Mnemonics of Ophthalmology

Examination technique of senile cataract

 V- DOTS

*Visual acuity testing

*Distant direct ophthalmoscopic examination 

* Oblique illumination examination 

* Test for iris shadow

* Slit lamp examination

"DWARF" for describing Nystagmus

Direction=plane of movement-horizontal,vertical

Waveform= Pendular or Jerky

Amplitude= fine or coarse

Rest=At primary position or gaze evoked

Frequency= How often the eye moves

Features of Behcet's Disease: ORAL UPSET

Occlusive periphlebitis

Retinitis

Anterior uveitis

Leakage from retinal vessels

Ulceration (aphthous/genital)

Pustules after skin trauma (Pathergy test)

Scratching leaves lines (dermatographism)

Erythema nodosum

Thrombophlebitis

Clinical features of Reiter’s: PLUCKING

Plantar Fasciitis

Urethritis

Conjunctivitis

Keratoderma blenorrhagica

Inflamed joints

Nail dystrophy

Gum ulceration

Ophthalmic features of TB: BCG GP

Busacca & Koeppe nodules on iris

Choroiditis

Granulomata in choroid

Granulomatous uveitis (with mutton fat KP’s)

Periphlebitis

Stye and Chalazion

STYE is Hordeolum externum (STAY OUT) ; Moll's gland / Zeis gland affected
Chalazion is Hordeolum INternum - Chronic Inflammatory granuloma of MEiBOMian glands (Remember : See (C)  me in Bombay)

Cataracts: causes

CATARAct:
Congenital
Aging
Toxicity (steroids, etc)
Accidents
Radiation
Abnormal metabolism (diabetes mellitus, Wilson's)

Surgeries for Ptosis

F L U F F Y
F- fasanella servat operation
L- levator resection {blaskovics n everbush's}
F- frontalis sling operation

Causes of lid retraction

4M= Myasthenia Gravis, Marcus Gunn jaw winkling syndrome, Myotonic causes like dystrophica myotonica. Metabolic causes like uraemia,cirrhosis

4P= Perinauds syndrome, Parkinson's Disease/ Progressive supranuclear palsy, Ptosis of other eye, Palsy (aberrant III cranial nerve regeneration)

Causes of retinal detachment

Mnemonic: SITS

Secondary to some intraocular problem (melanoma)
Idiopathic
Trauma
Surgery for cataract

Nerves passing through superior orbital fissure

“Live Frankly To See Absolutely No Insult”

• Lacrimal nerve
• Frontal nerve
• Trochlear nerve
• Superior division of oculomotor nerve
• Abducens nerve
• Nasociliary nerve (branch of ophthalmic nerve)
• Inferior division of oculomotor nerve

 

Etiology of Neovascular Glaucoma

RUBEOTIC

Retinopathy and Retinal vein occlusion (PDR, CRVO)
Retinal detachment
Uveitis
BRVO
Eale's Disease
Ocular Ischemic Syndrome
Trauma
Intraocular tumours (choroidal melanoma)
Carotid Cavernous Fistula

ANGLE SRUCTURES

"I Can See Till Schwalbe's Line"

Iris root

Cilliary Body

Scleral spur

Trabecular Meshwork

Schwalbe's Line

ACROMEGALY & MARFANS

Remember ocular features of acromegaly with ACROM

Angiod streaks

Chiasmal syndrome

Retinopathy

Optic atrophy,papilloedema

Muscle enlargement

Remember the systemic features of Marfan syndrome with MARFANS

Mitral prolapse

Aortic dissection

Regurgitant aortic valve

Fingers long (arachnodactyly)

Arm span>height

Nasal voice (high arched palate)

Sternal excavation

characteristics of Perinaud's Dorsal Midbrain Syndrome with "CLUES"

Convergence retraction nystagmus

Lightnear Dissociation

Upgaze paralysis

Eyelid retraction

Skew deviation

Characteristics of congenital nystagmus with CONGENITAL

Convergence & eye closure dampens

Oscillopsia absent

Null zone that is present,increases foveation time which results in increased acuity

Gaze poisition doesnot change the horizontal direction of nystagmus

Equal amplitude and frequency in each eye

Near acuity is good

Inversion of optokinetic response

Turning of head to acheive null point

Abolishes in sleep

Latent (occlusion) nystagmus occurs

Causes of downbeat nystagmus with DoWNBEAT

Degeneration,Demyelination or Drugs (Lithium)

Wernicke's Encephalopathy

Neoplasm or paraneoplastic cerebeller degeneration

Brainstem disease (Syringomyelia)

Encephalitis

Arnold-Chiari malformation

Trauma or Toxin

Content & veins draining the Cavernous Sinus with Rule of 3

3 Afferent veins: Sphenoparietal sinus (Vault veins), Superficial  Middle cerebral Vein (Brain), Ophthalmic vein (Orbit)
3 Efferent Veins: Superior petrosal sinus, Inferior Petrosal Sinus, Communicating vein to pterygoid plexus
3 Contents; Cranial Nerves (III,IV, V1,V2 & VI)
3 Areas Drain into it: Vault Bones, Brain (Cerebral Hemisphere), Orbit
3 Nerves: Motor(III,IV,VI),Sensory (V1,V2), Sympathetic

Structures derived from surface ectoderm with

 S1L2E3

Skin of Eyelids and its derivatives viz. cilia, tarsal glands, conjunctival gland
Lens,
Lacrimal Gland,
Epithelium of Conjunctiva,
Epithelium of Cornea,
Epithelium of lacrimal passage

Ocular structures derived from neuroectoderm

Muscles of pupil
Optic Nerve
Retina (with RPE)
Epithelium of Iris
Epithelium of Cilliary Body

Sterilization in ophthalmology with ABCDEFG

AUTOCLAVE
BOILING
CHEMICALS like Alcohol (Rectified spirit), Isopropyl alcohol/CIDEX: 2% Glutaraldehyde
DRY HEAT temperature of 150°C is used for 90 minutes
ETHYLENE OXIDE for sterilization of IOL etc.
FUMIGATION of operation theatre/ FORMALIN vapour
GAMMA-IRRADIATION: Gamma rays from Cobalt-60

Causes of trabecular pigmentation

"PIGMENT"

Pseudoexfoliation & Pigment dispersion syndrome
Iritis
Glaucoma (Post angle closure Glaucoma)
Melanosis of angle (oculodermal melanosis)
Endocrine (Diabetes & Addison’s Syndrome)
Naevus (Cogan-reese syndrome)
Trauma

PR IS DANGEROUS IN TB

key word
PR--> PROTOANOPES cant see RED
DG--> DEUTROANOPES cant see GREEN
TB--> TRITOANOPES cant see BLUE

IM INJECTION IS EAZY

key word IM --> internal hordeolum is in meibomiam gland
EaZy--> external hordeolum is in zeis gland

Systemic diseases associated with Retinitis Pigmentosa

L U C H R

Laurence moon biedl synd
Usher's synd
Cockayne's synd
Hallgren's synd
Refsum's synd

Surgeries for Entropion

CICATRICIAL ENTROPION:  "skin n muscle of beautiful jia khan"
 
1- skin n muscle resection
2- skin, muscle n tarsus resection
3- burrow's operation
4- jaesche arlt' operation
5- ketssey's operation

SENILE ENTROPION:  "BeWiTched "

1- bick's procedure
2a- wheeler's operation
2b- weiss operation
3- tucking of inferior lid retactors

complicated cataract is RIGID

R- retinal detachment
I- inflammatory conditions like iridocyclitis, hypopyon, choroiditis, endophthalmitis
G- glaucoma {primary n secondary}
I- intraocular tumors
D- degenerative conditions {retinitis pigmentosa, retinal dystrophies}

Trachoma

Herbert's pit are found in Trachoma. Classification is McCallan's Classification
Remember herberTs piTs TraChoMa McCallans
                                 T   T    C  M  M C

Pupil

Argyll-Robertson Pupil : Remember A-R-P, P-R-A : Accomodation Reflex Present, Pupilary Reflex Absent. Pupillary reflex absent due to damage at Pretectal area. Also called the "Prostitute's pupil" (Syphilitic pupil)

What is HIPpus: It is alternate RYTHMic contractions and dialatation of the pupil. (Remember, the pupil plays HIP HOP to RYTHM)

Innervation of Extra Occular muscles

Remember LR6SO4 :
Lateral Rectus is supplied by 6th cranial nerve,
Superior Oblique by 4th
and the rest of extraoccular muscles by occulomotor. 

Small pupils are due to : AMOrPHine' :

• Argyll -Robertson pupil
• Morphine
• Organophosphate poisoning
• Pontine hemorrhage
• Horners syndrome
• ine-insignificant

Actions of Superior oblique muscle

'SOLID'
Superior Oblique -

• Lateral rotation (Abduction)
• Intorsion
• Depression

Congenital cloudy cornea: Conditions

STUMPED "

• Sclerocornea
• Tears in Descmet's membrane
• Ulcer
• Metabolic conditions
• Posterior corneal defect
• Endothelial dystrophy
• Dermoid

Interstitial keratitis: Causes

 " TIC TAC' S "

• Tuberculosis
• Inherited syphilis (Congenital syphilis)
• Trypanosomiasis
• Acquired syphilis
• Cogan's syndrome
• Sarcoidosis

Iris shadow: visible in

' Iris Shadow '
 Immature Senile cataract.

Logic: When there is any clear cortex between the iris and the opacity (greyish white in immature senile cataract), the shadow of the iris which falls upon the opacity, as light is cast upon the eye is visible through the clear cortex. This is called the 'iris shadow' and is a common sign in immature senile catarct.

Ocular features of Marfan syndrome

   "CLUMPS"

• Cupping(glaucoma)
• Lattice
• Upward lens subluxation
• Myopia
• cornea Plana
• Sclera blue

Retinal detachment: Features

"4 F's"

• Floaters (small dark spots on a bright background are usually harmless)
• Flashes 
• Field loss
• Falling acuity

Cherry red spot on Retina: Causes

"Cherry Trees Never Grow Tall"

• Central retinal artery occlusion
• Tay-Sachs disease
• Niemann-Pick disease
• Gaucher's disease
• Trauma (Berlin's edema)

Tears: Composition

"Water PLUSS"

• Water 
• Protein
• Lysozyme
• Urea
• Salts and
• Sugar

Home Treatment of Retinal Detachment Treatment  

6 S"

• Sealing of retinal breaks
• SRF drainage  (SRF is Subretinal fluid)
• Scleral buckling
• SF6 pneumatic retinopexy
• Sectioning vitreous (vitrectomy)
• laSer prophylaxis

Diabetic retinopathy: Signs of the Non-proliferative stage

"Microsoft  Dot com  Rated  Internet  Very  Cool  and  Definitely  Hot"

• Microanuerysms
• Dot and blot hemorrhages
• Retinal edema
• Intraretinal microvascular abnormalties
• Venous abnormalities
• Cotton-wool spots
• Dark blot hemorrhages and
• Hard exudates

TUMOURS

Suspicious Choroidal Naevi: To Find Small Ocular Melanoma


Thickness >2mm

Fluid (subretinal)

Symptoms

Orange pigment (lipofuscin)

Margin at optic disc

Classification of Retinoblastoma: ABCDE

SmAll (<3mm br="br">
Bigger (>3mm, macular, subretinal fluid)

Contained Seeds

Diffuse seeds (>3mm)

Extensive (>50% globe, opaque media, NVI)

RETINA

Differential Diagnosis of Drusen: AGEING

Alports Syndrome

Glomerulonephritis

Exudate (Hard)

Inherited (Familial Dominant Drusen)

North Carolina Dystrophy

starGardts and fundus flavimaculatus

SCLERA

Features of posterior scleritis: POST SCLER

Proptosis

Ophthalmoplegia

Swelling of disc

Thickening of sclera (US/CT) & T sign (fluid in sub-Tenon’s space)

Subretinal exudates

Choroidal foLds

Exudative RD

Ring choroidal detachment

LENS

Causes of cataract: DAMAGED

Diabetes

Atopy

Myopia / Myotonic dystrophy

Anterior uveitis (chronic)

Glaucomflecken

Electricity / radiation / trauma

Drugs / Dystrophies

&

CATARAct:

Congenital
Aging
Toxicity (steroids, etc)
Accidents
Radiation
Abnormal metabolism (diabetes mellitus, Wilson's)

Drugs causing cataract: ABCD

Amiodarone

Busulphan

Chlorpromazine

Dexamethasone (po/g)

Causes of ectopia lentis: ECTOPIC M&M

Eye degeneration (phthisis)

Choroidal tumours

Trauma

Overstretched zonules (buphthalmos / megalocornea)

AR with Pupil ectopy

Isolated AR

Cystathione beta-synthase deficiency (homocystinuria)



Marfans

&

Weill-Marchesani syndrome

Periorbital cellulitis: etiology

SIGHT:
Sinusitis
Insect Bite
Globular/ Glandular Spread
Heme Spread
Trauma

Optic atrophy causes

ICING:
Ischaemia
Compressed nerve
Intracranial pressure [raised]
Neuritis history
Glaucoma

Diplopia (uniocular): causes

ABCD:
Astigmatism
Behavioral: psychogenic
Cataract
Dislocated lens

Secondary glaucoma: PILES

Pigmentary

Iridoschisis



Lens (phacolytic/phacomorphic)

Iridocorneal Endothelial syndromes

Seclusio pupillae (in iritis)

Choroidal neovascular membrane

HAMMAR:
Histoplasmosis
ARMD
Multifocal Choroiditis
Myopia
Angiod
Rupture of the choroid

Systemic associations of keratoconus: ABCDEF

Atopy

Bones (osteogenesis imperfecta)

Crouzon’s syndrome

Down’s syndrome

Ehler’s Danlos syndrome

Fingers (Marfan’s)

Features of Keratoconus: CONES

Central scarring & Fleischer ring

Oil drop reflex / Oedema (hydrops)

Nerves prominent

Excessive bulging of lower lid on downgaze (Munson’s sign)

Striae (Vogt’s

Associations of Vortex Keratopathy: ABCD

Arthritis (diclofenac)

Breast Cancer (Tamoxifen)

Cardiac (amiodarone)

Dementia / Depression (Chlorpromazine)

Enzyme deficiency (see F)

Fabry's Disease

Features of Post Enucleation Socket Syndrome (PESS)

Ptosis

Enophthalmos

Deep upper Sulcus

Slack lower lid