Subgroups 1, 2

1. Eyelids and conjunctiva: structure, blood supply, innervations, functions.

2. Uveal tract of eye: structure, functions, features of innervations.

3. Retina and optic nerve: physiological properties, blood supply, functions. Anatomy of nerve pathways (optic chiasm, visual tracts).

4. Lens, vitreous body, chambers of eye: structure, functions, normal properties.

5. Blood supply and innervations of eye. Vascular links with cranial cavity.

6. Clinical anatomy of orbit; links with nasal sinuses and cranial cavity.

7. Anatomy of lachrymal organs.

8. External ocular muscles, their functions and innervations.

9. Visual acuity, normal data, age development, way of examination.

10. Visual fields: definition and methods of examination. Possible disorders, their role in diagnosis of local and general pathology. Types of scotoma.

11.  Ophthalmoscopy: goal, techniques, normal properties of eye fundus structures.

1) At perimetry the patient was found to have a bitemporal hemianopia. Determine the level of damage. Tactics?

2) A patient 20 years of age having suffered for peptic ulcer for long period of time, has noticed worsening of twilight vision. His visual acuity is 1.0 in both eyes; optical medias are transparent, visual fields and eye fundus are normal. What is the most probably reason of the phenomenon? Tactics?

3) A patient 30 years old has absolute negative scotoma in lateral part of visual field in 12-15 degrees from the point of fixation. The scotoma’s vertical size is about 15 degrees and horizontal is 10 degrees Evaluate the result. Yours tactics?

4) Patient’s visual acuity is zero but pupil reaction to light is present. What is the level of lesion? Tactics?

5) A patient demonstrates ptosis, exophthalmos, mydriasis, eyeball immobility, sensitivity disorder in innervations region of the 1st branch of trigeminal nerve. What is preliminary diagnosis? Tactics?

6) At examination in transmitted light there is an opacity moving in the same direction with the eye movement. Where is it possible localization? What more methods of examination does the patient need?

7) At examination in transmitted light an opacity is revealed that moves in direction opposite to the eye movement, and stops together with the eye movement. Where is it possible localization? What more methods of examination does the patient need?

8) At examination in transmitted light opacity was revealed that moves in direction opposite to the eye movement, and continue  its movement even after the eye had stopped. Determine localization of the opacity. What more methods of examination does the patient need?

9) Examination of the right eye has revealed next: direct reaction of pupil to light is absent; consensual reflex from the right eye to the left eye is present but consensual reflex from the left eye to the right one is absent. Evaluate this phenomenon. Tactics?

10) At the right eye examination next situation is revealed: the pupil is wide, direct reflex to light is absent. Consensual reflex from the right eye to the left one is absent but is present from the left eye to the right one. Evaluate this phenomenon. Tactics?

Example of answer:

Diagnosis: homonyme hemianopsie. Intracranial process is probable

Tactics: refer the patient to neurologist.

1.  Physical and clinical refraction of eye.

2. Types of   clinical refraction of eye, their clinics, possible complications, development with age.

3. Anisometropia: definition, complications, features of optic correction

4. Hypermetropia: clinics, possible complications, and their prevention

5. Myopia: theories of occurrence, clinics, differential diagnosis, prevention

6. Progressive myopia: pathogenesis, clinics, possible complications and their prevention

7. Accommodation: definition, mechanism, role at different types of eye refraction.

8. Subjective examination of clinical refraction.

9. Asthenopia: types, clinics, treatment.

10.  Accommodative spasm: etiology, clinics, differential diagnosis, treatment tactics.

11. Presbyopia: etiology, clinics, correction. 

12. Extraocular muscles: biomechanics, innervations

13. Relationships of accommodation, convergence, and the pupil diameter. Their reasons, value in clinical practice

14. Binocular vision: definition, conditions for it occurrence, age development.

15. Strabismus (cross-eye): classification.

16. Differential diagnosis of concomitant and paralytic strabismus.

17. Concomitant strabismus: etiology, types, clinics, treatment tactics.

18. Amblyopia: definition, types, classifications, treatment

19. Abnormal retinal correspondence: conditions of its occurrence, clinics, treatment features

20. Paralytic strabismus: etiology, clinics, treatment tactics. 

21. False strabismus.

22. Latent strabismus: definition; diagnosis, prognosis.

1)    A patient, 30 years of age, has vis OD 0.3, vis OS 0.3. With spherical lenses minus1.0 D, -1.5 D, -2.0 D vis = 1.0. After mydriasis vis is the same. What is the diagnosis? Prescribe eyeglasses for the patient.

2)    A child 10 years of age demonstrates vis 0,1 in both eyes. With spherical lenses minus1.0 D, -1.5 D, -2.0 D vis = 1.0. After mydriasis vis is 1,0, refraction is emmetropic. What is the diagnosis? Yours recommendations?

3)    A patient, 55 years of age, complains of blurred vision at close distance. Vis for far distance is 1,0 for both eyes. Diagnosis? Recommendations?

4)    A patient, 55 years old, complains blurred vision at close distance. Vis in both eyes is 0.4 with spherical lens plus 1.5 D = 1.0. Diagnosis? Prescribe eyeglasses for close-distance work the patient.

5)    A patient, 25 years old, suffering from high myopia, complains of flashes of light in front of his right eye. What complication must you think about? What is tactics of GP?

6)    A patient, 15 years of age, complains of redness of her eyes, sand sensation in the evenings. Objectively: there is mild redness of both eyes, discharges are absent, vis = 0,7 with spherical lens +3.0 D = 1,0. Diagnosis? Yours recommendations?

7)    A patient, 35 years of age, complains of redness of her eyes, sand sensation in the evenings. Objectively: there is mild redness of both eyes, discharges are absent, vis = 0,6 with spherical lens +3.5 D = 1,0. Diagnosis? Yours recommendations?

8)    A patient, 40 years old, has vis in both eyes 0.8. With spherical lenses +1.0 D, +1.5 D and +2,0 D vis = 1.0. What is the diagnosis? Prescribe eyeglasses for the patient.

9)    A patient, 20 years of age, has vis in both eyes 1.0. The same vision he has with spherical lenses +0.5 D, +1.0 D, +1.5 D and +2,0 D. What type of refraction and its level (in dyopters) does he have?

10)   A patient, 20 years old, suffers from high myopia. Objectively: vis in both eyes is 0.02, with lens -10.0 D = 0.6. There is focus of hyperpigmentation in central part of retina. What are yours recommendations?

 11) A child, 3 years of age, has alternate deviation of both eyes toward the nose. Eyes movements are normal. After ametropia correction the deviation disappears. Visual acuity is 0.8, with spherical lens +2.5 D = 1.0 in both eyes. Refraction - hypermetropia 3.5 D. Diagnosis? Treatment plan?

12)    A child, 4 years old, demonstrates constant deviation of his right eye inward. Primary and secondary angle of deviation is 20 degrees, the eyeball movements are normal. In eyeglasses angle of deviation gets 10 degrees. Visual acuity of the right eye is 0,4; of the left eye is 1.0. Refraction is hypermetropia 5.0 D in the right eye, and hypermetropia 2.0 D in the left eye. Diagnosis? Treatment?

13)    A child, 5 years old, having been treated regularly in ophthalmologic department for 2 years, demonstrates constant deviation of his left eye inward. Primary and secondary angle of deviation is 15 degrees, the eyeball movements are normal. In eyeglasses the angle of deviation is the same. Visual acuity of both eyes is 1.0; refraction is hypermetropia 1.0 D. Diagnosis? Treatment?

14)    A child, 4 years old, demonstrates periodical deviation of his right eye inward for 2 weeks, having occurred at the background of high body temperature. Primary and secondary angle of deviation is 15 degrees, the eyeball movements are normal. In eyeglasses the angle of deviation is the same. Visual acuity of both eyes is 0.6; refraction is hypermetropia 5.0 D. Eye fundus and optical medias are normal. Preliminary diagnosis? Tactics?

15)    A child, 2.5 years old, has constant deviation of his left eye outward. Primary and secondary angle of deviation is 15 degrees, eyeball movements are normal. In eyeglasses angle of deviation is the same. Visual acuity of the left eye is 0,4, of the right eye is 1.0. Refraction is hypermetropia 2.0 D in the right eye, and hypermetropia 4.0 D in the left eye. Diagnosis? Treatment?

16)    A child, 5 years of age, who had cranial trauma 2 years ago, demonstrates constant deviation of his right eye outwards. Primary angle of deviation is 15 degrees, secondary one is 30 degrees. There is limitation of the right eye movements to nose. Visual acuity is 0.4 in his right eye and 1.0 in the left eye. Refraction is emmetropic in both eyes. Diagnosis? Treatment tactics?

17)    Parents of a 5-year old child have noticed simultaneous deviation of both his eyes to nose. At examination reflexes are localized in both eyes symmetrically but displaced inwards a bit. Visual acuity is 1.0 in both eyes, refraction is emmetropia. Eyeballs movements are not limited; the child has binocular vision. Diagnosis? Treatment plan?

18)    A patient, 70 years of age, has been treated for stroke in neurology department for 3 weeks. The day before he was discharged from the department. The patient complains of diplopia and deviation of his left eye to nose. Objectively: angle of deviation of the sick eye is 10 degrees, secondary angle is twice larger; there is limitation of the left eye movement outwards. Visual acuity is 1.0 in both eyes. Diagnosis? Treatment tactics?

19)  A patient, 75 years old, having had cataract of his right eye for 5 years, has noticed deviation of the eye outward. Objectively: angle of deviation is up to 15 degrees, primary and secondary angles are equal, the eyeball movements are normal. Visual acuity - light perception with correct projection in his right eye and 1.0 in his left eye. Diagnosis? Treatment tactics?

20)  A patient, 40 years of age, had cranial trauma 7 monthes ago. Was treated in neurology department. The patient complains of diplopia and deviation of his right eye outward. Objectively: angle of deviation of the sick eye is 15 degrees, secondary angle is 25 degrees; there is limitation of the right eye movements inwards. Visual acuity is 1.0 in both eyes. Diagnosis? Treatment tactics?

Examples of answers: 

1) Diagnosis: mild myopia of both eyes (-1.0 D). 

Treatment: eyeglasses for far distance OD sph -1.0 D, OS sph -1.0 D.

2) Diagnosis: concomitant non-accommodative esotropia OS, moderate disbinocular amblyopia OS; anisometropia: mild hypermetopia OD, high hypermetopia OS.

Treatment: 

1) eyeglasses for constant wearing OD sph +1.0 D, OS sph +5.0 D

2) occlusion of the right eye

3) pleoptic therapy for the left eye

1.     Blepharitis: etiology, types, clinics, complications, treatment tactics.

2.     Eyelid inflammations: etiology, types, clinics, possible complications, emergency help, treatment tactics.

3.     Ectropion, entropion, ptosis, lagophthalmos (hare’s eye): etiology, clinics, complications, treatment.

4.     Eyelid tumors: clinics, treatment.

5.     Bacterial conjunctivitis: etiology, types, symptoms, possible complications, treatment tactics, prevention.

6.     Membranous conjunctivitis: types, clinical features, complications, and treatment tactics.

7.     General symptoms and clinical features of adenovirus conjunctivitis.

8.     Trachoma: etiology, clinics, complications, treatment tactics, prevention.

9.     Allergic conjunctivitis features and treatment tactics.

10.           Acute and chronic dacryocystitis in children and adults: pathogenesis, clinics, possible complications, treatment.

11.           Orbital cellulites: etiology, clinics, possible complications, differential diagnosis, emergency help, treatment, prognosis.

1)    A patient complains of moderate purulent discharges from both eyes, "glued eyes" in the morning, sand sensation in eyes. At examination: hyperemia of tarsal conjunctiva, superficial injection of eyeball. Cornea is clear. While pressing the lachrymal sac discharges from lachrymal puncta are absent. What diagnosis is the most probable? Treatment?

2)    A patient complains of infiltrate at eyelid edge that is of a pea sized. The eyelid is edematous, hyperemic. There is purulent dot in the center of the infiltrate. Diagnosis? Treatment?

3)    A child has tarsal and bulbar conjunctiva hyperemia had occurred on the background of nasopharyngitis and parotid lymph nodes enlargement. There are single small infiltrates on the cornea. Any discharges from conjunctival sac are absent except of tears. What diagnosis is the most probable? Treatment?

4)    A 2-months-old child has constant watering and moderate mucous-purulent discharges from conjunctival cavity of his right eye. Objectively: there is epiphora, mild hyperemia of tarsal and bulbar conjunctiva. While pressing the lachrymal sac region there are mucous-purulent discharges from lachrymal puncta. Projection of lachrymal sac is not changed. What disease should be thought about? Tactics of GP?

5)    A 80-years-old patient complains of constant watering of his right eye. A lachrymal stream is wide; tears are accumulating in the eye. Passability of lachrymal pathways is normal. When lachrymal sac pressing any discharges from lachrymal puncta are absent. The eye is not irritated. What is the most likely cause of the lachrymation? Tactics?

6)    A 40-years-old patient complains of his eyes redness, blurred visual acuity, watering. He got sick about 10 days ago. Objectively: there is eyelids edema, mixed injection of eyeballs, a lot of pink, small superficial follicles in hyperemic conjunctiva of eyelids and fornicis. In the optical part of the cornea  there are nummular infiltrates. What pathology does he have? Treatment?

7)    A child 12 years of age has hyperemia and thickening of eyelids edge, sensation of “foreign body” in his eyes. There are whitish scales between the eyelashes roots. Diagnosis? Treatment tactics?

8)    A patient with etmoiditis has noticed onset of eyelids hyperemia and edema, exophthalmos, eyeball hyperemia. General condition is of moderate severity. Body temperature is 38.5 C. There is leukocytosis in blood. Neurological symptoms are absent. What complication does he have? Tactics of GP?

9)    A patient, 32 years of age, complains of hyperemia and edema of both tarsal and bulbar conjunctiva had occurred after he tried to squeeze out hordeolum. The eye position in the orbit is correct. Body temperature is 38 C. Optic structures and the eye fundus are normal. Diagnosis? Tactics?

10)           A patient having just come from a tropic country complains of heaviness in his eyes, sensation of foreign body. At examination: the upper eyelids are some lowered, infiltrated. In the upper conjunctival fornix there are a lot of large follicles with muddy content. What you can suspect first of all? Tactics?

Example of answer: 

Diagnosis: nonspecific bacterial conjunctivitis of both eyes.

Treatment: 

1) ciprofloxacin solution 0.3% - eye drops 8 times a day

2) ______________

3) ______________

1.     General symptoms of corneal pathology (types of eye injection and corneal vascularization, types of new and old corneal opacities and their differential diagnosis)

2.     Cardinal symptoms of keratitis, possible complications, outcomes.

3.     Emergency medical help in patients with keratitis, general principles of treatment.

4.     Herpes simplex keratitis: features, clinics (dendritic, discoid, metaherpetic), treatment tactics, prevention.

5.     Phlyctenular keratitis: clinical features.

6.     Deep tuberculous keratitis: clinical features.

7.     Syphilitic keratitis: clinical features.

8.     Acanthamoeba keratitis: groups of risk, clinical features

9.     Fungal keratitis: the course and therapy features

10.           Scleritis: etiology, clinics, treatment tactics

11.           Keratoconus: etiology, clinical manifestations, consequences, approaches to treatment

1)    A patient, 40 years of age, complains of pain in his right eye, watering, blurred visual acuity, and foreign body sensation under the eyelids. Objectively: mixed injection of eye, in the cornea there is discoid infiltrate of grey color with blurred borders and rough surface. Corneal sensitivity is absent. Diagnosis? Treatment tactics?

2)    A patient complains of severe pain of his left eye, watering, impossibility to open the eye. Objectively: blepharospasm, mixed injection of eyeball. On the cornea there is deep defect with black bubble at its bottom. Diagnosis? Tactics?

3)    A 60-years-old patient complains of bad vision of his left eye. Two months ago he had redness and pain in the eye but did not visit a doctor. At examination visual acuity is 0.2, correction does not improve it. The eye is not irritated. There is round opacity of white color 2 mm of diameter in the cornea. Cornea surface above the opacity is smooth. Diagnosis? Recommendations?

4)    A patient complains of redness of his left eye, sand sensation. A year ago was treated in eye hospital because of keratitis of the eye. Objectively: superficial injection of the eye, moderate mucous discharges from conjunctival sac. There is white opacity in the central part of the cornea. Corneal surface above the opasity is smooth. Diagnosis. Treatment?

5)    A child 10 years of age being suffered from keratitis has pronounced corneal syndrome, very severe photophobia, edema of face soft tissues. On the cornea there are nodules. What etiology of keratitis can be suspected? Tactics of GP?

6)    A patient, had been treated for tuberculosis for 6 months, complains of foreign body sensation in his right eye, watering eye. Objectively: blepharospasm, mixed injection of eyeball. There is tree-like opacity on the cornea. Corneal sensitivity is absent. Diagnosis? Tactics?

7)    A patient, suffering from of chronic dacryocystitis, complains of redness and pain of his right eye. Objectively: mixed injection of eyeball, watering, blepharospasm. An infiltrate of yellow color with defect in the center is seen in the cornea: one border of the defect is undermined, the other is sloping. There is hypopyon 2 mm of height in the anterior chamber. Pupil is 2 mm of diameter, its response to light is slow. What is preliminary diagnosis? Tactics of GP?

8)    A patient complains of redness of his both eyes, sensation of "sand" for 3 days after general viral infection. Worsening of the left eye condition was noticed yesterday: blurred vision, watering, blepharospasm have occurred. Objectively: bilateral conjunctival injection, petechial hemorrhages in the conjunctiva. Any discharges from conjunctival sac are absent. Right eye: vis = 1.0, cornea is clear. Left eye: vis is 0.7, there are small subepithelial infiltrates in the cornea. Other structures of eye are normal. Diagnosis? Tactics?

9)    A patient, 22 years old, contact lenses user, complains of pain, watering, photophobia, blurred vision in both her eyes. The symptoms occurred after she has washed her face with tap water. Objectively: pericorneal injection, blepharospasm. In the cornea there is ring infiltrate of grey color with blurred borders. Cornea is edematous. What is the preliminary diagnosis? Diagnostic and treatment tactics?

10)           Patient, 14 years of age, has myopic astigmatism that increases in power for the last year. What pathology must be suspected? Diagnostic and treatment tactics?

Example of answer: 

Diagnosis: metha-herpetic keratitis of the left eye.

Tactics: 

1) single instillation of Atropine eye drops 1.0% into the eye

2) refer the patient to ophthalmologist

1.     Anatomic and physiologic features of uveal tract that affect clinical symptoms of uveitis.

2.     Uveitis: classification and etiology.

3.     Iridocyclitis: clinics, complications, emergency help, and treatment tactics.

4.     Differential  diagnosis  of  iridocyclitis,  acute  conjunctivitis  and  acute  attack of  angle-closure glaucoma.

5.     Choroiditis: clinics, possible complications, treatment.

6.     Features of uveitis in children.

7.     Uveitis etiology; laboratory diagnostics

8.     Cataracts: definition, classification.

9.     Senile cataract: etiology, clinics, complications, modern way of treatment.

10.           Congenital cataract: types, treatment tactics.

11.           Complicated cataracts

1)    A patient, 20 years of age, complains of rapid and significant loss of vision in his right eye after the influenza. The eye is not injected. Optical structures are transparent. On the eye fundus a yellow focus with fuzzy borders, surrounded by retinal edema is seen. Diagnosis? Tactics of GP?

2)    A patient, 63 years of age, notices worsening of visual acuity in both eyes for some last years. Objectively: vis OD = 0.04, vis OS = 0.3, eyeglasses don't improve vision. Both eyes are not inflamed, cornea is transparent, anterior chamber is of average depth. The right eye: lens is diffusely opaque, semilunar shadow from iris and reflex from eye fundus is absent. The left eye: lens is unevenly opaque, at examination in focal light semilunar shadow from iris is seen on the anterior lens surface; reflex from eye fundus is very dim. Intraocular pressure is normal in both eyes. Complete diagnosis? Tactics?

3)    A patient complains of pain in his left eye, watering, photophobia. Objectively: mixed injection of the eyeball, keratic precipitates, tenderness at the eyeball palpation. The pupil is small with sluggish reaction to light. Diagnosis? Tactics?

4)    A patient complains of pain in his left eye increasing at night, redness of the eye, blurred vision. Objectively: pericorneal injection, dust-like keratic precipitates, pupil is narrow, misshaped because of posterior synechiae. From anamnesis the petient is known to have synovitis also and inflammatory pathology of urogenital tract. Diagnosis? What etiology of the disease should you suspect? Tactics of GP?

5)    A patient 60 years of age complains of vision loss during the last 5 years. The eye is not inflamed. Anterior chamber is shallow. Lens is diffusely opaque with milk hue. Reflex from eye fundus is absent. Diagnosis? Tactics?

6)    A patient complains of sensdtion of fullness in his right eye, periodical blurring of vision. A month ago he had iridocyclitis. Treatment and observation were irregularly. Results of examination: now the eye is not inflamed. There are shallow anterior chamber, pupil of irregular shape, adhesions between the pupil edge and anterior surface of lens, protrusion of the iris root. Lens and vitreous are transparent, eye fundus is normal. What is the most likely cause of the patient's complaints? Formulate a complete diagnosis. Treatment tactics?

7)    A child 1.5 years old has lens opacity in his left eye. The opacity is localized on the anterior pole of the lens, its diameter is 1 mm.  Diagnosis? Tactics?

8)    Parents of 3-months child noticed white color of his pupils (leukocoria). After pharmacological mydriasis bilateral opacities of lens are revealed. The opacity is about 4 mm in diameter and localized in central part of lens, peripheral part of lens is transparent. Preliminary diagnosis? Tactics?

9)    A patient 70 years old complains of gradual painless loss of vision in his left eye for 10 years. The patient had not visited a doctor before. Visual acuity of the eye - light perception with correct projection of light. The eye is not inflamed. Anterior chamber is deep. At the eyeball movement trembling of iris is seen. The capsule of lens is empty, in its lower part there is brown nucleus. Diagnosis? Tactics?

10)           Mother of 4-years-old girl noticed white color of her right eye. Objectively: vis OD = 0.1, symptoms of inflammation are absent. On the cornea there is opacity within borders of open eye slit, with transparent sites, looking like "Swiss cheese". What pathology must be suspected? Tactics of GP?

Example of answer: 

Diagnosis: iridocyclitis of left eye, secondary glaucoma.

Tactics: 

1) single instillation of Atropine eye drops 1.0% into the eye

2) refer the patient to ophthalmologist

1.     Production and outflow of intraocular fluid.

2.     Glaucoma: definition, classification.

3.     Primary open-angle glaucoma: etiopathogenesis and clinical features.

4.     Angle-closure glaucoma: etiopathogenesis, clinics. Acute attack of angle-closure glaucoma, emergency care, and treatment tactics.

5.     Glaucoma diagnosis. Tactics of general practitioner.

6.     Modern ways of treatment for primary glaucoma

7.     Differential diagnosis of cataracts and primary open-angle glaucoma.

8.     Differential diagnosis of acute angle-closure glaucoma and acute iridocyclitis.

9.     Secondary glaucoma: reasons, treatment tactics.

10.           Congenital glaucoma: etiology, clinics, treatment tactics

11.           Supervision of glaucoma patients

1)    A patient, 80 years of age, has gradually lost vision in both his eyes. The patient did not have any eye inflammation or pain. At examination: vis OD = 0, pupil is wide, without reaction to light; vis OS = 0.2. In both eyes cornea is transparent, anterior chamber is of average depth. There are spoke-shaped opacities in lenses. Optic discs are gray, with large cups. IOP is 35 mm.Hg. Diagnosis? Tactics?

2)    A 60-years-old patient complains of severe pain in his left eye with irradiation to the left half of head, redness of eye, and significant loss of vision. Onset of the disease was sudden and started after a physical work. Objectively: visual acuity is 0,02; mixed injection of the eyeball; cornea is edematous, rough. Anterior chamber is shallow; pupil is wide with absence of reaction to light. Reflex from eye fundus is very dim. At palpation the eye is tight like a stone. Diagnosis? Tactics?

3)    A patient, 45 years of age, complains of heaviness feeling in his right eye. Objectively: OD - anterior chamber is shallow, there is bombage of iris, circular posterior synechiae. IOP 32 mm.Hg. The patient is known to have  redness and pain in the eye in anamnesis. Diagnosis? Tactics? Ways of the pathology prevention?

4)    A 6-months-old child has mild irritation of his left eye, corneal edema; diameter of the cornea is increased to 11 mm. What pathology must be suspected firstly? Tactics of GP?

5)    A patient, 62 years of age, complains of blurred vision of his right eye. Objectively: vis OD = 0.3, vis OS = 0,8. There is concentrical narrowing of visual fields in right eye. In the left eye temporal meridians are normal, but in nasal meridian visual field is 40 degrees. Anterior segments of both eyes are normal. Eye fundus reflex is red. Optic discs are cupped (the cupping is more prominent in the right eye), of gray color, and with normal borders. Retina and retinal vessels are normal. Diagnosis? GP tactics?

6)    When ophthalmic examination of a patient, having suffered for diabetes mellitus during 15 years, IOP of right eye was revealed to be 33 mm.Hg. Objectively: OS - cornea is transparent, there is neovascularization of the iris, lens is partially opaque, neovascularization in the retina and at optic disc. Diagnosis? Tactics?

7)    A patient, 65 years old, complains of dark spot on his right iris, that she has noticed two weeks ago. Objectively: OD - mild conjunctival hyperemia, cornea is clear, anterior chamber of the eye is of uneven depth. In the upper-outer quadrant of right iris there is black spot with a bit blurred borders. Lens is opaque in the same quadrant. IOP 35 mm.Hg. Diagnosis? Tactics of GP?

8)    A patient, 70 years of age, complains of redness of her left eye, and pain with irradiation into the half of head. The eye is known to have low vision for two years because of lens opacity. The patient was recommended to operate her cataracta but she refused. Objectively: OS - mixed, congestive injection of eye, cornea is edematous, anterior chamber is shallow, pupil is of white color. Lens is totally opaque, with calcifications of the anterior capsule. IOP 35 mm.Hg. Preliminary diagnosis? Tactics?

9)    Ophthalmologic inspection of a 42-years-old patient revealed IOP 28 mm.Hg in both eyes. Visual acuity, visual fields and optic discs are normal. Possible variants of the diagnosis? Tactics of GP?

10)           A 54-years-old patient, suffering for primary open-angle glaucoma, was discharged from the eye hospital with recommendations of hypotensive therapy. In 6 months, during a routine inspection, doctor reveled narrowing of visual fields in superior-nasal meridian to 20 degrees, enlargement of optic disc cup, however IOP is normal. Diagnosis? Tactics of GP?   

Example of answer: 

Diagnosis: primary open-angle advanced glaucoma of the right eye.

Tactics: 

1) supervision of general practitioner every 3 month;

2) in case of the process decompensation refer the patient to ophthalmological hospital

1.     Classification of ocular trauma.

2.     Absolute and relative signs of penetrating injury of eye.

3.     Penetrating injury of eye: emergency care.

4.     Traumatic iridocyclitis: types, clinics, prognosis.

5.     Sympathetic ophthalmia: etiopathogenesis, prevention.

6.     Endo- and panophthalmitis: clinics, treatment tactics, prognosis.

7.     Methods of localization of intraocular foreign body.

8.     Metallosis: types, clinics, treatment tactics.

9.     General symptoms of blunt eye trauma.

10.           Eye burns: classification, clinics, emergency care.

11.           Electroophthalmia: reasons, clinics, emergency care.

1)    A patient, having had penetrating injury of his right eye a week ago, complains of vision worsening. Objectively: vis OD = light perception with correct projection of light, corneal sutures; anterior chamber is of average depth, iris is not changed; pupil is 3 mm, of white color. Lens is diffusly opaque; fundus reflex is absent. Preliminary diagnosis? Treatment?

2)    A patient with 3-days penetrating injury of his left eye complains of pain, redness of the eye, photophobia. Objectively: vis OS = 0, mixed injection of the eye, conjunctival chemosis; there is hypopion in the anterior chamber, fundus reflex is yellowish-green. Ophthalmoscopy is impossible. Position of the eye is correct, movements are normal. Probable diagnosis? Tactics?

3)    A 7-years boy has got the burn of his both eyes with petard explosion. Objectively: both eyes – blepharospasm, photophobia. Visual acuity is impossible to be examined. There are multiple foreign bodies of eyelids, skin damage. Cornea is edematous, but without defects. Fluid of anterior chamber is clear, pupil is narrow, its reaction to light is sluggish. Deeper structures of eyes are impossible to see because of severe photophobia. The child feels pain during ciliary body palpation. Diagnosis? Tactics of GP?

4)    A patient just has got trauma of his right eye. Objectively: blepharospasm, at meridian 10 hours o'clock there is corneo-scleral wound of about 3 mm. Piece of metal is seen in the wound. Another small piece is in the inferior conjunctival fornix. Anterior chamber of eye is full of blood, other structures of eye are closed with hyphema. Diagnosis? Tactics?

5)    A patient complains of pain in his left eye, redness, watering, photophobia. A day before he admitted to the eye hospital with penetrating eye injury. The wound was stitched; metallic foreign body was removed from the eye. Today objectively: vis OS = 0.1, OS - mixed injection of eye, in the temporal-superior quadrant there is subconjunctival hemorrhage. On meridian 12 o'clock close to the limb there is 4-mm corneal suture. Cornea is edematous. In the upper half of anterior chamber air bubble is seen. Iris pattern is smooth; pupil reaction to light is sluggish. Pupil is of black color, fundus reflex is dim. Diagnosis? Treatment?

6)    A medical nurse complains of foreign body sensation, watering, photophobia in both eyes. The symptoms occurred after her having looked at quartz lamp. Objectively: prominent blepharospasm, photophobia; mild hyperemia of bulbar conjunctiva; light corneal edema in both eyes. Other structures of eye are normal. Diagnosis? Treatment?

7)    A patient with blunt trauma of his left eye complains of blurred vision, photopsias, metamorphopsias in the eye. Objectively: vis OS = 0.2, moderate subconjunctival hemorrhage. Cornea, anterior chamber, iris, pupil, lens are normal. In the central area of the retina edematous focus is seen. Retinal hemorrhages are absent, optic disc is normal. The eye position is correct. Preliminary diagnosis? Plan of examination? Treatment tactics?

8)    A patient on the 2nd day after penetrating injury of eye complains of pain, redness of the eye. Objectively: vis OS = 0, mixed injection of the eye, conjunctival chemosis; hypopyon in the anterior chamber, fundus reflex is yellowish-green. Ophthalmoscopy is impossible. There is moderate exophthalmos, ophthalmoplegia. Probable diagnosis? Tactics?

9)    A patient, having had penetrating injury of his right eye 6 months ago, complains of pain in the left eye. Objectively: vis OD = 0, the eye is sub atrophic, hypotonic, without symptoms of inflammation. OS - pericorneal injection, posterior synechiae, tenderness during palpation; vitreal opacification, eye fundus is blurred. What pathology must be suspected first of all? Treatment tactics?

10)           A patient noticed change of iris color in his right eye. Two months ago he had penetrating injury of the same eye. The eye was stitched, no foreign bodies were found. Objectively: OD - mild injection of the eye, iris is of rust color, lens is opaque, vitreal corpus opacifications, eye fundus is bad visible. Preliminary diagnosis? Tactics?

Example of answer: 

Diagnosis: penetrating corneal injury of the right eye, complications: _______.

Treatment: 

1) ____________________;

2) ____________________;

3) ____________________