... Flashcards
Other tests for refractive error
Pinhole
Cover test (refractive amblyopia)
Stereopsis
Swinging pupil test
Relative afferent pathway (RAPD)
- Light held 3s in eye
- Fast swap to alternate eye
Expect constriction, then dilation
Afferent pupil pathway
RGC layer forms afferent pupillary fibers, travel through optic tract to sup. Colliculus, then midbrain, then to Edinger-Westphal nuclei bilaterally (both sides).
Efferent fibers travel on oculomotor nerve to ciliary ganglion, then short ciliary nerves, to iris sphincter muscles for constriction
Fluorescein:
Stains albumen in tear film
Examines breaks in epithelium via tear pooling
Good for contact and TBUT exam
Requires cobalt blue filter
CSR treatment
Cease steroid/MDMA usage
Self resolve in 3 months
Clinical tests for CSR
OCT
Fluroescein angiography (rule out neovascularisation)
Hx for ptosis
Onset (congenital/aquired)
alleviating factors (time of day)
Lid pain (mechanical)
Family history
History of Sx, trauma
Previous photographs
Association with chewing
CLARE symptoms
Sudden onset of unilateral pain, photophobia, epiphora, irritation, hyperaemia, watering.
Corneal infiltrates (without epitheliopathy)
CLARE pathophysiolo
Colonisation of gram negative bacteria on CLs (pseudomonas aeruginosa common) > overnight use > exotoxin release > antigen-antibody immune response > inflammatory cascade > immune cell influx > conjunctival dilation
Severe pain, photophobia, tearing, hyperaemia, corneal infiltrates
CLARE DDX
Mucopurulent discharge and hyponyon > BK
Large ulcer with stain > CL induced peripheral ulcer / BK
CLARE treatment
Cease CLs
self resolve in in 2 weeks
Monitor, culture if epitheliopathy or not resolving
CLPU patho
Colonisation of gram positive bacteria (Staph aureus) on CLs > exotoxin release > antigen-antibody immune response > macrophage/neutrophil influx to cornea
CLPU symptoms And treatment
Unilateral well defined infiltrate, with light epitheliopathy
Ulcer anywhere on cornea (unlike central BK)
Self resolve after 2 weeks, but if no improvement in one day, suspect infection
