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Short case Ophthalmology
1
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Do not press palm against eye
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- 6/6…6/60, 5/60, 4/60…1/60, CF-3 (counting finger at 3m), CF-2, CF-1, CF close to
face, HM +ve, PL +ve, PL –ve
- Charts for illiterate: E chart/Landolt’s C chart/simple picture chart
- Pinhole: removes need for focus
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- Near vision: Jaeger’s chart, Roman test types, Snellen’s near vision
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3
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5
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7
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9
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Look at reflection on both pupils
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- Lacrimal puncta- eversion, discharge, stenosis, absence
- Lacrimal sac area – redness, swelling
Conjunctiva
- Palprebal conjunctiva – anemia
- Bulbar conjunctiva
o Use torch
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Ask patient to look up: Check congestion, chemosis
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Ask patient to look down: Check congestion, chemosis,
conjunctival bleb
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Check for pterygium, pinguecula
 Pterygium:degenerative conjuctival fold
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Slightly vascular
 Pinguecula: degenerative condition
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10
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Anterior chamber
- Depth
- Contents: hyphaema, hypopyon, ACIOL
12
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Pupil
- Location, shape, size, symmetry, colour
o E
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centrally placed, round, normal size, symmetrical, blacl
o Vertically oval pupil – acute congestive glaucoma
o Festooned pupil on dilation – uveitis
o Mention if pharmacologically dilated
- Reflex – DIM LIGHTS
o Direct light reflex
o Consensual light reflex – shine on other pupil
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o Swinging light reflex (Marcus Gunn pupil) – to check for relative afferent
pupillary reflex (RAPD) – Positive in optic neuritis, optic atrophy, CRVO,
CRAO, RD
o Accomodation reflex – focus on pen, bring close to eyes

14
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Status
4th Image
Phakic
Dull
Aphakic
Absent
Pseudophakic
Bright
Transparent/ opaque – In pseudophakia: posterior capsular opacification
Color of opacity
Iris shadow test – shine at 45degree
o Mature cataract: no shadow
o Immature cataract: shadow at the pupillary margin in the direction of
light
Red reflex
o Red globe bright and uniform – no opacities
o Location of opacities if seen
 Periphery – cuneiform
 Central – polar/ nuclear
o To confirm lens/ corneal opacity
 Ask patient to move eyes
 Opacity moves in same direction – cornea
 Opacity moves in opposite direction – lenticular
o Also check for patency of iridectomy/iridotomy
 Reflex present from scar : patent

Posterior segment
1
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Red reflex: round and uniform
b
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Direct ophthalmoscopy
a
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b
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c
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Colour: pinkish yellow
ii
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Cup:disc ratio: 0
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Shape? Size?
v
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Neovascularisation
d
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Hypertensive changes
ii
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Neovascularisations
iv
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Ask patient to look at light

i
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Foveal reflex
f
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g

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