Round no 2 Corneal examination 1- obesity or 2- ulcers How to examine the cornea :The examination done for transparency and

sensitivity ( causes of corneal obesity ) 1cornea is a vascular (so nutrition by tears in the front centrally by aqueous humorous peri papillary plexus ) 2cornea is dehydrated ( interiorly epithelium prevent tear from entering and posteriorly endothelium prevent enter to aqueous humorous . 3no mylene sheath to keep cornea clear Ex liprosy 4forming of collagen bandles keep cornea transparent Ex corneal ulcer (obasity in cornea ) you have to comment on the cornial obisty like this site of obesity (central perephral ) size ( one third tow thirds >>of the cornea ) depth superficial (libula ) if in epithelium and puman membrane leucoma all the layer (epithelium and puman membrane and stroma ) divided to tow 1adherent attached to iris 2non adherent no adhesion macula obesity deep obesity (vascularised and non vascularised ) corneal ulcers :define as discontinuity of surface epithelium with involvement of puman membrane corneal laseration - define as discontinuity of surface epithelium with no involvement of puman membrane symptom of corneal ulcer :1pain most important part because contain sensory nerve ending (so if there is no pain damage of trigeminal ganglia , or herpes zoster virus or herpes simplex virus ) 2photophobia light irritant pain to eye (characteristic for corneal ulcer ) 3reflex lacremation 4redness of eye ( cilliary injection or curcum coroude ) 5diminution of vision ( if sever central if mild perephral )

examination of the cornea :1loss of laster 2localized edema and obesity 3cellular .. grayesh color 4iregulatory of the surface the suring sign 1drop of sodium floroscen (chang from orang to green ) on area of corneal ulcer 2rose pinjal stain in area loss of epithiluim dye chang to pink *corneal sensation by pice of cotton and forming contraction reflex Corneal banace ( vascularisation and infiltration ) 1Trachomatous banace ( upper part of cornea cover by eye lead and the follicles ) 2Vernal kerato conjunctivitis 3Degenerative banace 4Lyprotic 5Frectonal Cerato conous :Charachtrised by occur in 1st 10 years of age normal vision then in age of buberty will form deminusion of vision On examination :1Central part of cornea thinner and pulging 2Thikness less than 400 micro ( 0,4 mm) * normaly 0.5 mm So diagnosis by measuring the central part of the cornea by 1keratometer = measure central cerveature 2corneal bacometer = measure thikness of cornea 3corneal topography = measure cerveture of all surface

Examination of the sclera :By using wide open light eye and move eye every direction Normal sclera is white on color abnormal sclera is :1- elevated ( ectatic ) bluish = staphyloma ( weak sclera and increase IOP) occure in advanced neglected glaucoma staphyloma can be cilliary equatorial ( at extreme ends ) usually staphyloma occur in blind eye or poor vision 2- bluish with out elevation : normal under 3 years congenital glaucoma adult with deep necrotizing scleritis 3- localized redness in sclera episcleritis in superficial lamellae schleritis in all the layer usually occur in postmenopusal women that has arthritis examination of anterior chamber : its the space between the sclera , iris and pupil ( ) contain the agues humorous angel of A.C .. HOW to examine A.C. :By oblique position Normaly it is transparent because of the fluid Abnormally :1hyphymia red fluid fill the A.C ( blood ) usually post traumatic or post operative and can be in sicklers 2hypopion yellow fluid fill the A.C it is buss from irido scyclitis 3* anterior chamber intraocular lens ACIOL , use in complication occur in PCIOL * posterior chamber intraocular lens PCIOL , use in all chatarct cases 4Forien body in A.C like iron F.B , GLASS F.B and Normal depth of A.C = 2.5 to 3.5 mm ( measure by slight lamb )

Shallow A.C occur with 1 2- Corneal fiscula * iris pumbai (in acute angel glocuma Deep A.C :1IN afacia ( abcent of the lens ) 2Posterior dislocation of lens 3Congenital glaucoma Comment of A.C is ( normal depth and normal content ) Angle of A.C between cornea and iris Normaly cute angle 35- 45 To measure the angle use bonoscopy Type of Angle :1open angle _ in normal individual or open angle glaucoma treat by drug 2close angle close angle glaucoma treat by surgery 3narrow angle narrow angle glaucoma treat by surgery angle containe :1last part of iris 23Sclera spare 4Trabicular mish work 5 open angle By the gonio lens

Iris :Anterior part of middle coat of the eye How to examine iris 1color of the iris ( usually brown ) hemogenous equal in both iris abnormal called hetrochromion congectival horner syndrome is different between the R L color heterochromic irodo scycilitis 2iritis atrophy patches white patches 3repusis iridis red iris ( because of abnormal BV in iris 4bilateral but asymmetric prolefrative diabetic retinopathy central retinal vein occlusion

normal iris have elevation and depression examine by slight lamb upper area of pubil is light brown while lower is dark brown see the iris colarit ( ) AND the iris cribt pupil loss of iris pattern :1iritis (inflammation ) 2iris atrophy (lose iris pattern ) comment of iris ( normal pattern and normal color ) iris adhesion :anterior adhesion (synicia ):- between iris and cornea posterior adhesion (synicia) :- between iris and the lens synicia = iris adhesion effect of truma on iris :1traumatic myosis 2traumatic medriasis 3irido dialysis (disensertion of iris from cellulary body ) this patient have tow pupil ( unioccular dipplopia ) 4traumatic uniridia = no iris in examenation examenation of the pupil :1- must be round pupil EX : irido dialysis D shape pupil vertically oval pupil in acute congestive glaucoma fistoned pupil ( ) in chronic iritis 3edge of pupil must be regular irregular = chronic iritis 4puopil must reactive to light if no reflex to light abscent of pupilary light reflex ex of eye has no reflex :1acute congestive glocuma ischemia in muscle 2central retinal artry occlusion 3optec nuritis and atrophy ( affrent ) 4sever pressure in optic ciazma 5brain tumer 6affect the 3rd cranial nerve 7disease affect cellulary ganglion

comment on pupil ( rounded regular reactive ) ( RRR) size of the pupil :- 3- 5 mm in diameter less than 2mm = myosis more than 6 ml mydriasis anyso chornea : unequal size of both pupil myosis causes :1senile myosis ( normal finding on old age ) 2myotic eye drop ( bilocarbine eye drop ) 3iritis because of inflammatory spasm in sphincter muscle 4morphine and opioid 5organo phosphorus poisoning medriasis causes :1medriatic eye drop ( trobicamide most common , or atropine , adrenaline , ) 2cerebral hemmorhhage duo to paralysis of 3rd cranial nerve so there is dilated pupil in the side of hemorrhage and normal other side 3acute congestive glocuoma 4post traumatic 5. 6. 7,,, Color of pupil normaly black Abnormal color of pupil 1white pupil : old age cataract (lens obesty in adult adolescent old age can occur ) child ( 1-2 years ) a) congenital cataract b) malignant tumor ( retino plastoma ) c) congenital hyper plastic metrius d) retinopathy of prematurity ( increase o2 in incupators) 2yellow pupil duo to infection of retina or vitrous in endophthalmitis
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red pupil duo to hemorrhage inside the pupil

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grayesh ( bluish ) pupil acute congestive glocouma

examination of the lens :1lens is totally clear and transparent 2in normal location just behind the pupil transparent lens must form with normal color of the pupil black abnormality in lens :1white pupil cataract (les is totally opaque ) mature cataract 2grayish white on color (immature incomplete cataract ) 3gray color ( early cataract ) 4iris shadow \ signs of cataract 5red reflex >>on straight light lamb with dark room pupil will form the red color normally , while abnormal will form black (totally opaque )or partial opaque ( red and black ) 6present of white obesity in region of the lens change position of the lens posterior dislocation 1change of color of the pupil to jet black ( ) a\ aficic 234
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b\ posterior dislocation of the lens deep anterior chamber more than 4.5 mm tremolos iris ( no support behind it ) absent of normal anatomy anterior dislocation of lens deep increase of A.C like oil drop in aqueous humorous in A.C

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CONGENITAL IN marphan syndrome Sublaxation = not all zonules are cut Intra ocular pressure :By goldman tonometer Drop 1- saudium florocene dye 2-local anesthetic Normal IOP = 12- 21