Cumulative Flashcards
1
Q
Carotid cavernous fistula is caused by?
And what is the triad?
A
Closed head trauma, spontaneous ruptured carotid aneurysm and high pressure blood from carotid posterior to globe
Triad
1) chemosis
2) pulsatile proptosis
3) ocular bruit
2
Q
Hyperthyroid systemic symptoms
A
Heat intolerance
Weight loss
Palpitations
sweating
Irritability
3
Q
Thyroid function tests
A
TSH
T4
T3
TSI
4
Q
Which hormones are increased in hyperthyroidism?
A
T3 & T4
TSI
T3: triiodothyronine
T4: thyroxine (total and free)
TSI: thyroid-stimulating immunoglobulin
5
Q
True or false
TSH is high in hyperthyroidism
A
FALSE!!!
* TSH is low while T3, T4 and TSI are high
6
Q
NO SPECS is a mnemonic for the eye findings in which disease?
A
Grave’s disease
NO SPECS
N: no signs or symptoms
O: only signs
S: soft tissue involvement (s/s)
P: proptosis
E: extra ocular muscle involvement
C: corneal involvement (SLK)
S: sight loss (optic nerve compression)
7
Q
TED mostly affects what age and gender?
A
females 30-40 years old
8
Q
True or false
Tolosa hunt syndrome leads to painful external ophthalmoplegia
A
TRUE
*inflammation of the orbital apex and anterior cavernous sinus
9
Q
Dalrymple’s sign
A
Widened palpebral fissure due to upper eyelid retraction in thyroid disease
10
Q
Globe lags behind upper lid on up gaze in thyroid disease
A
Kocher’s sign
11
Q
Lid lag on down gaze in thyroid disease
A
Von Graefe’s sign
12
Q
TED ocular signs (name at least 5)
A
Eyelid retraction
Edema
Lagophthalmos
Lid lag
Reduced blinking
Superficial keratopathy
Conjunctival injection
Exophthalmos
EOM limitations
(+) forced duction
Decreased VA
Decreased color vision
RAPD
VF defects
13
Q
Tx for optic neuropathy secondary to Grave’s disease
A
- Immediate treatment with oral steroids
- Orbital decompression for compressive optic neuropathy
* performed by oculoplastic surgeon
14
Q
Tolosa-hunt syndrome
A
Rare, idiopathic orbital inflammation of cavernous sinus + superior orbital fissure = acute painful external ophthalmoplegia
15
Q
Tx for corneal exposure due to eyelid retraction, lagophthalmos and reduced blink rate in TED
A
- AT’s up to q1h
- Ointment QHS
- lid taping or moisture chamber goggles at bedtime
- punctal occlusion for severe dry eyes
- permanent lateral tarsorryhaphy or canthorrhaphy for lateral chemosis or widened lateral palpebral fissure
16
Q
Steven Johnson syndrome is what type of hypersensitivity reaction?
A
Type 4
- hypersensitivity to drug/infectious agent
- sulfonamides= pseudoblistering of conjunctiva (BM intact, inflammation below)
- amoxicillin and Augmentin can cause SJS
17
Q
Basal cell carcinoma is more common in males or females?
A
Males
* fair skin
* UV exposure
18
Q
Pt with hx of chronic unilateral chalazia should be evaluated for what?
A
Sebaceous gland carcinoma
* F>M
* malignancy of sebaceous glands, highly infiltrative + inflammatory, high mortality rate
19
Q
What is the most lethal primary skin cancer of the melanocytes?
A
Malignant melanoma
20
Q
True or false SCC is more aggressive than BCC
A
TRUE
* 2nd most common eyelid malignancy
* M>F
21
Q
What conjunctival lesion is the precursor to SCC of the conjunctiva?
A
Conjunctival intraepithelial neoplasia (CIN)
* looks gelatinous and white near limbus
* can lead to SCC
* mostly in elderly white males, heavy smokers, UV radiation, HPV
22
Q
Phlyctenules are what type of hypersensitivity reaction?
A
Type 4!!
* in teenage girls
* located at limbus
* ask about Hx TB
* hypersensitivity reaction to staph blepharitis, goes away in ~14 days
* associated with rosacea
23
Q
Yoked and Fresnel prisms are for near or distance?
A
Near
24
Q
Reverse telescopes are used for?
A
Ambulating
*increase field of view
25
Patient wants to be able to read 20/40 letters on a bus, what is the most appropriate power of a telescope to meet this goal?
OD: +4.00 -2.00 x090 distance 20/100, near 20/100 @ 40cm
OS: +4.00 -2.00 x 000 VA 20/400 distance, near 20/400 @ 40cm
2.5X telescope
Steps to solve:
1) take denominator of can read and divide it by want to read
100/40 =2.5
2) 2.5X telescope will allow pt to see 20/40 without decrease in FOV
26
What is the inheritance pattern of Coat’s disease?
None,
It’s idiopathic, non-hereditary
27
S/S of Coats disease (name at least 3)
Leukocoria
Strabismus
Nystagmus
Decreased VA
Pain
Iris heterochromia (because of NVI)
28
If Coat’s disease is left untreated, how would the disease progress?
1. Lead to end stage total exudative RD and neovascular glaucoma
2. Can cause blind and painful eye
3. Enucleation
29
Coats disease can lead to what type of retinal detachment?
Exudative RD
30
What is an adverse prognostic factor related to histological features in choroidal melanomas?
Large number of epithelioid cells (vs. spindle cells)
## Footnote
Epithelioid cells are associated with a worse prognosis compared to spindle cells.
31
What pigmentation characteristic is associated with a worse prognosis in choroidal melanomas?
Lack of pigmentation
## Footnote
Tumors that lack pigmentation tend to be more aggressive.
32
Why will an RD located superiorly be more likely to spread than an RD located inferiorly?
Because of gravity
* emergency! Refer to retinal specialist ASAP
33
At what gestational age does the retinal vasculature reach the nasal periphery?
8 months gestation
34
At what age does the retinal vasculature reach the temporal periphery in normal gestation?
1 month after birth
35
Choroidal melanoma
36
Choroidal nevus
37
Myelinated nerve fiber layer can be associated with what ocular conditions?
Amblyopia
Strabismus
Nystagmus
Myopia
Optic neuritis
Neovascularization of the retina
38
Tx for toxocariasis
Prednisone
* Tx intraocular inflammation caused by death of toxocara larva and eye reaction immunologically to the antigens released
39
What lab tests helps confirm toxocariasis?
ELISA
* toxocara ELISA testing
40
Inheritance pattern of Stargardt
Autosomal recessive
41
ERG and EOG in best disease
Normal ERG
Abnormal EOG
42
What does EOG measure?
Potential between bruch’s membrane (RPE) and cornea
43
ERG and EOG in Stargardt
Normal ERG and EOG
45
GPC shows what two types of hypersensitivity reactions?
Type I and Type IV
46
GPC symptoms
Contact lens intolerance
Blurred vision
Excessive lens movement with blinking
Pruritis and mucous production
* general discomfort develops 2-3 years after previously tolerating contacts well
47
GPC diagnosis is characterized by the presence of?
Large papillae located on the upper tarsal conjunctiva
*associated with Hx of CL wear
48
What is the pathophysiology of GPC?
Immune reaction to denatured protein deposits
Mechanical irritation for the superior tarsal conjunctiva
Discontinue CL use
Tx with pataday, switch to dailies
49
Tx and RTC for GPC
1. Discontinue CL wear
2. Mast cell stabilizer example: oloptadine 1 gtt OU bid for 2 weeks
3. Switch to dailies or hydrogen peroxide based solution for cleaning CLs
RTC 2-4 weeks
50
Tx for contact dermatitis
1. Determine and remove offending agent (ex: new make up, eye cream, lotion)
2. Cool compress
3. PF AT’s and topical antihistamine/ mast cell stabilizer combo
4. Topical steroid cream for eyelids (dexamethasone 0.05% bid or tid for 5 days)
* oral antihistamine like Benadryl can be added
51
RTC for contact dermatitis
1 week
52
What skin lesion is a precursor to SCC of the eyelids?
Actinic keratosis
* occur on inferior eyelid/ sun exposed areas of skins
* older white patients
*squamous cell carcinoma occurs due to excessive proliferation of the stratum spinosum (cell division should not occur at this layer, that’s why SCC is more invasive than BCC)
53
What are the layers of the skin epidermis from superficial to deep?
**Superficial**
Stratum corneum
Stratum lucidum
Stratum granulosum
Stratum spinosum (abnormal for cell division, SCC occurs in this layer)
Stratum basale (normal for cell division, BCC occurs in this layer)
**Deep**
54
What does a positive Jones 1 test mean?
Patent punctum and no blockage
55
If Jones 1 is negative what is the next step?
Irrigate with saline
56
Saline irrigation in Jones 2 demonstrates reflux of fluid through the same punctum, where is the blockage?
Upper/lower canaliculus blockage
57
Saline irrigation in Jones 2 shows retrograde flow through opposite canaliculus, where is the blockage?
Nasolacrimal duct
58
Saline irrigation in Jones 2 patient tastes saline/ recover in nose, what does that mean?
Blockage is cleared
59
HSV dosage for acyclovir
400mg po 5x/day for 7 days
60
HZO dose for acyclovir
800mg 5x/day for 7 days
61
HSV dosage for valacyclovir
500mg TID po for 7 days
62
HZO dose for valacyclovir
1000 mg po TID for 7 days
63
AIDS medication Retrovir may cause what ocular conditions?
Amblyopia
Macular edema
64
Causes of whorl keratopathy
CHAI T
Chloroquine
Hydroxychloroquine
Amiodarone
Indomethacin
Tamoxifen
And Fabry’s disease
65
Which drugs can cause NAION? (4)
Amiodarone
Imitrex
Vardenafil
Viagra
66
Causes of bull’s eye maculopathy
Chloroquine
Hydroxychloroquine
Progressive cone dystrophy
Stargardt’s disease
Thioridazine
67
Name 2 commonly used aminoglycosides
Tobramycin
Gentamicin
68
Dosage for besifloxacin
TID to q1h
69
Name 2 commonly used macrolides
Azithromycin
Erythromycin
70
Cyclosporine drug class
(Restasis)
Immunomodulator
71
Keflex drug class
Cephalosporins
* Keflex is brand name for cephalexin
72
Tx for endogenous endophthalmitis caused by fungal Candida
- Systemic antifungal
- If moderate to severe inflammation: pars plana vitrectomy and intraocular injection of antifungal and steroid
- topical steroid and cycloplegic
- medical consultation
73
Fungal infections such as candidiasis mostly occur in what type of patients?
Immunocompromised
IV drug abusers
74
RTC for candidiasis
Daily
75
Oral antibiotics used to treat MRSA
* Bactrim (trimethoprim + sulfamethoxazole)
* Doxycycline
* Clindamycin
76
Intravenous antibiotics used to treat severe MRSA infections
Vancomycin
77
Bacteria that invades intact corneal epithelium
Corynebacterium diptheriae
Neisseria gonorrhoeae
Haemophilus
Listeria
*Canadian National Hockey League invades intact corneal epithelium*
78
Etiology of acanthamoeba keratitis
Contact lens wearers using nonsterile water or have poor CL cleaning habits
* patients who wore CL while in fresh water environments like lakes or in a hot tub
79
Signs for acanthamoeba keratitis
**Early**
1. Mild SPK, pseudo dendrite (will stain with FL)
*misdiagnosed as herpes simplex!
**Late stages** (3-8 weeks)
2. Ring ulcer and corneal melt
80
Tx for acanthamoeba keratitis
1. Discontinue CL wear
2. Polyhexamethylene biguanide q1h, chlorhexidine q1h, propamidine isethionate q1h or dibromopropamidine isethionate ointment
3. Can also use antifungal
4. Topical cycloplegic and oral NSAID for pain
RTC 1-4 days, then 1-3 weeks
Treatment for 3-12 months
81
What does ERG measure?
Electrical currents across the eye
*Cornea is positive relative to RPE
*when retina is stimulated, specific retinal cells become excited and firm the electrical wave that creates ERG
82
What is ocular histoplasmosis?
A retinal condition linked to a type of fungus known as Histoplasma capsulatum
83
What type of organism causes ocular histoplasmosis?
Histoplasma capsulatum
84
How is Histoplasma capsulatum contracted?
Through inhalation
85
Multiple sclerosis s/s
S/S:
Numbness
Fatigue
Muscle weakness
Optic neuritis
86
Syndrome with optic atrophy in one eye and disc edema in the fellow eye
Foster-Kennedy syndrome
*vision loss from intracranial mass compressing optic nerve, and papilledema in the other eye due to increased intracranial pressure
87
Tx for optic neuritis associated with MS
IV steroids
Followed by oral steroids along with interferon beta-1a treatment
*stabilize condition and reduced risk of progression of optic neuropathy for 2-3 years
88
What VF defects can optic neuritis cause?
**Altitudinal defect**
Overall depression central 30 degrees
Central/centrocecal scotoma
89
Demographic for MS
18-45 females
Raised in northern hemisphere
90
Hutchinson sign
Herpes zoster lesion on tip or side of nose
*signal development of ocular involvement
91
Shafer’s sign
Release of pigment into the vitreous chamber from retinal tear
* noted with sudden increase in floaters
92
Psoriasis Skin scale is removed and pinpoint bleeding occurs
Auspitz sign
93
What diagnostic testing do you order if you suspect ankylosing spondylitis?
1) CBC
2) ESR
3) HLA-B27
4) Sacroiliac spine radiograph
94
In which layer of the cornea do deposits accumulate in whorl keratopathy?
Epithelium
*yellow/brown or white
*located inferior to visual axis, spins outward
Associated with drug use:
**amiodarone** class 3 anti-arrhythmic
Chloroquine
Hydroxychloroquine
Indomethacin
Tamoxifen
95
Red cap desaturation test procedure
1. Pt wears best near correction, fully lit room
2. Better seeing eye is tested first, occlude weaker eye
3. Show patient red cap bottle and tell them this is 100%, then switch to weaker eye
4. Ask patient to compare level of saturation of red between the two eyes as a percentage from 100%
* perceived difference between the eyes of 20% or more = APD likely
96
True or false
Aspirin can make symptoms of tinnitus worse
TRUE
* tinnitus is caused by damage to hair cells in inner ear from exposure to excessive noise, medications (aspirin), aging and diseases
97
DBL + A =?
Frame PD
98
Minimum blank size equation
MBS = ED + TLD
ED: effective diameter
TLD: total lens decentration (TLD = |(A + DBL) - distance PD)
99
Which layer of the cornea is affected in acute hydrops in patients with keratoconus?
Descemet’s membrane
100
Transpose plus cyl into minus cyl form
OD: - 4.25 + 0.75 x 077
OS: - 4.00 + 1.00 x 098
OD: -3.50 - 0.75 x 167
OS: -3.00 - 1.00 x 008
101
What is the average annual progression rate for childhood myopia?
0.3 to 0.5 diopters per year
102
Is Positive relative accommodation indirect or direct measure of accommodation?
Indirect
* measures ability to increase accommodation while maintaining a clear, single binocular vision
* how much negative lens power tolerate before blur occurs at near target
Normal PRA -3.00
low PRA (early blur) = reduced accommodative ability (accommodative insufficiency or convergence excess)
High PRA (excessive minus tolerated) = overactive accommodation or accommodative spasm
103
Neomycin + poly B + dexamethasone
Maxitrol
104
Which IOP lowering drug class is contraindicated in patients with sickle cell?
Carbonic anhydrase inhibitors
*because they can cause metabolic acidosis, increase risk for hypoxia and exacerbate sickle cell retinopathy
105
Can a patient with sickle cell use acetazolamide to lower IOP?
**NO!!!**
Because it can cause metabolic acidosis
*this would make blood pH acidic and promotes red blood cell sickling
106
What is the Americans with Disabilities Act? (ADA)
Civil rights law that prohibits discrimination against individuals with disabilities. Ensures equal opportunities and access to public spaces, employment, and transportation.
107
Which drugs should be avoided in children and pregnant women because they damage blood marrow?
Methotrexate (immunomodulator)
Pyrimethamine (tx toxo)
Trimethoprim (+ sulfamethazine = Bactrim)
108
Methotrexate is used to treat what autoimmune and inflammatory diseases?
(MOA: folate antagonist)
Rheumatoid arthritis
Psoriasis and psoriatic arthritis
Inflammatory bowel disease
Lupus
Uveitis and scleritis
*can also be used as cancer treatment for lymphomas and leukemias
109
Which infectious disease is caused by inhalation of fungal spores from bird and bat droppings?
Histoplasmosis
110
What conditions can cause both unilateral and bilateral swollen nerves?
* Sarcoidosis
* TB
* Syphilis
* Lupus
## Footnote
These conditions affect the optic nerves.
111
What are the causes of premature cataracts?
Atopic Dermatitis, Diabetes, Myotonic Dystrophy, and Wilson's Disease
Mnemonic: Wilson is MAD about early cataracts
M: myotonic dystrophy
A: atopic dermatitis
D: Diabetes
## Footnote
These conditions can lead to early cataract formation.
112
How can swollen nerves be categorized?
Based on if the swelling is unilateral or bilateral
## Footnote
This classification helps in diagnosis.
113
What causes bilateral swollen optic nerves (papilledema)?
Increased intracranial pressure
## Footnote
This can be due to various systemic conditions.
114
What causes unilateral swollen nerves (papillitis)?
Complications anterior to the optic chiasm such as:
* Vascular (Diabetes, Central Retinal Vein Occlusions)
* Ischemic (NAION, AION)
* Compressive (Thyroid)
* Optic Disc Drusen
## Footnote
These factors lead to localized nerve swelling.
115
What medications can cause Pseudotumor Cerebri?
Accutane, Idiopathic, Nalidixic Acid, Oral Contraceptives, Tetracyclines, and Vitamin A
## Footnote
These substances are linked to increased intracranial pressure.
116
What causes retinal neovascularization and subsequent tractional retinal detachments?
Diabetic retinopathy, ocular ischemic syndrome, retinopathy of prematurity, sickle cell retinopathy, and vein occlusions
## Footnote
These conditions lead to abnormal blood vessel growth in the retina.
117
What are the causes of transillumination defects?
* Pigment dispersion syndrome
* pseudoexfoliation syndrome
* albinism
* herpetic uveitis
* trauma
* PCIOL intraocular surgery
118
What causes whorl keratopathy?
Amiodarone, Chloroquine, Hydroxychloroquine, Fabry's Disease, Indomethacin, and Tamoxifen, Amiodarone
## Footnote
These substances can lead to characteristic corneal changes.
119
What are the causes of hypopyon?
Bechet's Disease, VKH Syndrome, Endophthalmitis, Bacterial Keratitis, and Blebitis
## Footnote
Retinoblastoma may also cause a pseudohypopyon.
120
Which bacteria can invade the intact corneal epithelium?
Corynebacterium diphtheria, Haemophilus, Listeria, Neisseria gonorrhea, and Pseudomonas aeruginosa
## Footnote
These pathogens can lead to serious ocular infections.
121
Nalidixic acid MOA
Inhibits DNA gyrase
* can cause increased intracranial pressure —> pseudotumor cerebri
122
DEPRIVENS is the mnemonic for diseases that can cause cystoid macular edema, name them.
D: Diabetes
E: Epinephrine
P: Pars Planitis
R: Retinitis pigmentosa
I: Irvine-Gas’s
V: Vein Occlusions
E: E2-Prostaglandin
N: Nicotinic acid and Niacin
S: Surgery
123
Imitrex drug class, MOA, indication and ocular sequelae
Serotonin receptor agonists
MOA: vasoconstrictor of cranial blood vessels
Indicated for migraines and cluster headaches
Can cause NAION
124
What are the risk factors for retinal breaks?
High myopia, lattice degeneration, aphakia/pseudophakia, and trauma
## Footnote
These factors increase the likelihood of retinal detachment.
125
What mnemonic can be used to remember the causes of Angioid Streaks?
PEPSI: Pseudoxanthoma Elasticum, Ehlers Danlos, Paget's, Sickle Cell Disease, Idiopathic
## Footnote
Each letter of PEPSI corresponds to a specific condition that causes Angioid Streaks.
126
What are the causes of blue sclera? (4)
* Minocycline
* Ehlers Danlos Syndrome
* Rheumatoid Arthritis
* Scleritis
## Footnote
Blue sclera: scleral appears blue due to thinning and increased transparency of the scleral collagen, allowing the underlying darker choroid vasculature to show through
127
Name some causes of exudative retinal detachments. (5)
* Central Serous Retinopathy
* VKH Syndrome
* Optic Pits
* Morning-Glory Syndrome
* Coats Disease
## Footnote
Exudative retinal detachments can result from several syndromes and diseases.
128
What can cause bull's eye maculopathy?
* Chloroquine
* Hydroxychloroquine
* Progressive Cone Dystrophy
* Stargardt's Disease
* Thioridazine
## Footnote
Bull's eye maculopathy is associated with drug toxicity and genetic conditions.
129
List some causes of keratoconus.
T-DOME
* Turner Syndrome
* Down's Syndrome
* Osteogenesis Imperfecta
* Marfan's Syndrome
* Ehlers Danlos Syndrome
* Atopy, excessive eye rubbing
## Footnote
Keratoconus is a progressive eye disease that can be associated with these syndromes.
130
What are the causes of lens subluxation? (Name 4)
* Blunt trauma
* Marfan's Syndrome
* Homocystinuria
* Ectopia Lentis et Pupillae
* Hyperlysinemia
* Microspherophakia
* Sulfite Oxidase Deficiency
* Simple Ectopia Lentis
## Footnote
Lens subluxation can occur due to genetic conditions or trauma.
131
What can lead to macular thickening?
* Chronic intraocular inflammation
* Intraocular surgery
* Intraocular tumor
* BRVO
* Best's disease
* Retinitis pigmentosa
* Neuroretinitis
## Footnote
Rhegmatogenous retinal detachments do NOT cause macular thickening.
132
Name conditions associated with nyctalopia? (Name at least 3)
* Choroideremia
* Gyrate Atrophy
* Enhanced S-Cone Syndrome/Goldmann-Favre Syndrome
* Thioridazine Retinopathy
* Retinitis Pigmentosa
* Leber’s congenital amaurosis
## Footnote
Nyctalopia: night blindness
133
What can cause papillae?
* Allergies
* Bacteria
* Idiopathic
## Footnote
The presence of papillae can be due to allergic reactions or infections.
134
Capillary hemangioma
* most common BENIGN orbital tumors in children
* will spontaneously resolve/disappear by when the patient turns 10
135
Patient unhappy with vision through new glasses, what is the FIRST thing you should do?
Verify the prescription is correct via lensometer
136
Inheritance pattern for juvenile retinoschisis
X-linked recessive
*mostly affects males, females are carriers
137
4.5 year old white male
OD: +0.75 DS
OS: +1.00 DS
BCVA 20/50 OD, OS
Juvenile retinoschisis
* X-linked recessive
138
Pathophysiology of retinoschisis
Separation of nerve fiber layer from outer retinal layers
139
True or false
Highest incidence of retinoschisis is in African Americans
**FALSE**
highest incidence in caucasians
140
What are some causes of photophobia?
* Albinism
* Aniridia
* Aphakia/Pseudophakia
* Cataracts
* Macular degeneration
* Retinitis pigmentosa
## Footnote
Photophobia, or light sensitivity, can arise from various ocular conditions.
141
What is the legal doctrine known as respondeat superior?
A doctrine meaning 'let the master answer' where an employer is responsible for the actions of an employee.
142
Can a patient sue an optometrist directly for breaching confidentiality?
Yes, a patient can sue the optometrist for breaching confidentiality even if an employee made the disclosure.
143
What federal act can a patient file a complaint under for a violation of confidentiality?
Health Insurance Portability and Accountability Act of 1996 (HIPAA)
144
True or False: Patients can file private lawsuits under HIPAA.
False
145
Who may pursue a claim against an optometrist's office for a HIPAA violation?
The federal government
146
What may some states do in response to professional misconduct by an optometrist?
Take action against the optometrist personally.
147
What should be done if a breach of patient confidentiality occurs?
Get immediate legal counsel.
148
What is the best treatment for CME s/p yag cap
Topical steroid + topical NSAID
Example: 1 gtts ketorolac QID and 1 gtts prednisone acetate QID
149
What is the fluorescein angiography pattern for CME?
Small HYPERfluorescent spots in early phase with “flower petal” pattern of HYPERfluorescent in late stage
150
Chronic long standing CME can lead to?
Lamellar hole
*small fluid filled cystic spaces may fuse to form larger fovea cysts and coalesce and form a lamellar macular hole
* lamellar hole has poorer acuity and worse prognosis because it can cause irreversible damage to central vision
151
White without pressure is commonly observed in which region of the retina?
Inferior temporal
*at the location of the vitreous base and Ora serrata
152
Retinal dialysis
Retina torn from its insertion site at the Ora serrata
153
Signs of blunt trauma to eye
Retinal dialysis
Choroidal rupture
Commotio retinae
Berlin’s edema
Hyphema
Lens subluxation
Iridodialysis
154
Which population has the highest occurrence of white without pressure?
African Americans
155
Which ancillary procedure should be performed if you have a patient that has white without pressure?
Scleral depression
*check for retinal holes, tears, or retinal detachments
156
Cobblestone degeneration commonly found in which area of the retina?
Inferior temporal
157
Potential surgical treatments for keratoconus
Corneal cross-linking
Deep anterior lamellar keratoplasty
Penetrating keratopasty
158
Initial management of acute hydrops
1) Cycloplegic (reduce pain/photophobia)
2) Antibiotic (prophylactic to prevent infection)
3) hypertonic solution (reduce corneal edema)
**atropine**
**ciprofloxacin**
**sodium chloride (use once defect has healed)**
159
Tx interstitial keratitis
Strong steroid (Pred acetate)
*If herpes simplex keratitis treat with topical antiviral like trifluridine
160
Ocular HTN
* IOP > 21 mmHg with open angle + without optic neuropathy
161
Fill in the blank: The American Optometric Association (AOA) states that a breach of patient confidentiality can be the basis for a _______.
malpractice claim
162
What is MEGALOCORNEA?
Rare, x-linked condition in males with horizontal corneal diameter greater than 13 mm.
## Footnote
Common in Marfan's syndrome, Ehlers-Danlos, osteogenesis imperfecta. Associated with myopia, lens subluxation, angle abnormalities (glaucoma).
163
What is MICROCORNEA?
Rare, autosomal dominant condition with horizontal corneal diameter < 10 mm.
## Footnote
Associated with hyperopia and risk for angle closure.
164
What characterizes CORNEA PLANA?
Corneal curvature equal to scleral curvature (K ~ 20-30 D).
## Footnote
Associated with hyperopia, shallow anterior chamber, sclerocornea.
165
What is ANIRIDIA?
Partial or complete loss of iris tissue.
## Footnote
Associated with glaucoma, foveal hypoplasia, disc hypoplasia, choroidal coloboma.
166
What are HAAB'S STRIAE?
Horizontal cracks in Descemet's membrane due to congenital glaucoma.
## Footnote
Indicate increased intraocular pressure.
167
What is AXENFELD-RIEGER SYNDROME?
Developmental arrest of neural crest mesectoderm affecting anterior segment structures.
## Footnote
Type 1 has iridocorneal adhesions; Type 2 has lenticular-corneal adhesions.
168
What is POSTERIOR EMBRYOTOXON?
Anteriorly displaced Schwalbe's line.
## Footnote
Found in up to 15% of normal eyes.
169
What characterizes AXENFELD ANOMALY?
Posterior embryotoxon plus angle abnormalities.
## Footnote
Increases risk for glaucoma.
170
What is RIEGER ANOMALY?
**Posterior embryotoxon** plus angle abnormalities and iris stromal hypoplasia.
## Footnote
May include polycoria, corectopia, anterior synechiae.
Polycoria: more than 1 pupillary opening
Corectopia: pupil displacement
Anterior synechiae: iris sticks to cornea
171
What is RIEGER SYNDROME?
Rieger anomaly plus systemic deformities affecting face, teeth, and bones.
172
What is PETER'S ANOMALY?
Autosomal recessive condition with white corneal opacities and iris adhesions.
## Footnote
Can lead to secondary glaucoma.
173
What is DELLEN?
Area of poor wetting leading to stromal dehydration and corneal thinning.
## Footnote
Risk factors include contact lens wear and filtering bleb.
174
What is EXPOSURE KERATOPATHY?
Condition resulting from eyelid issues such as Bell's palsy or ectropion.
*lagophthalmos, incomplete eyelid closure
175
What is FILAMENTARY KERATOPATHY?
Chronic irritation or dryness resulting in filaments formed by degenerated epithelial cells and mucous.
176
What is THYGESON'S SPK?
Acute recurrent bilateral inflammation with raised central corneal lesions.
## Footnote
Typically seen in younger patients.
177
What is NEUROTROPHIC KERATITIS?
Loss of corneal epithelial repair due to damage to the trigeminal nerve.
## Footnote
Conditions include HSV, HZO, and diabetes.
178
What is RECURRENT CORNEAL EROSION (RCE)?
Condition often associated with corneal dystrophies and trauma.
179
What causes THERMAL/UV KERATOPATHY?
Prolonged sun exposure or welding without protective eyewear.
## Footnote
Results in apoptosis of corneal cells.
180
What is KERATOCONJUNCTIVITIS SICCA?
Dry eye disease characterized by decreased tear production.
181
What is the Schirmer 1 test?
Measures basal + emotional + reflex aqueous secretions; < 10 mm in 5 min indicates dry eye.
182
What is AQUEOUS DEFICIENT dry eye?
183
What is EVAPORATIVE dry eye?
Condition characterized by meibomian gland dysfunction or low blink rate.
184
What is SUPERIOR EPITHELIAL ARCUATE LESION (SEAL)?
Condition due to tight contact lenses causing upper lid chafing.
185
What is DIMPLE VEILING?
Occurs with RGP lenses that have excess inferior edge lift.
186
What is CL ACUTE RED EYE?
Inflammatory reaction to Gram-negative bacterial toxins.
187
What is CORNEAL WARPAGE (OVERWEAR SYNDROME)?
Condition seen in long-term PMMA or RGP wearers with poorly fitting lenses.
188
What is SUPERIOR LIMBIC KERATOCONJUNCTIVITIS (SLK)?
Condition due to contact lens hypersensitivity or poor fitting lenses.
189
What is TIGHT LENS SYNDROME?
Condition where contact lenses do not move with blinking, leading to redness and edema.
190
Which hypersensitivity reaction is Staph marginal keratitis?
Type 3
Ag-Ab complex—-> complement response
191
Hudson-Stahli line is iron deposits in which layer of the cornea?
Epithelium
* horizontal corneal epithelial iron line at the inferior third of the cornea at the level of tear film caused by normal aging
192
Reis-Buckler
Rare, autosomal dominant corneal dystrophy
* donut shaped gray reticular opacities, painful episodes of RCE
*honeycombs
193
Cone dystrophy
Slow progressive decrease central vision
* severe photophobia
* blue/yellow color loss
* central geographic atrophy of RPE —> bulls eye maculopathy
* temporal ONH pallor
194
Tx for IIH
If pt obese, initiate program for weight loss (5-10%)
195
Tx papilledema
Oral acetazolamide 1000-2000 mg po QD in divided doses, up to 4000 mg qd
196
Pseudotumor cerebri may be associated with what conditions/ medications?
Conditions:
Venous sinus thrombosis
COPD
Pregnancy
Medications:
Tetracyclines
Vitamin A
Isotrentinoin (Accutane)
Contraceptives
Fluoroquinolones
Levothyroxine
Nalidixic acid
197
Malignant HTN
Systolic >180 mmHg
Diastolic > 120 mmHg
198
What are the phases of FA?
199
Parinaud’s oculoglandular syndrome
Unilateral conjunctivitis with conjunctival granulomas and preauricular or submandibular lymphadenopathy
*may have fever, malaise and rash
* caused by cat-scratch fever, TB, syphilis, Epstein-Barr Virus, fungi, sarcoidosis
200
Cat scratch disease caused by?
Bartonella henselae infection
201
Wilson’s disease pathophysiology
Abnormal accumulation of copper in body
*affects pt 5-40 years old
*hepatolenticular disease
202
Signs of Wilson’s disease
Kayser-Fleischer ring (copper at descemet’s)
Sunflower cataract
203
In which layer of the cornea is copper deposited in Kayser-Fleischer ring?
Descemet’s membrane
204
Chronic Alcoholism ocular signs
1) Optic nerve pallor
2) Up and downbeat nystagmus due to nerve hydrocephalus and demyelination
*alcoholism leads to nutritional deficit
205
True or false
Staph marginal keratitis is a type III hypersensitivity reaction
TRUE
206
What are the most common cancers in men?
Prostate, lung, colon
207
Most common cancers that lead to death in men and women?
Men: lung, prostate, colon
Women: lung, breast, colon
208
Randot stereoacuity of < 40 arcseconds
Normal binocular stereoacuity
209
50-100 arc seconds in randot stereoacuity means?
Good stereo vision
210
Randot stereoacuity of 100-400 arc seconds means?
Fair stereo vision, mild impairment
211
> 400 arc seconds or unable to perceive on Randot stereoacuity means what?
Poor or absent stereo vision (possible strab or amblyopia)
212
Reye syndrome ocular manifestations
(Brain swelling)
1. Dilated pupils
2. Cortical blindness
3. Papilledema
213
SEI
Subepithelial infiltrates
214
Tx for SLK
Silver nitrate solution
Bandage CL
Mast cell stabilizer (cromolyn QID, olopatadine BID)
215
Syphilis is caused by what organism?
***Treponema pallidum***
* sphirochette bacteria
* 3 stages
* end stage: neurosyphilis
* congenital or acquired
* congenital (Hutchinson’s triad: peg-shaped teeth, deafness and interstitial keratitis)
* interstitial keratitis is inflammation of corneal stroma without prior epi or endo involvement
216
Pulfrich phenomenon
Perception of Stereopsis (elliptical motion of pendulum) caused by difference in nerve conduction times between eyes and cortex
*seen in multiple sclerosis
217
What is the phenomenon where a patient perceives elliptical motion of a pendulum? It is associated with multiple sclerosis
Pulfrich phenomenon
218
Visual field anomaly in which a moving object can be seen but not a static one
Riddoch phenomenon
219
Hyper mature cortical cataract in which liquified cortex allows nucleus to sink inferiorly
Morgangnian cataract
220
Increased pigmentation anterior to Schwalbe line in pseudoexfoliation syndrome
Sampaoelesi line
221
Scheie line
Pigment on lens equator and posterior capsule in pigment dispersion syndrome
222
Forced vergence fixation disparity curve for eso fixation disparity and show poor adaptation to BI
223
Does this forced vergence fixation disparity curve show eso or exo?
Exophoria
224
What is the purpose of forced vergence fixation disparity curves?
Evaluate the efficiency of a patient’s Vergence system by observing how fixation disparity changes when different amounts of base-in and base-out prisms are introduced to the eyes
225
Fusional vergence dysfunction symptoms
1. Asthenopia at near
2. Eye strain and headaches after short periods of reading, blurred vision, difficulty concentrating, sleepiness when performing near tasks
226
What condition does this patient have?
Decreased NRA and PRA
Decreased NFV and PFV
Deceased accommodative facility
Normal phorias at distance and near
Normal AC/A
Fusional vergence dysfunction
227
Vision therapy Exercises for convergence insufficiency
Pencil push ups
Eccentric circles free-space fusional cards
Brock string
228
Persistent pupillary membrane
*congenital
* remnants of anterior tunica vasculosa lentis (did not fully disintegrate)
* does not affect vision
229
Which tests directly measure the accommodative system?
Monocular facility testing with +/- 2.00 lenses
Monocular estimation method
Monocular amplitudes
230
BIM is hard for exo or eso?
ESO
* difficult to clear with base in and minus power lenses
231
True or false
Lag on MEM in basic esophoria
True
232
Inheritance pattern for osteogenesis imperfecta
Autosomal dominant
* congenital
* brittle bones because abnormal production of type 1 collagen
* blue sclera
233
What is the most common accommodative dysfunction observed in the general population?
Accommodative insufficiency
234
Herbert pits
Scarred limbal follicles
*chalmydial conjunctivitis
235
What caution should be exercised when prescribing tiotropium (Spiriva)
Caution with narrow angles/ hyperopic patients
*because drug causes mydriasis and can lead to angle closure—> increase IOP —> glaucoma
236
Tilted disc syndrome typically causes what visual field defect?
Bilateral superior temporal defects
*disc insertion at an oblique angle inferior nasal —> superior temporal defect that does not respect the midline
237
Crouzon syndrome is associated with what optic nerve condition?
Tilted disc syndrome
* Crouzon syndrome is autosomal dominant, results in proptosis due to shallow ocular orbits, maxillary hypoplasia, abnormal craniofacial formation, hypertelorism, and strabismus
*monitor for exposure keratitis because all affected with proptosis
238
Average axial length
24mm
239
Ocular signs of isolated complete cranial nerve 3 palsy
EOM limitations in ALL fields of gaze except temporally
240
Partial EOM limitation in all field of gaze except temporally described what external ophthalmoplegia?
Incomplete isolated cranial nerve 3 palsy
241
What is 3 AND 9 O'CLOCK STAINING?
Common complication of GP lens wear due to low-riding lenses that leave parts of the cornea uncovered.
242
What is the definition of external ophthalmoplegia?
Extraocular muscle impairment
## Footnote
This refers to the inability to move the eyes properly due to muscle dysfunction.
243
What characterizes complete 3rd nerve palsy?
Extraocular muscle limitation in all fields of gaze except temporally
## Footnote
This means the patient cannot move their eyes in any direction except outward.
244
What distinguishes incomplete 3rd nerve palsy from complete 3rd nerve palsy?
Partial extraocular muscle limitation in all fields of gaze except temporally
## Footnote
Incomplete palsy allows for some movement in certain directions.
245
What is a superior division palsy?
Inability to look up only
## Footnote
This type of palsy affects the muscles responsible for upward eye movement.
246
What is an inferior division palsy?
Inability to look nasally or inferiorly, with a dilated pupil
## Footnote
This indicates that the muscles controlling downward and inward movement are affected.
247
What does internal ophthalmoplegia refer to?
Pupil reaction
## Footnote
This involves the response of the pupil to light and accommodation.
248
What is a pupil-involving condition?
Fixed, dilated, poorly reactive pupillary response to light
## Footnote
This indicates significant nerve damage affecting pupillary function.
249
What is a pupil-sparing condition?
Pupil is not dilated; normal response to light
## Footnote
This suggests that the pupil is functioning normally despite other symptoms.
250
What characterizes a relative pupil-sparing condition?
Partially dilated pupil; sluggish reaction to light
## Footnote
This indicates some impairment in pupillary function, but not complete loss.
251
What is the first step in evaluating patients with an acute isolated third nerve palsy?
Immediate CNS imaging should be completed
## Footnote
This is to rule out a space-occupying lesion or aneurysm.
252
What type of third nerve palsy requires immediate CNS imaging?
Pupil-involving 3rd nerve palsies
## Footnote
This includes either relative or complete involvement.
253
List the associated factors for pupil-sparing third nerve palsies that necessitate CNS imaging.
* Patients <50 years old (unless long-standing diabetes or hypertension is present)
* Incomplete third nerve palsies
* Patients with additional cranial nerve abnormalities or neurologic symptoms
* Children <10 years old (regardless of pupil status)
## Footnote
Incomplete palsies may evolve into complete pupil-involving palsies.
254
What is a situation where prompt CNS imaging should be obtained?
When aberrant regeneration develops
## Footnote
This excludes regeneration in post-traumatic third nerve palsies.
255
When should imaging be obtained for pupil-sparing third nerve palsies?
If they have not resolved within a period of 3 months
## Footnote
Close monitoring is necessary for signs or symptoms progression.
256
Is imaging typically required for complete pupil-sparing third nerve palsy?
No, it is not typically required
## Footnote
Especially in patients >50 years old with a known history of vascular disease.
257
In order to determine unknown etiology of anisocoria, which drop would you instill if anisocoria was greater in dim illumination?
10% cocaine
*will dilate normal pupils only
258
In order to determine unknown etiology of anisocoria, which drop would you instill if anisocoria was greater in bright conditions?
0.125% pilocarpine
*check if enlarged pupil will constrict
*0.125% pilocarpine will not dilate normal pupil
259
True or False: Imaging is required for all patients with third nerve palsy.
False
## Footnote
Imaging is not typically required for complete pupil-sparing third nerve palsies.
