Practical - Dr. Zainab.pptx4567890-=987werg

ophthalmology

1. Practical Ophthalmology Review Dr. Zainab Kadhim Fahad

2. Mature nuclear sclerotic cataract

3. D ense corticular cataract

4. H ypermature cataract with wrinkling of the anterior capsule

5. Morgagnian cataract with liquefaction of the cortex and inferior sinking of the nucleus

6. Diabetic snowflake cataract

7. P osterior subcapsular cataract spokes assuming a stellate morphology in myotonic dystrophy

8. S hield-like anterior subcapsular cataract in atopic dermatitis

9. B lunt trauma showing a flower-shaped opacity

10. Preseptal cellulitis. (A) Left preseptal cellulitis resulting from an infected eyelid abrasion; (B) axial CT showing opacification anterior to the orbital septum

11. CT of left orbital floor blow-out fracture – coronal view showing a defect in the orbital floor (arrow) and the ‘tear drop’ sign due to soft tissue prolapse into the maxillary antrum

12. Blow-out fracture of the left medial wall and floor. (A) Defective left abduction; (B) CT coronal view showing fractures of the medial wall (arrow) and floor (arrowhead)

13. (A) Small unstained corneal abrasion

14. L arge corneal abrasion stained with fluorescein

15. (A) Small hyphaema

16. T otal hyphaema

17. C orneal blood staining due to sustained high intraocular pressure associated with a total hyphaema

18. A) Retained superficial subtarsal foreign body

19. B) Linear corneal abrasion stained with fluorescein

20. (C) Insect retained in the inner canthus

21. D) Recently embedded corneal foreign body

22. Chemical burns: Limbal ischaemia

23. Chemical burns: Grade 2 – corneal haze but visible iris detail – the white area at left is the reflected slit beam rather than haze alone

24. Chemical burns: Grade 3 – corneal haze obscuring iris details

25. Chemical burns: Grade 4 – opaque cornea

26. Lower lid haematoma with subconjunctival haemorrhage in temporal side

27. subconjunctival haemorrhage with no visible posterior limit

28. Panda eyes

29. (A ) Upper lid colobomas ; (B) lower lid colobomas in Treacher Collins syndrome ; ( C) Treacher Collins syndrome

30. Dominantly inherited blepharophimosis . The child’s grandfather and father have undergone surgery to correct the defect

31. Blepharophimosis , ptosis and epicanthus inversus syndrome Blepharophimosis , ptosis and epicanthus inversus syndrome (BPES ) is a complex of eyelid malformations consisting of moderate–severe symmetrical ptosis with poor levator function, telecanthus , epicanthus inversus , manifesting with small palpebral fissures. Inheritance is usually Autosomal dominant ( AD ). Treatment initially involves correction of epicanthus and telecanthus , followed later by bilateral frontalis suspension . It is also important to treat amblyopia, which is present in about 50 %.

32. Epicanthus inversus

33. Lens complications of trauma Flower-shaped cataract

34. Lens complications of trauma D ense traumatic cataract with ruptured anterior capsule and prolapsed lens contents

35. Lens complications of trauma D islocation into the vitreous in a pseudophakic eye with pseudoexfoliation (arrows show the edge of the capsule )

36. Lens complications of trauma D islocation into the anterior chamber

37. Ruptured globe showing large corneal rupture with prolapse of intraocular structures

38. Epithelial herpes simplex keratitis. (A) Stellate lesions

39. (B) bed of a dendritic ulcer stained with fluorescein

40. C) margins of a dendritic ulcer stained with rose Bengal

41. D) geographic ulcer

42. E) residual subepithelial haze

43. (F) recurrent ulceration after a corneal graft

44. Eyelid oedema and purulent discharge in neonatal conjunctivitis ( ophthalmia neonatorum )

45. Neonatal conjunctivitis ( ophthalmia neonatorum ) Causes: Organisms acquired during vaginal delivery: C. trachomatis, N . gonorrhoeae (now rare in wealthier countries, but previously responsible for 25% of childhood blindness) and herpes simplex virus (typically HSV-2). With all of these, conjunctivitis is not uncommonly associated with severe ocular or systemic complications. C. trachomatis is the most common cause in cases involving moderate–severe conjunctival inflammation . Staphylococci are usually responsible for mild conjunctivitis. Other bacterial causes include streptococci, H. influenza and various Gram-negative organisms. Topical preparations used as prophylaxis against infection may themselves cause conjunctival irritation (chemical conjunctivitis ) Congenital nasolacrimal obstruction. Despite poor neonatal tear production, a persistently mildly watery eye with recurrent mild bacterial conjunctivitis may be secondary to a blocked tear duct.

46. Preseptal  cellulitis. (A) Left  preseptal  cellulitis  resulting  from an infected eyelid abrasion; (B) axial CT  shows  opacification anterior to the orbital septum 

47. Preseptal  cellulitis Diagnosis The condition manifests with a swollen, often firm, tender red eyelid that may be very severe; however, in contrast to orbital cellulitis, proptosis and chemosis are absent, and visual acuity , pupillary reactions and ocular motility are unimpaired . The patient is often pyrexial . Imaging with MRI or CT is not indicated unless orbital cellulitis or a lid abscess is suspected, or there is a failure to respond to therapy . Treatment is with oral antibiotics such as co- amoxiclav 250–500 mg/125 mg 2–3 times daily or 875/125 mg twice daily, depending on severity. Severe infection may require intravenous antibiotics . The patient’s tetanus status should be ascertained in cases following trauma.

48. Pterygium. (A) Histology showing collagenous degenerative changes in vascularized subepithelial stroma

49. pterygium showing cap, head, body and Stocker line (arrow)

50. inflamed pterygium

51. pseudopterygium secondary to a chemical burn

52. Causes of traumatic cataract. (A) Penetrating trauma (black arrow indicates corneal penetration site and white arrow indicates a cut in the anterior capsule)

53. (B) intralenticular metallic foreign body (arrow showing crescentic opening in capsule)

54. (C) blunt trauma showing a flower-shaped opacity

55. Left globe luxation