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OPHTHALMOLOGY
INTRODUCTION FROM THE AUTHOR

ARISE MEDICAL ACADEMY 1

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OPHTHALMOLOGY
ORBIT:
• Pyramid shaped, 30 ml volume, eyeball
volume 6 ml
• Rule of 7 7 bones, 7 muscles, 7 nerves
in orbit, 7 attachments of eyeball
• Contents  eye ball, muscles, fascia,
fat pads, blood vessels and nerves
• 6 muscles of eyeball, 1 of eyelid
• 6 movements – elevation, depression, abduction, adduction,
intorsion, extorsion
LR6, SO4 R3
• Eyelid elevators  LPS, Muller’s muscle, Frontalis
• Only one eyelid closure muscle-orbicularis oculi
Eyelid Position:
upper eyelid covers 2mm of (N) cornea

Lower eyelid is at limbus

Ptosis: Drooping of upper eyelid



Droops > 2 mm

Congenital Acquired
Birth to 1 year of age > 1 year of age
Types:
Aponeurotic / Involutional-m/c - senile
Neurogenic -3rd CN palsy, Horner ‘s S
Myogenic – myasthenia gravis, Myotonic
dystrophy
Mechanical – Chalazion, lid tumour

Treatment Surgical – based on LPS action

(LPS aected in 80% cases)

 

ARISE MEDICAL ACADEMY 2

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OPHTHALMOLOGY
 Good LPS action - LPS resection
Moderate LPS – FASANELLA SERVAT
Poor LPS – Frontalis Sling / Suspension

ORBITAL BLOWOUT FRACTURES

• M/C fracture of orbit

• Fracture of orbit without
including rim
• Size of impact > size of orbital aperture
• M/c wall to facture – inferior wall / oor
• S/S: Diplopia, Infraorbital anaesthesia, Enophthalmos (DIE)
Tear drop sign in CT scan diagnostic

Proptosis /Exophthalmos – protrusion of eyeball

• Causes – Thyroid Eye disease, Tumors, Orbital cellulitis, Metastasis
• MCC Thyroid eye disease / Graves’ Ophthalmology
• D/to deposition of MPS on muscle belly leading to its
enlargement, with sparing of tendon.

Thyroid Eye Disease

Females>> Males- 40-60 years
MC presentation – Lid retraction
Lid lag
U/L or B/L proptosis
Restriction of EOMIMSL- Inferior rectus rst
Muscle is replaced by fatty tissue
Muscle involvement IRMRSRLR (I M So Lucky)

Enophthalmos Retraction of eye ball

Causes: Blow out facture/
Ca breast metastasis

ARISE MEDICAL ACADEMY 3

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OPHTHALMOLOGY
Orbital tumors
MC primary tumour of the orbit in children  Dermoid cyst
MC malignancy of the orbit in children  Rhabdomyosarcoma
MC secondaries to the orbit in children  Metastasis from Neuroblastoma
MC primary tumor of orbit in adults  Cavernous hemangioma /
lymphoma
MC secondary tumor of orbit in adult’s  Ca breast/ Lungs / Prostate

Enucleation Evisceration
Removal of whole eye leaving Removal of intraocular contents of eye
all other contents of orbit leaving sclera
intact
Removal of middle and inner layers

Ocular Prosthesis

ARISE MEDICAL ACADEMY 4

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OPHTHALMOLOGY
BASICS OF OPHTHALMOLOGY
Human Eye
Three concentric layers

• Cornea /sclera (outer)

• Uvea (middle layer)
• Retina (innermost layer)

Cornea/Sclera:

• Eyewall  Cornea/ sclera

• Anterior 1/6 cornea  Transparent posterior 5/6  sclera]
• Function  Protection of intraocular contents
• Made up of collagen, GAG [Glycosaminoglycans]
• Regular arrangement of collagen with equal spacing gives cornea its
clarity
• Cornea contributes 70% of power of eye – 43 D/60 D
Refractive Index – speed of light in a particular media compared to speed
of light in air
Amount of light that can be bent by a particular media.
RI  bending of light
Highest RI  Centre of lens / nucleus of lens
Cornea = 1.376
Aqueous humor and vitreous = 1.33
Air = 1/Glass = 1.5/ Water = 1.3
Lens = Centre (1.40)
Periphery (1.38)

ARISE MEDICAL ACADEMY 5

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OPHTHALMOLOGY
UVEA = Grape (Middle layer)

Iris Ciliary body Choroid

(Anterior uvea) (Intermediate uvea) (Posterior Uvea)

IRIS:
• Named after Greek goddess of rainbow
• Pupil – contracts and dilates to control
entry of light
• Iris pattern – dierent for everyone,
used in biometrics of Aadhar card
• Pupil can contract to 1mm and dilate
to 9mm-sphincter pupillae / dilator pupillae
• Normal pupil diameter varies from 3-4 mm

Ciliary Body:

Pars plicata – folds, Pars plana – plane, Ciliary muscle

anterior CB posterior CB
Function
1. Aqueous humor production
2. Accommodation (ciliary m/s)

ARISE MEDICAL ACADEMY 6

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OPHTHALMOLOGY
IRIDODIALYSIS – D-Shaped pupil:
Iridodialysis  Separation of Iris
from root (ciliary body)