Peshawar Medical College
Curriculum of Ophthalmology
Student’s study guide
2012-13
Exit Competencies (Year 03 & year 04)
The competencies are graded into four categories described below;
Category A:Be able to diagnose and treat in emergency:
This category refers to emergency conditions that require an urgent provisional
diagnosis and appropriate referral after emergency treatment.
Category B:Be able to diagnose and manage:
This category includes conditions that the students must be able to diagnose and
appropriately manage after graduation.
Category C:Be able to make provisional diagnoses and refer appropriately:
This category includes clinical conditions that are rare or complicated and require
advanced knowledge of the subject which is beyond the competence level of the
medical graduate. The student would be expected to make a provisional diagnosis of
the clinical condition & refer appropriately. Appropriate referral means making a
provisional diagnosis and referring to the appropriate physician or surgeon with proper
documentation of his/ her clinical findings, investigations, diagnosis and reason for
referral. This implies that he/she would be able to equip him/herself with the knowledge
of the clinical presentation and line of management for the condition. Specific treatment
of the condition is considered to be beyond the competence of a medical graduate.
Category D:Briefly describe:
This category refers to clinical conditions that are considered as “ nice to know” for the
medical graduate. This means that the student would have some knowledge of the
subject.
Category A: Diagnose and treat in emergency
By the end of 4th year MBBS the students would be able to diagnose
the following conditions, provide initial treatment and refer
appropriately:
1. Orbital cellulitis
2. Lid abscess
3. Lid laceration
4. Acute Dacryocystitis
5. Open Globe Injury (OGI)
6. Close globe injury (CGI)
7. Hyphaema
8. Chemical burns of the eye
9. Superficial conjunctival foreign body
10. Ophthalmia neonatorum
11. Corneal ulcer
12. Acute Congestive Glaucoma
Category B: Be able to diagnose and manage
By the end of 4th year MBBS the students would be able to diagnose &
manage the following conditions:
1.
2.
3.
4.
5.
6.
An uncomplicated case of bacterial, allergic & viral conjunctivitis.
Subconjunctival haemorrhage (uncomplicated)
Blepharitis
Stye
Trachoma
Superficial corneal foreign body/Abrasion
Category C: Be able to make provisional diagnosis and refer
appropriately
By the end of 4th year MBBS the students would be able to make a
provisional diagnosis of the following diseases/ conditions and refer
appropriately for specific treatment:
1. Ectropion
2. Entropion
3. Trichiasis
4. Chalazion.
5. Ptosis
6. Blocked NLD in a child
7. Chronic Dacryocystitis
8. Refractive error
9. Squint
10. Presbyopia
11. Pterygium
12. Allergic conjunctivitis
13. Red eye (from various causes)
14. Superficial corneal foreign body
15. Keratitis
16. Cataract .
17. Congenital or developmental cataract in a child
18. Leukocoria in children
19. Glaucoma (adults)
20. Congenital Glaucoma
21. Papilloedema
22. Optic atrophy
23. Anterior uveititis
24. Diabetic retinopathy & other diabetic ocular disorders.
25. Eye disorders due to hyperthyroidism (Graves’s disease)
26. Vitamin A Deficiency Disorders in children, adolescents and adults.
27. Endophthalmitis and Panophthalmitis
28. Retinal detachment???
29. Central retinal artery occlusion & Central retinal vein occlusion ???
Category D: Briefly describe:
By the end of 4th year MBBS the students would be able to briefly
describe the following conditions:
1. Prevalence and prevention of common health problems related to ophthalmology
in the community.
2 . Basal cell carcinoma and squamous cell carcinoma of the lids
3 . Differential diagnosis of painless and painful acute visual loss
4 . Differential diagnosis of gradual visual loss
5 . Differential diagnosis of night blindness
6 . Corneal dystrophy.
7 . Corneal oedema.
8 . Keratoconus.
9 . Malignant melanoma in the eye.
1 0 . Retinal detachment
1 1 . Retinoblastoma.
1 2 . Relationship between eye and systemic diseases.
1 3 . Refractive surgery.
1 4 . Uses of various LASERS in ophthalmology.
Skill competencies
The graduate would be able to perform the following independently with
professionalism (4):1. Obtain an elaborate clinical history of an ophthalmic case and record it in the
standardized format (4).
2. Perform assessment of visual acuity for distance and near (4)
3. Perform assessment of anterior segment of the eye with a torch (4)
4. Perform examination of the lids with a torch (4)
5. Perform Lacrimal Regurgitation test (4)
6. Perform upper lid eversion (4)
7. Examine pupil and its reactions to light and accommodation (4)
8. Recognize and characterize strabismus by performing Hirschberg (corneal
reflection) test, cover test and ocular movements (4).
9. Assess intraocular pressure by digital tonometry (4)
10. Use direct ophthalmoscope and perform Distance Direct Ophthalmoscopy
(DDO), recognize optic disc atrophy/pallor and Papilloedema with it.
11. Perform visual field assessment by confrontation method (4)
12. Instill eye drops & eye ointments (4)
13. Stain a corneal ulcer with flourescein (4)
14. Irrigation of the eye in case of spillage of a chemical into the eye (4)
15. Counsel a patient (4)
16. Provide health education to the patient and the attendants(4)
The graduate would have observed (2):1. Assessment of colour vision by Ischihara charts(2)
2. Applanation tonometry(2)
3. Refraction(2)
4. Slit lamp examination(2)
5. Indirect ophthalmoscopy(2)
6. Biometry(2)
7. Measurement of proptosis by ruler(2)
8. Preoperative preparation of the patient for ophthalmic surgery under local/
general anesthesia cataract surgery(2)
9. Surgery for cataract(2)
10. Sterilization of surgical instruments and linen items(2)
11. Scrubbing in theatre(2)
12. Patient cleaning, toweling and draping before surgery(2)
13. Organization of patient notes for admission and surgery(2)
14. Filling of investigation forms for a patient(2)
15. Reading of CT scan and MRI scans of the brain (visual pathway) and orbit(2)
The graduate must have a basic understanding of how the following
procedures are performed (1)
16. Lacrimal sac lavage/ wash-out(1)
17. Automated perimetry(1)
18. Corneal transplantation(1)
Outline of the Ophthalmology Module for 3rd year MBB
Title
1.
2.
3.
Learning outcome
Introduction to the eye & By the end of the session the students would be
ophthalmology
able to:
1. Define blindness , visual impairment/ low vision
according to the WHO- ICD-10 classification
Blindness
By the end of the session the students would be
able to:
1. Critically evaluate the definition & its
socioeconomic implications
2. Describe the global burden of blindness & visual
impairment.
3. Identify the major causes of blindness at global,
national level and local levels.
Review of clinical
anatomy & physiology of
the eyelids & common
infective and
inflammatory disorders
of the eyelids
4.
Disorders of position of
the eyelids & the eyelid
margin
By the end of the session the students would be
able to:
1. Correlate the structure of the eyelids with
their functions and clinical presentation in
common infective and inflammatory
disorders.
2. Define stye, chalazion, trichiasis &
blepharitis.
3. Differentiate between stye & chalazion on
the basis of clinical presentation and
describe the treatment.
By the end of the session the students would be
able to:
Content
TLM
Assessment
-
Definition
WHO classification
interactive
LGF
MCQs
-
Epidemiology
Magnitude
Causes
Prevention
interactive
case-based
LGF
MCQs
Lids
Gross Anatomy
Microscopic structure
Clinical presentation,
complications & treatment of
Infections; stye
Disorders of Lid margin;
Blepharitis
Chalazion
- Differential between stye &
chalazion
interactive
case-based
LGF
MCQs
SEQ
OSCE
-
interactive
case-based
LGF
MCQs
SEQ
OSCE
-
1. Define the various disorders of
malposition of the lids
2. Classify ectropion, entropion & ptosis &
correlate their clinical presentation with
the underlying structural and functional
disorder
3. Identify the complications of ectropion,
entropion & ptosis
Disorders
1LGF
of lid position
Classification, clinical
presentation, complications
and treatment of Ectropion,
entropion, ptosis, lid lag
4. Outline the management of ectropion,
entropion & ptosis
5.
Review of clinical
anatomy & physiology of
the orbit & categories of
orbital diseases &
symptomotology
By the end of the session the students would be
able to:
-
1. Correlate the structural organization of the
orbit with its functions and clinical
significance
2. Categorize orbital diseases
3. Correlate the common symptoms & signs of
orbital diseases with the underlying
structural and functional disorder
-
6.
Clinical evaluation in
orbital disordersOrbital cellulitis &
blowout fracture
7.
Review of clinical
anatomy & physiology of
the lacrimal system & its
clinical evaluation
By the end of the session the students would
be able to
1. Outline the protocol for the clinical
evaluation of a patient with orbital
disorder
2. Differentiate between preseptal and
true orbital cellulitis
3. Explain why it is considered to be an
ocular emergency
4. Describe the causes, clinical
presentation, complications & line of
management of orbital cellulitis
5. Explain the mechanism of blow-out
fracture of the orbit, describe its clinical
presentation, complications & outline
the management
By the end of the session the students would be
able to:
1. Correlate the structure of the lacrimal
system with its functions and clinical
presentation in common clinical disorders.
-
-
Anatomy of orbit
interactive
Anatomical dimensions,
case-based
important openings of the
LGF
orbit, orbital walls, relations of
the orbit, contents of the orbit,
orbital fascia and spaces,
radiographic anatomy of the
orbit, X-rays, CT and MRI scans
Classification of orbital
disorders
Common symptoms and signs
in orbital diseases
MCQs
1LGF
Clinical evaluation of a case of
orbital disease
Orbital cellulitis
Orbital fractures
interactive
case-based
LGF
SEQs
MCQs
Anatomy, Physiology &
Congenital disorders of
Lacrimal system.
Evaluation of a case of
epiphora.
interactive
case-based
LGF
MCQs
SEQ
2. Outline the clinical examination protocol
for the assessment of lacrimal system in a
patient presenting with epiphora.
8.
9.
By the end of this session the students would
be able to:1. Diagnose a case of acute and
Acute & chronic
chronic dacrocystitis, congenital
dacrocystitis &
nasolacrimal duct blockage; enlist
congenital NLD blockage
their complications & outline the
management.
By the end of this session the students would
be able to;
1. Correlate the structure of the
conjunctiva with its functions and
clinical presentation in common clinical
Review of clinical
anatomy & physiology of
disorders
the conjunctiva
2. Identify important anatomical
landmarks on conjunctival photographs
and histological microphotographs.
10.
Classification of diseases
of the conjunctiva;
Pterygium & dry eyes
1. Classify diseases of the conjunctiva
2. Identify the common symptoms and
signs of conjunctival diseases
1. Enlist the causes & risk factors of
conjunctivitis.
2. Differentiate between bacterial, viral,
chlamydial and allergic conjunctivitis
on the basis of clinical presentation.
3. Describe the associated complications,
treatment and prevention strategies
for each type of conjunctivitis.
3. Identify Pterygium on photographs,
describe its pathogenesis, complications
and treatment.
4. Describe the clinical presentation of dry eyes,
-
-
-
Infections & Inflammation of
Lacrimal
1LGF
Sac; acute and chronic
interactive
dacrocystitis
case-based
Cong & acquired N.L.D.
LGF
blockage
Management of Epiphora
Anatomy of conjunctiva
Clinical presentation &
classification
-
Infective disorders; clinical
presentation, complications, treatment
& differential of allergic, viral ,
bacterial & trachomatous conjunctivitis
Prevention
Clinical presentation , complications
and treatment of pterygium
Dry eyes, causes, clinical presentation,
complications and treatment
interactive
case-based
LGF
MCQs
SEQ
OSCE
MCQs
SEQ
OSCE
interactiv MCQs
e caseSEQ
based LGF OSCE
correlate it with the underlying structural and
functional abnormality, describe its
complications and outline the treatment.
11.
Review of clinical
anatomy & physiology of
the cornea
By the end of this session the students would
be able to;
1. Correlate the structure of the
cornea with its functions.
2. Identify important topographic
landmarks of the cornea & describe
the normal anatomical & functional
parameters of the cornea i.e.
corneal diameter, thickness,
curvature, refractive power.
3. Describe the factors responsible for
the transparency of the cornea.
4. Describe the process of healing of a
corneal abrasion/ ulcer and the
clinical significance of the limbal
stem cells in this process.
12.
Corneal ulcer
1. Identify the sign & symptoms of
common corneal disorders
2. Diagnose a case of corneal ulcer,
differentiate between bacterial, viral,
fungal & nutritional corneal ulcer.
3. Describe the principles of treatment for
bacterial, viral , fungal and nutritional
corneal ulcer
Gross and microscopic Structure
of the cornea with its functions.
Important topographic
landmarks of the cornea &
normal anatomical & functional
parameters of the cornea i.e.
corneal diameter, thickness,
interactive
case-based
curvature, refractive power.
LGF
Factors responsible for the
transparency of the cornea.
The process of healing of a
corneal abrasion/ ulcer and the
clinical significance of the limbal
stem cells in this process.
4. Common symptoms and
signs of corneal diseases
5. Clinical presentation of
corneal ulcer, ;bacterial,
viral, fungal & nutritional
corneal ulcer.
6. Clinical evaluation of a
case of corneal ulcer
7. Principles of treatment
for bacterial, viral ,
fungal and nutritional
corneal ulcer
interactiv
e casebased LGF
MCQs
SEQ
OSCE
13.
Introduction to clinical
anatomy and physiology
of the lens
14.
Cataract
15.
1. Correlate the structure of the lens with
its functions.
2. Define cataract, describe its
epidemiology & enlist various
classification systems for cataract
3. Classify cataract on the basis of
aetiology & morphology
Structure of the lens & its
functions
Definition of cataract
Epidemiology & classification of
cataract
By the end of this session the students would
be able to;
4. Diagnose a case of cataract; describe
the complications of cataract in children and adults.
5. Describe the surgical procedures for the
treatment of age-related cataract and
enlist the complications of cataract
surgery.
By the end of this session the students would
be able to:
1. List the routes of administration of
drugs used in ophthalmic practice
2. Describe the rationale for using various
routes
3. Correlate the structure & function of
Therapeutics:
ocular structures with
Introduction to general
pharmacodynamics of drugs used in
principles & definitions
ophthalmic practice to achieve
as applied to ophthalmic
optimum concentration & effect of
practice
drugs
4. Identify commonly used ocular local
anaesthetics, mydriatics and stain used
for diagnostic and therapeutic purposes
& describe their clinical uses and
adverse effects.
interactiv MCQs
e caseSEQ
based LGF
Clinical presentation of case of
Cataract in children and adults
2LGF
Clinical Evaluation
Treatment & its surgical
complications
interactive
case-based
LGF
MCQs
SEQs
OSCE
Principles of Therapeutics
Routes of administration of
drugs
Common ophthalmic drugs.
interactive
LGF
MCQs
SEQs
16.
Therapeutics:
Antibiotics & steroids in
Ophthalmic practice
17.
Clinical approach to
Refractive errors
By the end of this session the students would
be able to;
1. Describe the indications for various
types of antibiotics used in
ophthalmological practice, enlist their
side effects.
2. Describe the indications for various
types of steroids used in
ophthalmological practice, enlist their
side effects
By the end of this session the students would
be able to;
1. Correlate optics with the various types
of refractive errors
2. Describe the clinical presentation of
refractive errors
3. Describe the clinical protocol for the
assessment of refractive errors
-
-
-
Antibiotics
Commonly used antibiotics in
ophthalmic practice
1 LGF
Indications and side effects
Steroids
Commonly used steroids in
ophthalmic practice
Indications and side effects
Clinical optics
1 LGF
Refractive errors
Clinical Presentation
2LGF
Clinical evaluation
Treatment
interactive
LGF
MCQs
SEQs
OSCE
interactive
LGF
MCQs
SEQs
18.
End-of-Module
Assessment
19.
50 MCQs + 05 SEQs ( CBQs)
By the end of the session the students would
be able to:
Ophthalmic history
and examination
protocol
20.
Clinical Assessment of
pupils
1. Obtain an elaborate clinical history of an
ophthalmic case and record it in the
standardized format
2. Perform assessment of visual acuity for
distance and near
3. Perform Lacrimal Regurgitation test
Ophthalmic history taking and
recording in the standardized format
Practical
Ocular examination protocol
session
Assessment of visual acuity
Lacrimal regurge test
By the end of the session the students would Physical examination of the pupils
Direct light reflex, indirect light
be able to:
1. Examine pupil and its reactions to light and reflex & swinging light reflex
accommodation
Practical
session
OSCE
OSCE
21.
By the end of the session the students would
be able to:
Ocular motility
1. Recognize and characterize strabismus by
performing Hirschberg (corneal reflection)
test, cover-cover-uncover-alternate cover
test and ocular movements
Ocular motility assessment
Hirschberg test
Cover; cover/uncover test
Ocular movements
Assessment of accommodation &
convergence; estimation of NPC &
NPA
Practical
session
OSCE