B.Sc. Optometrics
Scheme of Examination :
S.No. / Name of the subject / Exam duration / Max. Marks1 YEAR
1. / Language (Including Indian and foreign language) / 3hrs / 100
2. / English / 3hrs / 100
3. / General Anatomy / 3hrs / 100
4 / General Physiology / 3hrs / 100
5 / Optics and Refraction / 3hrs / 100
2 YEAR
6 / Ocular Anatomy / 3hrs / 100
7 / Ocular Physiology / 3hrs / 100
8 / Nutrition / 3hrs / 100
9 / Pharmacology / 3hrs / 100
10 / Pathology & Microbiology / 3hrs / 100
3 YEAR
11 / Common Eye Diseases / 3hrs / 100
12 / Systemic Ophthalmology / 3hrs / 100
13 / Optical instruments in Opthalmology / 3hrs / 100
14 / Contact Lenses / 3hrs / 100
15 / Physical & Geometric Optics / 3hrs / 100
16 / Internship / 50
17 / Internal / 50
Internal Evaluation for Internship (III Year Only):
Seminar Presentation - 2 X 15 = 30
Assignments - 2 X 10 = 20
Total = 50
Marks for Internal Evaluation for theory papers:
Tests (2 out of 3 ) 15x 2 = 30
Assignment 2x10 = 20
Total = 50
Hospital Internship
The internship program will helped to understand the functioning of the patient care areas and the support service departments and various other departments and their function as the candidate will have hands on experience during the course of his/her study.
Question paper pattern
The theory examinations will be for 100 marks with the following components.
Section – A : Objective type of question with no choice
(20 question – 4from each unit) = 20 marks
Section – B : Short answer question of either / or type
( 5 question – 1 from each unit) = 30 marks
Section – C : Essay type question of either / or type
( 5 question – 1 from each unit) = 50 marks
SYLLABUS – III YEAR
PAPER - I
COMMON EYE DISEASES
UNIT I
Conjunctiva
Acute types - ACCO mucopurulent caused by Koch - week’s bacillus common type – pneumococci - C diphtheria - pseudo-membranous conjunctivitis - ophthalmia neonatorum Tric agents - urethritis in males and cervicitis in females - gonococcus - adenovirus and chronic follicular – ACCO-grittiness - congested eye - matting of eye lashes - coloured halos - marginal keratitis - treatment irrigation topical antibiotic and ointment at bed time
Purulent conjunctivitis - cornea ulcerate and complications of perforation-intense xlline
Penicillin drops 10,000/ml 2hrly local atropine - inj CP 10lacs bd/benzathine penicillin Membranous conjunctivitis - cicatrisation - paresis of accommodation - topical CP drops - ointment to prevent symblepharon Pseudomembraneous conjunctivitis
Angular co caused by Morax - Axenfeld bacillus cingestion confined to angles - tetra - -adenovirus 8&19 follicles lower part-SPK - preauricular glands - watery discharge - topical acivir antibiotics and steroids - oral acivir - Phlyctenular Co - Spring catarrh – palpebral - papillary hyper trophy - limbal thickening
Pingicula, pterygium - Dry eye syndrome
UNIT II
Lid , Cornea and sclera
LID-Blepharitis squamous dandruff – madarosis – tylosis - a stye acute gland of zeis - epilation oral local antibiotics - chalzion chronic granuloma meibomain gland - I&C-intra lesional triamnicolone – entrpion – ectropion – ptosis - Bacterial, fungal, viral Hypopion - clinical features management - complication perforation an sequelae Non ulcerative deep keratitisIK-disciform keratitis Deep keratitis - Corneal ulcers - anti viral in viral and antifungal in fungal - Keratomelacia - Lagothhthalmos – tarsorraphy - neuroparalytic keratitis - corneal dystrophies – keratoconus - oedema SCLERA episcleritis – superficial - periodic – slceritis - chronic recalcitrant – gout - rheumatic disorders - TB, collagen diseases topical steroids and oral NSAID/steroid - systemic steroids - scleral staphyloma – cillary - equatorial and posterior stahyloma in high myopia
UNIT III
UVEA AND VITREOUS RETIN Congenital anomalies – hetercromia - persistent papillary membrane – Iridocyclitis -non-granulomatous –a cute - flare++-fine KPs - multiple small synichiae - no definite cause - exacerbations remission - prognosis better – endogenous - septic foci – allergy - Granulomatous iridocyclitis
Chronic insidious - Mutton fat KPs - minimal flare - broad based synichiae - Iris Stromal nodules (Busacca) - prognosis bad-chronic granulomatous diseases -vitreous opacities and yellowish white active raised patches rising the retinal surface Chronic or Acute-on healing give raise chorioretinal scar-white due to sclera seen – Malignant melanoma choriod-tumour detachment-liver metastasis-Vitreous liquefaction and fluidity-posterior vitreous detachment (PVD) Anterior basel detachment and retino dialysis due to contusion of eye-inflammatory cells in uvetis and retinitis-blood in vitreous-fibrous tissue vitreous-congenital persitenthyaloid-asteroid bodies (Ca soaps)-synchsis scintillans (cholesterol crystals) RETINA Rentinal detachment-rhegmatogenous –due to retinal holr-lattice and myopic degeneration and-exudative detachment uveitis-toxaemia of pregnancy-tumour detachment due to malignant melanoma-traction detachment-contraction of fibrous bands vitreous anchored on the retina-Rentinoblastoma malignant-amaurotic cat’s eye-internal squint-secondary glaucoma-proptosis-distant metastasis bones-early enucleating late palliative and chemo theraphy-
CRAO-arterial occlusion sudden loss of vision-cherry red spot macula-atheroma-hypertension arterial-CRVO fundus splashed with haemorrhage-disc oedema-veins dilated-ischemic-non-ischemic-diabetes-glaucoma-hemoglobinopahies-treatment laser coagulation- Diabetic retinopathy Background type-maculopathy-pre –proliferative(PPDR)-intra retinal vascular malformations-soft exudates and superficial Hges-Proliferative type(PDR) neo-vascularisation near the disc and away destructive in nature-vitreous haemorrhage-rubeosis iridis-control of diabetes photo coagulation Hypertensive retinopathy-arteriolar narrowing-soft exudates-flame shaped Hges-papilloedema-exudative detachment Retinopathy of prematurity is due to exposure of premature children to high concentration of oxygen-leading to formation of fibro vascular tissue in the vitreous-prophylaxis-lasers and cryo may
help-Retinitis pigmentosa-night blindness-abiotrophy-hereditary-progressive degeneration pf rods –arteriolar narrowing-waxy pallor of disc –bone corpuscle shaped pigment in equator and periphery-ring scotoma
UNIT IV
LENS AND GLAUCOMA-Cataract-opacity of lens in capsule cortex nucleus-congenital types nuclear-lamellar-coronary-acquired-cortical-nuclear-cupuliform-complicated Radiational=toxic-traumatic-steroids-metabolic diabetes-Congential cataract-needling curette evacuation-lensectomy-phacoemulsification-aphakic lens-contact lens secondary implant-adult type-immature mature-hyper maturemoragagnian-shrunken calcified-
Extraction-ICCE or ECCE-aphakic correction-SICS/phacoemulsification P/C or A/C IOL-suluxation dislocation lens-Glaucoma-Raised IOP-
Congenital-buphthalmos-primary-associated-mesodermal remanats at angle-surgery gonitomy-trabeculectomy-trabeculetomy-Acquired-narrow angle-miotics acute phase tntensive miotic theraphy-preferably-Laser iridomoty-PBI-CSG-raised IOP-field defects-baring of blind spot-Bjerrum’s scotoma-arcuate scotoma etc-medical therapy-miotics-beta blockers-prostaglandin derivatives-chlorine esterase inhibitors-Alpha 2 agonist-surgery ALT-trabeculectomy-NPGS
UNIT V
Lacrimal apparatus Epiphora-lacrimation-dry eyes-Dacryocystitis Cogenital-NLD non-canalisation –sac area massage-antibiotic drops-probing of NLD-Acquired chronic non specific –acute-lacrimal abscess-lacrimal fistula-mucicele-scaring atrophy of sac-specific rhinosporidiosis DCT-DCR-dry eyes-tear substitutes-DCT-punctal acclusion Orbit-Orbital cellulites-exogenous endogenous-cavernous sinus thrombosis-tenonitis antibiotics-Endocrine exophthalmos-tumours of lacrimal gland-optic nerve glioma-meningioma-cogenital oxycephaly
Injuries-Penetrating injury-sympathetic aphthamia-retained IO foreign bodies-Fe-siderosis and alloyed Cu-chalcosis bulbi-Pb Zn local reaction-gold,silver,platinum no reaction-pure Cu,Hg purulent reaction-Concussion/blunt-Black eye-SC hges-abrasion cornea-hyphema-pupillry margin rupture-iridodialysis-concussion cataract-subluxation- dislocation lens-Vitreous hges-Berlin’s oedema-chorioretinal ruptures-avulsion optic nerve
REFERENCES
1-Clinical ophthalmology – Sashikapoor
2-Ophthalmology A.K Khurana
3-Parson’s diseases of the eye – Miller
4-Ophthalmology for under graduates – Aggrawal
5-Clinical methods in ophthalmology - Dutta
6-Text book of retina and vitreous-Peyman
PAPER - II
SYSTEMIC OPHTHALMOLOGY
UNIT I
Nutritional deficiencies
Vitamin-A – Sub acute deficiencies produce night blindness - Xeropthamia Bitots spots - epithelial xerosis - Acute protein malnutrition Kwashiorkor
Produce keratmelacia - Prophylactic vitamin A supplement - infants 100,000 IU -1-6years - 200,000 IU, pregnant and lactating mother 20,000 IU
Therapy of acute deficiency 100000 IU im daily for days and after one month - WHO classification of xerophthlmia
Deficiency of B 1 will produce corneal anaesthesia - dystrophy and RB neuritis
Deficiency of B 2 corneal vascularisation
Deficiency of vitamin C SC haemorrhage, hyphema
Delayed wound healing
Deficiency of vitamin D - zonular cataract - papilloedema lacrimation
Essential amino acids – methionine threonine etc gives rise to corneal vascularisation
UNIT II
Systemic infection –Viral – Measles – ACCO, Koplik’s spots conjuctiva, optic neuritis renitis Mumps Dacryoadenitis – conjunctivitis – uveitis – keratitis - Rubella first semester of pregnancy – microphthalmos - cataract glaucoma chorioretinitis – AIDS - Retinal microvasculopathy - Herpes zoster and simplex infections - CMV and Toxoplasmosis choriorentinitis – endophthalmits - fungalcryptococal infections - Occurrencec of Kaposi’s sarcoma of lids - burkitt’s lymphoma orbit Multiple Cranial nerve palsies
Diphtheria-membraneous co-paresis of accommodation-EOM palsies-Brucellosis iritis , chorioditis, opticneritis-Gonococcus purulent Co-ophthalmia neonatorum-Tuberculosis phlycten-deep keratitis-granulomatous uveitis-scleritis-Syphilis produce-deep keratitis-uveitis acute chronic-ARP-optic atrophy-Leprosy-deep sclero keratitis-uveitis-7th nerve palsy-lagophthlmos-neuroparalytic keratitis-madarosis nodules on lids
Parasitic Toxoplasmic chriorentinitis-cysticercosis-Toxa cara enophthalmitis-Fungal corneal ulcers-candida-aspergillus-Uveitis-endophtahmitis-aspergillus-cryptococcus-histoplasma
UNIT III
Metabolic disorders
Gout scleritis epicleritis-uveitis-Diabetes mellitus- Xanthelasma-recurrent stye-conjunctival telengectasia, rubeosis iridis-diabetic cataract-diabetic retinopathy, lipaemia retinalis, external phthalmoplegia, optic neuritis-refractive changes-hyperglycaemia producing myopia and hypoglycaemia hypermetropia-Galactosaemic cataract
UNIT IV
Skin and mucous membranes
Atopic dermatitis- Conjunctivitis keratoconus and cataract-Rasacea-Blepharitis- conjunctivitis-keratitis and rosacea pannus Dermatitis-herpetiformis recurrent bullae-ulceration and cicatrisation-Epidermolysis bullosa-cicatrising conjunctivitis and keratitis-Pemphigus-vesicles on mucosa and conjuctiva-membranous patches leading to shrinkage of conjuctiva and dry eye Steven-Johnson syndrome—serve form of drug reaction leading to vesiculo bullous eruptions of mucosa of body including conjuctiva-leads to keratits- bullous conjunctivitis leading to severe xerosis ulcer and perforations-very serious condition Usual drugs are sulpha , thioacetozones-
UNIT V
Central nervous system
Usual lesions CNS are infection,aneurysms, tumours and demyelenation disorders
Papilloedema-pleocrocephalic oedema of optic disc-duevto raised ICT- all intracranial tumours other than medulla oblongata-common with mid brain, parieto occipital and cerebellum-anterior fossa tumours late pailloedema-brain abscess-sub arachnoid haemorrhage-usually bilateral- Anterior cranial fossa tumours-frontal lobe and pituitary tumours papilloedema is rare-ipsilateral optic atrophy and contra lateral papilloedema common Foster-Kennedy syndrome-Optic neuritis demylenating diseases like disseminated sclerosis-neuromyelitis optica-3rd ,4th and 6th palsies-6th nerve palsy non-specific-3rd and fourth and 6th nerves are involved in acute and chronic infection of meninges and brain-temporal lobes 3rd and 5th ne-loss of corneal sensitivity-parietal lobe conjugate movements affected-cerebral peduncles 3rd nerve involvement-Upper Pontine lesions 3rd nerve-lower pontine lesion-7th and 6th-cerebello-potine angle tumour-papilloedema 7th nerve-vth nerve-6th nerve –in cerebollar lesion nystagmus –
Abnormal papillary reactions-afferent papillary-ill sustained-Marcus-Gunn in optic
Neuritis-ARP in neurosyphilis-total internal ophthlmoplegia dilated fixed pupil-Hutchinsons pupil in head injury-Field defects –Bitemporal hemianopia in chiasmal syndromes-anterior optic tract homonymous hemianopia with pupil involvement-posterior tract and lateral geniculate bodyonly field defect-temporal lobe superior homonymous quantrantopia and inferior in parietal lobe-occipital lobehomonymous hemianopia or quadrantopia –macular spring
REFERENCE
1-Ophthalmology for undergraduates-Agarwal
2-Parsons diseases of the –Miller
3-Ophthalmology A.K.Khurana
4-Ocular syndrome and systemic diseases – Roy
PAPER - III
OPTICAL INSTRUMENTS IN OPHTHALMOLOGY
UNIT I
Slit lamp-is - illuminating system - observing system (binocular microscope) - a mechanical system - used to examine anterior segment and anterior face of vitreous – gonoscopy - fundoscopy with three mirror lens - +90 lens - Hruby lens - applanation tonometry - contact lens fitting – yag laser cpsulotomy – iridotomy – ALT - other instruments for anterior segment evaluation are – keratometer - corneal topography – pachometry - secular microscopy etc
UNIT II
Ophthalmoscope – direct - indirect binocular - SLO(scanning laser ophthalmoscope analysis of disc in glaucoma, macular diseases – retinal thickness analyzer (RTA) used in diabetic macular, ARMD cystoid macular oedema etc - retinal nerve fibre analyzer - direct ophthalmoscopy easier to practice - higher magnification - direct image - but cannot visualise fundus periphery – illumination less - Indirect ophthalmoscopy difficult to practice - less magnification - good illumination - visualise periphery – vertically inversed and laterally inversed
UNIT III
Optical coherence tomography (OCT) - OCT ophthalmoscopy – OCT - basically Michaelson interferometer - fundus viewing unit - interferometric unit - computer display - control panel - colour ink jet printer - Posterior segment - macular holes, oedema –ARMD – CSR - Disc evaluation in glaucoma and suspects - Anterior segment – imaging pachymetry - IOL and implant imaging
UNIT IV
Operating microscope - observation system - binocular microscope - illumination system - mechanical support system - Lensmeter measure power of spectacle lenses – standard - and automatic varieties
UNIT V
Perimeters – Dynamic - arc perimeters (Lister) - hemispherical perimeters (Goldmann) - Bjerrum’s screen (central fields) Static - Automated perimeters - Humphery and Octopus Ophthalmic Scan - A-scan for IOL power determination – displays - curve spikes for cornea - anterior and posterior surface of lens - retina, sclera Orbiatal fat - B-scan produces 2-D acoustic image eye as dots - useful in evaluating posterior segment in ocular medical opacities
REFERENCES
1-Ultra sound of eye and orbit-Byrne
2-Theory and practice of refraction-A.K.Khurana
PAPER – IV
CONTACT LENSES
UNIT I
Contact lens materials, optics indications and contra indications
Rigid lens materials – PMMA - gas permeable - cellulose acetate butyrate Silicone acrylate – silicone – styrene – fluropolymers - Hydrophilic soft lens materials - hydrogel materials – HEMA - HEMA VP - MMA PVD - Glycidyl methacrylate - Lens cutting - spincasting moulding - contact lens and nutrition of eye - tear film – disturbance - optical indications - therapeutic indications – parameters - overall diameter and optical zone diameter - base curve - peripheral curve - Central and peripheral anterior curves - intermediate anterior curve - blend edge of lens - power of lens - central thickness - tint
UNIT II
Rigid and soft contact lenses
Rigid contact lens - non gas permeable - gas permeable - fitting history general ocular examination – keratometry - trial lens fitting – diameter - base curve – power - evaluation of fitting done by using fluorescein and blue filter of slitlamp - mobility of lens - position of lens – steep - flat curve - ideal fit - insertion and removal of contact lens - Rigid lens problems - blurred vision for near and distance - awareness and irritation - tilting of head - difficulty in removal and insertion - formation of dry spots and corneal oedema - short wearing time
SOFT LENS – fitting - ocular examination – refraction – keratometry - corneal diameter - selection of trial lens – diameter - base curve – power and evaluation - practical approaches - corneal diameter technique - corneal curvature technique - median fit and sagittal depth technique - insertion removal - wearing schedule
UNIT III
Extanded wear and disposable contact lenses
Extended wear lens - Hydrogel soft lens - low water content - medium water content - high water content - fitting technique similar to soft lenses – problems - lens deposits – keratitis - corneal vascularisation
Extended rigid wear lenses – problems - persistent striae-3-9 staining - back surface debris - lens binding, arcuate stain – indentation - micro cysts