As we get close to another cycle of exams, deciding on how and what to review can be more challenging than the effort of reviewing.

Realistically, there is no feasible way to cram the whole of ophthalmic knowledge in the next 1-3 months to perform well on an exam. Hopefully this time is spent reviewing and solidifying knowledge we’ve accumulated previously, and not attempting to learn concepts for the first time!

So as you gear up for this next cycle of studying, here are a few ideas on how to review:

Review Conditions That Integrate Multiple Concepts

Concepts that force you to recall basic ocular anatomy, physiology, related diseases, and pharmacology are excellent review topics. Take the time to quiz yourself about even the most fundamental elements to solidify your knowledge.

Example: Orbital Apex Syndrome

Orbital apex syndrome is a great example of a clinical constellation of findings that helps us localize the patient’s problem to a single location. While I’m not going to get into a lot of the details, recall that in lesions that affect the orbital apex, the optic nerve, superior and inferior divisions of CN III, the nasociliary branch of V1, CN VI, and sympathetic and parasympathetic nerves to the eye are affected. This causes vision loss, ophthalmoplegia (preserving CN IV/superior oblique function), ptosis (sympathetic and parasympathetic paralysis), anisocoria (sympathetic and parasympathetic paralysis), and eye pain and/or anesthesia. Proptosis may be present. Many conditions can lead to orbital apex syndrome, including thyroid orbitopathy and other orbital inflammation (nonspecific orbital inflammation, IgG4-related disease, sarcoidosis, etc.), orbital tumors, etc.

So in just remembering what orbital apex syndrome is and the differential diagnosis, we can also review the following concepts (not a comprehensive list, I’m sure there are other topics too!):

Anatomy of the orbital apex
- Annulus of Zinn
- Structures that pass through the Annulus of Zinn
- Structures that pass above the Annulus of Zinn
- Course of the optic nerve
- Blood supply of the optic nerve
- Course of CN III, IV, V1, and VI
- Course of parasympathetic and sympathetic nerves
Physiology
- Function of the cranial nerves and ocular autonomic nerves
Clinical presentations (and the differential diagnosis, workup, and management)
- Proptosis
- Unilateral vision loss
- Neurogenic ptosis
  - CN III palsy
  - Horner syndrome
- Unilateral ophthalmoplegia
- Ocular pain and/or anesthesia
- Neurotrophic keratopathy
Specific diseases associated with orbital apex syndrome
- Orbital inflammation
  - Thyroid orbitopathy
  - Nonspecific orbital inflammation
  - IgG4-related disease
  - Sarcoidosis
  - Giant cell arteritis
  - ANCA-associated diseases
- Orbital neoplasms
  - Orbital lymphoma
  - Optic nerve sheath meningioma
  - Langerhans cell histiocytosis
  - Orbital xanthogranulomas

As you can see, there’s a lot of different things that can be reviewed within a single topic! This approach can make your reviewing more efficient, and help you “connect the dots.”

Review Multidisciplinary Conditions

There are some conditions we encounter in different subspecialties. A disease may affect multiple parts of the eye, necessitating multiple specialties assisting in the management of the disease. Not only are these conditions more likely to be tested (easier question fodder), but knowing all of these diseases' ocular and periocular manifestations is critical for us as ophthalmologists.

Example: Sarcoidosis

Sarcoidosis is a systemic disease that may affect the eye and periocular structures in many ways, with diverse presentations. Here are just a few examples:

Orbit: orbital granulomas
Eyelid: eyelid granulomas
Conjunctiva: granulomatous conjunctivitis
Cornea: calcific band keratopathy
Anterior segment: anterior uveitis
Glaucoma: uveitic glaucoma
Iris: granulomatous iris nodules
Lens: cataract
Vitreous: vitritis
Retina: retinitis, perivascular inflammation, macular edema, choroiditis
Optic nerve: optic neuritis, optic nerve granulomas
Neurological: increased intracranial pressure (leading to papilledema), granulomas in cerebral cortex, brainstem, or along cranial nerves

I found it helpful to organize disease manifestations anatomically, anterior to posterior, as it helps me systematically work through the presentation of these diseases.

Look Up Example Images And Diagnostic Test Results

There are thousands of excellent example images of most ophthalmic diseases or concepts. While many of those images may be copyright protected, the protection is typically for reproduction and distribution, not for personal study/education. That means that in most cases (exceptions are typically noted on the copyright licenses), you can use the images for your personal study. Of course, there are caveats, such as ensuring that the images you find are accurately labeled.

Because all of the exams we take in learning ophthalmology will have questions in which visual recognition of a disease or interpretation of a diagnostic test is required, I believe that quizzing with images is a very effective study method.

Hope those are helpful tips! Do you have any other review tips? Leave a comment below or message me on social media or send me a message!