EYE OSCE DOC:
STATION # 1 (Viva)
Diagram with case history of child with white pupillary reflex
Retinoblastoma
D/D: Retinoblastoma, Retrolental fibroplasia, Anterior persistent primary viterous, Coat's
disease, Endopthalmitis, Toxocarial granuloma
Types: Heritable and non-heritable
Rx: Photocoagulation, cryotherapy, Laser thermotherapy, Enucleation
STATION # 2 (Static)
Case history of dracyocystitis
Complications: Lacrimal abscess, cellulitis, panophthalmitis, fistula
Surgery: Dracrycystorhinostomy (DCR)
STATION # 3 (Viva)
Trachoma
Causative agent: Chlamydia Trachomatis
Clinical features: 4 stages. Stage 1 – Minimal symptoms. Stage 2 – Follicular hyperplasia, Papillary hypertrophy, Corneal pannus, Corneal ulceration. Stage 3 – Arlt’s line, Herbit’s pits, Regression of corneal pannus. Stage 4 – Opaque cornea with gross reduction of vision
Complication: Trichiasis, Entropion, Ptosis, Dry eye
Rx : Improve personal hygeine, topical antibiotics (tetracycline), systemic antibiotics (azithromycin), surgery
STATION # 4 (Examination)
Perform or assess field of vision
STATION # 5 (Static)
Case history of central retinal artery occlusion
Signs on examination: Profound loss of vision, absent papillary reflex, whitish appearance on fundus examination, thin retinal arteries, cherry-red spot
Management: Relieve inta-occular pressure with acetazolamide/mannitol, ocular massage, Isosorbide sublingually, Streptokinase IV, Retrobulbar tolzoline injection
STATION # 6 (Viva)
Red eye
D/D: Conjunctivitis, Keratitis, Acute congestive glaucoma, Acute iridocystitis, Episcleritis, Scleritis, Sub-conjunctival hemorrhage, Foreign body
Causes of subconjunctival hemorrhage: Severe coughing, sneezing???
Investigations of sub-conjunctival hemorrhage: ???
Types of conjunctivitis: Based on exudate – Watery, mucoid, mucopurulent, purulent. Based on reaction – Follicular, papillary. Based on etiology – Infective, non-infective.
STATION # 7 (Viva)
Diabetic retinopathy
Predisposing factors: Duration of uncontrolled diabetes, Hypertension, Obesity, Pregnancy, Nephropathy, Smoking, Hypercholesterolemia, Anemia
Pathogenesis: Microvascular leakage and occlusion
Signs: Microaneurysms, Flame-shaped hemorrhages in nerve-fiber layer of retina, Hard exudates, Retinal edema, Cotton-wool spots, Neavascularization, Viterous detachment
Rx: Control of risk factors, laser photocoagulation, pars plana virectomy
STATION # 8 (Static)
Strabismus
Name the surgeries used to treat strabismus: Radial keratotomy, photorefractive keratotomy, LASEK, LASIK, Clear lens extraction, Phakic posterior chamber implant
Complications of Hypermetropia: Amblyopia
Complications of Myopia: Posterior staphyloma, Macular hemorrhage, Retinal detachment, Glaucoma
STATION # 9 (Viva)
Indirect ophthalmoscope
Advantages: Stereoscopic view, Retina visible anterior to equator/in haze media/ in high refractive error
Disadvantages: Inverted view, Higher light intensity might be uncomfortable for patient
STATION # 10 (Static)
Cataract
Indications of surgery: Visual improvement, phacolytic glaucoma, untumescent lens-induced angle closure glaucoma, cataract causing problems in treatment of retinal detachment and diabetic retinopathy, cosmetic reasons
Phacoemulsification advantages: More controlled operating conditions, avoidance of suturing, rapid wound healing with lesser degrees of corneal distortion, reduced post-operative intra-ocular complications
Phacoemulsification complications: High risk of posterior capsular tear
Cosmetic purpose: To make pupil appear black
STATION # 11 (Static)
Myopia of both eyes
Treatment: ???
Finding in pathological myopia: Myopic crescent in optic disk, Lacquer cracks in Bruch’s membrane, Subretinal neovascularization, Fuch’s spots, Posterior staphyloma, Degenerative changes in vitreous, Retinal detachment
STATION # 12 (Static)
Acute Angle-closure glaucoma
Diagnosis: Raised IOP, Hazy cornea, Decrease visual acuity, Shallow anterior chamber, Pupil vertically oval semi-dilated/fixed/unresponsive to light, Optic disc hyperemia
Management: Keep patient in bright light and supine position, IV Acetezolamide/Mannitol/Glycerol, analgesics, antiemetics, topical pilocarpine, beta-blockersm corticosteroids
Role of laser: To prevent attack in other eye (laser iridotomy)
STATION # 13 (Static)
Leukocoria
D/D: Congenital cataract, retinoblastoma, persistent hyperplastic primary vitreous, Retro-lental fibroplasia, Toxocara endopththalmitis, Coat’s disease
B-Scan findings: Calcifications
STATION # 14 (Static)
Hypertensive and diabetic patient presents with sudden loss of vision in left eye
Most probable diagnosis: Central retinal vein occlusion
Confirmed by : Flourescein angiography
STATION # 15 (Static)
Actue dracyocystitis
Identify : Actue dracyocystitis
Cause : Nasolacrimal duct obstruction
Rx: Antibiotics, Analgesics, Hot fomentation, Incision and drainage of abscess
Complications: External fistula, preseptal cellulitis
STATION # 16 (Static)
Ptosis
Identify: Ptosis
Types: Congenital, Neurogenic, Myogenic, Aponeurotic, Mechanical
Problems: Cosmetic disfigurement, Amblyopia, Squint, Abnormal head posture
Rx: Fasanella servat operation, Levator resection, Brow-suspension procedure, Aponeurotic strengthening, Spectacle props
STATION # 17 (Static)
Mydriatic drug
Classify: Mydriatic
Uses: Dilating the pupil for opthalmoscopy, paralyzing muscles of accommodation as an aid in refraction, in uveitis to prevent synechia formation and relieve pain and photophobia
Adverse effects: Angle-closure glaucoma
STATION # 18 (Static)
Bacterial conjunctivitis
Identify: Bacterial conjunctivitis
D/D: Conjunctivitis, Keratitis, Acute congestive glaucoma, Acute iridocystitis, Episcleritis, Scleritis, Sub-conjunctival hemorrhage, Foreign body
Types: Mucopurulent, Purulent, Membranous
Rx: Irrigation, Antibiotics, Lid hygiene
STATION # 19 (Static)
60 year old man presents with gradual loss of vision
Most probable diagnosis: Cataract
Rx options: Dark glasses, papillary dilation, Extra-capsular cataract extraction, Intra-capsular cataract extraction, Pars plana lensectomy
Most commonly used surgical method: Phacoemulsification
Complications of Rx delay: Phacomorphic glaucoma, phacolytic glaucoma, phacoantigenic uveitis, Dislocation of lens, Incarceration
STATION # 20 (Static)
Glaucoma
Identify: Optic disc cupping
Diagnosis: Glaucoma
Rx options: IV Acetezolamide/Mannitol/Glycerol, analgesics, antiemetics, topical pilocarpine, beta-blockersm corticosteroids
Types: Primary open angle, primary closed-angle, Secondary glaucoma, Congenital glaucoma, Normal tension glaucoma
STATION # 21 (Viva)
Chalazion
Difference between Hordeolum and Chalazion: Chalzion is chronic inflammatory lipogranuloma of Meibomian glands. Hordeolum is acute suppurative infection of lash follicle and its associated glands of Zeis and Moll
Rx of Chalazion: Corticosteroids, systemic antibiotics, surgical excision
Complications: Mechanical ptosis, Astigmatism
STATION # 22 (Viva)
Herpetic corneal ulcer
Identify: Herptic corneal ulcer
Rx: Topical anti-virals, Debridement, Topical anti-biotics, Cyclopegics
Various stains used: Fluorescein stain, Rose Bengal stain
STATION # 23 (Viva)
Pterygium
Findings: Fibrovascular growth in triangular fashion at the limbus with base towards cornea
Diagnosis: Clinical findings
Complications: Astigmatism, mechanical obstruction of vision
Pseudo-pterygium: Fold of bulbur conjunctiva attached to cornea
Prevention of recurrence: Conjunctival auto-graft, Mitomycin C, Radiation, Argon laser
STATION # 24 (Viva)
Chronic dacryocystitis
Findings: Painless enlargement of lacrimal glands, S-shaped curve of eyelid margins, displacement of eyeball downward and inward
Rx: Treat underlying cause
STATION # 25 (Viva)
Acute iridocyclitis
Findings: Reduced visual acuity, Limbus-circumcorneal congestion, Aqueous flare, muddy iris, posterior synechiae
Rx: Mydriatics/cyclopegics, topical steroids, systemic NSAIDs, anti-biotics
STATION # 1 (Viva)
Diagram with case history of child with white pupillary reflex
Retinoblastoma
D/D: Retinoblastoma, Retrolental fibroplasia, Anterior persistent primary viterous, Coat's
disease, Endopthalmitis, Toxocarial granuloma
Types: Heritable and non-heritable
Rx: Photocoagulation, cryotherapy, Laser thermotherapy, Enucleation
STATION # 2 (Static)
Case history of dracyocystitis
Complications: Lacrimal abscess, cellulitis, panophthalmitis, fistula
Surgery: Dracrycystorhinostomy (DCR)
STATION # 3 (Viva)
Trachoma
Causative agent: Chlamydia Trachomatis
Clinical features: 4 stages. Stage 1 – Minimal symptoms. Stage 2 – Follicular hyperplasia, Papillary hypertrophy, Corneal pannus, Corneal ulceration. Stage 3 – Arlt’s line, Herbit’s pits, Regression of corneal pannus. Stage 4 – Opaque cornea with gross reduction of vision
Complication: Trichiasis, Entropion, Ptosis, Dry eye
Rx : Improve personal hygeine, topical antibiotics (tetracycline), systemic antibiotics (azithromycin), surgery
STATION # 4 (Examination)
Perform or assess field of vision
STATION # 5 (Static)
Case history of central retinal artery occlusion
Signs on examination: Profound loss of vision, absent papillary reflex, whitish appearance on fundus examination, thin retinal arteries, cherry-red spot
Management: Relieve inta-occular pressure with acetazolamide/mannitol, ocular massage, Isosorbide sublingually, Streptokinase IV, Retrobulbar tolzoline injection
STATION # 6 (Viva)
Red eye
D/D: Conjunctivitis, Keratitis, Acute congestive glaucoma, Acute iridocystitis, Episcleritis, Scleritis, Sub-conjunctival hemorrhage, Foreign body
Causes of subconjunctival hemorrhage: Severe coughing, sneezing???
Investigations of sub-conjunctival hemorrhage: ???
Types of conjunctivitis: Based on exudate – Watery, mucoid, mucopurulent, purulent. Based on reaction – Follicular, papillary. Based on etiology – Infective, non-infective.
STATION # 7 (Viva)
Diabetic retinopathy
Predisposing factors: Duration of uncontrolled diabetes, Hypertension, Obesity, Pregnancy, Nephropathy, Smoking, Hypercholesterolemia, Anemia
Pathogenesis: Microvascular leakage and occlusion
Signs: Microaneurysms, Flame-shaped hemorrhages in nerve-fiber layer of retina, Hard exudates, Retinal edema, Cotton-wool spots, Neavascularization, Viterous detachment
Rx: Control of risk factors, laser photocoagulation, pars plana virectomy
STATION # 8 (Static)
Strabismus
Name the surgeries used to treat strabismus: Radial keratotomy, photorefractive keratotomy, LASEK, LASIK, Clear lens extraction, Phakic posterior chamber implant
Complications of Hypermetropia: Amblyopia
Complications of Myopia: Posterior staphyloma, Macular hemorrhage, Retinal detachment, Glaucoma
STATION # 9 (Viva)
Indirect ophthalmoscope
Advantages: Stereoscopic view, Retina visible anterior to equator/in haze media/ in high refractive error
Disadvantages: Inverted view, Higher light intensity might be uncomfortable for patient
STATION # 10 (Static)
Cataract
Indications of surgery: Visual improvement, phacolytic glaucoma, untumescent lens-induced angle closure glaucoma, cataract causing problems in treatment of retinal detachment and diabetic retinopathy, cosmetic reasons
Phacoemulsification advantages: More controlled operating conditions, avoidance of suturing, rapid wound healing with lesser degrees of corneal distortion, reduced post-operative intra-ocular complications
Phacoemulsification complications: High risk of posterior capsular tear
Cosmetic purpose: To make pupil appear black
STATION # 11 (Static)
Myopia of both eyes
Treatment: ???
Finding in pathological myopia: Myopic crescent in optic disk, Lacquer cracks in Bruch’s membrane, Subretinal neovascularization, Fuch’s spots, Posterior staphyloma, Degenerative changes in vitreous, Retinal detachment
STATION # 12 (Static)
Acute Angle-closure glaucoma
Diagnosis: Raised IOP, Hazy cornea, Decrease visual acuity, Shallow anterior chamber, Pupil vertically oval semi-dilated/fixed/unresponsive to light, Optic disc hyperemia
Management: Keep patient in bright light and supine position, IV Acetezolamide/Mannitol/Glycerol, analgesics, antiemetics, topical pilocarpine, beta-blockersm corticosteroids
Role of laser: To prevent attack in other eye (laser iridotomy)
STATION # 13 (Static)
Leukocoria
D/D: Congenital cataract, retinoblastoma, persistent hyperplastic primary vitreous, Retro-lental fibroplasia, Toxocara endopththalmitis, Coat’s disease
B-Scan findings: Calcifications
STATION # 14 (Static)
Hypertensive and diabetic patient presents with sudden loss of vision in left eye
Most probable diagnosis: Central retinal vein occlusion
Confirmed by : Flourescein angiography
STATION # 15 (Static)
Actue dracyocystitis
Identify : Actue dracyocystitis
Cause : Nasolacrimal duct obstruction
Rx: Antibiotics, Analgesics, Hot fomentation, Incision and drainage of abscess
Complications: External fistula, preseptal cellulitis
STATION # 16 (Static)
Ptosis
Identify: Ptosis
Types: Congenital, Neurogenic, Myogenic, Aponeurotic, Mechanical
Problems: Cosmetic disfigurement, Amblyopia, Squint, Abnormal head posture
Rx: Fasanella servat operation, Levator resection, Brow-suspension procedure, Aponeurotic strengthening, Spectacle props
STATION # 17 (Static)
Mydriatic drug
Classify: Mydriatic
Uses: Dilating the pupil for opthalmoscopy, paralyzing muscles of accommodation as an aid in refraction, in uveitis to prevent synechia formation and relieve pain and photophobia
Adverse effects: Angle-closure glaucoma
STATION # 18 (Static)
Bacterial conjunctivitis
Identify: Bacterial conjunctivitis
D/D: Conjunctivitis, Keratitis, Acute congestive glaucoma, Acute iridocystitis, Episcleritis, Scleritis, Sub-conjunctival hemorrhage, Foreign body
Types: Mucopurulent, Purulent, Membranous
Rx: Irrigation, Antibiotics, Lid hygiene
STATION # 19 (Static)
60 year old man presents with gradual loss of vision
Most probable diagnosis: Cataract
Rx options: Dark glasses, papillary dilation, Extra-capsular cataract extraction, Intra-capsular cataract extraction, Pars plana lensectomy
Most commonly used surgical method: Phacoemulsification
Complications of Rx delay: Phacomorphic glaucoma, phacolytic glaucoma, phacoantigenic uveitis, Dislocation of lens, Incarceration
STATION # 20 (Static)
Glaucoma
Identify: Optic disc cupping
Diagnosis: Glaucoma
Rx options: IV Acetezolamide/Mannitol/Glycerol, analgesics, antiemetics, topical pilocarpine, beta-blockersm corticosteroids
Types: Primary open angle, primary closed-angle, Secondary glaucoma, Congenital glaucoma, Normal tension glaucoma
STATION # 21 (Viva)
Chalazion
Difference between Hordeolum and Chalazion: Chalzion is chronic inflammatory lipogranuloma of Meibomian glands. Hordeolum is acute suppurative infection of lash follicle and its associated glands of Zeis and Moll
Rx of Chalazion: Corticosteroids, systemic antibiotics, surgical excision
Complications: Mechanical ptosis, Astigmatism
STATION # 22 (Viva)
Herpetic corneal ulcer
Identify: Herptic corneal ulcer
Rx: Topical anti-virals, Debridement, Topical anti-biotics, Cyclopegics
Various stains used: Fluorescein stain, Rose Bengal stain
STATION # 23 (Viva)
Pterygium
Findings: Fibrovascular growth in triangular fashion at the limbus with base towards cornea
Diagnosis: Clinical findings
Complications: Astigmatism, mechanical obstruction of vision
Pseudo-pterygium: Fold of bulbur conjunctiva attached to cornea
Prevention of recurrence: Conjunctival auto-graft, Mitomycin C, Radiation, Argon laser
STATION # 24 (Viva)
Chronic dacryocystitis
Findings: Painless enlargement of lacrimal glands, S-shaped curve of eyelid margins, displacement of eyeball downward and inward
Rx: Treat underlying cause
STATION # 25 (Viva)
Acute iridocyclitis
Findings: Reduced visual acuity, Limbus-circumcorneal congestion, Aqueous flare, muddy iris, posterior synechiae
Rx: Mydriatics/cyclopegics, topical steroids, systemic NSAIDs, anti-biotics
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