Fundamentals/Miscellaneous

Question 1

• Associations for microphthalmos:

Answer 1

dwarfism, intellectual disability, trisomy 13.

Question 2

• Ductions v versions

Answer 2

ductions are monocular (duck under cover!), versions are binocular (like the word convergence)

Question 3

• Lidocaine

Answer 3

add sodium bicarb to help with the pain, add hyaluronidase to help with dispersion, add epinephrine to increase elimination time.

Question 4

• Basic secretion test

Answer 4

drop of anesthetic then filter paper x 5 minutes. Abnormal is <3 mm. Equivocal is 3-10 mm. Normal is >10 mm.

Question 5

• Schirmer 1:

Answer 5

same as basic secretion test but no anesthetic <5.5 mm after 5 minutes is considered abnormal. Tests basic secretion AND reflex tearing.

Question 6

• Schirmer 2:

Answer 6

same as Schirmer 1 but also stimulate nasal mucosa. Tests reflex secretion only .<15 mm after 2 minutes is considered abnormal.

Question 7

• Dye disappearance test:

Answer 7

put fluorescein and see if it disappears from the ocular surface. Indicates it went through the nasolacrimal system. Results less certain.

Question 8

• Jones 1

Answer 8

put fluorescein in then check with cotton swab to inferior meatus at 2 and 5 minutes to see if fluorescein is there. If so then + jones 1 test and at least partial patency.

Question 9

• Jones 2:

Answer 9

irrigate lacrimal system with cannula. Collect fluid in the nose with swab. Some people have negative jones 1 but positive jones 2 indicating a functional obstruction.

Question 10

• Risk of uveal melanoma with ocular melanocytosis

Answer 10

1 in 400

Question 11

• Hypersensitivity reactions

Answer 11

o Type 1: anaphylaxis (allergic/atopic conjunctivitis)
o Type 2: cytotoxic antibodies (ocular cicatricial pemphigoid)
o Type 3: immune complex reactions (scleritis)
o Type 4: cell-mediated reactions (contact dermatitis, corneal graft rejection, SJS)
o Type 5: stimulatory hypersensitivity (MG, TED)

Question 12

• Parameters for ALT:

Answer 12

50 micron spot, 0.1 s duration, power between 300-1000 mW

Question 13

• Laser lengths

Answer 13

o excimer laser: 193 nm, photoablation;
o ND-YAG laser: 1064 nm, photothermal disruption
o Femtosecond laser 1053 nm, photodisruption

Question 14

• For alkaptonuria

Answer 14

treat with high dose vitamin C

Question 15

• Transillumination defects:

Answer 15

peripheral associated with PDS, marginal associated with pseudoexfoliation syndrome

Question 16

• Embryology—neuro-ectoderm

Answer 16

“really really obvious” RPE, Retina, Optic nerve, axons and glia

Question 17

• Embryology—neural crest

Answer 17

corneal stroma, corneal endothelium, iris pigment epithelium, sclera (also mesoderm), TM, Bones/cartilage, ciliary ganglion, choroidal stroma, extraocular sheaths and tendons, optic nerve sheath, fat (also mesoderm), melanocytes. “Neural crest creates cornea, is super terrific for bones and cartilage, can create sheaths and tendons, and fat melanocytes.”

Question 18

• Surface ectoderm embryology

Answer 18

lens, vitreous, conjunctival epithelium, lacrimal drainage system and lacrimal gland, cilia of skin of eyelids and caruncle, sweat glands. “Helps us cry (lacrimal), sweat (glands) and see (lens and vitreous).”

Question 19

• Mesoderm:

Answer 19

EOMS, fat (also neural crest) iris stroma, iris sphincter, iris dilator, temporal sclera, vitreous (also surface ectoderm), and vascular endothelium. (Think muscles and vessels, you will have to randomly remember vitreous and temporal sclera.)

Question 20

• Gland types:

Answer 20

meibomian = holocrine; lacrimal = merocrine, Krause/wolfring = merocrine; moll = apocrine

Question 21

o Culture media thioglycolate broth:

Answer 21

best for culturing anaerobic bacteria

Question 22

o Culture media blood agar, chocolate agar or thioglycolate broth

Answer 22

best for culturing aerobic bacteria

Question 23

culture media Lowenstein Jensen

Answer 23

best for culturing mycobacteria

Question 24

o Culture media nonnutrient agar with e coli overlay

Answer 24

best for culturing acanthamoeba

Question 25

o Culture media sabourad’s

Answer 25

best for culturing fungi

Question 26

• Meds not to use in someone with CME

Answer 26

dont use nonselective adrenergic agonists including epinephrine and the pro drug, dipivefrin. +/- don’t use prostaglandin analogs (like latanoprost)

Question 27

• Accomodation amplitudes

Answer 27

lose approx. 1 D q4years until age 40. Then you have approx. 6D left of accommodation. From 40-48 you lose 1.5D every 4 years. At 48 you have approx. 3 D of accommodation left. You then lose 0.5D q4years after that.