Important Notes for Competitive Exams

Diagnostic Tests for Eye Conditions

1. Tonometry

✅ Definition: Measures intraocular pressure (IOP) to diagnose and monitor glaucoma.
✅ Normal IOP: 10-21 mmHg
✅ Types:

• Applanation tonometry – Gold standard (Goldmann applanation tonometer).
• Non-contact tonometry – Uses an air puff.
• Indentation tonometry – Uses a Schiötz tonometer.

2. Snellen’s Chart

✅ Definition: Measures visual acuity (sharpness of vision).
✅ Procedure:

• Patient stands 6 meters (20 feet) away from the chart.
• Reads the smallest line possible with one eye covered.
  ✅ Interpretation:
• 6/6 (20/20) vision – Normal vision.
• 6/60 (20/200) vision – Legal blindness.
  ✅ Uses: Detects myopia, hypermetropia, and astigmatism.

Infections and Inflammatory Conditions of the Eye

1. Blepharitis

✅ Definition: Chronic inflammation of the eyelid margin.
✅ Causes: Staphylococcal infection, seborrheic dermatitis, Demodex mites.
✅ Symptoms:

• Red, swollen eyelids
• Burning, itching, crusting of eyelashes
  ✅ Treatment:
• Lid hygiene (warm compresses, eyelid scrubs)
• Topical antibiotics (Erythromycin ointment)
• Artificial tears for symptom relief

2. Stye (Hordeolum)

✅ Definition: Acute bacterial infection of an eyelash follicle or Meibomian gland.
✅ Cause: Staphylococcus aureus
✅ Symptoms:

• Painful, red lump on the eyelid
• Swelling, tenderness
  ✅ Treatment:
• Warm compresses 4–6 times daily
• Topical antibiotics (Mupirocin, Erythromycin ointment)
• Incision and drainage if needed

3. Chalazion

✅ Definition: Chronic, painless inflammatory granuloma of the Meibomian gland.
✅ Symptoms:

• Firm, non-tender nodule on the eyelid
• No redness or pain unless infected
  ✅ Treatment:
• Warm compresses
• Intralesional steroid injection
• Surgical removal if large

4. Entropion

✅ Definition: Inward turning of the eyelid, causing eyelashes to rub against the cornea.
✅ Causes:

• Age-related degeneration
• Trauma, burns
  ✅ Symptoms:
• Foreign body sensation
• Tearing (Epiphora)
• Corneal irritation and ulceration
  ✅ Treatment:
• Lubricating eye drops
• Surgical correction

5. Ectropion

✅ Definition: Outward turning of the eyelid, leading to exposure of the conjunctiva.
✅ Causes:

• Aging
• Facial nerve palsy
  ✅ Symptoms:
• Dry, red eyes
• Tearing (Epiphora)
  ✅ Treatment:
• Artificial tears
• Surgical correction

6. Dacrocystitis

✅ Definition: Infection of the lacrimal sac due to nasolacrimal duct obstruction.
✅ Causes:

• Staphylococcus aureus, Streptococcus
  ✅ Symptoms:
• Pain, redness, and swelling near the inner corner of the eye
• Purulent discharge
  ✅ Treatment:
• Warm compresses
• Oral antibiotics (Amoxicillin-Clavulanate)
• Surgical intervention (DCR – Dacryocystorhinostomy) in chronic cases

7. Conjunctivitis (Pink Eye)

✅ Definition: Inflammation of the conjunctiva (mucous membrane covering the eye).
✅ Types:

• Viral (Most common, Adenovirus) – Watery discharge, preauricular lymphadenopathy
• Bacterial (Staphylococcus, Streptococcus, Gonorrhea, Chlamydia) – Purulent discharge
• Allergic (Pollen, dust, pet dander) – Itching, redness, watery discharge
  ✅ Treatment:
• Viral: Supportive care, artificial tears
• Bacterial: Topical antibiotics (Moxifloxacin, Chloramphenicol)
• Allergic: Antihistamines, mast cell stabilizers

8. Trachoma

✅ Definition: Chronic conjunctivitis caused by Chlamydia trachomatis leading to blindness.
✅ Stages:

• Follicular inflammation
• Scarring of conjunctiva
• Trichiasis (inward eyelashes)
• Corneal opacity and blindness
  ✅ Treatment: SAFE strategy
• S – Surgery (for trichiasis)
• A – Antibiotics (Azithromycin, Tetracycline ointment)
• F – Facial cleanliness
• E – Environmental hygiene

9. Pterygium

✅ Definition: Triangular fibrovascular tissue growth on the conjunctiva extending onto the cornea.
✅ Cause: UV exposure, dust, wind
✅ Symptoms:

• Redness, irritation
• Blurry vision if large
  ✅ Treatment:
• Lubricating eye drops
• Surgical excision if vision is affected

10. Keratitis

✅ Definition: Inflammation of the cornea.
✅ Causes:

• Bacterial (Pseudomonas, Staphylococcus) – Contact lens users
• Viral (Herpes Simplex Virus – HSV) – Dendritic ulcer
• Fungal (Aspergillus, Candida) – Trauma with vegetative matter
  ✅ Symptoms:
• Pain, photophobia, blurred vision
• Corneal opacity, ulceration
  ✅ Treatment:
• Bacterial: Topical antibiotics (Fluoroquinolones)
• Viral: Acyclovir eye drops
• Fungal: Natamycin, Amphotericin B

11. Corneal Ulcer

✅ Definition: Open sore on the cornea due to infection, trauma, or contact lens use.
✅ Causes:

• Bacterial (Pseudomonas, Staphylococcus, Streptococcus)
• Viral (Herpes simplex, Varicella zoster)
• Fungal (Aspergillus, Fusarium, Candida)
  ✅ Symptoms:
• Severe pain, photophobia, tearing
• Corneal opacity, ulceration
  ✅ Treatment:
• Bacterial: Fluoroquinolone antibiotics (Moxifloxacin)
• Fungal: Natamycin, Amphotericin B
• Viral: Acyclovir

Key Points for Exams

🟢 Tonometry – Used for glaucoma diagnosis (Normal IOP: 10-21 mmHg).
🟢 Snellen’s Chart – 6/6 vision is normal; 6/60 is blindness.
🟢 Most common cause of conjunctivitis – Viral (Adenovirus).
🟢 Trachoma is caused by Chlamydia trachomatis.
🟢 Commonest bacterial keratitis in contact lens users – Pseudomonas aeruginosa.
🟢 Dacrocystitis treatment – DCR surgery in chronic cases.
🟢 Herpes simplex keratitis – Dendritic ulcer, treated with Acyclovir.

Degenerative Eye Conditions

1. Cataract

✅ Definition: Opacification (clouding) of the lens leading to progressive vision loss.
✅ Causes/Risk Factors:

• Aging (Senile Cataract – Most Common)
• Diabetes Mellitus (Diabetic Cataract)
• Trauma (Traumatic Cataract)
• Congenital (Rubella, Galactosemia, Down Syndrome)
• Radiation Exposure (UV rays, X-rays, Infrared light – Glassblower’s Cataract)
  ✅ Symptoms:
• Painless, gradual vision loss
• Blurred, cloudy vision
• Glare and halos around lights
• Absent red reflex in advanced cases
  ✅ Types of Cataract:
• Nuclear Cataract – Central lens hardening (most common age-related type).
• Cortical Cataract – Spoke-like opacities from periphery to center.
• Posterior Subcapsular Cataract – Affects near vision first, seen in diabetes & steroid use.
  ✅ Diagnosis:
• Slit-lamp examination – Detects opacity.
• Direct Ophthalmoscopy – Absence of red reflex.
  ✅ Treatment: Surgical removal
• Phacoemulsification (Most common, small incision, faster recovery).
• Extracapsular Cataract Extraction (ECCE) (Used in very hard cataracts).
• Intraocular Lens (IOL) implantation is done post-surgery.
  ✅ Complications:
• Posterior Capsule Opacification (PCO) – Treated with YAG laser capsulotomy.

🔹 Competitive Exam Tip:

• Senile Cataract is the most common type.
• Diabetes is a major risk factor.
• Treatment is surgical (Phacoemulsification preferred).

2. Retinopathy (Retinal Blood Vessel Damage)

✅ Definition: Damage to the retina due to vascular disorders.
✅ Types of Retinopathy:

a) Diabetic Retinopathy (DR)

✅ Definition: Retinal damage due to chronic hyperglycemia in diabetes.
✅ Stages:

• Non-Proliferative Diabetic Retinopathy (NPDR) – Microaneurysms, hemorrhages, cotton wool spots.
• Proliferative Diabetic Retinopathy (PDR) – Neovascularization, vitreous hemorrhage, retinal detachment.
  ✅ Complication:
• Diabetic Macular Edema (DME) – Leading cause of vision loss in diabetes.
  ✅ Diagnosis:
• Fundoscopy (Retinal Exam): Identifies hemorrhages, neovascularization.
• Fluorescein Angiography (FA): Detects retinal ischemia.
• Optical Coherence Tomography (OCT): Identifies macular edema.
  ✅ Treatment:
• Blood Sugar Control (HBA1C <7%)
• Anti-VEGF Therapy (Ranibizumab, Bevacizumab) – Inhibits abnormal vessel growth.
• Laser Photocoagulation (Panretinal Photocoagulation – PRP) – Prevents progression.

🔹 Competitive Exam Tip:

• Diabetic Retinopathy is the leading cause of blindness in adults.
• Fluorescein Angiography is the gold standard test.
• Anti-VEGF injections (Bevacizumab) are first-line for treatment.

b) Hypertensive Retinopathy (HR)

✅ Definition: Retinal damage due to chronic hypertension.
✅ Stages (Keith-Wagener Classification):

• Grade 1: Mild arteriolar narrowing.
• Grade 2: Arteriovenous (AV) nicking.
• Grade 3: Flame-shaped hemorrhages, cotton wool spots.
• Grade 4: Papilledema (Hypertensive Crisis – Medical Emergency).
  ✅ Diagnosis: Fundoscopy – Copper wiring, silver wiring, AV nicking.
  ✅ Treatment: Strict BP control (Goal <130/80 mmHg).

🔹 Competitive Exam Tip:

• Papilledema is a medical emergency.
• AV nicking is a classic sign of hypertensive retinopathy.

3. Retinal Detachment (Separation of Retina from Underlying Tissue)

✅ Definition: Separation of the neurosensory retina from the underlying retinal pigment epithelium, leading to vision loss.
✅ Causes/Risk Factors:

• High myopia (Most common)
• Trauma (Blunt injury, head trauma)
• Diabetic retinopathy
• Posterior vitreous detachment (PVD)
  ✅ Types:
• Rhegmatogenous (Most Common) – Due to retinal tears/holes.
• Tractional – Due to fibrosis (seen in diabetic retinopathy).
• Exudative – Due to fluid accumulation (Uveitis, Tumors).
  ✅ Symptoms:
• Flashes of light (Photopsia)
• Floaters (Black spots moving in vision)
• Curtain-like shadow over vision
• Sudden painless vision loss
  ✅ Diagnosis:
• Fundoscopy – Identifies detached retina.
• OCT (Optical Coherence Tomography) – Detailed imaging.
  ✅ Treatment:
• Laser Photocoagulation or Cryotherapy – Seals small tears.
• Scleral Buckling Surgery – For larger detachments.
• Vitrectomy + Gas Bubble Injection (Pneumatic Retinopexy) – For advanced cases.

🔹 Competitive Exam Tip:

• Retinal Detachment is PAINLESS vision loss.
• Flashes & Floaters are early warning signs.
• Laser treatment (Photocoagulation) is done for small tears.

🔹 Quick Revision Table for Competitive Exams

Condition	Key Features	Diagnosis	Treatment
Cataract	Cloudy lens, gradual vision loss, absent red reflex	Slit lamp, Fundoscopy	Surgery (Phacoemulsification, IOL implant)
Diabetic Retinopathy	Microaneurysms, hemorrhages, neovascularization	Fundoscopy, Fluorescein Angiography	Anti-VEGF, PRP laser, strict sugar control
Hypertensive Retinopathy	AV nicking, copper wiring, papilledema	Fundoscopy	Blood pressure control
Retinal Detachment	Flashes, floaters, curtain vision loss	Fundoscopy, OCT	Laser, Scleral buckle, Vitrectomy

🛑 Key High-Yield Points for Exams:

🟢 Cataract surgery (Phacoemulsification) is the treatment of choice.
🟢 Diabetic retinopathy treatment includes Anti-VEGF therapy.
🟢 Hypertensive Retinopathy Grade 4 (Papilledema) is a medical emergency.
🟢 Retinal detachment presents with PAINLESS vision loss and curtain-like shadow.

Miscellaneous Eye Conditions –

1. Strabismus (Squint)

✅ Definition: Misalignment of the two eyes, causing them to look in different directions.
✅ Types:

• Esotropia (Inward deviation) – Common in children.
• Exotropia (Outward deviation) – Seen in myopia.
• Hypertropia (Upward deviation)
• Hypotropia (Downward deviation)
  ✅ Causes:
• Congenital (Most common in children)
• Neurological disorders (Cranial nerve palsy – CN III, IV, VI)
• Uncorrected refractive errors (Amblyopia risk)
  ✅ Diagnosis:
• Cover-Uncover Test – Detects latent squint.
• Hirschberg Test – Light reflex deviation test.
  ✅ Treatment:
• Glasses for refractive errors
• Eye patching for amblyopia (Lazy Eye)
• Surgical correction (Extraocular muscle surgery)

🔹 Competitive Exam Tip:

• Esotropia is the most common squint.
• Cover-Uncover Test is the confirmatory test.

2. Refractive Errors

✅ Definition: Defects in focusing light on the retina, leading to blurred vision.
✅ Types:

• Myopia (Nearsightedness) – Distant objects are blurry; corrected with concave (-) lenses.
• Hypermetropia (Farsightedness) – Near objects are blurry; corrected with convex (+) lenses.
• Astigmatism – Uneven curvature of the cornea/lens, causing blurred vision in all directions.
• Presbyopia – Age-related loss of near vision due to lens hardening; corrected with reading glasses (+ lenses).
  ✅ Diagnosis:
• Snellen’s Chart – Visual acuity test.
• Retinoscopy & Autorefractometry – Objective measurement.
  ✅ Treatment:
• Glasses or Contact Lenses
• LASIK Surgery (Laser-Assisted In Situ Keratomileusis) for permanent correction

🔹 Competitive Exam Tip:

• Myopia is the most common refractive error worldwide.
• LASIK is commonly used for permanent correction.

3. Tumors of the Eye

✅ Common Tumors:

• Retinoblastoma (Most common eye tumor in children)
• Choroidal Melanoma (Most common malignant eye tumor in adults)
  ✅ Retinoblastoma:
• Cause: Genetic mutation (RB1 gene).
• Symptoms:
  • Leukocoria (White Reflex in Eye – First Sign)
  • Strabismus
  • Vision loss
• Diagnosis:
  • Fundoscopy (White tumor mass in retina).
  • Ultrasound, MRI (For tumor extension).
• Treatment:
  • Enucleation (Surgical removal of the eye in advanced cases).
  • Chemotherapy, Cryotherapy, and Radiotherapy for early-stage tumors.

🔹 Competitive Exam Tip:

• Leukocoria is the most important early sign of Retinoblastoma.
• Choroidal Melanoma is common in adults and treated with radiotherapy.

4. Color Blindness

✅ Definition: Inability to distinguish certain colors due to genetic defects in retinal cones.
✅ Types:

• Red-Green Color Blindness (Most Common, X-linked recessive)
• Blue-Yellow Color Blindness
• Total Color Blindness (Achromatopsia – Rare)
  ✅ Diagnosis:
• Ishihara Chart Test – Identifies red-green deficiency.
  ✅ Treatment:
• No cure (Genetic disorder).
• Special tinted glasses can help improve color differentiation.

🔹 Competitive Exam Tip:

• Red-green color blindness is X-linked recessive (more common in males).
• Ishihara Chart is the standard test for diagnosis.

5. Night Blindness

✅ Definition: Poor vision in dim light due to retinal disorders.
✅ Causes:

• Vitamin A deficiency (Most common worldwide)
• Retinitis Pigmentosa (Genetic disorder causing progressive retinal degeneration)
• Cataracts (Due to lens opacification blocking light entry)
  ✅ Symptoms:
• Difficulty seeing in low light or darkness
• Slow adaptation to darkness
  ✅ Diagnosis:
• Fundoscopy – Retinal examination.
• Dark Adaptation Test – Measures time taken for vision adjustment to darkness.
  ✅ Treatment:
• Vitamin A supplementation (For nutritional cause).
• Genetic counseling for Retinitis Pigmentosa.
• Cataract surgery if lens opacity is the cause.

🔹 Competitive Exam Tip:

• Vitamin A deficiency is the most common cause of night blindness.
• Dark Adaptation Test is used for diagnosis.

6. Total Blindness

✅ Definition: Complete loss of vision with no light perception.
✅ Causes:

• Optic Nerve Damage (Optic Neuritis, Glaucoma, Trauma).
• Retinal Diseases (Retinal Detachment, Retinitis Pigmentosa).
• End-stage Diabetic Retinopathy.
  ✅ Diagnosis:
• Light Perception and Projection Test.
• Electroretinography (ERG) – Measures retinal activity.
• Visual Evoked Potential (VEP) – Tests optic nerve function.
  ✅ Treatment:
• Depends on the cause (Early intervention in treatable conditions).
• Rehabilitation (Braille, Visual Aids, Guide Dogs).

🔹 Competitive Exam Tip:

• Diabetic Retinopathy is a leading cause of blindness in adults.
• Retinitis Pigmentosa leads to progressive blindness with tunnel vision.

🛑 High-Yield Points for Competitive Exams

Condition	Key Features	Diagnosis	Treatment
Strabismus	Eye misalignment (Esotropia, Exotropia)	Cover-Uncover Test, Hirschberg Test	Glasses, Patching, Surgery
Refractive Errors	Blurred vision (Myopia, Hypermetropia, Astigmatism)	Snellen Chart, Retinoscopy	Glasses, LASIK surgery
Retinoblastoma	Leukocoria, Childhood tumor	Fundoscopy, Ultrasound, MRI	Chemotherapy, Enucleation
Color Blindness	Inability to see colors (Red-Green most common)	Ishihara Chart	No cure, tinted glasses
Night Blindness	Poor vision in dim light (Vit A deficiency)	Dark Adaptation Test	Vitamin A supplements
Total Blindness	Complete vision loss	ERG, VEP, Light Perception Test	Rehabilitation, Visual Aids

🛑 Must-Know Facts for Exams:

🟢 Myopia is the most common refractive error.
🟢 Retinoblastoma presents with Leukocoria (White Reflex).
🟢 Color blindness is tested using the Ishihara Chart.
🟢 Vitamin A deficiency is the most common cause of Night Blindness.
🟢 Diabetic Retinopathy is a leading cause of blindness in adults.
🟢 Retinal detachment presents with flashes, floaters, and curtain-like vision loss.

Ocular Emergencies

1. Glaucoma (Increased Intraocular Pressure – IOP)

✅ Definition: A group of diseases characterized by optic nerve damage due to increased intraocular pressure (IOP), leading to vision loss.
✅ Types of Glaucoma:

a) Acute Angle-Closure Glaucoma (Ophthalmic Emergency 🚨)

✅ Pathophysiology: Sudden blockage of the trabecular meshwork, leading to rapid rise in IOP.
✅ Risk Factors:

• Hypermetropia (Farsightedness)
• Older age, female sex
• Pupillary dilation (Dark rooms, stress, medications like atropine, anticholinergics)
  ✅ Symptoms:
• Severe eye pain, headache
• Sudden vision loss (Haloes around lights)
• Red eye, mid-dilated non-reactive pupil
• Nausea, vomiting (Mimics acute abdomen)
  ✅ Diagnosis:
• Tonometry (IOP > 30 mmHg) – Normal: 10-21 mmHg
• Gonioscopy – Detects closed angle
  ✅ Treatment:
• Medical Emergency – Immediate IOP Reduction
• IV Acetazolamide (Carbonic Anhydrase Inhibitor) – Lowers IOP
• Topical Beta-Blockers (Timolol), Pilocarpine (Constriction opens angle)
• Definitive Treatment: Laser Peripheral Iridotomy (LPI)

🔹 Competitive Exam Tip:

• Acute Angle-Closure Glaucoma presents with severe pain and nausea.
• IV Acetazolamide is the first-line emergency treatment.

b) Open-Angle Glaucoma (Chronic, Painless)

✅ Pathophysiology: Gradual loss of optic nerve function due to slow trabecular meshwork dysfunction.
✅ Symptoms:

• Painless progressive peripheral vision loss (Tunnel vision)
• No acute symptoms
  ✅ Diagnosis:
• Tonometry (IOP > 21 mmHg)
• Optic disc cupping > 0.6 (Cup: Disc Ratio)
• Visual Field Test (Perimetry)
  ✅ Treatment:
• First-line: Prostaglandin Analogs (Latanoprost)
• Beta-Blockers (Timolol)
• Surgical: Trabeculectomy if medical therapy fails

🔹 Competitive Exam Tip:

• Open-angle glaucoma is asymptomatic until advanced stages.
• Peripheral vision loss is the first symptom.

2. Foreign Body in the Eye

✅ Definition: Presence of dust, metal, wood, or glass in the conjunctiva or cornea.
✅ Symptoms:

• Foreign body sensation, tearing, photophobia
• Redness, pain, blurred vision
  ✅ Diagnosis:
• Slit lamp examination – Detects small particles
• Fluorescein Staining & Blue Light – Identifies corneal abrasions
• X-ray/CT Scan (If metallic or intraocular foreign body suspected)
  ✅ Treatment:
• Do NOT rub the eye.
• Irrigate with Normal Saline (First-Line).
• Use a cotton swab for small particles.
• Use a Slit Lamp & Remove with a Needle (For Embedded Foreign Bodies).
• Tetanus prophylaxis if necessary.

🔹 Competitive Exam Tip:

• Fluorescein stain test is used to detect corneal abrasions.
• Never apply cotton swabs if intraocular penetration is suspected.

3. Acid & Alkali Burns (Chemical Burns – True Ophthalmic Emergency 🚨)

✅ Definition: Eye damage due to exposure to strong acids or alkalis.
✅ Types:

• Acid Burns (Less severe, coagulative necrosis) – Sulfuric acid, Hydrochloric acid
• Alkali Burns (More severe, liquefactive necrosis) – Ammonia, Lye, Lime, Sodium hydroxide
  ✅ Symptoms:
• Severe eye pain, photophobia, tearing
• Redness, corneal clouding, vision loss
  ✅ Diagnosis:
• pH Testing of the Eye (Normal pH: 7.0-7.5)
  ✅ Treatment (Immediate & Critical 🚑)
• First-Line: Irrigation with Copious Normal Saline or Ringer’s Lactate (30 min – 1 hour)
• Topical Antibiotics (Prevent secondary infection).
• Cycloplegics (Atropine) to reduce pain.
• Steroids (Short course) to reduce inflammation.

🔹 Competitive Exam Tip:

• Alkali burns are more dangerous due to deeper penetration.
• Immediate irrigation is the first and most crucial step.

4. Trauma to the Eye

✅ Definition: Any blunt or penetrating injury affecting the eye or surrounding structures.
✅ Types & Management:

a) Blunt Trauma (Orbital & Corneal Contusions)

✅ Common Causes:

• Punch injuries, Sports injuries, Airbag trauma
  ✅ Findings:
• Ecchymosis (Black eye), Hyphema (Blood in Anterior Chamber)
• Retinal hemorrhage, Traumatic Cataract
  ✅ Management:
• Elevate Head Position (Reduces IOP).
• Cold Compress for 24 hours to reduce swelling.
• Cycloplegic Drops (Pain relief & prevent pupil constriction).

🔹 Competitive Exam Tip:

• Hyphema is seen in blunt trauma and needs IOP monitoring.

b) Penetrating Eye Injury (Globe Rupture – Emergency 🚨)

✅ Findings:

• Teardrop-shaped pupil, Iris prolapse, Severe vision loss
• Positive Seidel Test (Fluorescein leak from corneal wound)
  ✅ Management:
• Do NOT apply pressure on the eye.
• Cover with a rigid eye shield (No cotton dressing).
• Emergency Surgery Required.

🔹 Competitive Exam Tip:

• Seidel test confirms globe rupture.
• Immediate surgical intervention is needed.

🛑 High-Yield Revision Table for Competitive Exams

Emergency	Key Features	Diagnosis	Treatment
Acute Glaucoma	Severe pain, red eye, mid-dilated pupil, halos, nausea	Tonometry (IOP > 30 mmHg), Gonioscopy	IV Acetazolamide, Timolol, Pilocarpine, Laser Iridotomy
Foreign Body	Foreign body sensation, redness, tearing	Slit lamp, Fluorescein Staining	Irrigation, Slit lamp removal, Antibiotic drops
Acid/Alkali Burns	Severe pain, corneal opacity, redness	pH Testing	Immediate irrigation, Antibiotics, Atropine
Blunt Trauma	Hyphema, Black eye (Ecchymosis)	Fundoscopy, Slit Lamp	Cold compress, Elevate head, Cycloplegics
Penetrating Trauma	Teardrop pupil, Seidel’s sign	Seidel Test, CT Scan	Rigid eye shield, Emergency surgery

🛑 Must-Know Points for Exams:

🟢 Acute Angle-Closure Glaucoma is a medical emergency (Treated with Acetazolamide & Iridotomy).
🟢 Alkali burns cause liquefactive necrosis & are more severe than acid burns.
🟢 First step in chemical burns is immediate irrigation (DO NOT delay).
🟢 Seidel Test is used to diagnose globe rupture (Penetrating Trauma).
🟢 Hyphema in blunt trauma requires strict IOP monitoring.

Eye Care Procedures & Drug Therapy –

l) Instillation of Eye Drops & Ointments

✅ Definition: Proper administration of medicated drops and ointments into the eye for therapeutic effects.
✅ Procedure for Eye Drops:

1. Wash hands & wear gloves.
2. Position the patient (head tilted back, looking up).
3. Pull down the lower eyelid to create a conjunctival sac.
4. Instill 1 drop into the sac (Avoid touching the eye).
5. Ask the patient to close the eye gently (Do not blink excessively).
6. Press on the lacrimal sac (Punctal Occlusion) to prevent systemic absorption.
   ✅ Procedure for Eye Ointment:

• Apply a thin strip inside the lower conjunctival sac.
• Ask the patient to close the eye gently for even distribution.
  ✅ Common Mistakes to Avoid:
• Do NOT touch the dropper tip to the eye.
• Do NOT apply two medications immediately (Wait 5 minutes between drops).

🔹 Competitive Exam Tip:

• Punctal Occlusion prevents systemic absorption & side effects.
• Eye drops should be applied before eye ointments.

m) Cold & Hot Compress

✅ Cold Compress (Used for Inflammation & Swelling):

• Indications:
  • Conjunctivitis
  • Blepharitis
  • Eye allergies
  • After eye surgery
• Procedure:
  • Wrap ice in a clean cloth.
  • Apply gently over the closed eyelid for 5-10 minutes.
    ✅ Hot Compress (Used for Infections & Blocked Glands):
• Indications:
  • Stye (Hordeolum)
  • Chalazion
  • Dry eye syndrome
  • Dacryocystitis
• Procedure:
  • Soak a clean cloth in warm water (~40°C).
  • Apply for 10-15 minutes, 3-4 times/day.

🔹 Competitive Exam Tip:

• Cold compress reduces inflammation, hot compress improves circulation & drainage.
• Hot compress is first-line treatment for Stye & Chalazion.

n) Eye Dressing & Bandaging

✅ Definition: Protecting the eye from infection, injury, or light sensitivity using sterile dressing and bandages.
✅ Types of Eye Dressing:

1. Simple Eye Pad Dressing – For post-surgical care & minor injuries.
2. Pressure Dressing – For post-cataract surgery, trauma.
3. Binocular Dressing – For double-eye injuries to prevent movement.
   ✅ Procedure:

• Wash hands & wear gloves.
• Clean the eye area with sterile solution.
• Apply a sterile eye pad.
• Secure with bandage/tape (Do not apply excessive pressure).
• Educate the patient to avoid rubbing or touching the dressing.

🔹 Competitive Exam Tip:

• Pressure dressings are used post-surgery to reduce swelling.
• Binocular dressing restricts movement in both eyes.

o) Assisting for Sac Syringing (Lacrimal Syringing)

✅ Definition: A procedure to clear blocked nasolacrimal ducts by flushing with sterile saline or antibiotic solution.
✅ Indications:

• Dacryocystitis (Inflammation of the lacrimal sac)
• Chronic tearing due to blocked tear ducts
  ✅ Procedure:
• Instill topical anesthetic (Proparacaine 0.5%).
• Insert a blunt lacrimal cannula into the punctum.
• Flush with normal saline (Observe reflux or free drainage into the nose).
• If blocked, massage or probe may be needed.

🔹 Competitive Exam Tip:

• Sac syringing is done to diagnose & treat nasolacrimal duct blockage.
• A free flow of saline confirms normal duct patency.

p) Assisting for Removal of Foreign Body

✅ Definition: Removing dust, metal, or glass particles from the conjunctiva or cornea.
✅ Procedure:

• Assess the eye with a Slit Lamp or Torch.
• Instill local anesthetic drops (Proparacaine 0.5%).
• Use saline irrigation for superficial particles.
• For embedded objects, use a cotton swab or sterile needle.
• Apply antibiotic ointment post-removal.
  ✅ Emergency Action:
• If penetration is suspected, do NOT remove the object (Cover with an eye shield & refer to an ophthalmologist).

🔹 Competitive Exam Tip:

• Fluorescein staining is used to check for corneal abrasions.
• DO NOT attempt removal if intraocular penetration is suspected.

q) Alternate Therapies for Eye Care

✅ Yoga & Eye Exercises:

• Palming Exercise – Rub hands together & place over closed eyes (Relaxes muscles).
• Eye Rotation Exercises – Improves focus & eye muscle strength.
  ✅ Ayurvedic Therapies:
• Triphala Eye Wash – Herbal solution for eye health.
• Netra Tarpana – Ghee therapy for dry eyes.
  ✅ Home Remedies:
• Cucumber slices, Rose water, Cold tea bags – Reduces puffiness & irritation.

🔹 Competitive Exam Tip:

• Palming is used to reduce digital eye strain.
• Triphala eye wash is a common Ayurvedic remedy.

r) Drugs Used in the Treatment of Eye Disorders

✅ 1. Anti-Glaucoma Drugs (Reduce IOP):

• Prostaglandin Analogs (First-Line) – Latanoprost, Bimatoprost
• Beta-Blockers – Timolol
• Carbonic Anhydrase Inhibitors – Acetazolamide (IV in emergencies)
• Miotics (Constriction of Pupil) – Pilocarpine

✅ 2. Antibiotics (For Eye Infections):

• Bacterial Conjunctivitis: Ciprofloxacin, Chloramphenicol
• Trachoma (Chlamydia): Azithromycin
• Dacryocystitis: Amoxicillin-Clavulanate

✅ 3. Anti-Inflammatory & Steroids (For Allergic & Autoimmune Conditions):

• NSAIDs: Ketorolac, Diclofenac Eye Drops
• Steroids (Short-Term Use): Prednisolone, Loteprednol

✅ 4. Antiviral Drugs (For Herpes Keratitis):

• Acyclovir Eye Ointment

✅ 5. Artificial Tears & Lubricants (For Dry Eyes):

• Carboxymethylcellulose (CMC), Hydroxypropyl Methylcellulose (HPMC)

✅ 6. Mydriatics & Cycloplegics (For Eye Exams & Uveitis):

• Tropicamide, Atropine

✅ 7. Anti-Allergic Drugs (For Allergic Conjunctivitis):

• Antihistamines: Olopatadine, Ketotifen

🔹 Competitive Exam Tip:

• Latanoprost is the first-line drug for Glaucoma.
• Timolol is a Beta-Blocker that lowers IOP.
• Azithromycin is used for Trachoma treatment.
• NSAIDs like Ketorolac are used to treat post-operative inflammation.

🔹 Quick Revision Table for Competitive Exams

Procedure	Key Points
Eye Drop Instillation	Punctal occlusion prevents systemic absorption
Cold Compress	Used for conjunctivitis, swelling
Hot Compress	Used for Stye, Chalazion
Eye Dressing	Pressure dressing for post-surgical care
Sac Syringing	Used for blocked nasolacrimal ducts
Foreign Body Removal	Use Slit Lamp & Fluorescein Staining
Anti-Glaucoma Drug	Latanoprost (First-Line)
Antibiotic for Trachoma	Azithromycin

Preventive & Rehabilitative Aspects in Ophthalmology

g) National Programs on Blindness & Trachoma

✅ 1. National Programme for Control of Blindness and Visual Impairment (NPCB&VI)

• Launched: 1976 (Modified in 2017)
• Aim: Reduce prevalence of blindness from 1.4% (1976) to <0.3% (2020).
• Objectives:
  • Provide free cataract surgeries and corneal transplants.
  • Promote eye donation and corneal retrieval programs.
  • Strengthen primary eye care services (Vision Centers).
  • School screening programs for refractive errors.
  • Vitamin A supplementation to prevent childhood blindness.
• Targets:
  • Cataract Surgery Rate (CSR): At least 3000 surgeries per million population per year.
  • Universal free eye care for poor & elderly.

🔹 Competitive Exam Tip:

• NPCB&VI was initially launched in 1976.
• The current goal is blindness prevalence <0.3%.

✅ 2. Trachoma Control Programme

• Cause: Chlamydia trachomatis infection.
• India declared Trachoma-Free in 2017.
• WHO SAFE Strategy:
  • S – Surgery for trichiasis
  • A – Antibiotics (Azithromycin)
  • F – Facial cleanliness
  • E – Environmental hygiene

🔹 Competitive Exam Tip:

• India achieved Trachoma-Free status in 2017.
• SAFE strategy is recommended by WHO.

h) Current Trends in Management of Ophthalmic Conditions

1. Hospital Corneal Retrieval Program (HCRP)

✅ Definition: A system for timely collection of corneas from hospital-based donors.
✅ Process:

• Identifying potential donors (Brain death, ICU patients).
• Rapid response team for corneal retrieval.
• Coordination with eye banks & donation counseling.
  ✅ Importance:
• Increases cornea donation rate.
• Reduces waiting time for corneal transplantation.

🔹 Competitive Exam Tip:

• HCRP is crucial for increasing corneal donations in hospitals.

2. Grief Counseling in Eye Donation

✅ Definition: Psychological support for families of deceased persons to motivate eye donation.
✅ Steps:

• Approach the family with compassion.
• Explain eye donation benefits (Restores vision).
• Address cultural & religious beliefs.
• Provide emotional support.
  ✅ Effectiveness:
• Increases consent for eye donation.
• Helps families find solace in donation.

🔹 Competitive Exam Tip:

• Grief counseling plays a key role in increasing eye donations.

3. Eye Collection & Corneal Preservation

✅ Eye Collection Process:

• Within 6 hours of death (Ideal collection time).
• Sterile technique is used to remove the cornea.
• Corneas are stored in MK medium or Optisol-GS (Preserves up to 14 days).

✅ Corneal Transplantation:

• Types:
  • Penetrating Keratoplasty (PKP) – Full thickness corneal graft.
  • Lamellar Keratoplasty (LKP) – Partial corneal graft.
  • Endothelial Keratoplasty (DSEK, DMEK) – For corneal endothelial diseases.

🔹 Competitive Exam Tip:

• Corneas should be collected within 6 hours after death.
• Optisol-GS medium preserves corneas for 14 days.

4. Counseling for Eye Donation

✅ Who Can Donate?

• Anyone above 1 year of age (No upper age limit).
• Even spectacle wearers & cataract patients can donate.

✅ Contraindications for Eye Donation:

• HIV, Hepatitis B/C, Rabies, Septicemia.

✅ Procedure:

• Inform Eye Bank (Within 6 hours).
• Cornea retrieval takes 15-20 minutes (No disfigurement).
• Issued a “Corneal Donation Certificate” for family.

🔹 Competitive Exam Tip:

• Eye donation can be done even if the donor has poor vision.
• HIV & Rabies patients cannot donate.

5. Obtaining Consent for Eye Donation

✅ Types of Consent:

• Opt-In System (India): Family must give consent.
• Opt-Out System (Spain, Belgium): Consent presumed unless refused before death.

✅ How Consent is Obtained?

• During hospital admission (Voluntary pledge).
• After death through next of kin.
• Grief counseling team helps in decision-making.

🔹 Competitive Exam Tip:

• India follows the Opt-In system for eye donation.

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🛑 Quick Revision Table for Competitive Exams

Topic	Key Features
NPCB&VI	Aims to reduce blindness to <0.3%
Trachoma-Free India	Achieved in 2017, SAFE strategy
Hospital Corneal Retrieval	Identifies brain-dead donors for eye collection
Grief Counseling	Helps families in eye donation decision
Eye Collection	Done within 6 hours, Optisol-GS medium preserves for 14 days
Opt-In Consent System (India)	Requires family approval for donation