The Ophthalmology section provides the most common eyed disorders tested in the USMLE, COMLEx, Medical School, and Residency. for Providing educational resources for students who are interested in the medical field, medical school, and medical professionals. Learn ahead and have fun.

Eye Muscles

Superior rectusElevation
CN3 – Superior
Inferior RectusDepression
CN3 – Inferior
Medial RectusAdduction of eye (CN3 – inferior)Superior ObliqueIntorsion
Lateral RectusAbduction of eye (CN 6)Inferior ObliqueExtorsion


  • Presentation:
    • Burning, itching, excessive tearing, red/swollen eyelids, crusting/flaking, light sensitivity, blurred vision, +/- conjunctival infection
  • Cause:
    • Anterior: eyelashes (MC Seborrhea or S. aureus)
    • Posterior: inner lid & meibomian glands (MC Rosacea or S. aureus)
  • Management:
    • Chronic disorder:
      • Educate
      • Warm compress, lid massage to express glands, lid washing
      • Antibiotics:
      • -Mild: topical azithro 1 %
    • Severe:
      • Oral antibiotics

clubtable / Public domain


  • Presentation:
    • Painless, progressive, visual impairment, typically bilateral, poor night vision, difficulty reading fine print
  • Cause:
    • Opacity of the lens of the eye. Cataract Sx is the MC performed Sx in the US. Leading cause of blindness. MC >65 y/o.
  • Acquired:
    • from systemic dz (DM), Trauma, Toxic (Steroids)
      Congenital: Hereditary, early embryonic (transplacental) damage (MC Rubella)
  • Risk:
    • Increased risk: Ageing, Sun exposure, radiation exposure, smoking
  • Management:
    • Definitive: refer for surgery – Standard Extracapsular Cataract Extraction (ECCE)
    • CI: uncontrolled glaucoma, macular degeneration

Rakesh Ahuja, MD, CC BY-SA 3.0, via Wikimedia Commons


  • Presentation:
    • Rubery, painless non tender nodular lesion that may distort vision if pressing on the cornea
  • Cause:
    • Obstruction of meibomian glad causing inflammation/lesion
      May occur following a hordeleum
  • Management:
    • Warm compress, usually resolves in a few months
    • Refer for Incision and Curettage if persistent


Bacterial Conjunctivitis
  • Presentation:
    • Unilateral, eyelids stuck together in the morning, not itchy, conjunctival swelling, mild photophobia, discomfort, mucopurulent discharge w/ yellow crusting,
    • Lasts 10-14 days
  • Cause:
    • MC: S. aureus, Moraxella catarrhalis, H. Influenzae
  • Management:
    • Erythromycin Ointment or Trimethoprim-polymyxin B drops
      IF Contacts: Ofloxacin to cover pseudomonas

Viral Conjunctivitis
  • Presentation:
    • begins unilaterally and progresses to bilateralitchy, fever, sore throat, foreign body sensation, watery dischargecobblestoning palpebral conjunctiva,
      Lasts 7-10 days
  • Cause:
    • MC: Adenovirus
  • Management:
    • Patient education (very contagious), cold compress, artificial tears (3-5 x day)

Corneal Abrasion

  • Presentation:
    • Severe Pain, photophobia, foreign body sensation
  • Cause:
    • Caused by traumatic events from foreign body or contact lenses
  • Physical Exam:
    • Assess: visual acuity loss, penlight – pupils, fundoscopic – confirm red reflex
  • Diagnosis:
    • Fluorescein Stain, do this after above exams to confirm diagnosis
  • Management:
    • Differentiate b/w abrasion & ulceration

Corneal Ulcer

  • Presentation:
    • Pain, photophobia, tearing, decreased visual acuity, circumcorneal inje purulent or watery discharge
  • Diagnosis:
    • Fluorescein Stain


  • Presentation:
    • Pain, tenderness, swelling, redness in the tear sac area or lacrimal gland area, purulent discharge
    • If chronic: MC is mucopurulent drainage
  • Cause:
    • Congenital or acquired infection of the nasolacrimal system
    • MC in infants & adults >40y/o
    • Acute: S. aureus or GABHS
    • Chronic: S. epidermidis or C. albicans
  • Complications:
    • Periorbital Infections & Sepsis
  • Management:
    • Congenital:
      • usually resolves, but can do probe or nasolacrimal intubations
    • Acute:
      • Blood & drainage cultures, oral abx (IV if orbital cellulitis) 
      • Clindamycin and Vancomycin, +/- Sx
    • Chronic:
      • Topical Tobramycin 3 to 5 days, 
      • Dacryocysthrinostomy, +/- nasolacrimal intubation


  • Presentation:
    • dry, painful eye with excessive tearing (epiphora), redness, chronic conjunctivitis, keratitis
  • Cause:
    • Turning out of edge of eyelid so inner surface is exposed
      Causes: Facial palsy, Age, Scaring, Down’s syndrome
  • Complications:
    • Corneal abrasions, ulcers, infections, light sensitivity, decreased vision
  • Management:
    • Artificial tears
    • Symptomatic
      • – tighten eyelid


  • Presentation:
    • Decreased vision, excessive tearing/mucus, discomfort/pain, redness
  • Cause:
    • Turning in of edges of the eyelid (usually lower)
    • Can be acquired or congenital
    • Acquired: due to aging
      • 1. dehiscence of lower-lid from the inferior tarsal border
      • 2. horizontal lid laxity
      • 3. enophthalmos
    • Cicatricial: Scaring of palpebral/tarsal conjunctiva from Tacoma, chem burn, diseases or trauma
  • Management:
    • Artificial tears, tape eyelids
    • Symptomatic
      • – Botox A to paralyze orbicularis muscle


Acute Angle-Closure Glaucoma
  • Presentation:
    • Emergency! Leads to permanent blindness
    • Pain centered over eye
      First episode
    • Rapid onset unilateral pain & pressure, blurred vision, seeing halos/photophobia, peripheral to central vision loss, pupillary dilationsteamy cornea, fixed pupil, red eye (conjunctival injection)
  • Physical Exam:
    • Red Eye
    • Decreased visual acuity
  • Diagnosis:
    • IOP >21 & Cup to Disk >0.3
  • Management:
    • Timolol, Diamox, mannitol, laser iridotomy

Chronic Open Angle Glaucoma
  • Presentation:
    • usually asymptomatic & may be diagnosed accidentally during the exam. Slow, painless bilateral peripheral vision loss & poor night vision.
  • Cause:
    • MC types & characterized as chronic
  • Diagnosis:
    • Tonometry IOP >21, Cup to Disk >0.5
      Exam: Cupping of the optic disc with thinning rim
  • Management:
    • 1st line beta-blockers (timolol)
    • 2nd line: Prostaglandin analogs (Xalatan or Latanoprost)
    • Laser trabeculoplasty or open Sx

Herpes Keratitis

Conjunctival injection/erythema, swollen, painfulInfection of the corneaFluorescein stain (dendritic pattern)NEVER use steroids
Acyclovir PO
Topical trifluridine or idoxuridine (anti-herpetic)

Hordeolum (Stye)

Painful, Purulent nodular lesion of eyelidExternal: Abscess of hair follicle/external sebaceous gland
Internal: Abscess of meibomian gland (seen when eyelid is inverted)

MC acute bacterial (S. aureus)
1st line Topical Abx: Bacitracin, tobramycin, erythromycin
Warm Compress

2nd Line: Oral/IV Abx to prevent orbital cellulitis
Incision & Drainage if no improvement in 48 hours


Photophobia, >21 mmHg IOP, decreased visual acuity, corneal blood staining, enlarged/misshapen pupilBlood in the anterior chamber following trauma or coagulopathyProtection & Bed rest at 30 degrees
Beta blocker or carbonic anhydrase inhibitor

Macular Degeneration

Gradual Bilateral loss of central vision, difficulty driving/readingMCC of blindness in elderly in USAmsler Grid
Dry (10%):
– Macular atrophic changes w/ ageing
– Drusen (yellow retinal deposits)

Wet (90%):
– Neovascular changes cause macular degeneration
– More rapid and severe
– Supportive: Vit A, C, E, Zinc and Beta Carotene

– Intravitreal injections (ranibizumab, bevacizumab or aflibercept)
– Anti-VEGF
– Laser

Optic Neuritis

Painful acute monocular vision loss, slow pupillary responseAcute inflammation & demyelination of the optic nerve
MRI to confirm demyelinationMethylprednisolone IV, Neuro eval

Orbital Blow-out Fracture

protrusion or impingement of orbital fat, Diplopia, enophthalmosOrbital fracture from trauma to eye globe or orbital rim
Causes EOM entrapment and nerve damage –> paralysis of gums, upper lip, cheek
CTSurgery w/in 10 days

Orbital Cellulitis

decreased mobility, pain with eye movement, proptosisInfection of the extraocular muscles & periorbital fat
MC in younger children
Polymycrombial infection MC Staph/Strep sp. may be fungal.

Secondary to other infections: Sinusitis, orbital trauma, eye sx, dacryocystitis, tooth infection, facial infection, inner ear infection, mucocele
CT to confirm orbital involvementCombo IV Abx
Vanco + Ceftriaxone or Cefotaxime

Periorbital Cellulitis

No visual changes, No pain with eye movementInflammation of eyelid and surrounding skin. More beningn than Orbital CellulitisCT to confirm orbital involvementCombo IV Abx
Vanco + Ceftriaxone or Cefotaxime


Benign growth, yellow color, does not grow onto the cornea


Benign vascular corneal growth starting from nasal conjunctiva –> cornea. Triangular appearanceArtificial tears,

Surgical removal if:
– Obstructs vision, decreased eye movement, persistent irritation, cosmetic

Retinal Artery Occlusion

Amaurosis Fugax, Sudden unilateral visual loss, cherry red macula, pale optic nerveAcute occlusive disease of retinal artery, MCC is ruptured carotid plaque100% O2 therapy, ocular massage, acetazolamide (decrease ocular pressure), thrombolytic

Retinal Vein Occlusion

Branch RVO: often asymptomatic

Central RVO: Sudden blurry or loss of vision in one eye, “blood and thunder” appearance
Hemi RVO
2nd MCC of Retinopathy (after DM)Ranibizumab, Intravitreal steroids, thrombolytics, Sx (Vitrectomy)

Retinal Detachment

Painless visual field loss associated with location of detachment.

Small: Floaters or flashing lights

Large: “Curtain coming down”
Spontaneous: DM, extreme myopia
Tear or degradation of retina: DM, Retinopathy, vitreous invasion
w/o tear: Ophtho follow-up

w/ tear: Sx reattachment, laser, cryotherapy, injection of expandable gas, sclera buckler


Amblyopia (lazy eye)
– Esotropia: eye turns towards nose
– Exotropia: eye turns outward
– Hypotropia: eye turns down
– Hypertropia: eye turns up
Eyes move in different directions sending different images to the brainRetinal detachment or EndophthalmitisGlasses, surgery to achieve binocular vision & alignment

Thrombosis of Cavernous Sinus

Same as orbital cellulitis plus Fever, Ptosis, Chemosis (conjunctival edema) & Palsy of any one of the involved CN, visual loss or diplopia, venous drainage may be impairedInfection of the sphenoid sinus & internal carotid artery, CN III, IV, V & VI. Infection can spread to contralateral cavernous sinus & Intracranial.Emergency Abx & Surgery of sinus