Syllabus - עיניים - שנה ה' (96809)

רשימת נושאים / תכנית הלימודים בקורס:
1. Anatomy

Anatomy of the Anterior Segment

The eye as an optical device

The eyeball
The Extraocular Muscles
Eyewall

Lids and Tear film
Tear films
Glands
Conjunctiva
Sclera
Tenon’s capsule

The anterior segment
A/C borders

Cornea
Corneal layers
The limbus

Iris
Iris muscles

Lens
Lens development

The A/C angle
Trabecular meshwork

Ciliary body and Aquous humor
Ciliary epithelium
Ciliary muscles and accomodation

Anatomy of the Posterior Segment

Vitreous body
Areas of attachment
Posterior vitreous detachment

Retina
Neural tissue
Ora serrata
Histological layers
Retinal cell types
Macula

Blood supply and drainage
Choroid
Central retinal artery
Vortex veins
Superior and inferior ophthalmic veins

Optic nerve
Intraocular
Intraorbital
Intracanalicular
Intracranial

Orbit
Bones
Apertures
optic canal
superior orbital fissure
inferior orbital fissure

Extraocular muscles
Rectus muscles
Oblique muscles

2. Cornea and External Eye Diseases

Infectious diseases
Blepharitis
Seborrheic, Staphylococcal
Chalazion, Hordeolum
Conjunctivitis
Viral, Bacterial, allergic
Papillary vs. follicular reaction
Microbial Keratitis
Herpes Simplex Keratitis
Epithelial
Stromal
Ophthalmic Herpes Zoster

Keratoconus

Pterygium and Pinguecula

Inflammatory diseases
Dry Eye Syndromes
Classification
Pathophysiology
Clinical tests (Schirmer, TBUT, dye staining)
Management
Tear substitutes (preserved, non-preserved)
Anti-inflammatory
Punctal occlusion

Allergic Eye Disorders
Contact dermatitis
Giant papillary conjunctivitis
Seasonal allergic conjunctivitis
Vernal keratoconjunctivitis

Limbal stem cell deficiency
Diagnosis
Surgical procedures

Red Eye

Symptoms and Signs
Differential Diagnosis

3. Retinal Disorders

Vascular retinal diseases
• Diabetic retinopathy
Definition
Prevalence
Pathogenesis
Clinical findings
Classification
Diagnosis
Systemic factors
Treatment
• Retinal vein and artery occlusions – clinical findings, risk factors, diagnosis, treatment
Central retinal vein occlusion
Branch retinal vein occlusion
Central retinal artery occlusion
Branch retinal artery occlusion
• Hypertensive retinopathy –clinical findings, grading

Age related macular degeneration (AMD)
Definition
Prevalence
Pathogenesis
Clinical findings
Classification
Treatment

Retinal Detachment
Etiology (rhegmatogenous, tractional, exudative)
Risk factors
Posterior vitreous detachment
Peripheral retinal degenerations, retinal tears
Signs and Symptoms of retinal detachment
Vitreo-retinal surgical procedures
Complications of vitreo-retinal surgey

Ancillary testing:

- Visual field testing (perimetry)

- Contrast sensitivity

- Color Vision testing
Physiology of color vision
Congenital versus acquired color vision deficiencies
The Ishihara and Farnsworth-Munsell D-15 color tests
- flourescein angiography

- OCT

Hereditary retinal degenerations:

-Retinitis pigmentosa (RP):
Prevalence
Modes of inheritance
Symptoms and signs
Funduscopic findings
Electroretinographic findings
Genetics
Treatment

-Cone-rod dystrophies:
Symptoms and signs
Funduscopic findings
Electroretinographic findings

-Acquired color blindness

4. Acute Visual loss

Causes:
Corneal diseases
Anterior chamber diseases
Lens diseases
Vitreous disorders
Retinal detachment
Retinal vascular diseases
Optic nerve diseases

5. Cataract

Lens anatomy
Classification of cataract
By age
By anatomy
Metabolic cataract
Indications for surgery
Cataract surgery
Intra-ocular lenses
Complications of cataract surgery

Refractive Surgery

The excimer laser

Laser ablation in myopia, hyperopia, astigmatism

Surgical procedures:

Results of refractive surgery

Indications and contraindications in refractive surgery

Imaging of the cornea (Corneal topography, Orbscan)

Wavefront technology (high order aberrations, aberrometer)

Complications of refractive surgery

6. Neuro-Ophthalmology

Neuroanatomy of the visual pathway

The Neuro-ophthalmological History
Symptoms & Signs
Visual disturbances
Double vision
Medications
Past Medical History
Review of Systems
Hereditary Diseases

Differential Diagnoses - etiological processes

The Neuro-ophthalmological Examination
Visual Acuity
Color Vision
Contrast Sensitivity
Visual Fields
Visual field abnormalities due to visual pathway lesions
Pupils
RAPD
Horner's syndrome
Adie's pupil
Anterior Segment and Exophthalmus

Ocular Motility
Neuroanatomy of Eye Movements
Examination
Internuclear Ophthalmoplegia
Third Cranial Nerve Palsy
Fourth Cranial Nerve Palsy
Sixth Cranial Nerve Palsy

Papilledema
Pseudotumor Cerebri

Optic Disc Edema
Idiopathic & primary demyelinating optic neuritis
Atypical Optic Neuritis
Ischemic Optic Neuropathy
Non-arteritic
Arteritic

7. Glaucoma

The triad of glaucoma
Intraocular pressure
Optic nerve damage
Visual field damage

Relevant Anatomy
Anterior chamber angle
Outflow channels
Optic nerve head

The characteristic damage in glaucoma
Optic nerve head cupping
Glaucomatous visual field defects

Epidemiology and risk factors of glaucoma

Relevant topics
Measuring intraocular pressure,
Gonioscopy,
Visual field examination,
Optic nerve head cupping,
Open versus closed anterior chamber angle.

Glaucoma subtypes
Open versus Closed angle glaucoma,
Primary versus Secondary glaucoma.

Diagnosing glaucoma
Normal
Ocular hypertension
Glaucoma

Medical treatment of glaucoma
Different groups: beta blockers, alpha agonists, cholinergic agonists, carbonic anhydrase inhibitors, prostaglandin analogs, hyperosmotic agents
Effects and side effects

Laser treatment of glaucoma
Trabeculoplasty
Iridotomy

Surgical treatment of glaucoma
Trabeculectomy
Other surgical procedures.

8. Pediatric Ophthalmology & strabismus

• Pediatric Ophthalmology

Why is pediatric ophthalmology a separate entity?
Characteristics of the infant eye
Infant vision - Developmental milestones

How do we determine vision in infants?
Visual acuity in preverbal children
Fixation behavior
Teller Preferential Looking
Spatial Sweep VEP
Optokinetic nystagmus
Visual acuity in verbal children
Picture cube – single optotypes vs linear optotypes
Illiterate "E"
Snellen

Clinical signs of poor vision

Amblyopia
Definition
Classification (anisometropic, strabismic, ametropic, deprivation, iatrogenic)
Pathophysiology of amblyopia
Assessment of amblyopia
Treatment of amblyopia – penalization, patching

Selective topics in pediatric ophthalmology:
1. Ophthalmia neonatorum – etiology, diagnosis and treatment

2. Childhood ptosis – differential diagnosis, complications and treatment

3. Congenital dacryostenosis – pathophysiology, diagnosis and treatment

4. Periorbital and orbital cellulites (in children) – clinical diagnosis, complications and treatment

5. Childhood cataract – unilateral vs. bilateral, etiology, work-up and treatment, aphakia vs. pseudophakia – pros and cons

6. Childhood glaucoma – Difference from adult glaucoma, signs and symptoms, treatment

7. Retinopathy of prematurity – etiology, who is at risk, staging (brief version) and treatment

8. Congenital anomalies

• Strabismus

1. Definition –when is it pathologic?
2. Anamnesis: onset, Familiar history, medical history
3. Differential diagnosis: epicantus
4. Neuroanatomy of extraocular muscles
5. Eyes movements: ductions, versions, diagnostic position of gaze
6. Clinical characteristics: laterality, intermittent, alternating,
7. Comitant vs. incomitant
8. Association amblyopia and strabismus.
9. Clinical tests: Hirschberg test, cover test, alternating cover test, phorias/tropias,
10. Types of Esotropias: accommodative, Partial Accommodative, Sensory, Infantile, (Duane Syndrome, high Myopia)
11. Types of Exotropias: Sensory, intermittent, convergence insufficiency, divergence excess
12. Vertical strabismus: SO palsy, TED, MS, MG, orbital fractures
13. Treatment of strabismus: glasses, prisms and surgical treatments

9. Intraocular tumors
Uveal melanoma (iris, ciliary body and choroid)

Retinoblastoma

Metastasis

Epidemiology
Clinical aspects, signs and symptoms
Diagnostic methods
Histopathology
Prognostic factors and metastasis
Treatment
Differential diagnosis of leukocoria

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10. Oculoplastics
Eyelids
Inflammations
Sty
Chalazion
Blepharitis
Malposition of eyelids
Ptosis
Entropion
Ectropion
Tumors of the eyelids
Benign lid tumors (papilloma, verucca, nevusmolluscom)
Malignant lid tumors (BCC, SCC, sebaceous gland carcinoma, melanoma)

Lacrimal system
Anatomy
Physiology
Clinical examination, tests, imaging, treatment including surgery of:
Naso Lacrimal Obstruction
Inflammations
Neonatal dacryostenosis
Orbital diseases
Anatomy
Orbital symptoms Examination, Imaging, Evaluation,
Inflammations
Infections
Idiopathic
Thyroid
Orbital pseudotumor
Tumors
Dermoid cyst
Cavernous hemangioma
Lymphoma
Rhabdomyosarcoma

11. Uveitis

1. Definition

2. Classification
a. Anatomical
b. Clinical
c. Etiological
d. Pathological

3. Symptomatology

4. Clinical signs

5. Clinical presentation of the different uveitic subtypes

6. Diagnosis and differential diagnosis:
Implications of diagnosis on:
Management, visual outcome, systemic outcome

7. Clinical entities
a. Anterior uveitis:
• HLA-B27 related diseases
• Juvenile idiopathic arthritis
• Herpetic uveitis
b. Intermediate uveitis:
• Pars Planitis
• Toxoplasmosis
c. Posterior uveitis:
• Behcet’s disease
• CMV retinitis
d. Panuveitis :
• Sarcoidosis
• Sympathetic ophthalmia

8. Management
a. Importance of prompt management
b. Treatment of the different anatomical types of uveitis
c. Treatment of the different clinical entities
d. Systemic treatment: steroids and immunosuppressive agents.

12. Eye Trauma

Introduction
Natural eye protection mechanisms
Trauma prevention
Eye injuries in a multiple trauma setting
Assessment of eye trauma

Ocular burns:
Thermal, UV, Chemical
Diagnosis and treatment

Minor ocular trauma
erosions and superficial foreign bodies
Diagnosis and treatment

Perforating eye trauma, anterior and posterior
Diagnosis and treatment
Intraocular foreign bodies

Blunt eye trauma, anterior and posterior
Diagnosis and treatment
Hyphema
Ruptured globe

Eye affected by a distant trauma
Shaken Baby syndrome

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