Ophthalmology Course for Medical Students
Dr Hisham Jammal, FRCSEd
Description of the course: During fifth year teaching students will be with the ophthalmology unit for a concentrated two weeks block.
The general aims of the course are twofold:
1- firstly to introduce the students to common ophthalmic conditions, ensuring that they can competently examine the eye and adnexae and perform ophthalmoscopy
2- secondly to help them understand the relevance and importance of ophthalmic signs as part of systemic disease which they will have covered in previous years.
The timetables have been established to permit them to cover a broad aspect of ophthalmology, loosely attached to consultant clinics and closely liaising with the senior resident in that clinic. Each day there will be seminars from 8.00 to 9.00 am at KAUH. Students will be divided into four equal groups, rotating between eye clinics at KAUH, Princess Basma teaching hospital, and the ward at KAUH.
Objectives: The following describes both the aims of the ophthalmology attachment and what students are expected to know or be able to do by the end of the attachment:
1. Acquire basic knowledge in the anatomy and physiology of the eye, adnexae and orbit.
2. Obtain a complete history from the patient and/or relatives and understand the significance of symptoms elicited.
3. Assessment of visual acuity in both adults and children
4. Specialist examination of the eye including pupil responses, direct ophthalmoscopy, ocular movements and visual field examination.
5. Assessment of acute red eyes due to inflammation and injury.
6. Performing minor procedures such as examination of the lids and eversion of the upper lid and removal of sub?tarsal foreign bodies.
7. Assessment and management of conditions which give rise to sudden loss of vision.
8. Discussion of the medical conditions related to both venous and arterial occlusion of the retinal vasculature.
9. Assess and discuss the management of common causes of gradual loss of vision and visual handicap. These include cataract and glaucoma.
10. Discussion of diabetes, diabetic retinopathy, its treatment and the importance of screening for diabetic retinopathy.
11. Discussion of the management of ophthalmic presentations of systemic disease such as hyper and hypo?thyroidism, pituitary tumours, connective tissue disorders including rheumatoid arthritis, hypertension and malignancy.
The following is a list of the most common ophthalmic conditions the course is expected to cover at a level of a medical student.
- TRAUMA: Subtarsal foreign body, Corneal foreign body, Corneal abrasion, Penetrating injury, Hyphaema, Intraocular foreign body
- LIDS AND LACRIMAL SYSTEM: Hordoleum (Stye), Chalazion Etropion, Ectropion, Sticky eye in an infant, Acue dacryocystitis, Blocked nasolacrimal duct/mucocele of lacrimal sac
- NEURO?OPHTHALMOLOGY: Papilloedema, Optic atrophy, Paralytic squint, Pupillary disorders.
- ACUTE RED EYE: Conjunctivitis, Dendritic ulcer, Corneal ulcers due to other causes, Acute iritis, Acute angle closure glaucoma.
- MEDICAL EYE CONDITIONS: Central retinal artery occlusion, Central retinal vein occlusion, Hypertensive retinopathy, Diabetic retinopathy, Dysthyroid eye disease.
- MISCELLANEOUS EYE CONDITIONS: Cataract, Chronic open angle glaucoma, Secondary glaucoma, Age related macular degeneration, Choroidal naevus, Choroidal melanoma, Retinal detachment, Concomitant (non?paralytic)squint, divergent convergent High Myopia, Herpes Zoster. Clinical Tasks Vision Assessment of visual Acuity with Snellen Chart, Assessment of vision in children
EXAMINATION OF THE EYE: Pen torch examination of anterior segment, Pupil responses, Ophthalmoscopy, Red reflex, Neuro Ophthalmology, Ocular movements and ocular alignment. Visual Fields Minor Procedures Examination of Lids with eversion, Removal of subsarsal corneal foreign body,
- OTHERS: Management Care of child with squint/amblyopia, Care of patient with cataract, Care of patient with glaucoma, Care of patient with diabetic retinopathy, Care of patient of age related macular degeneration.
Lectures
- Sunday: General anatomy and physiology, History and physical examination in Ophthalmology.
- Monday: Eyelids and Orbit.
- Tuesday: Glaucoma and common Neuro-ophthalmic disorders.
- Wednesday: Squint.
- Thursday: Cataract and Uveitis.
-Sunday: Cornea and refractive errors.
- Monday: Retinal disorders.
- Tuesday: Ophthalmic emergencies.
- Wednesday: Ocular trauma.
ASSESSMENT: At the end of the block students will be assessed by short case clinical examination and/or clinical slides. The student's knowledge will be assessed in the following aspects as feasible:
A. History of presenting complaint and relevant medical history.
B. Examination findings.
C. Management or Management plan.
D. Relevant social impact to patient.
E. Long term prognosis; with discussion of relevant present knowledge for such conditions.
F. The ability to elicit major signs.
Marks are distributed as follows: Attitude, attendance and participation 20% End of block examination 20% Seminar 20% Final MCQ exam 40% Requirements These are evident from previous sections of the syllabus.
Students are required to prepare for the seminars in advance, and to participate actively in the discussion. In the clinic, they are required to learn and master certain tasks (see clinical tasks). On the teacher’s side, a multimedia data show with a PC is required for demonstration of different clinical conditions.
REFERENCES
a) ABC of Eyes ? A R Elkington, P T Khaw
b) Basic Ophthalmology (for medical students and primary care physicians) Frank Berson, American Academy of Ophthalmology
c) Lecture Notes on Ophthalmology ? B James, Chew & A Bron
d) Clinical Ophthalmology ? J Kanski e) Atlas of Clinical Ophthalmology ? Spalton
