OPTH 432

   
Course Description
 
Theoretical and Practical Activities in Ophthalmology Course  432:

 

ACTIVITIES	OUTLINE
I. Theoretical Activities	1.     Lectures.
II. Practical Activities	(1) Clinical skill sessions.                Main objectives: To train and supervise a small group of students to master certain clinical skills, and to handle simple ophthalmic instruments Examine the eye and periocular adnexa with proper             note  keeping
	(2) Clinics:               Main objectives: -    Examination for selected patients.             -   Assessment and planning management of Ophthalmic                      patients.
	(3) Operation Room:                Main objectives:                      Discussion of common indications, procedures and                      possible complications of common ophthalmic                        Surgeries.

 

  
LECTURE CONTENTS
 
I. History taking and physical examination in ophthalmology

1. The parts of ophthalmic history
2. The basic relation of eye and different part of body (e.g. vascular neurological relations).
3. The basic of comprehensive ophthalmic evaluation including an analysis of the physiologic function and anatomic status of the eye, visual system, and related structures.

 
II. Basic Anatomy and Physiology of the Eye

1. Very brief embryology
2. Anatomy of orbit, extraocular muscles, eyelid and lacrimal system
3. Anatomy of visual pathway
4. Anatomy of eye (globe)
5. Physiology of eye (e.g. vision, intraocular pressure)

 
III. Lid, Lacrimal, and Orbit Disorders
     a. Lid disorders (Blepharitis, Entropion, Ectropion)
b. Lacrimal apparatus disorders (lacrimal duct obstruction, lacrimal gland tumors)
c. Orbital cellulitis (etiology, management)
d. Inflammatory orbital disorders
 
IV.  Ocular emergencies and red eye
a. Classification of ocular emergency depending on presentation and management
b. Conjunctivitis (causes, clinical features, and management)
c. Microbial Keratitis (causes, clinical features, and management)
d. Ocular trauma including subconjunctival haemorrhage , corneal abrasion, open globe injury, blunt injury, and chemical burn
e. Giant cell arteritis
 
V.  Strabismus, Amblyopia and Leukocoria  
a. Strabismus

• Definition
• Extraocular muscles, innervations and function
• Types of ocular deviation (concomitant and non-concomitant)
• Adaption: abnormal head position, suppression, amblyopia
• Association of strabismus
• Therapy

    b. Amblyopia

• Definition
• Visual development
• Predisposing factor
• Presentation, detection and management

c.   Leukocoria (definition, causes and management)
VI. Acute Visual Loss
a. Acute glaucoma (causes, clinical manifestation and management)
b. Retinal artery and vein occlusion (causes, clinical manifestation, and management)
c. Retinal detachment (classification, causes, clinical manifestation and Management)
d. Uveitis (causes, clinical manifestation and Management)
e. Keratitis (causes, clinical manifestation and management)
 
VII. Chronic Visual Loss
a. Chronic glaucoma (causes, types, management)
b. Senile cataract
c. Diabetic macular edema
d. Hereditary retinal diseases
 
VIII. Refractive Errors
a. Basics of optics
b. Concept of accommodation
c. Types of refractive errors (myopia, hyperopia, and astigmatism) and their causes, clinical manifestation.
d. Presbyopia (definition, management)
e. Anisometropia (definition, management)
f. Optical correction (e.g. glasses, contact lenses)
h. Surgery for refractive errors
 
IX. Ocular manifestations of systemic diseases
a. Endocrine disorders (e.g. diabetic retinopathy)
b. Cardiovascular disorders (e.g. hypertensive retinopathy)
c. Skin and connective tissue disorders
d. Infectious and inflammatory disorders (tuberculosis)
e. Hereditary and hematopoietic disorders
 
X.  Neuro-ophthalmology
a. Applied neuro anatomy including visual pathway, pupil, motor  nerves (cranial nerves III, IV, VI, VIII)
b. Causes of raised intracranial pressure and papilloedema
c. Cerebrovascular disorders and ocular signs (e.g. carotid cavernous fistula, cavernous sinus thrombosis)
 
XI. Ocular Pharmacology and Toxicology
a. General pharmacological principles of ocular drugs
b.Ocular pharmacotherapeutics (cholinergic agonists and antagonists,  antiinflammatory drugs, etc.)
c. Ocular toxicology (complications of topical administration, ocular, reaction to systemic drugs)
 
CLINICAL SKILL SESSIONS CONTENTS
I. External Ocular Examination, Ocular Motality and Alignment
a. External ocular examination

• Inspection of head and face (skin, bones, lymph nodes, etc.)
• Evaluation of eyelids, orbit, and globe (e.g. ptosis, proptosis)
• Using torch to judge corneal clarity and lustre, assess anterior chamber   depth, and appreciate cataract                                                                                  
• How to evert upper eyelid for examining the palpebrale conjunctiva

 
b. Ocular motality and alignment

• Motality and strabismus terminology
• Function of extraocular muscle
• Ocular motility examination (ductions and versions)
• Tests of binocularity and fusion including stereopsis
• Tests of alignment including corneal light reflection test, and cover test

 
II. Visual acuity and Ophthalmoscopy
a. Visual acuity

• concept of visual acuity
• measurement notations and abbreviations
• test targets
• visual acuity measurement (far and near)
• pinhole acuity test

 
b. Ophthalmoscopy

• use of direct Ophthalmoscope to assess the red reflex and detect its  abnormalities. Also to examine and comment on retinal and disc condition. 
• brief about indirect ophthalmoscope

 
 III. Visual field, Tonometry, Pupill Examination
a. Visual field

• overview of visual pathway
• basics of confrontation field testing
• common field defects
• localizing field defects

 
b. Tonometry

• intraocular pressure measurement conventions and population means
• types of tonometers (Goldmann application tonometers, tonopen, etc)

 
c. Pupill examination

• general pupillary observation
• light-reflex test
• swinging flashlight test
• near-reflex test
• relative afferent pupillary defect

 
   
LEARNING RESOURCES
 
1. Required Text(s)

1. Lecture notes Ophthalmology (latest edition)

By: Bruce James (published by Blackwell Science)

1. Basic Ophthalmology (latest edition)

By: Cynthia A. Bradford (published by American Academy of Ophthalmology)

1. Practical Ophthalmology: A manual for Beginning Residents (latest edition)

By: Fred M. Wilson (published by American Academy of Ophthalmology
 
2. Essential References

1. Vaughan and Asbury’s general Ophthalmology (latest edition)

By: Paul Riordan-Eva (published by LANGE)
 
3- Recommended texts and reference materials

1. Clinical Ophthalmology: A Systematic Approach (latest edition)
2.  

 
b. Ophthalmology, Archive journal of Ophthalmology, American journal Ophthalmology, British journal of Ophthalmology
 
4-.Electronic Materials, Web Sites etc
a.    Department internet website.
b.   Department’s teaching staff personal websites on University site.
c.    University and KAUH Library.

1. Audiovisual Unit of the Ophthalmology Department.
2. PubMed
3. Medscape
4. The digital journal of ophthalmology (www.djo.harvard.edu)