Atestace Oftalmologie cheat sheet

Corneal layers (anterior to posterior): epithelium, Bowman's layer, stroma, Descemet's membrane, endothelium; endothelium is non-regenerating and pumps fluid out of stroma.

Aqueous humor pathway: ciliary body (pars plicata) → posterior chamber → pupil → anterior chamber → trabecular meshwork → Schlemm's canal → episcleral veins; obstruction raises IOP.

Embryology: optic vesicle from forebrain evaginates → optic cup; surface ectoderm → lens placode; neural crest → corneal stroma/endothelium, sclera, uveal melanocytes; mesoderm → extraocular muscles and vascular endothelium.

Retinal layers: photoreceptors (rods/cones) → bipolar cells → ganglion cells; horizontal and amacrine cells modulate laterally; Müller cells are principal glia spanning the retina.

Visual pathway: optic nerve → chiasm (nasal fibers cross) → optic tract → lateral geniculate nucleus → optic radiations (temporal lobe = inferior retina, parietal = superior retina) → primary visual cortex (occipital pole).

Pupillary light reflex: afferent = optic nerve; efferent = oculomotor nerve (Edinger-Westphal) → ciliary ganglion → sphincter pupillae; a relative afferent defect indicates optic nerve/macular disease.

Tear film: lipid (meibomian glands), aqueous (lacrimal and accessory glands), mucin (goblet cells); deficiency causes dry eye and instability.

Extraocular muscles: four recti (superior, inferior, medial, lateral) and two obliques (superior, inferior); blood supply from ophthalmic artery branches; cranial nerves III, IV, VI innervate them.

Snell's law: n1 sin θ1 = n2 sin θ2; refractive index of cornea ≈ 1.376, aqueous ≈ 1.336, lens ≈ 1.42, vitreous ≈ 1.336.

Gullstrand reduced eye: total power ≈ 60 D (cornea ≈ 43 D, lens ≈ 20 D); axial length ≈ 24 mm; 1 mm axial length change ≈ 3 D refractive change.

Myopia corrected with minus (concave) lenses; hyperopia with plus (convex); astigmatism with cylinder; presbyopia requires near add (plus) due to loss of accommodation.

Contact lens oxygen permeability (Dk) and Dk/t; extended wear increases microbial keratitis risk; daily disposable reduces deposit-related complications.

Keratometry measures anterior corneal curvature; average K ≈ 43 D; contact lens base curve should align with corneal curvature (typically 0.1–0.2 mm steeper).

Spherical equivalent = sphere + ½ cylinder; used for rough refractive estimation and IOL power planning.

Tear film break-up time (TBUT) < 10 s suggests dry eye and contact lens intolerance; fluorescein staining assesses corneal integrity.

Orthokeratology uses reverse-geometry rigid lenses to flatten central cornea temporarily; risk of microbial keratitis if hygiene poor.

Visual acuity: Snellen or logMAR chart at 6 m (20 ft); pinhole improves refractive error but not media opacity or retinal disease.

Confrontation visual fields screen for gross defects; automated perimetry (Humphrey 24-2 or 30-2) quantifies field loss and progression.

Slit-lamp biomicroscopy with fluorescein staining detects corneal epithelial defects, ulcers, and foreign bodies; cobalt blue filter enhances fluorescence.

Tonometry: Goldmann applanation is gold standard (IOP in mmHg); central corneal thickness affects readings (thicker cornea overestimates IOP).

Gonioscopy visualizes anterior chamber angle (Shaffer grading) to classify open-angle vs angle-closure glaucoma.

Optical coherence tomography (OCT) provides cross-sectional retinal imaging; macular edema, subretinal fluid, and ganglion cell loss are quantifiable.

Fundus fluorescein angiography (FFA) identifies leakage, non-perfusion, and neovascularization; indocyanine green (ICG) images choroidal vasculature.

B-scan ultrasonography assesses posterior segment when media opaque (dense cataract, vitreous hemorrhage) and detects retinal detachment or intraocular tumor.

Chalazion = blocked meibomian gland (sterile granuloma), treated with warm compresses or incision; hordeolum = acute bacterial infection (stye) of gland.

Ectropion (outward turning) commonly involutional; entropion (inward turning) causes trichiasis and corneal abrasion; both corrected surgically.

Ptosis: levator dehiscence (most common, adults), myasthenia gravis (fatigable), Horner syndrome (miosis, ptosis, anhidrosis), or third nerve palsy (ptosis with eye down and out).

Nasolacrimal duct obstruction: epiphora, recurrent dacryocystitis; probing in infants, dacryocystorhinostomy (DCR) in adults.

Orbital cellulitis: fever, proptosis, pain on eye movement, restricted motility; requires urgent IV antibiotics and imaging (CT/MRI) to exclude abscess.

Thyroid eye disease: lid retraction, proptosis, restrictive myopathy (inferior rectus most common), optic neuropathy risk; associated with Graves disease.

Orbital floor blowout fracture: restricted upgaze, enophthalmos, infraorbital numbness (V2), diplopia; CT confirms; surgery for entrapment or persistent diplopia.

Dermoid cyst: congenital benign choristoma at superotemporal orbit; rupture causes intense inflammation; excision if symptomatic.

Bacterial conjunctivitis: purulent discharge, papillary reaction; common organisms Staphylococcus aureus, Streptococcus pneumoniae, Haemophilus influenzae; topical antibiotics.

Viral conjunctivitis: watery discharge, follicles, often adenovirus; highly contagious; supportive care; pharyngoconjunctival fever and epidemic keratoconjunctivitis.

Allergic conjunctivitis: itching, papillae, chemosis; topical antihistamines/mast cell stabilizers; avoid allergens.

Corneal ulcer: epithelial defect with stromal infiltrate; bacterial (contact lens wear, trauma) requires urgent fortified antibiotics; fungal (agricultural trauma) requires natamycin/voriconazole.

Herpes simplex keratitis: dendritic ulcer with terminal bulbs; fluorescein stains; topical antiviral (ganciclovir) or oral acyclovir; avoid steroids alone.

Dry eye disease: tear film instability, hyperosmolarity, inflammation; Schirmer test < 5 mm/5 min indicates aqueous deficiency; treat with artificial tears, cyclosporine, punctal plugs.

Pterygium: fibrovascular growth from conjunctiva onto cornea (nasal); associated with UV exposure; excision with conjunctival autograft if visual axis threatened.

Keratoconus: progressive corneal thinning and ectasia, irregular astigmatism; managed with rigid contact lenses or corneal cross-linking.

Anterior uveitis (iritis): pain, photophobia, ciliary flush, cells and flare in anterior chamber, miosis; HLA-B27 associated, idiopathic, or herpetic.

Granulomatous uveitis: mutton-fat keratic precipitates, iris nodules (Koeppe/Busacca); causes include sarcoidosis, tuberculosis, syphilis, Vogt-Koyanagi-Harada.

Posterior uveitis: vitritis, retinitis, choroiditis; infectious (toxoplasmosis, CMV, syphilis) vs immune-mediated (birdshot, Behçet).

Toxoplasma retinochoroiditis: focal necrotizing retinitis adjacent to old scar, “headlight in fog” vitritis; treat with pyrimethamine/sulfadiazine or clindamycin.

CMV retinitis: HIV/AIDS with CD4 < 50, “pizza pie” hemorrhagic retinitis; treat with ganciclovir, valganciclovir, or foscarnet.

Sympathetic ophthalmia: bilateral granulomatous panuveitis after penetrating trauma to one eye; prevent by enucleation within 2 weeks if eye blind.

Uveitis workup: CBC, syphilis serology, chest X-ray (sarcoid/TB), HLA-B27, ACE; tailor to history and examination.

Treatment: topical corticosteroids for anterior; periocular/intravitreal steroids or systemic immunosuppression for posterior; mydriatics to prevent synechiae.

Age-related cataract: nuclear sclerotic (yellow-brown, myopic shift), cortical (spokes), posterior subcapsular (glare, near vision difficulty).

Phacoemulsification: ultrasonic fragmentation of lens through small incision; foldable intraocular lens (IOL) implanted in capsular bag.

IOL power calculation: SRK/T, Hoffer Q, Haigis formulas; axial length and keratometry; aim for emmetropia; adjust for prior refractive surgery.

Cataract surgery complications: posterior capsule rupture, vitreous loss, endophthalmitis (rare, presents with pain and vision loss days after surgery), retinal detachment, cystoid macular edema.

Endophthalmitis: acute postoperative (Staphylococcus epidermidis most common); treat with intravitreal antibiotics (vancomycin + ceftazidime); vitrectomy if severe.

Congenital cataract: leukocoria, absent red reflex; urgent surgery to prevent amblyopia; associated with rubella, galactosemia, and genetic syndromes.

Secondary cataract (posterior capsule opacification): treated with Nd:YAG laser capsulotomy; risk of retinal detachment and IOL dislocation.

Lens-induced glaucoma: phacomorphic (swollen lens closes angle) or phacolytic (leaking lens proteins cause macrophage obstruction); treat with IOP lowering and cataract extraction.

Open-angle glaucoma: progressive optic neuropathy with cupping, field loss; IOP is major risk factor; treat with prostaglandin analogs first-line (latanoprost).

Angle-closure glaucoma: acute attack with severe pain, halos, mid-dilated pupil, corneal edema, high IOP; treat with topical beta-blocker, pilocarpine, IV acetazolamide, and laser peripheral iridotomy.

Normal-tension glaucoma: glaucomatous damage with IOP ≤ 21 mmHg; consider vascular risk factors, sleep apnea, and treat with IOP lowering.

Gonioscopy grading (Shaffer): grade 4 open, grade 0 closed; synechial closure in neovascular glaucoma.

Optic disc cupping: cup-to-disc ratio > 0.6 or asymmetry > 0.2 suspicious; neuroretinal rim thinning (ISNT rule: inferior > superior > nasal > temporal).

Visual field defects: arcuate scotoma, nasal step, paracentral scotoma, altitudinal defect; advanced = central island or temporal remnant.

Medical therapy: prostaglandins increase uveoscleral outflow; beta-blockers decrease aqueous production; alpha-agonists and carbonic anhydrase inhibitors also lower IOP.

Surgical options: trabeculectomy (with mitomycin C), glaucoma drainage devices, minimally invasive glaucoma surgery (MIGS) for mild-moderate disease.

Diabetic retinopathy: nonproliferative (microaneurysms, hemorrhages, hard exudates, cotton wool spots) and proliferative (neovascularization); treat with panretinal photocoagulation or anti-VEGF.

Diabetic macular edema: central retinal thickening; first-line anti-VEGF (ranibizumab, aflibercept, bevacizumab) or focal laser for non-center-involving.

Age-related macular degeneration: dry (drusen, geographic atrophy) vs wet (choroidal neovascularization); wet treated with anti-VEGF; Amsler grid for monitoring.

Retinal detachment: rhegmatogenous (horseshoe tear, photopsia, floaters, field defect), tractional (diabetes), exudative (tumor, inflammation); surgery (pneumatic retinopexy, scleral buckle, vitrectomy).

Central retinal artery occlusion: sudden painless monocular vision loss, cherry-red spot, pale retina; emergency, treat with ocular massage, IOP lowering, and systemic workup (carotid, cardiac).

Central retinal vein occlusion: blood and thunder fundus, disc edema, macular edema; treat underlying risk factors; anti-VEGF for macular edema.

Retinitis pigmentosa: progressive night blindness, bone-spicule pigmentation, ring scotoma, attenuated vessels; genetic counseling; no cure.

Choroidal melanoma: pigmented elevated lesion, associated with metastasis (liver); treat with plaque brachytherapy, enucleation, or proton beam.

Optic neuritis: painful vision loss, relative afferent pupillary defect, dyschromatopsia; associated with multiple sclerosis; MRI brain and orbits with contrast.

Papilledema: bilateral disc swelling from raised intracranial pressure; preserves visual acuity until late; urgent neuroimaging and lumbar puncture.

Third nerve palsy: ptosis, eye down and out, mydriasis; pupil-involving suggests compressive lesion (aneurysm) requiring urgent imaging.

Fourth nerve palsy: vertical diplopia, head tilt to opposite side, hypertropia; congenital or traumatic.

Sixth nerve palsy: horizontal diplopia, esotropia, inability to abduct; false localizing sign of raised ICP; workup for microvascular or compressive cause.

Horner syndrome: ptosis, miosis, anhidrosis; apical lung tumor (Pancoast), carotid dissection; test with cocaine or apraclonidine drops.

Strabismus: esotropia (inward), exotropia (outward), hypertropia; amblyopia risk in children; treat with patching, glasses, or surgery.

Nystagmus: jerk (pendular) or see-saw; optokinetic testing; congenital vs acquired; acquired requires neuroimaging.

Leukocoria (white pupillary reflex): congenital cataract, retinoblastoma, Coats disease, persistent fetal vasculature, toxocariasis; urgent evaluation.

Retinoblastoma: most common intraocular malignancy in children; RB1 gene mutation; treat with chemotherapy, enucleation, or focal therapy; genetic counseling.

Congenital glaucoma: buphthalmos, cloudy cornea, tearing, photophobia; urgent surgery (goniotomy or trabeculotomy).

Amblyopia: reduced vision from abnormal visual experience (strabismus, anisometropia, deprivation); treat with occlusion or atropine penalization before age 8–10.

Strabismus in children: congenital esotropia requires early surgery; accommodative esotropia corrected with hyperopic glasses.

Retinopathy of prematurity (ROP): preterm infants < 32 weeks or < 1500 g; screening with indirect ophthalmoscopy; treat with laser or anti-VEGF for type 1 ROP.

Inherited retinal dystrophies: retinitis pigmentosa, Leber congenital amaurosis (RPE65), Stargardt disease; genetic testing guides prognosis and trials.

Congenital nasolacrimal duct obstruction: epiphora and discharge in infants; resolves by 1 year; probing if persistent.

Uveal melanoma: most common primary intraocular malignancy in adults; risk of liver metastasis; treat with plaque radiotherapy, enucleation, or proton beam.

Retinoblastoma: leukocoria, strabismus; calcification on CT; genetic testing for RB1; avoid biopsy to prevent seeding.

Ocular trauma: chemical injury requires immediate irrigation; open globe requires shield and urgent surgical repair; intraocular foreign body needs CT and antibiotics.

Hypertensive retinopathy: arteriolar narrowing, AV nicking, flame hemorrhages, cotton wool spots, papilledema (malignant hypertension).

Diabetic retinopathy is a leading cause of blindness in working-age adults; control of blood glucose, blood pressure, and lipids reduces progression.

Thyroid eye disease: associated with Graves disease; smoking worsens; treat with lubricants, steroids, orbital decompression, or teprotumumab.

Sarcoidosis: granulomatous uveitis, conjunctival nodules, lacrimal gland enlargement; chest X-ray and ACE levels; systemic steroids.

Syphilis: great masquerader; uveitis, optic neuritis, Argyll Robertson pupil; serology (VDRL, FTA-ABS) and penicillin treatment.