Eye Yield: Ophthalmology Basics for Board and FRCS Part 1 Exams

270 Pages·2021·7.053 MB·English

by  Saif Aldeen Saleh AlRyalat

Eye Yield
Ophthalmology Basics for
Board and FRCS Part 1 Exams
Saif Aldeen Saleh AlRyalat
123
Eye Yield
Saif Aldeen Saleh AlRyalat
Eye Yield
Ophthalmology Basics
for Board and FRCS Part 1 Exams
Saif Aldeen Saleh AlRyalat
Department of Ophthalmology
The University of Jordan
Amman
Jordan
ISBN 978-981-16-2967-9 ISBN 978-981-16-2968-6 (eBook)
https://doi.org/10.1007/978-981-16-2968-6
© The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Singapore
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Foreword
I have been in ophthalmology practice for almost 30 years. Being in close contact
with residents for that long period, I have noticed that junior residents spend a lot of
time collecting basic ophthalmic data from different books. I believe they deserve
one single book with high yield information helping them prepare for their basic
ophthalmology examinations.
The design of Eye Yield book brought by Saif Aldeen Saleh AlRyalat makes it
stand out against its competitors in many aspects. The most conspicuous feature is
the informative tables, diagrams, and note boxes. The content is presented in an
attractive smooth sequence. The introduction chapter is concise and fruitful. The
bulk of the other 21 chapters discusses specific eye structures emphasizing basic
knowledge on anatomy, physiology, and pathology. The added value of this book is
including chapters, rich in basic knowledge needed for ophthalmologists, on embry-
ology, genetics, pharmacology, pathology, microbiology, and immunology.
In my case I was impressed with the organization of the book. It has been a plea-
sure to read through the first edition and to write this foreword. I am sure that many
residents in ophthalmic practice will find this book valuable.
Department of Ophthalmology Muawyah Al Bdour
The University of Jordan
Amman, Jordan
December 2020
v
Preface
In a specialty like ophthalmology, where ophthalmology rotations and residency
duration are relatively short, students and residents cannot afford to spend much
time studying details on basic ophthalmology topics. Moreover, ophthalmology is a
field poorly covered during medical school in most countries, so graduate medical
doctors usually face difficulties understanding its concepts afterward. These facts
among others led to the conception of the book Eye Yield, which aims to provide
high yield information for the basic ophthalmology exams.
This book includes 22 chapters discussing specific structures, including the ret-
ina and macula to each cranial nerve, where relevant anatomy, physiology, pathol-
ogy, and other basics related topics are discussed. After that, and as ophthalmology
exams usually include questions about general and ophthalmic pharmacology,
pathology, immunology, microbiology, embryology, and genetics, relevant chapters
are provided separately for these topics. Despite the non-exhaustive coverage of
non-ophthalmology basics, the included material mostly will introduce the high
yield information in such topics.
After completing this book, we encourage students to test their knowledge using
question and answer books, where we recommend the following books:
• Revision in Sciences Basic to Ophthalmology by Raman Malhotra and
David Easty
• Basic Sciences in Ophthalmology: A Self-Assessment Text by John Ferris
• MCQs for FRCOphth and ICO Basic Sciences Examinations (Masterpass) by
Sameer Trikha and colleagues
Ophthalmology exams usually ask a question about a topic, provide 4–5 state-
ments, and ask you to choose the most accurate statement. To answer the question,
you either need to know the accurate statement, or need to know the other non-
accurate statement. Statements might be inaccurate due to changing a number or a
sign. For example, the average tear production rate is 1.2 μl/min, while the state-
ment that might be provided is 1.2 ml/min. Pay attention to these trivial details dur-
ing your study, where we will try to emphasize on these details through “Eye Yield
Note” boxes. The following tips may also help you in choosing the best answer:
vii
viii Preface
• Statements containing “always” and “never” are rarely true statements, as they
mostly implicate a 100% knowledge of the topic. The reason behind that is oph-
thalmology knowledge is still evolving and we are still not sure about most of its
aspects. An exception would be well-established facts, like “malignant cells
always invade surrounding tissue.”
• Statements containing “may” or “might” are more likely to be true statements, as
there are wide variations in mechanisms, diseases, and structural differences.
Amman, Jordan Saif Aldeen Saleh AlRyalat
Acknowledgments
The author would like to thank the valuable contribution of his mentors and col-
leagues, whose great insight curated this book in its current shape.
The author would also like to acknowledge Dr. Mo’ath AlShawabkeh for his
great insight regarding additions of high yield topics.
Figures within chapters are mostly created with BioRender.com, a web-based
tool specifically designed for life-science figures.
ix
Contents
1 Introduction and Pre-exam Eye Yield . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
1.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
1.2 Constituents of Ocular Structures . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
1.3 Transport in Ocular Structures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
1.4 Glucose Metabolism . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
1.5 Refractive Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
1.6 Light Absorption . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
1.7 Structural Dimensions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
1.8 Ocular Muscles . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
1.9 Retina and Visual Pathway . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
1.10 Miscellaneous . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
2 Basics of Eyelids for Ophthalmology Board Exams . . . . . . . . . . . . . . . 9
2.1 Organization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
2.2 Appendages . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
2.3 Blood, Nerves, and Lymphatics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
2.3.1 Arterial Supply . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
2.3.2 Venous Drainage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
2.3.3 Lymphatic Drainage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
2.3.4 Nerve Supply . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
2.4 Muscles . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
2.4.1 Elevating Eyebrow (3 Muscles) . . . . . . . . . . . . . . . . . . . . . . . 14
2.4.2 Depressing Eyebrow (5 Muscles) . . . . . . . . . . . . . . . . . . . . . 14
2.5 Pathology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
3 Basics of Orbit for Ophthalmology Board Exams . . . . . . . . . . . . . . . . . 17
3.1 Dimensions and Constituents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
3.1.1 Orbital Walls . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
3.1.2 Orbital Margins . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
3.2 Relations and Connections . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
3.3 The Orbital Septum and Associated Structures . . . . . . . . . . . . . . . . . 21
3.4 Pathology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
3.4.1 Atrophy of Globe . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
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xii Contents
4 Basics of Lacrimal System for Ophthalmology Board Exams . . . . . . . 25
4.1 The Lacrimal Production System . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
4.2 Tear . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26
4.3 The Lacrimal Drainage System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28
4.4 Pathology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30
5 Basics of Conjunctiva for Ophthalmology Board Exams . . . . . . . . . . . 33
5.1 Gross Anatomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
5.2 Histology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
5.3 Blood, Nerves, and Lymphatics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34
5.3.1 Arterial Supply . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34
5.3.2 Nerve Supply . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35
5.3.3 Lymphatic Drainage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35
5.4 Tenon Capsule . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35
5.5 Pathology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35
5.5.1 Inflammatory Conjunctivitis . . . . . . . . . . . . . . . . . . . . . . . . . 36
5.5.2 Degenerative Lesions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36
5.5.3 Neoplastic Lesions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37
6 Basics of Cornea and Limbus for Ophthalmology Board Exams . . . . . 39
6.1 Corneal Layers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39
6.2 Corneal Content . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41
6.3 Dimensions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41
6.4 Innervation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42
6.5 Cornea Metabolism . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42
6.6 Limbus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43
6.7 Pathology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45
6.8 Corneal Dystrophies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46
6.9 Inflammation and Infection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48
6.9.1 Bacterial Keratitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48
6.9.2 Herpes Viral Keratitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48
6.10 Peripheral Ulcerative Keratopathy . . . . . . . . . . . . . . . . . . . . . . . . . . . 50
6.11 Metabolic Syndromes Affecting the Cornea . . . . . . . . . . . . . . . . . . . 50
6.12 Congenital Anomalies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52
6.13 Miscellaneous . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52
7 Basics of Sclera for Ophthalmology Board Exams . . . . . . . . . . . . . . . . 55
7.1 Gross Anatomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55
7.2 Histology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56
7.3 Pathology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57
7.3.1 Inflammatory Diseases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57
7.3.2 Congenital Diseases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58
7.3.3 Degenerative Diseases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58
8 Basics of Uveal Tract for Ophthalmology Board Exams . . . . . . . . . . . . 59
8.1 Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59
8.2 Iris . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59