1. Using the direct ophthalmoscope…
You will find a word at each of the points indicated by the boxes…

2. A patient standing six metres from a standard Snellen Chart can
only see the top line. How is this recorded in snellen notation?

3. E
5 minutes of arc: 6/6 acuity
10 minutes: 6/12
20 minutes: 6/24
30 minutes: 6/36
6 metres
E 50 minutes of arc: 6/60 acuity
The human eye is just able to discern separate objects if the angle between
them is 30 seconds of arc.

4. 6
12
The test distance
An average eye would see this line at 12
metres

5. Identify these refractive errors
Myopia
“Short sighted”
Hypermetropia
“long sighted”

6. What abnormality does this photo show, and what is the
surgical procedure called which corrects it?

8. What is this abnormality called, and what is the main symptom it
causes?

9. What stain has been used, and what abnormality is shown?

10. What abnormality is shown here?
Suggest two important differential diagnoses
Suggest two useful investigations

11. This patient suddenly lost all useful vision in her
right eye a few hours before the photo was taken.
What is the diagnosis?
What tests would you perform
What is the commonest accompanying systemic
disease?
What pupil abnormality would be present?

13. Name three abnormalities shown here
Give the diagnosis
Suggest a cause

14. Extra-ocular muscles
Medial Rectus Third nerve
Sixth nerve
Third nerve
Third nerve
Fourth nerve
Third nerve
Lateral rectus
Superior Rectus
Inferior rectus
Superior Oblique
Inferior Oblique
Muscle: Nerve supply:

15. 3
5
9
2
8

16. Humphrey Visual Field Analyser

17. Identify two abnormalities, and suggest a diagnosis

18. What is the diagnosis here?

19. What’s the diagnosis here?

20. What is the main abnormality shown here?

21. And here?

22. Which is the abnormal eye, and what word is used to describe
the visual acuity deficit?

23. Before After
Diagnosis?

24. What is this condition called?

25. What’s the link..?

26. Different patients, same underlying diagnosis…

27. Laser treatment

33. Answers
• Slide 2 - 6/60
• Slide 5 – Myopia “Short sighted” (top pic)
and hypermetropia “long sighted” (bottom
pic)
• Slide 6 - Cataract – phaco-emulsification
• Slide 8 - Entropion, where eye lash folds
in towards eye. Main symptom: gritty
scratchy “there’s something in my eye”
kind of pain

34. Answers
• Slide 9 - Fluoracin stain showing up
corneal ulcer
• Slide 10 - Abnormality: swollen, blurry
optic disc edge (papilloedema).
Differentials: Raised intracranial pressure,
malignant hypertension, idiopathic
intracranial hypertension. Investigations –
blood pressure, CT scan

35. Answers
• Slide 11 - Painless sudden loss of vision =
central retinal artery occlusion/thrombosis.
Tests – BP, cholesterol, glucose. Patient would
be a vascularpath. Pupil abnormality is relative
afferent pupillary defect, as retina not able to
detect light
• Slide 13 – Complete ptosis, “down & out” eye,
dilated pupil = 3rd
nerve palsy. Possible cause =
posterior communicating artery aneurysm
pressing on nerve, or vascualr occlusion along
the length of the 3rd
nerve.

36. Answers
• Slide 15
– 2 – right eye loss of vision
– 3 – bitemporal hemianopia “tunnel vision”
– 5 – right homonymous hemianopia
– 8 – right homonymous hemianopia
– 9 – right homonymous hemianopia with central
sparing
• Slide 17 – Horners, see partial ptosis,
constricted pupil & decreased sweating. Causes
anything along the length of the sympathetic
chain, e.g. tumour, vascular origin

37. Answers
• Slide 18 – anterior uveitis, aka iritis
• Slide 19 – glaucoma (see cupping of optic
disc and increased intraocular pressure)
• Slide 20 – leukochoria (white reflex/white
pupil). Causes = retinoblastoma, cataract
• Slide 21 – strabismus (“squint”)
• Slide 22 – left eye abnormal. Amblyopia
• Slide 23 - hypothryroidism

38. Answers
• Slide 24 – central retinal vein occlusion,
see multiple haemorrhages
• Slide 25 – internal carotid artery atheroma
and consequent embolus seen on retina
• Slide 26 – diagnosis = diabetic retinopathy
• Slide 28 – Stevens Johnson with
decreased tear production & scarring

39. Answers
• Slide 29 – areas of depigmentation of
retina
• Slide 30 – RA and see deterioration of the
sclera called scleromalacia perforans
• Slide 31 – sturge weber syndrome
• Slide 32 – inverting eye lid with cotton bud