Subgroups 3, 4, 5

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

2. General symptoms and clinical features of adenoviral conjunctivitis.

3. Trachoma: etiology, clinical manifestations, complications, treatment tactics, prevention.

4. Features of allergic conjunctivitis and treatment tactics.

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

6. Cardinal symptoms of keratitis, possible complications, consequences.

7. Emergency medical care for patients with keratitis, general principles of treatment.

8. Keratitis caused by the herpes simplex virus: features, clinical manifestations (tree-shaped, disc-shaped, metaherpetic), treatment tactics, prevention.

9. Endogenous keratitis: types, clinical features.

10. Scleritis: etiology, clinical manifestations, treatment tactics

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

12. Anatomical and physiological features of the uveal tract affecting the clinical symptoms of uveitis.

13. Uveitis: classification and etiology.

14. Iridocyclitis: clinical manifestations, complications, emergency care and treatment tactics.

15. Choroiditis: clinical manifestations, possible complications, treatment.

16. Etiology of uveitis; laboratory diagnosis

1) A patient complains of moderate purulent discharge from both eyes, glued eyes in the morning, sand sensations in the eyes. During the examination: there is hyperemia of the palpebral conjunctiva, superficial irritation of the eyeball. The cornea is transparent. When pressing on the lacrimal sac, there is no discharge from the lacrimal puncta. What is the most likely diagnosis? Treatment?

2) A child has hyperemia of the bulbat and palpebral conjunctiva, which arose against the background of nasopharyngitis and an increase in parotid lymph nodes. There are solitary small infiltrates on the cornea. No discharges from the conjunctival sac, except for tears. What is the most likely diagnosis? Treatment?

3) A 40-year-old patient complains of the eyes redness, deterioration of visual acuity, lacrimation. The patuent got sick about 10 days ago. Objectively: there is eyelids edema, mixed irritation of the eyeballs, in the hyperemic conjunctiva of the eyelids and phornicies there are a lot of pink, small surface follicles. In the optical part of the cornea nummular infiltrates are visible. What is the pathology? Treatment?

4) A patient who has just arrived from a tropical country complains of heaviness in the eyes, a foreign body sensation. On examination: the upper eyelids are slightly lowered, infiltrated. There are many large follicles with cloudy contents in the upper conjunctival fornix. What should you suspect first? Tactics?

5) A patient, 40 years old, complains of pain in the right eye, lacrimation, reduced visual acuity and foreign body sensation under the eyelids. Objectively: there is a mixed irritation of the eye, a gray infiltrate in the cornea with blurred borders and a rough surface. Corneal sensitivity is absent. Diagnosis? Treatment tactics?

6) A patient complains of severe pain in the left eye, lacrimation, inability to open the eye. Objectively: blepharospasm, mixed irritation of the eyeball. There is a deep defect on the cornea with a black bubble at the bottom. Diagnosis? Tactics?

7) A 60-year-old patient complains of poor vision in the left eye. Two months ago, he had redness and pain in his eye, but he did not visit a doctor. During examination, visual acuity is 0.2, not corrected. The eye is not irritated. In the cornea, a round opacity of white color, with clear borders, 2 mm in diameter. The surface of the cornea above the opacity is smooth, shiny. Diagnosis? Recommendations?

8) A patient complains of redness of his left eye, sand sensation. A year ago, he was treated in an eye hospital for keratitis of this eye. Objectively: there is superficial irritation of the eye, moderate mucous discharge from the conjunctival sac. In the central part of the cornea, there is a white haze with clear borders. The surface of the cornea above the opacity is smooth. Diagnostics. Treatment?

9) A patient, who was treated for tuberculosis for 6 months, complains of a foreign body sensation in the right eye, lacrimation. Objectively: blepharospasm, mixed irritation of the eyeball. On the cornea, there is a dendritic opacity of gray color. Corneal sensitivity is absent. Diagnosis? Tactics?

10) A patient suffering from chronic dacryocystitis complains of redness and pain in the right eye. Objectively: there is mixed irritation of the eyeball, lacrimation, blepharospasm. In the cornea, there is a yellow infiltrate with a defect in the center: one border of the defect is overhanging, the other is sloping. Hypopyon 2 mm in the anterior chamber. The pupil is 2 mm in diameter, the reaction to light is sluggish. What is the previous diagnosis? General practitioner tactics?

11) A patient complains of pain in the left eye, lacrimation, photophobia. Objectively: there is mixed irritation of the eyeball, precipitates, pain when palpating the eyeball. The pupil is narrow, the reaction to light is sluggish Diagnosis? Tactics?

Example of answer: 

1) Diagnosis: nonspecific bacterial conjunctivitis of both eyes.

Treatment:

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

2) ______________

3) ______________

2) Diagnosis: metaherpetic keratitis of the left eye.

Tactics:

1) instill a 1% solution of atropine sulfate into the eye

2) refer the patient to an ophthalmologist

1. Occlusion of the central retinal artery and its branches: etiology, pathogenesis, clinical manifestations, emergency care

2. Occlusion of the central retinal vein and its branches: risk groups, classification, clinical manifestations, complications, emergency care

3. Ischemic optic neuropathy: classification, clinical manifestations, tactics of a general practitioner

4. Optic neuritis: classification, risk groups. Clinical manifestations of anterior neuritis (papilitis), emergency care

5. Retrobulbar neuritis: features of the course, differential diagnosis, possible causes

6. Penetrating eye injuries: absolute and relative signs, emergency care.

7. Traumatic iridocyclitis: types, clinical manifestations, prognosis.

8. Sympathetic ophthalmia: etiopathogenesis, prevention.

9. Endo- and panophthalmitis: clinical manifestations, treatment tactics, prognosis.

10. General symptoms of blunt trauma of eye.

11. Retinal detachment: classification, risk groups, clinical manifestations, consequences, emergency care

12. Hemophthalmus: causes, clinical manifestations, diagnosis, tactics of a general practitioner

13. Eye burns: classification, clinical manifestations, emergency care.

1) A patient with rheumatic heart disease suddenly became blind in the right eye. Visual acuity is 0 (zero). The eye is not irritated. Optical media are transparent. On the fundus, the optic disk is pale, edematous, in the center of the retina there is widespread milky-white swelling of the retina with a red spot in the center. The retinal arteries are sharply narrowed. Indicate preliminary diagnosis and emergency aid.

2) A patient suffering from arterial hypertension complains of a sudden significant loss of vision. Visual acuity is 0.05, not corrected. The eye is not irritated, the optical media are transparent. On the fundus, the optic disk is hyperemic, edematous, with blurred borders. Retinal veins are dilated, tortuous, arteries are narrow. There are multiple flame-shaped hemorrhages in the center of the fundus. The paired eye is healthy. What is the most likely diagnosis? What are the next tactics of a general practitioner?

3) A hypertensive patient suddenly lost vision in one eye. Visual acuity is 0.04, not corrected. The anterior part of the eye is normal. Optical media are transparent. Optic disk is pale, edematous, with petechial hemorrhages. The retinal arteries are narrowed. Color vision is impaired by the acquired type. Inferior hemianopsia is present in the visual fields. What is your opinion about diagnosis and emergency care?

4) After the flu, the patient's vision in the left eye quickly decreased to 0.02, it is not corrected, the anterior part of the eye, the optical media, the fundus are normal. Peripheral visual fields are normal, but a central absolute scotoma is present. Color vision is impaired by the acquired type. Indicate probable diagnosis and emergency aid.

5) The patient has rapid significant loss of vision up to 0.03, which is not corrected, against the background of meningoencephalitis. The anterior part of the eye, and the optical media are normal. The optic disk is hyperemic, its borders are blurred. The disc is moderately edematous with exudate in the cup area. The visual fields are concentrically narrowed Color vision is impaired according to the acquired type. Indicate probable diagnosis and tactics of a general practitioner.

6) A patient with severe diabetes mellitus suddenly lost vision in her right eye. The eye is not irritated, the lens is transparent, there is no fundus reflex. What is the most likely cause of vision loss? What are the next tactics of a general practitioner?

7) In a patient with high myopia, after significant physical exertion, the vision in the left eye rapidly decreased, which was preceded by the appearance of lightning in front of the eye. On examination, the eye is not irritated. The cornea and lens are transparent. A gray bubble with a shallow wrinkled surface is visible on the fundus, which oscillates when the eye moves. A bright red spot in the form of a horseshoe is visible against the background of the gray bubble. What disease can we be talking about? What is a general practitioner's tactics?

8) A patient who suffered a penetrating injury to the right eye a week ago complains of visual impairment. Objectively: vis OD = light perception with correct light projection; there are corneal sutures; anterior chamber is of average depth, iris is unchanged; pupil is 3 mm in diametr, of white color. The lens is diffusely opaque; fundus reflex is absent. What is preliminary diagnosis? Indicate treatment tactics.

9) A patient who had a penetrating injury of the left eye 3 days ago complains of pain, redness of the eye, photophobia. Objectively: vis OS = 0, there is mixed irritation of the eye, conjunctival chemosis; hypopyon in the anterior chamber, reflex from the fundus is yellowish-green. Ophthalmoscopy is not possible. The position of the eye is correct, the movements are normal. What is the most likely diagnosis and treatment tactics?

10) A 7-year-old boy was burned in both eyes during a firecracker explosion. Objectively: there is bilateral blepharospasm, photophobia. Visual acuity is impossible to be examined. There are numerous foreign bodies, damage to the eyelids skin. The cornea is edematous, but without defects. The anterior chamber is transparent, the pupil is narrow, it's photoreaction is sluggish. Deeper structures of the eyes are not visible because of severe photophobia. The child feels tenderness during ciliary body palpation. Indicate diagnosis and tactics of a general practitioner.

11) A patient has just got an injury to his right eye. Objectively: there is blepharospasm, a corneal-scleral wound about 3 mm in the 10 o'clock meridian. A metal fragment is visible in the wound. Another small fragment is located in the inferior conjunctival fornix. There is blood in the anterior chamber of the eye, other structures of the eye are covered with hyphema. Indicate probable diagnosis and tactics of a general practitioner.

12) The patient complains of pain in the left eye, redness, lacrimation, photophobia. A day ago he was admitted to an ophthalmological hospital with a penetrating injury to this eye. Primary surgical treatment of the injury was done; a metal foreign body was removed from the eye. Objectively today: vis OS = 0.1, not corrected; OS - there is mixed irritation of the eye, subconjunctival hemorrhages in the upper temporal quadrant. On the cornea there is a 4 mm long suture in the 12 o'clock meridian close to the limbus. The cornea is edematous. There is an air bubble in the upper part of the anterior chamber. The iris pattern is smoothed; the pupil photoreaction is sluggish. The pupil is of black color, but the fundus reflex is dim. Indicate probable diagnosis and tactics of a general practitioner.

13) A patient with a blunt trauma of the left eye complains of impaired vision, photopsia, metamorphopsia in this eye. Objectively: vis OS = 0.2, not corrected; there is moderate subconjunctival hemorrhage. Cornea, anterior chamber, iris, pupil, lens are normal. An edematous focus is visible in the central part of the retina. There are no hemorrhages in the retina, the optic disk is normal. The position of the eye is correct. Indicate preliminary diagnosis. Make an examination plan. What is the next treatment tactics?

14) The next day after a penetrating injury to the left eye, the patient complains of pain, redness of this eye. Objectively: vis OS = 0, there is mixed irritation of the eye, conjunctival chemosis; moderate exophthalmos, ophthalmoplegia, hypopyon in the anterior chamber, a yellowish-green reflex from the fundus. Ophthalmoscopy is not possible. What is the most likely diagnosis and tratment tactics? 

15) A patient who suffered a penetrating injury to the right eye 6 months ago complains of pain in the left eye. Objectively: vis OD = 0, the eye is subatrophic, hypotonic. OS - there is pericorneal injection, posterior synechiae, pain upon ciliary body palpation; vitreous opacifications, eye fundus is in haze. What pathology should be suspected first of all? Indicate treatment tactics.

Example of answer: 

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

Treatment:

1) ____________________;

2) ____________________;

3) ___________________

1. Cataracts: definition, classification

2. Senile cataract: etiology, clinical manifestations, complications, modern method of treatment

3. Nuclear cataract: features of clinical manifestations and treatment

4. Aphakia: its signs, modern methods of correction

5. Congenital cataract: types, treatment tactics

6. Complicated cataract

7. Age-related macular dystrophy: causes of development, risk groups, classification

8. Dry form of AMD: clinical course, prevention, treatment.

9. Wet form of AMD: diagnosis, treatment, prognosis, consequences.

1) A 1.5-year-old child has an opacification of the anterior pole of the lens with a diameter of 1 mm in the left eye. Indicate diagnosis and tratment tactics.

2) The parents of a 3-month-old child noticed the white color of his pupils (leukocoria). After pharmacological mydriasis, bilateral opacities of the lens with a diameter of about 4 mm are found, located in its central part. The periphery of the lenses is transparent. What is preliminary diagnosis and tratment tactics?

3) A 70-year-old patient complains of a gradual painless loss of vision in the left eye for 10 years. He has not visited a doctor before. Visual acuity of both eyes is light perception with correct projection. The eye is not irritated. The anterior chamber is deep. There is iris trembling when the eyeball movements. The capsule of the lens is empty, in its lower part the nucleus is visible. Indicate diagnosis and tratment tactics.

4) A 63-year-old patient's vision decreased to 0.04 over several years. The eyes are not irritated. The corneas are transparent. The anterior chambers of the eyes are shallow. Lenses are diffusely opaque, with a pearl tint, there is a crescent shadow from the iris. The fundus reflex is very dim. IOP is 20 mm Hg. Indicate the most probable diagnosis and tratment tactics. What complication should be avoided in this patient and at this stage of the disease?

5) A 60-year-old female complains of loss of objective vision for the past 5 years. The eye is not irritated. The anterior chamber is shallow. The lens is diffusely opaque, with a milky tint. There is no fundus reflex. Make a preliminary diagnosis and determine the tactics of a general practitioner.

6) A patient, age of 70, complains of a gradual painless decrease of vision in the right eye. During examination: the visual acuity of the right eye is 0.6, not corrected, of the left eye is 0.8, not corrected. The eyes are not irritated, there are spoke-shaped opacifications of both lenses, the fundus reflex is pink. Fundus: optic disks are of pale pink colors, borders are net, arteries are narrowed, sclerosed. There is hypopigmentation in the macular area of ​​the right eye, speckling in the left eye. Periphery of the retina is without features. Intraocular pressure is normal. What is the most likely cause of vision loss? Make a diagnosis, determine the tactics of a general practitioner.

7) A 77 years old patient complains of reduced vision in the left eye, the appearance of a "spot" in front of the eye, distortion of objects contours. During examination: the visual acuity of the right eye is 0.4, not corrected, the visual acuity of the left eye is 0.02, not corrected. The eyes are not irritated, the lenses of both eyes are initially opaque. Fundus: optic disk is pale, monotonous, with clear borders. In the macula of the right eye there is a white dystrophic focus, in the macula of the left eye - an area of ​​swelling, the periphery of the retina is without features. Make a preliminary diagnosis. What are the next tactics of the general practitioner? What treatment can be applied in this case?

 Example of answer: 

Diagnosis: senile immature cataract of the left eye.

Tactics:

refer the patient to the ophthalmology department for surgical treatment

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. Blepharitis: etiology, types, clinical manifestations, complications, treatment tactics.

2. Eyelids inflammation: etiology, types, clinical manifestations, possible complications, emergency care, treatment tactics.

3. Ectropion, entropion, ptosis, lagophthalmos: etiology, clinical manifestations, complications, treatment.

4. Eyelid tumors: clinical manifestations, treatment.

5. Neonetatl dacryocystitis: causes, clinical manifestations, tactics of a general practitioner.

6. Acute and chronic dacryocystitis in adults: pathogenesis, clinical manifestations, possible complications, treatment.

7. Orbital cellulitis: etiology, clinical manifestations, possible complications, differential diagnosis, emergency care, treatment, prognosis.

8. Eyeball tumors: classification, clinical manifestations, prognosis.

1) A patient complains of a small infiltrate on the eyelid edge. The eyelid is edematous, hyperemic. At the top of the infiltrate is a purulent point. Indicate dignosis and treatment tactics.

2) A 2-month-old child has constant lacrimation and moderate muco-purulent discharges from the conjunctival cavity of the right eye. Objectively: there is lacrimation, mild hyperemia of the palprbral and bulbar conjunctiva. When pressing on the area of ​​the lacrimal sac, mucous-purulent discharges appear from the lacrimal puncta. The projection of the lacrimal sac is not changed. What disease should you think about? What is a general practitioner tactics?

3) An 80-year-old patient complains of constant lacrimation from the right eye. The tear stream is wide; patency of the lacrimal ducts is normal. When pressing on the lacrimal sac, there is no discharge from the lacrimal puncta. The eye is not irritated. What is the most likely cause of the lacrimation and treatment tactics?

4) A 12-year-old child has hyperemia and thickening of the eyelids edge, a foreign body sensations in the eyes. Whitish scales are visible between the roots of the eyelashes. Indicate diagnosis and treatment tactics.

5) A patient with ethmoiditis noticed the appearance of hyperemia and swelling of the eyelids, exophthalmos, eyeball hyperemia. General condition is of moderate severity. Body temperature is 38.5 C. There is leukocytosis in the blood. There are no neurological symptoms. What complication does it have? What is a general practitioner tactics?

6) A 32-year-old patient complains of hyperemia and swelling of the conjunctiva after he tried to squeeze out a stye. The position of the eye in the orbit is correct. Body temperature is 38 C. Optical structures and fundus are normal. Indicate dignosis and treatment tactics.

7) A patient, age of 60, complains of the upper eyelid edema, protrusion of the right eye, which developed gradually. Objectively: there is protrusion of the right eyeball, its displacement downwards, repositioning is impossible. The visual acuity of the right eye is 0.1, not corrected, the visual acuity of the left eye is 1.0. The left eye is clinically healthy. The right eye is not irritated, on the fundus the optic disc is whitened, its borders are blurred, the vessels are dilated and twisted. What is the most likely diagnosis? What are the tactics of a general practitioner.

8) The patient, age of 55, complains of weight loss, feeling hot, palpitations. Symptoms appeared about six months ago, develop gradually. During the examination, attention is drawn to the protrusion of both eyeballs. The eyes are not irritated, the optical media and fundus are unchanged. Visual acuity 0.8 with glass +1.0 dptr = 1.0. What is the most likely diagnosis? What are the next tactics of a general practitioner?

 Example of answer: 

Diagnosis: preseptal cellulitis of the right eye.

Tactics:

1) emergency aid - _________________________________;

2) urgently refer the patient to an ophthalmology hospital

1. Clinical and pathophysiological mechanisms of pathological changes of the fundus in patients with arterial hypertension and kidney diseases

2. Ocular manifestations of arterial hypertension: hypertensive angio-, retino- and neuroretinopathy

3. Ocular manifestations of kidney diseases

4. Pathogenetic mechanisms of development of diabetic angio- and retinopathy

5. Eye manifestations of diabetes mellitus

6. Diabetic lesions of eyefundus: classification, clinical manifestations, tactics of the general practitioner

7. Endocrine ophthalmopathy: classification, clinical manifestations, prognosis

8. The main symptoms of endocrine ophthalmopathy

9. Endocrine myopathy: risk groups, clinical manifestations

1) The patient, 55 years old, complains of weight loss, feeling hot, palpitations. Symptoms appeared about six months ago, develop gradually. During the examination, attention is drawn to the protrusion of both eyeballs. The eyes are not irritated, the optical media and fundus are unchanged. Visual acuity is 0.8 with glass +1.0 dptr = 1.0. What is the most likely diagnosis? Indicate next tactics of a general practitioner.

2) A 10-year-old child suffering from keratitis has a very pronounced corneal syndrome, severe photophobia, swelling of the soft tissues of the face. Nodules are visible on the cornea. What etiology of keratitis can be suspected? Indicate next tactics of a general practitioner.

3) A patient complains of pain in the left eye, which worsens at night, redness of the eye, decreased vision. Objectively: there is pericorneal irritation, small, dusty precipitates, the pupil is narrow, of irregularly shape as a result of posterior synechiae. The patient also is known to have synovitis and inflammatory pathology of the urinary tract. Make a preliminary diagnosis? What etiology of the disease should be suspected? Indicate a general practitioner tactics,

4) Mother of a 4-year-old girl noticed the whitening of her right eye. Objectively: vis OD = 0.1, not corrected, there are no any symptoms of inflammation. On the cornea within the open eye gap, there is opacity with transparent areas, looks like "Swiss cheese". What pathology should be suspected? What is a general practitioner tactics?

5) A 30-year-old patient, who has been treated by a dentist for a month for stomatitis, erosion of the mucous membranes of the oral cavity, has redness of both eyes, minor mucous discharge from the conjunctival cavity. The patient also is known to have problems with the urinary system, he is being treated by a urologist for urethritis. What disease should be suspected in the patient? What is its etiology? What are the next tactics of a general practitioner?

6) A student, 20 years old, who came from a Middle Eastern country, complaints of painful sensations in the oral cavity. On examination: there are aphthae of yellow-white color with ulceration on the mucous of the lips and oral cavity. During the examination, the doctor paid attention to the redness of the patient's right eye, the presence of a strip of pus in the anterior chamber. To the doctor's question, the patient replied that he was being treated by an ophthalmologist for uveitis of this eye, which had occurred a few days before against the background of general malaise and low-grade fever. What disease should be suspected in the patient? What is its etiology? What else should be asked of the patient? What are the further tactics of the doctor?

7) A patient, 60 years old, discovered a painless swelling near her right ear a few days ago. The patient feels badly, she has a fever (37.2 C). During examination, enlargement of parotid salivary gland is founded. Oncopathology and ear diseases are excluded. Examination reveals bilateral soft, painless swelling of the glands; the skin above them is not changed, the opening of the mouth is free, the mucous membrane is of pale pink color, the mouths of the excretory ducts are not changed, saliva is liquid. Objectively: there are irritation (redness) of the right eyeball, deposit of cellular elements on the corneal endothelium, the pupil is narrow, its photoreaction is sluggish. What is the most likely diagnosis? What can be the cause of the disease? What are the next tactics of a general practitioner?