocular.
3. The examiner holds the ophthalmoscope and looks through the lens while adjusting focus to examine the different structures of the eye from the anterior segment to the fundus.
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This document discusses objective refraction techniques, primarily retinoscopy. It begins by explaining the principles of retinoscopy, including far point concept and how different ametropias affect the far point. It then describes the components and optics of the retinoscope, how it works, and retinoscopy techniques. Key aspects covered include neutralization, prerequisites for retinoscopy, and problems that can occur. Autorefractometry is also briefly discussed. In under 3 sentences:
Retinoscopy is the primary objective refraction technique discussed, which uses a retinoscope to illuminate the retina and observe the movement of the red reflex to determine the refractive error, neutralizing with trial lenses. The document covers the optics
Slit lamp fundoscopy
Evaluation of the disc, macula and periphery of the retina using the slit lamp and fundus aspheric lens 90D, 78D, 60D or 120D.
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This document discusses aphakia and pseudophakia. It defines aphakia as the absence of the crystalline lens and lists various causes. It describes how aphakia changes the optical properties of the eye, eliminating accommodation. Treatment options for aphakia include spectacles, contact lenses, and intraocular lens implantation. Spectacles can cause issues like image magnification, roving ring scotomas, and restricted visual field. Contact lenses and intraocular lenses are better options as they avoid these problems but have disadvantages as well. Pseudophakia refers to the condition after intraocular lens implantation to correct aphakia. The document discusses calculating the power of intraocular lenses and the different refractive outcomes
Retinoscopy
Retinoscopy is an objective refraction technique used to estimate the refractive error of the eye. It involves using a retinoscope to observe the movement and characteristics of the pupil reflex when trial lenses are placed in front of the eye. The examiner finds the lens that causes the pupil reflex to become neutral, indicating the refractive error. Sources of error include incorrect working distance, mirror position, or patient fixation. Retinoscopy requires dim lighting and takes practice to become proficient in techniques like identifying astigmatism or difficult patient types.
Cycloplegic retinoscopy
Cycloplegic retinoscopy is a procedure used to determine a patient's complete refractive error by temporarily paralyzing the ciliary muscle with cycloplegic drugs. Commonly used cycloplegics include atropine, homatropine, cyclopentolate, and tropicamide. Cycloplegic retinoscopy is indicated for young children, uncooperative patients, those with excessive accommodation, pseudo myopia, strabismus, or asthenopic symptoms. The procedure involves dilating the pupil and using a retinoscope to objectively determine refractive error while the patient fixates on a target.
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When a person is diagnosed with visual impairment, the biggest fear that most people are forced to face is loss of independence. To face the challenges that come from visual impairment, patients must embrace the tools available. What is “Low Vision”? Any chronic uncorrectable visual impairment that limits daily functioning
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This document discusses different methods for examining the fundus of the eye, including direct ophthalmoscopy, indirect ophthalmoscopy, and indirect slit lamp biomicroscopy. It provides details on how each method works, including magnification, field of view, advantages, and disadvantages. Key structures that can be observed during fundus examination are also described, such as the optic disc, blood vessels, macula, and signs of common eye conditions like glaucoma, optic nerve diseases, retinal problems, and diabetes-related changes.
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normal fundus , the retina how it works & how it is visualised is described here.
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Abnormalities of retina how are they seen.
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1. The document describes the technique of direct ophthalmoscopy, providing details on its history, modern instrumentation, use, and what can be observed through examination of the retina.
2. Key aspects covered include how the examiner is able to view the retina by aligning their eye with the light source entering the patient's eye, and modern ophthalmoscopes using mirrors to reflect light at a 90 degree angle.
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Binocular Indirect Ophthalmoscopy
Binocular indirect ophthalmoscopy (BIO) allows examination of the retina using a condensing lens held close to the eye. It provides a stereoscopic, wide-field view of the retina. Mastering BIO takes practice due to its technical challenges. Key steps include properly dilating the eye, positioning the patient, choosing the right lens based on desired magnification and field of view, minimizing lens distortions, adjusting the indirect headset, and depressing the sclera for a dynamic view of the peripheral retina.
Bio optos-8-21-2011
Indirect ophthalmoscopy provides binocular visualization of the retina using an illuminated, inverted image located between the examiner and patient. There are two main types:
1. Binocular indirect ophthalmoscopy (BIO) allows for the best view of the retina through large fields of view and minimal refractive error effects. A condensing lens focuses light into the pupil and forms an aerial image magnified by the lens power.
2. Direct ophthalmoscopy provides a monocular view with high magnification but limited field of view and issues with reflections. It is better for viewing small pupils or the retinal nerve fiber layer.
Key factors that affect the view include the condensing lens power, examiner distance,
Myopia
This document provides information about myopia (nearsightedness), including its definition, causes, types, classifications, signs and symptoms, and treatment options. It discusses the different mechanisms that can cause myopia, including excessive axial length growth. It classifies myopia based on clinical features, degree, and age of onset. Treatment options covered include optical correction with glasses or contact lenses, as well as surgical procedures like LASIK, PRK, phakic IOL implantation, and corneal ring segments.
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This document provides instructions for performing a direct ophthalmoscopy exam, including: examining the red reflex and funduscopic view of the optic disc, vessels, macula and any pathology; using lenses and filters to better visualize structures; documenting findings; and ensuring patient comfort and consent throughout the process. Key steps involve darkening the room, inserting dilating eye drops if needed, positioning the patient, and systematically examining both eyes with an ophthalmoscope to evaluate internal eye structures and diagnose any abnormalities.
Refraction using a phoropter
This document describes the process of refraction using a phoropter. A phoropter is an ophthalmic testing device used to measure refractive error and determine eyeglass prescriptions. It contains different lenses. The summary describes the preliminary steps, which include positioning the patient and adjusting the device. It then outlines the 6 steps of subjective refraction: 1) test visual acuity, 2) establish spherical power, 3) refine cylindrical axis, 4) refine cylindrical power, 5) refine spherical power, and 6) perform binocular balancing.
Fundus examination
The document summarizes different techniques used to examine the fundus of the eye, including:
1. Direct ophthalmoscopy provides an upright 15x view of the posterior pole but no stereopsis. Indirect ophthalmoscopy uses lenses from 14-30D for an inverted 40-50 degree view with stereopsis.
2. Slit lamp biomicroscopy provides a 30-40 degree inverted view at higher magnifications up to 16x using a +78D lens.
3. A -55D lens provides a virtual upright view for examining the optic nerve and retina through dilated pupils. A contact lens combines high magnification and stereopsis for detailed macular exams.
4. Wide
Techniques of fundus
Techniques of fundus examination include direct ophthalmoscopy, indirect ophthalmoscopy, and slit-lamp biomicroscopic examination using various lenses. Direct ophthalmoscopy provides an upright 15x magnified view of the fundus but has a limited field of view. Indirect ophthalmoscopy uses a condensing lens to produce an inverted real image with a wider field of view, allowing examination of the peripheral retina. Slit-lamp biomicroscopy employs contact lenses or small diameter lenses like a +78D or +90D to provide magnified views of the posterior pole under illumination.
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This document discusses progressive addition lenses (PALs) and how to properly fit them. PALs provide uninterrupted vision at all distances without visible lines but require careful fitting. The fitting process involves identifying patient needs, selecting an appropriate frame, adjusting the frame measurements, determining pupil distance, marking the lens insert position, checking the fit, and delivering instructions. Common fitting issues include incorrect pupil distance, lens heights, or prescriptions. Proper troubleshooting requires identifying potential causes and remedies through refitting adjustments or remaking lenses. Attention to detail in fitting and addressing patient complaints is important for successful PAL adaptation.
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This document discusses ophthalmoscopy, which allows health professionals to examine the inside of the eye. It describes how an ophthalmoscope works using a light source and magnifying lenses to view the posterior structures of the eye. The document outlines the different types of ophthalmoscopes and lenses used, as well as the procedures for direct and indirect ophthalmoscopy examinations. It also notes some potential risks and limitations of direct ophthalmoscopy examinations.
Direct ophthalmoscopy final
1. Direct ophthalmoscopy allows for a magnified but erect virtual image of the fundus using a light source and lenses.
2. It provides the highest magnification of fundus examination techniques but has a limited field of view and is monocular.
3. The examiner holds the ophthalmoscope and looks through the lens while adjusting focus to examine the different structures of the eye from the anterior segment to the fundus.
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Clinical Management of Aphakia and Pseudophakia.pptx
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2) Management of pseudophakia involves correcting the refractive error after cataract surgery and lens implantation through intraocular lenses. Considerations for lens type and power calculations in adults and children are discussed.
3) Complications of the different management approaches are compared, noting advantages and disadvantages of contact lenses versus intraocular lens implantation. Refractive surgery techniques for correction of aphakia are also briefly mentioned.
Nehal lilawala
Conventional contact lenses and its common problems
How to manage contact lens in covid 19 situation
Basic care & maintenance
In which aspect conventional Cl are using
Hydrogel contact lens
Pediatric management in contact lens-P82502
This document discusses pediatric contact lens management and fitting considerations. Key points include:
- Anatomical considerations for pediatric eyes such as shorter axial length and steeper corneal curvature compared to adults.
- Indications for pediatric contact lens fitting include high refractive errors, aphakia, and irregular astigmatism.
- Silicone elastomer, hydrogel, and RGP lenses are commonly used in pediatric fittings, each with advantages and disadvantages.
- A thorough prefitting exam evaluates lid and corneal health before determining initial lens parameters based on age.
- Fitting is assessed using fluorescein pattern and lens movement, with progress evaluated regularly according to age.
INDIRECT OPHTHALOMOSCOPE
Indirect ophthalmoscopy requires practice to master. The summary provides steps to properly perform indirect ophthalmoscopy:
1. Dilate the patient's eyes well using tropicamide and phenylephrine. This allows for a good peripheral exam.
2. Position the patient laying flat or partially upright to allow viewing different areas of the retina. Tilting the head also helps with viewing.
3. Use a 20D lens for general exams and a 30D lens initially for the ora serrata. Hold lenses correctly and focus by moving them in and out.
Removal Of Dislocated Contact Lens
A dislocated contact lens can cause pain, blurry vision, and eye irritation. To remove it, the eye care professional will first apply numbing drops if needed. They will then examine the eye closely, possibly using fluorescent dye, to locate the lens under the eyelid or elsewhere in the conjunctiva. Once found, the lens can usually be slid onto the cornea and removed, though sometimes irrigation or special tools are required. After removal, the eye is checked for abrasions and the patient instructed on proper lens wear and follow up care.
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Clinical Management of Aphakia and Pseudophakia.pptx
Clinical Management of Aphakia and Pseudophakia.pptx
More from BABLI SHARMA
ACCOMMODATIVE ESOTROPIA.pptx............
Accommodative Esotropia
Definition
Esotropia (ET) linked to accommodation
History
Onset 6 months - 7 years (average 2.5 years)
May be intermittent at onset, (sometimes precipitated by trauma or illness) becoming constant
Diplopia may occur but usually disappears as the patient develops suppression scotoma
Approximately 75% have a family history
Amblyopia common (50%)
No associated IOOA or DVDs
Classification
Accommodative
High AC / A
Mixed (most common)
Definition
Hypermetropia means that a high amount of accommodation (with a proportionate amount of convergence) is required to focus even on a distant target
Accommodation is associated with a dis-proportionately high amount of convergence
Hypermetropia
High AC / A
1.Fully accommodative
Esotropia (ET) fully corrected by full cycloplegic refraction
2. Partially / (Non)
accommodative
ET only partially corrected by full cycloplegic refraction (i.e. still ET for D&N)
Distance prescription corrects distance deviation but a deviation remains at near
CTD / N
ET Distance= ET Near (within 8Δ)
Straight Distance (after correction), ET Near.
ET for near may be reduced or eliminated by a +3.0 add
ET Distance < ET Near (by >8Δ)
i.e. When straight for distance with full cycloplegic correction will still have ET for near.
ET for near may be reduced or eliminated by a +3.0 add
Refraction
Hypermetropia (e.g. +3 to +10D)
Emmetropia (ranges from myopic to high hyperope)
Hypermetropia
AC / A ratio
Normal (e.g. 3-5)
High
High
Examination Structure
1. Visual Acuity (Best Corrected)
Amblyopia is common (50%, especially partially accommodative)
2. Spectacles
3. Inspection
Abnormal Head Position (AHP)?
Hirschberg (pupil margin=30Δ, limbus=90Δ) - Esotropia
(Lids normal)
(Pupils normal)
4. Cover-Testing
Comitant ET (Measure distance & near as an estimation of AC / A. An ET that is greater for near than distance suggests a high AC / A, but this can only be proven by formal testing- see below)
A) Without glasses: CTD, CTN
B) With glasses: CTD, CTN
(NB: Attempts may also be made to measure the AC / A ratio by the lens gradient method by cover-testing at near with and without +3D lenses)
5. Ocular Rotations
Full ductions (Exclude CNVI palsy) ± IOOA
DVD is uncommon
6. Stereopsis
7. Dilated Fundoscopy
8. Cycloplegic Refraction
Often Hypermetropic. Use:
Cyclopentolate 1%, (Phenylephrine 2.5%) or
Atropine 1% bd for 3 days prior if dark irides, amblyopic, unsure, unco-operative
Summary
Fully / Partially / Non-Accommodative ET with presumed Normal / High AC / A
Investigations
Most accommodative esotropias do not require further investigations. However, neuroimaging (MRI brain) should be considered when the presentation is atypical:
Acute onset
Older (>7yrs)
Incomitant i.e. abduction deficit
Diplopia, other neurological signs (e.g. CN VI, papilloedema, nystagmus)
No hypermetropia
STRABISMUS EXAMINATION.pptx.............
Eye Movements Examination
Examination Structure
Sit on the right of the patient, your eyes and the patient’s eyes should be at the same level
Speak whilst examining
Ask children their age
Look around the room for clues – spectacles, parents (for inherited syndromes)
1. Visual Acuity (Best Corrected)
The worse eye is usually the affected one (may be amblyopic)
2. Spectacles
It is easiest to estimate the script of spectacles by comparing the image of a line viewed through the lens and just around it. A distance line such as a doorway is perfect for this purpose.
Hand Neutralise
Minus lens → “With” movement
Plus lens → “Against” movement
Astigmatism
Ground in Prism
The image of the line through the lens has a fixed deviation away from the image of the line just around it. This cannot be compensated by moving the lens. The apex of the prism points towards the deviation.
Fresnel Prism
Method for easy check: turn spectacles side-on
BO (CNVI palsy), BD (CNIV palsy on affected eye)
3. Inspection
Have the patient fixate on a distant target- choose one line above their visual acuity
Only comment on a strabismus if it is obvious (say “there appears to be an exo or eso deviation” in case the patient has a dragged macula and there is no tropia)
1. Abnormal Head Posture (AHP)
Ask patient to “Please sit up straight” and stand back to inspect
Face turn? In direction of action of paretic muscle
Chin up / down? Up in elevator paresis, Down in depressor paresis
Correct any AHP before cover tests (check for neck pathology)
2. ± Corneal Light Reflexes (Hirschberg)
Shine a pen torch into the patient’s eyes and inspect the corneal reflexes. In patients with straight eyes, they should be symmetrical and lie over the same point on the cornea. In patients with strabismus, the corneal reflex of the fixing eye will lie centrally within the pupil, and the other will be displaced (1mm of corneal decentration = 15 Δ strabismus, Pupil margin = 30 Δ, Limbus = 90 Δ). Be aware that tropias can only be definitively diagnosed with cover testing. The Hirschberg test becomes more important when vision is poor (e.g. < 6 / 60 in either eye) and cover-testing is not possible.
3. Ptosis (CNIII palsy)
4. Pupils (Anisocoria) (CNIII palsy)
5. Globe Position
Proptosis (axial vs. non-axial)
6. Other
Nystagmus, facial asymmetry, hearing aids, scars (conjunctiva- squint surgery)
7. Ask Yourself
“Could this be TED?”- proptosis, chemosis, injection, lid retraction
4. Cover-Testing
Ensure the patient can fixate “Tell me if I block your view”
If VA <6 / 60 can’t do cover! → Perform Hirschberg (corneal light reflexes) and / or Krimsky (corneal light reflexes through prism placed over the fixing eye) tests.
The patient should wear their distance (& near) spectacles (unless they have prisms!)
This helps the patient if they can’t fixate on a target uncorrected
It is crucial in accommodative esotropia to test with and without spectacles
Cover for tropia (manifest)
Uncover for phoria (latent)
ANTERIOR SEGMENT EXAMINATION.PPTX.......
1. Visual Acuity, IOP, Inspection, ± Refraction
Always stand back and examine the patient as a whole. Age / gender / ethnicity are often useful in narrowing the potential differential diagnoses. Iris heterochromia, symblephara, ankyloblepharon and forniceal shortening are often more obvious on gross inspection before beginning the slit lamp examination.
2. Lid, Lashes, Lacrimal Structures
Blepharitis,
Ectropion / entropion / punctum
Madarosis / hypertrichiasis
Scarring from HZO / pigment changes
3. Conjunctiva/Sclera
Ask the patient to ‘Look up’ (while pulling the lower lid down): Symblepharon / ankyloblepharon / forniceal shortening
Ask the patient to ‘Look down’ (while pulling the upper lid up): Trabeculectomy bleb / glaucoma drainage device
Scleral buckle
Offer to evert the upper lid
4. Cornea
Always mark the visual axis.
Always draw a cross-section with corneal epithelium / stroma / endothelium, iris and lens (Figure 1.1.1). It is important to document the level, size, shape and location of any corneal lesion.
Note:
Shape: e.g. Keratoconus
Size: Measure the corneal diameter with a handheld ruler if suspicious of congenital glaucoma. Greater than 12mm in an adult is abnormal, Microcornea is defined as corneal diameter <10mm
Thinning: Estimate and document the remaining thickness as a % of normal
Scars, wounds
Corneal graft
i. Type (penetrating vs. anterior lamellar vs. endothelial)? Size? Clarity?
ii. Sutures? (interrupted, continuous, broken / loose?)
iii. Pay special attention to the graft-host junction
iv. Neovascularisation?
v. Look at the other eye for clues as to why the patient had a graft
± Tear film / marginal tear strip
In addition, look at each corneal layer:
Epithelium: Epithelial defects, punctate epithelial erosions, superficial punctate keratitis, dystrophies, microcystic oedema, Fleischer ring, limbal stem cell failure (conjunctivalisation of the cornea)
Stroma: Dystrophies, stromal oedema, vessels (superficial or deep?), prominent corneal nerves
Endothelium: Guttata, pigment dispersion, keratic precipitates (KP), Descemet’s membrane folds
The presence of one sign (e.g. a conical cornea) should prompt you to look for other associated signs of that condition (e.g. Down syndrome, vernal kerato-conjunctivitis, Fleischer ring- best seen with cobalt blue light, prominent corneal nerves, hydrops / corneal scarring and Vogt striae of keratoconus).
If an ocular surface mass is present (e.g. Ocular surface squamous neoplasia), you must exclude orbital invasion. Check for:
Lymphadenopathy
Corneal sensation
Ophthalmoplegia
Intraocular examination including gonioscopy for angle involvement
5. Anterior Chamber
Cells / flare
Hypopyon, hyphaema
Anterior chamber depth (narrow angle?). Von Herrick’s test can estimate angle depth
If an intraocular mass is present (e.g. iris melanoma), then check for:
Hyphaema
Nodular vs diffuse configuration
Ectropion uveae – seen in iris melanoma
Refractory glaucoma - raised IOP
Gonioscopy
PSEUDOSTRABISMUS.pptx
Pseudostrabismus is the clinical impression of ocular deviation
when no squint is present.
• Epicanthic folds may simulate an esotropia
• Abnormal interpupillary distance, if short may simulate an esotropia and if wide an exotropia
• Angle kappa is the angle between the visual and anatomical
(pupillary) axes.
○ Normally, the fovea is situated temporal to the
anatomical centre of the posterior pole. The eyes are
therefore slightly abducted to achieve bifoveal fixation
and a light shone onto the cornea will therefore cause a
reflex just nasal to the centre of the cornea in both eyes. This is termed a positive angle kappa.
○ A large positive angle kappa (e.g. temporally displaced
macula) may give a pseudoexotropia
○ A negative angle kappa occurs when the fovea is situated
nasal to the posterior pole (e.g. high myopia). In this
situation, the corneal reflex is situated temporally to the
centre of the cornea and it may simulate an esotropia.
Soft Contact Lens Material.pptx
Soft contact lenses are made of hydroxyethyl methacrylate (HEMA), which was developed by Wichterle and Lim. HEMA contains a polar OH group that allows water to bind. Contact lenses can have water contents ranging from 38-80%, with lower water content lenses being more stable and easier to handle, and higher water content lenses having greater oxygen permeability but being less stable. Lenses can also be ionic or non-ionic, with ionic lenses being more deposit-prone but better wettable, and non-ionic lenses being less deposit-prone but less wettable. The FDA classifies soft contact lenses into four groups based on water content and ionicity. A lens's Dk, or
Contact Lens Material.pptx
Ideal Properties
Provides sufficient oxygen
Optically transparent
Stable dimensions
Good wettability
Resists spoliation
Easily machinable
Easy to manufacture
Physical Properties
Wettability : ability of the tears to form complete film over then lens surface
Flexibility : highly flexible material will contour to the cornea
Optical quality : optically homogenous and transparent
Bicompatibility : should not induce any inflammatory or immunological responses.
Manufacturing ease : easy and cost effective
Stable parameters : dimensionally stable and easily polished.
Accommodative Facility Testing.pptx
Accommodative Facility Testing
If the patient wears glasses for close work, these should be used.
Hold Accommodative Rock Card 40 cm from the patient’s face at eye level and place the +2.00 lens in front of the patient’s eyes.
The test is initially performed binocularly.
PRROCEDURE
Ask the patient to try to get the letters clear and single as quickly as possible.
Instruct the subject to report (say “clear”) as soon as the letters are clear.
When the letters are reported to be clear, quickly flip the flipper so the minus side is before the same eye, again instructing the subject to read the letters and report when the letters appear clear or if they disappear.
Continue alternating sides of the flipper lenses for 1 minute, calculating the cycles per minute achieved (1 cycle = plus and minus).
Repeat the procedure monocularly if the patient is unable to pass binocularly. The only difference in monocular testing is that the patient only has to report when the target is clear (diplopia is no longer an issue).
Record the cycles per minute. Record if one side (plus or minus) of the flippers was more difficult, or if neither side was more difficult.
EXAMPLES
The patient can complete 18 flips in 1 minute. This equals 9 cpm.
If the patient cannot clear −2.00 at all, record as 0 cpm, fails minus.
If the patient cannot clear +2.00 at all, record as 0 cpm, fails plus.
If the patient reports diplopia, record as 0 cpm, diplopia with +2.00 or diplopia with −2.00.
IMP. POINTS
Stress the importance of trying to keep the target both clear and single
Negative Relative Accommodation and Positive Relative.pptx
EQUIPMENT NEEDED
Phoropter
Near point card with vertical line of 20/30 letters
SETUP
1. Seat the patient comfortably behind the phoropter with the patient’s distance correction in place.
2. Place the near point card at a 40-cm distance from the patient, with good illumination.
PROCEDURE
1. Instruct the patient to look at the target and keep it clear and single.
2. Instructions: “I will be changing the lenses in front of your eyes. Try to keep the line of letters clear and
single for as long as you can. Tell me as soon as the letters become blurry
3. Add plus lenses in +0.25 D increments until the patient reports the first sustained blur or diplopia.
4. Record the amount of plus added above the distance prescription as the NRA.
5. Remove the plus lenses and return to the distance prescription.
6. Add minus lenses in −0.25 D increments until the patient reports the first sustained blur or diplopia.
7. Record the amount of minus added above the distance prescription as the PRA.
8. Stop the PRA test when you reach −2.50 D above the distance prescription.
IMPORTANT POINTS
1. Stress the importance of reporting both blur and diplopia.
2. Discontinue the PRA at −2.50 D.
Vergence Facility Testing.pptx
Vergence Facility Testing
EQUIPMENT NEEDED
Gulden vergence facility prism (12 base-out/3 base-in combination)
Gulden fixation stick (20/30 target)
SETUP
1. If the patient wears glasses for close work, these should be used.
2. Hold Gulden fixation stick tongue depressor 40 cm from patient’s face at eye level.
PROCEDURE
1. Say the following: “I want you to look at the letter on this stick. When I place this measuring device in
front of your eye, you will see double. Try to get the target to be clear and one as soon as possible. Say
‘now’ as soon as it is clear and one.”
2. Begin with either base-out or base-in and count how many cpm the patient can complete in 60 seconds
(one cycle equals successful completion of both base-out and base-in).
3. Record the number of cpm.
4. If the patient cannot do either base-in or base-out, record as 0 cpm, fails base-out or base-in.
5. If the patient cannot do both, record as 0 cpm, cannot do base-in or base-out.
EXAMPLES
1. The patient can complete 18 flips in 1 minute. This equals 9 cpm.
2. If the patient cannot regain single and clear vision at all, record as 0 cpm, fails both base-in and base-out.
3. If the patient cannot regain single and clear vision with base-in, record as 0 cpm, fails base-in.
4. If the patient cannot regain single and clear vision with base-out, record as 0 cpm, fails base-out.
IMPORTANT POINTS
1. Control accommodation by stressing the importance of keeping the target clear.
2. Stress the importance of trying to regain clear and single vision as quickly as possible
NPC.pptx
EQUIPMENT NEEDED
Penlight
Gulden fixation stick
Red/green glasses
SETUP
1. If the patient wears glasses for close work, these should be used.
2. Hold Gulden fixation stick tongue depressor 40 cm from patient’s face at eye level.
3. Ask the patient to look at the isolated 20/50 target on the Gulden fixation stick.
PROCEDURE
1. Slowly move the fixation stick toward the patient at eye level and between the two eyes.
2. Ask the patient to keep the target one for as long as possible.
3. Ask the patient to tell you when he or she sees two targets.
4. Once diplopia occurs, move the fixation stick in another inch or two and then begin to move it away from the patient
5. Ask the patient to try and see “one” again.
6. Also watch the eyes carefully and observe whether the eyes stop working together as a team (one eye will usually drift out).
7. Record the distance at which the patient reports double vision and when the patient reports recovery of single vision.
8. Repeat the test using a penlight and red/green glasses if you suspect that dissociation may reveal a more receded NPC.
IMPORTANT POINTS
1. Repeat the test several times if results are not definitive.
2. Watch the patient’s eyes and try to objectively determine when the break and recovery occur
ASOP-06-0634.pdf
Background: Strabismic amblyopia is characterized by an imbalance of the sensorial and motor system. Differences between both
eyes due to squinting during 1st months of life can originate an entire fovea fixation and ARC, which is a binocular condition generated
by the absence of a correct bi-foveal fixation [2]. Accommodative esotropia usually presents between 2 and 4 years of age with an
increase in accommodative needs and is directly linked to the amount of hypermetropia [9]. Although patching remains the gold
standard therapy of amblyopia, several new treatment options have emerged over the years. These include refractive adaptation,
atropine penalization, and several binocular activities with varying success rates [10].
Case Report: 6-year-old male presented with complaints of inward deviation, and blurring of vision for distance and near. A proper
squint evaluation was performed to determine the presence of the type of squint. Accommodative esotropia with amblyopia in one
eye was reported. Synoptophorehaidinger brushes were recommended for foveal stimulation for the amblyopic eye followed by
patching. The patient reported good compliance and significant vision improvement in the amblyopic eye and no longer blur and
deviation with glasses were observed.
Conclusion: Accommodative esotropia with amblyopia showed substantial improvement with the help of Haidinger brushes in the
amblyopic eye. A combination of patching and Haidinger brushes is an efficacious approach for achieving an improvement in visual
acuity and binocular function in strabismic amblyopia.
Keywords: Accommodative Esotropia; Strabismic Amblyopia; Haidinger Brushes; Synoptophore
diplopia-201224103449.pptx
This document provides guidance on evaluating patients presenting with diplopia. It outlines key questions to ask the patient regarding the orientation and characteristics of the double vision. Examining the eye movements, lids, and pupils can help localize the cause. Systemic neurological symptoms or asymmetric pupils indicate potentially serious conditions like aneurysm that require immediate imaging. Isolated cranial nerve palsies are often due to ischemia. Multiple cranial nerve involvement raises concern for life-threatening conditions like tumor or stroke within the cavernous sinus. Refractive errors and decompensating phoria are common causes of intermittent diplopia.
SYNAPTOPHORE.pptx
SYNAPTOPHORE
Also known as major amblyoscope
It is haploscopic device based on mechanical dissociation of the two eyes , by the means of two optical tubes
Strength of the lenses with eyepiece +6.50D
OPTICS OF SYNAPTOPHORE
Consist of :
Light source
Slide of focal length of lens
Plane mirror
+6.50D eyepiece
SLIDES
Range of slides
Size of picture on the slides subtends , visual angles of different degrees at nodal point .
Simultaneous macular perception (SMPp slides
Fusion slides
Stereopsis slides
After image slides
Haidinger brushes
NSBD.pptx
This document summarizes non-strabismic binocular dysfunction (NSBD), which refers to visual abnormalities that remain undetected in individuals with normal eye health and no strabismus. It describes the components of binocular single vision and covers evaluation procedures like cover testing, phoria measurement, near point of convergence, and tests of fusion, vergence, and stereopsis. Common forms of NSBD like convergence insufficiency, divergence excess, and various types of phoria are explained. Treatment options focus on refractive correction, addition of prisms, and vision therapy.
CASE PRESENTATION ON OPTIC NEURITIS
Swelling of the eye’s optic nerve
Optic nerve carries light signals from the back of the eye to the brain , so that person can see.
If optic nerve is swollen , damaged or infected , we can’t see clearly .
This condition may caused by the body’s immune system attacking optic nerve tissue
Seems more likely to happen in people who have viral problems like mumps , measles , and the multiple sclerosis etc.
Symptoms :
It can be unilateral and bilateral
Symptoms : include : -
Blurring of vision
Colors appears dull and faded
Pain in the back of the eye socket
Pain when moving eyes
Stereograms vergence therapy
Stereogram exercise helps to improve the symptoms of convergence insufficiency , divergence excess etc
Ideally only one central complete image should be seen . three images with two partial and central complete image is also acceptable .
The image appear slightly out of focus as the concentration is on the pen tip
This exercise should be done with patients glasses on .
Binocular vision
This document discusses binocular vision and its evaluation and treatment. It defines binocular vision as the coordination of the two eyes to align their foveas on an object, allowing for fusion. It describes various binocular vision disorders like esotropia, exotropia, convergence and divergence insufficiencies, and accommodative disorders. It outlines tests to evaluate the magnitude and type of deviation, accommodative amplitude and response, and binocular vision status. Finally, it discusses treatment options for binocular vision disorders like optical correction, plus adds, prism, vision therapy, and surgery.
Clinical case presentation
ANTERIOR UVEITIS
Inflammation of iris and ciliary body.
Also called iritis ,iridocyclitis,cyclitis.
Iritis:- inflammation predominantly affects iris
Iridoclyclitis:- involved iris and pars plicata part of C.B. equally involved.
Cyclitis :-in which pars plicata part of C.B. is predominantly affected.
It can be : Acute and Chronic
Acute: sudden symptomatic onset and last for about six weeks to 3 months.
Chronic : asymptomatic onset and it persist longer than 3 months to even years and it usually diagnosed when it causes defective vision.
Binocular interaction in amblyopia and its clinical feasibility
BINOCULAR INTERACTION ITS ASSOCIATION WITH AMBLYOPIA
Apart from binocular summation, the two eyes can influence each other in at least three ways.
Pupillary diameter. Light falling in one eye affects the diameter of the pupils in both eyes. One can easily see this by looking at a friend's eye while he or she closes the other: when the other eye is open, the pupil of the first eye is small; when the other eye is closed, the pupil of the first eye is large.
Accommodation and vergence. Accommodation is the state of focus of the eye. If one eye is open and the other closed, and one focuses on something close, the accommodation of the closed eye will become the same as that of the open eye. Moreover, the closed eye will tend to converge to point at the object. Accommodation and convergence are linked by a reflex, so that one evokes the other.
Interocular transfer. The state of adaptation of one eye can have a small effect on the state of light adaptation of the other. Aftereffects induced through one eye can be measured through the other.
Singleness of vision
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Negative Relative Accommodation and Positive Relative.pptx
Negative Relative Accommodation and Positive Relative.pptx
Binocular interaction in amblyopia and its clinical feasibility
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Soft contact lens (1) (1)
- 1. SOFT CONTACT LENS BABLI SHARMA B.OPTOM ,M.OPTOM
- 2. INDICATIONS • Optical- Anisometropia, unilateral aphakia, myopia, low astigmatism • Therapeutic- corneal scar, iris abnormalities, post keratoplasty, microbial keratitis, amblyopia ( opaque lens) glaucoma etc. • Cosmetic- corneal scar, phthsis bulbi • Occupational- sportsman, pilots, actors
- 3. CONTRAINDICATIONS • Mental incompetence/ poor motivation • Dry eye syndrome • Corneal dystropies and degenerations • Recurrent diseases- episcleritis, iridocyclitis, stye etc • Irregular astigmatism
- 4. ADVANTAGES • Initial comfort • Rapid adaptation • Easy to fit • Suitable for frequent changes b/w contact lens and glasses. • Low risk of toxic or allergic reactions • Suitable for extended wear • Less expensive
- 5. DISADVANTAGES • Lenses are fragile • Decreased oxygen transmission • High risk of infection • more surface depositions • Easily dry out
- 6. COMPLICATIONS • Giant papillary conjunctivitis • Contact lens acute red eye • Keratitis • Neovascularization • Corneal deposits • Corneal abrasions • Corneal edema
- 7. CLASSIFICATION On the basis of wearing modality- • Daily wear- Worn for day and removed before sleeping • Extended wear- designed for 7 days and 6 consecutive nights. • Continuous wear- used for day and night upto 1 week to 1 month • Flexible wear- extended wear as 2-3 nights then daily wear
- 8. Initial examination • Slit lamp evaluation • Tear film evaluation- TBUT ( tear breakup time) • Accurate refraction ( cylinder<0.75D or spherical: cylindrical power= 4:1 ratio) • Corneal curvature- keratometer or corneal topography • HVID ( horizontal visible iris diameter) • Selection of lens type, water contact , material, thickness, modality, etc. • Selection of trial lens
- 9. LENS PARAMETERS • Lens diameter-=HVID+2mm Range available- 12-15.5 mm • Base curve= mean K+1 Range available- 7.6-9.6 mm • Power/ back vertex power- If spectacle power<4.0 D: CL power same spectacle Rx If spectacle power <4.0 D sph with ≤ 0.75 D cyl : contact lens power = spherical equivalent. If spectacle power>4.0 D: back vertex compensation If spectacle power >4.0 D sph with cyl: sph equivalent then back vertex compensation.
- 10. Back vertex compensation Fc = Fs/1-dFs where Fc= contact lens power, Fs= spectacle power, d= back vertex distance Spherical equivalent= sph+1/2cyl • Lens thickness- Thick- 1mm-1.5 mm Thin-0.5mm to 1mm Ultra thin-<0.6mm
- 11. Rule of thumb
- 12. CL INSERTION The One-Hand Placement Technique • Place the lens on your index finger. Be sure the lens is right- side-out (the edges should turn up, not out). • With your head up, looking straight ahead, pull down your lower eyelid with the middle finger of your placement hand • Look up steadily at a point above you. Then place the lens on the lower white part of your eye. • Remove your index finger and slowly release the lower lid. • Look down to position the lens properly. • Close your eyes for a moment: the lens will center itself on your eye.
- 13. The Two-Hand Placement Technique • With the lens on your index finger, use the middle finger of the other hand to pull the upper lid against the brow. • Use the middle finger of your placement hand to pull down the lower lid and then place the lens centrally on your eye. • While holding this position, look downward to position the lens properly. • Slowly release your eyelids.
- 15. FITTING EVALUATION • On the basis of initial comfort- fairly comfortable- probably good fit Uncomfortable- loose fit Very comfortable- steep fit • Corneal coverage- limbus to limbus Ideal: 1-2 mm Lens too large: >2mm lens too small: corneal exposure
- 16. • Lens centration- Ideal- centred in all position of gaze 0.2- 0.75 mm decentration is acceptable in primary gaze • Lens movement- Ideal: 0.2-0.4mm (thin lenses) and 1-2mm (thick lenses) Steep fit - less movement loose fit- much movement • Edge alignment- Edges should be smoothly aligned with conjunctiva -
- 17. • PUSH UP TEST o Patient is asked to looks straight and the examiner pushes the lens up vertically, through pressure on the lower lid and then the smoothness by which lens recenters is noticed. o Ideal fit- Smoothly recentration o Steep fit- resistance to displacement and may not recenter o Loose fit- easy displacement and eractic recovery .
- 18. • Blinking- Ideal fit- Vision remain same before and blinking. Steep fit- vision clear with blink Loose fit- vision blurs with blink
- 19. Ideal fit
- 20. Steep fit- conjunctival indentation
- 21. Decentration
- 22. CL REMOVAL • Wash, rinse, and dry your hands thoroughly. • Always be sure that the lens is in the correct position on your eye before you try to remove it (a simple check of your vision, closing one eye at a time, will tell you if the lens is in the correct position). Look up and slowly pull down your lower lid with the middle finger of your removal hand and place your index finger on the lower edge of the lens. Squeeze the lens lightly between the thumb and index finger and remove it. Avoid sticking the edges of the lens together. • Remove the other lens by following the same procedure.
- 23. THANK YOU