PPO2 Flashcards
1
Q
ARCUS
Type, Mechanism, Layer, Prevalence, Mgmt
A
Degeneration
STROMA
60% (40-60), 90% (70-90)
No mgmt
Abnormals - serum lipid profile (young/thick)
2
Q
LIMBAL GIRDLE OF VOGT
Type, Mechanism, Layer, Prevalence, Mgmt
A
Degeneration
SUB EPI collagen (UV)
60% (40-60), 90% (70-90)
No mgmt
3
Q
HUDSON-STAHLI LINE
Type, Mechanism, Layer, Prevalence, Mgmt
A
Degeneration
BOWMAN’S
20% (20’s), 60% (60’s)
No mgmt
4
Q
DECEMET’S STRIAE
Type, Mechanism, Layer, Prevalence, Mgmt
A
Degeneration
DESCEMETS
Normal unless large - (+) pachymmetry stromal edema
No mgmt
5
Q
MOSAIC SHAGREEN
Type, Mechanism, Layer, Prevalence, Mgmt
A
Degeneration
STROMA
Normal unless trauma - (+) pachymmetry stromal edema
No mgmt
6
Q
HASSAL HENLE BODIES + GUTTATA
Type, Mechanism, Layer, Prevalence, Mgmt
A
Degeneration
Henle - peripheral, Guttata - central
Raised bits of DECEMETS into endothelium, stroma
70% (40’s)
No mgmt unless pigment, edema, fuchs - (+) pachymmetry stromal edema
7
Q
CORNEAL FARINATA
Type, Layer, Prevalence, Mgmt
A
Degeneration
STROMA lipofusin
Normal bproduct of age
No mgmt
8
Q
SALZMANN’S NODULAR DEGEN
Type, Mechanism, Layer, Prevalence, Mgmt
A
Degeneration
Rare ~old keratitis, mucopolysaccharides, osteoporosis, pterygium
Plaque between EPITHELIUM + BOWMAN’s
Mgmt:
monitor yearly, if (+) epithelial breakdown:
rewetting drops, mytomycin C, PTK
9
Q
BAND KERATOPATHY
Type, Mechanism, Layer, Prevalence, Mgmt
A
Degeneration
Gray calcium/phosphate salts 3/9oclock
STROMA
Normal in elderly, unless longstanding inflamm/glaucoma/hyperPTH/RA/vit D toxicity
No mgmt unless above:
serum Ca/Mg levels, Uric acid (gout), N2, Creatinine, ACE (sarcoid)
Va affected = chelating agent + scraping
10
Q
DELLEN
Type, Mechanism, Layer, Prevalence, Mgmt
A
Rare Finding
Thinning cornea next to raised area
STROMA
Mgmt: TREAT to prevent scar/neo, remove cause, lubricate
11
Q
KAYSER-FLEISCHER RING
A
Rare finding - WILSON’S D+ copper ring
DECEMETS
Mgmt: REFER to internist, low Cu+ diet
12
Q
Kayser-Fleisher Ring
A
Rare finding - WILSON’S D+ copper ring
DECEMETS
Mgmt: REFER to internist, low Cu+ diet
13
Q
PANNUS
A
Normal finding in small amounts Limbal vessels 1-2mm (micro), 2< (gross) Mgmt: FIND CAUSE micro - conj, staph bleh, CL wear, acne roseaca gross - (+) trachopa, atopic keratoconj
14
Q
POSTERIOR EMBRYOTOXIN
A
Congenital finding, Rare = glaucoma
DESCEMETS (Schwalbe’s line)
Mgmt: DDX GLAUCOMA
IOP, gonio, iris/corneal changes
15
Q
KRUCKENBERG SPINDLES
A
Abnormal finding
ENDOTHELIUM
Mgmt: DDX GLAUCOMA
IOP, gonio, iris transillumination, PXE/PDS
16
Q
VORTEX KERATOPATHY
A
Other finding EPITHELIAL+STROMA Mgmt: Drugs (plaquenil/amiodarone) = normal Fabry's D+ = abnormal - refer for enzyme replacements
17
Q
FLEISCHER’S RING
A
Fe ring at base of cone in keratoconus
18
Q
FERRY LINE
A
Fe ring around filtering blep
19
Q
STOCKER’S LINE
A
Fe at the head of pterygium
20
Q
COAT’S RING
A
Fe around FB
21
Q
AXENFELD LOOPS
A
loop of nerve from anterior ciliary body ~12% eyes
22
Q
OCULARMELANOSIS
A
extra pigment in the eye
23
Q
EPICAPSULAR STARS
A
remnant of TUNICA VASCULOS LENTIS. star shaped distn of brown flecks on anterior capsule
24
Q
Y SUTURE
A
anterior Y, posterior flipped
25
ZONULAR OPACITIES
embryonic opacity affecting only innermost lens
26
CORNEAL SCAR
injruy to Bowman's/Stroma
27
CORNEAL SCAR
injruy to Bowman's/Stroma
28
3 types of corneal dystrophies
keratoconus, fuch's dystrophy, epithelial/BM disorders
29
3 Hallmarks of Keratoconnus
irregular astigmatism, apical protrusion, paracentral stromal thinning
30
Munson's sign
keratoconus - convexivity of lower lid on downgaze
31
Fleischer's ring
keratoconus - Fe at base of cone
32
Vogt's striae
keratoconus - vertical striae posterior stroma
33
Corneal hydrops
keratoconus - due to breaks in decemets membrane. Decrease vision, cause pain, edema in stroma. T(X) cycloplegics + hypertonics
34
Mechanism of keratoconus?
- unable to eliminate ROS/NO- = oxidative damage
- poor collagen x-linking = Bowman's fibrillates
- causes epi to be in contact with stroma
35
T(X) keratoconus?
glasses
rgp's, scleral CL's, piggyback lenses*
corneal x-linking (riboflavin + UV)*
keratoplasty (transplant)
36
Prevalence of Fuch's Epithelial Endothelial dystrophy?
Autosomal dominant, slow progression, bilateral, females
37
Ocular signs of Fuch's dystrophy?
Early - guttata: change sin endo due to dec ability to act as a pump
Progression - stromal edema, corneal scarring, epithelial edema, bullous keratopathy
38
Complications of Fuch's?
2˚ glaucoma - same mechanism that destroys endo prob destroys trabecular meshwork
39
T(X) fuch's?
Hairdryer in morning
5% NaCl hypertonic drops, ointment at night
BCL's
PTK for corneal scarring
Decemet stripping automated endothelial keratoplasty (DSAEK) in severe cases
40
Prevalence of Epithelial BM dystrophy
40's to 70's, women
41
Causes of epithelial BM dystrophy?
Problems with the BM: thickening causes Epi to unadhere from stroma = melformed hemidesmosome connections
42
4 ocular findings of epithelial BM dystrophy?
dots (microcysts in epithelium)
fingerprints (projections of BM into epi)
maps (thick BM overlying epi)
blebs (mounts of granular tissue bw bowman's + BM)
43
best way to view findings of epithalial BM dystrophy?
direct retro for opacifications in corneal epithelium and BM!
44
Complications of epithelial basement membrane dystrophy?
Increase chance of erosion
45
Epithelial BM Dystrophy T(X)
```
No S(X) = monitor
DE = lubricate
Erosions = ointment, pressure patch, NaCl- agents
PTL on Bowman's to help healing
```
46
Loss of Corneal claricity is caused by 4 things
NISE
| neo, injury, scarring, edema
47
How long for epithlium to regen?
24-48 hrs, total cycle is 7-14 days
48
How long for BM to regen?
6-8 days
49
Where does neo happen = loss of claricity
Surface + Stroma
50
Diff between surface + stromal neo?
Superficial neo - tight CL's, trachoma, superior limbal keratitis
Deep stromal neo - infection, usually Syphilis, TB, mumps, interstitial keratitis
51
5 symptoms of corneal injury
```
PPHVL
Pain
Photophobia
Halos
dec VA
Lacrimation
```
52
Causes of corneal injury
abrasion, bullous keratopathy, trauma
53
DDx Ulcer vs Abrasion
Ulcer = (+) history, pain, wbc's, epithelium and stroma, takes up NaFl
Abrasion = epithlium, NaFl stays in would, red, no discharge
54
How do you T(x) a corneal abrasion?
antibiotics + cycloplegia
55
How do you treat a recurrent corneal erosion?
pressure patch, scrape epi to improve healing, BCL
56
How do you treat a FB in the cornea?
irrigate, alger brush, then treat as if abrasion (lub, BCL's, antibiotics, cyclo)
57
Explain epithelial edema
Cause: PMMA's, rbcs,abrasion, swimming, scatters light >5%
Sign: sclerotic scatter = dark
S(X): dec VA, halos, spec blur
Mgmt: hypertonic NaCl, hair dryer, lower IOP, remove cause
58
Explain stromal edema
Cause: Soft CL's, Fuch's, surgical, trauma, ulcers, IOP, glaucoma
S(X): glare
Mgmt: pachymetry, DSAEK, steroids
59
8 layers of the lid
eyelashes, skin, vasculature, muscles, grey line, orbital septum, tarsal plate, conjunctiva
60
Glands in the eyelashes
glands of moll (sweat), glands of zeiss (sebaceous)
61
innervation to eyelid
orbicularis oculi (CN7) - close shut
muellers (SNS) - tonic elevation
levator (CN3) - open
62
Where are the glands of moll?
eyelashes
63
Where are the glands of zeiss?
eyelashes
64
where are the meibomian glands?
tarsal plate
65
Components of anterior lid
eyelashes, skin, vasculature, muscles, grey line
66
components of posterior lid
tarsal plate, conjunctiva
67
dividing line of the lid
physical: orbital septum
surgical: gray line
68
Poliosis
whitening of the lashes
69
Trichiasis
Misdirection of the lashes
70
Madarosis
Partial loss of lashes
71
Alopecia
complete loss of lashes
72
lid coloboma
congenital abnormality
gaps in lid
congenital
oculoplasty
73
epicanthal folds
congenital abnormality
autosomal dominant in asians
DDX: pseudo-ET
oculoplasty
74
distichiasis
extra row of lashes instead of meibomian glands
rare autosomal dominant
FB trackstaining inferior cornea
T(X): BCL, epilation, electrolysis, chyrotherapy (N2)
75
blepharophimosis
small lid fissures
~ epicanthal folds/levator not working
autosomal dominant
oculoplasty
76
blepharochalasis
idiopathic acute lid swelling
| when D+ quiet, oculoplasty
77
dermatochalasis
```
redundant skin, thin, loss of elasticity
normal in elderly
causes dry eye, pseudoptosis
DDX: pseudoptosis
T(X): blepharoplasty
```
78
ectorpion
eyelid eversion, puncta displaced, reflex tearing, inferior hyphema
due to: congenital, involutional, paralytic, idiopathy, acoustic neuroma, hcronic allergies, mechanical
T(X): surgery, AT/lube, BCL
79
Entropion
eyelid inversion, tearing, FB sensation, irritation
find track staining, trichiasis
cause: age, congenital, spastic
T(X): surgery, AT, BCL, remove lashes (epilation, electrolysis, chryotherapy)
80
Congenital ptosis
(+) history, lack tarsal fold
~ marcus gunn jaw winking syndrome (V/III)
- damae to CN3
81
Acquired ptosis
(-) history, (+) tarsal fold
| -trauma, horner's, cn3 palsy diabetes
82
Testing a ptosis
hold frontalis muscle, measure movement up and down (8-15mm)
Grade;
mild - top edge of pupil
mod - 1-2mm down
severe - halfway or more covering pupil
83
Nevus
benign, flat, congenital, uniform pigmentation.
| Document
84
Papilloma
Benign lid lesion
upward proliferation of epithelial cells.
Elevated, focal lesions, smooth, non-infectious
Caused by UV
MGMT: doc, monitor, surgery, bichloracetic acid
85
Xanthelasma
yellow raised deposits, bialteral women
| Doc, medically evaluate, surgery, serum cholesterol profile maybe
86
Pseudoriferous cyst
plugged gland of Moll - clear fluid
focal elevation, taut surface
T(X): excision with drainage, (+/- prophylactic antibiotic)
87
Sebaceous cyst
plugged Meibomian gland - yellow fluid
focal elevation, taut surface
T(X): excision with drainage, (+/- prophylactic antibiotic)
88
Basal cell carcinoma
```
lower, medial, insidious
same color as skin
slow growing, non-metastisizing
progresses laterally = dip in the middle
- nodular, ulcerative, sclerosing, multicentric
```
89
T(X) basal cell carcinoma
biopsy, excision (mohr's technique), frozen section surgery, radio-therapy, cryosurgery
90
staph blepharitis - difference bw acute and chronic appearance
acute: sudden uni--> bilateral
inflammed margins, collarettes at base, lids stuck in the morning, hyperemic conj
chronic: (+) history, rosettes, ulceration of lid margins, lids stuck often
91
T(X) acute staph blepharitis vs chronic staph bleph
acute: hot compress 10min, lid scrubs (5:1) bidx2weeks, antibiotics (topical bid 1 week)
chronic: everything (+) throw out makeup, (+) broadspectrum antibiotics, (+) steroid if inflammed, (+) pulse treatment
92
Seborrheic blepharitis
dandruf-like collarettes suspended on lashes
oily looking
NO INFLAMMATION
alcoholics - zinc sulphate
T(X): lid scrubs, hot compress, broad antibiotics if combined with staph
93
Meibomian gland dysfunction
dry eye, inflamed margins, capped orifices, dry eye
| lid hygiene, hot compress, express glands with Q tip
94
external hordeolum
staph infection @ gland of Zeiss
acute inflamm = HOT, RED, TENDER, ELEVATED
sudden onset with pus point
T(X) hot compress to accelerate infection
prophylaxis antibiotics bid 1 week
95
internal hordeolum
staph infection @ meibomian glands
acute inflamm = HOT, RED, TENDER, ELEVATED
T(X) hot compress to accelerate infection
prophylaxis antibiotics bid 1 week
DDX pre-septal cellulitis
-infection has spread to anterior lid (+) oral antibiotic
96
DDIX pre-septal cellulitis vs orbital cellulitis
Orbital septus has decreased vision, decreased EOMs, narrow fissure. OCULAR EMERGE!
97
hordeolum vs chalazion
hordeolum: HOT, ELEVATED, TENDER, RED, INFALMMED. ACUTE
chalazion: H(X) of previous infection, not tender or hot, slow onset, progressively enlarging
98
chalazion
```
noninfections, non inflammatory
SLOW onset
chronic, reoccuring
focal internal lesion NOT WARM/TENDER
progressively enlarges
```
MGMT: hot compress
biopsy/excision (DDX sebaceous cell carcinoma)
DDX internal hordeolum
T(X): steroid injection to get rid of inflamm components
99
demodex
8-legged
tubular sleeve of collarettes at BASE of lashes
1. brevis - sebaceous gland
2. follicularum - hair follicle
S(X): itchy in the MORNING, BURNING, SORE lids
T(X): remove excess, smother in ointment + steroids, confirm: 4 lashes > 6 demodex
100
Phthiris Palpebraum
6-legged, darker, longer
S(X): itchy ALL DAY, rubbing, burning
T(X): a/b steroid qid 1 week, come back after 2 days, remove nits, contact family doctor
101
Molluscum contagiosum
DNA Pox virus
-follicualr conjunctivitis
certain size, stays there, cheesy appearance
T(X): cauterization when D+ quiet, self-dissolving, excision
102
Verruca
HPV, broccoli looking appearance, multilobulated (vs papilloma)
S(X): painless
T(X): cauterization, self dissolving
103
Contact dermatitis
allergic reaction - conjunctivitis (follicular)
S(X) swelling, red, eventually flakey, itchy, epiphora, red
T(X) determine allergin, cold compresses, topical steroid, antihistamines
104
Conjunctival follicles
pink, watery, elevated, shiny bumps "blistery"
Causes - hypersensitivity, viral conjunctivitis
T(X) - resolves on own.. find cause
105
Conjunctival papillae
red, bumpy dilated vessels (PMN's, wbc's)
Causes - bacterial, CL wear, allergic, prosthesis
T(X) - find cause
106
Retention cyst
clear vacuole like, spherical, interpalpebral space, asymptomatic
Cause - cellular degen due to DE
T(X) - lancing
107
Xerosis
yellow opaque, flat keratinization on bulbar conj
S(X) severe dry eye + night blindness
Cause: vitamin A deficiency
T(X): lubrication, treat deficiency
108
Pinguecula
```
UV = fibrovascular degeneration
Mechanical rubbing (CL's)
```
surgery, wear sunscreen, lubricate
109
Pterygium
Flsehy, vascularizaed trnagular growth, apex on cornea, destroy's BOWMAN's layer caused by UV
S(X) blurry vision, FB sensation, diplopia, DE
Stocke's line: Fe at head of pterygium
T(X): remove + beta radiation 1xweek/3weeks
110
Concretion
Small yellow-white opaque deposits due to age/degeneration + allergies
S(X) FB sensation, asymptomatic
T(X) loosen with Q tip
111
Adenochrome deposits
Black deposits found on lower side that are reversible. Acquired secondary due to glaucoma meds NE
MGMT: doc, monitor
112
Melanoma
A/B/C? asymmetrical, bleeding, color? vascularized.
from nevus or spontaneously due to UV. REFER!
113
Subconj heme
S(X): painless, upserficial, bleeds laterally, aviods limbus
Due to coughing, trauma, birth, medication (blood thinner)
MGMT: TRAUMA H(X)? check ant seg - workup VA, SLE, Pupils, EOMs, IOP, DFE
114
Broad signs of conjunctivitis
- BV dilation = red + hyperemia
- Cellular infiltrates (wbc's and exudates)
- Edema = chemosis
- Discharge (watery or mucopurulent)
- Papillae (bacterial)
- Follicles (viral)
- Pre-aurricular nodes (viral)
- Cornea involvement
- Collarettes (bacterial)
115
Acute Bacterial Conjunctivitis
Unilateral to bilateral in 2-3 days, H(X)?
S(X) - lashes matted in morning, red, no pain
Causes - s. aureus/epidedermis, strep, h. influenza
Signs:
-mucopurulent discharge
-hyperemic bulbar conj @ FORNIX
-palpebral papillae dark red
-cornea +/- SPK @ BOTTOM / FOCAL
-scrape/smear = (+) PMN's
- (-) pre-auricular node
116
Treat acute bacterial conjunctivitis?
discard makeup
lid scrubs
warm compress
topical broad spectrum antibiotic
if non resolving... compliance? cultures? sensitivity? second opinion..
117
Chronic bacterial conjunctivitis
usually accompanies corneal + lid inflammation
S(X): burning, FB, (+) H(X)
Signs:
-Lids (tyalosis, madarosis, poliosis, collarettes)
-Lumps/Bumps (hordeolum, chalazion)
-Cornea (PERIPHERAL SPK + SEI****)
- (-) pre-auricular node
118
Two types of adenoviruses
Pharyngoconjunctival fever (PCF) + Epidemic keratoconjunctivitis (EKC)
119
Pharngyoconjunctival fever
DNA adenovirus
S(X): red eye, discharge, uni--> bilateral, fever, sore throat
Signs: follicles, watery, no collarettes, smear = lymph, cornea = CENTRAL SEI, DIFFUSE SPK
(+) pre-auricular nodes
pseudomembranes
T(X) cold compresses, H(X)
120
Epidemic keratoconjunctivitis
```
DNA adenovirus
S(X) malaise, tired, fever, unilateral --> bilateral
Signs: week of 7
week1:
-acute follicular conjunctivitis
-discharge --> pseudomembrane
-diffuse hyperemia
-watery
-smear = lymph
-cornea = diffuse SPK
-(+) preauric nodes
week2: elevated lesions (-) NaFl
week3: central SEI
```
121
Treating EKC
remove pseudomembrane
cold compresses
topical steroids for SEI when VA is down (Pregnenalone)
Betadine - offuse 4-5 drops 1 min, wash off
122
Treating Sub-epithlial infiltrates
Steroids ie pregnenalone acetate
tapered:
qidx1week, bidx3days, qidx2 days, etc
123
SPK in chronic bacterial infections vs acute/hyperacute?
```
acute = top/bottom focal SPK
chronic = peripheral SPK
```
124
SPK in bacterial infections vs viral?
bacterial = focal SPK
| viral + chronic bacterial conj= diffuse SPK
125
Herpes Zoster is caused by what virus
Varicella virus (Shingles)
126
Signs of herpetic viral conjunctivitis
- unilateral vesicular eruption
- ophthalmicus nerve
- hutchingson's sign: 40% chance if involves nose will involve eye
- viral signs: (+) chemosis/water/preaur node
- cornea (+) SPK (+) PSEUDODENDRITES (rose bengal)
- uveitis
- trabeculitis (2˚ glauc)
- episcleritis
- INCREASED CORNEAL sensitivity
127
Treatment of herpetic viral conjunctivitis
- atlernative meds ie acupuncture
- oral antivirals = Acylovir 5xweek 7-10days
- preventative: zostavax vaccine
- steroids for anti-inflammation
128
Jones test
Patency bw puncta + inf meatus (blow nose test/q-tip)
129
Regurgitation test
Patency bw puncta + nasolac sac (squeeze sac and water back thru puncta)
130
Tear prism
tear volume - look at lid margin - tear meniscus height should be 0
131
phenol red thread test
tear volume - normal is 10mm in 15s
132
shirmer's test
tear volume - with/without anesthetic
133
TBUT
tear stability <5mm (little)
SPK - few cells damaged
punctate erosions - lots of areas
geographic areas - huge
134
Mires
Non-invasive TBUT
measures when mires distort
abnormal <10s
135
Lactoferrin immunological test system
Osmolarity test
| Abnormal if ring doesn't increase in size
136
Biomarker analysis
Osmolarity - increased = the goblet cells are affected
137
Line of marx
tear film analysis - mucocutaneous, border moves anterior, thicker, irregular
138
Meibomian expression
Lipid layer measure
-no inflamm
apply stable force to mimic blink
139
Cause + Mgmt: Punctum Stenosis
age/inflamm - surgery probing
140
Cause + Mgmt: Punctum eversion
age/inflamm - surgery
141
Cause + Mgmt: Stenosis of canaliculus
age/inflamm - surgery, probing, antibiotics if infection*, warm compresses
142
Cause + Mgmt: Dacryocystitis
infection/inflamm of lac sac SECONDARY TO OBSTRUCTION/INFECTION
-unilateral
DDx internal hordeolum/chalazion
-infants - wait 6mo-1 year for probing antiobiotics
143
Mechanism Allergic Dry eye
INFLAMM = goblet cell death = DE
144
Mechanism Blepharitis-causing Dry eye
EVAPORATION = impaired lipid layer
- anterio bleph = staph bleph/seborrheic bleph
- posterior bleph = meibomian gland disfunction
145
Mechanism eye drops causing Dry eye
INFLAMM = cytotoxic PT's damage mucin/goblet cells
146
Mechanism Viral conjunctivitis
INFLAMM = cytokines damage mucin/goblet cells
147
Some causes of dry eye? and Mechanism?
EVAPORATION + INFLAMM
CL's, Environment
aging, Aging, Hormones (androgens dec inflamm)
systemic D+ sjogren's, RA, Graves, Gout
Meds: anti HT, anti H, preservatives (BAK)
148
Treating Dry eye
```
NPAT/AT
Warm compresses 10min
Lid scrubs 5:1
Blinking exercises
Punctal occlusion
NSAIDs (Restasis + Lotemax)
```
149
Artificial Tears for DE
help only with S(X)
tear vol replensihment + stabilization
protect cornea
dec osmolarity
150
corticosteroids for DE
antiinflammatory (taper)
151
NSAIDS for DE
```
Restasis(immunosuppressant) + Lotemax(steroid)
day 1: lotemax prn
day 14: lotemax bid + restasis bid
day 60: restasis bid
6mo: monitor progression
```
152
Punctal occlusion for DE
1-2mm down, collagen or silicone
153
maskin probes for DE
evacuate meibomian glands
154
When would you R(X) a small prescription?
Adults - task specific, antimetropia
155
How much change in cyl can an adult tolerate?
15˚ axis, 0.75D
156
Rules of myopes and presbyopes in prescribing?
don't take away minus frm myope or NN from presbyope (NN = D + Add)
157
Children <5 how do you prescribe
bold + caution. Amblyopia vs emmetropization
Aniso Iso
H >1 >5
A >3 >8
M >1.5 >2.5
158
How much anisometropia induces vertical phoria?
>1.0 D in DOWNWARD GAZE
159
Aniseikonia's experience vertical phoria where?
all gazes.. play with BC, centre thickness, n, aspherics
160
How much antimetropia induces vertical phoria?
0.5 D
161
Anisophoria: their NVP is 10cm
OD = -5.00sph
OS = -2.00 sph
How much prism should be put on glasses and what eye?
F(OD = 5(0.1) = 0.5∆ BD OD aka 0.5∆ R. hypophoria
Therefore.. 0.5∆ BU OD
or, 0.25 BU OD + 0.25 BD OS
162
Malingering
figure out their goal.. want glasses? $? attn?
163
Clinical hysteria
psychological acute stress/trauma
R/O organic pathology
Reassure
Refer to psychologist
164
Streff (Non-malingering)
kids 8-18
Bilateral loss at distance + near (with Rx)
reassure
refer
165
Dispenasary hocus focus
vague complaints about glasses/Rx that don't make sense cuz of external factors
166
Munchausen (by proxy) syndrome
Attn munching!
| MANDATED report + refer for mental health
