2012/ 2013

Ophthalmology Student study guide

Ophthalmology Department Units

1 2 3 4 5 6 Prof. Zafer Fahim Prof. Mervat Salah Prof. Aly Saad Prof. Ismail Hamza Prof. Shreif Zaki Prof. Othman Ziko + + + + +

Teaching
Lectures Tutorials Problem based learning Self-directed learning Clinical skills

Lectures

There will be ten lectures (8-9 AM O'clock lectures). It will start on the second month of the round. The topics include: 1. Ocular pharmacology 2. Pain and headache 3. Defective vision (two lectures) 4. Ocular manifestation of systemic disease (two lectures) 5. Laser in ophthalmology 6. Red eye 7. Neuro-ophthalmology 8. Trauma and ocular emergency

2-

Clinical skills

Practice safety measures (hand hygiene) 1. Eye lid examination 2. Conjunctival examination 3. Anterior segment examination (by torch) 4. Pupillary light reflex examination 5. Visual acuity measurement 6. Visual field examination (confrontation) 7. Extra-ocular muscles testing 8. Simulate first aid measures for emergencies and trauma (eye patching)

ocular

Checklist
Before any patient examination, introduce yourself to the patient and ask him/her to examine his/her eyes and explain the test shortly.

Before any patient examination that include touching the eye practice safety measures (hand hygiene)
1.

Eye lid examination: (by a pen torch)

1 Inspect the upper eyelids for symmetry and position relative to the pupil and cornea 2 If asymmetrical, decide which lid is ptotic (drooping) or whether the other lid is retracted. 3 If ptosis is present you have to measure: Palpebral fissure height Marginal reflex distance Levator muscle function 4 Inspect the lid margin position and eye lashes 5 Inspect the lid for masses and signs of inflammation

Conjunctival torch)
2.

examination: (by a pen

2 3

Inspect and comment on: Color Appearance/texture of the conjunctiva Masses If mass is present comment on: size, site, shape, color, vascularization If pterygium is present comment on: Site Consistency (fleshy or fibrous) Vascularization Extension into the cornea

Anterior segment examination: (by a pen torch)

3.

1 Inspect the cornea for opacities (number, site, size, density, adherence to the iris and vascularization) 2 Inspect the iris for color, iridectomies and atrophy 3 Inspect the pupil for site, size, shape, regularity and color 4 Inspect the lens for color and position
4.

Pupillary light reflex:

1 2 3 4

Use distance fixation Be sure of moderate ambient lighting Check the patients pupillary reaction (directly and consensually) Test for RAPD by swinging light between both eyes

5.

Visual acuity measurement:

1 Illuminate the room 2 Test monocularly using an occluder 3 Ask the patient to sit 6 m from the chart without glasses 4 Start with the top of the chart, test one letter per line until it is difficult to recognize 5 If the patient cannot see the largest letter, retest after approximation by 1 m at a time 6 If the patient cannot see 1/60, proceed to measure CF (counting fingers vision) 7 If CF cannot be seen, move your hand in front of the patients eye (both horizontally and vertically) 8 If hand movements are not perceived, test for light perception 9 Record the lowest line the patient is able to read at least half of the letters as a fraction like 6/6, 6/9etc.

6. Visual field assessment:

1 2 3 Sit yourself about one meter away from the patient Ask the patient if he can see any missing part of the face Show the target (your finger or a 5 mm white pin) you will be using to the patient and ask if he can see it at a distance of 0.5 m Make sure your eye level is the same as the patients eyes Check for fixation (make sure the patient looks at your eye)

4 5

6 7 8

Both patient and examiner should be using the corresponding eye at a time (cover the other eye) The target must be half way between you and the patient Bring the target centrally from the four different quadrants

7. Ocular motility:
1 Inspect both eyes for: i. Ocular deviation ii. Abnormal head posture iii. Any associated ptosis 2 Cover/ uncover test i. Ask patient to look at an object 6 meters away ii. Perform cover/ uncover test iii. Look for any tropia in the uncovered eye iv. Perform alternating cover test on the patient and look for phoria 3 Ask the patient to follow the light in the six gazes and observe any change of the angle or any reported diplopia by the patient

8. Eye patching:
1 2 3 Make sure there is no pus in the conjunctival sac Instruct the patient to close the eye Put the oblong patch in the down slanting position (one end upper nasal and one end lower temporal) 4 For non self-adhesive patches, put few straps of plaster in a converging way (one end upper nasal and one end lower temporal also)

Exam will stations:

be

in

the

form

of

multiple

1. The Clinical Evaluation will be based on the degree to which you meet the teaching objectives while examining patients under the supervision of one of the teaching staff 2. 3 stations each = 5 marks 3. Needed material: Illuminated torch, gel for sterilization of your hand, occluder, tissues, 5mm white pin

3- Self-directed learning
Research:

Group of four to six students Preset format and rules The whole round period One topic per group Evaluation: work, presentation and questions

Criteria to write essay:

1. Font size: 14 2. Font face: Times New Roman

3. Minimum five pages 4. Minimum six different references (not same web

site)

Power point presentation:

Done by all students of the same group: its duration = 15 minutes

Checklist of the essay

Item 1. Team work and cooperation with the supervisor 2. Classification and titles of the topic 3. Core of the topic, (+ tables or figures if relevant) 4. References (how much updated from electronic sites and medical journals with appropriate formatting according to international rules) 5. Spelling and grammar 6. General style and formatting (including choice of font type, character and size, correct paragraphing, indexing and line justification) 7. Good preparation of power point presentation 8. Fulfillment of appropriate presentation features as eye to eye contact, good command of language and body language Total mark

Mark 3 2 3 3

2 2

2 3

20

Course Assessment
Exam
1. Self-learning

Mark s 20 30 15

Timing At the end of the round At the end of the round At the end of the round At the end of the year

(research) 2. Problem solving 3. Clinical

4. Written: 125: 55 i. Short assay and 70 case ii. MCQs 5. Oral 20 At the end of the year 6. Slides 40 At the end of the year Total = 250 marks

Resources
1. Department book 2. Kanski textbook (E-book) 3. E-medicine ophthalmology content available at http://www.emedicine.com/oph/contents.htm

Websites Ocular anatomy:

This site gives a nice quick overview of retinal

anatomy http://thalamus.wustl.edu/course/eyeret.html
The Washington University School of Medicine

Neuroscience Tutorial is a good review for your neuro-anatomy http://thalamus.wustl.edu/course/ Cases/Images: Vienna Ophthalmic Case Studies 22 cases where you go through the history, physical, and other investigations http://www.akhwien.ac.at/augen/englisch/steps.htm
seven self-directed learning modules from the

Canadian OphthalmologySociety http://www.eyesite.ca/7modules/index.html Videos:

The

UCDavis Neurological Eye Simulator reproduces muscle or nerve lesions and even has a quiz mode http://cim.ucdavis.edu/eyes/eyesim.htm

Other: York Universitys Fun Things in Vision has some fun illusions http://www.yorku.ca/eye/funthing.htm Best Wishes for your future practice in Medicine! We sincerely hope you will enjoy your brief exposure to Ophthalmology Dear student: Detailed information http://mic.shams.edu.eg/moodle4