Ophtha Notes Flashcards
1
Q
Hard exudate
A
Deep yellow with sharp margins, often circinate Diabetes, hypertension, von Hippel Lindau disease, radiation
2
Q
Rhegmatogenous
A
with a retinal break, tear or hole associated with formation of a retinal periphery associated with peripheral retinal thinning of high myopia
3
Q
inner blood retina barriers
A
attributed to the tight endothelial cell junctions of the retinal capillaries.
Any disturbance - leads to oozing of fluid and/or blood, as well as lipids and proteins from the retinal vascular tree
4
Q
A
Soft Exudates
5
Q
Retinal detchment
A
condition where retinal pigment epithelium is separated from the inner retinal layers, with accumulation of fluid in the subretinal space
6
Q
A
keratoconus
7
Q
Posterior portion of the uveal tract, located between the retina and the sclera
A
Choroid
Blood from the choroidal vessels drain via the FOUR VORTEX VEINS
8
Q
fascia behind the the portion of the orbicularis muscle that lies between the orbital rim and the tarsus
A
Orbital septum
9
Q
Condition wherein parallel light rays do not fall into a pinpoint focus on the retina
A
Ammetropia
10
Q
lie at the junction of the peripheral cornea and the root of the iris SCHWALBE’s line: trabecular meshwork which overlies the schlemm’s canal and the scleral spur
A
Anterior chamber angle
11
Q
Anti-glaucoma drug which decreases aqueous production acts on the epithelial cells of the
A
PARS plicata
12
Q
fascial reflections that become continuous with the fascia of the muscles and the fused fascia sends out expansions to the surrounding structures and to the orbital bones
A
check ligaments
13
Q
Lesion on the optic nerve
A
Central Scotoma
14
Q
Thickened fold of bulbar conjunctiva at the inner canthus
A
Semilunar folds
corresponds to the nictittaing membrane
15
Q
Dermoid choristoma
A
congenital
inferotemporal limbus smooth elevated, tan to fleshy color, round to oval solid mass embedded in the superficial cornea and sclera
dermoids are composed of fibrous tissue and hair with sebaceousglands that is convered with conjunctival epithelium
16
Q
Choroidal capllary heamngioma
A
benign, isolated, round, well circumscribed reddish orange tumors under the retina, of varying sizes, u
sually discovered as an incidental finding during a routine eye examination.
TX: laser treatment, cryopexy, photodynamic therapy, external beam irradiation and transpupillary thermotherapy
17
Q
Volume of orbit
A
30 cc in adults
18
Q
First of the ten layers of the Retina Outermost
A
Retinal pigment epithelium
adjacent to the choriocapillaries of the CHOROID and is separated by the BRUCH’s MEMBRANE
19
Q
Commonly known as nearsightedness..
focus at a point in front of the retina
A
Myopia
eyeball longer than average
Corneal curvature steeper than average
use DIVERGENT LENS (Negative or biconcave lens)
20
Q
Corneal scars
A
Tan to white color formed after an inflammatory process when fibrosis sets
21
Q
Fibers of the optic nerve
A
Visual fibers : 80% synapse in the lateral geniculate body of neurons whose axons terminate in the visual cortex of the occipital lobe
Pupillary fibers: 20%. bypass the geniculate body en route to the pretectal area
22
Q
A
Central retinal artery occlusion
23
Q
Amacrine cells
A
horizontal cells allow multiple photoreceptors to plug into a smaller number of bipolar and ganlion cells
24
Q
Floaters (muscae volitantes)
A
black to gray spots and/or fibers that move about in the field of any vision of the patient.
commonly observed after the age of 45 -50 when vitreous liquefaction and vitreous collapse and or detachment have begun
25
Ciliary Body
consists of
2 zones
* **PARS PLICATA** 2 mm wide ciliary processes arise 2 layers (internal non pigmented layer and the external pigmented layer)
* **PARS PLANA** 4mm flattened posterior zone
26
Types of Astigmatism
Simple Myopic - One image on the retina, one image in front
Simple Hyperopic - one image on the retina, ome image behind the retina
Compound myopic - both images in front of the retina
Compound hyperopic - both images at the back of the retina
Mixed astigmatism - one image in front, one image at the back
27
curvature of the cornea of the lens is not the same in different meridians.
Astigmatism
28
5 layers of the cornea
* **Epithelium** (5-6 layers of cell, continuous with the bulbar conjunctiva)
* **bowman's membrane** (clear acellular layer)
* **Stroma** (90% of corneal thickness)
* **Descemet's membrane** (basal lamina of corneal epithelium)
* **Endothelium** (single layer of cells, responsible for maintaining deturgescence of the cornea)
29
2 parts of conjunctiva
**Palpebral** - posterior surface of he eyelid and is adherent to the tarsus
**Bulbar conjunctiva** - loosely attached to the orbital septum in the fornices and is folded many times
30
Standard distance of the patient from the chart
20 ft or 6 meters
31
Arterial supply of the lacrimal gland and upper
lacrimal artery
32
Central Retinal Artery Occlusion
sudden painless loss of vison
Vison loss is sevre, and residual vision just after the episode is usally in the area of li**ght perception to count fingers**
Retina is **very pale** so that the usually darker macula becomes more prominent and is described as cherry red spot HOLLENHORST PLAQUE
treatment must be instituted **within 5 minutes**
33
Fundus fluorescein angiography
proedure that involves the injection of a dye, sodium fluorescein, into the antecubital vein.
outlines the retinal and choroidal vascular system
34
has an adenoid layer and fibrous layer
conjunctival stroma
35
Cataract
any opacity in the lens that precludes optimal vision.
36
Pterygium
conjunctival disorde
r benign conjunctival lesion that behaves malignantly
wing shaped or triangular fold of conjucntiva anf fibrovascular tissue with its apex invading the superficial cornea
Strong correlation with UV exposure
37
Arterial supply of the sclera
Muscular branches to the muscles contnue to form the anterior ciliary arteries
38
Age related Macular degeneration
over 50 years of age
2 types: non -Neovascular and vascular
39
Inferior Oblique
O: Behind Lacrimal Fossa
I: Posterior to the equator in infero-temporal quadrant
A: Extorsion, elevation, abduction
N: III
40
Preferred method for IOP mesurement with patients with corneal scar
Indentation tonometry affected by scleral rigidity
41
Bitot Spots
Keratinization of areas of the conjunctiva
42
Nerve supply to the lacrimal glands is by
Lacrimal nerve
great superficial petrosal nerve
Sympathetic nerve
43
hallmark of proliferative stage
growth of abnormal vessels either on the disc or on the retina
44
fibrous membrane covering the globe from the limbus to the optic nerve.
**Tenon's capsule**
Tennon's capsule and episclera are fused together
45
flat surface with a central opening.
Iris
2 pigmented posterior layers of the iris represent anterior extensions of the neuroretina and the retinal pigment epithelium
46
Superior Rectus
O: AOZ
I: 7.7 mm from superior limbus
A: Elevation, intorsion, Adduction
N: III
47
Posterior subcapsular cataracts
affect the region near the central posterior capsule
begin in the center, they usually cause early visual symptoms in the form of night time glare/haloes around the lights and poor vision under bright illumination
more commonly associated with diabetes, trauma, corticosteroid use, inflammation, and exposure to ionizing radiation
48
Funch's Endothelial dystrophy
after age of 50
Females\> males
abnormally high rate of endothelial cell loss
initially present with central corneal guttata.
49
Corneal staining due to heme
50
Most common cause of cataract
Aging
51
* A = Fungal keratitis
* B = Bacterial Keratitis
52
PDR with retinal hemorrhages and extensive fibrovascular membranes (white arrows) with vitreoretinal traction
53
Red Anomaly
Protanomalous
54
Toxoplasmosis scar
55
Cataracts are best viewed via
slit lamp biomicroscope
visualization of the layers
56
Hard exudates
57
Most common type of cataract
Nuclear cataract
58
Indocyanine Green Angiography
similar to FA but uses indocyanine green dye instead of sodium fluorescein
59
Blot Hemmorhages
60
Bleeding from superficial retinal vessels on a fibrovascular stalk extending into the vitreous Diabetes, hypertension, trauma
Vitreous hemorrhages
61
Inferior Rectus
O: AOZ
I: 6.5 mm from the inferior limbus
A: Depression, Extorsion, Adduction
N: III
62
Neovascular type ARMD
choroidal neovascular membrane grows under the retina and causes scarring and extensive damage of the retina above it
causes sudden onset of central visual problems such as blurry vision, metamorphosia and scotomas
Management: thermal laser treatment to the abnormal vascular complex (extrafoveal) Intravitreal injections of anti vascular endothelial growth factors (subfoveal)
63
Bleeding from superficial pre-capillary arterioles, small veins Hypertension, retinal vein occlusion, blood dyscrasia, trauma
Flame hemorrhages
64
Bedside examination most useful for evaluating and prognosticating catracts
Swinging flashlight test
65
Dot hemorrhages
Bleeding from capillaries Diabetes
66
Retinitis pigmentosa
67
Basic principles of retinal reattachment surgery
1. find the break
2. close the break
3. seal the retinal breaks
68
PDR high risk with pre retinal hemorrhages (white arrows, NVDs (black), NVEs (yellow)
69
Retinal detachment
70
biconvex, avascular clear structure which is 4mm thick and 9mm in diameter. consist of 65% water and 35% protein
LENS
anterior to the lens is the AQUEOUS
posterior : VITREOUS
semipermeable membrane (water and electrolytes)
71
Vogt-koyanagi- harada syndrome
rare and unusual form of diffuse granulomatous uveitis
bilateral disease
sudden onset of blurry vision, photophobia, perhaps floaters, sometimes with headache, neck stiffness and/or tinnitus yellow white patches
72
Cortical cataract
affect the outermost and youngest layers of the lens
Lens hydration changes produce clefts in a radial pattern around the equatorial region
This can result in glare, seeing haloes around the lights and monocular diplopia
73
Cataract
74
condition wherein parallel light rays fall into a pinpoint focus on the retina
Emmetropia
75
Central retinal vein occlusion
76
keratomalacia
Diffuse corneal necrosis
77
Clear, avascular body, coprising 2/3 of the volume and weight of the eye.
Vitreous
Hyaloid membrane: outer surface of the vitreous is in contact with the posterior lens capsule
78
MACULA
79
Lateral rectus
O: AOZ
I: 6.9 mm from lateral limbus
A: Abduction
N: VI
80
Superior Oblique
O: orbit apex above Annulus of Zinn
I: Posterior Equator at superotemporal quadrant
A: Intorsion, depression, Abduction
N: IV
81
Acid chemical Burn
denaturation and precipitation of the collagen and lead to scar formation
82
Soft exudate
Fluffy gray-white; usually near optic disc Hypertension, diabetes, connective tissue disease, HIV
83
Blue Anomaly
Trianomalous
84
Vitreous syneresis
degeneration of the vitreous gel (liquefaction of the gel) with eventual detachment of the vitreous from the retina
45-50 years old
85
Endothelial dystrophy
infants with bilateral diffuse corneal haziness and ground glass appearance, thickened cornea with normal corneal diameter and eye pressure and absence of birth trauma
86
consists of 2-5 layers of stratified columnar epithelial cells. the superficial part consists of mucous secreting goblet cells basal cells are deeper and may contain pigments near the limbus
Conjunctival epithelium
87
fibrous outer layer of the eye consisting mainly of collagen thinniest at the insertion of the recti muscles (0.3mm)
Sclera
88
Corneal and conjunctival neoplasia
89
HIV retinopathy
may affect the eye directly
CMV retinitis, toxoplasmosis, candida retinitis, Pneumocystitis carinii
90
Corresponds to the termination of the corneal endothelium.
Schwalbe's line
91
Optical coherence Tomography
Scan of the retina
92
Arterial supply of the ciliary body
Long posterior ciliary arteries 2 forms the major arterial circle of the iris
93
Medial Rectus
O: Annulus of Zinn
I: 5.5 mm from medial limbus
A: Adduction
N: III
94
Amsler grid
a black and white card with a fine grid and a fixation point use to detect and quantify central visual changes
95
Corneal intraepithelial neoplasia
translucent, gray, or frosted epithelial sheet starting from the limbus and extending onto the cornea with fimbriated or scalloped borders
Blurring of vision will occur once the growing epithelial sheet reaches the central area
96
Peter's anomaly
central corneal leukoma with defects in the posterior stroma.
97
Calcific band keratopathy
98
Corneal trauma
Mechanical and chemical require surgical treatment
99
Exposure Keratitis
100
MAchine that takes IOP readings by calculating the maount of corneal flattening by the fixed air puff pressure
Air puff noncontact tonometer
101
located approximately 2.5 disc diameters temporal to the optic disc. There are no blood vessels in the area and it appears darker than the surrounding retina
Macular area
102
Green anomaly
Deuteranomalous
103
Lesion on the optic chiasm
Bitemporal Hemianopsia
104
Lesion on the opic radiation (Parietal)
"pie in the floor"
105
provides quantitative method for determination of IOP by measuring the amount of pressure required to indent the cornea with the use of SCHIOTZ TONOMETER
Indentation tonometry
106
pterygium
107
VKH
108
NPDR with hard exudates (black arrows), microaneurysms (red arrows), dot and blot hemorrhages (yellow arrows), Soft exudates (white arrows)
109
mechanism throgh which the ye is able to increase its dioptic power allowing it to focus on a nearby object
Accomodation
110
Two stages of Diabetic Retinopathy
Non proliferative
Proliferative
111
thin transparent mucous membrane covering the globe anteriorly
Conjunctiva
112
Metastatic Choroidal tumor
Metastatic tumors to the uveal tract are the most common intraocular malignancies.
113
Only treatment option for cataract
Surgery
114
unit of measurement of lens power
Diopter
D=1/f
115
The tennon's capsule fuses with the fascia of the inferior rectus and inferior oblique to form.....
suspensory ligament of Lockwood
116
Drusen
117
Thin, semi transparent, multilayered sheet of neural tissue that lines the inner wall of the posterior 2/3 of the eye
Retina
Extends anteriorly as the **ora serrata**
118
Layer of the retina that receives its oxygen supply from the choriocapillaris is the
photoreceptors
119
10 layers of the retina
* Internal Limiting Membrane
* Nerve fiber layer
* Ganlion cell layer
* Inner plexiform layer
* Inner nuclear layer (bipolar cell bodies)
* Outer plexiform layer
* Outer nuclear layer
* External limiting memberane
* Photoreceptor layer
* Retinal pigment epithelium
120
Lens Anatomy
121
Arterial supply of the retina
Central retinal artery
122
Dermoid choristoma
123
total converging power of the eye
60 diopters
cornea - +40
Lens - +20
124
Normal cup to disc ratio
0.5
125
Bleeding from large superficial retinal veins into the space between the retina and vitreous; sometimes this break into the vitreous cavity Trauma, blood dyscrasia, sudden increase in intracranial pressure
Boat hemorrhages
126
Blood retina barriers
Inner Blood Retina Barrier
Outer Blood Retina BArrier
127
Central retinal vein occlusion
Ischemic vs non-ischemic (stasis retinopathy)
**ISCHEMIC**
* the fundus is covered with multiple splinter and bot hemorrhages
* Cotton wool
* Very poor vision
* Tx: retinal photocoagulation
**NONISCHEMIC**
* fewer retinal hemorrhages
* no soft exudates
* definite retinal venous tortousity and dilation
* Tx; no definite ocular treatment but the primary cause must be identified
128
Esotropia
Inward misalignment
129
Arterial suuply of the choroid and part of the optic nerve
Short posterior ciliary arteries
130
Hypotropia
downard misalignment
131
composed of the iris, ciliary body, and the choroid
Uveal tract
132
Main functions of the cornea
Transmission of light
Refraction of Light
133
Toxic keratitis
microtrauma to the corneal surface epithelium scondary to contact with chemicals or topical medications
134
Near visual acuity should be performed only for patients (age)
35 years old
135
Muller cells
structural cells of the retina
136
* A = Corneal scar (typical)
* B = hypertrophic corneal scar
137
Retinitis Pigmentosa
family of heredo-degenerative disease characterized by progressive degeneration of the rods and cones. migration of pigment epithelial cells into the retina
Sx: Night blindness or nyctalopia for most cases of type I, progressive contraction of peripheral visual fields, blurring of vison in some cases, development of cataracts
Usually bilateral disease
138
Infection, which causes inflammtion of the yellids and periorbital structures
preseptal cellulitis
139
Alkali chemical Burn
corneal destruction is more severe since it causes corneal necrosis and melting due to its ability to penetrate deeply into the cornea
140
Drusen
Clusters of yellow orange spots, usually centered aound the fovea
Age related MAcular degenreration
141
Loss of focusing or accomodative power of the human lens
Presbyopia around 40 years of age
142
Arterial supply arteries to both eyelids
Medial palpebral arteries
143
normal pupil size
2mm-4mm
144
Arterial supply of the fovea
choriocapillaries
susceptible to irreparable damage when the macula is detached
145
Causes of corneal scars
Mircrobial keratitis
Corneal Trauma
Exposure Keratopathy
Lid margin and lash disorders
Congenital corneal scars
146
Flashes (photosopsias)
caused by retinal problems
described as arcuate lightning like streaks of bright light in the periphery noted with or without eye and/or head movements
147
Layers of the eyelid
Skin
Orbicularis oculi muscle
Areolar tissue
Tarsal Plates --- main support of the eyelids
Palpebral conjunctiva
148
Phacoemulsification
form of ECCE
utilizes an ultasonic probe to break up the cataract into smaller pieces which can be removed by aspiration
149
Laser MArks
clusters of yellow white spots, usually uniform in size and regularly distributed in entire retina or around macular area Post retinal photocoagulation
150
Herpes simplex virus
commonly affect the trigeminal ganglion which is the main source of sensosry nerve supply to the cornea.
the cornea exhibits hypoesthesia at the ulcer site
151
Standard near vision chart
14 inches or 35 cm
152
Exotropia
Outward misalignment
153
Rate of production of the aqueous
2.5uL/min
subject to diurnal variation
154
Ciliary muscle fibers
**CIRCULAR FIBERS**: contraction and relaxation of the zonular fibers that alters the capsule of the lens
**LONGITUDINAL FIBERS:** insert to the trabecular meshwork, influencing its pore size RADIAL FIBERS
155
commonly known as farsightedness... focus at point behind the retina
Hyperopia
Eyeball is shorter than average
Corneal curvature is flatter
use CONVERGENT LENS (positive or biconvex lens)
156
Lipid Keratopathy
seen in vascularized corneal scars of various etiologies Invasion of blood vessels into the cornea will lead to leakage and eventual deposition of glycoproteins, cholesterol and neutral fat into the cornea.
Yellow or cream colored lacated at the corneal stromal layer
157
NON-Neovascular type ARMD
more common and visual loss is not as severe.
Accumulation of cellular debris and formation of "drusen" under the retina.
There is accompanying atrophy of the retinal pigment epithelium.
causes gradual painless detrioration of central vision
158
Leukocoria
159
Normal IOP
10 - 21 mmHg
and the difference in IOP between 2 eyes does not exceed 2 mmHg
160
Vitamin A deficiency
Xerophthalmia
Prolonged Vit. A deficiency can lead to external eye involvement including xerosis, metaplastic keratinization of areas of the conjunctiva (Bitot spots)
161
Mircobial keratitis
infections of the cornea
corneal tissue necrosis,
melting and rupture
Natural course of the disease: redness and other symptoms will disappear except for blurring of vision
162
Exposure keratopathy
cornea is prone to dessication exposed cornea
163
Bleeding from choroidal vessels under the fovea Age related macular degeneration
Submacular/foveal hemorrhage
164
Orbital walls
**Roof:** frontal bone, lesser wing of the sphenoid bone
**Lateral wall:** greater wing of the sphenoid bone, zygomatic
**Floor**: maxillary bone, zygomatic bone, palatine bone
**Medial bone**: ethmoid bone , lacrimal bone, frontal bone, maxillary bone
165
Modified sweat glands; ipen in a row near the base of the eyelashes
Gland of Moll
166
Corneal edema
corneal epithelium is the single most imporatant structure of the cornea when cell density dips below a critical level, the direction of flow of water is reversed and the cornea will retain water and swell like a sponge
167
Causes of corneal edema
Endothelial dystrophy
surgical trauma
Increased IOP
168
Lesion on the Optic Radiation (temporal)
"pie in the sky"
169
Ocular B scan Ultrasonography
useful tool to evaluate the anatomic relationships among the VITREOUS, RETINA, and CHOROID
170
Axons comprising the optic nerve come from which cells in the retina?
Ganglion cells
171
Congenital hereditary endothelial dystrophy
172
Hypertropia
upward displacement
173
Modified sebaceous glands; open onto hair follicles at the base of eyelashes
Glands of Zeis
174
Calcified Band Keratopathy
seen in eyes with chronic inflammation like anterior uveitis and in patients with HIGH SERUM CALCIUM and disorders in phosphate metabolism
Calcium hydroxyapatite particles deposit at the Bowman's layer
175
Type of cataract surgery that will routinely require aphakic lenses for visual correction
ICCE
176
considered as gold standard of IOP determination
Applanation
177
Corneal staining
Hyphema (blood in the anterior chamber)
178
Synkinetic triad
Accomodation covergence miosis
179
clear fluid that fills the anterior and posterior chambers of the eye.
Produced by the ciliary epithelium
AQUEOUS
230 uL
180
Tonometer used in Applanation tonometry
Goldman Applanation Tonometer
cannot be used with patients with corneal abnormalities
181
Lesion on the occipital lobe
Homonymous Hemianopia
182
Outer blood Retina barriers
found in the RPE zonula occludens
keep the RPE leak proof form the highly vascular choriocapillaries
183
Lesion on the temporal optic tract
Homonymous hemianopsia
184
Keratoconus
central or paracentral cornea undergoes progressive thinning and bulging
185
is a transparent tissue inserted at the limbus.
Cornea
Thicker at the periphery (0.65mm) center (0.52,,) h
oriontal diameter 11. 75 cm vertical diamter 10. 6mm
