EYE BALLZ

Question 1

Slit lamp used for

Answer 1

Corneal involvement (pinguecula and pterygium)

Question 2

CT scan use

Answer 2

R/o orbital cellulitis in Dx of dacroadenitis

Question 3

Tied for MC eye dz in US

Answer 3

Cataracts and macular degeneration

Question 4

MC eye dz worldwide resulting in blindness

Answer 4

Cataracts

Question 5

Tx for macular degeneration

Answer 5

• Ranibizumab (Lucentis): prevents neovascularization by inhibiting VEGF aka only indicated w/ neovascular-associated MD
• may preserve vision
• monthly injections
• ADR: traumatic cataract, increase IOP, detached retina
• Also supplementation: vit e, ascorbic acid, beta carotene, zinc and cupric oxide

Question 6

MC eye dz in US and worldwide (rank 1-4)

Answer 6

US: 1 & 2– tied w/ cataracts and macular degeneration
3– retinopathy
4– glaucoma

W: 1- cataracts
2- glaucoma
3- macular degeneration
4- retinopathy

Question 7

Drusen spots:

Answer 7

Macular degeneration

Question 8

This dz can lead to optic neuritis if left un-tx

Answer 8

Open Glaucoma

Question 9

Cotton wool patches and neovascularization are seen w/

Answer 9

Diabetic retinopathy

Question 10

AV nicking, papilledema, and retinal hemorrhage are seen w/ this dz

Answer 10

Hypertensive retinopathy

Question 11

Narrowing of eye arteries w/ indentations where veins cross

Answer 11

AV nicking in hypertensive retinopathy

Question 12

These are caused by infarcted nerve fibers

Answer 12

Cotton wool patches in diabetic retinopathy

Question 13

These are caused by chronic hypoxia in the retinal tissue; stimulated by VEGF

Answer 13

Neovascularization w/ diabetic retinopathy

Question 14

High pressure to BV resulting in vessel rupture

Answer 14

Retinal hemorrhage in hypertensive retinopathy

Question 15

NSAID eye drops: 
Brand/generic
Indication:
MOA: 
SE:

Answer 15

Ketorolac (acular)
Diclofenac (voltaren)
MOA: inhibit prostaglandin e2 in aqueous humor
Use: primary use--> post-op w/ catarct surgery; inflammation w/ seasonal allergic conjunctivitis; weird eye webs (pinguecula, pterygium)
SE: minor ocular irritation
But also..
- iritis
- superficial keratitis
- superficial ocular infx
- ocular and corneal edema

Question 16

Opth. Corticosteroids:
Generic/brand
Use 
MOA
SE

Answer 16

Prednisolone (pred-forte)
Tobramycin-dexamethazone (tobradex)
Triamcinoclone (Triesence)
Use: inflammation of eye
- anterior uveitis
- burns
- superficial bacterial infx
- weird web things (pingueculum, pterygium)
MOA: inhibit prostaglandins and leukotrienes- aka inflammatory mediators
SE: glaucoma

Question 17

Difference between pterygium and pinguecula

Answer 17

Pterygium w. Corneal involvement; may require surgical excision
Pingueculum w/o

Question 18

Difference between hordeolum and chalazion

Answer 18

Chalazion- internal surface of eyelid
- blocked meibomian gland
- non-tender
- no real tx; warm compress/watch and wait 2-4 wks--> refer to Opth.
Hordeolum: external surface of eyelid 
MC w. Staph A
- tender and painful
- oral abx
-warm compress/watch and wait 2-4 wks--> refer to Opth.

Question 19

Describe blepharitis s/s and tx

Answer 19

S/s: inflammation of the eyelid that is pruritic and “crusty”
- pt visibly uncomfortable and may feel foreign object
Tx: wash w/ baby shampoo; warm compress; if severe, may Rq. Erythromycin or bacitracin ointment

Question 20

Xanthelasma etiology, presentation, & tx

Answer 20

• likely related to unregulated lipid levels–> chronic hyperlipidemia
• yellow plaque on eyelid
• tx: control chronic dz; potentially cosmetic surgery

Question 21

C/i of corticosteroid drops

Answer 21

• glaucoma

- herpetic keratitis–> blindness

Question 22

Lubricant eye drops:
2 kinds
Indications
MOA

Answer 22

Syntane
Lacri-lube
- relief for dry or itchy eyes
- buffers to adjust pH; maintains ocular Tonicity; increases viscosity of eye fluids to increase hydration and comfort (via petrolatum, carboxymethylcellulose, & polysorbate)

Question 23

Tx for open angle glaucoma (first, second, and third)

Answer 23

1: prostaglandin inhibitors & beta blockers
2: selective alpha-2 receptor agonists & cholinergic agents
3: topical carbonic anhydrase inhibitors

Question 24

Flow of tears in general:

Answer 24

Lacrimal gland–> canaliculi–> sac–> duct–> nasal cavity & beyond to swallow

Question 25

Main difference between dacroadenitis and dacrocystitis

Answer 25

Lacrimal gland vs. lacrimal duct: i.e. Location of pain or discomfort

Question 26

Dacroadenitis/dacrocystitis tx

Answer 26

R/o orbital cellulitis Mild: keflex or augmentin w/ 24h f/u Severe: IV abs & admit to hospital

Question 27

B-blocker tx for open angle glaucoma: drugs and MOA

Answer 27

1st line tx 1- selective: Betaxolol (betopic) 2- non selective: timolol (timoptic) & levobunolol (betagan) MOA: decrease production of aqueous humor Systemic SE: respiratory arrest, bradycardia, masks hypoglycemia C: COPD, asthma, pulmonary edema, type 2 or 3 heart blocks

Question 28

Prostaglandin inhibitor: tx for open angle glaucoma--> drugs and MOA

Answer 28

``` 1st line tx Bimatoprost (lumigan) Latanoprost (xalatan) MOA: increase aqueous outflow Results w. 25%; qd dosing AE: hypertrichosis & drake eyelashes (latisse); increase iris pigmentation ```

Question 29

Selective alpha2-receptor agonist tx for open angle glaucoma: drugs and MOA

Answer 29

``` 2nd line tx - brimonidine (alphagan) - increases aqueous outflow & decreases aqueous production AE: blepharo-conjunctivitis Systemic: ha, fatigue, dry mouth ```

Question 30

Cholinergic tx for open angle glaucoma: drugs and MOA

Answer 30

2nd line tx - pilocarpine soln (isopto carpine) - increase aqueous outflow; physically pulls open trabecular meshwork - miotic agent; only applied w/ decreased IOP AE: brow ache, vision probs, accommodation/myopia probs Systemic: n/v/d, bradycardia C: sulfa allergy, COPD, hepatic insufficiency, Renal failure, hypo- kalemia and natremia

Question 31

Topical carbonic anhydrase inhibitors: tx for open angle glaucoma: drugs and MOA

Answer 31

3rd line tx Topical: brinzolamide(azopt) Systemic: acetazolamide(diamox) - decrease aqueous production Cease secretion of na and bicarbonate from ciliary body to aqueous humor SE: systemic--> parasthesis and kidney stones; acidosis CI: same as cholinergic agents- except hypernatremia

Question 32

Never repair an eye lid laceration w/

Answer 32

Tarsal plate or medial canthus involvement | - or if potential globe penetration

Question 33

Never do this with an eyebrow laceration

Answer 33

Shave the eyebrow

Question 34

Make sure to do this with an eyelid foreign body sensation

Answer 34

Invert and avert the upper and lower eyelids