Master Ophthalmology
for FMGE

Core Concepts

Ophthalmology deals with the anatomy, physiology, and diseases of the eye. Understanding key structures (cornea, lens, retina, optic nerve) and their functions is crucial. Common high-yield conditions include:

• Refractive Errors: Myopia (nearsightedness), Hyperopia (farsightedness), Astigmatism (irregular corneal curvature), Presbyopia (age-related loss of accommodation). Corrected with lenses or surgery.
• Cataract: Opacification of the natural lens, leading to painless progressive vision loss. Most commonly age-related.
• Glaucoma: Progressive optic neuropathy, typically associated with elevated intraocular pressure (IOP), leading to irreversible visual field loss.
  • Primary Open-Angle Glaucoma (POAG): Chronic, asymptomatic until advanced.
  • Primary Angle-Closure Glaucoma (PACG): Acute, painful, vision-threatening emergency.
• Retinal Diseases:
  • Diabetic Retinopathy: Microvascular damage due to diabetes. Proliferative (neovascularization) and Non-Proliferative forms.
  • Age-Related Macular Degeneration (AMD): Degeneration of the macula, causing central vision loss. Wet (neovascular) and Dry (atrophic) forms.
  • Retinal Detachment: Separation of neurosensory retina from retinal pigment epithelium. Surgical emergency.
  • Retinal Vascular Occlusions (CRAO/CRVO): Sudden, painless vision loss.
• Ocular Infections & Inflammations:
  • Conjunctivitis: Inflammation of conjunctiva (viral, bacterial, allergic).
  • Keratitis: Inflammation/infection of cornea.
  • Uveitis: Inflammation of uveal tract (iris, ciliary body, choroid). Can be anterior, intermediate, or posterior.
• Strabismus & Amblyopia: Misalignment of eyes; "lazy eye" due to poor visual development.
• Neuro-ophthalmology: Optic Neuritis, Papilledema, cranial nerve palsies affecting ocular motility.

Clinical Presentation

• Vision Loss:
  • Sudden, painless: CRAO/CRVO, vitreous hemorrhage, retinal detachment.
  • Sudden, painful: Acute angle-closure glaucoma, optic neuritis, endophthalmitis, corneal ulcer.
  • Gradual, painless: Cataract, POAG, AMD, diabetic retinopathy.
  • Transient: Amaurosis fugax (TIA), papilledema.
• Red Eye:
  • Painless: Conjunctivitis (bacterial, viral, allergic), subconjunctival hemorrhage.
  • Painful: Acute angle-closure glaucoma, keratitis, uveitis, scleritis, orbital cellulitis.
• Ocular Pain: Glaucoma, keratitis, uveitis, trauma, foreign body.
• Discharge: Watery (viral conjunctivitis, allergic), purulent (bacterial conjunctivitis), stringy (allergic).
• Photophobia: Uveitis, keratitis, acute glaucoma, meningitis.
• Diplopia (Double Vision): Cranial nerve palsies (III, IV, VI), myasthenia gravis, thyroid eye disease.
• Floaters/Flashes: Posterior vitreous detachment, retinal tears/detachment, vitreous hemorrhage.

Diagnosis (Gold Standard)

Comprehensive eye exam is paramount. Key diagnostic tools:

• Visual Acuity: Snellen chart (distance), Jaeger chart (near). Pinhole improves vision if refractive error.
• Slit-Lamp Examination: Detailed view of anterior segment (lids, conjunctiva, cornea, anterior chamber, iris, lens). Crucial for keratitis, uveitis, cataract.
• Fundoscopy (Direct/Indirect): View of retina, optic disc, macula, blood vessels. Essential for glaucoma, diabetic retinopathy, AMD, retinal detachment.
• Tonometry: Measures Intraocular Pressure (IOP) – Goldmann Applanation Tonometry is gold standard.
• Perimetry (Visual Field Testing): Detects field defects (e.g., in glaucoma, neurological conditions).
• Pupil Examination: Size, shape, reactivity to light (direct/consensual). Relative Afferent Pupillary Defect (RAPD) indicates optic nerve pathology.
• Ocular Motility: Assesses extraocular muscle function for strabismus, diplopia.
• Optical Coherence Tomography (OCT): High-resolution cross-sectional imaging of retina and optic nerve head (for glaucoma, AMD, diabetic macular edema).
• Fluorescein Angiography (FFA): Evaluates retinal and choroidal vasculature (for AMD, diabetic retinopathy, vascular occlusions).
• B-scan Ultrasonography: When fundus view is obscured (e.g., dense cataract, vitreous hemorrhage).

Management (First Line)

• Refractive Errors: Corrective spectacles, contact lenses, refractive surgery (LASIK, PRK).
• Cataract: Surgical extraction (Phacoemulsification with intraocular lens implantation).
• Glaucoma:
  • POAG: Topical prostaglandin analogues (e.g., Latanoprost) are first-line to reduce IOP. Beta-blockers (Timolol) also used. Laser trabeculoplasty, surgery (trabeculectomy) for refractory cases.
  • PACG (Acute): Urgent reduction of IOP (IV Acetazolamide, topical beta-blockers, pilocarpine). Laser peripheral iridotomy after acute attack.
• Diabetic Retinopathy:
  • Non-Proliferative: Strict glycemic/BP control.
  • Proliferative/Macular Edema: Panretinal photocoagulation (PRP) laser, anti-VEGF injections (e.g., Ranibizumab, Bevacizumab), vitrectomy.
• AMD:
  • Dry AMD: Antioxidant vitamins (AREDS formulation).
  • Wet AMD: Anti-VEGF intravitreal injections.
• Retinal Detachment: Urgent surgical reattachment (scleral buckle, vitrectomy, pneumatic retinopexy).
• Conjunctivitis:
  • Bacterial: Topical broad-spectrum antibiotics (Moxifloxacin, Gatifloxacin).
  • Viral: Self-limiting, symptomatic relief.
  • Allergic: Topical antihistamines, mast cell stabilizers.
• Keratitis: Topical antibiotics (bacterial), antivirals (herpetic), antifungals (fungal). Avoid steroids without specialist consultation.
• Uveitis: Topical corticosteroids (anterior), cycloplegics (Atropine, Cyclopentolate). Systemic steroids/immunosuppressants for posterior/severe cases.
• Ocular Foreign Body: Irrigation, removal under topical anesthetic. Refer if deep or penetrating.