Course Content
👁️ Station 1 — Ophthalmic History Taking
• Take a structured history from a patient presenting with an ocular complaint. • Identify the chief ocular complaint and its duration. • Explore relevant associated ocular symptoms. • Obtain relevant previous ocular, medical and treatment history. • Present the important findings of the ocular history in a concise clinical format.
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Topic: 👁️ Station 1 — Ophthalmic History Taking
🔤 Station 2 — Visual Acuity Examination
• Correctly position the patient and visual-acuity chart. • Assess distance visual acuity in each eye separately. • Record visual acuity correctly. • Use pinhole assessment where appropriate. • Interpret an abnormal visual-acuity result.
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Topic: 🔤 Station 2 — Visual Acuity Examination
🔦 Station 3 — Pupillary Examination
• Inspect pupil size, shape and symmetry. • Assess direct pupillary light reflex. • Assess consensual pupillary light reflex. • Assess the pupillary response systematically. • Recognize an abnormal pupillary response.
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Topic: 🔦 Station 3 — Pupillary Examination
👀 Station 4 — Visual Field Examination by Confrontation
• Position the patient correctly for confrontation testing. • Examine each eye separately. • Assess the major visual-field quadrants systematically. • Compare the patient's visual field with the examiner's field. • Identify the presence of a gross visual-field defect.
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Topic: 👀 Station 4 — Visual Field Examination by Confrontation
🔬 Station 5 — Slit-Lamp and Anterior Segment Examination
Integrated KMU activities: 5. Slit-Lamp Examination 6. Anterior Segment Examination Learning Objectives The student should be able to: • Identify the major parts/components of a slit lamp. • Explain the basic purpose of slit-lamp examination. • Position the patient appropriately. • Examine the anterior segment systematically using the slit lamp. • Identify important anterior-segment structures during examination.
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Topic: 🔬 Station 5 — Slit-Lamp and Anterior Segment Examination
🩺 Station 6 — Direct Ophthalmoscopy and Fundus Examination
• Demonstrate correct handling of the direct ophthalmoscope. • Position themselves and the patient appropriately. • Perform direct ophthalmoscopy systematically. • Visualize the optic disc and retinal background. • Describe important fundus findings seen during examination.
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Topic: 🩺 Station 6 — Direct Ophthalmoscopy and Fundus Examination
📊 Station 7 — Interpretation of Common Ophthalmic Investigations
The student should be able to: • Identify a presented ophthalmic investigation. • Describe the basic information provided by OCT. • Interpret common visual-field findings. • Recognize the role/output of ocular biometry. • Interpret basic B-scan findings. • Recognize FFA and corneal-topography images and state their clinical use.
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Topic: 📊 Station 7 — Interpretation of Common Ophthalmic Investigations
👁️ Station 8 — Ptosis Examination
• Inspect a patient with suspected ptosis. • Compare eyelid position between both eyes. • Perform a systematic clinical assessment of ptosis. • Identify important abnormal findings. • Record and communicate the findings appropriately.
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Topic: 👁️ Station 8 — Ptosis Examination
👓 Station 9 — Examination of Common Lid Abnormalities
• Examine the eyelids systematically. • Recognize ectropion. • Recognize entropion. • Identify chalazion. • Identify stye. • Differentiate common lid abnormalities from one another on clinical examination or photographs.
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Topic: 👓 Station 9 — Examination of Common Lid Abnormalities
👁️ Station 10 — Proptosis Examination
• Recognize the presence of proptosis. • Compare both eyes for symmetry. • Perform a structured ocular examination in a patient with proptosis. • Assess relevant associated ocular findings. • Present the examination findings systematically.
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Topic: 👁️ Station 10 — Proptosis Examination
💧 Station 11 — Topical Anaesthesia, Fluorescein Staining and Corneal Assessment
• Demonstrate appropriate use of topical ocular anaesthesia. • Demonstrate fluorescein staining of the ocular surface. • Examine the stained cornea appropriately. • Identify a superficial corneal abnormality/foreign body when presented. • Explain the purpose of corneal scraping in suspected corneal infection.
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Topic: 💧 Station 11 — Topical Anaesthesia, Fluorescein Staining and Corneal Assessment
💦 Station 12 — Lacrimal Regurgitation Test
• Explain the purpose of the lacrimal regurgitation test. • Position the patient appropriately. • Perform the test correctly. • Observe for reflux from the lacrimal puncta. • Interpret a positive or negative result.
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Topic: 💦 Station 12 — Lacrimal Regurgitation Test
🚨 Station 13 — Ocular Trauma and Chemical Eye Injury First Aid
• Perform an initial assessment of an ocular-trauma patient. • Identify the need for urgent eye first aid. • Demonstrate immediate management of chemical eye injury. • Perform appropriate eye irrigation/eye wash. • Explain essential precautions during initial ocular-trauma management.
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Topic: 🚨 Station 13 — Ocular Trauma and Chemical Eye Injury First Aid
🔍 Station 14 — Optic Disc Examination: Normal, Glaucomatous and Swollen Disc
• Identify and describe a normal optic disc. • Examine or interpret the optic disc systematically. • Recognize features of a glaucomatous disc. • Recognize a swollen optic disc. • Differentiate a normal disc from major abnormal disc appearances.
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Topic: 🔍 Station 14 — Optic Disc Examination: Normal, Glaucomatous and Swollen Disc
🩸 Station 15 — Retinal Lesions and Retinal Vascular Disease
• Inspect a retinal photograph/fundus image systematically. • Detect common retinal abnormalities. • Recognize common retinal vascular abnormalities. • Differentiate common retinal vascular conditions from one another. • Describe the important visual findings presented.
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Topic: 🩸 Station 15 — Retinal Lesions and Retinal Vascular Disease
⚠️ Station 16 — Recognition of Retinal Detachment
• Recognize retinal detachment in a clinical image. • Describe the abnormal retinal appearance. • Distinguish detached retina from a normal retinal appearance. • Identify retinal detachment as a significant cause of visual loss. • Communicate the finding clearly in an OSCE setting.
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Topic: ⚠️ Station 16 — Recognition of Retinal Detachment
📈 Station 17 — Tonometry and Glaucoma Assessment
• Identify the Goldmann applanation tonometer. • Explain the purpose of tonometry. • Describe the basic method of Goldmann tonometry. • Interpret an intraocular-pressure reading in the clinical context. • Relate tonometry to assessment of glaucoma.
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Topic: 📈 Station 17 — Tonometry and Glaucoma Assessment
🌫️ Station 18 — Cataract Examination and Recognition
• Perform a basic ocular assessment for cataract. • Recognize the presence of cataract on ocular examination. • Describe the abnormal lens appearance. • Differentiate a clear lens from a cataractous lens. • Recognize adult and congenital cataract when presented clinically or visually.
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Topic: 🌫️ Station 18 — Cataract Examination and Recognition
↔️ Station 19 — Extraocular Movements and Ocular Motor Examination
• Inspect ocular alignment. • Examine extraocular movements systematically. • Test the major directions of gaze. • Identify limitation of ocular movement. • Recognize an abnormal ocular-motility pattern during examination.
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Topic: ↔️ Station 19 — Extraocular Movements and Ocular Motor Examination
🔁 Station 20 — Squint Examination: Cover Tests and Squint Pattern
• Assess ocular alignment. • Perform the cover test. • Perform the uncover test. • Perform the alternate-cover test. • Identify the presence of manifest or latent deviation from the examination. • Differentiate an esotropia pattern from an exotropia pattern.
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Topic: 🔁 Station 20 — Squint Examination: Cover Tests and Squint Pattern
AIM OSPE/OSCE Lab — Ophthalmology Module | 4th Year MBBS
AIM OSCE / OSPE • MBBS • 4th Year • Eye

Station 15 — Retinal Lesions and Retinal Vascular Disease

Rapid Revision • Practical Skills • Viva

🎯 Candidate Task

Inspect the provided retinal photograph/fundus image systematically. Describe the important abnormalities, identify the most likely retinal or retinal vascular condition, and state the visual features that support your interpretation.

⚡ Model Station Answer

  • I would inspect the optic disc, macula, retinal vessels and all visible retinal quadrants systematically.
  • I would look specifically for haemorrhages, microaneurysms, hard exudates, cotton-wool spots, vascular calibre changes, venous tortuosity, retinal pallor and neovascularization.
  • Diabetic retinopathy is suggested by microaneurysms, dot-blot haemorrhages and exudates; hypertensive retinopathy by arteriolar narrowing, AV nicking and flame haemorrhages.
  • CRVO produces widespread retinal haemorrhages with dilated tortuous veins, whereas CRAO classically shows a pale retina with a cherry-red macular spot.

🔎 How to Perform / Approach

1
Identify the image. Confirm that it is a fundus/retinal photograph and identify the eye if this is indicated.
2
Inspect the optic disc. Note colour, margins and any disc swelling or abnormal vessels.
3
Assess retinal vessels. Compare arterial and venous calibre, tortuosity, narrowing, AV crossing changes and vascular obstruction patterns.
4
Inspect the retina systematically. Look for microaneurysms, flame or dot-blot haemorrhages, cotton-wool spots, hard exudates, pallor and neovascularization.
5
Assess the macula. Look for exudation, haemorrhage, oedema-related changes or a cherry-red spot.
6
Interpret the pattern. Combine the distribution and type of retinal and vascular abnormalities, then state the most likely diagnosis clearly.
Exam technique: Describe what you can actually see before naming the diagnosis. A structured description scores better than immediately guessing the condition.

🖼️ Visual Learning

VISUAL 1

Comparison of Common Retinal Vascular Abnormalities

 

 

📝 Important Viva Questions

1. What is the earliest clinically visible lesion of diabetic retinopathy?

Answer: A retinal microaneurysm is the earliest clinically visible lesion.

2. What is the difference between a flame-shaped and a dot-blot retinal haemorrhage?

Answer: Flame haemorrhages lie superficially in the retinal nerve-fibre layer, whereas dot-blot haemorrhages occur in deeper retinal layers.

3. Which fundus finding is classically associated with central retinal artery occlusion?

Answer: A pale ischemic retina with a characteristic cherry-red spot at the fovea.

4. What are the characteristic fundus features of central retinal vein occlusion?

Answer: Dilated tortuous retinal veins with widespread retinal haemorrhages, often accompanied by disc oedema and cotton-wool spots.

5. Name two important vascular changes seen in hypertensive retinopathy.

Answer: Generalized arteriolar narrowing and arteriovenous crossing changes such as AV nicking are important findings.

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