 These are the slides that dr.yasser al-faki revises every cycle, if you memorize & understand them, you will have no problem identifying & answering most of the O.S.C.E. Questions.

 The exam is formed of 20 stations , Each has 1 photo with 1 M.C.Q. that you have to Answer in 1 minute.

 It’s not as hard as it sound if you give it the time to see these slide again & again.

 GOOD LUCK

 Lower Lid Ectropion (cicatrical) N.B. Involutional is the most common cause Tx: Release the Scar or Graft Complication : Exposure Keratitis.

 Arcus Senalis

 Upper Lid Entropion & 2ry Trachiasis Most common cause is Trachoma (Cicatrical) Involutional Entropion Never Affects the Upper lid Rx: Sugery

 Stye (External Hardiolum) : Inflamation of the Upper Lid With Pus Formation Tx: Antibiotics + Drainage + Remove eye lashes + Hot Compressors.

Painless Swelling of the Lower Lid with pus formation  Chalazion (Meibomian Cyst) Common Tx: Surgical Evacuation NO ANTIBIOTICS (it is Sterile) If Recurrent : Think of Tumer of the Gland N.B. AcuteChalazion = Internal Hardiolum

Painless Swelling for 1 year Then regressing

 Capillary Haemagioma No Tx unless there is obstruction of vision wich may lead to amblyopia (Give intralesional long acting steroid).

 Aggressive Tumer in a 70 y.o. patient Melanoma (Usually black color) Metastasize Early Tx: Ramoval or at least Debulk.

 Medial Rectus → No  Superior Rectus → No   Levator Palpepre Superioris → No

3 rd Nerve Palsy (Occulomotor) Right Side



Tx: if there is involvment of the introcular muscles → Surgical Tx.

-If not → medical

 Lareral Rectus → YES  Inferior Rectus → No

 Bilateral Severe ptosis (With compensatory chin left) congenital  Tx: Depends on the Levator Function : If ok then resect (shorten) If severe use a graft (Fascia lata) Time of Tx is after 1 year if bilatral but before 2 years to prevent C-spine deformety (becase of the constant chin lefting) If Unilatral → Amblyopia

 Flurocena Dye (Green) Uses : 1- Corneal Abrasion/scar 2- Tear film → Lacrimal system assesment.

3- I.O.P.

4- Detect Leaking.?

 Dentritic Ulcer (Herpetc Keratits)  Caused by HSV, HZV & Tyrosinemia  Tx: Antiviral (Acyclovir)  NEVER GIVE STEROIDS (Sarhani notes page 91)

 Corneal Ulcer Stained by Flurocene + Entropion & 2ry Trichiasis  Tx: Tx Entropion 1 st Scraping the ulcer for a sample Embirical Broad spectrum Antibiotics (Cipro) (Topical) Because the cornea is avascular -NEVER GIVE STEROIDS in corneal Ulcer with infection

 Slit lamp examination showing very shallow anterior chamber. Iris touching the cornea  After glucoma surgery? : Trabelectomy  Mesure I.O.P. : if low → Leak or over drainage If high → Malignant Glucoma

 Rose Bengal Stain : Kerato conjectivitis Sicca = Dry Eye Syndrome  Why Not to use Flurocene?: Becaue it is hydrophilic & the epithelium will take hydrophobic (rose Bengal) so, -Dentritic : if infected →rose Bengal ?

-If desquamated → Flurocene

 Swelling with tightly closed eye in a child  DDx: Angiorretic edema Preseptal cellulites → Give Antibiotics.

Cavernous Sinus Thrombosis (bilateral)  Orbital Cellulitis  Tx: Admetion I.V. Broad spectrum antibiotics.

Temperature Chart.

CT Scan

 Orbital Cellulitis

 Orbital Cellulitis:??

 Signs: Connectival injection.

Disharge seen near the lowr lid.

Protrusion.

Hx of: Fever , Sinusitis, Very ill patient

 Rt. Orbital Cellulitis.

 Unilateral (Left) Proptosis & Lid Retraction (most common cause in adults is Dysthyroid)  Tx: Treat the thryoid. Thyroid Function & CT are the most important investigations

 Exophthalmus

 Exophthalmometer

 In Any Retinal Slide , You have to see & comment on the following:

Optic Disc :

Atrophy?, Cupping?, New Vessels?.

Is there any Exudate?

The Macula :

Is there any Lesion?

The Retinal Background :

Hemorrhages?

Is There Any

Veins :

Congested?, A-V Crossing?

Is there any

Vitreous Hemorrhage

? ( the wool picture would be blocked by it)

 Non-Prolifarative Diabetic Retinopathy (No New vascular Formation) Tx: Focal Laser (Not Sure?) Hard Exudate.

Congested Veins. Heamorrages

 Proliferative Diabetic Retinopathy.

Fan-shaped New Vascular Formation Around the Disc Tx: P.R.P. (Pan Retinal Photocoagulation).

 Vitreous Heamorrage -Tx: Vetrotomy & P.R.P.

-But In Type II DM ; we can wait for 3/12 because it may resolve spontaneously.

 Post-P.R.P.

 Disc Cupping: Chronic Open Angle Glaucoma. Most likely Primary.

- In Closed angle Glaucoma: there is no time for cupping to develop.

 Optic Nerve Edema.

Exudates.

Cotton wool.

Blurring of optic disc (you can’t say where the disc ends & the Retina Starts).

Flame-Shaped Hemorrhage.

 DDx:

Optic Neuritis

: (↓ Visual Acuity) Systemic Steroids? , HTN, ↑ I.C.P., Nutritional, Syphlis.

Papilledema

: BILATERAL, 2ry to ↑I.C.P. With Enlarged Blinad Spot.

 Papilledema: Same Previous Picture but Bilateral.

 Optic Nerve Edema: (With Marked Venous Congestion).

Hemorrhages.

Cotton Wool.

The Same patient of the previous picture; with ↑↑ E.S.R. & Hx of Headache

 Giant cell Arteritis (Temporal Arteritis).

These Engorged Vessels are sign of poor prognosis.

We must Give High Doses of Systemic Steroids to Preserve the other eye but not to treat this eye.

 Central Retinal Artery Occlusion.

Severe Loss of Vesion, Poor Prognosis.

Segmentation of the Blood Vessels & Marked Edema with Chari-red spot Ischemia of the inner 2/3 of the retina (White/Yellow color) But the Fovia is preserveed (Supplied by the choroidal artery)

 Flame-Shaped Hemorrhage but without Cotton wool, no Exudate.

 HemiRetinal Vein occlusion (Branch).

Tx: Observation & Medical Assesment.

Complications: the most serious is New vessels formation → Neovascular Glucoma.

So, If anyNew Vessels = P.R.P.

 Robiosis Iridis. (new Vessels in the iris) Complicated by neovascular glaucoma.

Tx: By Treating Retina Ischemia & P.R.P. if Any New Vessels.

Cataract???????

 Regmatogenous Retinal Detachment.

Because of the U-shaped (Horse-shoe) Tear The macula is still intact but may detach soon. (Emergency)

25 y.o. female with depigmentation of the eye lashes, eye brow (poliosis) , vitiligo & Hearing loss  V.K.H. disease She will also have : Uveitis & Exudative Retinal detachment.

 Vitiligo

 Macroglossia → Acromegally → Pituitary Tumer→ Chiasmal Lesion →

Bitemporal Hemianopia

 Confrontation Test : Visual Field testing method.

 Pinhole Test : If improve → Refractive error

 Regmatogenous Retinal Detachment - U-shaped Tear

 Optic Disc Atrophy : Milky white optic head ) سمش (

Conjunctiva

 Identify the area of maximum Injection.

 Usually starts Unilateral then become Bilateral.

 Conjunctivitis: Bacterial : Purulent or Mucoid Discharge.

Viral Watery Discharge.

Allergic: Watery then Mucoid, Asymptomatic or itching.

Follicular conjunctivitis is Caused by: 1- Viral : Preauricular L.N. involvement.

2- Active Trachoma : Most common.

3- Medication side effect.

 Bacterial Conjunctivitis: - Red conjunctiva & Mucopurulent.

 Viral Conjunctivitis: - Watery & L.N.?

 Active Trachoma (Follicular Conjunctivitis).

Tx: Oral erythromycin…etc.

Complications: Entropion , Corneal Scar/Ulcer.

 Injection Around the Limbus.

 DDx: Anterior Uveitis (Iritis) Keratitis.

Acute Angle closure Glaucoma.

 Injection around the limbus.

 Iritis: Pain, photophobia, blurred vision, Redness.

 Tx: Topcal Steroids.

 If posterior uveitis : Systemic Steroids.

 Iritis =Iridocyclitis =Anterior Uveitis.

 NOTE THE HYPOION (Pus or cells in the Ant. Chamber) Which requires Tx.

In uveitis we will see in the Ant. Chamber: 1- Cells.

2- Flare.

3- Keratic precipitate.

 Slit lamp Examination Showing Keratic Precipitates in the posterior corneal surface. (UVEITIS).

 Hypopion + Marked Conjucival njection = CORNEAL ULCER Flurocene to confirm & Corneal Scrap (Sample).

Tx: Antibiotics (Topical) + Cycloplegics & Patch (Don’t patch without antibiotics)

Hx of Trauma (Punch)

 Sub-conjuctival Hemorrhage.

Asses visual acuity & eye movement. If ok → Reassure the patients (Usually resolve in 2-3 weeks) If Visual acuity or eye movement not ok → consider blow out fracture

 Allergic Seasonal Conjunctivitis + Tranta’s Spots → Vernal Keratoconjuctevitis.

Itching, Watery then Mucoid.

We used to give local steroids But now we give Antihistamines.

 Cobble-Stone Appearance (Giant Papilla): Severe Vernal K.C. (Papillary).

If mild → no Tx.

If severe → Short term steroids then Antihistamines + Mast cell Stabilizer

 Laser Iridotomy.

In angle Closure Glaucoma.

Note the ECLIPSE sign. ( Sign of a shallow Ant. Chamber) .

راسيلا ىلع لظ سوق + نيميلا ىلع ءوض سوق

 Episcleritis.

 Manson’s Sign.  KERATOCONUS.

 Mopes. Steep?

 Associated with V.K.C.& Atopic Dermatitis.

 Tx: Hard Contact lens or KERATOPLASTY.

 N.B. LASEK is CONTRAINDICATED.

 Deep Ant. Chamber.

 Mature Cataract. If the Age of Patient is 70 y.o. → Senile If the age is 30 y.o. → Presenile: DM, Steroids, Trauma, Atopic dermatitis.

If 2 y.o. → conjenital Cataract : TX as soon as possible to prevent Amblyopia.

 ??

 Cataract + Atopic Dermatitis.

 Post-Iredectomy (Cataract)

 Sumluxated lens (SuperoTemporally)→ Marfan’s Syndrome

 Anterior Dislocated Lins.

 Leukocaria in a child.

- It Should be Considered RETINOBLASTOMA until proven otherwise.

 Cataract.

 Buphthalmus (Rt.) = Congenital Glaucoma.

 Pseudostrapismus. (large epicanthal fold (

 Left esotropia.

Exclude Retinoblastoma (20% presents with Strabismus) Tx: Surgery. Reset the medial rectus & resect the Lateral rectus.

 Right esotropia.

 ?????????

 Accommodative Right Esotropia. Corrected by glasses.

 Left Exotropia.



Right 4

th

Nerve palsy.

 If you Are Told that this Child Is looking Forward, Then the Dx Would Be:  Alternating Strabismus.

 But if you Are told That she is trying to look to the left :  Right 6 th Nerve Palsy.

 Duan Syndrome?

 Iridectomy

 Posterior Synechia (Irregular Pupil)

 Hyphema (Blood in the Ant. Chamber)



Ptyrigium.

- Tx if Extending to the cornea (Excision)

 Acute Dacryocystitis.

Tx: Antibiotic (Systemic & Local) Drainage DCR (Dacriocystorhinostomy) after elemination of the acute phase.

 Chronic Dacryocystitis. (Pus come out with pressure on the sac)

 Marcus-Gun Jaw Winking Syndrome.

- Stimulation of the ptyregoid activates the lavator palp. Super. Of the same side.

 Posterior synechia.?

 Exophthalmus + Lid Retracion.

Comlications: 1- Exposure Keratitis.

2- Compression on the Optic Nerve.

Examine Color vision, Visual Acuity, Pupellary Reflex, Fundus Investigations: TSH T3 & T4 + CT scan (to see the size of the Extra occular muscles).

 Ptosis.

 DDx: Horner’s Syndrome (mild Ptosis, Myosis & Anhydrosis) Mysthenia Gravis.

Involutional 3 rd Nerve Palsy (Most Common) Pseudoptosis Due to Lack of support (Artificial eye) Trauma.

 Bilateral Senile Ptosis.

 Post-Peripheral Iridectomy.

 Basal cell Carcinoma (Rudent Ulcer)

 Ptergium with Corneal Involvement.

 Indications for Surgery: 1- Decreased Vision.

2- Cosmetic.

3- May predispose to Keratopathy.

4- Astigmatism.

5- Decrease function of extraocular muscles.

 Unilateral Ptosis.

 Marcus-Gun Jaw Winking Syndrome.

 - Stimulation of the ptyregoid activates the lavator palp. Super. Of the same side.

 Morgagnian Cataract. (Liquefaction of the Cortex + Neucleus is down)

 Iridodialysis. (Trauma) Blurred Vision Mono-ocular Diplopia? Cataract?

 Blow-out fracture

 Blow-out Fracture:  Ptosis.

 Hematoma.

 Blurred vision.

 Dipopia on looking up (Due to Entrapment of the inferior Rectus)  Enophthalmos.

 Tx:  Systemic Antibiotics.& Surgery if Fracture more than 50% of orbital floor & Diplopia not improving or if enophthalmus more than 2mm.

 Corneal Ulcer : Marked conjuctival Injection & Hypopion. → Exposure Keratitis.

 Dermoid Cyst.

Tx: Intralesional steroids.

 Left Ptosis with contra lateral pseudo lid retraction (compensatory).

 Sub-conjuctival Hemorrhage.

 Left Exotropia

 Right Proptosis. Meningioma if the patient is an Adult & Glioma if child ???????

 Orbital Cellulitis.

Admit , I.V. Antibiotics & if there is an abcess → Drain Cavernous sinus thrmbosis may give the same picture but bilateral.

 Ant. Dislocation of the lins.

 Capillary Heamangioma.

 Tx: Long-acting intralesional Steroids.

 Same Patient after steroid therapy.

 DDx: 1- Heamangioma.

2- Cyst.

3- Chalazion.

 Port-Wine Stain. (Naevus Flammeus) Can Cause ipsilateral Glaucoma in 30%

 Entropion? + Arcus Senalis & Pseudoptosis.

 Non-proliferative Diabetic retinopathy.

 Tx: Focal Laser for macular edema.

This patient presented with night blindness

 Retinitis Pigmentosa.

 Corneal Scar.

If the conjunctiva white → inactive.

If Red → Active.

Flurocene to conferm.

 DDx: 1- Cellulitis.

2- Angiorritic edema.

Check slide 22

 Inferionasal coloboma of iris.

 Black red Reflex: Cataract.

Vetrious hemorrhage.

Corneal Opacity.

 Ptregium.

 That’s the end of the Revision Slides.

 The following were not covered by the DOCTOR, but are very important.

 Bilateral Eyelid Edema Due to Herpes Zoster Ophthalmicus

 Anterior Blepharitis with Localized folliclitis.

 Xanthelasma

 Acute Dacriocystitis 2ry to delayed canalization of Nasolacrimal Duct.

 Geographic Ulcer.

Stained with Flurocin.

 Caused by HSV, HZV & Tyrosinemia  Tx: Antiviral (Acyclovir)  NEVER GIVE STEROIDS (Sarhani notes page 91)

 Arcus Senilis.

 Shallow Ant. Chamber.

 Iridodialysis. (Traumatic)

 Optic Atrophy & Vascular Occlusion.

 End Stage Bahçet Disease.

 Retinitis Pigmentosa .

 Bransh Retinal Artery Occlusion.

 Engorgement of Conjectival & Episcleral Blood Vessels in a patient with Carotid-Cavernous Communication.

 Left Dermoid Cyst.

 Bilateral Ectropion.

 Reg. Retinal Detachment.



Primary Herpes Simplix Lesion. ??



Poliosis + Vitiligo = V.K.H. Disease.



Papilloma ????????

 The Same patient In Slide # 79.

That’s All,, GOOD LUCK



yassE.R.