Group⟨D⟩~[4th Year]^(39)

Slit limp component #Practical_notes. #second_day_Ophthalmology #Practical_Ophthalmology. #GroupA1

🔷 Direct ophthalmoscope use for fundus examination 🔶 Insulin needle used for remove suture,FB, sub conjuctiva injection, intravtreaus injection, take chalazion, endophthalmitis,cataract Eye drop with red cap is mydriatic, green cap is miotic, yellow cap is ansethetic جهاز slitlamb مع الكرسي حقه نسميه slitlamb unit سرعه الضوء في الثانيه 300الف #second_day_Ophthalmology #GroupA4 #practical_ophthalmology

🔷️Retinoscope: Note: When we focus the light on the wall The light of  retinoscope >>> vertical &horizontal line But the light of  ophthalomscope >>> round 🔹️ we use the retinoscope to measure a patient's refractive error The way of use بشرحها ب العربي 😅 طبعا ضروري العين تكون موسعه استخدم دواء موسع مثل Tropicamide. 0.5% or 1% بعدين اجلس مقابل المريض وكمان اخليه يشوف لبعيد ل. اي شي علاشان اتتجنب. accommodation وكمان الغرفه يكون الضوء فيها  خافت   وكمان انتبه انو لو انا بقيس عين المريض اليمين انا استخدم نفس العين واغطي العين الثانيه وامسك الجهاز بيدي اليمين والعكس 🙂 وبعدين ابدا اقيس للمريض نظرة  بعد ما اتاكد انو عينه full dilated طيب الان ابدا اشوف عين المريض بواسطه   retinoscope  الضوء تبعه  لمن يقع على العين بشوفه على شكل  مستقيم واضل احرك يدي يمين وشمال اذا كان الضوء يتحرك مع حرك يدي اذا هذا  المريض يحتاج plus  spherical  lenses والعكس اذا تحرك الضوء عكس حركه يدي استخدم minus  cylindrical  lenses طبعا اضل اغير في قوة lenses لمن انعكاس الضوء ماعد اشوفه  ويحصل. neutralization    ماعادفي ضوء  يتحرك مع حركه يدي هنا خلاص قوة هذي العدسه هي الي بتصحح نظرة المريض اذا حاولت انو ازيد القوة بيرجع يتحرك الضوء عكس حركه يدي نفس الطريقه كمان اذا الشخص عندة myopia or hypermetropia 🔹️🔹️🔹️🔹️ Myopia &hypermetropia   Light reflex with movement hypermetropia >>>use plus lenses ( spherical concex) Light reflex against movement >>> myopia >>> use minus lenses(  spherical concave) 🔹️🔹️🔹️🔹️ Astigmatism Light reflex with movement >>> use plus sylindrical lenses Light reflex against movement >>> use minus sylindrical lenses #practical_ophthalmology ##second_day_ophthalmology #GroupA3

هذا فديو توضيحي ل Fundoscope وكيفيه استخدمه وكمان يبين بعض abnormal signs #practical_ophthalmology #second_day_Ophthalmology #GroupA3

🔷️ Fundoscope: It's important to know how we use it And what we can see  by it >>>>> 🔸️We can see more details And the pupil must be dilated 🔸️The first thing that we see if there red reflex or not Red reflex >>> good red reflex that mean the patient see good Red reflex >>> bad red reflex that mean there is problem in the media like cataract,  vitreous Hemorrhage, coreal opacity ..... Note: When the red reflex strong  that mean the patient has myopia When the red reflex pale the patient has hypermetropia But we can often determine it 🔸️ media : (Cornea, Aqueous humor ,lens,vitreous humor ) Must be clear  that let us to see more details 🔸️ optic disc: Nasally ,round,defined margin, mostly pink, small opening ( cup),blood vessels 🔹️Note : focus on diameter of cup ( 0.3) More there is problem Normal blood vessels >>>flat Hanging blood vessels ( appear as interrupted) >>> there is problem in the cup 🔸️Temporally Must be clear and We see the reflex of fovea #practical_ophthalmology #second_day_Ophthalmology #GroupA3

🟠 أهم الملاحظات والمعلومات: التي ذكرها اليوم الدكتور عدنان ثابت والدكتورة سميحة الإرياني: 🟠 Anatomy of the eye: ◾️Adenxia of the eye: 1- eye lid 2- Conjunctiva 3- lacrimal system 4- Extra ocular muscles 5- Orbit. ◾️Ant. Segment of eye: د. عدنان 1- Cornea 2- Ant. Chamber 3- Iris 4- pupil 5- post. Chamber (lens) 6- Ant. Surface of vitreous ◾️Ant. Segment of eye: د. سميحة 1- Cornea 2- Ant. Chamber 3- Iris 4- pupil 5- post. Chamber 6- ant. Capsule of the lens سألناها بالنسبة للعدسة قالت الـ lens تعتبر الفاصل الذي يقسم العين إلى  Ant. & post. Segments فـ لذا هذه الفروقات مهمة في الشفوي؛ فجاوبوا كل دكتور حسب ما شرح! ◾️Post segment of the eye: 1- Viterous 2- Retina 🟠 Physiology of the eye: ◾️ Function the eye : 1- Organ of vision (Night, day, Near & Far). 2- Binocular vision. ◾️Function of retina: - Contains photoreceptors which convert optical images to chemical impluse (rhodopsin & idopsin) and from chemicals to nerual impulse which transmitted theoug the visual pathway to cerebral cortex in occipital lobe. 🟠 Method of examination: ◾️Ant. Segment examination: 1- Slit lamp 2- Tourch ◾️Post. Segment examination: 1- Ophthalmscopy (direct and indirect) 2- Ultrasound (A & B) 3- slit lamp with (auxillary lens) ⭕️ Note: ◾️Ultrasound A : used to measure Axial length of the eye. (A --> Axial) ◾️Ultrasound B : used to diagnose posterior Segment disease, (B --> post. Segment disease diagnosis). ⭕️ ملاحظة هامة جدا : ◾️Ultrasound B : used before cataract surgery to exclude retinal detachment, viterous hemorrhage and tumors in retina and choroid. ◾️Visual acuity: by - Snelllen chart = letters chart .. for educated.. - Landolt broken ring =  C ring chart.. for non-educated.. ⭕️ إضافة من الدكتور عدنان ثابت ◾️There are other many types of charts: - E chart  - Maching chart وغيرها من الأشكال... ويعتمد استخدامها على المريض هل هو متعلم أم غير متعلم. ◾️Visual field: by perimetery ◾️ Color test: by Eshihara test  ⭕️ أهم ثلاثة ألوان :  (Blue , Red & Green ) ◾️Kertaometry (K1, K2) : Used to measure the curvature of the cornea to detect size of IOL. ◾️Pentacam: is the most modern machine to examin the Keratoconus ◾️Squint test : - Corneal light reflex (Hirschberg test) - Cover test - Cover - uncoverd test - Maddox rod (For far) - Maddox wing test (For near) ◾️Fluroscene angiography ◾️Optical coherence tomography ⭕️ Additional Notes: ◾️Don't confuse between the following tests : Corneal reflex ( to measure sensitivity). Corneal light reflex (to measure squint angle). Light projection (to examin visual field). Light reflex ( to detect pupillary reaction). ◾️Angle of alpha (5°) = Angle of kappa: it is the angle between optical axis & visual axis. ◾️Argon laser: used for proliferative diabetic retinopathy. ◾️Yag laser: used for glaucoma , cataract & post surgical opacity.. ◾️The difference between exudate and transudate? أهم مقارنة هي  specific gravity. Exudate : more than 1.020 Transudate : less than 1.012 #first_day_ophthalmology #Practical_Notes. #Group_A_2.

➡️ Auto-refractor or optometer is an instrument that helps in the automated assessment of refraction (refractive error) #SubGroup_D4

➡️ Differentiation between direct and indirect ophthalmoscope. #SubGroup_D4

➡️Indirect ophthalmoscope (binocular indirect ophthalmoscope) Use to inspect the fundus or back of the eye. #SubGroup_D4

➡️ ophthalmoscopy 🔹uses: to screen for eye diseases and conditions that can affect blood vessels. These conditions include: ١) damage to your optic nerve retinal tear or detachment 2) glaucoma 3) macular degeneration, 4) cytomegalovirus (CMV) retinitis, an infection of your retina 5) melanoma 6) DM hypertension 🔺Advantages 1)High magnification view (15x) 2)Relatively good imaging through a small pupil 3) Readily portable: good for domiciliary use 4) Relatively inexpensive 5) View of fundus is correct way up and non-reversed 🔻Disadvantages: 1) Magnification varies with patient's refractive error: higher in myopes 2) Very small field of view (10° in an emmetrope): difficult to scan fundus 3) Monocular view 4) Difficult to use on small children 5) Image degrades significantly with media opacities 6) Poor at showing colour and elevational changes 7) Close proximity to patient essential #SubGroup_D4

➡️ Specular Microscopy. Screen for corneal diseases such as, keratoconus, trauma and other types of corneal dystrophies. #SubGroup_D4

➡️goniolens miror Uses: 1- Examination of angle of A/C 3- Laser trabeculoplasty 2- Goniotomy 4- Fundus examination #SubGroup_D4

➡️Ultrasonography 🔻B-scan ultrasound:is most useful when direct visualization of intraocular structures is difficult or impossible. Situations that prevent normal examination include lid problems (eg, severe edema, tarsorrhaphy), corneal opacities, hyphema, miosis, dense cataracts, or vitreous opacities (eg, hemorrhage). In such cases, diagnostic B-scan ultrasound can accurately image intraocular structures and give valuable information on the status of the lens, vitreous, retina, choroid, and sclera. However, in many instances, ultrasound is used for diagnostic purposes even though pathology is clinically visible. Such instances include differentiating iris or ciliary body lesions; ruling out ciliary body detachments and differentiating intraocular tumors, choroidal detachments, retinal detachments, and papilledema. 🔻A-scan ultrasound: is provides data on the length of the eye, which is a major determinant in common sight disorders #SubGroup_D4

➡️Optical coherence tomography (OCT). The appearance of a variety of posterior segment pathologies using OCT has been described. These include diabetic retinopathy, macular holes, epiretinal membranes, cystoid macular edema. 🔹Uses A) OCT in the retina: is useful in the diagnosis of many retinal conditions, especially when the media is clear. In general, lesions in the macula are easier to image than lesions in the mid and far periphery. OCT can be particularly helpful in diagnosing: 1) macular hole 2) vitreomacular traction 3) macular edema 4) detachments of the neurosensory retina and retinal pigment epithelium (e.g. central serous retinopathy or age-related macular degeneration) B) OCT in the Optic neuropathies: is gaining increasing popularity when evaluating optic nerve disorders such as glaucoma. OCT can accurately and reproducibly evaluate the nerve fiber layer thickness. #SubGroup_D4

➡️Corneal topography (photokeratoscopy) Corneal topography is most commonly used for the following purposes: 1) Refractive surgery: To screen candidates and ruling out keratoconic patterns. Post operatively, topography can help to assess the post excimer ectasia 2) Keratoconus: Early screening of keratoconus 3) Post surgery astigmatism: Post cataract surgery and post keratoplasty corneal astigmatism can be studied with the topographer and selective suture removal or other interventions can be planned. 4) Effect of corneal and ocular surface disorders: Disorders such as pterygium, limbal dermoid, localised corneal scars can cause a change in the corneal topography and thus the monitoring is very useful. #SubGroup_D4

➡️ Goldmann Applanation Tonometer (GAT) used to measure intraocular pressure (IOP) #SubGroup_D4

➡️ Perimetry test: Is a visual field test (help find certain patterns of vision loss) #SubGroup_D4

➡️ Synoptophore (Major Amblyoscope) Equipment which can be used to assess the angle of deviation and binocular potential at a theoretical distance fixation. #SubGroup_D4