Clinical Ophthalmology Syllabus

Ophthalmology syllabus: all 11 chapters

Expand any chapter to see its topics and sub-topics.

1. 1

   Anatomy and Physiology of the Eye

   2 topics

   • Anatomy of the Eye
     • External Structures
     • Eyelids and Lacrimal Apparatus
     • Extraocular Muscles
     • Globe of the Eye
     • Anterior Segment
     • Posterior Segment
   • Physiology of Vision
     • Light Perception
     • Visual Pathway
     • Accommodation
     • Pupillary Reflexes
     • Color Vision
2. 2

   Clinical Examination of the Eye

   4 topics

   • History Taking
     • Chief Complaints
     • Past Ocular History
     • Medical and Family History
     • Medications and Allergies
   • Visual Acuity Assessment
     • Snellen Chart
     • Near Vision Testing
     • Pinhole Test
   • External Examination
     • Inspection
     • Palpation
     • Slit Lamp Examination
   • Fundus Examination
     • Direct Ophthalmoscopy
     • Indirect Ophthalmoscopy
     • Fundus Photography
3. 3

   Refractive Errors

   4 topics

   • Myopia
     • Etiology
     • Clinical Features
     • Management
   • Hypermetropia
     • Etiology
     • Clinical Features
     • Management
   • Astigmatism
     • Etiology
     • Clinical Features
     • Management
   • Presbyopia
     • Etiology
     • Clinical Features
     • Management
4. 4

   Diseases of the Conjunctiva

   2 topics

   • Conjunctivitis
     • Bacterial Conjunctivitis
     • Viral Conjunctivitis
     • Allergic Conjunctivitis
     • Chlamydial Conjunctivitis
   • Pterygium and Pinguecula
     • Etiology
     • Clinical Features
     • Management
5. 5

   Diseases of the Cornea

   3 topics

   • Keratitis
     • Bacterial Keratitis
     • Viral Keratitis
     • Fungal Keratitis
     • Acanthamoeba Keratitis
   • Corneal Ulcer
     • Etiology
     • Clinical Features
     • Management
   • Corneal Dystrophies
     • Etiology
     • Clinical Features
     • Management
6. 6

   Diseases of the Lens

   2 topics

   • Cataract
     • Etiology
     • Clinical Features
     • Types of Cataract
     • Management
   • Dislocation of the Lens
     • Etiology
     • Clinical Features
     • Management
7. 7

   Glaucoma

   4 topics

   • Primary Open-Angle Glaucoma
     • Etiology
     • Clinical Features
     • Management
   • Primary Angle-Closure Glaucoma
     • Etiology
     • Clinical Features
     • Management
   • Secondary Glaucoma
     • Etiology
     • Clinical Features
     • Management
   • Congenital Glaucoma
     • Etiology
     • Clinical Features
     • Management
8. 8

   Diseases of the Retina

   4 topics

   • Diabetic Retinopathy
     • Pathophysiology
     • Clinical Features
     • Management
   • Retinal Detachment
     • Types
     • Clinical Features
     • Management
   • Age-Related Macular Degeneration
     • Etiology
     • Clinical Features
     • Management
   • Retinitis Pigmentosa
     • Etiology
     • Clinical Features
     • Management
9. 9

   Neuro-Ophthalmology

   3 topics

   • Optic Neuritis
     • Etiology
     • Clinical Features
     • Management
   • Papilledema
     • Etiology
     • Clinical Features
     • Management
   • Ocular Myasthenia Gravis
     • Etiology
     • Clinical Features
     • Management
10. 10

    Pediatric Ophthalmology

    3 topics

    • Congenital Cataract
      • Etiology
      • Clinical Features
      • Management
    • Retinopathy of Prematurity
      • Etiology
      • Clinical Features
      • Management
    • Strabismus
      • Types
      • Clinical Features
      • Management
11. 11

    Ocular Trauma

    3 topics

    • Blunt Trauma
      • Mechanism of Injury
      • Clinical Features
      • Management
    • Penetrating Trauma
      • Mechanism of Injury
      • Clinical Features
      • Management
    • Chemical Injuries
      • Types of Chemicals
      • Clinical Features
      • Management

Clinical Ophthalmology flashcards — 50 questions with answers

1. What are the three tunics (coats) of the eyeball from outermost to innermost?

   1) Fibrous/outer coat: cornea + sclera. 2) Vascular/middle coat (uvea): iris, ciliary body, choroid. 3) Nervous/inner coat: retina.

2. Name the three layers of the tear film from anterior to posterior and their sources.

   1) Outer lipid layer (meibomian glands). 2) Middle aqueous layer (lacrimal + accessory glands of Krause and Wolfring). 3) Inner mucin layer (conjunctival goblet cells).

3. What are the five layers of the cornea from anterior to posterior?

   1) Epithelium, 2) Bowman's layer, 3) Stroma (substantia propria, ~90% thickness), 4) Descemet's membrane, 5) Endothelium.

4. List the refractive media of the eye and their approximate dioptric powers.

   Cornea $\approx +43\ \text{D}$ (main refractive element), aqueous humour, crystalline lens $\approx +17\ \text{to}\ +20\ \text{D}$, and vitreous. Total resting power of the eye $\approx +58\ \text{to}\ +60\ \text{D}$.

5. What is the difference between rods and cones in the retina?

   Rods ($\approx 120$ million): highly sensitive, function in dim/scotopic light, no colour, peripheral, contain rhodopsin. Cones ($\approx 6$ million): high acuity and colour (photopic) vision, concentrated at the fovea, three types (S/M/L).

6. Describe the phototransduction cascade in rods triggered by light.

   Light isomerizes 11-cis-retinal to all-trans-retinal, activating rhodopsin $\to$ transducin (G-protein) $\to$ phosphodiesterase, which hydrolyses cGMP. Falling cGMP closes Na$^+$ channels, hyperpolarizing the photoreceptor and reducing glutamate release.

7. What is the visual cycle regeneration of rhodopsin?

   All-trans-retinal released from opsin is reduced to all-trans-retinol, transported to the retinal pigment epithelium (RPE), converted back to 11-cis-retinal, and returned to the photoreceptor to recombine with opsin, regenerating rhodopsin.

8. What is the fovea centralis and why does it give the highest visual acuity?

   The fovea is the central pit of the macula containing only tightly packed cones with a near 1:1 cone-to-ganglion cell ratio, and overlying retinal layers are displaced aside, allowing light to reach photoreceptors directly.

9. What structures make up the anterior chamber angle relevant to aqueous drainage?

   Formed by the cornea/sclera anteriorly and iris root/ciliary body posteriorly; contains the trabecular meshwork leading to Schlemm's canal (conventional outflow, ~90%) and the uveoscleral pathway (~10%).

10. Trace the pathway of aqueous humour from production to drainage.

    Produced by the ciliary body (non-pigmented epithelium) into the posterior chamber $\to$ through the pupil into the anterior chamber $\to$ trabecular meshwork $\to$ Schlemm's canal $\to$ aqueous/episcleral veins.

11. What key questions should a focused ophthalmic history cover for a red or painful eye?

    Onset and duration, laterality, vision change, pain vs. gritty/itch, discharge (watery/purulent), photophobia, halos, trauma/foreign body, contact-lens wear, previous eye disease, and systemic disease (diabetes, hypertension, autoimmune).

12. How is visual acuity recorded with a Snellen chart, and what does 6/60 mean?

    Recorded as $\frac{\text{test distance}}{\text{distance a normal eye reads that line}}$. $6/60$ means the patient at 6 m reads what a normal eye reads at 60 m; larger denominator = worse acuity.

13. What steps are used when a patient cannot read the largest Snellen letter?

    Progress through: counting fingers (CF), hand movements (HM), perception of light (PL) with projection, and no perception of light (NPL/NLP).

14. What is the pinhole test and what does improvement with it indicate?

    Viewing through a small pinhole reduces the effect of peripheral rays. If acuity improves, the defect is refractive (correctable with lenses); no improvement suggests an organic/pathological cause.

15. How is the LogMAR acuity notation related to Snellen, and what LogMAR equals normal 6/6 vision?

    LogMAR = $\log_{10}(\text{minimum angle of resolution in arc min})$. Normal $6/6$ (20/20) vision equals LogMAR $= 0.00$; higher LogMAR means worse vision, lower/negative means better.

16. What does the swinging-flashlight test detect, and what is a positive result called?

    It detects a relative afferent pupillary defect (RAPD, Marcus Gunn pupil). When light swings to the affected eye, both pupils paradoxically dilate, indicating an afferent (optic nerve/retina) lesion.

17. Describe how the direct and consensual pupillary light reflexes should behave normally.

    Shining light in one eye constricts that pupil (direct) and the fellow pupil (consensual) equally, because the afferent optic nerve signal reaches both Edinger-Westphal nuclei.

18. What structures are assessed during external examination of the eye and adnexa?

    Eyelids and lashes (position, ptosis, entropion/ectropion), lacrimal apparatus, conjunctiva, sclera, cornea (clarity), anterior chamber depth, iris, pupil size/shape/reaction, and ocular alignment/movements.

19. What is the difference between the direct and indirect ophthalmoscope for fundus examination?

    Direct: monocular, upright, highly magnified ($\approx 15\times$) but small field, no stereopsis. Indirect: binocular with condensing lens, wide field, stereoscopic, real inverted image, better peripheral view.

20. What features of the optic disc are assessed on fundus examination?

    Colour (pink with pale centre), margins (sharp), and the cup-to-disc ratio (normal $\leq 0.3$); an enlarged cup or notch suggests glaucoma, while pallor suggests optic atrophy.

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