Ординатура / Офтальмология / Английские материалы / Comprehensive Ophthalmology_Khurana_2007

Cyclodialysis operation is useful in which type of

glaucoma?

Glaucoma in aphakes

ENUCLEATION AND EVISCERATION OPERATIONS

What is enucleation operation ?

It is complete excision of the eyeball.

Enumerate indications of enucleation.

Absolute indications are:

Retinoblastoma

Malignant melanoma Relative indications are:

Painful blind eye due to absolute glaucoma

Painful blind eye due to endophthalmitis

Mutilating ocular injury

Phthisis bulbi

Anterior staphyloma

What precautions should be taken while performing enucleation in a patient with

retinoblastoma?

During enucleation the longest possible piece of optic nerve should be excised.

What is evisceration operation?

It is removal of the contents of the eyeball leaving behind the sclera. Frill evisceration is preferred over simple evisceration. In it, only about 3 mm frill of the sclera is left around the optic nerve.

What are the indications of evisceration?

Panophthalmitis

Expulsive choroidal haemorrhage

Bleeding anterior staphyloma

How can the cosmetic appearance be improved

after enucleation or evisceration operation?

For best results, an orbital implant should be implanted at the time of surgery and an artificial eye of plastic should be worn after about 2 weeks of surgery. A delay in the use of artificial eye may lead to a contracted socket.

OPERATIONS ON EYELIDS

For important questions related to eyelid operations see page 526-531

LACRIMAL APPARATUS OPERATIONS

Questions related to operations on the lacrimal apparatus are described on page 531-533

LASERS AND CRYOTHERAPY IN

OPHTHALMOLOGY

What are the properties of laser light?

Monochromaticity

Coherence

Collimation

Name the different types of lasers and their mechanism of action.

Enumerate uses of argon/diode laser.

In glaucoma

1.Laser trabeculoplasty for primary open-angle glaucoma.

2.Laser goniopuncture for developmental glaucoma.

3.Laser iridotomy for narrow-angle glaucoma.

4.Cyclophotocoagulation for absolute glaucoma.

In lesions of retina

1.Diabetic retinopathy

2.Eales’ disease

3.Coats’ disease

4.Sickle-cell retinopathy

5.Exudative age-related macular degeneration

What are the therapeutic uses of Nd-YAG laser?

1.Capsulotomy for thickened posterior capsule

2.Membranectomy for pupillary membranes

What are therapeutic applications of excimer laser?

1.Photorefractive keratectomy (PRK) for correction of myopia and hypermetropia.

2.Phototherapeutic keratectomy (PTK) for corneal diseases such as band-shaped keratopathy.

Describe the laser treatment for diabetic

retinopathy.

Photocoagulation by argon or diode laser is employed as follows:

1.Panretinal photocoagulation (PRP) is indicated in severe cases of preproliferative and proliferative diabetic retinopathy.

2.Focal laser burns are applied in the centre of the hard exudate’s ring in focal exudative maculopathy.

3.Grid pattern laser burns are applied in diffuse exudative maculopathy.

What do you mean by cryopexy ?

Cryopexy means to produce tissue injury by application of extremely low temperature (–100°C –40°C). This is achieved by a cryoprobe from a cryounit.

On what principle is the working of a cryoprobe

based?

Working of a cryoprobe is based on the JouleThompson principle of cooling.

Which gas is used in a cryo-machine?

The cryounit uses freon, nitrous oxide or carbondioxide gas as a cooling agent.

Enumerate the applications of cryo in

ophthalmology?

1. Lids: (i) cryolysis for trichiasis, (ii) cryotherapy

for warts and molluscum contagiosum, (iii) cryotherapy for basal cell carcinoma and haemangioma

2.Conjunctiva: Cryotherapy for hypertrophied papillae of vernal catarrh

3.Lens: Cryoextraction of the cataractous lens

4.Ciliary body: Cryclocryopexy for absolute glaucoma and neovascular glaucoma

5.Retina: (i) cryopexy is widely used for sealing retinal breaks in retinal detachment, (ii) prophylactic cryopexy to prevent retinal detachment in certain prone cases, (iii) anterior retinal cryopexy (ARC) for neovascularization and, (IV) cryotreatment of retinoblastoma.

A

Abnormal retinal correspondence, 320 Abrasion, corneal, 404 Acanthamoeba keratitis, 106 Accommodation, 39-43

amplitude, 41 anomalies, 41 insufficiency of, 42 paralysis of, 42 spasm of, 43

Acetazolamide, 426

Achromatopsia, 305

Acne rosacea, keratitis, 108 Acquired immune

deficiency syndrome (AIDS), 436 Acute multifocal placoid

pigment epitheliopathy, 160 Acyclovir, 421 Adaptation-dark, 15

Adenocarcinoma, pleomorphic, 376 Adie's pupil, 293

Age-related cataract, 175 corneal degenerations, 115 macular degeneration, 274

Amaurosis, 306 Amblyopia,

congenital, 306 ethyl alcohol, 296 ex anopsia, 319 hysteria, 307 methyl alcohol, 296 quinine, 297 tobacco, 296

Amblyoscope major, 329 Ametropia, 28 Aminoglycosides, 419 Amoxycillin, 419 Amphotericin B, 422 Ampicillin, 419

Anaesthesia, ocular surgery, 571-573 Anatomy of

angle of anterior chamber, 205 anterior chamber, 4

ciliary arteries, 135-136 ciliary body, 134

conjunctiva, 51 cornea, 89

extraocular muscles, 313 eyeball, 3

iris, 133

lacrimal apparatus, 363 lens, 167

lids, 339

optic disc, 249, 287 optic nerve, 287 ora serrata, 250 orbit, 377

retina, 249 sclera, 127 uveal tract, 133

visual pathway, 287 vitreous, 243

Angiography, fluorescein, 487 Angiomatosis, retinae, 285 Angle kappa, 27, 321 Angular conjunctivitis, 61 Aniridia, 137

Aniseikonia, 39

Anisocoria, 293 Anisometropia, 38 Ankyloblepharon, 354 Ankylosing spondylitis, 157 Annular scleritis, 129 Annular synechia, 144 Anomaloscope, Nagel's, 305 Anomalous retinal

correspondence, 320 Anterior chamber

antomy of, 4 angle, 205 examination, 472

flat or shallow postoperative, 200 Anterior ischaemic optic

neuropathy, 297 Antibacterial agents, 418 Antifungal agents, 422 Antiglaucoma drugs, 423-427 Antiviral agents, 420 Aphakia, 31, 174 Applanation tonometer, 480 Aqueous flare, 143

Aqueous humour, 207 drainage, 208

flare, 143

nature and formation/ production, 207

Aqueous veins, 207

Arcus senilis and juvenilis, 115 Argon laser trabeculoplasty, 223 Argyll Robertson pupil, 293 Argyrosis, 85

Arlt's line, 64 Astigmatic fan, 556 Astigmatism, 36

against the rule, 36 bioblique, 36

compound hypermetropic, 37 compound myopic, 37 irregular, 38

mixed, 37 regular, 36

simple hypermetropic, 36 simple myopic, 36

with the rule, 36

Atopic kerato-conjunctivitis, 76 Atropine, 98, 146, 550

Axes of the eye, 27

B

Basal cell carcinoma conjunctiva, 87 lids, 360

Band keratopathy, 115 Behcet's disease, 156 Bell's phenomenon, 357 Benedikt's syndrome, 310 Bergmester's papilla, 253 Berlin's oedema, 406

Beta-adrenergic blockers, 425 Binocular loupe, 544 Binocular vision, 318

anomalies of, 318 grades of, 318

Birdshot retinochoroidopathy, 161 Bitot's spots, 434

Bjerrum's scotoma, 219 screen, 482

Blepharitis, 344 squamous, 344 ulcerative, 344

Blepharophimosis syndrome, 356 Blepharospasm, 355

Blindness

cataract, 446, 452 causes, 445 childhood 447, 452 colour, 303 corneal, 453 cortical, 306 definition, 443 glaucoma, 452 hysterical, 307 magnitude, 444 prevention, 445-457 snow, 111

Blue sclera, 131 Bowman's membrane, 80 Brown's syndrome, 335 Bruch's membrane, 135 Buphthalmos, 212 Burns

chemical, 414 thermal, 415

Burow's operation, 350 Busacca's nodules, 144, 473

C

Calcific corneal degeneration, 115 Campimetry, 482

Canal of Cloquet, 243

Canal of Schlemm, 207 Candidiasis uveitis in, 159 Capsulotomy, 201

anterior, 189 posterior, 202

Carbonic anhydrase inhibitors, 426 Carcinoma

of conjunctiva, 87 of lids, 360-361

Caruncle, 53 Cataract, 170-202

acquired, 175

aetiological classification of, 170 after, 201

anterior capsular, 171 black, 178

capsular, 171 complicated, 181

concussion, rosette-shaped, 405 congenital, 170

coronary, 173 cupuliform, 176 developmental, 170 diabetic, 181

electric, 182

extraction, extracapsular, 185, 187 galactosaemic, 181

implant surgery of, 195 intracapsular extraction of, 185, 187 incipient, 176

intumescent, 177 irradiation, 182 lamellar, 172 mature, 177 metabolic, 181 morgagnian, 177

morphological classification of,170 myotonia dystrophica, 176 nuclear, 178

parathyroid tetany, 181 phacoemulsification, 186, 191 polar, 171

posterior subcapsular, 170 punctate, 173 reduplicated, 171

rosette, 405 secondary, 201 senile, 175

SICS, 185-186, 189 sunflower, 181 toxic, 182 traumatic, 405

treatment of, 174, 183 unilateral, treatment of, 174 zonular, 172

Cataracta brunescens, 178 Cauterisation, corneal ulcer, 99 Cavernous sinus thrombosis, 387 Central retinal artery occlusion,255 Central serous retinopathy, 272 Cephalosporins, 419

Chalazion, 346 clamp, 347, 581

Chalcosis, 410 Chemical injuries, 414

Chemosis, conjunctival, 83 Cherry-red spot, 255, 406, 478 Chiasmal syndrome, 310 Chlamydia, 62

Chloroquine maculopathy, 271 Choriocapillaris, 135 Choroid, 135

Choroidal atrophy, 162 coloboma, 137

degeneration, 162 detachment, 200

haemorrhage, expulsive, 199 melanoma, 163

rupture, 406 Choroiditis, 148 anterior, 149 central, 149 diffuse, 149

disseminated, 149 juxta papillary, 149 syphilitic, 155 treatment, 150 tubercular, 155

Chromatic aberrations, 27 Ciliary body, 134

anatomy of, 134 injury, 404

partial destruction of, 240 tumours of, 165

Ciliary muscle, 135 Ciliary processes, 135 Ciliary staphyloma, 132 Circle of least diffusion, 26

Closed angle glaucoma, 225-231 Coat's disease, 266

Colloid bodies, 274 Coloboma

iris, 137 lens, 204 lid, 342

optic disc, 252 uveal tract, 137 retina, 252

Colour blindness, 303 sense, 17 vision, 17, 303 testing of, 305

Commotio retinae, 406 Concretions, 64, 82 Cones, 250 Confrontation test, 482 Conical cornea, 119 Conjunctiva/conjunctival

anatomy of, 51 chemosis, 83 congestion,83 cysts, 85

degenerative conditions, 80 discoloration of, 85 ecchymosis, 83 examination, 468 hyperaemia, 83

oedema, 83

pinguecula, 80 pterygium, 80 tumours, 86 xerosis, 84, 434

Conjunctivitis

acute haemorrhagic, 69 acute serous, 69 allergic, 73

atopic, 76 angular, 61 bacterial, 55 chlamydial,62 follicular, 69 giant papillary, 77 granulomatous, 79 inclusion, 68 infective, 55 membranous, 59 muco-purulent, 56 phlyctenular, 77 purulent, 58

pseudomembranous, 60 simple chronic, 60 vernal, 74

viral, 68

Consensual light reflex, 291 Contact dermo-conjunctivitis, 79 Contact lenses, 44

Contusional injuries, 403 Convergence

insufficiency, 321 near point, 323

Corectopia, 137

Cornea/corneal abrasion, 404 anatomy, 89

congenital anomalies, 91 degeneration, 114 dystrophies, 117 epikeratophakia, 32 examination, 470

facet, 122 fistula, 97 guttata, 118 inflammation, 91 keratoplasty, 124 leucoma, 121 macula, 121 nebula, 121 oedema, 121 opacity, 121 perforation, 97

physiology, 13, 90

sensitivity, 471 staining, 472 vascularization, 122 xerosis, 434

Corneal ulcer, 92 bacterial, 92 complications, 97 dendritic, 102 fungal, 100 healing, 94 hypopyon, 96 marginal, 99 Mooren's, 109 mycotic, 100 perforation of, 97 serpiginous, 109 treatment of, 97 viral, 101

Coronary cataract, 173 Cortical blindness, 306 Corticosteroids, 428 Cover test, 322, 327

Craniofacial dysostosis, 383 Craniosynostosis, 383 Cross-cylinder, 555 Cryotherapy, 431 Cryptophthalmos, 343 Cupping of disc

glaucomatous, 216 physiological, 216 Cupuliform cataract,176

Cyclitis, 138 Cyclocryopexy, 241 Cycloplegia, 550 Cycloplegics, 98, 146, 550 Cyst,

conjunctival, 85 tarsal, 346

Cysticercus in conjunctiva, 86 Cystoid macular oedema, 200, 273 Cytomegalovirus retinitis, 160, 253

D

Dacryo-adenitis, 375 Dacryocystectomy, 376 Dacryocystitis, 369-375 Dacryocystography, 368 Dacryocystorhinostomy, 372

conventional, 372 endonasal, 373

Dacryops, 376 Dalen-Fuch's nodules, 413

Dalrymple's sign, 391 Day-blindness, 303 Defective vision

causes, 462 Degenerations

conjunctival, 80 corneal, 114 macular 264 retinal, 269-272 uveal tract, 161

Demyelinating diseases, 310 Dendritic ulcer, 102 Dermoids

conjunctival, 86 orbital, 393

Dermo-lipoma, conjunctival, 86 Descemetocele, 97

Descemet's membrane, 90 Detachment of

cilio-choroid, 200 retina, 275 vitreous, 244

Deuteranopia, 305 Development of eyeball, 5-11 Deviation,

primary, 331 secondary, 331 Devic's disease, 310

Diabetic cataract, 181

retinopathy, 259 Diffraction of light, 27 Dilator pupillae, 134 Diplopia, 320, 331, 333, 463 Disciform

degeneration of macula, 264 keratitis, 103

Distichiasis, 342

Doyne's honeycomb dystrophy, 478 Dry eye, 365

Duane's retraction syndrome, 335 Duochrome test, 556 Dystrophies

corneal, 117 retinal, 268

E

Eales' disease, 254 Ecchymosis, conjunctival, 83 Ectopia lentis, 202, 204 Ectropion of lid, 351-353

cicatricial, 351, 353

paralytic, 352, 353 senile, 351, 352

Electromagnet, 411 Electro-oculography, 489 Electroretinogram, 488 Elschnig's pearls, 201 Emmetropia, 28

Encephalofacial angiomatosis, 285 Endophthalmitis, 150 Enophthalmos, 383

Entropion, 348-351 cicatricial, 349 congenital, 349 senile, 349 spastic, 349

Enucleation, 284

Epicanthus, 342

Epidemic keratoconjunctivitis, 70 Epikeratophakia, 32

Epiphora, 12, 367

Episcleritis, 128

Errors of refraction, 28-39 astigmatism, 36 hypermetropia, 28 myopia, 32

Esophoria, 321

Esotropia concomitant, 325 Evisceration of eyeball, 154 Examination of eye

anterior chamber, 472 conjunctiva, 468 cornea, 470

external eye, 466 field of vision, 481 fundus oculi, 477 iris, 473

lacrimal apparatus, 467 lens, 475

lid, 467

oblique illumination, 543 pupil, 473

sclera, 470 slit lamp, 544

Excimer laser, 47 Exophoria, 321 Exophthalmometry, 381

Exophthalmos (Proptosis) 379 bilateral, 381

endocrinal, 390 pulsating, 381 thyrotoxic, 391 thyrotropic, 391 unilateral, 380

Exotropia, concomitant, 326 Exposure keratitis, 108 Eyeball

anatomy of, 3 development of, 5-11 dimensions of, 3

Eyebanking, 456

Eyecamps, 455

F

Faden operation, 335

Far point of eye (punctum remotum), 41 Farnsworth-Munsell test, 305 Fasanella-Servat operation, 358 Favre-Goldmann syndrome, 271

Field of vision, 481 Fincham's test, 228 Fixation, eccentric, 328 Fleischer's ring, 119 Fluorescein angiography, 487 Fluoroquinolones, 420 Fogging method, 556 Follicular conjunctivitis, 69 Foreign body

chalcosis, 410 diagnosis, 410 extraocular, 402 intraocular, 408 removal, 411 siderosis, 409

Form sense, 16 Foster Fuch's spot, 34 Fovea centralis, 251

Foville's syndrome, 310 Fuch's corneal dystrophy, 118 Fuch's heterochromic

iridocyclitis, 160 Fumigation, 586 Fundus

examination, 477

posterior fundus contact lens, 568

G

Galactosaemia, cataract,181 Giant papillary conjunctivitis, 77 Glaucoma,

absolute, 231

acute congestive,229 aphakic, 234 capsulare, 234 chronic simple, 214

closed angle, 225-231 congenital / developmental, 212 infantile, 211

inflammatory, 145, 233 juvenile, 211

medical treatment of, 222 neovascular, 234

normal tension, 224 open angle, 214 operative treatment, 237 phacolytic, 181, 232 phacomorphic, 181, 232 pigmentary, 234

post-inflammatory, 145, 233 primary, 214-225 secondary, 231-237

steroid induced, 235 Glaucomatocyclitic crisis, 160 Glioma, optic nerve, 394 Goldmann three-mirror contact lens,546

Gonioscopy, 546

Goniotomy, 213

Gonorrhoea conjunctivitis, 58, 71 Granulomatous

conjunctivitis, 79 uveitis, 141, 147

Grave's ophthalmopathy, 390

H

Haemangioma choroidal, 162 lids, 359-360 orbit, 393

Haemorrhage choroidal, 199 expulsive, 199 subhyaloid, 264 vitreous, 246

Halos cataract, 178

glaucoma, 228 Hamarlopia, 303

Hand-Schuller-Christian disease,397 Hassal-Henle bodies, 115

Head injury, ocular signs, 310 Hemianopia, 290

binasal, 290 bitemporal, 290 homonymous, 290

Hering's law, 316

Herpes simplex, 101

Herpes zoster ophthalmicus, 103, 159 Hess screen, 333

Heterochromia iridis, 137 iridum, 137

Heterochromic iridocyclitis, 160 Heterophoria, 321 Heterophoria, 321

esophoria, 321 exophoria, 321 Histiocytosis-x, 396

Hordeolum externum, 345 internum, 347

Horner's syndrome, 356 Hruby's lens, 568 Hutchinson's pupil, 311 Hyperlacrimation, 367 Hypermetropia, 28 Hypertensive retinopathy, 257 Hyphaema, 199, 404 Hypopyon ulcer, 96 Hysterical blindness, 307

I

Idoxuridine eye drops, 421 Inclusion conjunctivitis, 68 Infantile glaucoma, 211 Inflammations of

conjunctiva, 54 cornea, 91 orbit, 384 retina, 253 sclera, 128 uvea, 138

Injuries, ocular chemical, 414 choroid, 406

closed globe, 401, 403 contusions, 401 cornea, 404, 408 electrical, 416

globe rupture, 407

iris and ciliary body, 404 lens, 405, 408 mechanical, 401

open globe, 401 optic nerve, 407 perforating, 407 radiational, 416 retina, 406

sclera, 404, 408 thermal, 415 vitreous, 406

Instruments, ophthalmic, 573-584 Intraocular foreign bodies, 408 Intraocular lens implantation, 195 Intraocular pressure, 208

measurement of, 476, 479 Iridectomy, 589

for glaucoma, 237 optical, 122 technique of, 237

Irideremia (Aniridia), 137 Iridocorneal endothelial syndrome,237 Iridocyclitis, 141

acute, 141 chronic, 141

granulomatous, 141, 146 heterochromic, 160 hypertensive, 145, 233 purulent, 150

Iridodialysis, 404 Iridodonesis, 31, 204, 473 Iridotomy, laser, 237, 431 Iris

anatomy, 133 anti-flexion, 404 atrophy, 161 coloboma, 137 colour, 473 examination, 473 rupture, injury, 404 tumours, 166

Iritis, 138

Irradiation cataract, 182 Ishihara pseudo-isochromatic

charts, 305

J

Jaeger's test types, 466 Jaesche-Arlt operation, 350 Jaw-winking synkinesis, 356 Jones dye test, 368

Juvenile chronic arthritis uveitis in, 157

K

Kaposi's sarcoma, 437

Kayser-Fleischer's ring, 410

Keratectasia, 122

Keratic precipitate, 142, 464

Keratitis, 91-114