3-step test: for diagnosis of superior oblique palsy... 1.

perform the coveruncover test in the primary position to identify the side of the hyperdeviation. 2. Observe an increase in hyperdeviation with gaze to the opposite side. 3. Document an increase in the hyperdeviation with the head tilted to the same side by performing the Bleischowsky test... 3 C's of congenital toxoplasmosis: convulsions, chrioretinitis & intracranial calcification... Argyll-Robertson pupil: light-near dissociation (absent reaction to light, present to near stimulus), small, frequently irregular pupils... dilate poorly with mydriatic... the hallmark of neurosyphilis... Amaurotic cat's eye reflex: yellowish white mass seen through fixed dilated pupil in metastatic forms & those cases of endophthalmitis with deep infections where posterior segment is first involved... Amsler's sign: filiform haemorrhage which develop with anterior chamber paracentasis 180 degree awa from the puncture site.. mostly d/t presence of fine radial twig-like vessels in the chamber angle in Fuch's heterochronic cyclitis... APMPPE: Acute Posterior Multifocal Placoid Pigment Epitheliopathy: a rare idiopathic disease typically affecting both eyes of a young-adult... 50% have a prodromal influenza-like illness a/w erythema nodosum... initial symptom being subacute u/l impairment of central vision f/b involvement of the fellow eye a few days later... typical lesion being deep placoid cream coloured or grey-white areas involving the postequatorial retina & posterior pole... no effective treatment... Behcet's disease: an idiopathic multisystem disease typically affecting young men from the eastern Mediterranian region & Japan, HLA-B51 positive... The basic lesion being obliterative vasculitis c/b abnormal circulating immune comlexes... The 4 major features being- a. recurrent oral ulceration(almost all) b. genital ulceration(90%) c. uveitis(70%)(recurrent, b/l nongranulomatous) d. skin lesions(erythema multiforme)... no satisfactory treatment, corticosteroids & chlorambucil... Birdshot retinochoroidopathy (vitiligenous retinochoroiditis): a rare idiopathic bilateral chronic multifocal choroidopathy & vasculopathy typically affecting healthy middle-aged individuals positive for HLA-A29, more in women... c/b numerous flat creamy-yellow spots d/t focal chorioretinal hypopigmentation resembling the pattern of 'bird-shot scatter from a shotgun'... vitreous floaters or blurring of central cision d/t macular oedema are the initial symptoms... Steroids tried unsatisfactorily... Benedikt's syndrome: c/b ipsilateral 3rd nerve palsy, contralateral ataxia & flapping tremor... Bruch's membrane: basal lamina of choroid... Busacca's nodules: iris nodules on peripheral part of anterior surface of iris near collarette in granulomatous uveitis, larger but less common then Koeppe's nodules... Callender's microscopic classification of uveal melanomas: i) Spindle A melanoma ii) Spindle B melanoma iii) Fascicular melanoma iv) Epithelioid cell melanoma v) Mixed call melanoma vi) Necrotic melanoma Candle wax exudates or candle wax drippings: periphlebitic nodules d/t perivascular accumulation of granulomatous tissue in severe periphlebitis(vasculitis)...

seen in sarcoidosis... Choroideremia: X-linked recessive choroidal dystrophy affecting only males... presents within 1st 5-10 years of life with defective night vision... Collar-stud tumour: circumscribed malignant melanoma of choroid which ruptures through the Bruch's membrane... Cotton-balls or snow-balls: vitreous opacities d/t small gelatinous exudates...characterisitically in pars planitis...also seen in sarcoidosis & candidiasis... Cotton-ball or puff-ball colonies: in case of ocular candiidiasis, small retinal lesions enlarge & extend into the vitreous gel giving rise to floating white colonies... Catford drum: for optokinetic nystagmus in small children...useful for visual acuity in them... Central scotoma: scotoma involving only fixation... typically in optic neuritis, also ischaemic & compressive optic nerve lesions... Centrocaecal scotoma: scotoma extending from fixation to the blindspot... typically in toxic optic neuropathies & Leber's optic neuropathy... Chiasm syndrome: Heteronymous bilateral temporal hemianopsia with decreased visual acuity and unilateral or bilateral optic nerve atrophy Champagne cork appearance: in chronic papilloedema the optic disc gives appearance of the dome of a champagne cork... Ciliospinal centre of Budge: the first neurone of the sympathetic nerve supply to the eye terminates here... City university colour vision test: a spectroscopic test where a central coloured plate is to be matched to its closest hue from four surrounding colour plates... Congruity: the tendency for an incomplete homonymus hemianopia to be symmetrical in the two visual fields... Dalen-Fuch's nodules: small deep yellow-white spots scattered through out both fundi in sympathetic uveitis...formed d/t proliferation of the pigment epithelium of the iris, ciliary body & choroid asociated with invasion by the lymphocytes & epithelioid cells... Diktyoma: medulloepithelioma, a rare congenital tumour arising from the nonpigmented epithelium of the ciliary body... Double circulation: demonstration of large blood vessels within a small tumour (eg, choroidal melanoma) on fluorescein angiography indicating that it is probably malignant... Duke Elder's aetiological classification og uveitis: i) infective uveitis ii) allergic uveitis iii) toxic uveitis iv) traumatic uveitis v) uveitis associated with non-infective systemic diseases vi) idiopathic uveitis De Morsier's syndrome (septo-optic dysplasia): bilateral optic nerve hypoplasia,

absence of the septum pellucidum & agenesis of the corpus callosum... only a single anterior ventricle on CT scanning... Dorello's canal: the 6th cranial nerve passes through it under the petroclinoid ligament to enter the cavernous sinus... Double-floor sign: in pituitary adenoma, one of the earliest radiological signs is erosion of the dorsum sellae. the sella then becomes enlarged & the asymmetrical erosion of its floor gives rise to this sign... Double-ring sign: in optic nerve hypoplasia, a small grey optic disc surrounded by a yellow halo of hypopigmentation d/t a concentric choroidal & retinal pigment pigment epithelial abnormality is seen... Downbeat nystagmus: fast phase downwards... pathognomonic of a lesion involving the cervicomedullary junction at the foramen magnum... Eale's disease: an idiopathic peripheral periphlebitis typically affecting both eyes of a young male... presenting feature being sudden blurring of vision d/t vitreous haemorrhage... unsatisfactory treatment, laser panretinal photocoagulation & pars plana vitrectomy... Edridge-Green lantern: the most popular for the lantern test... Farnsworth-Munsell 100 hue test: a spectroscopic test in which subject has to arrange the coloured chips in ascending order. The colour vision is judged by the error score, i.e. greater the score poorer the colour vision... Finger-mimicking test: a modification of the finger-counting test in which the patient is asked to hold up the same number of fingers as tehe examiner... useful in toddlers & aphasic patients... Foster-Kennedy syndrome: pressure optic atrophy on the side of lesion & papilloedema on the other side d/t increased ICP... d/t olfactory or sphenoidal meningiomata & orbital surface of fronral lobe tumours... Foville's syndrome: caused by a lseion in the dorsal pons... c/b ipsilateral 6th nerve pasy combined with a gaze palsy, ipsilateral facial weakness, ipsilateral facial analgesia, ipsilateral Horner's syndrome & ipsilateral deafness... Fuch's uveitis syndrome(Fuch's heterochromic cyclitis): a chronic nongranulomatous anterior uveitis typically affecting one eye of a middle-aged adult... Gyrate atrophy of choroid: autosomal recessive disease d/t in \born error of ornithine ketoacid aminotransferase activity... a/w increased levels of ornithine in plasma, urine, CSF & aqueous humour...begins in 1st decade with symptoms of night blindness... Treatment is massive supplemental doses of pyridoxine (vitamin B6) & diet low in proteins & arginine... Gradenigo's syndrome: c/b 6th nerve palsy, facial weakness, deafness & severe pain in the distribution of the 1st division of the trigeminal nerve... Greggs syndrome involving lens opacity, an open ductus arteriosus, and sensorineural hearing loss Heerfordt's syndrome (uveoparotid fever): in sarcoidosis, c/b b/l granulomatous

panuveitis, painful ebnlargement of parotid glands, cranial nerve palsies, skin rashes, fever & malaise... Histo pots: atrophic spots consisting of roundish, slightly irregular yellowish-white lesions measuring b/w 0.2-0.7 DD seen un presumed ocular histoplasmosis syndrome... Haller's layer: layer of large vessels in the stroma of choroid... Hutchinson's sign: those with a vesicular eruption on the tip of the nose from involvement of external nasal branch of the nasociliary nerve are at particular risk of HZO... Hardy-Rand-Rittler plates: same principle as Ishihera's plates... Hayreh's theory: papilloedema ddevelops as a result of stasis of axoplasm in the prelaminar region of optic disc, d/r an alteration in the pressure gradient across the lamina cribrosa... Hemianopia: a complete defect involving one half of the visual fiels... Holmes-Adie tonic pupil: c/b affected pupil larger, extremely poor or absent reaction to light, very slow & tonic reaction to near stimulus... frequently accommodation is slow & verniform movements of the iris border... constriction of pupil with 2.5% mecholyl or 0.125% pilocarpine.. typically in women in 3rd & 4th decades... a/w absent tendon reflexes... Holmgren's wools test: the usbject is asked to make a series of colour-matches from a selection of skeins of coloured wools... Hruby-Irvine-Gass syndrome (is the development of cystoid macular edema following intracapsular cataract extraction with incarceration of the vitreous body in the wound). Horner's syndrome (oculosympathetic palsy): caused by a total or partial interruption of the sympathetic chain anywhere alonmg its course from the hypothalamus to the eye c/b moderate degree of ptosis, elevation of the lower lid, apparent enophthalmos, variable miosis which is more marked in dimn illumination, diminished sweating on the ipsilateral part of the face, heterochromia & increase in the amplitude of accommodation... Hummelsheim procedure: a procedure in which the lateral halves the superior & inferior rectus muscles are disinserted from their origins & attached to the superior & inferior margins of the scleral insertions of the paretic lateral rectus muscle in 6th nerve palsy... Iridodialysis: detachment of iris from its root at the ciliary body following trauma c/b D-shaped pupil & a black biconvex area seen at periphery... Iridoschisis: b/l atrophy of iris occurring as a senile degeneration in patients over 65 years of age... also occur following iris trauma... c/b a cleft b/w the anterior & the posterior stroma of the iris... Iris pearls: small glistening lesions composed of lepra bacilli within histiocytes present at the pupillary margin, pathognomonic of lepromatous leprosy...

Ishihera's plates: pseudo-isochromatic chrts for screening of colour blindness... J-shaped sella sign: in a glioma of the optic nerve at its junction with the chiasm, there is enlarged sella turcica with typical undercutting of the anterior clinoids & erosion of the anterior aspect of the sella gicing rise to this sign... Jensen's modification of Hummelsheim procedure: spitting of the superior, lateral & inferior rectus muscles lengthwise & then tying the lateral half of the superior rectus muscle to the superior half of the lateral rectus muscle & tying the lateral half of the inferior rectus muscle to the inferior half of the lateral rectus muscle with nonabsorbable sutures... Junctional scotoma: an ipsilateral central scotoma & a contralateral upper temporal field defect... d/t a tumour compressing the junction of the chiasm & optic nerve that interfers with the anterior knee of Wilbrand consisting of a loop of the contralateral inferonasal fibres... Jensen's choroiditis: juxtacaecal or juxtapapillary choroiditis typicallly occurring in young persons... oval in shape as an exudation close to & about the same size as the disc...c/b sector-shaped defect in field of vision... Kimura, Thygeson & Hogan grading of vitreous activity with D/O: 0 no opacities + few scattered fine & corase opacities with a vlear view of the fundus ++ scatterd fine & coarse opacities with fundus details somewhat obscured +++ many opacities with marked blurring of the fundus ++++ dense opacities with no view of the fundus Koeppe nodules: iris nodules at pupillary border in granulomatous uveitis, smaller than Busacca nodules.. Kveim-Slitzbach test: saline suspension of sarcoid tissue obtained from spleen of the patient with active sarcoidosis is introduced intradermally, mostly on anterior aspects of legs, which is biopsied 4 weeks later & shows non-caseating granuloma... Positive in 80% of patients with sarcoidosis... Kearns-Sayre syndrome: a triad of chronic progressive external ophthalmoplegia, pigmentary retinopathy & heart block that may cause sudden death... manifested before 20 years of age usually... a/w short stature, cerebellar ataxia, deafness, mental retardation & delayed puberty... Leber's idiopathic stellate maculopathy: the least common form of optic neuritis having all the features of optic neuritis plus a macular star... Leber's optic neuropathy: a rare hereditary disorder affecting mostly young males... c/b acute painless progressive & permanent monocular visual loss followed by involvement of the other eye within weeks or months...c/b telangiectatic microangiopathy in the acute stage Lander's sign: preretinal nodules in sarcoidosis are typically discrete, grey-white, located inferiorly & anterior to the equator... Macular histospot: atrophic macular star in presumed ocular histoplasmosis

syndrome... Masquerade syndrome: Retinoblastoma, iris melanoma, reticulum call sarcoma, leukaemia, lymphoma, histiocytic cell sarcoma etc may present with C/F of uveitis... Mutton fat' KPs: Large thick fluffy lardaceous KPs with greasy or waxy appearance, composed of clusters of epithelioid cells & mononuclear macrophages, characteristically in granulomatous uveitis... Marcus-Gunn pupil: caused by an optic nerve lesion that is not severe enough to cause an absence of light perception... detected by swinging flash light test... Meningioma en plaque: affects the greater & lessser wings of the sphenoid bone... the most common to involve the orbit secondarily... Millard-Gubbler syndrome: caused by lesion in ventral pons... c/b contralateral hemiplegia in addition to variable signs of a doral pontine lesion... Mikuliczs syndrome: Bilateral chronic inflammation of the lacrimal and salivary glands Morning glory syndrome: a dysplastic coloboma of the optic disc which resembles the morning glory flower... the optic nerve head appears enlarged & excavated & contains persistent hyaloid remnants within its base & the blood vessels emerge from the rim of the excavation in a radial pattern like the spokes of a wheel... Nagel's anomaloscope: the observer is asked to mix red & green colour in such a proportion that the mixture should match the given yellow coloured disc... The judgement about the defect is made from the relative amount of red & green colours & the brightness setting used by the observer... Nodular lepromata: yellow globular polymorphic single masses in leprosy, less common than iris pearls... Nussenblatt grading of vitreous activity by I/O: ++++ optic nerve head obscured +++ optic nerve head visible but borders blurred ++ better visualization of retinal blood vessels + better definition of optic nerve head & retinal blood vessels +- blurring of retinal nerve fibre striations 0 nerve fibre striations well defined Oculopharyngeal dystrophy: c/b chronic progressive external ophthalmoplegia, involvement of pharyngeal muscles, wasting of the temporalis muscle... Parinaud's syndrome: midbrain lesions involving tectum, e.g. pinealoma, pupil larger, may be eccentric, impairment of upward gaze from damage to the vertical gaze centre & convergence-retraction nystagmus... Parinauds Oculoglandular Syndrome Causes: Tumors such as pineal gland tumors that selectively damage fibers between the pretectal nuclei and the Edinger-Westphal nucleus. Diagnostic considerations: - Fixed dilated pupils that do not respond to light. - Normal near reflex.

- Limited upward gaze (due to damage to the vertical gaze center) and retraction nystagmus. Periodic alternating nystagmus: a jerk nystagmus that undergoes rhythmic changes in amplitude & direction... usually d/t vascular or demyelinating brainstem disease... Photobia: optic atrophy... Pie in the sky: superior quadrantic hemianopia d/t lesion in temporal lobe... Pie on the floor: inferior quadrantic hemianopia d/t lesion in parietal lobe involving only the anterior parietal part of the optic radiation... Plerocephalic papilloedema: non-inflammatory oedema of the optic disc with increased ICP... Positive OKN sign: if the optomotor pathways in the posterior hemispheres are damaged, the optokinetic nystagmus(OKN) response will be diminished when the targets are rotated towards the side of the lesion (away from the hemianopia)...In most cases, the combination of a homonymus hemianopia & OKN asymmetry suggests a parietal lobe lesion, often a neoplasm... Pseudo Foster-Kennedy syndrome: u/l papilloedema a/w increased ICP & a preexisting optic atrophy on the other side... Pseudo-Graefe phenomenon: elevation of the upper eyelid with attempted adduction or depression d/t aberrant regeneration following traumatic or aneurysmal 3rd nerve palsy... Pseudo-isochromatic charts: there are patterns of coloured & grey dots which reveal one pattern to the normal individuals & another to the colour deficients... a quick methois of screening colour blinds from the normals... Pseudopapilloedema: elevation of the disc similar to papilloedema in conditions such as optic disc drusen, hypermetropia, persistent hyaloid tissue... Pseudo tumour cerebri (benign intracranial hypertension): common in young obese women... c/b chronic headache & bilateral papilloedema... Pulfrich's phenomenon: in optic neuritis, depth perception, particularly for the moving object is impaired... Purkinje shift: in dim light (scotopic visiov) all colours are seen as grey... Posner-Schlossman syndrome (glaucomatocyclitic crisis): c/b recurrent attacks, usually unilateral, of secondary open-angle glaucoma with mild anterior uveitis typically affecting young adults, 40% with HLA-Bw54... IOP is elevated severely (40-60 mm Hg) for b/w a few hours to several days..pain is rare... white eye(no congestion)... dilated pupil... Pseudoretinitis pigmentosa: secondary choroidal degeneration following inflammatory lesions of the fundus... c/b scattered area of chorioretinal atrophy & pigment clumping resembling retinitis pigmentosa ophthalmoscopically...

Reiter's syndrome: A triad of urethritis, conjunctivitis & seroegative arthritis, in 20% of the cases there is acute u/l iridocyclitis... Rubeosis iridis: Iris neovascularization common in chronic anterior uveitis, Fuch's uveitis syndrome... Retraction syndrome (special form of abducent nerve palsy): Causes: Retraction syndrome is a congenital unilateral motility disturbance resulting from a lesion to the abducent nerve acquired during pregnancy. Effects: The lateral rectus is no longer supplied by the abducent nerve but by fibers from the oculomotor nerve that belong the medial rectus. This has several consequences. As in abducent nerve palsy, abduction is limited and slight esotropia is usually present. In contrast to abducent nerve palsy, the globe recedes into the orbital cavity when adduction is attempted. This narrowsthe palpebral fissure. This retraction of the globe in attempted adductionresults from the simultaneous outward and inward pull of two antagonists on the globe because they are supplied by the same nerve (oculomotor nerve). Sabin-Feldman dye test: for toxoplasmosis, based on the fact that live organisms exposed to normal serum take up methylene blue, whereas those exposed to serum containing antitoxoplasma antibodies fail to take up the dye... Sattler's layer: layer of medium vessels in the stroma of the choroid... Seafan neovascularization: peripheral neovascularization, a complication of periphlebitis, common in sarcoidosis... Sentinal vessels: dilated episcleral vessels in same quadrant as the ciliary body melanoma... Serpigenous (geographical) choroidopathy: a rare idiopathic recurrent disease of retinal pigment epithelium & choriocapillaries typically affecting bilaterally in patinets b/w 4th & 6th decades... Snowbanking: a grey-white plaque involving the inferior pars plana which can be seen only with I/O... The hallmark of pars planitis... Still's disease: juvenile rheumatoid arthritis with hepatosplenomegaly & other systemic features... String of pearls: Several cotton-ball colonies in candidiasis join together by opalescent strands... See-saw nystagmus of Maddox: c/b one eye rising & intorting & while the other eye falling & extorting... when accompanied by bitemporal hemianopia, it is usually caused by a chiasmal lesion... Stevens-Johnsonsyndrome(erythema multiforme) Chronic Allergic, membranousconjunctivitis with blisteringand increasingsymblepharon; often the skin is alsoinvolved. toxic immunologic disorder,usually generalized as a reaction to medications (generally an antibiotic); lifethreatening treatment: - Bland ointment therapy (such as Bepanthen)

- Rarely cortisone eye ointment - Clean conjunctiva of fibrin daily - Lysis of symblepharon Scotoma: an absolute or relative area of depressed visual funciton surrounded by normal vision... a positive scotoma 'obstructs' a part of the visual field typical of macular lesions... a negative scotoma produces a 'hole' in the visual field typical of optic nerve lesions... Spasmus mutans: c/b asymmetrical pendular fine rapid horizontal (may be vertical or rotatory also) nystagmus, abnormal head position & head nodding... develops b/w 4-12 months of life & clears prior to 3 yrs... The lantern test: the subject has to name the various colours shown to him by a lantern & the judgemant is made by the mistake he makes... Tolosa-Hunt syndrome: acute inflammation of the cavernous sinus or superior orbital fissure which produces a painful ophthalmoplegia... idiopathic granuloma at the apex of the orbit. Twitch sign of Cogan: in myasthenia gravis, on making the patient rapidly redirect his gaze from downward to the primary position when the upper eyelid will be seen to twitch upward & then slowly resettle to its ptotic position... Tersons syndrome (subarachnoid hemorrhage, increase in intraocular pressure, acutely impaired drainage of blood from the eye, dilation and rupture of retinal vessels, retinal and vitreous hemorrhage). Uhthoff's phenomenon: impairment of cision with increased body temperature in optic neuritis... Upbeat nystagmus: the fast phase is upwards... common cause is drug intoxication like phenytoin, also posterior fossa lesions... Vintage: in papilloedema that has been present for several months, the acute haemorrhagic & exudative components resolve & the optic nerve head takes the appearance of a champagne cork...

Vogt-Koyanagi-Harada syndrome: an idiopathic multisystem disorder typically affecing pigmented individuals, esp. HLA-B22, DR4 & Dw15 in Japanese patients... At least 3 of the 4 must be oresent for diagnosis: a. cutaneous signs (alopecia, poliosis, vitiligo) b. neurological signs (neurological irritation, encephalopathy, auditory symptoms, CSF lymphocytosis) c. anterior uveitis(granulomatous) d. posterior uveitis...treatment is topical, periocular & systemic steroids... Weill-Marchesani syndrome: symptoms include short stature and brachydactyly. & lens is abnormally round and often too small; lens is usually eccentric and displaced inferiorly. Widow defect: destruction of RPE in choroidal melanoma gives rise to hyperfluorescence from increased background choroidal fluorescence in fluorescein angiography...

Wood's classification of non-suppurative uveitis: i) non-granulomatous uveitis ii) granulomayous uveitis Weber's syndrome: c/b ipsilateral 3rd nerve palsy & contralateral hemiplegia... Wernicke's hemianopic pupil: in lesion of optic tract, ipsilateral direct & contralateral consensual light reflex is absent when t\light is thrown on the temporal half of the retina of the affected side & nasal half of the opposite side & present with reversal of the sides... Wernicke's reaction: contralateral hemianopic pupillary reaction in lesion of optic tract...

Structures of eye derived from Embryonic layers 1.Surface Ectoderm -crystalline lens. -Epithelium-cornea,conjuntiva,eyelids,lacrimal app -LACRIMAL GLAND. 2.Neural Ectoderm -RETINA n PIGMENT LAYER -Epithelial layers of ciliary body,Iris -SPHINCTER N DILATOR PUPILLAE -OPTIC NERVE -Melanocytes -Secondary Vitreous -Ciliary Zonules 3.Paraxial Mesoderm -Primary vitreous -sclera -ciliary muscles -Sheaths of optic nerve -extraocular muscles -Upper n medial walls of orbit -Connective tissue of orbit n upper eyelid 4.Visceral mesoderm of maxillary process -lower n lateral walls of orbit -Connective tissue of lower eyelid.