The physician noticed the following finding in a patient that came to the OPD for an eye exam. Which of the following pair of muscles are likely to be affected in this patient? Muller's muscle and superior rectus 3) Levator palpebrae superioris and superior oblique Superior oblique and superior rectus Levator palpebrae superioris and Muller's muscle‘#Eponyms —#Clinical #lmageBased The patient has mild right eye ptosis. Injury or weakness of levator palpebrae superioris and Muller's muscle leads to ptosis. Levator palpebrae superioris is the important upper eyelid retractor. Frontalis and Muller's muscle assist in the elevation of the upper eyelid, Ans D ‘A28 year old man presents to the medicine OPD with cough with hemoptysis of 1 month duration. A sputum culture done is shown below. What is the most common ocular manifestation associated with this infection? Uveitis ©) Phiyetenularkeratoconjunctivitis ) Complicated cataract 1) Vitreous haemorrhageThe image shows the growth of Mycobacterium tuberculosis colonies on the Lowenstein- Jensen medium. In tuberculosis (TB), granulomatous panuveitis is the most common ocular feature The most common allergic manifestation of TB is phlyctenular keratoconjuncti Treatment is anti-tubercular therapy (ATT) plus steroids. Ans A ‘A mother noticed the following finding in her 3- month-old child. There is a history of watering and discharge from his right eye since birth. Which of the following is the best next step in the treatment? 2) Syringing Probing with syringing Sac massage with topical antibictics DacryocystorhinostomyThe image shows right-sided swelling in the lacrimal sac area along with watering of the eye is suggestive of congenital dacryocystitis. Treatment for a 3-month-old child includes sac massage with topical antibiotics. More than 90% of patients with congenital nasolacrimal obstruction undergo spontaneous resolution by 1 year of age. Treatment depends on the age of the child: * Less than 9 months * Massaging (Crigler’s massage, which increases the hydrostatic pressure) * Antibiotics eye drops * 9months to 4 years * Probing * Older children (> 4 years): * Dacryocystorhinostomy (OCR) * In DCR, an opening is made into the nasal cavity from the la * DCR gives the best result. Ans C 7. On administration of phenylephrine, the following change was noted as shown in the images below. What is the probable diagnosis? A. Nodular scleritis B. Nodular episcleritis C. Tenon's cyst D. Nodular phlyctenThe image shows a nodule surrounded by redness. On administration of phenylephrine, blanching of superficial episcleral vessels is seen. Hence, the probable diagnosis is nodular episcleritis. 2.5% phenylephrine can be used to differentiate episcleritis and scleritis. Since the vessels of the episclera are superficial, they blanch. Whereas, in scleritis, the vessels do not blanch. Episcleritis is benign, recurrent, inflammation of the episclera, involving the overlying Tenon's capsule but not the underlying sclera. It is more common in women than in men. It is an allergic reaction to an endogenous toxin. It is commonly associated with rheumatoid arthritis, Episcleritis is characterized by redness, mild ocular discomfort described as a gritty, burning, or foreign body sensation Clinically, two types of presentations may occur: * Simple episcleritis is characterized by sectorial or diffuse inflammation of the episclera. * Nodular episcleritis is characterized by a pink or purple flat nodule surrounded by injection, usually situated 2:3 mm away from the limbus. The nodule is firm, and tender and can be moved separately from the sclera, and the overlying conjunctiva also moves freely. Treatment includes topical NSAIDs, corticosteroid eye drops, cold compress, and artificial tears. In recurrent cases, systemic NSAIDs are used. Scleritis refers to an inflammation of the sclera proper. It usually occurs in elderly patients (40-70 years) involving females more than males. It is frequently associated with an underlying systemic inflammatory condition. The patient presents with moderate to severe pain, redness, lacrimation, photophobia, and diminution of vision Ans B6. A32-year-old lady presented with dry, itchy eyes, blurred vision, and sensitivity to light. She says there are black dots floating around in her visual field. She denies wearing any spectacles or contact lenses. On fundoscopy, the following image is obtained. What is the diagnosis? A. CMV retinitis B. Sarcoidosis C. Toxoplasmosis D. Behcet's diseaseThe image depicts candle wax dripping in sarcoidosis. Ocular inflammation occurs in 25- 70% of sarcoid patients, depending on ethnicity. Chronic granulomatous panuveiti manifestation. is seen, with anterior uvei being the most common Ophthalmologic manifest: ns of sarcoidosis: 1. "Mutton fat" keratic precipitates (KPs) and/or small granulomatous KPs. 2. Iris nodules (Koeppe and/or Busacca) 3. Trabecular meshwork (TM) nodules and/or tent-shaped peripheral anterior synechiae (PAS) 4, Snowball opacities/string of pearl appearance 5. Interstitial keratitis 6, Band-shaped keratopathy 7. Fundus changes: * Candle-wax dripping- Thick venous sheathing of periphlebitis * Pre retinal nodules- Lander's sign * Choroidal granulomata * Sarcoid infiltration Ans B4. Jai presented to the clinic with severe left eye pain, watering, and swelling of the lid for 2 days. He says it's difficult to see the laptop screen while working and he is unable to complete his daily targets. On examination, tender swelling is noted as shown below. What is the cause of this finding? A. Acute infection of Zeis gland B. Acute infection of Moll gland C. Acute infection of meibomian gland D. Chronic infection of meibomian gland Ans C2. A woman comes to the ophthalmology OPD because of having vision difficulties for the last 3 months. On fundoscopic examination, the following findings are seen. Which of the following is the most likely diagnosis? Hypertensive retinopathy Diabetic retinopathy op > Pathological myopia D. SarcoidosisThe image shows a fundus typical of pathological myopia due to the stretching of the retina. The tigroid appearance or tessellated appearance of the fundus can be appreciated. As the eye enlarges, the retinal pigment epithelium becomes thinner, resulting in: * A tessellated (checkered) appearance of the fundus * Increased visibility of the choroidal vasculature Other features of the myopic fundus are as follows: Lacquer cracks are spontaneous ruptures of the elastic lamina of Bruch’s membrane. It appears yellowish-white. it is usually located in the posterior pole. Annular gray shadow around the optic disc * Lattice degeneration * Foster Fuchs spots * Cystoid degeneration * Total retinal atrophy Fundus changes in pathological myopia ecg Sal cg Cee ay Ae Porc) Cag Crone eee Ans C1. Which of the following muscle is responsible for ptosis in horner's syndrome? A. Levator palpebrae superioris muscle B. Oribicularis oculi C. Horner's muscle D. Muller's musclePtosis in Horner's syndrome is due to the paralysis of Muller's muscle. Muller's muscle(superior tarsal muscle) maintains the elevation of the upper eyelid. It is innervated by the sympathetic nervous system. Fasanella-Servat operation is indicated in cases having mild ptosis(< 2 mm) and good levator function. In this surgery, the upper tarsal border along with its attached Muller's muscle and conjunctiva are resected, MARROW Surgical treatment of different types of ptosis Pearl PMO799 + Depiteakroiegy — Fasanella~Servat Levator Resection~Anterior approach (Everbusch operation) Moderate iene, Lever resection with ponetotic sage Frontalis suspension-Fascia Poor Ans D <2mm Any Any Any >2mm Homer Syndrome Larger resection in ptosis Moderate resection in ptosis Acquired ptosis Congenital ptosis~ ‘Marcus~Gunn ptosisOption A: Symblepharon is the adhesion between the palpebral and bulbar conjunctiva, whereby the eyelids become adherent to the eyeball Option C: Blepharophimosis is a congenital anomaly in which the extent of the palpebral fissure is decreased. It appears contracted at the outer canthus.