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PaS*

128

To prevent ciliary spasm

4.
5.
6.

7.
8.

To prevent synechiae
NSAIDS * Antacids: for pain-10 to 14 days
Promotion of re-epithelisation by

Application of lubricants
: Lid closure by taping/bandage contact lens/tarsoraphy
Prevention of esrneal perforation: by application sf
Sinoacrylate glue or
Coniunctival flap, hooding (helps in healing as its vascular & also prevents
perforation).
Keratoplasty.
Follow up: after 7 days. Advice: use dark glass * avoid water enffy. Treatment
continues for 4-5 weeks.

Q36. ttUhot are the principles of monogment of virot ulcer? Or, Tell the pr{nciple

monogement of virol kerotitia or dendritic kerotitis.
Ans:
1. Antiviral Drug:
Acyclovir ointrnent 3Vo: S times daily for 14 days.
OralAryclovir: maybe added (1tab 4 times dailyfor 5 days)
Ganciclovir
Foscarnet

2. Atropine (1%) or homatropine (2Vo) eye drop 2-3 times daily.
3. Debribementofulcer
4. Improvement of the general health
5. Topical Antibiotic drop - to prevent secondary bacterial infection
6. Artificial tears
7. Use darkglass.
Symptoms of viral keratitis:

a) Redness & foreign body sensation
b) Watering of the eye (most common)
c) Photophobia Qight inrolerance)
Signs of viral keratitis:

a) Opaqtre epithelial cells arrangement as coarse punctate pattern.
b) Linear brunching pattern ulcer (dendritic)

of

Q. 3?.What

ir the principle of treotment of fungcl kerctitis?

Answer:

L.
2.
3.

Scraping & debribement of the ulcer.
Atropine eye ointment 3 times daily
Antifungal drugs(a) Topical - 5Yo natamycin eye drop t hourlywith orwithout ointment
(b) Systemic -if the ulcer is deep, marginal or perforated. Tablet ketoconazole
or fluconazole for 2-3 weeks maybe tried.
4. Cauterization of the ulcer may be done in nonresponsive cases.
5. Therapeutic full thicliness keratoplasty (lamellar)
6. Antibiotic eye drop may be given to prevent secondary bacterial infection.
Advice:
To avoid contact of eyes with water.
To wear dark glasses.
Q.38. Superficial foreign body in cornea.

Howwill you manage?

Answer:
\#ash
Surface ana*sthssia {{}.4s6

"ayUupr*cain*}

't

26 G needls- Scrap the cornea; if fails

$
Remcve the f*r*ign bcdy hy f*reign bcdy spur
J,

* pressure

bandage+ antihiutic drop
$
Hyc pad rf,rrlsved after Z4h*urs and keep F*IIaw up
Eye pad

'ttta',..t,,,
'

Advice: dr*ps & *ir:tment, artifficial tear

Clini*al features cf for*ign b*dy in ey*:
1. Irritation or fareign body sensation
2. Watering of eye
3" Redness of eye

,s.

Pggs

llo

Examination of eye wittr slit lamp microscope to see any erosion or tarsal conjunctivitis

Ulhat ore the signs of ocute onterior uveitis & its Eeoment?
Answer:
Q.39"

Signs:

1.
2.
3.

Decreased visual acuity

Swollen eyelid

Ciliarycongestion
4. Presence of keratic precipitates in the corneal endothelium
5. Presence of aqueous cells and flare in anterior chamber
6. Pupil constricted and irregular
7. IOP may be normal, decreased or increased
Treatment:
1. Topical steroids to reduce inflammation: prednisolone, dexamethasone,
betamethasone. 6hourly or t hourly depending on swerity.
2. Mydriatic & cycloplegrc = phenylephrine * homatropine
Atropine 1oz6
3. NSAIDs: Diclofenac orindomethacin; when steroids are contraindicated
4, Immunssuppressive agents: eyelosporine, azathrioprine
5. TreaBnentof complications if any.
Uveitis: inflammations of the uveal tract
Classification:
1. Anatomical classification:
(a) Anterior uveitis: iris & anterior part of citiary body (iritis, cyclitis,
iridocyclitis)
(b) Intermediate uveitis: posterior ciliary body & extreme peripheral part of
retina * underlying choroid
(c) Posterior uveitis: choroid * retina (choroiditis * retinochoroiditis or

chorioretinitis)

Z.

3.

(d)Panuveitis: whole uveal tract
Clinical classification:
(a)Acute uveitis ) sudden,s)rmptomatic onset, persists upto 3 months
(b) Chronic uveitis * insidious,asymptomatic onset, persist longer than 3
months (acute and sub-acute exacerbation)
(e) Reeurrent uveitis ) inflammfltqn following initial attaek
Aetiological classification:
(a) Idiopathic nonspecifrc - 2596
(b) Idiopathie speeifie i. Fucfis heterochromic cyclitis
ii. Sympatheticophthalmitis
(c) Associated wittr systemic disease -Sarcoidosis

d

=

4.

(d) Infection i, bacteria - Tuberculosis
ii. virus - Herpes zoster
iii. fungi - Candidiasis
{e} Infestation - Tcxcplasm*sis, Tox*cariasis
(f] Lens-induc*d
(g) Direct spreaC i. Cornea - deep keratisis
ii" sclera - scleritis
iii" retina - retinitis
(h) Infucticn ficn: other parts
i. sinusitis, t*nsilitis, *titis
accsrding t* routes:
{a) End*gensus * micro-orga*isrns from within the patiemt
(b) Exogenous ) external injury to uvea or micro organisqftom outside
t!:,e:

5"

Patholcgicatr classificatiCIn:
(a) firanulomatous - TB, sarc*id*sis, leprosy
{h} Non-granuloxratuus - idispathic, allergic
rftrres *f acute
as:rfc anteri*r
enfpri*r uveitis:
uvpifis:
Clinical features

Symptoms:

3., Rectness *f eye

2.
3"

4.
5,

Pain in eye
Watering *f eye
Photophcbia
Simness cf visiCIn

l,r:.'..*

:iir:,

Signs:

3.

Presence sf keratatic precipitates

4,

7,

norffial /increased/ decreased
Inyestigati$ns of AAU:
1. tslood ccunt
Seral*gica} *RF, ANA,HLA BZT
3. Xray chest & Iurnbar spine
4. MT
Fate *f AA#:
1-" Chronic uveitis
Z. Ccmplicated cataract
3. Posteriar slmechia
4" Scclusion pupitrlae

2*

,

,.

IOP

ri.

' iiji'
il:a}.j-+'
-'::i.-"

P*ge

132

4. Occlusion pupillae
5. Seclusion pupillae
5. Iris bombe
7. Ciliaryshutdown
8. Phthisis bulbi (shrinkage of eyeball)
Q.40. trl/hen

cctoract surgerg indicoted?

Answer:

1.
2.
3.

To improve the vision ( if it hampers the daily activities)
For cosmetic purpose

Prevention of complication like phacolytic, phacomorphig phacoanaphylactic
glaucoma or uveitis)
4. In retinopathy, for further evaluation (angiogram, fundus photography),
vitreoretinal diseas e (vitreous hemorrhage, D M retinopathy, retinal
detachment), removal of cataract is necessary
Cataract surgery done to preserse the depth perception and ability to do fine work.

what complicotion moy arise after operation in o hgpermcture cqtarsct?
Answer: Posterior capsular opacity as the zonula is weak the capsule's weak too.
To check for vision after cqtoroct operotion?

Answer:

L. Macula function

test:
(a) Visual acuity
(b) Two point discrimination
(c) Madox rod test
(d) Color vision
2. Optic nerue function test:
(a) Light reflex test (pupillary reaction)
(b) Perception of light
(c) Projection of ray
Components of biometry:
* Keratometry: to measure the corneal thickness or
(d) Color vision
curvature.
Investigations of cataract:
*
A
scan: to measure the
of the eyeball.
L. Ocular investigation:
{a} Bismetry ts calcul ate ttre power of the intraocular lens.
{b} B scan fsr asse$sment af retina & vitresus.
{c} Tonomeffy t* measure the IOP.
{d} Specular microscspy to count the correal endat}reliurn cell.
2. General investigations:
{a} Slasd sugar
{b} Hamoglobin Are
What is axial length, It is the anterioposterior
diameter of the eyeball.

Tgpes of cataroct surgerg:

A) Intracapsular
B) Extracapsular

cataract extraction: Lens with its capsule is removed
cataract extraction: Lens removed but capsule retained.
(a) Large incisional/ conventional method
(b)Small incisional method: Incision 6 mm
(c) Phacoemulsification:

*
*

I

Incision2.4-3.2 mm in case of foldable lens,
Incision 5.5 mm in case of solid lens.

ntracapsular cataract extra*tion Merits:
(a) Simple
(b) Quick
(c) Cheap
(d) As eapsule is removed no posterior capsular opacity is developed,
less chance of uveitis, secondary glaucoma due to lens particle.
Demerits:
(a) Can not be performed safely on patients under 35 years of age
(b) Posterior chamber IOL implantation is impossible
(c) Vitreous related anterior chamber problem is higher e.g pupillary
block, delayed wound healing, endothelial decompensation
glaucoma.
(d) Postoperative cystoid macular edema is higher.
(e) Postoperative (aphakic) retinal detachment is higher.
(f) Comealastigmatism is more as the limbalsection is larger

*

Extracapsular cataract extraction:
Merits:
(a) Posterior charnber IOL implantation is better.
(b) Decrease chance cystoid macular edema due to intact posterior
capsule.
(c) Decrease chance of pupillary glaucoma & retinaldetaehment.
(d) Chances of vitreous loss is very minimal.
(e) Vitreous related anterior segment complication less.
Demerits:
(a) A difficult microsurgical techniques.
(b) Costly and takes time to master.
(c) lridocyclitis & glaucoma due to lens particles are common.
(d) Opacification of the posterior capsule is more common.
(e) Can not be done in dislocation & difficult in sublaxation of the
lens cases.

*

ry
PaSe

134

Phacoemulsification:
Merits:
(a) Suture less surgery
(b) Rapid healing
(c) Short convalescence period
(d) Early stabilization of refraction with minimum or no astigmatism
Demerits:
(a) Difficult procedure
(b) Expensive
(c) Difficult to perform with white nuclear rmature cataract, grade 4+ cataract
(d) lncrease complications with beginners.

*

*

fi*emBlf,cmti#sls *ff cmt#r#ffi sffir#*rg:

A)

B)

trntraoperative:
1. Posterior capsular tear
Z. Vitreous prolapse
3. Lens drop
4. Expulsive hemorrhage due to choroidal hemorrhage.
Postoperative:
L. Early postoperative:
(a) Straite keratopathy
(b) Hyphema
(c) Iris prolapse
(d) Endophthalmitis

PaSe
(e) Postoperative secondary glaucoma
(f) Postoperative uveitis
(g) Retained lens matter

L.
-

f

------L!--pos[operaLrve:
Lare
(a) Posterior capsular opacification
/L\
f,*^!-:l
^ )-.-^
---l-lrri{uural
trucrrra
tuJ rrySLUru --^
{c} H,etinal detachment

iei Crrneal enduthelial dstsirip*nsatiait
Hxsrninstion done to dins$o$i$ c{rtcr{rct:
Visuai acuity
Slit lam,p sx#$.,inati r;n
Refracti*n
Macular furrctifin test

Exsmination before cstoroct surgerg:
:t:

a::..:.;,,:.'::;.,,,.
t::l;'i;,;:1;j:,:,,.,

Visual acuity
flllrt,:-,,.',.:-.
'*.:- ::::
J.:: '-.r-.-I
$rrr rarrltr] exarurllatrLlrl
ISp
Fundus sxaminatian
Sac patency test

i..ia:i!ri:l.i.a'l
,.;,...,1ii

'"1:tat...:
.:r.::::

.r;.-:,:;

*
*
*

n pati*nt can after operatisn.

s

B scan is done

f;ata

*
*

ry will do
lt,ira'

smgsrywill d*

s<

'*-f

**!'-!-*

*.o

t}r \rr5l#fi
X*pia or pstypia
ss
**
f,***&
Er?.*F
^.f
t"rltt {Jr
Irt tr
EysI}

af catsrsct:
{a} Co}*r *f lens: gre}rish/ Fearl}rl rnill{f rnrhite
{b} Iris shad*w
{c} Fundal glow
{d} Purkinje's images

lSS

i'';

page

lA6

q&Lllfhot are the ecusesof csngenital cotoract? Tell the principles of monagement
of congenital catoract.
Answer: Ccuses of congenitol cotoroct
1. Idibpathi'c
2. Isolated hereditary cataract
3. ehromosomal abnormalities- Down syndiome, Edward's s5mdrome,
Patau's sSrndrome
4. Maternal infectian: Rubella CbIV, toxoplasma

ffiaternaf mainurritio ns
6. Metabolic disorders: galactosemia Salactokinase deficiency
7, Toxic:
* Srugs: colticastersids
t Radiaticn
B. Ocular diseases: Aniridia anterior sesment
5.

Priciples of msnagenrentof congenital c*tarcct:
Diagnosis;
.:i History:

.1.

Symptoms:

White spot or multiple tiny

{,b Sigms:
of accommodation reflex

that stimulus deprivation amblyopia can prevent

.

Unilateral partial cataract: obseruation

For children aged 2 years & above IOL is given but age below two years IOL is not
advocated
Surgical techniques: Extracapsular cataract extraction with posterior capsulorhexis &

anterior vitrectomy + PCIOL
Visual rehabiliation in children after cataract surgery:

t.

Definition of cotoracc opocitg of htrman crgstolline lens or its copsule either
congenitol or ccquired irrespective of the etrec.on vkion
Classifications of cataract:

A)

1.
2.

Etiological classification:
Congenital cataract
Acquired cataract
(a) Senile cataract
(b) Secondary cataract (due to some systemic disease)
Diahet*s ffi*llitus
Hypccalcaer*ia

My*t*nic dystr*phy
At*pic derrnatitis
(c) Complicated cataract {due t* s*m* other frcular dissase}
Antericr urreitis
High myspia
R*tinatr deta*hment

Mecha*ical

t*d wi& fataract

Z, Mature cataract
C) Morphabgical classification:

t.

Acquired:


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