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Ophthalmology MBBS - Complete Syllabus & Strategy Guide

Exam Pattern (CBME Curriculum)

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Full MBBS Ophthalmology Syllabus (Topic-wise)

1. Anatomy & Physiology of the Eye (OP1)

• Anatomy of the globe, orbit, extraocular muscles, optic pathway
• Physiology of vision, aqueous humor, lens, retina
• Visual pathway lesions and their field defects
• Auditory & visual evoke potentials

2. Examination Techniques (OP Practical Core)

• Visual acuity - Snellen chart, LogMAR, pinhole test, near vision, color vision
• Perimetry - confrontation, Goldman, Humphrey automated
• Tonometry - applanation (Goldmann), non-contact, Schiotz
• Gonioscopy - open vs closed angle
• Slit lamp biomicroscopy
• Fundus examination - direct & indirect ophthalmoscopy
• Retinoscopy and refraction
• Central corneal thickness

3. Refractive Errors (OP1)

• Myopia, hypermetropia, astigmatism, presbyopia, anisometropia
• Correction: spectacles, contact lenses, refractive surgery (LASIK, PRK)
• Pin hole test mechanism

4. Eyelids (OP2)

• Chalazion vs hordeolum (stye)
• Blepharitis (anterior and posterior)
• Ptosis - types, causes, Herring's law
• Entropion / ectropion
• Trichiasis / distichiasis
• Orbital cellulitis - preseptal vs postseptal
• Lid tumors - sebaceous cell carcinoma, BCC
• Xanthelasma

5. Conjunctiva (OP3)

• Red eye differential (conjunctivitis vs uveitis vs glaucoma vs keratitis)
• Acute bacterial, viral (adenoviral EKC), allergic conjunctivitis
• Trachoma - WHO grading (TF, TI, TS, TT, CO), blinding trachoma
• Vernal keratoconjunctivitis - cobblestone papillae, shield ulcer
• Pterygium vs pinguecula
• Subconjunctival hemorrhage
• Symblepharon / ankyloblepharon

6. Cornea (OP4)

• Corneal ulcer - bacterial, fungal, viral (HSV - dendritic ulcer), Acanthamoeba
• Interstitial keratitis
• Corneal degeneration (Fuchs', band keratopathy, Salzmann's)
• Corneal dystrophies (Granular, Lattice, Macular - mnemonic: GLM)
• Keratoconus
• Penetrating keratoplasty (PK) - indications, graft rejection
• Descemetocele

7. Sclera (OP5)

• Episcleritis vs scleritis
• Anterior vs posterior scleritis
• Associations with systemic diseases (RA, GPA)

8. Uvea/Uveitis (OP6)

• Anatomy of uveal tract (iris, ciliary body, choroid)
• Anterior uveitis (iritis/iridocyclitis) - KPs, flare, cells
• Posterior uveitis - choroiditis, pars planitis
• Panuveitis
• Granulomatous vs non-granulomatous uveitis
• Causes: HLA-B27 diseases, sarcoidosis, TB, toxoplasmosis, syphilis
• Complications: posterior synechiae, iris bombe, cataract, glaucoma
• Treatment: topical/systemic steroids, mydriatics, immunosuppressants

9. Lens & Cataract (OP7)

• Anatomy and metabolism of lens
• Cataract - types (nuclear, cortical, posterior subcapsular, congenital)
• Causes: aging, diabetes, steroid, radiation, trauma, uveitis
• Surgical techniques: ECCE, PHACO (phacoemulsification), SICS
• IOL types and power calculation (SRK formula)
• Complications: posterior capsule opacification (PCO), Nd:YAG laser capsulotomy
• Congenital cataract: red reflex absent, leukocoria/white pupillary reflex

10. Vitreous

• Vitreous hemorrhage - causes, management
• Posterior vitreous detachment (PVD)
• Endophthalmitis - post-op, endogenous; treatment (intravitreal antibiotics)

11. Glaucoma (OP8)

• IOP, aqueous humor dynamics (production, outflow via trabecular and uveoscleral)
• Primary open angle glaucoma (POAG) - silent, triad: raised IOP + cupping + field defect
• Primary angle closure glaucoma (PACG) - acute attack: red eye + hard eye + hazy cornea + mid-dilated fixed pupil + halos
• Normal tension glaucoma
• Secondary glaucoma - steroid-induced, neovascular, lens-induced
• Optic disc cupping - C:D ratio > 0.6, notching, RNFL loss, Bjerrrum scotoma
• Visual field defects in glaucoma
• Drugs: beta-blockers (timolol), prostaglandin analogues (latanoprost), carbonic anhydrase inhibitors (acetazolamide), alpha-2 agonists (brimonidine), pilocarpine
• Surgery: trabeculectomy, laser PI (iridotomy)
• Acute angle closure emergency: IV acetazolamide + IV mannitol + topical + laser PI

12. Retina (OP9)

• Diabetic retinopathy (DR) - NPDR vs PDR; classification; laser photocoagulation; anti-VEGF
• Hypertensive retinopathy - Keith-Wagener-Barker grading
• Retinal detachment (RD) - rhegmatogenous vs tractional vs exudative; Shafer's sign (tobacco dust); treatment - scleral buckle, vitrectomy
• CRVO / CRAO - flame hemorrhages in all 4 quadrants (CRVO) vs cherry red spot (CRAO); emergency management
• Age-related macular degeneration (AMD) - dry (drusen) vs wet (neovascular, anti-VEGF)
• Retinitis pigmentosa - night blindness, bone spicule pigmentation, tunnel vision
• Retinoblastoma - leukocoria, genetics (RB1 gene, 13q14), hereditary vs sporadic
• Macular hole, epiretinal membrane
• Coats disease

13. Optic Nerve & Neuro-ophthalmology (OP10)

• Visual pathway lesions - know the chart cold:
  • Monocular blindness = optic nerve
  • Bitemporal hemianopia = optic chiasm (pituitary adenoma)
  • Homonymous hemianopia = optic tract / radiation
  • Macular sparing = occipital cortex
• Papilledema vs optic neuritis vs papillitis
• AION vs NAION
• Optic atrophy - primary vs secondary vs consecutive
• Pupil reflexes - RAPD (Marcus Gunn pupil), Argyll Robertson pupil, Horner syndrome
• Third nerve palsy - surgical (posterior communicating artery aneurysm) vs medical (DM)
• Sixth nerve palsy - false localizing sign

14. Squint (OP11)

• Comitant vs incomitant squint
• Amblyopia - "lazy eye", critical period, treatment (patching)
• Cover test, Hirschberg test
• Esotropia / Exotropia
• Pseudosquint (epicanthal folds)
• Paralytic squint - diplopia, head tilt

15. Ocular Trauma (OP12)

• Chemical injury - alkali worse than acid; immediate copious irrigation (most important first step)
• Mechanical trauma - hyphema, lens subluxation, vitreous hemorrhage
• Blowout fracture of orbit - diplopia on upgaze, enophthalmos, periorbital emphysema
• Penetrating vs perforating injury
• Sympathetic ophthalmia
• Foreign body removal

16. Ocular Emergencies

17. Orbit (OP13)

• Orbital cellulitis - classification (Chandler's)
• Cavernous sinus thrombosis - signs
• Proptosis - axial vs non-axial; causes
• Thyroid eye disease (Graves orbitopathy) - lid lag, lid retraction, proptosis, optic nerve compression
• Orbital tumors (capillary hemangioma, dermoid, lymphoma)

18. Ocular Pharmacology (PH1.58)

19. Community Ophthalmology

• Blindness - causes in India (cataract #1, glaucoma, trachoma, refractive error)
• National Programme for Control of Blindness (NPCB)
• Vitamin A deficiency - Bitot's spots, night blindness, xerophthalmia, keratomalacia
• School vision screening

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Exam Strategy

Book Selection

• 1st choice: Parson's Diseases of the Eye (for Indian MBBS - most exam-oriented)
• Kanski's Clinical Ophthalmology (available in library - excellent clinical images, 10th edition)
• Wills Eye Manual (available in library - concise emergency/clinical reference)
• For MCQs: A.K. Khurana's Review or Ruchi Rai's MCQ book

Time & Priority Distribution

How to Study Each Topic (5-step method)

1. Anatomy first - draw the eye, mark relevant structures (aids long-term memory)
2. Pathophysiology - understand the mechanism (e.g., angle closure = aqueous outflow blocked)
3. Clinical features - symptoms + signs + specific findings (e.g., KPs in uveitis, Shafer's sign in RD)
4. Investigations - what to order and what you'll find
5. Management - medical first, then surgical; know the emergency drug doses

Short Notes Most Frequently Asked (prepare these as templates)

• Diabetic retinopathy (classification + treatment)
• Acute angle closure glaucoma (pathophysiology + emergency management)
• Retinal detachment (types + surgical treatment)
• Corneal ulcer (bacterial vs fungal vs viral)
• Retinoblastoma (genetics + presentation + management)
• Cataract surgery (PHACO technique + IOL power)
• Trachoma (WHO grading + blinding trachoma)
• Papilledema vs Optic neuritis
• Visual field defects (draw the diagram!)
• Amblyopia

Practical/Clinical Viva Tips

• Always know the clinical signs for each condition (e.g., "what will you see on slit lamp in uveitis?")
• Practice the cover-uncover test and Hirschberg's test for squint
• Know how to use direct ophthalmoscope - settings for red reflex, fundus examination
• Memorize Snellen chart principles and pinhole test rationale
• Visual field confrontation - must demonstrate in OSPE/viva

Diagrams to Draw Perfectly

• Anatomy of the eye (cross-section)
• Visual pathway and field defects
• Fundus in diabetic retinopathy (draw flame hemorrhages, hard exudates, NVD)
• Fundus in CRVO vs CRAO
• Cup-disc ratio and glaucomatous cupping
• Stages of retinoblastoma (Reese-Ellsworth or IIRC classification)

Mnemonics

• RAPD: Relative Afferent Pupillary Defect - swinging flashlight test
• Glaucoma triad: Raised IOP + Optic disc cupping + Visual field loss
• Red eye causes: 5Cs - Conjunctivitis, Corneal ulcer, iritis (Chamber), acute angle Closure, subConjunctival hemorrhage
• Vitamin A deficiency stages: Night blindness → Xerosis → Bitot's spots → Keratomalacia
• DR grading: mild NPDR → moderate → severe (4-2-1 rule) → PDR (NVD/NVE)

30-Day Study Plan Outline

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Key Sources

• Kanski's Clinical Ophthalmology: A Systematic Approach, 10th Ed. (in textbook library)
• The Wills Eye Manual (in textbook library - excellent for emergencies and clinical diagnosis)
• NMC/MGMUHS CBME Ophthalmology Curriculum (official competency list)
• Parson's Diseases of the Eye (standard Indian MBBS reference)