Optom General Flashcards

Question

MPS1 criteria for suspicion?

Answer 1

Widespread stromal corneal dystrophy in children and adolescents

Answer 2

Papilloedema, optic atrophy, pigmentary retinopathy

Answer 3

Corneal verticillata: eccentric corneal scar. Does not usually affect vision. Yellowish brown colour

Answer 4

in the absence of verticillata, at least two of... anterior cortical cataract retinal vascular lesions: retinal vascular tortuosity at posterior pole conjunctival vascular lesions: tortuosity or MA in conj vessels.

Answer 5

Metabolic Specialist: Dept of Nephrology, Royal Melb Hospital

Answer 6

Normal: 550um +/- 35 Keratoconus: 448 +/- 58

Answer 7

\>=317mOsmol/L Sensitivity : 96% Specificity: 67%

Answer 8

\<=5s Sens: 95.9% Spec: 90.8%

Answer 9

Almost all type 1 diabetes and more than 60% of type 2 diabetes will develop diabetic eye disease within 20 years of diagnosis.

Answer 10

almost one-third (29.1%) of Australians with diabetes

Answer 11

**SES: Sagging eye syndrome.** ~25% of \>60yr old w diplopia have SES (Sagging eye syndrome) as cause of their diplopia.

Answer 12

Sx: Acute/Chronic horizontal/vertical diplopia. Non-commutative version (looking diagonally to the up/left or up/right) is higher than a consecutive version (looking left the up or right then up). divergence paralysis” esotropia for distant targets SES may asymptomatically and symmetrically reduce supraduction Bilaterally asymmetrical LR pulley sag results in hypotropia and excyclotropia of the eye with the greater sag, causing symptomatic cyclovertical diplopia

Answer 13

low BP and long term high BP are risk factors for glaucoma don’t just ask about hypertension understand BP duration, severity and medical therapy

Answer 14

Diet, exercise are modifiable factors

Answer 15

Parapapillary atrophy can be differentiated into an outer “alpha” and inner “beta” zone that borders the optic disc. The outer alpha zone may be characterized by irregular hypo- and hyperpigmentation, followed by the inner beta zone, which reveals sclera at the optic disc border as well as large visible choroidal vessels.

Answer 16

Glaucoma is associated with a larger beta zone compared w normals.

Answer 17

Grade0: clear fluid expressed Grade1: greasy, slgithly turbid fluid expressed. Grade2:opaque expression Grade3:semi-solid substance expressed Grade4:waxy substance if anything at all expressed

Answer 18

dropbox SRC 2019 Day 1 Session 1.8

Answer 19

Horizontal Saccades Vertical Upgaze Pursuits 12deg object, slow moving Fixation/saccade to face OKN VOR (Vestibular ocular reflex)

Answer 20

PT 9 Wrap 6.5 BVD 12

Answer 21

Superb and Individual

Answer 22

Balanced (dist bias) Intermediate bias Near bias

Answer 23

Takes into account large pupil size for night time Drivesafe and Individual have it

Answer 24

Superb/Individual as will give wider Int

Answer 25

Instil NaFl in both eyes and check for drainage after 5min. (especially obvious if unilateral blockage) If not draining then do irrigation to check for blockage.

Answer 26

PLOPCDN Overproduction: Dry eye/Exposure Poor Drainage: Conjunctivalchalasis Lids Punctal Stenosis Canaliculitis Dacryocystitis NLDO

Answer 27

Sjogren's and Non-Sjogren's

Answer 28

Primary and Secondary

Answer 29

1. Primary lacrimal gland deficiency 2. Secondary lacrimal gland deficiency 3. Obstruction of lacrimal gland ducts 4. Reflex Hyposecretion

Answer 30

Intrinsic and Extrinsic

Answer 31

91% Female av age 51 Dx: any 2 of... Postiive Blood Test Ocular Staining Score \>=3 (SICCA) Salivary Gland Biopsy

Answer 32

Intrinisic: picture arrow pointing INto.. 1. MGD… Meibomian Gland 2. Disorders: expand gland to look like a messy and disorderly room 3. Low: MG filled with Meibum but has flashing sign saying low. 4. Drug: needle sticking into MG injecting drug. MGD, DisLoD 1. MGD 2. disorders of lid aperture 3. Low Blink Rate 4. Drug Action: Eg Accutane

Answer 33

1. Vit A deficiency 2. Topical Drugs Preservative 3. CL Wear 4. Ocular Surface Disease Eg. Allergy

Answer 34

Check difference in drainage of NaFl after 5min

Answer 35

~1mm is normal

Answer 36

Examine eye immediately after LG instilled. Make sure to get p to blink several times

Answer 37

Cornea: G0:0 G1: 1-5 G2: 6-30 G3: \>30

Answer 38

G0: 0-9 G1: 10-32 G2: 33-100 G3: \>100

Answer 39

cornea only: +1 for each of... - patches of confluent staining - staining in pupillary area - 1 or more filaments

Answer 40

35% EDE 10% ADDE 25% both 30% neither

Answer 41

Hycor ointment

Answer 42

FML qid for 2wks, then bid for 4wks. Rev at 2wk and 6wk mark.

Answer 43

immediately: 200um after 30min: 150um

Answer 44

obesity, obstructive sleep apnea, Down syndrome, and keratoconus.

Answer 45

nocturnal lagophthalmos, compromised lid seal, floppy eye syndrome, recurrent corneal erosions, air travel, CPAP eye protection.

Answer 46

- rev 1-2yrly depending on risk - rev 6/12ly posterior borders scalloped and extensive vitreous degeneration. - p's in 40s/50s, have increased risk of associated retinal breaks and detachment because of increased vitreous liquefaction and/ or vitreous detachment (PVD). - high myopia is a risk

Answer 47

Chol BP Insulin pregnancy renal disease Indigineous/non-english speaking background retinal arteriorlar tortuosity

Answer 48

**_F_**i**_V_**e**_S_**-**_C_**o Fixation to: lights, visual/auditory objects Vertical downgaze Saccade to penlight Co-ordinated head-eye movents

Answer 49

Asymmetries in... 1. binocular OKN 2. Smooth Pursuits 3. Nystagmus

Answer 50

5. 7% 41. 7%

Answer 51

Friction-\>exposure-\> Inflamm-\>worse reflex tearing

Answer 52

drops, steroids, surgery

Answer 53

Congenital NLDO is estimated to occur in 20% of infants and most commonly resolve in 1 year. If doesn't resolve by 6mo then refer for NLD probing.

Answer 54

• BLOCKAGE NOT PRESENT AND ANOTHER CAUSE OF EPIPHORA SHOULD BE EVALUATED • BLOCKAGE WAS RELEASED DURING lavage • POSSIBLE FUNCTIONAL BLOCKAGE

Answer 55

DIFFICULTY DEPRESSING PLUNGER OR FLUID MAY REGURGITATE FROM INFERIOR OR SUPERIOR PUNCTA * INFERIOR REFLUX: INFERIOR CANALICULUS BLOCKAGE * SUPERIOR REFLUX: COMMON CANALICULUS OR LACRIMAL SAC • IF THIS OCCURS, PRESS SUPERIOR PUNCTUM AGAINST ORBITAL RIM TO OCCLUDE AND IRRIGATE AGAIN

Answer 56

FUNCTIONAL BLOCKAGE * PATENT SYSTEM UNDER HIGH-PRESSURE IRRIGATION * PATHWAY COLLAPSES UNDER LOW-PRESSURE SITUATIONS OF NORMAL TEAR DRAINAGE • JONES DYE TESTS USED TO HELP DIFFERENTIATE FUNCTIONAL BLOCKAGE VS. PATENT SYSTEMS -\> refer if suspect functional block.

Answer 57

about a one-month period

Answer 58

nafl: \>5 corneal spots (view after 1min) LG: \>9 conj spots (view after 1min)

Answer 59

LG: 2drops per strip x2; +ve is \>=2mm length and/or \>= 25% sagittal width view after 3min

Answer 60

+ve is OCT nasal RNFL \> 86um, gives 80% sens and spec

Answer 61

**_S_**ix **_D_**ioptres of **_L_**ong **_V_**ision in **_O_**ne eye. **_I_**t **_C_**an **_G_**row **_M_**uck 1. How **severe** is the eye discomfort? 2. Do you have any mouth **dryness** or swollen glands? 3. How **long** have your sx's lasted and was there any triggering event? 4. Is your **vision** affected and does it clear on blinking? 5. Are the sx's or any redness much worse in **one eye** than the other? 6. Do the eyes **itch**, appear swollen or crusty, or have given off any discharge? 7. Do you wear **CL's**? 8. Have you been Dx'd with any **GH** conditions (incl recent respitory inf) or 9. are you taking any **meds**?

Answer 62

close eyes for 30s, depress just 2-3mm below lid margin at angle of 30deg.

Answer 63

reported to occur from 10 to 15 blinks per minute

Answer 64

Normal 0-12 Mild 13-22 Moderate 23-32 Severe 33-100

Answer 65

240" ie. Test Plate V If fails -\> possible amblyopia/squint

Answer 66

5yo 70-100" 6yo 40"

Answer 67

1. 800 2. 400 3. 200 4. 140 5. 100 6. 80 7. 60 8. 50 9. 40

Answer 68

Schwalbe's line Anterior TM (non-pigmented) Posterior TM (pigmented) SS CB

Answer 69

G0: Closed Schwalbe's line not visible G1: Schwalbe's line visible G2: Ant TM visible G3: SS visible G4: Ciliary band visible G0+G1: high risk G2: Medimum risk G3-4: lower risk

Answer 70

50% eventually develop glauc

Answer 71

CONEYECON conjunctival chemosis, eyelid edema conjunctival papillae

Answer 72

80% of ocular allergy; but is not a symptom known to be associated with DED

Answer 73

"Family atop as" family history, atopic dermatitis asthma

Answer 74

AntiH can cause dry eye -\> reduced tear volume -\> more allergans -\> more ocular allergy.

Answer 75

1. Fast to clear -3.50/-2.00 and MEM+1.25/+1.50 -\> no add req'd. 2. slow/fail -3.50 + fast -2.00 + MEM(+0.50 to +1.50) - \> Rev 6/12ly watch for decomp 3. slow/fail -3.50 and -2.00 + MEM(+1.25/+1.50) - \> needs add 4. MEM \>= +1.75 (give Add)

Answer 76

normal accommodative lag falls between +0.50 and +1.00 inclusive,

Answer 77

reading through plus/minus flippers for 20 minutes per day, flipping every sentence to challenge the accommodative response to demand (use +/-2 Flippers)

Answer 78

include large upper tarsal papillae and hyperemia with usually minimal corneal or bulbar conjunctival involvement

Answer 79

Red is for choroid. Green is for sensory retina

Answer 80

Autofluorescence imaging is a brightness map reflecting the distribution of **lipofuscin** and other ocular **fluorophores** and reflects how the **RPE is functioning**

Answer 81

 Hyperfluorescence indicates metabolic compromise, “sick” RPE under stress  Hypofluorescence indicates dead or absent RPE

Answer 82

Quantify Hirschberg test when squint present. Place increasing prism powers in front of fixating eye so that both eyes have symmetric hirschberg reflexes. This gives estimate of magnitude of deviation. For esoT, use BO prism.

Answer 83

Use ophthalmoscope at 1m in dark room. Don't use if \<8months old.

Answer 84

If suspect microtropia Shine grid on child's hand and ask to touch the center. MUST occlude other eye Dim ophthalmoscope. Sometimes easier if dilated.

Answer 85

G0 = zero G0.5+: 1-5 G1+: 6-15 G2+: 16-25 G3+: 26-50 G4+: \>50

Answer 86

P-HOARD Numerous other conditions, such as **P**osterior vitreous detachment, **h**ypertension, **o**ptic neuropathy, **a**nemia, **r**etinal vascular disease, **d**iabetes.

Answer 87

1. The observation of a disc hemorrhage should prompt a thorough investigation for glaucoma, and individuals with disc hemorrhages should be considered glaucoma suspects. 2. In individuals with known glaucoma, a disc hemorrhage may be a sign of active disease and progression. Thus, while a disc hemorrhage does not need to be treated, per se, its presence may signal the need to initiate or intensify IOP-lowering therapy.

Answer 88

0. 4% in normals 20. 5% in low tension glaucoma 4. 2% in POAG

Answer 89

PDS 30% become OHT/Glauc

Answer 90

C-PACKS Conjunctivitis (potentially cicatrizing), Periorbital eczema, Anterior polar cataracts Corneal neovascularization that could lead to eventual conjunctivalization of the cornea, Keratoconus Symblepharon

Answer 91

Rhegmatogenous and non rhegmatogenous

Answer 92

Tractional: Scar-related, Vitreo-retinopathy Exudative: Mass, inflamm, posterior scleritis

Answer 93

Atropic Holes: retinal thinning Retinal Tears: Vitreous traction -\> Operculated or flap tears

Answer 94

ACT and prism over the **non-fixating** eye to neutralize.

Answer 95

how: place neutralizing prism over non-fixating eye while covering the fixating eye simultaneously. Do so briefly to prevent dissociation. when: Only used to measure small angle tropias

Answer 96

Vernal keratoconjunctivitis (VKC) signs... Same: Rapid fluorescein breakup time, SPK associated with sodium fluorescein staining and increased conjunctival lissamine green staining **PIECoB** Diff: intense **I**tching, **B**urning, **E**piphora, **C**onjunctival injection and **P**hotophobia **M**a**CHS** VKC: younger **_M_**ale patients most notably those under age 18 large **_C_**obblestone papillae and/or **_H_**orner-Trantas dots **_S_**hield ulcers and scarring

Answer 97

**Location:** Neurosensory retina separates from RPE v Within neurosensory retina between inner/outer layers **Commonest location** Superior temporal v Inferior temporal **Appearance** Rippled, irregular, drifts with eye movements v Smooth, shiny, stationery **Refractive error** Myopes over-represented v 70% in hyperopes **Monocular/bilateral** Tends to be unilateral (or at least one eye at a time) v Tends to be bilateral **Tobacco dust, flashes & floaters**: Present v Absent **Associated field defect** Relative, progressive v Absolute, stable

Answer 98

1. rules out constant strab 2. If intermittent strab then implies good sensory fusion when straight

Answer 99

**MUCO** **M**orning crusting is also common. recent **U**pper respiratory tract infection close **C**ontact with someone with a red eye. redness and irritation in **O**ne eye initially, often spreading to the fellow eye within a few days. **P**reWERM **P**reauricular lymphadenopathy is also commonly present, **w**atery, **e**dematous, **r**ed lids, **m**ucoid discharge

Answer 100

**SOMSS** Significant **s**ub-retinal/serous fluid (say more than one disc diameter) **o**verlying vitreous on edges of the hole **M**ore highly myopic patient, **s**ymptomatic, **s**uperior location

Answer 101

PIG-HOLE **Pig**mentation evident around edge of hole **Hole** has been present for longer time

Answer 102

Atrophic hole v Operculated Tear v Flap tear **Shape**: Round or oval v Round, disc-shaped operculum floating above v U-shaped with central flap **Vitreous traction** None v Initially created the break, but absent once the operculum has separated v Usually continuous **Retinal or vitreous haemorrhages** Never v Rarely v Often **Symptoms** Only if clinically significant detachment v Possible in traction phase, or if clinically significant detachment v Frequent in traction phase **Incidence of detachment** Uncommon but possible v 1 in 6 (less if asymptomatic) v 1 in 3 **Referral/treatment :** Generally monitor, but refer if symptomatic or significant localised detachment v Generally monitor, but refer if symptomatic or significant localised detachment v Always refer promptly, treat with barrier laser

Answer 103

Lattice degeneration, white without pressure and posterior vitreous detachments

Answer 104

occurs in young/myopic eyes, 6-10% of normal pop 40% risk refer if Flashes/floaters else annual review.

Answer 105

snowflake/microcystic degen Reticular/Honeycomb degen (common in elderly)

Answer 106

Get 90D and shine a v small light on affected area. If can’t see it then it is schisis

Answer 107

EKC is when adenovirus invades cornea -\> corneal infiltrates -\> irritation/pain/vision blur lasting months/years. Periorbital edema and inflamm which may involve EOMs. Early stage has PAN on ipsilateral side of red eye, 1wk later corneal infiltrates start.

Answer 108

Congenital Hypertrophy of the Retinal Pigment Epithelieum (CHRPE) Significance: Common benign lesion Can appear as pigmented, with lacunae, or become depigmented over time Result in RPE defects Association of CHRPE-like lesions with familial links to bowel cancer (FAP) If see 4+ CHRPE then screen for cancer.

Answer 109

Choroidal naevi Incidence of choroidal naevi in Caucasians estimated to be 5-8%, in Asians 1.5% 1 in nearly 9,000 naevi transform into melanoma

Answer 110

Choroidal Melanoma – “To Find Small Ocular Melanoma Using Helpful Hints Daily” Thickness \>2mm Fluid (sub-retinal) Symptoms Orange (lipofuscin) pigment Margin within 3mm of disc Ultrasonic Hollowness Halo absent (unlike naevus) Drusen absent

Answer 111

Red: All visible Green: All visible except nevus FAF: Nevus: not visible except drusen Melanoma: Hyper/Hypo CHRPE: Black

Answer 112

inflamm of choroid small, yellowish choroidal spots and vitreous inflamm FAF shows hyper spots

Answer 113

Multifocal Evanescent White Dot Syndrome White dots in deep retina caused by inflamm FAF shows hyper dots in central and peripheral retina.

Answer 114

normal fusion or AC to differentiate, do UCT while p fixates white dot (tell p to look by position rather than colour). If there is refixation of either eye on covering fellow eye -\> Strab+AC If no mvt then normal fusion.

Answer 115

Pharyngoconjunctival fever: Caused by adenovirus acute high fever, pharyngitis, bilateral follicular conjunctivitis, PAN Often in children and those living in close quarters Self-resolves in 1wk

Answer 116

Areas of hypo and hyper can be seen

Answer 117

Most are slow taking 20years. ~10% are fast and takes 10years.

Answer 118

Hydroxychloroquine Didanosine (HIV drug) Thioridazine (Schizophrenia) FAF shows hyper ring around macula

Answer 119

Deepening \> enlargement \> new defect.

Answer 120

Baseline Data –first 2 years –At least 2 reliable VF within the first 6 months • 3 within first 6 months when there is a high likelihood of visual disability – At least 2 further VF within the next 18 months –VF testing should be repeated sooner than scheduled if possible progression is identified –SIX VF within the first 2 years allows the clinician to identify rapid progression

Answer 121

In low‐and moderate‐risk: yearly (Sooner if possible VF progression –OR‐on other clinically tests) high risk: 6monthly

Answer 122

Event analysis (EA): change from baseline greater than a predefined threshold based on test‐retest variability according to the level of damage

Answer 123

Trend analysis (TA) (VFI): rate of change over time; significance is determined by both the magnitude of change and the variability of the measurement

Answer 124

In general, event analysis is used for follow‐up when fewer VF are available –When suspected progression is identified, at least TWO further tests should confirm that

Answer 125

In general, trend analysis (rate) is used later in the follow up (later than 2 years)

Answer 126

About 5% chance that a single point will fall outside the expected change on a single test –Much less likely that same point will do the same in a subsequent test If point is in same region of VF as existing defect –much more likely to be “real” change –Point in central 10 degrees exceeding expected change is much more likely to be “real” change

Answer 127

Prostaglandin Analogs (PGAs) Mechanism of action: increase uveosceral outflow Effect: excellent (25-35% reduction) Dosing: once daily (doesn’t matter am/pm) Side effects: – Minimal systemic Ocular: (3Hyper-Deep) Hyperemia • Hypertrichiasis • Hyperpigmentation –iris and periorbital skin • deepening of upper eyelid sulcus

Answer 128

• When to reconsider: ACUPUN Acute rise in IOP CME Hx or risk of CME (ok in DM+) Unilateral therapy Pregnancy Uveitic glaucoma (???) Neovascular glaucoma (???)

Answer 129

Optical explanation MORE LIKELY if... No increase in PSD, in cases where MD is better than -10dB

Answer 130

target IOP is adjusted or significant change in therapy Last 2 tests that confirmed progression can be new baseline exams Frequency of testing needs to increase again

Answer 131

False Positives.

Answer 132

beta-adrenergic antagonists (beta blockers) • Mechanism of action: decrease aqueous production • Efficacy: very good (25-30% reduction) * Dosing: once vs twice daily * Side effects: – Minimal ocular side effects – Systemic: • Bradycardia • Bronchial constriction • \*\* CHECK EXISTING MEDS, VITALS • Short term escape (days-weeks) & long term drift (months-years)

Answer 133

More or Less a wet uni more **M**ore Common in children **L**ess common v viral/allergy **We**t DC v dry and crusty esp in morning (matted lashes) **U**nilateral or bilateral **M**ore conjunctival injection v DED/viral

Answer 134

When to use: – First line therapy for patients with contraindications to prostaglandins – Need rapid lowering of IOP – Cost (generic is cheap) – Added drug for prostaglandin users • Different mechanism of action •

Answer 135

When to reconsider: - Heart Disease - Pulmonary Disease Eg. Asthma – Patient on oral bb (+/-)? – Normal tension glaucoma (may reduce perfusion to ON)

Answer 136

–timolol maleate (Timoptol, Timoptol-XE) non-selective (better option) 29% reduction –betaxolol(Betoptic, BetoQuin) 26% reduction selective beta1 receptor blocker fewer systemic side effects not causing bronchospasm.

Answer 137

Correct even small refractive errors as even small amounts can cause fatigue. Correcting differences b/w eyes recovers normal accomm-verg in 63% of cases. Give ADD

Answer 138

**MoPS, R, 3VC** Most common OD anomaly. Peripapillary Halo (yellowing, mottled) Small ONH (pink, grey or pale) Ring of incr/decr pigm bordering halo ('double ring' sign) Veinous tortuosity VA: 6/6 to NLP VF defect possible CNS abnormalities (strong association) -\> MRI req'd

Answer 139

Glaucoma –alpha-adrenergic agonist • Mechanism of action: – Decrease in aqueous production – Increase in uveoscleral outflow • Efficacy: good (20-25% reduction) • Dosing: tid vs bid • Side effects: – Systemic: DiDS * Somnolence (sleepiness) * Dry mouth * Dizziness/fainting – Ocular: • allergy

Answer 140

Alphagan Alphagan-P (Preservative Free) - use for those allergic to preservative.

Answer 141

Tests: hirschberg, Bruckner, TNO (if old enough), wise to do cyclo Ret Mx: rev 3-4mo; if at review normal then rev 6/12 after this.

Answer 142

Absence of IOP asymmetry between the fellow eyes is associated with a 1 percent probability of having glaucoma. A difference of 3 mmHg is associated with a 6 percent probability and a difference of \>6 mmHg with a 57 percent probability of having glaucoma

Answer 143

RAPP **R**apid IOP lowering (esp in combo) - **A**dditivity: Excellent additivity with prostaglandin/Good with beta-blocker – **P**reservative toxicity/allergy – **P**regnancy Category B -can use in 1st trimester (discontinue in breastfeeding)

Answer 144

Target IOP –2 methods • Stage of Disease: –Mild: ~30% IOP drop from highest IOP –Moderate: 30-40% drop –Severe Loss: 40-50% drop • Stage of Disease: –Mild: high teens –Moderate: mid teens –Severe loss: low teens

Answer 145

Brimonidine | (alpha-agonist)

Answer 146

Glaucoma –carbonic anhydrase inhibitors * Mechanism of action: decreased aqueous production * Efficacy: excellent (oral –40-50%+); good (topical –15-20%) * Dosing: bid –tid * Side effects: – Topical: * Bitter taste * Stinging • Hyperemia * Corneal endothelial probs (if lots of guttates don't use CAI)

Answer 147

55yo+: prevalence of AMD is 3% 40+ yo: 10% have some signs of AMD (whether early/intermediate/late)

Answer 148

Glaucoma -CAIs • When to consider: – Good addition to prostaglandin – Brimonidine allergy • When to avoid: – Fuchs corneal endothelial dystrophy – Pregnancy – Sulfa allergy (???) • Available: – Dorzolamide (Trusopt, Trusamide, APOdorzolamide) – Brinzolamide (Azopt, BrinzoQuin)

Answer 149

Glaucoma -acetazolamide (diamox) * Typically used in emergency/acute situations rather than long term due to systemic side effects: * Typical use: – Post-surgical IOP elevation – Acute angle closure (NON-PUPILLARY BLOCK ONLY) – Extremely elevated IOP • Dosing: – 250 mg tablets qid(generic) – 500 mg time-released capsules (Sequels ®, generic) bid

Answer 150

Glaucoma -pilocarpine • Mechanism of action –increase trabecular outflow * Efficacy: good (25%) * Dosing: qid * Side effects: – Accommodative spasm – Browache – Bronchial constriction * Use: acute angle closure with pupillaryblock(low concentration)

Answer 151

Fixed Combination Medications • CAI + timolol –Brinzolamide/timolol (Azarga)

Answer 152

–Dorzolamide/timolol (Cosopt, Cosdor)

Answer 153

• Brimonidine + timolol (Combigan)

Answer 154

• Brinzolamide + brimonidine (Simbrinza)

Answer 155

• PGA + timolol –Bimatoprost + timolol (Ganfort, Ganfort PF) –Latanoprost + timolol (Xalacom, Xalamol, Lantim) –Travoprost+ timolol (Duotrav)

Answer 156

3months as new RNFL dropout may be seen.

Answer 157

standard dimensions PT 7, wrap 5, BVD 13mm

Answer 158

Use 0.5% in 0-12months old. Instil one drop in both eyes twice 5mins apart. (Clinician to do it as must observe for adverse affects within 30min) Note: Blond hair/blue eyes particulary susceptible. examine after 30min. for \>=1yr old use cyclo 1%

Answer 159

BVD of glasses and BVD of phoropter so they can compensate

Answer 160

increasing the corridor length.

Answer 161

wd 50cm - 0.75 for \<2yo - 1.00 for over 2+yo

Answer 162

CCOPP Chemosis of lids conjunctival injection ON dysfunction: VA down, CVD, RAPD Painful Ophthalmoplegia (EOM paralysis) Proptosis

Answer 163

PT very different when standing vs sitting. They tend to tilt head back to look up at people when standing. It can be as much as 10deg and 5mm Ht diff

Answer 164

Heights!! Else unwanted prism can be induced as lab will fit it on datum.

Answer 165

vary the PD of the trial frame 0.3mm for every prism diopter away from the base. Eg. RE 8BO prism -\> reduce the pd in that eye by 2.4mm

Answer 166

0. 25 +/-16 0. 50 +/-9 0. 75 +/-6 1. 00 to 1.50 +/-4 1. 75 to 2.50 +/-3 \>2.50 +/-2

Answer 167

PT: Incr tilt -\> drops the near zone lower and increases effective VF. BVD: Incr BVD -\> lifts the near zone higher and reduces effective VF.

Answer 168

Observation or Tx

Answer 169

First Stop Cushing's Sleep **First** acute episode in a young patient and less than 3 months onset * **STOP** corticosteroids!: oral, nasal sprays, joint injections, skin ointments * Consider **Cushing**’s Disease: A condition that occurs from exposure to high cortisol levels for a long time. (Signs are a fatty hump between the shoulders, a rounded face and pink or purple stretch marks.) * Treat **sleep** problems: shift work, sleep apnea

Answer 170

**SOC 40** Severe Vision loss * Occupational need for excellent binocular vision * Chronic sub-retinal ﬂuid (3-6 months) * \> 40 years of age

Answer 171

Use roving if central VF defect for everything else use fixating

Answer 172

LAANN Level map 124 Numeric Numeric Tic Marks Annotations Attributes

Answer 173

Is it worse in light or dark? also check light reaction. Implication: worse in light and poor light reaction in one eye means the more dilated pupil is abnormal. worse in dark and good light reaction means the smaller pupil has problems dilating.

Answer 174

dilation lag (dodgy pupil takes about 10-15sec to dilate cf normal pupil which takes 3-5sec) Implications: If dilation lag is absent then it is physiologic anisocoria. (Dilation occurs with 10% cocaine) If dilatation lag present -\> Horner's syndrome (dilation doesn't occur with 10% cocaine).

Answer 175

How: Instill cocaine drops in both eyes. Cocaine stops the reuptake of Nor-Adrenaline and therefore prolongs the affect of dilation (as there is more NA binding with he a1-receptor causing dilation). In normal -\> this will cause dilation in both eyes. In Horner's: there is disruption of the nerve pathway and therefore less/no NA has been released at the synapse and therefore no dilation will occur. The normal pupil will dilate but the Horner's pupil will not dilate.

Answer 176

Miosis (also Dilation Lag) Anhydrosis (lack of sweat of affected side) Ptosis (Affected side) Heterochromia (Affected iris lighter)

Answer 177

Use Paredrine (1% Hydroxyamphetamine) in horner's eye. paredrine acts to release NA from nerve terminal. Pre-ganglionic Horner's: Dilation occurs as the 3rd order nerve is normal and still has NA to be released. Post-ganglinic Horner's: Dilation does not occur as the 3rd order nerve is abnormal and has no NA to be released.

Answer 178

1. S/L exam of iris 2. Check Near constriction 3. Consider 0.125% pilocarpine test

Answer 179

L/N Dissociation has.. Quick NR but no/sluggish LR If see this... REFER!! could be Parinaud's Syndrome or Argyll-robertson pupil

Answer 180

While first time wearers will most often be placed in a softer design it may prove beneficial to implement a harder design for first time myopes in PAL's.

Answer 181

48% by age 15 years; 77% by age 18 years; 90% by age 21 years; 96% By age 24 years,

Answer 182

**_ST_**on**_C_**on Sector iris palsy (Iris streaming) Tonic near constriction (Delayed NR) Constriction w 0.125% pilo (cholinergic supersensitivity)

Answer 183

round pupil poor near constriction no constriction with 0.125% pilo constriction with 1%pilo Eyes down and out

Answer 184

Round Pupil Poor NR No constriction w 0.125% pilo No constriction w 1% pilo

Answer 185

Torn Pupillary Border Sluggish NR

Answer 186

check pupils for RAPD colour vision

Answer 187

Abnormality along Optic Nerve most commonly and rarely at the optic tract. It may also indicate wide-spread retinal damage.

Answer 188

Place neutral density filter over good eye and then retest MG+ Increase density until MG disappears. Make sure to quickly 'bleach' both eyes b/w increases so as to equalise the LR search youtube under "how to measure the rapd moran core"

Answer 189

In lit room, get p to look straight ahead, over the other eye, use iphone with a flash from the side. ACD(mm) = -3.3(E:Z) + 4.2, where E is limbus to centre of pupil and Z is limbus to cornea. \<2.5mm is high risk for AGC

Answer 190

Go to AAOO calculator under oblique astigmatism tab Enter dist rx and corridor lenght in cm Work out net vert prism and trial frame this with the add. If p able to fuse then don't compensate for it, else ask the lab to compensate.

Answer 191

Get the p to look eccentrically to induce diplopia.

Answer 192

Are you susceptible to motion sickness? Higher rate of rejection of MF and BF's (especially BF's)

Answer 193

\<43.5D flatter than 8.5mm or orders w BC\>9.2mm

Answer 194

strongly associated w fractures of the base of skull. Must ask if there is a recent head injury.

Answer 195

Brimonidine Uveitis. Can occur even after using it without problems for a long time eg. 10months.

Answer 196

periorbital dermatitis. Can cause hypersensitivity after taking topical dorzolamide and become allergic to BAK and so must use non-preserved.

Answer 197

PX setting: any age; 70-80% Female; FH in 40-50%; often emotional factors

Answer 198

strong boo versus lazy imps with nits steady, non-pulsatile dull ache - back, neck/bitemporal/bilateral - bilateral in 90% radiating to neck, temples, shoulders - variable severity; build slowly to peak (hours) - lasts hours upto 1 day, over several months; rarely interrupts sleep - improved w analgesics, sedatives, rest, massage - worse w activity/stress - Neuro sx's in 10%; maybe nausea/light-headed

Answer 199

Very common 12-35% of general population 70% Females FH in 65-90% Usu begins age 5 to 30 Emotional factors operative Types include: common (80%), Classic (12%), Complicated (3%), Cluster (5%)

Answer 200

dry 85-90% remainder wet

Answer 201

This technique should be carried out in a dark room Set the patient up at the slit-lamp and advise them to fixate straight ahead Lock the illumination at 60° temporally to the patient The viewing microscope should be set straight ahead Set the magnification to 10-16x Use a thin 1-2mm beam and turn it horizontally Place the beam over the temporal pupil margin, focused on the cornea A second beam on the iris/anterior lens will be visible on the nasal pupil margin Increase the height of the beam until the edges of the two beams just touch The illumination must be rotated 60° to the other side to measure the other eye

Answer 202

SL measurement x 1.31 average is 3.15 ACG risk if \<2.5mm

Answer 203

changing script, manipulating corridor length and moving the prism balance point or a combination of these

Answer 204

Wrap. 25% 50% in the performance of a progressive lens that does not take account of individual parameters. Individual progressive lenses still have a performance of almost 100%.

Answer 205

\>73mm (they will converge too much for the near zone) \<58mm (they won't converge enough for near zone)

Answer 206

Migraine: Gradual, 20-30min, binocular, homonymous, march with time (spread), flickering lights, photophobia. No med risk factors. Carotid Disease (TIA): Sudden, mid-aged and older, 1-7min, monocular, stationary, total or partial "grey-out", "black-out", "shade" or "veil", med risk factors present v Vertebrobasilar Insufficiency: Sudden, older, 1-7min, binocular, stationary, total or partial "grey-out", "black-out", "shade" or "veil", med risk factors present

Answer 207

Severe, Unilateral, pulsatile, visual disturbance, prodrome 20-30min, contralateral HA to sx's in 80%; Occurs after stressful stiuation Eg. weekends; HA lasts hrs and in cycles which may last over days Neurological sx's: nausea, vomiting, photophobia Triggers: stress, depression, menopause, menstruation, CP, histamines in choc, wine, nuts; tyramine in cheese, nitrates in meat;

Answer 208

Similar to classic migraine except HA is main sx Vague or absent prodrome Neurologic sx's rare

Answer 209

20-50yo males M/F 5/1; emotional factors present unilateral; knife-like pain around eye, v intense radiates to temple, maxilla, gum sweat/heat imbalance worse w stress/alcohol clusters of 1-6/day lasting 10-60min starts early 4am occurs at intervals of 1-3months ipsilateral, facial flush, nasal congestion, horner's (33%), sweating

Answer 210

**HOOBA** 1. Hemiplegic - gives paresis in some body part 2. Ophthalmoplegic: gives paresis of EOM 3. Acephagic - HA is absent w only visual sx's 4. Ocular: transient monocular vision loss, may or may not be mild HA (dx of exclusion) Cf. TIA's: in older people w vascular disease. 5. Basilar: 20-40mins: black/grey outs, usu young Females w severe occiptal HA.

Answer 211

If 30+yo and presents w 1st severe migraine

Answer 212

40-50yo; F/M 3/2; MS approx 15% sharp, quick, unilateral sudden, sec-minutes; occurs in spasms but w sx free periods V1-V3 distribution, but may radiate trigger points (eye/nose/mouth/teeth), worsens w cold,food etc Carbamazepine (80%), Phenytoin improves it.

Answer 213

TDHS Clever Boo Needs Breakfast Daily 20-50F; c/o multiple somatic sx's and lots of ops, depression/anxiety Insomnia HA: bizarre, 'band-like', squeezing, extreme psychological probs severe pain but indifferent constant 24/7, days to months bizarre radiation, nothing helps worse w stress blindness, fainting, paralysis Dx of exclusion

Answer 214

refer to ophthalmologist to rule out syndromic conditions.

Answer 215

esoP or Accomm lag give +1.50 or +2.00 Add

Answer 216

The rule states that when aneurysms compress the oculomotor nerve (CN3), the iris sphincter will be impaired, leading to a dilated or sluggishly reactive pupil.

Answer 217

If a child w 2myopic parents is +0.75D or less at age 6, they have a 75% chance of being myopic by age 13.

Answer 218

1. myopic parents 2. \<=+0.75D

Answer 219

Several studies have suggested that (in order of importance) 1. mean RNFL thickness 2. inferior quadrant thickness, 3. followed by superior quadrant thickness,

Answer 220

a cutoff of 8.0 seconds has 78% sensitivity and 72% specificity for diagnosing DED against tear hyperosmolarity

Answer 221

allergic conjunctivitis

Answer 222

VCLIP Person trying to blink but blocked by VCLIP Vdu computer reduced blink rate Cosmetic: on the vdu screen is someone having cosmetic surgery Laxity: botched surgery leads to lax lids!! Incomplete: lid closure now as they try to blink Partial: blink action sometime full sometimes half. long hour on **V**DU (reduced rate) **C**osmetic surgery, **L**id laxity, **I**ncomplete lid closure **P**artial blinking,

Answer 223

our blink is essential to naturally expressing meibum. So anything that prevents a proper blink is likely to be a cause of MGD.

Answer 224

the Korb-Blackie Light Test.

Answer 225

In your darkened room, instruct the patient to close their eyes as if sleeping, but not squeeze. Place the transilluminator on the closed upper eyelid and look for light escaping from the bottom between the eyelids.

Answer 226

If VA is 6/7.5 or better, even with CSME, observation v invasive tx gives same VA outcome after 2years. Therefore just observe.

Answer 227

Look for consistently blurred vision without dry eye signs, or a TBUT that consistently breaks up in the same place to be a possible EBMD presentation.

Answer 228

INTERMEDIATE AND ADVANCED AMD (NON-CENTRAL GEOGRAPHIC ATROPHY IN ONE OR BOTH EYES) -> reduces the risk of progression of the disease and loss of visual acuity by about 25% over five years

Answer 229

Acute: Totally resolved within 3mo, not caused by another pathology of cornea or post pole. Persistent > 3mo duration. Recurrent: Repeated episodes, but no recurrence for >=3mo w/o tx in b/w. Chronic: Recurs <3mo of ceasing tx. Higher risk of vision loss.

Answer 230

If mild ie. ACR G1 -> PF q1h anyway in case early stage; Rev 1day. Can reduce if still ok. Cyclo 1% tid is better than atropine. If severe PF q15 for 1hr then q1h, x2 stat bedtime; rev 24hrs If post synechiae: soak cotton tip in atropine 1%, put into inf fornix 15min, repeat in 1hr, then rx: atropine 1% bd/tid When ACR drops a grade reduce PF to q2h-3h (q2h for 2d, then q3h for 3d) and atropine to qd; then stop atropine. rev daily until ACR back to G1, then PF qid for 1w, then if G0-0.5 taper ie. reduce 1drop/week;

Answer 231

Paediatric Atypical, complicated, severe Non-responsive Intermediate/Posterior Chronic Bilateral Endophthalmitis possibly Granulomatous

Answer 232

rev in 24h to ruleout early MK, then again in 1w

Answer 233

"1223C" 1+ ACR 2mm+ in size 2+ adj lesions <=3mm from corneal centre culture cornea, if CL wearer then culture CL and case Note: if culture required then fortified Ab will be needed therefore send to RVEEH as well

Answer 234

Sig corneal thinning Large Area Compliance concern Culture required

Answer 235

Do crigler massage 10-15x/d

Answer 236

2.5yo+ try LEA <2.5yo use preferential looking/electrophysiology

Answer 237

Check CT in all directions using -2 Flipper for D and N (as it stimulates accommodation)

Answer 238

Young astigmats (everything is blurry to them)

Optom General Flashcards

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