Arab Board Ophthalmology Clinical & Oral cheat sheet

Corneal layers (anterior to posterior): epithelium, Bowman layer, stroma, Descemet membrane, endothelium; endothelium is non-regenerating and pumps fluid out via Na+/K+-ATPase.

Recurrent corneal erosion: first-line is nocturnal lubricant plus topical steroid; refractory cases treated with epithelial debridement and diamond burr or anterior stromal puncture.

Bacterial keratitis: corneal scrape for Gram stain and culture before antibiotics; intensive fortified therapy (e.g., cefazolin 50 mg/mL plus tobramycin 14 mg/mL) hourly.

Fungal keratitis: satellite lesions, feathery margins, and endothelial plaque suggest fungus; natamycin 5% for filamentous, voriconazole for deep or resistant cases.

Acanthamoeba keratitis: contact lens wearer with pain out of proportion, radial keratoneuritis, and ring infiltrate; treat with polyhexamethylene biguanide plus chlorhexidine.

Mooren ulcer: painful peripheral corneal ulcer with overhanging edge and no scleral involvement; treat with topical steroid, systemic immunosuppression, and conjunctival resection.

Fuchs endothelial dystrophy: guttata and central corneal edema; hypertonic saline early, Descemet stripping endothelial keratoplasty (DSEK/DMEK) for visually significant edema.

Keratoconus: inferior steepening, Vogt striae, Fleischer ring, and scissoring on retinoscopy; cross-linking for documented progression, rigid lenses for visual rehabilitation.

Ocular surface squamous neoplasia: gelatinous or leukoplakic limbal lesion; anterior segment OCT and impression cytology guide diagnosis; topical interferon or 5-fluorouracil are treatment options.

Biometry: optical coherence biometry is preferred; use IOLMaster or Lenstar; for prior myopic LASIK use measured Ks with adjusted formulas (e.g., Barrett True-K or Haigis-L).

Endophthalmitis after cataract surgery: incidence about 0.04-0.1%; treat with intravitreal vancomycin 1 mg/0.1 mL plus ceftazidime 2.25 mg/0.1 mL; vitrectomy if visual acuity is light perception only.

Toxic anterior segment syndrome: diffuse limbal-to-limbal corneal edema, hypopyon, and fibrin within 12-48 hours of surgery; treat with topical steroid and remove the offending agent.

Posterior capsule rupture: risk factors include pseudoexfoliation, high myopia, and prior vitrectomy; manage with anterior vitrectomy and sulcus or anterior chamber IOL.

Phacomorphic glaucoma: intumescent lens causes angle closure; treat with IOP-lowering agents, then cataract extraction with IOL.

Refractive surgery: LASIK flap is 100-160 micrometers; PRK avoids flap complications and is preferred in thin corneas or recurrent erosion risk.

LASIK ectasia: risk increases with residual stromal bed under 250 micrometers and abnormal preoperative topography; avoid surgery in forme fruste keratoconus.

Pseudophakic bullous keratopathy: endothelial keratoplasty (DSEK or DMEK) is preferred over penetrating keratoplasty when endothelium alone is diseased.

Primary open-angle glaucoma: progressive optic neuropathy with characteristic cupping and field loss; IOP is the only modifiable risk factor; lower IOP by 20-30% initially.

Acute angle-closure: IOP often over 40 mmHg with mid-dilated fixed pupil, corneal edema, and headache; treat with topical beta-blocker, pilocarpine after IOP falls, systemic acetazolamide, and laser peripheral iridotomy.

Normal-tension glaucoma: IOP within normal range with glaucomatous damage; check for nocturnal hypotension, sleep apnea, and vasospasm; target IOP reduction of 30%.

Pseudoexfoliation glaucoma: exfoliative material on lens capsule and pupillary margin; higher risk of rapid progression and zonular instability during surgery.

Optic disc hemorrhage: splinter hemorrhage at the disc margin is a strong risk factor for glaucoma progression.

Trabeculectomy: use mitomycin C to reduce scarring; watch for hypotony, bleb leak, and endophthalmitis; a flat bleb with shallow anterior chamber suggests overfiltration.

Angle grading: Shaffer system grades 0-4; grade 0 is closed, grade 1 is about 10 degrees, grade 4 is wide open.

Prostaglandin analogs: increase uveoscleral outflow; side effects include iris darkening, eyelash growth, and periorbital fat atrophy.

Diabetic retinopathy: severe nonproliferative disease or proliferative disease warrants panretinal photocoagulation; macular edema is treated with anti-VEGF or focal laser.

Central retinal artery occlusion: cherry-red spot and pale retina; visual prognosis is poor; treat as stroke equivalent and evaluate for carotid and cardiac sources.

Central retinal vein occlusion: blood and thunder fundus; anti-VEGF for macular edema; check for hypertension, diabetes, and hyperviscosity.

Retinal detachment: rhegmatogenous detachment shows a horseshoe tear and subretinal fluid; scleral buckle or pars plana vitrectomy depending on location and lens status.

Macular hole: stages 1-4; stage 3-4 treated with vitrectomy, internal limiting membrane peel, and gas tamponade; face-down positioning improves closure.

Age-related macular degeneration: dry type shows drusen and geographic atrophy; wet type shows choroidal neovascular membrane treated with anti-VEGF injections.

Retinopathy of prematurity: screening for infants under 1500 g or under 32 weeks gestation; treat type 1 disease with laser or anti-VEGF.

Vitreous hemorrhage: evaluate for underlying proliferative diabetic retinopathy or retinal tear; B-scan ultrasound if fundus view is obscured.

Anterior uveitis: cells and flare in the anterior chamber; HLA-B27 associated with acute unilateral recurrent disease; treat with topical steroid and cycloplegic.

Posterior synechiae: adhesion of iris to lens; prevent with cycloplegia and topical steroid; if extensive, may cause iris bombé and angle closure.

Behçet disease: recurrent oral and genital ulcers with hypopyon uveitis; treat with systemic immunosuppression or biologic agents.

Sarcoidosis: granulomatous uveitis with mutton-fat keratic precipitates and iris nodules; chest imaging and ACE level aid diagnosis.

Toxoplasmosis: focal necrotizing retinochoroiditis adjacent to a scar; treat with pyrimethamine plus sulfadiazine and folinic acid, or trimethoprim-sulfamethoxazole.

Sympathetic ophthalmia: bilateral granulomatous uveitis after penetrating trauma; prevent with enucleation of the blind injured eye within 2 weeks; treat with systemic steroid and immunosuppression.

Vogt-Koyanagi-Harada disease: bilateral panuveitis with serous detachment, meningismus, and vitiligo; treat with high-dose systemic corticosteroid.

JIA-associated uveitis: chronic anterior uveitis in children, often asymptomatic; screen regularly with slit lamp; treat with topical steroid and methotrexate.

Optic neuritis: painful vision loss with reduced color vision and afferent pupillary defect; associated with multiple sclerosis; treat with IV methylprednisolone to hasten recovery, not to change final acuity.

Anterior ischemic optic neuropathy: sudden painless altitudinal field loss with sectorial disc edema; non-arteritic type associated with hypertension and diabetes; arteritic type (giant cell arteritis) needs urgent steroid and biopsy.

Papilledema: bilateral disc edema from raised intracranial pressure; preserve visual field and check for headache, pulsatile tinnitus, and obesity; treat with acetazolamide or shunt.

Third nerve palsy: pupil-involving palsy suggests posterior communicating artery aneurysm; urgent imaging needed; pupil-sparing palsy often diabetic microvascular.

Horner syndrome: ptosis, miosis, and anhidrosis; postganglionic lesions may be associated with carotid dissection; order imaging of the sympathetic chain.

Internuclear ophthalmoplegia: lesion of the medial longitudinal fasciculus; impaired adduction on the affected side with nystagmus of the abducting eye; common in multiple sclerosis.

Leber hereditary optic neuropathy: bilateral sequential painless vision loss in young men; maternal inheritance; no proven treatment.

Cortical visual loss: normal fundus and pupillary responses with visual field loss; caused by occipital lesion; visual behavior may be preserved in blindness denial (Anton syndrome).

Orbital cellulitis: fever, proptosis, and limitation of eye movement; treat with IV antibiotics; watch for subperiosteal abscess and cavernous sinus thrombosis.

Thyroid eye disease: eyelid retraction, proptosis, and restrictive strabismus; treat active disease with steroid or teprotumumab; surgery for stable disease.

Basal cell carcinoma: most common eyelid malignancy; pearly nodule with telangiectasia; treat with excision with margin control.

Squamous cell carcinoma: more aggressive than basal cell; may arise from actinic keratosis; risk of perineural spread.

Dacryocystitis: infection of the lacrimal sac; treat with antibiotics and warm compress; dacryocystorhinostomy for chronic obstruction.

Orbital fracture: blowout fracture with restricted upgaze and enophthalmos; urgent repair if muscle entrapment or significant enophthalmos.

Ptosis: aponeurotic type most common in older adults; check for Marcus Gunn jaw-winking and myasthenia gravis; levator resection or frontalis sling depending on levator function.

Amblyopia: reduced vision without organic cause; treat with occlusion or atropine penalization; critical period is early childhood.

Esotropia: infantile esotropia presents before 6 months with large angle; treat with surgery; accommodative esotropia responds to hyperopic correction.

Exotropia: intermittent exotropia common; surgery if deterioration or poor control; check for underlying neurologic disease if constant.

Leukocoria: white pupillary reflex; differential includes retinoblastoma, congenital cataract, and Coats disease; urgent evaluation.

Retinoblastoma: most common intraocular malignancy in children; heritable form associated with RB1 mutation; treat with chemotherapy, focal therapy, or enucleation.

Congenital glaucoma: buphthalmos, corneal edema, and tearing; treat with goniotomy or trabeculotomy; urgent referral.

Strabismus surgery: recession weakens a muscle; resection strengthens; adjustable sutures allow postoperative adjustment.

Nasolacrimal duct obstruction: tearing and discharge in infants; treat with massage; probing if persistent beyond 12 months.

Uveal melanoma: most common primary intraocular malignancy in adults; treat with plaque brachytherapy, proton beam, or enucleation; monitor for metastasis.

Retinoblastoma: genetic testing for RB1; heritable cases need surveillance for second tumors.

Choroidal nevus: flat, pigmented lesion with drusen; monitor for growth, subretinal fluid, and orange pigment suggesting transformation.

Ocular surface squamous neoplasia: managed with topical chemotherapy or excision; recurrence risk high.

Lymphoma: masquerade syndrome with uveitis; biopsy for diagnosis; treat with chemotherapy or radiation.

Metastatic carcinoma: most common intraocular malignancy overall; breast and lung primaries; treat with systemic therapy.

Conjunctival melanoma: pigmented lesion with irregular borders; treat with excision and cryotherapy; risk of metastasis.

Chemical burn: irrigate copiously with saline for at least 30 minutes; check pH; treat with topical steroid and antibiotic; urgent ophthalmology referral.

Open globe: avoid pressure; shield the eye; give IV antibiotics and tetanus prophylaxis; surgical repair.

Hyphema: blood in anterior chamber; treat with head elevation, topical steroid, and cycloplegic; monitor for rebleed and glaucoma.

Traumatic cataract: may develop after blunt or penetrating injury; surgery after inflammation controlled.

Orbital compartment syndrome: proptosis and vision loss after trauma; urgent lateral canthotomy and cantholysis.

Retinal detachment after trauma: evaluate with dilated fundus exam; treat with surgery.

Corneal abrasion: epithelial defect; treat with topical antibiotic and lubricant; avoid steroid if infected.

Intraocular foreign body: history of hammering or explosion; order CT scan; remove surgically.

Corneal layers (anterior to posterior): epithelium, Bowman layer, stroma, Descemet membrane, endothelium; endothelium is non-regenerating and pumps fluid out via Na+/K+-ATPase.

Recurrent corneal erosion: first-line is nocturnal lubricant plus topical steroid; refractory cases treated with epithelial debridement and diamond burr or anterior stromal puncture.

Bacterial keratitis: corneal scrape for Gram stain and culture before antibiotics; intensive fortified therapy (e.g., cefazolin 50 mg/mL plus tobramycin 14 mg/mL) hourly.

Fungal keratitis: satellite lesions, feathery margins, and endothelial plaque suggest fungus; natamycin 5% for filamentous, voriconazole for deep or resistant cases.

Acanthamoeba keratitis: contact lens wearer with pain out of proportion, radial keratoneuritis, and ring infiltrate; treat with polyhexamethylene biguanide plus chlorhexidine.

Mooren ulcer: painful peripheral corneal ulcer with overhanging edge and no scleral involvement; treat with topical steroid, systemic immunosuppression, and conjunctival resection.

Fuchs endothelial dystrophy: guttata and central corneal edema; hypertonic saline early, Descemet stripping endothelial keratoplasty (DSEK/DMEK) for visually significant edema.

Keratoconus: inferior steepening, Vogt striae, Fleischer ring, and scissoring on retinoscopy; cross-linking for documented progression, rigid lenses for visual rehabilitation.

Ocular surface squamous neoplasia: gelatinous or leukoplakic limbal lesion; anterior segment OCT and impression cytology guide diagnosis; topical interferon or 5-fluorouracil are treatment options.

Biometry: optical coherence biometry is preferred; use IOLMaster or Lenstar; for prior myopic LASIK use measured Ks with adjusted formulas (e.g., Barrett True-K or Haigis-L).

Endophthalmitis after cataract surgery: incidence about 0.04-0.1%; treat with intravitreal vancomycin 1 mg/0.1 mL plus ceftazidime 2.25 mg/0.1 mL; vitrectomy if visual acuity is light perception only.

Toxic anterior segment syndrome: diffuse limbal-to-limbal corneal edema, hypopyon, and fibrin within 12-48 hours of surgery; treat with topical steroid and remove the offending agent.

Posterior capsule rupture: risk factors include pseudoexfoliation, high myopia, and prior vitrectomy; manage with anterior vitrectomy and sulcus or anterior chamber IOL.

Phacomorphic glaucoma: intumescent lens causes angle closure; treat with IOP-lowering agents, then cataract extraction with IOL.

Refractive surgery: LASIK flap is 100-160 micrometers; PRK avoids flap complications and is preferred in thin corneas or recurrent erosion risk.

LASIK ectasia: risk increases with residual stromal bed under 250 micrometers and abnormal preoperative topography; avoid surgery in forme fruste keratoconus.

Pseudophakic bullous keratopathy: endothelial keratoplasty (DSEK or DMEK) is preferred over penetrating keratoplasty when endothelium alone is diseased.

Primary open-angle glaucoma: progressive optic neuropathy with characteristic cupping and field loss; IOP is the only modifiable risk factor; lower IOP by 20-30% initially.

Acute angle-closure: IOP often over 40 mmHg with mid-dilated fixed pupil, corneal edema, and headache; treat with topical beta-blocker, pilocarpine after IOP falls, systemic acetazolamide, and laser peripheral iridotomy.

Normal-tension glaucoma: IOP within normal range with glaucomatous damage; check for nocturnal hypotension, sleep apnea, and vasospasm; target IOP reduction of 30%.

Pseudoexfoliation glaucoma: exfoliative material on lens capsule and pupillary margin; higher risk of rapid progression and zonular instability during surgery.

Optic disc hemorrhage: splinter hemorrhage at the disc margin is a strong risk factor for glaucoma progression.

Trabeculectomy: use mitomycin C to reduce scarring; watch for hypotony, bleb leak, and endophthalmitis; a flat bleb with shallow anterior chamber suggests overfiltration.

Angle grading: Shaffer system grades 0-4; grade 0 is closed, grade 1 is about 10 degrees, grade 4 is wide open.

Prostaglandin analogs: increase uveoscleral outflow; side effects include iris darkening, eyelash growth, and periorbital fat atrophy.

Diabetic retinopathy: severe nonproliferative disease or proliferative disease warrants panretinal photocoagulation; macular edema is treated with anti-VEGF or focal laser.

Central retinal artery occlusion: cherry-red spot and pale retina; visual prognosis is poor; treat as stroke equivalent and evaluate for carotid and cardiac sources.

Central retinal vein occlusion: blood and thunder fundus; anti-VEGF for macular edema; check for hypertension, diabetes, and hyperviscosity.

Retinal detachment: rhegmatogenous detachment shows a horseshoe tear and subretinal fluid; scleral buckle or pars plana vitrectomy depending on location and lens status.

Macular hole: stages 1-4; stage 3-4 treated with vitrectomy, internal limiting membrane peel, and gas tamponade; face-down positioning improves closure.

Age-related macular degeneration: dry type shows drusen and geographic atrophy; wet type shows choroidal neovascular membrane treated with anti-VEGF injections.

Retinopathy of prematurity: screening for infants under 1500 g or under 32 weeks gestation; treat type 1 disease with laser or anti-VEGF.

Vitreous hemorrhage: evaluate for underlying proliferative diabetic retinopathy or retinal tear; B-scan ultrasound if fundus view is obscured.

Anterior uveitis: cells and flare in the anterior chamber; HLA-B27 associated with acute unilateral recurrent disease; treat with topical steroid and cycloplegic.

Posterior synechiae: adhesion of iris to lens; prevent with cycloplegia and topical steroid; if extensive, may cause iris bombé and angle closure.

Behçet disease: recurrent oral and genital ulcers with hypopyon uveitis; treat with systemic immunosuppression or biologic agents.

Sarcoidosis: granulomatous uveitis with mutton-fat keratic precipitates and iris nodules; chest imaging and ACE level aid diagnosis.

Toxoplasmosis: focal necrotizing retinochoroiditis adjacent to a scar; treat with pyrimethamine plus sulfadiazine and folinic acid, or trimethoprim-sulfamethoxazole.

Sympathetic ophthalmia: bilateral granulomatous uveitis after penetrating trauma; prevent with enucleation of the blind injured eye within 2 weeks; treat with systemic steroid and immunosuppression.

Vogt-Koyanagi-Harada disease: bilateral panuveitis with serous detachment, meningismus, and vitiligo; treat with high-dose systemic corticosteroid.

JIA-associated uveitis: chronic anterior uveitis in children, often asymptomatic; screen regularly with slit lamp; treat with topical steroid and methotrexate.

Optic neuritis: painful vision loss with reduced color vision and afferent pupillary defect; associated with multiple sclerosis; treat with IV methylprednisolone to hasten recovery, not to change final acuity.

Anterior ischemic optic neuropathy: sudden painless altitudinal field loss with sectorial disc edema; non-arteritic type associated with hypertension and diabetes; arteritic type (giant cell arteritis) needs urgent steroid and biopsy.

Papilledema: bilateral disc edema from raised intracranial pressure; preserve visual field and check for headache, pulsatile tinnitus, and obesity; treat with acetazolamide or shunt.

Third nerve palsy: pupil-involving palsy suggests posterior communicating artery aneurysm; urgent imaging needed; pupil-sparing palsy often diabetic microvascular.

Horner syndrome: ptosis, miosis, and anhidrosis; postganglionic lesions may be associated with carotid dissection; order imaging of the sympathetic chain.

Internuclear ophthalmoplegia: lesion of the medial longitudinal fasciculus; impaired adduction on the affected side with nystagmus of the abducting eye; common in multiple sclerosis.

Leber hereditary optic neuropathy: bilateral sequential painless vision loss in young men; maternal inheritance; no proven treatment.

Cortical visual loss: normal fundus and pupillary responses with visual field loss; caused by occipital lesion; visual behavior may be preserved in blindness denial (Anton syndrome).

Orbital cellulitis: fever, proptosis, and limitation of eye movement; treat with IV antibiotics; watch for subperiosteal abscess and cavernous sinus thrombosis.

Thyroid eye disease: eyelid retraction, proptosis, and restrictive strabismus; treat active disease with steroid or teprotumumab; surgery for stable disease.

Basal cell carcinoma: most common eyelid malignancy; pearly nodule with telangiectasia; treat with excision with margin control.

Squamous cell carcinoma: more aggressive than basal cell; may arise from actinic keratosis; risk of perineural spread.

Dacryocystitis: infection of the lacrimal sac; treat with antibiotics and warm compress; dacryocystorhinostomy for chronic obstruction.

Orbital fracture: blowout fracture with restricted upgaze and enophthalmos; urgent repair if muscle entrapment or significant enophthalmos.

Ptosis: aponeurotic type most common in older adults; check for Marcus Gunn jaw-winking and myasthenia gravis; levator resection or frontalis sling depending on levator function.

Amblyopia: reduced vision without organic cause; treat with occlusion or atropine penalization; critical period is early childhood.

Esotropia: infantile esotropia presents before 6 months with large angle; treat with surgery; accommodative esotropia responds to hyperopic correction.

Exotropia: intermittent exotropia common; surgery if deterioration or poor control; check for underlying neurologic disease if constant.

Leukocoria: white pupillary reflex; differential includes retinoblastoma, congenital cataract, and Coats disease; urgent evaluation.

Retinoblastoma: most common intraocular malignancy in children; heritable form associated with RB1 mutation; treat with chemotherapy, focal therapy, or enucleation.

Congenital glaucoma: buphthalmos, corneal edema, and tearing; treat with goniotomy or trabeculotomy; urgent referral.

Strabismus surgery: recession weakens a muscle; resection strengthens; adjustable sutures allow postoperative adjustment.

Nasolacrimal duct obstruction: tearing and discharge in infants; treat with massage; probing if persistent beyond 12 months.

Uveal melanoma: most common primary intraocular malignancy in adults; treat with plaque brachytherapy, proton beam, or enucleation; monitor for metastasis.

Retinoblastoma: genetic testing for RB1; heritable cases need surveillance for second tumors.

Choroidal nevus: flat, pigmented lesion with drusen; monitor for growth, subretinal fluid, and orange pigment suggesting transformation.

Ocular surface squamous neoplasia: managed with topical chemotherapy or excision; recurrence risk high.

Lymphoma: masquerade syndrome with uveitis; biopsy for diagnosis; treat with chemotherapy or radiation.

Metastatic carcinoma: most common intraocular malignancy overall; breast and lung primaries; treat with systemic therapy.

Conjunctival melanoma: pigmented lesion with irregular borders; treat with excision and cryotherapy; risk of metastasis.

Chemical burn: irrigate copiously with saline for at least 30 minutes; check pH; treat with topical steroid and antibiotic; urgent ophthalmology referral.

Open globe: avoid pressure; shield the eye; give IV antibiotics and tetanus prophylaxis; surgical repair.

Hyphema: blood in anterior chamber; treat with head elevation, topical steroid, and cycloplegic; monitor for rebleed and glaucoma.

Traumatic cataract: may develop after blunt or penetrating injury; surgery after inflammation controlled.

Orbital compartment syndrome: proptosis and vision loss after trauma; urgent lateral canthotomy and cantholysis.

Retinal detachment after trauma: evaluate with dilated fundus exam; treat with surgery.

Corneal abrasion: epithelial defect; treat with topical antibiotic and lubricant; avoid steroid if infected.

Intraocular foreign body: history of hammering or explosion; order CT scan; remove surgically.