Dr /
M. Abd Ul-Ghaffar (MASS ) 2009
ﺳﺒﺤﺎن ﷲا و ﺑﺤﻤﺪه ﺳﺒﺤﺎن ﷲا اﻟﻌﻈﯿﻢ
٠١٦ ٥٧٠ ١٩١٤ : ﻣـــــﺎ س/ د
اﻟﻨﻈﺮ ﺣﺪة ﯿﻗﺎس
ﺗﺆدى ھﺬه اﻹﺧﺘﺒﺎرات ﻓﻰ ﺣﺠﺮة ﻣﻈﻠﻤﺔ ﯾوﻌﻠﻢ ﻗﺒﮭﻠﺎ اﻟﻤﯾﺮﺾ ﺗﺨﺘﺒﺮ ﻛﻞ ﯿﻋﻦ ﻟﻮﺣﺪھﺎ-
I- By Charts Principle of Visual Acuity Charts :
If 2-ends of broken ring made Visual Angle > 1minute we could see 2-separate points
passing with Nodal Point & stimulating 2-cones inbetween non-stimulating cone
If Visual Angle < 1minute the 2 points seen as 1-point with closure of broken ring
3-Types : a - Landolt`s chart.
b – Snellen`s chart
c – Emarah Arabic chart
A- Landolt`s Chart * Consist of 7-rows of broken rings ( C ) whose openings are in various directions * Pt. sits at distance of 6m and asked to state direction of opening of C * Testing each eye separately: . If he saw the last raw VA = 6/6 . If he saw the above one VA = 6/9, then 6/12, 6/18, 6/24, 6/36, 6/60 * When Pt. can`t see at distance of 6m: we move him 1-meter close to chart and . if he saw raw of 60 his VA = 5/60 . If not: move to 4/60, then 3/60, then 2/60, then 1/60 . If not of 1/60, we shift to another method: Counting Fingers * What do you mean by 6/60 ?! 6 Pt / 60 Normal eye
B – Snellen`s chart
C- Emarah Arabic chart
Principle: as Landolt`s chart but with letters
With Arabic letters, used in arabic people especially.
of different sizes, directions. Value: helpful in determination of uncontrolled astigmatism, because Pt can't see parallel lines of letter E. ١
ﺳﺒﺤﺎن ﷲا و ﺑﺤﻤﺪه ﺳﺒﺤﺎن ﷲا اﻟﻌﻈﯿﻢ
٠١٦ ٥٧٠ ١٩١٤ : ﻣـــــﺎ س/ د
II- Counting Fingers (CF) .
* * * *
Done when Pt can't see charts at 1-meter Ask Pt to count your fingers Start by 75cm, if Pt can count fingers VA = CF 75cm If not: to CF 50cm, then CF 25cm
III- Hand Movement (HM) - Done when Pt. can’t count fingers at all. - Teach Pt that your hand is now moving, and then stop movement and tell him it is now stopped - then Test Pt, if he can detect VA = HM
IV- Perception of Light (PL)
Done when Pt can't see HM At 1st Teach Pt.: this is Light and this is Darkness
Then ask him:
. if could perceive light VA = PL . if not VA = no PL / blind
V- Light Projection Test (Testing of Retinal Periphery) Time: done if vision
< CF 50cm.
st How: * At 1 , Do PL because if no PL
no Light projection occurs.
* To do test: - The eye is fixed in 1ry position - Teach Pt.: by telling him direction of light and then ask him about direction of light or ask him to catch it. Importance: Testing of retinal periphery when we can't see with Ophthalmoscope because
of total cataract or any opacity in media (to be sure of good retinal function before doing cataract extraction, …) ٢
ﺳﺒﺤﺎن ﷲا و ﺑﺤﻤﺪه ﺳﺒﺤﺎن ﷲا اﻟﻌﻈﯿﻢ
٠١٦ ٥٧٠ ١٩١٤ : ﻣـــــﺎ س/ د
Center of retina (Testing of function of Cones)
* Form sense: determination of shapes, figures via testing visual acuity. * Colour sense: - Ishihara colour book. - Wool threads. - Spectroscope * Visual Acuity * Maddox rod * ERG ect…
ﯿﻗﺎس ﻣﺠﺎل اﻟﺮﯾؤﺔ
(For testing Visual Field) Time: Vision must be > CF 50 cm How: To do the test
- Sit in front of Pt. - Ask Pt. to close Lt eye and cover your Rt eye - your uncovered eyes are fixing to each other - Distance between you and Pt. is at least 1 meter - With your index finger at distance 50-60 cm between you and Pt.,moving from outside inside till Pt see it - Begin from: Up Nasal side Down Temporal - Compare the sites at when Pt. can see your finger in all directions with your own field. Other accurate methods:
- Arc perimeter peripheral field changes. - Bjerrum screen central field changes. - Goldman perimeter both fields
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ﺳﺒﺤﺎن ﷲا و ﺑﺤﻤﺪه ﺳﺒﺤﺎن ﷲا اﻟﻌﻈﯿﻢ
٠١٦ ٥٧٠ ١٩١٤ : ﻣـــــﺎ س/ د
ﻧﻮر ﻟﻠﯿﻌﻦ
How: To do the test
1- Apply source of light to one eye and prevent light to reach the other eye by putting your hand vertically over bridge of nose 2- .Watch Direct light reflex in the same eye normally miosis occurs as long as the light is present. .Watch Indirect light reflex in the other eye. Pathway:
Light - Receptors: Visual receptors (Rods – Cones) nd - Afferent: ON (2 n) Optic chiasma (1 decussation: Nasal fibers cross to reach optic tract of opposite Optic tract (2nd decussation: side & Temporal fibers pass directly into optic tract of same side) - Stimulus:
st
Fibers leave optic tract at post 1/3 to relay in Pre-tectal nucleus of mid-brain both EW nuclei.
- Center: Edinger Westphal nucleus.
(3rd n) Ciliary ganglion - Effector: Sphincter Pupillae muscle. - Efferent: Oculomotor
Sphincter pupillae
- Response: reflex bilateral Miosis. NB: Consensual Light reflex : d2
Crossin of fibers in Chiasma Midbrain
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ﺳﺒﺤﺎن ﷲا و ﺑﺤﻤﺪه ﺳﺒﺤﺎن ﷲا اﻟﻌﻈﯿﻢ
Principle: ( When Near object is viewed
٠١٦ ٥٧٠ ١٩١٤ : ﻣـــــﺎ س/ د
3-related reflexes )
- Convergence: contraction of 2-MR muscles. - Miosis: contraction of 2-Sphincter pupillae muscles. - Accommodation: contraction of 2-Ciliary muscles. Pathway:
Blurring image - Receptors: Visual receptors ( Rods – Cones ) - Afferent: ON Optic chiasma (decussation: Nasal fibers cross ) Optic tract LGB Optic Radiation Occipital Cortex Frontal Cortex Internal Capsule Edinger Westphal nucleus. - Center: Edinger Westphal nucleus . rd - Efferent: Oculomotor (3 n) Ciliary ganglion Sphincter pupillae m. - Effector: 2-MR muscles & 2-Sphincter Pupillae muscle & 2-Ciliary muscles - Response: reflex bilateral Convergence + Miosis + Accommodation - Stimulus :
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ﺳﺒﺤﺎن ﷲا و ﺑﺤﻤﺪه ﺳﺒﺤﺎن ﷲا اﻟﻌﻈﯿﻢ
٠١٦ ٥٧٠ ١٩١٤ : ﻣـــــﺎ س/ د
ﺣﺲ اﻟﻐﺪة اﻟﺪﻣﯿﻌﺔ
Site: upper antero temporal part of orbit Normally:
not palpable
How: To do the test (Rt little finger to Rt eye)
- Ask patient to look down, nasally - Introduce your little finger with its bulls facing upward - Press between Upper lateral part of bony orbit & Globe: (Back Lat. Up) * If Lacrimal Gland was palpable that means it is enlarged.
(your finger opposite eye direction)
* What are causes of enlarged palpable lacrimal gland ?!
- Tumors of lacrimal gland (mixed cell tumour) - Dacryoadenitis
رﯾؤﺔ اﻟﻐﺪة اﻟﺪﻣﯿﻌﺔ
اﺟﻌﻞ اﻟﻤﯾﺮﯾ ﺾﻨﻈﺮ ﻟﺘﺤﺖ وﻟﺠﻮةBy little finger: ﻓﯿﻠﺸﻲ أﺣﻤﺮ
وﻟﻠﺨﺎرج ﺗﻠﺤ ﺮﺟﺰ ﮭﻇ ﻚأﻣﺎﻣ ء ﻷﻋﻠﻲ اﻟﻐﺪة( ﻆ ﻓﻮق ﺷ اﻟﺠﻔﻦ ) اﻟﻠﻲ-
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ﺳﺒﺤﺎن ﷲا و ﺑﺤﻤﺪه ﺳﺒﺤﺎن ﷲا اﻟﻌﻈﯿﻢ
٠١٦ ٥٧٠ ١٩١٤ : ﻣـــــﺎ س/ د
ا ﺪﻣﯿﻌﺔSac ﺣﺲ
Regurgitation Test
Site: Lacrimal Fossa in medial lower part of orbit, below MPL How: To do the test (Rt little finger to Lt eye)
- Push lateral lid margin down and lateral till feeling MPL medially - Press with your little finger under MPL: (back med.) to expose lower punctum and notice any regurgitation . If no regurgitation = -ve Regurge test . If any regurgitation (purulent, serous, …) = +ve Regurge test Q- What are the lesions in lacrinial sac with -ve regurgitation ?!
- Acute dacryocystitis: d2 congestion of epithelium of canaliculi which prevent regurgitation from lacrimal sac, being very tender. - Encysted mucocele: due to fibrous closure of the passage with accumulation of mucus inside. - Lacrimal Fistula: because any discharge will pass first to opening of skin. Q- How to test Patency of lacrimal passages ?!
1- Fluorescein test: drop in conjunctival sac + cotton pellet under inferior turbinate of nose 2- Syringing e saline 3- Probing 4- Dacryocystography (plain X-ray + lipidol) 5- ENT examination
7 n intact :ﻗﻮي ﯿﻋﯿﻨﻚ ﻏﻤﺾ th
Importance: detection of state of OO muscle & its 7 nerve How: To do the test
1- Ask Person to close his eye firmly 2- Insert your thumb and index fingers, try to open Person`s eye gently:. if difficulty opened = intact of OO, 7th . if opened easily = palsy of OO or 7th ٧
ﺳﺒﺤﺎن ﷲا و ﺑﺤﻤﺪه ﺳﺒﺤﺎن ﷲا اﻟﻌﻈﯿﻢ
٠١٦ ٥٧٠ ١٩١٤ : ﻣـــــﺎ س/ د
ﻗﻮة راﻓﻌﺔ اﻟﺠﻔﻦ
Importance: Assessment of Power or Function of LPS (Thumb test) as in Ptosis Normally: upper lid is elevated by 3 -muscles: LPS, MM, Frontalis
- LPS = 3rd n. - Frontalis = 7th n. - MM = sympathetic n. plexus (C1, C2) How: To do the test max - Correct Head position → Ask Pt to look down Fix brow against superior max orbital margin by thumb (اﻟﺪﻛﺘﻮر ) ?! → Ask Pt to look up Measure amount of elevation of UL margin (in mm): - Degrees: imum
imum
Excellent
Good
Fair
> 10 mm
7: 10 mm
4 : 6 mrn
- If Pt could not elevate his lid
Poor
< 3 mm
Ptosis (complete absence of levator action)
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ﺳﺒﺤﺎن ﷲا و ﺑﺤﻤﺪه ﺳﺒﺤﺎن ﷲا اﻟﻌﻈﯿﻢ
٠١٦ ٥٧٠ ١٩١٤ : ﻣـــــﺎ س/ د
ﻗﻠﺐ اﻟﺠﻔﻦ
Importance:
- FB impacted in sulcus subtarsalis. - PTDs, PTCs, Arlet`s line of Trachoma - Follicles and Papillae. - Membrane either true or pseudo - Presence of Hge How: To do the test
1- Ask Pt. to look down 2- Evert Lid by: . Glass rod with thumb + index finger, or Only . Your thumb + index finger 3- Index is put behind tarsus 4- Thumb holds up lashes or lid margin (the best) pull lid Forward index finger , acting as axis. إوﻋﻰ Press with your index on tarsus,
being hard
evert it over your
lid can’t be everted
* Normally: in Egyptians
PTDs, PTCs and Arlet`s line: being line of fibrosis along sulcus subtarsalis 2- from lid margin Q- Why Arlet’s line is present in sulcus subtarsalis: Because it is grooved, rich in BVs mm
Q- What is the difference () papillae of spring catarrh and trachoma
Papillae of Spring Catarrh Incidence Gender Season Symptoms Papillae - Appearance - Size - Color - Upper fornix Discharge
Papillae of Trachoma
-♀>♂ - ↑ in summer and spring ..Itching
-♀=♂ - any season ..Heaviness of lid
-Cobble stone -Larger -Bluish white -Free ..Roby, rich in eosinophils
-Top is rounded -Smaller -Red -Involved ..Watery, inclusion bodies (no eosinophils)
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ﺳﺒﺤﺎن ﷲا و ﺑﺤﻤﺪه ﺳﺒﺤﺎن ﷲا اﻟﻌﻈﯿﻢ
٠١٦ ٥٧٠ ١٩١٤ : ﻣـــــﺎ س/ د
ﯿﻗﺎس ﺿﻐﻂ اﻟﯿﻌﻦ
Normal IOP: 10-22 mmHg above atmospheric pressure. How: To do the test
A- Digital Palpation method - Via 2-index fingers - We ask Pt. to look down (not to close his eyes, because contraction of muscle will ↑ its tone false ↑ in IOP) - Feel tension above tarsus (behind it) via pressing with finger and receiving by other finger - Compare tension in both eyes before recording - Finally we say: (Hard or Firm or Soft) Tension NB: - Don’t feel tension over tarsus being fibrous, hard . - Here we measure Tension and not Pressure, measured via introducing needle of apparatus in the eye
Digital method is not accurate
rough ,
so we may use:
B- Schiotz indentation tonometer * Schiotz has the following disadvantages: - With instrumental errors * Schiotz has the followIng advatnagcs: - Simple
- Cheap
- Observer error - May be changed by changing ocular rigidity.
- Portable
C- Goldman applanation tonometer * Advantages of Applanation: - No error.
- No change with ocular rigidity.
D- Tonopen E- Airpuff Tonometer N.B.: A) IOP > 22mmHg is suspicious to be glaucomatous, so we do provocative tests: 1) Closed angle glaucoma:
- Dark room
- Mydriatic
2) Open angle glaucoma:
- Priscol.
- Water drinking test
B) Above 26 mmHg: Patient is sure glaucomatous
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ﺳﺒﺤﺎن ﷲا و ﺑﺤﻤﺪه ﺳﺒﺤﺎن ﷲا اﻟﻌﻈﯿﻢ
٠١٦ ٥٧٠ ١٩١٤ : ﻣـــــﺎ س/ د
.
How: To do the test
- The Material used and Hands of the doctor: should be clean and sterile - Hold piece of cotton under Lower Lid (LL) of Pt. and pull LL to expose inferior fornix. - Ask Pt. to look up - Apply the drops in fornix, and avoid touching the eye or lash for fear of infection transmission to another person or to your eye. * In case of suspected corneal ulcer apply Fluorescein ED Q- Uses of Fluorescein in Ophthalmology:
1- Lacrimal: - Test patency of NLD - Dry eye syndrome - Investigation of a case of epiphora 2- Cornea: Detection of corneal ulcer, corneal fistula, FB. 3- Retina: FA of DR , CRVO, CRAO N.B.: - Fluorescein may carry the danger of pseudomonas infection w prefer it, so be aware of this point
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ﺳﺒﺤﺎن ﷲا و ﺑﺤﻤﺪه ﺳﺒﺤﺎن ﷲا اﻟﻌﻈﯿﻢ
٠١٦ ٥٧٠ ١٩١٤ : ﻣـــــﺎ س/ د
Blinking Reflex
One of the protective mechanisms to the eye. How: To do the test
() أوﻻ ﺷﺘﺖ اﻧﺘﺒﺎﮫھ وﻻ ﺗﺠﻌﯾ ﮫﻠﺮى ﺣﺮﻛﯾ ﺔﺪك
- Twist end of piece of cotton to be a thread - Ask Pt. to look medially and with cotton thread touch cornea without touching lashes. Pathway:
- Stimulus: thread of cotton. - Receptors: touch receptors of cornea. - Afferent: 2-long ciliary nerves ( nasociliary n ophthalmic n - Center: area 18/occipital cortex. - Efferent: 7th nerve - Effector: Orbicularis Oculi muscle - Response: bilateral reflex closure of eye lids
5th nerve )
Types of Blinking:
- Spontaneous: Basal ganglia - Reflex: occipital cortex 18 - Voluntary: frontal cortex 8
ﯾﻐﻤﺰ
Q- What are Causes of diminished or lost corneal reflex
A- Factors due to affection of receptors hyposethia - Corneal scarring because fibrous tissue is insensitive. - Keratitis: herpitic keratitis (herpes simplex, herpes zoster) - Leprosy - Glaucoma (absolute, acute congestive) - Local anaesthesia of ED B- Factors due to affection of afferent and efferent nerves - 5th nerve injury or trauma - 7th nerve injury via tumors in pons, trauma, vascular lesion, Bell's palsy C- Factors due to lesion in the effector organ- Due to palsy of orbicularis oculi muscle
١٢
ﺳﺒﺤﺎن ﷲا و ﺑﺤﻤﺪه ﺳﺒﺤﺎن ﷲا اﻟﻌﻈﯿﻢ
٠١٦ ٥٧٠ ١٩١٤ : ﻣـــــﺎ س/ د
Definition: abnormal ocular deviation so that the 2-visual axes are not directed towards
fixation object, one of them being deviated. Clinical classification of Squint:- اﻟﻨﯿﻔﺲ رؤف/أد ﻣﻦ ھﺬه اﻟﺘﻘﯿﺴﻤﺔ
A ) Latent (Heterophoria):-
ﻣﺨﻔﻰ
1- Eso-phoria 3- Hypo-phoria 5- In-Cyclo-phoria
2- Exo-phoria 4- Hyper-phoria 6- Ex-Cyclo-phoria
B) Manifes t : - ﻇﺎھﺮ
1- False /Apparent / Pseudostrabismus ﻛ ـﺬاب 2- True squint: ﺻﺎدق * Incomitant (Paralytic) * Concomitant (Hetero-tropia) - Vertical: (Hypo-tropia – Hyper-tropia) - Horizontal: (Eso-tropia – Exo-tropia) - Mixed: (horizontal + vertical squint)
Importance: rough method to measure Angle of Squint. How: To do the test
1- Pt. is asked to look to source of light put at 50cm from him 2- The corneal reflection of light is noticed: . Normally, point of light at Center of both Pupils . if at Pupillary border = 10ْ -15ْ angle . if half-way () Pupillary border and Limbus = 20ْ – 25ْ . if at Limbus = 40ْ – 45ْ . if on the Sclera = 7ْ are added to each 1mm away from limbus. Measurement of Angle of Squint by: - Corneal reflection test - Arc Perimeter - Synoptophore
١٣
ﺳﺒﺤﺎن ﷲا و ﺑﺤﻤﺪه ﺳﺒﺤﺎن ﷲا اﻟﻌﻈﯿﻢ
٠١٦ ٥٧٠ ١٩١٤ : ﻣـــــﺎ س/ د
The movement of globe is controlled by 6-EOMs
* 4-Recti: medial, lateral, superior, inferior. * 2-Oblique: superior, inferior. Actions of EOMs
→
3-main Positions of the eye (9-Gazes/directions) A- Primary position B- Secondary positions C-Tertiary positions
3
2
3
2
1
2
3
2
3
Cardinal Directions of the Eye:
At each direction:
- only one muscle moves eye ball - So any defect in this direction = defect in its muscle To test Ocular Motility (2 movements),
1) Pt is asked to follow finger put at 50cm from his eye and move in all directions of gauze
Ocular movements are normal in latent and concomitant squint. Limitation of movement is found in paralytic squint. 2) Done uniocular (Duction) then binocular (Version) by 2-methods: A- Following movement. = F / O, 18 B- Order movement = O / F, 8 * Any defect in any direction = defect in muscle or its nerve supply So eye is squinting in opposite direction * What are the Muscles acting when looking up ?! (5- muscles) = 2-in eye: SR – IO & 3-in lid : LPS – MM – Frontalis * How to test the function of SR ?! By asking Pt. to Look up + out at the same time
* What is the muscle acting during reading ?! SO muscle ١٤
ﺳﺒﺤﺎن ﷲا و ﺑﺤﻤﺪه ﺳﺒﺤﺎن ﷲا اﻟﻌﻈﯿﻢ
د /ﻣـــــﺎ س ٠١٦ ٥٧٠ ١٩١٤ :
) (to diagnosis Latent Squintاﻟﻤﺨﻔﻰ ﯾﺆدى ھﺬا اﻹﺧﺘﺒﺎر ﻟـ ) ﻣﯾﺮﺾ داﺧﻠﻚ وﯿﻏﺮ ﻇﺎھﺮ ﻓﻰ ﯿﻋﮫﻨ ﺣََ ﻮل ‘ وأﻧﺖ ﺗﯾﺮﺪ أن ﺗﻌﺮف ھﻞ ﻋﻨﺪه ﺣﻮل ﻣﺨﻔﻰ أم ﻻ ( ﻏﻄﻰ أى ﯿﻋﻦ ﺛﻢ راﻗﺐ ﺣﺮﻛﮭﺘﺎ ﺑﻌﺪ إزاﻟﺔ اﻟﻐﻄﺎء- Make Pt. to fix on pencil_torch putting at 50cm - Cover one eye - Cover is rapidly removed - Latent squint is detected, if this eye is noticed to move to take fixation - This mains that this eye was squinting under Cover
) ( to diagnosis Concomitant Squint ﯾﺆدى ھﺬا اﻹﺧﺘﺒﺎر ﻟـ) ﻣﯾﺮﺾ داﺧﻠﻚ و ﻇﺎھﺮ ﻓﻰ ﯿﻋﮫﻨ ﺣََ ﻮل ‘ وأﻧﺖ ﺗﯾﺮﺪ أن ﺗﻌﺮف ھﻞ ھﺬا اﻟﺤﻮل ﻓﻰ ﯿﻋﻦ واﺣﺪة أم ﻓﻲ اﻹﺛﯿﻨﻦ ( ﻋﻤﻞ أوﻻ :ً Ocular motility testﻟﻠﺘﺄﻛﺪ ﻣﻦ أﮫﻧ Concomitant squintوﯿﻟﺲ Paralytic squint ﻏﻄﻰ اﻟﯿﻌﻦ اﻟﺴﯿﻠﻤﺔ ،ﺛﻢ اﺟﻌﻞ اﻟﯿﻌﻦ اﻟﻤﺤﻮﻟﺔ ﺗﺜﺒﺖ ﻋﻠﻰ ... ﻋﻨﺪ إزاﻟﺔ اﻟﻐﻄﺎء :راﻗﺐ اﻟﯿﻌﻦ اﻟﻤﺤﻮﻟﺔ اﻟﻤﻜﺸﻮﻓﺔ ﻷى ﺣﺮﻛﺔ : .إذا اﺣﻮﻟﺖ اﻟﯿﻌﻦ ﻣﺮة أﺧﺮى = Unilateral Concomitant Squint .إذا ﺛﺒﺘﺖ ھﺬه اﻟﯿﻌﻦ واﺣﻮﻟﺖ اﻟﯿﻌﻦ اﻟﻤﻐﻄﺎة = Alternating Concomitant Squint
١٥
Dr / M. Abd Ulghaffar (MASS) / 016 570 1914
ﺳﺒﺤﺎن ﷲا وﺑﺤﻤﺪه ﺳﺒﺤﺎن ﷲا اﻟﻌﯿﻈﻢ
Eye Lid Anterior Chamber
ﯿﻛﻒ ﺗﻌﺮﮭﻓﺎ
ﯿﻛﻒ ﺗﻌﺮﮭﻓﺎ
اﻟﺤﺎﻟﺔ
اﻟﺤﺎﻟﺔ
ﯿﻛﺲ دھﻨﻰ ﻋﻨﺪه ﻣﻦ زﻣﺎن
Pus in AC
1- Hypopyon
Blood in AC
2-Hyphaema
In case of ICCE
3- AC IOL
1- Chalazion
دﻣﻞ ﻃﺎﻟﻊ ﻣﮫﻨ ﺷﻌﺮه
2- Stye
ﻗﺸﺮ أﯿﺑﺾ ﯿﺑﻦ اﻟﺮﻣﻮش +ﺣﺎﻓﺔ اﻟﺠﻔﻦ ﺣﻤﺮاء +
3- Squamous Blepharitis
وﻟﻮ ﺳﺄﻟﺖ اﻟﻤﯾﺮﺾ :ﯿﺑﻘﻄﻊ ﺟﻔﮫﻨ ﻣﻦ اﮭﻟﺮش اﻟﺠﻔﻦ اﻟﻌﻠﻮى ﻣﺮﺗ ٍﺦ
Strabismus/ Squint
4- Ptosis
ﺟﻔﻦ ﻣﻘﻠﻮب ﻟﺠﻮه
5- Entropion
ﺟﻔﻦ ﻣﻘﻠﻮب ﻟﺒﺮه
6- Ectropion
ﻣﺶ ﻗﺎدﯾ رﻘﻔﻞ ﯿﻋﮫﻨ
* ﻣﺸﺮوح ﺑﺎﻟﻌﺮﺑﻲ ﻓﻰ ﻣﺬﻛﺮة
7- Lagophthalmos
إﻧﺖ ﺷﯾﺎﻒ ﯿﺑﺎض ﻣﻦ ﻓﻮق اﻟﻘﺮﯿﻧﺔ
)(Clinical examination
8- Lid Retraction
أﻗﻞ ﻣﻦ أرﺑﻌﺔ رﻣﻮﯾ شﺤﻜﻮن ﻓﻰ اﻟﯿﻌﻦ
9- Rubbing Lashes
ﺻﻒ زاﺋﺪ ﻣﻦ اﻟﺮﻣﻮﯾ شﺤﻚ ﻓﻰ اﻟﯿﻌﻦ
10- Distichiasis
أﻛﺜﺮﻣﻦ أرﺑﻌﺔ رﻣﻮﯾ شﺤﻜﻮن ﻓﻰ اﻟﯿﻌﻦ
11- Trichiasis
أﺑﻮ رﻣﻮش ﯿﺑﻀﺎء
Orbit
12- Poliosis
ﻻﻻﻻ رﻣﻮش اﻟﺤﺎﻟﺔ
ﯿﻛﻒ ﺗﻌﺮﮭﻓﺎ ﯿﻋﻦ ﻋﯿﻤﺎء ﺻﯿﻐﺮة ﻣﻨﻜﻤﺸﺔ داﺧﻞاﻷورﯿﺑﺖ واﺿﺤﺔ اﻟﻤﻌﺎﻟﻢ
1- Atrophia Bulbi
ﯿﻋﻦ ﺑﯾﺎﻈﺔ ،زى ﻟﺤﻤﺔ ﻣﺘﺤﺮﻛﺔ ،ﯿﻏﺮ واﺿﺤﺔ اﻟﻤﻌﺎﻟﻢ
2- Phthisis Bulbi
13- Madarosis
ﺣﺐ أﺻﻔﺮ ﻋﻠﻰ اﻟﺠﻠﺪ )رﺟﻞ ﻋﺠﻮز(
14- Xanthelasma
ﺟﻠﺪ ﻣﺘﺮھﻞ و زاﺋﺪ ﻣﻦ اﻟﺠﻔﻦ اﻟﻌﻠﻮى )رﺟﻞ ﻋﺠﻮز(
15- Dermatochalasis
ﺣﺎﻟﺔ ﻷول ﻣﺮة ﺗﻨﺰل ﻓﻲ إﻣﺘﺤﺎن اﻹﻛﯿﻠﯿﻨﻜﻰ اﻟﻌﺎم اﻟﻤﺎﺿﻰ
16- Papilloma Conjunctiva
ﯿﻛﻒ ﺗﻌﺮﮭﻓﺎ ﻇﻔﺮة ﻣﻠﺘﺤﻤﺔ ﺷﻜﮭﻠﺎ ﻣﺜﻠﺚ رأﮫﺳ إﻟﻰ اﻟﻘﺮﯿﻧﺔ -إﻣﺎ1ry or 2ry (Recurrent) :ﻣﻦ اﻵﺧﺮ :إﺳﺄ ل اﻟﻤﯾﺮﺾ ﻣﻠﺘﺤﻤﺔ ﻣﺎﺳﻜﺔ ﻓﻰ ﻋﺘﺎﻣﺔ ﻋﻠﻲ اﻟﻘﺮﯿﻧﯾ ﺔﻤﻜﻨﻚ إﻣﺮار ..ﺗﺤﮫﺘ ﻣﺜﻠﺚ أﺻﻔﺮ ﻗﺎﻋﺪﮫﺗ إﻟﻰ اﻟﻘﺮﯿﻧﺔ ،ﯿﻟﺲ ﻏﺸﺎء ﻣﺜﻞ اﻟﻈﻔﺮة ﺣﺎﮫﺟ ﺑﺰه ،ﻟﻮ ﺳﺄﻟﺖ اﻟﻤﯾﺮﺾ ﻋﻦ ﻋﻤﯿﻠﺔ ﯿﻣﺔ زرﮫﻛ ﯾﯿﻤﺰﻣﺎإذااﻟﺴﺒﺐ ﺧﺒﻄﺔ ﻟﻠﯿﻌﻦ أم ﻟﻠﺮأس... -دم ﺳ ﯾﺎﺢ ﺗﺤﺖ اﻟﻤﻠﺘﺤﻤﺔ
Lacrimal Apparatus
*Dacryocystitis: epiphora red swelling Lac. Sac +ve Regurge Test ttt: DCR
اﻟﺤﺎﻟﺔ
-
1- Pterygium 2- Pseudopterygium 3- Pinguecula )4- Diffuse Bleb (SST 5- Subconjunctival Hge 6- Symblepharon 7- Conjunctival Naevus 8- Red Conjunctiva
اﻟﺠﻔﻦ ﻣﺎﺳﻚ ﻓﻰ اﻟﯿﻌﻦ ﯿﺳﺌﺔ ﻓﻰ اﻟﯿﻌﻦ إرھﺎق ،إﻟﮭﺘﺎب .... ، أوﯿﻋﺔ ﺣﻤﺮة و واﺿﺤﺔ ﻗﻮى ﺣﻮل اﻟـ Keratitis, Iridocyclitis, Glaucoma ← Limbus
9- Ciliary injection
أوﯿﻋﺔ ﺣﻤﺮة و واﺿﺤﺔ ﻗﻮى ﺧﺎﺻﺔ ﻓﻰ اﻟـ Conjunctivitis ←Fornices
10- Conjunctival injection
Cornea ﯿﻛﻒ ﺗﻌﺮﮭﻓﺎ ھﻼل أﯿﺑﯾ ﺾﯿﺤﻂ اﻟﻘﺮﯿﻧﺔ ﻣﻦ ﻓﻮق ﺣﻠﻘﺔ ﻋﺘﺎﻣﺔ ﺗﯿﺤﻂ اﻟﻘﺮﯿﻧﺔ )اﻟﻌﺠﻮز( ﺳﺤﺎﺑﺔ ﻻﺗﺮاھﺎ إﻻ إذا اﻗﺘﺮﺑﺖ ﻣﮭﻨﺎ وﻧﻮرت ﻣﻦ اﻟﺠﺎﻧﺐ -ﻋﺘﺎﻣﺔ ﺑﻀﺎء ﻗﯾﻮﺔ
-إﻣﺎ LNA :اﻟﺘﻰ ھﻰ ﻋﺘﺎﻣﺔ ﻓﻘﻂ & LAاﻟﺘﻰ ﺗﺠﺪ ﻣﮭﻌﺎ اﻟﯿﻨﻨﻰ ﯿﻏﺮ ﻣﻨﺘﻈﻢ
اﻟﺤﺎﻟﺔ
Pannus Siccus Arcus Senilis Nebula Leucoma
1234-
ﻗﺮﯿﻧﺔ ﻗﻤﯿﻌﺔ ﻣﺨﺮوﯿﻃﺔ ﻣﺒﻈﺒﻈﺔ ﺷﻔﺎﻓﺔ :ﻟﻮ ﻧﻈﺮ ﻷﺳﻔﻞ : Angulation of LL on looking down ←Munson`s Sign
5- Keratoconus
ﻗﺮﯿﻧﺔ ﻣﻌﺘﻤﺔ و ﻣﺒﻈﺒﻈﺔ ﺑﺲ
6- Keratectasia
ﻗﺮﯿﻧﺔ ﻣﻌﺘﻤﺔ و ﻣﺒﻈﺒﻈﺔ +ﻣﺒﻄﻨﺔ ﺑـ iris
7- Ant. Staphyloma
Dr / M. Abd Ulghaffar (MASS) / 016 570 1914
ﺳﺒﺤﺎن ﷲا وﺑﺤﻤﺪه ﺳﺒﺤﺎن ﷲا اﻟﻌﯿﻈﻢ
Iris اﻟﺤﺎﻟﺔ
ﯿﻛﻒ ﺗﻌﺮﮭﻓﺎ
Pupil
ﻓﻮق-Part of iris is removed (near its root)
1- Peripheral iridectomy
اﻟﺤﺎﻟﺔ
-Pupil remains round -Part of iris is removed
2- Sector iridectomy
RRRCE =
(from:pupil to:ciliary border)
(Key-hole)
1- Normal Pupil
3- Visual iridectomy
- ﯾﺘﺤﻚ ﻋﯿﻠﻚ ﯾوﻌﻄﻰ اﻟﺤﺎج ﻗﻄﺮة ﺗﻮﯿﺳﻊ
(near pupil,but not reach Ciliary border)
2- Dilated fixed
اﺳﺄﮫﻟ ھﻞ وﻟﺪ ﮭﺑﺎ-
4- Coloboma of iris
- defect in iris
5- Iridodialysis
- lost peripheral area of iris
ﻓﻰً ﺗﺠﯿﻤﻌﺔ ﮭﻣﻤﺔ ﺟﺪاااااااا اﻟﺸﻔﻮى
6- Iridodoneisis
( ﻗﺰﯿﺣﺔ ﮭﺗﺘﺰtremulous iris)
3- An iso coria
7- Patches of iris atrophy
أﺟﺰاء ﯿﻣﮫﺘ ﻣﯿﺒﮫﻀ ﻋﻠﻰ ﺳﻄﺢ اﻟﻘﺰﯿﺣﺔ-
8- Anterior Synechia
-iris + cornea:
4- Drawn up
ﻣﻮﻟﻮد ﮭﺑﺎ ﻂ َ اﺗﺨ ﺒ اﺳﺄﮫﻟ ﻋﻦ أﻣﺮاﯾ ضﺸﺘﻜﻰ ﻣﮭﻨﺎ ﻣﺜﻞ اﻟﺴﻜﺮ واﻟﻀﻐﻂ-
- Complicated - Senile Cortical ﺳﻨﺔ٥٠ ﺣﺎج ﻛﯿﺒﺮ اﻟﺴﻦ ﻓﻮق اﻟـ وﯿﻏﺮﻣﻮﻟﻮد ﮭﺑﺎ، وﻻﻋﻨﺪه ﻣﺮض، ﻂ َ ﻣﺎ اﺗﺨﺒ-
ﺳﮫﻨ٥٠ ﺳﮫﻨ ﺗﺤﺖ اﻟـ-
Iris shadow + اﻟﻌﺪﺳﺔ ﮭﯿﻓﺎﻋﺘﺎﻣﺔ
اﻟﻌﺪﺳﺔ ﻛﮭﻠﺎ ﻋﺘﺎﻣﺔ-
Mature Intumescent
َاﺗﺨﺒ ﻂ ﻣﺎﻣﺜﻠﺜﺎت ﻓﻰ اﻻﻃﺮاف
Incipient Immature
اﻟﻌﺪﺳﺔ ﻣﻨﻔﻮﺧﺔ و ﺑﺘﻠﻤﻊ-
ﻋﺘﺎﻣﺔ ﻣﺜﻞ اﻟﺼﺪﻓﺔ أو ﻗﺸﺮ ﺳﻤﻚ-
Hyper mature: - Shrunken - Morgagnian
ﻟﺒﻦ و اﻟﻨﻮاة اﻟﺒﯿﻨﺔ ﻏﺎرﻗ ﺔ ﺗﺤﺖ اﺳﺄل اﻟﻤﯾﺮﺾ ھﻞ ﻧﻈﺮه ﯿﺑﺘﺄﺛﺮ ﺑﺎﻟﮭﻨﺎر أﻛﺜﺮ ﺻﻮرة واﺣﺪة ﻓﻘﻂ ﻋﻠﻰ اﻟﻘﺮﯿﻧﺔ- ﻋﻤﻞ ﻋﻤﯿﻠﺔ ﯿﻣﺔ ﯿﺑﮫﻀ وﻣﺎ زرﻋﺶ: اﺳﺄﮫﻟ-
- Aphakia AC IOL
- Pseudophakia PC IOL
- After Cataract
اﻟﻌﺪﺳﺔ ﻣﻨﻜﻤﺸﺔ و ﻣﻨﻘﮫﻄ أﯿﺑﺾ و أﺻﻔﺮ-
- brownish yellow opacity at Center of lens
- Senile Nuclear
(central , round)
-Leucoma Adherent -Ant, Post Synechia
Pupil
ﯿﻛﻒ ﺗﻌﺮﮭﻓﺎ
(Blunt Tr. & Penetrating Tr.)
Un equal 2-pupils
around pupil
ﻗﺰﯿﺣﺔ ﻣﺎﺳﻜﺔ ﻓﻰ اﻟﻌﺪﺳﺔ-
Lens / Cataract
- Traumatic
- 3rd nerve palsy
-Iris tissue is present all
Pupil 5- Irregular
- Developmental
- Absolute glaucoma
-Pupil isn`t
(ﻗﺰﯿﺣﺔ ﻣﺎﺳﻜﺔ ﻓﻰ ﮭﻇﺮ ﻗﺮﯿﻧﺔ ﺷﻔﺎﻓﺔ ) اﻟﯿﻨﻨﻰ ﯿﻏﺮ ﻣﻨﺘﻈﻢ
اﻟﺤﺎﻟﺔ
- CRAO - OA
pupil
- bilateral, down + in
- D-shaped pupil
-iris + lens
regular, reactive, round, central, equal on both sides
-Small part of iris is removed: (Down+ In)
9- Posterior Synechia
ﯿﻛﻒ ﺗﻌﺮﮭﻓﺎ
ﻋﻤﻞ ﻋﻤﯿﻠﺔ ﯿﻣﺔ ﯿﺑﮫﻀ وزرع ﻋﺪﺳﺔ اﻟﻌﺪﺳﺔ ﻛﮭﻠﺎ اﻣﺎﻣﻚ ﻋﻤﻞ ﻋﻤﯿﻠﺔ ﯿﻣﺔ ﯿﺑﮫﻀ وزرع ﻋﺪﺳﺔ ﯿﻋﮫﻨ ﺑﺘﺴﺮج وﺑﺘﺒﺮق: ﻣﺢ ﺣﺮﻛﺔ اﻟﻨﻮر ﻋﻤﻞ ﻋﻤﯿﻠﺔ ﯿﻣﺔ ﯿﺑﮫﻀ وردت ﻋﮫﯿﻠPupil: ﻋﺘﺎﻣﺔ ﻓﻰ-
