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Ophthalmic Assistant
PK Mukherjee
CHAPTER 1:
Anatomy of the Eye
ANATOMY OF THE EYE
Orbits
Extraocular Muscles
Optic Nerve
Intraorbital Part
Oculomotor Nerve
Trochlear Nerve
Abducent Nerve
Globe
Sclera
Cornea
1. Epithelium
Tear Film
Production of Tear
Drainage of Tear
2. Bowman's Membrane
3. Stroma
4. Descemet's Membrane
5. Endothelium
Limbus
Conjunctiva
Caruncle
Plica Semilunaris
Ocular Adnexa
Lids
Fibromuscular Layer of the Lid
Tarsal Plate
Muscles of the Lid
Lacrimal System
Puncta
Canaliculi
Lacrimal Sac
Intraocular Contents
Arrangement of Intraocular Contents
Visual Path
Near Reflex
Accommodation Reflex
Convergence Reflex (Fig. 1.22C)
Ciliary Body
Ciliary Processes
Aqueous Humor
Chambers of the Eye
Formation of Aqueous Humor
Choroid
Blood Supply of the Uvea
Anterior Ciliary Arteries
Retina
Nerve Supply of the Eye
Lens
Lens Epithelium
Fibers
Action of the Lens
Nutrition of the Lens
Vitreous
Development of the Eyes (Embryology)
CHAPTER 2:
The Physiology of the Eyes and Optics
THE PHYSIOLOGY OF THE EYE
OPTICS OF THE EYE
Dioptric System of the Eye
VISUAL SENSATION
Form Sense
Color Sense
Color Blindness
PHOTOCHEMICAL AND ELECTRICAL CHANGES THAT INITIATE VISION
Photochemical Changes
Neurology of Vision
Visual Fields
Types of Scotoma
Methods of Charting Field of Vision
Importance of Field Charting
Pupillary Pathway
Accommodation (See Fig. 1.22B)
Convergence (See Fig. 1.22C)
Interaction Between Convergence and Accommodation
Binocular Vision
Simultaneous Macular Perception
Binocular Fusion
Stereopsis
Advantage of Binocular Single Vision
Aqueous Humor (See Fig. 1.23)
Intraocular Pressure
Metabolism of Ocular Structures
Avascular Structure
Cornea
Corneal Transparency
Lens
PHYSIOLOGICAL OPTICS
Law of Reflection
Plane Mirror
Uses of Plane Mirror in Ophthalmology
Spherical Mirror
Uses of Concave Mirror in Ophthalmology
Convex Mirror
Uses of Convex Mirror in Ophthalmology
Refraction
Refraction at Single Surface
Refraction at Two Parallel Surfaces
How to Identify a Prism
LENSES
Construction of Lenses
Construction of Image Formed by a Lens
Points to Remember Information of Image by Convex Lens
Power of Combination of Two or more Lenses
Cylindrical Lenses
Identification of Lenses
Spherical
CLINICAL OPTICS
Refraction of a Normal Eye
ABNORMAL REFRACTION
Types of Ametropia
Myopia
Causes of Myopia
Clinical Signs of Myopia
Signs of Myopia
Treatment
HYPERMETROPIA (HYPEROPIA)
Cause (Etiology) of Hypermetropia
Axial Hypermetropia
Curvature Hypermetropic
Index Hypermetropia
Displaced Lens
Accommodation in Hypermetropia
Example
Symptoms of Hypermetropia
Treatment
Pathological Hypermetropia
APHAKIA
Signs of Aphakia
Management of Aphakia
ASTIGMATISM
Corneal Astigmatism
Lenticular Astigmatism
Retinal Astigmatism
Clinical Types of Astigmatism
Irregular Astigmatism
Symptoms of Astigmatism
Visual
Signs
Astigmatic Fan
Management
Surgery
Presbyopia
Management of Presbyopia
Example
Presbyopic Correction can be Given as (Fig. 2.45)
CHAPTER 3:
Symptomatology
DIMINISHED DISTANT VISION
DIMINISHED NEAR VISION
DIMINISHED VISION IN BRIGHT LIGHT
DIMINISHED NIGHT VISION
DIMINISHED COLOR VISION
COLORED HALOES ROUND LIGHTS
DIPLOPIA (DOUBLE VISION)
DIMINISHED FIELD OF VISION (SEE CHAPTER PHYSIOLOGY)
Points to Note
FREQUENT CHANGE IN POWER OF GLASSES
ASTHENOPIA
Less Common Visual Symptoms
REDNESS OF THE EYE
Watering from the Eyes
Causes of Lacrimation
Causes of Epiphora
Discharge from the Eyes
Pain in the Eyes
Causes of Pain in the Eyes
Causes of Pain in the Lid
Causes of Pain Over the Sac
Drooping of the Upper Eye Lid
Inability to Close the Lids
Deviation of the Eyeball
Paralytic Squint
Symptoms of Nonparalytic Squint
Swinging of the Eyeball (Nystagmus)
Whitening of the Black Portion of the Eye
Bulging of the Eye
Sinking of the Eyeball in the Orbit (Enophthalmos)
Nonocular Symptoms
CHAPTER 4:
Examination of the Eye
IMPORTANCE OF HISTORY TAKING IN OCULAR EXAMINATION
History of Past Illness
History of Past Surgery
History of Systemic Diseases
Family History
Recording of Vision (Visual Acuity)
Vision Consists of
Recording of Distant Vision
Testing of Distant Vision
Causes of Loss of Perception of Light
Causes of Faulty Projection of Light (PrL)
Procedure to Find Out Power of Spectacle Lens (Flow Chart 4.1)
Characteristics of Various Types of Lens
Uses of Lenses
Uses of Plus Cylinder
Uses of Minus Cylinder
Examination of Near Vision
How to Find out Power of Spectacle Lenses (Neutralizing)
Neutralizing by Lenses
Examination of Color Vision (Fig. 4.24)
Examination of Field of Vision
External Examination of the Eyes
Examination in Diffuse Light
Examination of Eye with Subnormal Vision
Method of Doing Retinoscopy
OPHTHALMIC EXAMINATION
Details of Examination Under Diffuse Illumination
Head Posture
Changes in Interpalpebral Aperture
Squint
Sunken Eyeball (Enophthalmos)
Examination Under Focal Illumination
Corneal Loupes
Binocular Loupe (Fig. 4.41)
Operating Telescopes (Fig. 4.42)
Slit Lamp Biomicroscope (Fig. 4.43)
EXAMINATION OF THE LIDS
Symptoms of Disorders of the Lids
Infection of Lid Margin
Change in Interpalpebral Aperture
Ptosis
Signs of Ptosis
Symptoms of Ptosis
Causes of Ptosis
Causes of Pseudoptosis
Lid Retraction
LAGOPHTHALMOS
Bell's Phenomenon
Blepharospasm
Tumors of the Lid
Examination of the Lacrimal Sac
Symptoms of Diseases of the Lacrimal Sac
Examination of a Case of Watering from the Eyes
Causes of Lacrimation
Causes of Epiphora
Examination of a Case of Dacryocystitis
Congenital Dacryocystitis
Chronic Dacryocystitis
Examination of Orbit
Proptosis (Fig. 4.57)
Exophthalmos
Examination of Conjunctiva
Causes of Watering from the Eyes
Causes of Discharge from the Eyes
Redness of the Eye
Causes of Generalized Redness of the Conjunctiva
Causes of Localized Redness of the Conjunctiva (see Fig 8.1)
Causes of Bright Red Color of the Conjunctiva
Characteristics of Conjunctival Congestion (see Fig. 8.2)
Circumciliary Congestion
Itching in the Eyes
Cause of Dryness of the Conjunctiva
Bitot's Spot
Dry Eye Syndrome
Examination of Globe
Changes in Size and Shape of the Globe
Signs of Microphthalms
Signs of Phthisis
Signs of Buphthalmos
Signs of Proptosis
Changes in Color of the Sclera
Staphylomas
Examination of Cornea
Shape of the Cornea
Size of Cornea
Causes of Megalocornea
Examining the Corneal Curvature
Examination of Corneal Surface
Corneal Transparency
Causes of Corneal Opacity
Causes of Bilateral Corneal Opacity
Examination of Level of Lesion in the Cornea
Examination of Corneal Sensation
Causes of Diminished Corneal Sensation
Corneal Stain
Examination of Thickness of Cornea
Causes of Thickened Cornea
Recording of Corneal Opacities
Corneal Vascularization
Causes of Superficial Vascularization of Cornea
Causes of Deep (Interstitial) Vascularization
Retro Corneal Vascularization (on the Back of Cornea)
Corneal Deposits
Causes of Opacities Between Bowmen's Membrane and Descemet's Membrane
Examination of Anterior Chamber
Contents of Anterior Chamber
Examination of Uvea
Coloboma
Examination of the Pupillary Margin
Posterior Synechia
Examination of Pupil
Color of Pupil
Reaction of Pupil
Examination of Lens
Subluxated and Dislocated Lens
Features of Subluxation of Lens
Dislocation of the Lens
Aphakic
Symptoms of Aphakia
Pseudophakia
Features of IOL
Examination of Squint
Symptoms of Squint
Symptoms of Latent Squint
Symptoms of Manifest Squint
Detection of Latent Squint
Examination of Manifest Squint
To Examine Manifest Squint
Characteristics of Paralytic Squint
Charting of Diplopia
Examination of Eye with Raised Intraocular Tension
Signs of Painless Glaucoma (Chronic Simple Glaucoma)
Symptoms of Painful Glaucoma (Narrow Angle Glaucoma)
Signs of Painful Glaucoma
Internal Examination of the Eye
Special Examination
CHAPTER 5:
Disorders of the Lids
PTOSIS
Pseudoptosis
CONGENITAL PTOSIS
Simple Congenital Ptosis
Complicated Ptosis
ACQUIRED PTOSIS
MYOGENIC PTOSIS
Ptosis with Blepharophimosis
Ankyloblepharon
Coloboma of the Lid
DISTICHIASIS
Trauma (Injury) to the Lids
Laceration (Tearing) of Lid (Fig. 5.10)
ABNORMALITIES OF LID MARGIN
Distichiasis
Trichiasis
Treatment
Entropion
Ectropion (Fig. 5.16)
Cicatricial Ectropion
Madarosis
Tylosis
Coloboma
Ankyloblepharon
Motility (Movement) Disorders of the Lid
Symptoms
Treatment
Lid Retraction
Blepharospasm
Common Causes of Blepharospasm
Infections of the Lid
Causes of Lid Edema are
Herpes Zoster Ophthalmicus
Treatment of Ocular Involvement
Vericella (Chickenpox)
Herpes Simplex
Molluscum Contagiosum
Warts (Verruca)
Infections of the Lid Margin
Blepharitis
Parasitic Infestation of Lid Margin
Inflammation of Glands of the Lid Margin
Stye
Chalazion (Meibomian Cyst, Tarsal Cyst)
New Growths of the Lid
Xanthelasma (Xanthoma)
Hemangioma
Neurofibromatosis
Nevi
Malignant Growth of the Lids
Basal Cell Carcinoma
Squamous Cell (Epidermoid) Carcinoma
Adenocarcinoma of the Lid
Xeroderma Pigmentosa
Malignant Melanoma
Kaposi Sarcoma
CHAPTER 6:
Disorders of the Lacrimal System
DRAINAGE OF TEAR
WATERING OF THE EYES
Lacrimation
Epiphora
Dryness of the Eyes
Deficiency of Components of Tear
Defect in Ocular Surface
Symptoms
Treatment
Sjögren's Syndrome
Diseases of Lacrimal Drainage System
Congenital Nasolacrimal Duct Obstruction
CHRONIC DACRYOCYSTITIS
Chronic Dacryocystitis in Adults
Stage I
Stage II
Stage III
Stage IV
Management
Chronic Dacryocystitis in Children
Diseases of Lacrimal Gland
Acute Dacryoadenitis
Treatment
Chronic Dacryoadenitis
CHAPTER 7:
Disorders of the Orbits
PROPTOSIS
Congenital Proptosis
Acquired Proptosis
Causes of Unilateral Proptosis
Pseudoproptosis
Direction of Proptosis
Measurement of Proptosis
EXOPHTHALMOS
Differentiation Between Exophthalmos and Proptosis
Infectious Diseases of the Orbit
ORBITAL CELLULITIS
Acute Orbital Cellulitis
Types of Acute Orbital Cellulitis
ORBITAL PERIOSTITIS
Cavernous Sinus Thrombosis
Chronic Inflammation of Orbit
Tumors of the Orbit
Classification of Tumors of Orbit Flow Chart 7.1
Meningocele
Encephalocele
Acquired Orbital Tumors
Primary Orbital Tumors
Metastatic Tumors of Orbit
Symptoms of Orbital Tumor
Signs of Orbital Tumor
Treatment
Enophthalmos
Signs of Enophthalmos
CHAPTER 8:
Disorders of Conjunctiva
HYPEREMIA
Conjunctival Congestion
Circumciliary Congestion
Episcleral Congestion
Subconjunctival Hemorrhage (Blood Under the Conjunctiva)
Lacrimation (Watering from the Eye)
Conjunctival Chemosis
Xerosis of Conjunctivitis (Xero = Dry)
Bitot's Spot
Grades of Xerophthalmia
Complication of Xerophthalmia
Prevention of Xerophthalmia
Diet
Conjunctival Exudation (Discharge)
Itching
Pinguecula
Pterygium
Progressive
Treatment
Episcleritis
Phlycten
Conjunctivitis
Bacterial Conjunctivitis
Treatment
Special Types of Acute Bacterial Conjunctivitis
Pneumococcal Conjunctivitis
Gonococcal Conjunctivitis
Ophthalmia Neonatorum
Management
Management of Ophthalmia Neonatorum
Complication of Ophthalmia Neonatorum
Gonococcal Conjunctivitis in Adults
Treatment
Diphtheretic Conjunctivitis
Management of Diphtheretic Conjunctivitis
Treatment
Moraxella Conjunctivitis
Viral Conjunctivitis
Pharyngo Conjunctival Fever
Epidemic Keratoconjunctivitis
Acute Hemorrhagic Conjunctivitis
Herpes Simplex Conjunctivitis
Herpes Zoster Varicella Conjunctivitis
Conjunctivitis in Measles
Chlamydial Conjunctivitis
Trachoma
Management of Trachoma
Prophylaxis
Management of Acute Stage
Management of Blinding Trachoma Consists
Management of Established Trachoma
Treatment of Complication
Adult Inclusion Conjunctivitis
Management
Ophthalmia Neonatorum by Chlamydia (See Ophthalmia Neonatorum)
Allergic conjunctivitis
Acute Allergic Conjunctivitis
Chronic Allergic Conjunctivitis
Spring Catarrh or Vernal Conjunctivitis
Management
Giant Papillary Conjunctivitis
Growth of the Conjunctiva
CHAPTER 9:
Disorders of the Cornea
CONGENITAL DISORDERS OF THE CORNEA
Microcornea
Buphthalmos
Commonest Acquired Disorders of the Cornea
Bacterial Corneal Ulcer
Hypopyon Corneal Ulcer
Causes of Bilateral Corneal Opacity
Management of Bacterial Corneal Ulcer
Treatment of Hypopyon Corneal Ulcer
How to Prepare Fortified Solution of Gentamycin
Management of Corneal Opacity
Keratoplasty
Viral Keratitis
Herpes Simplex Keratitis
Recurrent Herpes Simplex Keratitis
Treatment
Fungal Keratitis (Myotic Keratitis)
Marginal Corneal Ulcers
Phlyctenular Corneal Ulcer (Figs 9.16 and 9.17)
Marginal Corneal Infiltrates
Trachoma
Deep Keratitis
Adult form of Interstitial Keratitis
Disciform Keratitis
Corneal Degenerations
Band Keratopathy
Nodular Degeneration of Cornea
Corneal Dystrophies
Keratoconus (Conical Cornea)
Miscellaneous Condition of Cornea
Neurotrophic Keratitis
Neuroparalytic Keratitis
Bullous Keratitis
Exposure Keratitis
Welding Arc Injury
Keratomalacia
Management
CONTACT LENSES
Indications for Contact Lens (Why Contact Lenses are Prescribed)
Methods of Contact Lens Fitting
Contraindications of Contact Lenses
CONTACT LENS CARE
Corneal Surgeries
Refractive Corneal Surgeries
Corneal Trauma
CHAPTER 10:
Disorders of the Globe and Sclera
ENOPHTHALMOS
PHTHISIS BULBI
Inflammation of Sclera
EPISCLERITIS
Scleritis
STAPHYLOMA
Corneal Staphyloma (Anterior Staphyloma) due to Sloughing of Corneal Ulcer
Intercalary Staphyloma
Ciliary Staphyloma
Equatorial Staphyloma
Posterior Staphyloma
CHAPTER 11:
Disorders of the Lens
CATARACT
CATARACT IN ADULTS
Senile Cataract
Symptoms
Progress of Nuclear Cataract
Signs of Nuclear Cataract
Treatment
Cortical Cataract (Flow Chart 11.1)
Symptoms of Cortical Cataract
Treatment
Posterior Subcapsular Cataract (Fig. 11.5A)
Congenital Cataract (Figs 11.6A and B)
Zonular Cataract
Traumatic Cataract
Cataract Due to Penetrating Injury
Cataract Due to Blunt Injury
Vossius Ring
Concussion Cataract (Fig. 11.11)
Rubella Cataract
Treatment of Congenital Cataract
Treatment of Cataract in Adults
Evaluation of Patient for Lens Surgery
APHAKIA
Treatment of Aphakia (Figs 11.14A to I)
PSEUDOPHAKIA
Complications of Lens Surgery
Postoperative Endophthalmitis
Chronic Endophthalmitis
Posterior Capsular Opacification
After Cataract
Congenital Anomalies of the Lens
ABNORMAL POSITION OF LENS
Ectopia Lentis
CHAPTER 12:
Disorders of the Uvea
HYPOPYON
Treatment of Hypopyon
Pupil in Iridocyclitis
Iris Bombe
Nodule Formation on Iris
Recurrence
Differential Diagnosis of Iridocyclitis
Complication of Iridocyclitis
Posterior Uveitis
Panuveitis
Management
Postsurgical Endophthalmitis
Panophthalmitis
Sympathetic Uveitis (Sympathetic Ophthalmia)
Tumors of Uvea
Malignant Tumors of the Uvea
Treatment
Abnormal Contents of Anterior Chamber
CHAPTER 13:
Glaucoma
FORMATION OF AQUEOUS HUMOR
Normal Intraocular Pressure
Optic Nerve
TYPES OF GLAUCOMA (FLOW CHART 13.1)
Wide Angle Glaucoma
Signs
Visual Field
Gonioscope
Ophthalmoscopy
Treatment
Narrow Angle Glaucoma
Secondary Glaucoma
Glaucoma Due to Injury (Traumatic Glaucoma)
Steroid Induced Glaucoma
Glaucoma due to Intraocular Inflammation
Neovascular Glaucoma
Points to Remember in Glaucoma
CHAPTER 14:
Disorders of the Retina and Optic Nerve
FEATURES OF RETINAL DISORDERS
Normal Fundus
Indirect Ophthalmoscope
Ophthalmoscopic Appearance of Normal Fundus (Figs 14.2 and 14.3)
Congenital Anomalies of the Retina
RETINAL TRAUMA
Blunt Injury of the Retina
Other Causes of Red Spot in the Macula
Retinal Rupture
Retinal Dialysis
Traumatic Retinal Hemorrhage
Inflammatory Disorders of the Retina
Symptoms of Retinitis
SPECIFIC TYPES OF RETINITIS
Rubella
Cytomegalovirus—Retinitis
Retinitis in HIV
Bacterial Retinitis
Subacute Bacterial Retinitis
Parasitic Retinitis
Retinal Vasculitis
Common Causes of Nonimprovement of Vision in Eales’ Disease
Other Causes of Retinal Haemorrhages
Management
Treatment
Retinal Dystrophies and Degeneration
Retinal Dystrophies
Peripheral Retinal Dystrophies
Retinitis Pigmentosa
Atypical Retinitis Pigmentosa
Atypical Pigmentation
Differential Diagnosis
Simple Rule of Night Blindness
Treatment of Retinitis Pigmentosa
COMMON MACULAR DISORDERS
Central Serous Retinopathy
Management
Cystoid Macular Edema
AGE-RELATED MACULAR DEGENERATION (ARMD)
Vascular Disorders of Retina
Diabetic Retinopathy
Background Retinopathy
Proliferative Retinopathy
Management of Diabetic Retinopathy
Ocular Manifestations of Diabetes
HYPERTENSIVE RETINOPATHY
RETINOPATHY OF PREGNANCY
Retinopathy of Prematurity (Retrolental fibroplasia)
Sickle Cell Retinopathy
Obstruction of Retinal Vessels
On Examination
Central Retinal Vein Obstruction (Central Retinal Vein Thrombosis)
RETINAL DETACHMENT
Symptoms of Retinal Detachment
Diagnosis
Management
Treatment
TUMORS OF RETINA
Retinoblastoma
Symptoms and Signs of Retinoblastoma
Differential Diagnosis of Retinoblastoma
Treatment
DISORDERS OF THE OPTIC NERVE
Congenital Anomalies of Optic Nerve
Opaque Nerve Fibers
Hypoplasia of Optic Disc
Coloboma of the Optic Disc
Hereditary Disorder of Optic Nerve
Trauma to Optic Nerve
Inflammation of the Optic Nerve
Treatment
Retrobulbar Neuritis
Chronic Retrobulbar Neuritis
PAPILLEDEMA (SWOLLEN DISC)
OPTIC ATROPHY
Primary Optic Atrophy
Secondary Optic Atrophy
Tumors of the Optic Nerve
Glioma of the Optic Nerve
CHAPTER 15:
Squint (Strabismus)
DIPLOPIA
Polyopia
Amblyopia
Common Causes of Amblyopia
Treatment of Amblyopia
SQUINT
LATENT SQUINT (HETEROPHORIA)
Causes of Heterophoria
Symptoms of Heterophoria
Diagnosis
Treatment
MANIFEST SQUINT (HETEROTROPIA)
Symptoms of Heterotropia
Signs
Cover Test
Measurement of the Deviation
Management of Concomitant Squint
Alternate Squints
Paralytic Squint
Treatment
NYSTAGMUS
Ocular Causes of Nystagmus
Nonocular Causes of Nystagmus
Treatment
INDEX
TOC
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