Transcript ahma20.yolasite.com

‫اعوذ باهلل من الشيطان الرجيم‬
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‫ك الَ عْلمَ لَنَا إال َما عَل ْمتَنَا‬
‫{قَالُواْ ُس ْب َحانَ َ‬
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‫َ‬
‫نت ا ْل َعليمُ ا ْل َحكيمُ }‬
‫أ‬
‫ك‬
‫ن‬
‫إ‬
‫َّ‬
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‫َ‬
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‫‪7/22/2015‬‬
‫‪MAHGOUB SALEEM ~ INTRODUCTION TO OPHTHALMOLOGY‬‬
MAHGOUB SALEEM
MBBS (U of K) , DORCS (Eng.) , MRCOphth (UK), FRCOphth (UK) , FICS , FACS (USA)
SENIOR CONSULTANT OPHTHALMOLOGIST
ASSOCIATE PROFESSOR
FACULTY OF MEDICINE AL NEELAIN UNIVERCITY
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Introduction
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What is Ophthalmology?
Ophthalmology is a branch of medicine
specializing in the anatomy, function and
diseases of the eye and visual system.
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Ophthalmologist
Is a physician who specializes in the
medical and surgical care of the eyes and
visual system and in the prevention of eye
disease and injury
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Ophthalmic Health Care Providers
ER Dr
Ophthalmologist
GP
Optometrist
Family Physician
Optician
Ophthalmic technologist
Resp
Clerck
Ophthalmic assistant
Security
Ophthalmic nurse
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PG Degrees
 DO RC
 MRCOphth
 FRCOphth
 FRCS
 MD Ophth
 (American Board , etc..)
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PG Colleges
 The Royal College of Ophthalmologists
(RCOphth)
 The Royal College of Surgeons [FRCS]
 American Academy of Ophthalmology
( AAO)
 (AArab Board Ophth BOphth)
 Sudan Medical Specialisation Board ( SMSB)
 International Council of Ophthalmologists
[ICO]
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Subspecialties in Ophthalmology:
1.Cornea ,Refractive surgery and External Disease
2.Glaucoma
3.Neuro-Ophthalmology
4.Ophthalmic Pathology
5.Ophthalmic Plastic Surgery
6.Pediatric Ophthalmology
7.Vitreoretinal Diseases Surgical Rretina
Medical Retina
Diabetic E D
8. Community Ophthalmology
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8. Community Ophthalmology
Preventive Ophthalmology
PREVENTION OF BLINDNESS
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Ophthalmic Journals
AJO
Archives of Ophthalmology
BJO
Cornea
Digital JO
Ophthalmology
Eye
ESCRS
Journal of Catract and Refractive Surgery
Journal of Glaucoma
SJO(SUD)
SJO (KSA)
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BASIC
Ocular Anatomy
Ocular Physiology
Ocular Pharmacology
Ocular therapeutics
Ocular Genetics
+
G.Anatomy
G.Physiology
Microbiology
Genetics
Statistics
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MAHGOUB SALEEM ~ INTRODUCTION TO OPHTHALMOLOGY
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FACULTY OF MEDICINE AND HEALTH
SCIENCE
OPHTHALMOLOGY CURRICULUM
TEMPLATE
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AL NEELAIN
UNIVRSITY
~ UNDERGRADUATE
CURRICULUM
MAHGOUB
SALEEM
~ INTRODUCTIONOPHTHALMOLOGY
TO OPHTHALMOLOGY
13
Course Title
Code
7/22/2015
Ophthalmology
401MOphthal
Credit hours
4 Credit hours
Intended Semester
Semester Seven
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Course overview
The increasing age of the world population.
The high prevalence of common ophthalmic
problems.
The importance of vision in the information age.
Recognition of many ophthalmic
manifestations of medical , neurological ,
metabolic systemic diseases
etc...... .(Obgye., surgery, trumatology, Paed)
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Course overview
Recognition of many ophthalmic manifestations of
medical , neurological , and metabolic systemic diseases.
The Eye is linked with all
adjacent and remote structures
and organs of the body so
ocular manifestations are so
common in many if not all
systemic diseases
SO
Ophthalmic examination
is really an essential part
of clinical examination
in any medical case
Support the need for the expansion of
ophthalmic education for Medical students
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Course overview
Recognition of many ophthalmic manifestations of
medical , neurological , and metabolic systemic diseases.
The Eye is linked with all adjacent
and remote structures and organs of
the body so ocular manifestations are
so common in many if not all systemic
diseases
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SO
Ophthalmic examination is
really an essential part of
clinical examination in any
medical case
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Course overview (cont)
Our goal
In the Undergraduate Ophthalmology Curriculum
Is to provide a solid foundation in
ophthalmology to each medical student.
By essential
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A. Ophthalmic Knowledge
B. Clinical Ophthalmic Skills
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Course overview (cont)
But due to short time allotted for
Ophthalmic Education in medical schools
‘Educational Priorities Scoring System ’
Education
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is adopted
Assessment
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Course overview (cont)
‘Educational Priorities Scoring
System ’
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Course overview (cont)
‘Educational Priorities Scoring System ’
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1
2
* BASIC LEVEL
[60%]
** STANDARD LEVEL
[20%]
3
4
*** ADVANCED LEVEL
[10%]
**** ELECTIVE LEVEL
[? %]
5
CONTIONOUS ASSESSMENT
[10%]
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Course overview (cont)
A)
* Basic Level :
Information designated with
*)
a single asterisk (
‘Essential core material’
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Course overview (cont)
B)
** Standard Level :
Information designated with two
asterisks (**)
Reflect a higher level of ophthalmic
understanding and future ophthalmic
care so it is
‘Useful material’
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Course overview (cont)
C
) ***Advanced Level:
Information designated with three
asterisks (***)
Marks areas of advanced cognitive and
clinical skills important to future
ophthalmic care
‘ Less frequently needed material’
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Course overview (cont)
D) ****Elective Level:
Information designated with four
asterisks (****)
to be ‘ mentioned only’ marks areas of
very, advanced cognitive and clinical
skills important to future ophthalmic
care and career design
‘ Added for completeness’
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Course overview (cont)
The above knowledge and skills fall
in 12 ophthalmic subdivisions :
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Course overview (cont)
1.
2.
3.
4.
5.
6.
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Fundamental and Principles of
Ophthalmology
Cornea and External Diseases
Lens and Cataract
Glaucoma
Diseases of Eyelids ,Lacrimal
System, and Orbit
Paediateic Ophthalmology and Strabismis
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Course overview (cont)
7.
Vitreoretinal Diseases
8. Neuro-Ophthalmology
9. Ocular Manifestations of Systemic Diseases
10. Intraocular Tumors
11. Refraction , Refractive Surgery,and
Contact Lens
12. Ocular Manifestations of Systemic Diseases
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Course overview (cont)
For example
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Course overview (cont)
1.
2.
3.
4.
5.
6.
7/22/2015
Fundamental and Principles of
Ophthalmology
Cornea and External Diseases
Lens and Cataract
Glaucoma
Diseases of Eyelids ,Lacrimal
System, and Orbit
Paediateic Ophthalmology and Strabismis
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For example
1. Fundamental and Principles of
Ophthalmology:
A. Anatomy
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For example
* Gross Anatomy
* Orbit
** Periorbital Sinuses
** Bony Orbit
** Vascular Supply and
Drainage of the Orbit
* Eyelids
* Lacrimal Apparatus
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For example
Eyeball
** Tear Film
* Conjunctiva
** Tenon`s Capsule
* Sclera
* Limbus
** Episclera
* Cornea
* Uveal Tract
* a. Iris
* b. Ciliary Body
* c. Choroid
** Anterior Chamber
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For example
*** Anterior Chamber Angle
** Aqueous Humor
* Retina
** Vitreous
* Extraocular Muscles
* Cranial Nerves
* Optic Nerve (II)
** Visual Pathway
** Oculomotor Nerve (III)
*** Pathways for Pupil
Reflexes
** Trochlear Nerve (IV)
** Trigeminal Nerve (V)
** Abducens Nerve (VI)
** Facial Nerve (VII)
** Ocular Blood Supply
*** Cavernous Sinus
**** B. Embryology of the Eye
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For example
* Extra Ocular Muscles
*Anatomy
*Action
**Disorders
**Squint
* MR
LR
SR
IR
SO
IO
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For example
* B. Ocular Examination:
Ocular Examination A
* Distance Visual Acuity (VA)
* Snellen`s test type(6/6, 6/9, 6/12,..6/60
etc
** Snellen`s test type(20/20, 20/40, ..20/200
etc
* Counting Fingers (CF)
* Hand Movement (HM)
* Perception of Light (PL)
* No Perception of Light (NPL)
** Social and Legal VA requirements:
(Jobs, Driving License etc
** School children screening
** Alternative to Snellen
*** Pinhole (PH)
**** Log Mar
**** Picture tests
**** Matching tests
**** Contrast Sensitivity
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For example
* Visual Fields (VF)
** By Confrontation
*** Bjerrum Screen
*** Goldmann perimeter
*** Humphery perimeter
**** interpretation of VFs
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For example
Ophthalmic Equipments and Instruments
***Perimeters ( Goldmann , Humphery etc)
****A/B Scanners ****OCT
****Surgical Microscopes
****Ophthalmic Operation Table
****Ophthalmic surgical trays
****Ophthalmic surgical instruments
****Bipolar cautary
****Phaco Machine
****Vitrectomy Machine
****Argon Laser
****Yag Laser
****Excimer Laser
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For example
* History
* 1. Age,
Sex,Occupation,Resedance,Trib
e..etc
* 2. Ocular Symptoms
[ * mode of onset
* duration
* eye affected
* any glasses or
visual device used
* double vision
* associated nonocular symptoms]
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For example
**
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For example
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For example
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Knowledge
By the end of this
course the student
should be able to :
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Knowledge
By the end of this course the student should be able to :
1. Identify
The basic ocular anatomy and related
cranial nerves ( II, III, IV, V, VI, VII )
2. Describe
The functions of each ocular structure.
3. Identify
The rationale and interpretation of testing
the Red Reflex
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Knowledge
By the end of this course the student should be able to :
4. Define
The different refractive states of the eye
and their corrections
5. Recognize
The symptoms , signs , investigations and
causes of orbital diseases
6. Recognize
Symptoms , signs and treatments of lid
diseases.
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Knowledge
By the end of this course the student should be able to :
7. Recognize
Symptoms , signs and treatments of corneal
diseases
8. Recognize
Symptoms , signs and treatments of lens
diseases
9. Recognize
Symptoms , signs and treatments of
conjunctivitis
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Knowledge
10. Recognize
Symptoms , signs , treatments and
deferential diagnosis of Red Eye.
11. Recognize
Symptoms , signs and treatments of
vitreous diseases
12. Recognize
Symptoms , signs and treatments of retina
diseases
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Knowledge
13. Recognize
Symptoms , signs and treatments of optic
nerve diseases.
14. Recognize
Symptoms , signs and treatments of
lacrimal system
15. Recognize
Symptoms , signs and treatments of
glaucoma
16. Recognize
Preventable causes of blindness
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Knowledge
17. Identify
Cases need routine and urgent referral to
Ophthalmologist
Or other
Ophthalmic Health Care Providers
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Skills
By the end of this course
the student should be able
to perform :
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Skills
By the end of this course the students should be able to perform :
1. Obtain
An accurate and complete ocular history
2. Measure
And record near vision
3. Measure
And record distant vision in adult and
children
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Skills
By the end of this course the students should be able to perform :
4. Assess
Pupillary reflexes
5. Evaluate
Ocular motility
6. Use
The direct ophthalmoscope for assessment of
Red Reflex , the optic nerve , and posterior
fundus examination
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Skills
By the end of this course the students should be able to perform :
7. Dilate
the pupils
8. Perform
and evaluate visual fields by confrontation
9. Estimate
Intraocular pressure Digitally
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Skills
By the end of this course the students should be able to perform :
10. Aversion
of upper lid
11. Remove
simple conjunctival FBs
12. Install
eye drops ,topical fluorescein , local
anaesthetics ..etc
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Objectives:
Attitude
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Objectives: Attitude
By the end of this course the student
should demonstrate the ability to:
1. Be caring and compassionate
2. Communicate with patients and handle
them sensibly as appropriate to their age.
3. Be committed to work and learning
4. Be enthusiastic for patient care
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Objectives: Attitude (cont.)
By the end of this course the student
should demonstrate the ability to:
5. Work as a team member
6. Show respect for patients, family
members and other health care
workers
7. Show respect to others religions,
believes and culture
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Objectives: Attitude (cont.)
By the end of this course the student
should demonstrate the ability to:
8. Lay a foundation of self education
and a critical approach to Learning
9. Be sensitive to moral and ethical
issues in patient care.
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Curriculum Map (Structure)
Year
4
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Semester
7
No. Of weeks
17
Theoretical
hours
34
clinical rounds
Credit hours
64
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Instructional Methods
1. Lectures 30%
2. Clinical rounds : 50%
3. Demonstrations of Ophthalmic
equipments and instruments : 5%
4. Self learning :5%
5. Slides discussions :5%
6. OR tours : 5%
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Instructional Methods
6. OR tours : 5%
Ophthalmology is mostly a surgical specialty,
so medical students should be given an
opportunity to observe procedures in the
operating room. By allowing students to be
exposed to the surgical procedures, they will
acquire a more realistic understanding of
ophthalmic practice.
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Student`s Assessment
Methods
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Student`s Assessment Methods
Tool of Assessment
MCQs
Sub-division
Sub-division weight
a) *
35%
b) **
10%
c) ***
5%
d) ****
0%
Final
Weight
50%
OSCEs
a) *
25%
b) **
10%
c) ***
5%
d) ****
0%
40%
CME
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10%
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Constrains & Obstacles of
Curriculum Implementation
`Short of time
`Short of staff
`Restricted variety of cases in Alneelain eye hospital !!! .
`Students transportation!!!
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Recommendations
Needs:
` 2 semesters period to complete 32
week with credit hours of 8
` 1 more ophthalmologist
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Specific Objectives:
A. Anatomy
To Identify the anatomy of the eye, orbit, I,III,
IV, V, V, VII
Cranial nerves, papillary and visual pathways, to
permit an understanding of medical conditions
affecting these structures
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* Gross Anatomy
* Orbit
** Periorbital Sinuses
** Bony Orbit
** Vascular Supply and Drainage of the Orbit
* Eyelids
* Lacrimal Apparatus
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Eyeball
** Tear Film
* Conjunctiva
** Tenon`s Capsule
* Sclera
* Limbus
** Episclera
* Cornea
* Uveal Tract
* a. Iris
* b. Ciliary Body
* c. Choroid
** Anterior Chamber
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*** Anterior Chamber Angle
** Aqueous Humor
* Retina
** Vitreous
* Extraocular Muscles
* Cranial Nerves
* Optic Nerve (II)
** Visual Pathway
** Oculomotor Nerve (III)
*** Pathways for Pupil Reflexes
** Trochlear Nerve (IV)
** Trigeminal Nerve (V)
** Abducens Nerve (VI)
** Facial Nerve (VII)
** Ocular Blood Supply
*** Cavernous Sinus
**** B. Embryology of the Eye
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C. History and Examination
Specific Objectives:
By the end of these the student will be able to :
*
*
*
*
*
*
*
*
Take and understand an ophthalmic history
Examine the function of the eye(Visual Acuity and Field)
Test papillary reactions
Examine eye movements
Examine the structure of the eye
Detect and interpret Red Reflex
Use the ophthalmoscope
Record and Recall Ocular Data
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* History
* 1. Age, Sex,Occupation,Resedance,Tribe..etc
* 2. Ocular Symptoms
[ * mode of onset
* duration
* eye affected
* any glasses or visual device used
* double vision
* associated non-ocular symptoms]
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*a. Diminution of Vision
*b. Ocular pain
*c. Headache
*d. Watering
*e. Discharges( watery,mucoid,mucopurulent,purulent)
*f. Dislike for eye ( Photophobia)
*g. Medical History (Diabetes Mellitus, Hypertension,
Thyroid, CVD, Neurological , TB, Rheumatic ,
Infectious Diseases etc.
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*h. Past History
*i. Drug History
*j. Surgeries and injuries.
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* B. Ocular Examination:
Ocular Examination A
* Distance Visual Acuity (VA)
* Snellen`s test type(6/6, 6/9, 6/12,..6/60 etc
** Snellen`s test type(20/20, 20/40, ..20/200 etc
* Counting Fingers (CF)
* Hand Movement (HM)
* Perception of Light (PL)
* No Perception of Light (NPL)
** Social and Legal VA requirements:
(Jobs, Driving License etc
** School children screening
** Alternative to Snellen
*** Pinhole (PH)
**** Log Mar
**** Picture tests
**** Matching tests
**** Contrast Sensitivity
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** Near Visual Acuity (VA)
*** Colour Vision (CV)
*** Ishihara plates
**** Alternatives
**** Congenital and acquired CV
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* Visual Fields (VF)
** By Confrontation
*** Bjerrum Screen
*** Goldmann perimeter
*** Humphery perimeter
**** interpretation of VFs
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Ocular Examination B
* Intraocular pressure (IOP)
* Digitally
**** Tonometers ( Schiotz, Goldmann, Perkin`s,
Tonopen, Non-contact Air buff )
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Ocular Examination C
* Position of the eye
** corneal reflex
*** cover tests
*** Extraocular Muscle Tests
* Ocular Adenxa
* Lids
*** Lacrimal apparatus
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* Anterior Segment
* Conjunctiva
** Cornea
** Anterior chamber ( AC )
** Pupil
** Iris
** Lens
** Posterior Segment
** Direct ophthalmoscopy
** Red Reflex
*** Retina
*** Optic Nerve
*** Diabetic Retinopathy
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Lectures :
Conjunctivitis
Orbital diseases
Red Eye
Lid diseases.
Corneal diseases
Lens diseases
Vitreous diseases
Retina diseases
Optic nerve diseases.
Lacrimal system
Glaucoma
Ocular manifestations of systemic diseases
Preventable causes of blindness
Community ophthalmology
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Ophthalmic
Instruments
Equipments
and
*Direct Ophthalmoscope
**Indirect Ophthalmoscope
**Retioscpe
*Snellen`s charts
*Ischihara plates
*Slit Lamp
**Ophthalmic Units
***Chart Projector
***Keratometer ( Manual and Auto)
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Ophthalmic Equipments and Instruments
***Perimeters ( Goldmann , Humphery etc)
****A/B Scanners
****OCT
****Surgical Microscopes
****Ophthalmic Operation Table
****Ophthalmic surgical trays
****Ophthalmic surgical instruments
****Bipolar cautary
****Phaco Machine
****Vitrectomy Machine
****Argon Laser
****Yag Laser
****Excimer Laser
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The seven bones that articulate to
form the orbit.
yellow = Frontal bone
green = Lacrimal bone
brown = Ethmoid bone
blue
= Zygomatic bone
purple = Maxillary bone
aqua = Palatine bone
red
= Sphenoid bone
gray
= Nasal bone
The nasal bone is illustrated but
does not form part
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1. Lectures 35%:
2. Clinical rounds : 50%
3. Ophthalmic equipments
demonstrations : 5%
4. OR tours : 5%
5. Slides discus and self learning 5% :
93
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History and Examination
of an ophthalmic case
Learning objectives :
Take & understand an ophthalmic history
Examine the function of the eye (VA & VF)
Test pupillary reflexes
Examine eye movements
Examine the structure of the eye
Understand the use of fluorescen dye
Use the ophthalmoscope
Use slit lamp
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History and Examination
of an ophthalmic case
A. History
B. Examination
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A. History
`Important
`encourage patient to narrate his C/Os
` make relevant enquiries
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A. History
I. Demographic Data :
`name
` age (DOB)
`Gender (sex)
`Occupation
`Home
`Ethnicity ,, original race & tribe
` ID
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A. History
II. Chief complain & history of the present
illness (HPI) :
Visual Function : VA
`Present status of visual function,
Any Dimness of vision :
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A. History
a) mode of onset
i) sudden
CRAO , CRVO , RD . Papillitis,
Acute Congestive glaucoma ,
Vitreous haemorrhage
ii) Gradual
Catract , CSG , Others
( inflamations , amblyopia , destrophies
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A. History
b) Duration
i) short
ii) long
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A. History
c) for distance or near
d) Any double vision
paralytic squint ??
d) Any history of vision correction
glasses , contact lenses
or refractive surgery
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A. History
f) Night blindness
` Vit A dficiency
` RP
` congenital
` drugs
` acquared ( chloroquine etc..
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A. History
g) Associations
` photophobia
` lacrimation
` blepharospasm
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A. History
2)
Pain in the eyes
` mode of onset
( sudden or gradual )
` severity
( mild , moderate , severe )
` relation to close work
( Refractive errors {REs}
eg : presbyopia )
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A. History
2)
Pain in the eyes
` time of the day gets more worse
( if worse in evening ? Res)
` associations
( nausea , vomiting ,
photophpbia , drop of vision )
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A. History
3)
Headache
` location
frontal
occipital
temporal { temporal artritis }
` time of the day get worse
` severity ( mild , moderate , severe )
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A. History
3)
Headache (cont.)
` associations ( nausea , vomiting , blurring of
vision , etc..)
` type ( dull , throbbing , ? Strain ,,,,asenopia )
` frequency
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A. History
3)
Headache (cont.)
` relation to far or near vision
` Relieving factors
( analgesics , sleep , rest etc…)
` Aggravating factors
( tension exhaustion etc..)
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A. History
3)
Headache (cont.)
` aura
( migraine aura )
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A. History
* ocular causes of
headache
1. REs
2. poor accommodation & convergence ,A/C
3. CL over wear / ??? Glasses over wear ~
strain
4. Acute congestive glaucoma
5. iritis
6. HZ
7. Orbital cellulitis
8. superior orbital syndrome
9. migraine
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A. History
* ocular causes of
headache
1. REs
2. poor accommodation & convergence ,A/C
3. CL over wear / ??? Glasses over wear ~
strain
4. Acute congestive glaucoma
5. iritis
6. HZ
7. Orbital cellulitis
8. superior orbital syndrome
9. migraine
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A. History
4) Redness & congestion
(inflammation) :
of the
` eyelids
` eyeball
` surrounding the eye
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A. History
5) Watering ( excessive): 5)
` Duration
` Constant
` Intermittent
` Relations : close work
travelling
TV, cinema
` Associates
redness
FBs
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A. History
6: Discharges
1. Watery — viral conjunctivitis, allergic conjunctivitis, eye
allergies, dry eyes, eye injury, dacryocystitis.
2. Crusty — blepharitis, bacterial conjunctivitis and other eye
infections, stye.
3. Sticky— stye, bacterial conjunctivitis and other eye infections,
corneal ulcer, dacryocystitis.
4. Stringy — dry eyes, corneal ulcer, allergic conjunctivitis, eye
allergies
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A. History
6: Discharges
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A. History
•Inflammation
• Erythema
•Several causes:
Bacterial
Viral
Allergic
Chemical
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A. History
6: Discharges
Discharge
Purulent
Cause
Bacteria
Clear
Viral
White, stringy mucous
Allergies
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A. History
6: Discharges
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A. History
6: Discharges
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A. History
6: Discharges
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A. History
6: Discharges
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A. History
7.Light sensitivity (photophobia)
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A. History
8: HO Ocular trauma
direct
indirect
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A. History
9: Past Hostory
10: Drug History
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B. Examination
` VA
` Eyeball position
` proptosis
` ocular adenexa (eyelids,lacrimal)
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B. Examination
Conjuctiva
cornea
AC
pupils
lens
post.segment
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THANK YOU
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