MBBS Ophthalmology Syllabus

Ophthalmology syllabus — full chapter and topic list

Expand any chapter to see its topics and sub-topics. This is the whole examinable outline for Ophthalmology in MBBS, not a summary of it.

1. 1

   Anatomy and Physiology of the Eye

   2 topics

   • Anatomy of the eye
     • External structures (eyelids, conjunctiva, lacrimal apparatus)
     • Internal structures (cornea, iris, lens, retina)
   • Physiology of vision
     • Optics of the eye
     • Refraction
     • Accommodation
     • Visual pathways
2. 2

   Ophthalmic Examination and Investigations

   3 topics

   • Ophthalmic history taking
     • Chief complaint
     • Past medical history
     • Family history
     • Social history
   • Ophthalmic examination
     • Visual acuity assessment
     • Visual field testing
     • Slit-lamp examination
     • Dilated fundus examination
   • Ophthalmic investigations
     • Refraction
     • Tonometry
     • Gonioscopy
     • Ultrasound biomicroscopy
     • Optical coherence tomography (OCT)
     • Fundus fluorescein angiography (FFA)
3. 3

   Refractive Errors

   4 topics

   • Myopia
     • Definition
     • Pathophysiology
     • Clinical features
     • Management
   • Hyperopia
     • Definition
     • Pathophysiology
     • Clinical features
     • Management
   • Astigmatism
     • Definition
     • Types
     • Clinical features
     • Management
   • Presbyopia
     • Age-related changes in accommodation
     • Clinical features
     • Management
4. 4

   Cataract and Lens Disorders

   3 topics

   • Age-related cataract
     • Types of cataracts
     • Clinical features
     • Management
   • Congenital cataract
     • Clinical features
     • Diagnosis
     • Management
   • Phakomatoses
     • Ocular manifestations of neurofibromatosis
     • Ocular manifestations of tuberous sclerosis
     • Ocular manifestations of Sturge-Weber syndrome
5. 5

   Glaucoma

   3 topics

   • Primary open-angle glaucoma (POAG)
     • Pathophysiology
     • Clinical features
     • Diagnosis
     • Management
   • Angle-closure glaucoma
     • Acute angle-closure crisis
     • Chronic angle-closure glaucoma
     • Management
   • Secondary glaucoma
     • Causes
     • Clinical features
     • Management
6. 6

   Retinal Disorders

   3 topics

   • Diabetic Retinopathy
     • Classification
     • Clinical Features
     • Management
   • Age-related Macular Degeneration (AMD)
     • Dry AMD
     • Wet AMD
     • Clinical Features
     • Management
   • Retinal Detachment
     • Rhegmatogenous
     • Tractional
     • Exudative
     • Clinical Features
     • Management
7. 7

   Neuro-Ophthalmology

   3 topics

   • Optic neuropathies
     • Optic neuritis
     • Ischemic optic neuropathy
     • Compressive optic neuropathy
     • Toxic optic neuropathy
   • Cranial nerve palsies
     • Third nerve palsy
     • Fourth nerve palsy
     • Sixth nerve palsy
   • Neuro-ophthalmic syndromes
     • Papilledema
     • Pseudotumor cerebri
     • Horner syndrome
8. 8

   Pediatric Ophthalmology and Strabismus

   3 topics

   • Amblyopia
     • Definition
     • Causes
     • Clinical Features
     • Management
   • Strabismus
     • Types of Strabismus
     • Clinical Features
     • Management
   • Congenital Anomalies of the Eye
     • Congenital Glaucoma
     • Congenital Cataract
     • Retinopathy of Prematurity (ROP)
9. 9

   External Eye Diseases and Ocular Surface Disorders

   3 topics

   • Conjunctivitis
     • Infectious conjunctivitis (bacterial, viral, chlamydial)
     • Allergic conjunctivitis
     • Chemical conjunctivitis
   • Dry eye syndrome
     • Pathophysiology
     • Clinical features
     • Management
   • Blepharitis
     • Anterior blepharitis
     • Posterior blepharitis
     • Management
10. 10

    Ocular Oncology and Orbital Disorders

    3 topics

    • Ocular tumors
      • Retinoblastoma
      • Uveal melanoma
      • Conjunctival tumors
    • Orbital tumors
      • Orbital cellulitis
      • Orbital pseudotumor
      • Orbital metastases
    • Thyroid eye disease (Graves' orbitopathy)
      • Clinical features
      • Diagnosis
      • Management

Ophthalmology flashcards for MBBS

20 of 51 cards from the Ophthalmology deck — real questions with worked answers.

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

   1) Outer fibrous coat (cornea + sclera), 2) Middle vascular coat / uvea (iris, ciliary body, choroid), 3) Inner nervous coat (retina).

2. What are the refractive media of the eye and their approximate refractive powers?

   Cornea ($\approx +43\,\text{D}$, the strongest refractive surface), aqueous humor, lens ($\approx +17$ to $+20\,\text{D}$, variable with accommodation), and vitreous humor. Total resting power $\approx +58$ to $+60\,\text{D}$.

3. List the layers of the cornea from anterior to posterior.

   1) Epithelium, 2) Bowman's membrane (layer), 3) Stroma (substantia propria), 4) Descemet's membrane, 5) Endothelium. (Dua's layer is sometimes added before Descemet's.)

4. What are the ten layers of the retina from inner (vitreal) to outer (choroidal) side?

   Internal limiting membrane, nerve fibre layer, ganglion cell layer, inner plexiform layer, inner nuclear layer, outer plexiform layer, outer nuclear layer, external limiting membrane, photoreceptor (rods/cones) layer, retinal pigment epithelium (RPE).

5. Compare rods and cones in number, location, and function.

   Rods: $\approx 120$ million, peripheral retina, dim/scotopic vision, contain rhodopsin, no color. Cones: $\approx 6$ million, concentrated at the fovea, bright/photopic vision and color (S, M, L types), high acuity.

6. What is the macula lutea and the fovea centralis?

   The macula is the central retinal area ($\approx 5.5\,\text{mm}$) responsible for central/detailed vision. The fovea centralis is its center ($\approx 1.5\,\text{mm}$), a cone-only avascular pit giving the sharpest visual acuity.

7. What produces aqueous humor, and trace its normal drainage pathway.

   Produced by the ciliary body (non-pigmented epithelium of the ciliary processes). Flow: posterior chamber $\to$ through the pupil $\to$ anterior chamber $\to$ trabecular meshwork $\to$ Schlemm's canal $\to$ episcleral veins (conventional, $\approx 80\%$); the rest via the uveoscleral pathway.

8. What is the phototransduction cascade in rods (in brief)?

   Light isomerizes 11-cis-retinal to all-trans-retinal in rhodopsin $\to$ activates transducin (G-protein) $\to$ activates phosphodiesterase $\to$ hydrolyzes cGMP $\to$ closure of cGMP-gated $\ce{Na+}$ channels $\to$ photoreceptor hyperpolarizes $\to$ decreased glutamate release.

9. What is the dark current of photoreceptors?

   In darkness, high cGMP keeps $\ce{Na+}$ channels open, so $\ce{Na+}$ flows in (inward dark current), keeping the photoreceptor depolarized ($\approx -40\,\text{mV}$) and continuously releasing glutamate. Light closes these channels, causing hyperpolarization.

10. Define the visual axis and the optical (anteroposterior) axis of the eye.

    The optical axis is the line through the centers of the cornea and lens to the retina. The visual axis is the line from the fixation point through the nodal point to the fovea. The angle between them is the angle kappa.

11. What is accommodation and the change in lens power it produces?

    Accommodation is the increase in lens refractive power for near vision via ciliary muscle contraction (relaxing zonules, lens becomes more convex). It can add roughly $+14\,\text{D}$ in young eyes; declines with age.

12. State the components of the near reflex (accommodation triad).

    1) Accommodation (increased lens convexity), 2) Convergence (medial rectus contraction), 3) Pupillary constriction (miosis). All mediated by the parasympathetic CN III pathway.

13. What key elements should an ophthalmic history cover?

    Presenting complaint (vision loss, pain, redness, discharge, flashes/floaters, diplopia) with onset/duration/laterality; ocular history (refraction, surgery, trauma, drops); systemic history (diabetes, hypertension); drug and allergy history; family history (glaucoma, etc.); occupation/driving and social history.

14. In a patient presenting with a red eye, what features distinguish a sight-threatening cause from a benign one?

    Red flags: reduced visual acuity, moderate-severe pain, photophobia, ciliary (circumcorneal) injection, abnormal/poorly reactive pupil, corneal opacity or hazy cornea. Benign (e.g., conjunctivitis): normal acuity, gritty discomfort, discharge, diffuse injection, normal pupil.

15. 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 at $6\,\text{m}$ the patient reads what a normal eye reads at $60\,\text{m}$ (the top letter only). Normal is $6/6$.

16. What does a relative afferent pupillary defect (RAPD / Marcus Gunn pupil) indicate, and how is it tested?

    It indicates a unilateral or asymmetric optic nerve / severe retinal lesion. Tested with the swinging flashlight test: on swinging light to the affected eye, the pupil paradoxically dilates due to defective afferent input.

17. What does direct vs indirect ophthalmoscopy each provide?

    Direct: high magnification ($\approx 15\times$), erect, monocular, small field, good for the disc/macula. Indirect: lower magnification, inverted, binocular (stereoscopic), wide field, better for peripheral retina and used with scleral indentation.

18. How is intraocular pressure measured and what is the normal range?

    Measured by tonometry; Goldmann applanation tonometry is the gold standard. Normal IOP is $10$–$21\,\text{mmHg}$ (mean $\approx 15$–$16$).

19. What is the slit-lamp biomicroscope used to examine?

    It provides magnified, stereoscopic, illuminated examination of the anterior segment: lids, conjunctiva, cornea, anterior chamber (depth, cells/flare), iris, and lens; with adjuncts it assesses the angle (gonioscopy), IOP (applanation), and posterior segment (with lenses).

20. What is gonioscopy used for?

    To examine the anterior chamber drainage angle (iridocorneal angle) using a special contact lens, distinguishing open-angle from closed-angle glaucoma and identifying angle structures and abnormalities (e.g., neovascularization, recession).

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