INTRODUCTION TO

OPHTHALMOLOGY
Ophthalmology is the branch of medicine
which deals with the diseases of the eye
and their treatment.
The word ophthalmology comes from the
Greek roots ophthalmos meaning eye and
logos meaning word; ophthalmology
literally means "The science of eyes."
ANATOMY OF EYE
THE ORBIT:
Orbital cavities a pair of large bony
sockets.
Each cavity is pear shaped
Apex directed posteriorly, medially,
slightly upward.
The stalk of pear lying in the optic canal.
Medial wall runs parallel to sagital plane.
Lateral wall diverges to an angle of 45
degrees.
DIMENSIONS OF EYE BALL:
Anteroposterior diameter-24 mm
Vertical diameter-23 mm
Horizontal diameter-23.5 mm
Radius of curvature of ant.segment-8 mm
Radius of curvature of post.segment-12 mm
Anterior pole
Posterior pole
Total volume-6.5 ml
Total diopteric power-58.6 Diopters
Click icon to add picture
OCULAR
APPENDAG
ES:

OCULAR APPENDAGES
LAYERS OF EYEBALL:
OUTER FIBROUS LAYER:
◦ Cornea
◦ Sclera
MIDDLE VASCULAR LAYER:
◦ Choroid
◦ Ciliary body
◦ Iris
INNER NERVOUS LAYER:
◦ Neurosensory retina
◦ Retinal pigment epithelium
 RETINA:
 10 layers-from outside inward
1.RPE
2. layer of rods & cones
3. external limiting membrane(ELM)
4. outer nuclear layer(ONL)
5. outer plexiform layer(OPL)
6. inner nuclear layer(INL)
7. inner plexiform layer(IPL)
8. ganglion cell layer(GCL)
9. nerve fiber layer(NFL)
10. internal limiting membrane(ILM)
EXAMINATION OF EYE
Basic of Examination
 Directed Detailed history
 Physical Examination
Visual Acuity
External Eye
Confrontation of Visual Fields
Pupils
Ocular Motility
Anterior Segment
Fundus
Intraocular Pressure
Visual Acuity
 Snellen Eye Chart
 If pt. wears glasses and are
not available use pinhole
testing.
 If patient cannot read, then
document number of fingers
held up.
 Hand motion at 2 ft.
 If fails hand motion,
document light perception.
External Eye
Examine periorbital
skin and lids for
trauma, infection,
dysfunction,
deformity, crepitus,
proptosis,
subcutaneous
emphysema, and step
off deformities
Confrontation of Visual Fields
Screening starts in
temporal fields.
Ask patient to look in
examiner’s eyes.
Place hands two feet
apart, lateral to
patients ears. Move
slowly and record
when patient
visualizes them.
Ocular Motility
Ask pt. to keep head midline. May require
holding pt. head at times with hand on
forehead.
Moves a finger or use pencil to trace an H
in air midline approximately 2 feet
distance from patients head.
Pause during upward and lateral gaze to
detect nystagmus.
Using the Slit lamp
 A littlehistory:
 Since the 1800s, clinicians have
searched for a better way both to
magnify and to illuminate the
anterior segment of the eye.
 In 1891, Aubert developed the first
true binocular stereoscopic
microscope.
 In 1911, Gullstrand introduced a slit
illuminator device.
 The microscope and the illuminator
were combined by Henker in 1916
 Goldmann improved the mechanical
supports for the microscope and the
illuminator and in 1937
Other slit lamps
 Uses of the Slit Lamp
 Lids and lashes may be inspected for blepharitis and pointing of a lid abscess
(hordeolum). The inner canthus and lacrimal punctum may be better viewed
for evidence of dacryocystitis.  
 The anterior chamber may be examined for cells (e.g., red and white blood
cells) and “flare.”
 Collections of layered blood or pus called hyphema or hypopyon. Graded by
the percentage of the vertical diameter of the visible iris.
 Foreign bodies that have penetrated the cornea may be found floating in the
anterior chamber.
Indications and Contraindications
 Contraindications
Indications
 Patients
Abrasionswho cannot tolerate an upright sitting position
 Foreign Bodies
 Iritis
 Also facilitates FB removal and is also used in
conjunction with most applanation tonometers
Seating and light position
Dendritic lesions in Herpes
Seidel with Leakage
Hyphema
Hypopyon
Other
Conjuntivitis
◦ Generally presents with
mucopurulent discharge
and inflammation.
◦ The cornea is clear
without flourescence
staining.
Trauma
 Examples of blunt injuries
include orbital blowout
fracture, orbital and lid
contusions, iris injury,
ruptured globe traumatic
iritis, subconjunctival
hemorrhage, hyphema--blood
in the anterior chamber,
retinal hemorrhage, commotio
retinae, vitreous hemorrhage,
choroidal rupture, retinal
tears, and retinal detachment.
Severe Inflammation
CATARACT:
SQUINT:
OCULODIAGNOSTICS:
 

 LIST OF INVESTIGATION AVAILABLE IN

AFIO
 

1. OPTICAL COHERENCE TOMOGRAPHY

2. FUNDUS FLUORESCEIN ANGIOGRAPHY 
3. VISUAL FIELDS
4. CORNEAL TOMOGRAPHY
5. SPECULAR MICROSCOPY
6. IOL-MASTER BIOMETRY
7. HESS CHARTING
8. U/S B Scan
9. ANTERIOR SEGMENT PHOTOPGRAPHY
10.NON-MYDRATIC FUNDUS PHOTOGRAPHY
11.ELECTRORETINOGRAM / ELECTROOCULOGRAM
12.VISUAL EVOKED POTENTIAL
13.RETCAM
14.FM 100 Hue COLOUR TESTING
What is OCT?
Diagnostic imaging technique that
examines living tissue non-invasively. It is
based on a complex analysis of the
reflection of low coherence radiation from
the tissue under examination.
Real time cross sectional analysis
OCULAR COHERENCE TOMOGRAPHY

Normal retina Age-related macular

(fovea) degeneration

Macular hole
FUNDUS FLOURESCEIN
ANGIOGRAPHY:
Inner and Outer blood retinal barriers are
key!
Both barriers control movement of fluid,
ions & electrolytes from intravascular
space to extracellular space in retina
FFA – method of examining competence
of blood retinal barriers and making
permanent record
Fundus Fluorescein Angiography
FFA is photographic surveillance of the
passage of fluorescein through retinal and
choroidal circulation
Fluorescein
◦ Orange water soluble dye
◦ 70 – 85% (Bound form)
◦ Excitation peak = 490 nm
◦ Emits light of 530 nm
Filters
12s arterial phase 15s early venous

20s venous phase 52s late phase

CRAO
FTMH

CMO DR
Specular Microscopy
Study of changes in different layers of
cornea under magnification
100 times greater than slit lamp
Photographs corneal endothelium
Cellular size, shape, density
3000 cells/mm2
SPECULAR MICROSCOPY:
Specular microscopy is a non-invasive photographic technique that facilitates rapid and accurate
diagnosis of corneal endotheliopathies.
Corneal Topography
Specular reflection of the image of an
object by the tear film
Provides colour coded map of the corneal
surface
Corneal Topography….
A – Scan
One dimensional time – amplitude
evaluation in form of spikes along a base
line.
Indications
◦ Biometry
◦ Measurement of AC depth, lens thickness
◦ Intraocular mass thickness
A – Scan
B – Scan
Two dimensional USG provides
topographic information concerning size
shape and quality of a lesion
Linear probe / vector probe
ULTRASONOGRAPHY

ineyes with opaque

media.
INDIRECT OPHTHALMOSCOPY
SLIT LAMP
BIOMICROSCOPY
VITREORETINA
 Central serous retinopathy ( CSR )

• Self-limiting disease of young or middle-aged men

• Usually unilateral
• Localized, shallow detachment of sensory retina at posterior pole

• Often outlined by glistening reflex

 full-thickness macular hole
• Typically affects elderly females
• Eventually bilateral in 10%
• VA about 6/60

• Round punched-out area at fovea • Multiple yellow deposits within crater

• Surrounding halo of sub-retinal fluid • Positive Watzke-Allen sign
 Clinical diagnosis of CMO

• Loss of foveal depression • Retinal thickening

• Yellow spot at foveola • Multiple cystoid areas
DIABETIC RETINOPATHY
RETINAL DETACHMENT
 CLASSIFICATION
Rhegmatogenous RD Exudative RD

Tractional RD
OCULOPLASTICS
ECTROPION
PRE-OP POST-OP
ENUCLEATION
PRE-OP POST-OP
ENUCLEATION
PRE-OP POST-OP
EYELID INJURY
PRE-OP POST-OP
EYELID INJURY
PRE-OP POST-OP
EYELID INJURY
PRE-OP POST-OP
EYELID INJURY
PRE-OP POST-OP
PTOSIS
PRE-OP POST-OP
CORNEA AND
REFRACTIVE
 KERATOPLASTY
ANOPERATION IN WHICH ABNORMAL
CORNEAL HOST TISSUE IS REPLACED BY
HEALTHY DONOR CORNEA

◦ FULL THICKNESS (PENETRATING)

◦ PARTIAL THICKNESS (LAMELLAR OR DEEP

LAMELLAR)
TECHNIQUE OF PENETRATING
KERATOPLASY
INTERRUPTED SUTURES
CONTINUOUS SUTURES
REFRACTIVE SURGERY
 INTRODUCTION
A RANGE OF PROCEDURES AIMED
AT CHANGING REFRACTION OF THE
EYE BY ALTERING THE CORNEA
AND / OR CRYSTALLINE LENS
REFRACTIVE ERRORS CORRECTED
INCLUDE MYOPIA,
HYPERMETROPIA AND
ASTIGMATISM
 CORRECTION OF MYOPIA
CORNEAL SURGERY
◦ RADIAL KERATOTOMY
 RADIAL INCISIONS IN PERIPHERAL CORNEA
◦ PHOTOREFRACTIVE KERATECTOMY
◦ LASER-IN-SITU KERATOMILEUSIS (LASIK)
◦ INTRASTROMAL PLASTIC RINGS
 CAUSE CENTRAL CORNEAL FLATTENING
 CORRECTION OF HYPERMETROPIA

CORNEAL SURGERY
◦ PRK
 CAN CORRECT LOW DEGREES OF HYPERMETROPIA
◦ LASIK
 CAN CORRECT UPTO 4 D
◦ LASER THERMAL KERATOPLASTY
 HOLMIUM LASER
LENS SURGERY
◦ PHAKIC INTRAOCULAR LENS IMPLANTATION A
AN EARLY STAGE
CORRECTION OF ASTIGMATISM
CORNEAL SURGERY
◦ ARCUATE KERATOTOMY
 MAY BE COMBINED WITH COMPRESSION SUTURE
PLACED IN PERPENDICULAR MERIDIAN
◦ PRK
 CAN CORRECT UPTO 3 D
◦ LASIK
 CAN CORRECT UPTO 5 D
LENS SURGERY
◦ USING A TORIC INTRAOCULAR LENS IMPLANT
◦ POSTOPERATIVE ROTATION OF IMPLANT MAY
OCCUR
APPEARANCE DURING PRK
CORNEAL FLAP CREATED WITH A
KERATOME DURING LASIK
AFIO

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