Extras

  1. Blepharospasm

    • It is relieved by thorough anesthesia cf photophobia which is partially relieved by cycloplegia.

  2. Corneal sensation : reduced

    1. Herpetic keratitis
    2. Acute attack of Angle closure glaucoma
    3. Keratomalacia
    4. Leprosy
    5. Neurotrophic keratitis (fifth nerve damage)
    6. Post corneal surgery
    7. Long standing corneal edema

       

  3. Corneal vascularisation

    1. Corneal ulcer
    2. Trachoma
    3. Interstitial keratitis
    4. Leprosy
    5. Diabetes
    6. Post penetrating keratoplasty

       

  4. Effects of block (Local anesthesia)

    1. Anesthesia of intra ocular structures e.g. iris
    2. Akinesia of all extra ocular muscle except superior oblique
    3. Mydriasis
    4. Hypotony : due to loss of tone of extra ocular muscles & bulbar massage
    5. Proptosis
    6. Decreased oculo cardiac reflex

       

  5. Enucleation

    • It is the surgical removal of the eyeball with a portion of the optic nerve from the orbit.

      Absolute Indication:

      i. MOST COMMON ” EYE DONATION”

      ii. Retinoblastoma

      iii. Malignant melanoma

      iv. Severely traumatised eye with no Light perception to prevent sympathetic ophthalmitis of the fellow eye.

      Relative Indication:

      i. Painful : a. absolute glaucoma, b. chronic iridocyclitis c. intra ocular hemorrhage

      ii. Blind & disfigured eyes : Anterior Staphyloma & Ciliary Staphyloma

      iii. Phthisis bulbi with calcification

      iv. Endophthalmitis, not responding medically

      v. Sympathetic ophthalmitis


  6. Hyphema

    1. Contusion
    2. Penetrating injury
    3. Intra ocular surgery
    4. Neo vascularisation of iris
    5. Intra ocular Lens
    6. Tumors

       

  7. Miosis

    1. Aged patients
    2. Bright light
    3. Opium addiction
    4. Morphine intoxication
    5. Pontine hemorrhage
    6. Acute iritis
    7. During sleep
    8. Use of miotics

       

  8. Mydriasis

    1. In dark
    2. Optic atrophy
    3. Acute attack in angle closure glaucoma
    4. Absolute glaucoma
    5. Comatose patient
    6. Head injury
    7. Third nerve palsy
    8. Use of mydriactics

       

  9. Oculo Cardiac reflex

    • Traction on extra ocular muscle or pressure on eyeball elicit variety of cardiac arrythmias.
    • Afferent : Trigeminal nerve
    • Efferent : Vagus nerve
    • Management :
      1. Temporary cessation of surgical stimulation until heart rate increases
      2. Confirmation of adequate ventilation, oxygenation & depth of anesthesia.
      3. i.v. Atropine 10 microgm/kg
      4. if recalcitrant, infiltrate rectus muscle with local anesthetist

  10. Pale disc : D/D

    • Non- pathological:
      1. infants
      2. Axial myopia
      3. Elderly with nuclear sclerosis – temporal pallor with large physiological cup.
    • Pathological:
      1. Optic atrophy
      2. Hypoplasia
      3. Congenital pit
      4. Coloboma

  11. Paracentis : Indications

    • Diagnostic
      1. Intra ocular malignancy : cytology & LDH assay
      2. Intra ocular parasite infestation
    •  Therapeutic
      1. massive hyphema to control secondary glaucoma & to prevent blood staining of the cornea
      2. Corneal ulcer with massive hypopyon to improve corneal nutrition
      3. Impending corneal perforation
      4. Central retinal arterial occlusion
      5. Control secondary glaucoma following : iridocyclitis & traumatic cataract with soft lens matter in A/C.

  12. Principle of PIN HOLE

    1. It masks peripheral aberrations
    2. It focuses circle of least diffusion on retina
    3. Photoreceptors are sensitive to light falling perpendicular to it which is possible in light passing through pin hole.

       

  13. Shallow A/C

    1. Hypermetropia
    2. Hypermature cataract
    3. Intumescent cataract
    4. Angle closure glaucoma
    5. Iris bombe

       

  14. Tubular Vision

    1. Advanced stage of glaucoma
    2. High myopia
    3. Retinitis pigmentosa
    4. Central retinal arterial occlusion with sparing of cilio retinal artery
    5. Quinine toxicity.

       

  15. Vitreous Adhesions

    • Normal:
      1. Vitreous base
      2. Optic base
      3. Around fovea, weak except in vitreo macular traction & macular hole formation
    • Abnormal:
      1. Posterior border of island of lattice degeneration
      2. Retinal pigment clumps
      3. Peripheral paravascular condensations
      4. White without pressure & white with pressure areas.