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1
Q

different visual acuity notations

A
  • US notation:20/40 (standard 20/20)
  • 6 meter notation:6/12
  • Decimal notation: 0.50
  • MAR (MAgnification Requirement ): 2.0
  • logMAR: 0.3 (standard 0.0: [+0.1]=[-1 line on chart )
  • VAS(Visual Acuity Score): 85 (standard 100 points)
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2
Q

OCT stands for

A

Optical coherence tomography

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3
Q

The most common early to mid stage glaucomatous field.

A

Superior / Inferior Arcuate Defect

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4
Q

Severe Constriction with a Central Island visual field indicates

A

end stage glaucoma

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5
Q

Legal blindness is defined as

A

central visual acuity of 20/200 or worse in the better-seeing eye with best correction or a visual field of 20 degrees or less.

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6
Q

4 major causes of severe vision loss and blindness in older adults

A
  1. age-related macular degeneration (AMD),
  2. ocular complications of DM,
  3. glaucoma,
  4. age-related cataracts
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7
Q

Amsler Grid is used to

A

test macular function or to detect a central or paracentral scotoma

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8
Q

LASIK stands for

A

Laser-assisted in-situ keratomileusis (Refractive Eye Surgery)

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9
Q

Describe corneal layers

A
  1. Stratified Squamous epitheliem
  2. Bowman’s membrane
  3. Stroma
  4. Descemet’s membrane
  5. Endothelium
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10
Q

Anterior Chamber Angle is formed by

A

the posterior corneal surface and the anterior surface of the iris

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11
Q

Normal angle structure seen in Gonioscopy (posterior to anterior approach)

A

“ICSTS”

  1. Iris
  2. Ciliary body band (CB)
  3. Scleral spur (SS)
  4. Pigmented Trabecular Meshwork (TM)
  5. Non-Pigmented Trabecular Meshwork (TM)
  6. Schwalbe’s line (SL)
  7. Posterior corneal surface
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12
Q

what is Seidel Test?

A

A test to detect a wound leak. [If a perforation and leak exist, the dark orange (concentrated) fluorescein dye is diluted by the aqueous and appears as a green (dilute) stream seen with the cobalt blue light of the slit lamp.]

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13
Q

A diopter

A

the power of a lens to properly focus light on a person’s retina—>defined as “the inverse of a person’s focal length in metres.”
-myopia
+hyperopia

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14
Q

normal range of Intraocular pressure (IOP)

A

10 to 21 mm Hg

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15
Q

normal aqueous humor outflow routes

A
  1. trabecular meshwork (most)

3. uveoscleral routes —->suprachoroidal space

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16
Q

two most common forms of glaucoma

A
  1. primary open-angle glaucoma (POAG)

2. primary angle-closure glaucoma (PACG)

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17
Q

Pathophysiology of glaucoma

A
  • POAG:Outflow pathways is diminished.

- PACG: Abnormally positioned iris

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18
Q

the typical disease course of glaucoma left untreated

A

asx(chronic, progressive, and irreversible visual field loss)—> tunnel vision—>loss of central vision.

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19
Q

Glaucoma medications

A

Goal: ↓IOP

  • Decreases inflow:
    1. Beta-blockers
    2. Selective α2-receptor agonists
    3. Topical carbonic anhydrase inhibitors (CAIs)
  • Increases outflow:
    1. Prostaglandin agonists (1st line)–uveoscleral pathway
    2. Miotics–TM pathway
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20
Q

Is IOP useful in screening Glaucoma?

A

No. about 50% of patients with glaucoma have “normal” range IOP (10 to 21 mm Hg) at Dx

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21
Q

Sx of acute angle closure Glaucoma

A
  • unilateral (rarely bilateral) blurred vision
  • halos or rainbows around lights (corneal edema)
  • pronounced pain around the eye
  • N&V
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22
Q

Signs of acute angle closure Glaucoma

A
  • mid-dilated pupil,
  • conjunctival injection,
  • cloudy cornea (microcystic corneal edema)
  • closed angle
  • acutely ↑ IOP
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23
Q

Dx of acute angle closure Glaucoma

A

Migraine

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24
Q

Risk Factors for Glaucoma

A
  • FHx
  • Age
  • Race
  • Others: DM, ↑IOP, thin central corneal thickness, refractive error (myopia–POAG; hyperopia–PACG).
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25
Q

Surgery indications in patients with glaucoma:

A
  • progressive visual field loss on max meds,
  • intolerant of glaucoma meds,
  • poorly adherence
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26
Q

Glaucoma surgery includes

A
  • Laser trabeculoplasty for POAG
  • Laser iridotomy for PACG,
  • incisional (trabeculectomy and tube shunt devices)
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27
Q

Gonioscopy of POAG:

A
  • Normal-appearing, open anterior chamber angle

- No peripheral anterior synechiae (PAS)

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28
Q

Characteristic appearance of optic nerve head in Glaucoma

A
  • loss of rim tissue
  • splinter or NFL hemorrhage that crosses the disc margin
  • bayoneting
  • ↑C/D ratio>0.6
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29
Q

10 layers of retina

A

vitreous → choroid

  1. ILM
  2. NFL
  3. GCL
  4. IPL
  5. INL
  6. OPL
  7. ONL
  8. ELM
  9. IS/OS
  10. RPE
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30
Q

Visual field defects in Glaucoma

A
  • nasal step, (nasal field loss)
  • paracentral scotoma,
  • arcuate scotoma (respect the horizontal midline)
  • altitudinal defect,
  • tunnel vision
  • generalized depression
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31
Q

distinguish Optic atrophy from Glaucoma

A
  1. more optic nerve pallor than cupping.
  2. IOP usually nl
  3. Color vision and central vision ↓
  4. Visual field defects respect the vertical midline (typical of intracranial lesions at the chiasm/beyond)
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32
Q

distinguish chronic angle closure glaucoma from POAG

A
  1. sx: episodic blurred vision or headache
  2. gonioscopy:
    - Shallow anterior chamber,
    - peripheral anterior synechiae (PAS)
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33
Q

examinations of Glaucoma

A
  1. complete ocular examination
  2. baseline optic nerve head
  3. formal visual field testing
  4. measure central corneal thickness (affects tonometry)
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34
Q

what to do first if glaucoma damage progresses after meds?

A

check compliance

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35
Q

which agent will precipitate PACG

A

anticholinergics

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36
Q

signs of increasing urgency for pressure reduction in acute ACG

A
  1. Worsening vision

2. spontaneous arterial pulsations

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37
Q

definition of Angle Recession Glaucoma

A
  • Glaucoma due to the angle recession( usually takes 10 to 20 yrs to develop).
  • Angle recession: a tear between the circular and longitudinal fibers of the ciliary body (Gonioscopy:↑ width of CB)
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38
Q

3 biochemical factors that may involved in the pathogenesis of cataract

A
  1. Hydration
  2. Desaturation of lens protein
  3. Sclerosis
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39
Q

stages of senile cortical cataract

A
  1. lamellar separation (grey pupil, reversible)
  2. incipient (lens striae, peri-)
  3. immature (swollen lens, shallow AC, iris shadow)
  4. mature (whole cortex, no iris shadow)
  5. hypermature
    - sclerotic (shrunken, deep AC, tremulous iris)
    - morgagnian (liquefied, milky cortex above, nucleus below)
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40
Q

what test may help differentiate optic neuropathy-related and macular visual loss?

A

color vision test

  • optic neuropathy, esp. demyelin. : proportionately >
  • macular: degrees =
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41
Q

what is glare?

A

Glare is when a light source affects our ability to see clearly. (eg. in bright sun or from oncoming headlights while driving at night)

42
Q

symptoms of cataract

A
  1. Slowly(mos/yrs) progressive visual loss or blurring
  2. Glare (esp. cortical, PSC)
  3. altered color perception
43
Q

types of cataract based on sites

A
  1. Nuclear: yellow/brown, index myopia
  2. Cortical: vacuoles/radial, spoke-like, peri-, late
  3. Post.Subcapsular.:dilation helps, causes, age<50 yr
44
Q

most common cause of acquired cataract

A

Age

45
Q

causes of cataract

A
  1. age
  2. trauma
  3. toxic(eg. steroids)
  4. secondary: eg. chronic ant. uveitis, acute ACG
  5. Endocrine: eg. DM
  6. metabolic: eg. Ca, Cu
  7. chromosomal. eg. Down
46
Q

examinations of cataract

A
  1. complete eye: cause VA ↓

2. pre-op

47
Q

indications of surgery in patients w/ cataract

A

• visual function
• ocular disease (e.g., lens-related glaucoma or uveitis)
. ease management

48
Q

cataract related complications

A
  1. glaucoma

2. uveitis

49
Q

nonsurgical Rx in cataract

A
  1. corrective lenses

2. mydriasis, esp PSC

50
Q

surgery for cataract

A

phacoemulsification (US) + implantation intraocular lens (IOL)

51
Q

most common complication of cataract surgery

A

post. capsule opacification (laser post. capsulotomy)

52
Q

ddx for eye pain

A
  1. headache
  2. eyelids
  3. conjunctiva
  4. cornea
  5. sclera
  6. uvea
  7. glaucoma
  8. optic neuritis
53
Q

how to detect corneal defects?

A

Slit lamp examination w/ fluorescein staining

54
Q

how to classify decreased vision?

A
  1. Transient (<24hrs): vascular, CNS, migraine
  2. > 24 hours
    - sudden, painless: vascular, retina, CNS
    - gradual, painless: cataract, glaucoma, refractive error, ARMD, DR
    - painful:AACG, optic neuritis
  3. Posttraumatic
  4. axis
55
Q

ddx of photophobia

A
  1. abnl eye: cornea, ant. uveitis

2. nl eye: migraine, meningitis,

56
Q

ddx of red eye

A
  1. adnexal
  2. conjunctival
  3. corneal
  4. others: eg. ant.uveitis, ACG, cluster headache
57
Q

Relief of pain with the instillation of anesthetic drops (e.g., proparacaine) strongly suggests the etiology of pain is

A

corneal epithelial disease

58
Q

Why cant anesthetic drops be used chronically?

A

these drops inhibit epithelial healing and may cause corneal ulceration.

59
Q

clinical signs of Dry eye syndrome include

A
  1. Poor tear lake (normal meniscus >=0.5mm and convex),
  2. ↓tear break-up time(blink–>tear film defect by using fluorescein stain: <10s),
  3. ↓Schirmer test (anesthetized<=5mm in 5min)
60
Q

what agent can relieve eye pain and photophobia?

A

cycloplegic drop (e.g., cyclopentolate 1% to 2% t.i.d)

61
Q

what hx is important for corneal diseases?

A

Contact lens wear

62
Q

non-specific Rx for Superficial punctate keratopathy (SPK)

A

Contact lens wearer: Discontinue

  1. small: [artificial tears q.i.d.+lubricating ointment q.h.s.]
  2. large: [Abx ointment+cycloplegic drop]
    - non-contact lens wearer: bacitracin/polymyxin B or erythromycin q.i.d
    - contact lens wearer: “Fluoroquinolone / aminoglycoside
63
Q

sx of Dry eye syndrome

A
  1. Burning, dryness, foreign body sensation, mildly to moderately decreased vision, excess tearing.
  2. Often exacerbated by smoke, wind, heat, low humidity, or prolonged use of the eye
  3. Usually bilateral and chronic .
  4. Discomfort often out of proportion to clinical signs.
64
Q

ddx of Dry eye syndrome

A

causes of SPK

65
Q

causes of Dry eye syndrome

A
  1. Idiopathic: menopausal and post-
  2. life-style
  3. evaporative (Lipid layer): blepharitis, meibomian (waking)
  4. aqueous layer: age (later day / use)
  5. conjuctival scarring
  6. corneal refractive surgery
  7. lacrimal glands: rad, infil, eg. sarcoidosis
  8. Others:connective tissue diseases(e.g., Sjögren syndrome), drugs, vit A
66
Q

Schirmer test Technique

A

1.drying,
2.Schirmer filter paper junction of the middle and lateral 1/3 of the lower eyelid in each eye for 5 min.
3.Eyes are to remain open with normal blinking.
• Unanesthetized(basal and reflex tearing): nl >=15 mm
• Anesthetized,:Topical anesthetic (e.g., proparacaine) (basal tearing) Abnl <=5 mm, <10 mm borderline.

67
Q

which connective tissue disease is associated with dry eye syndrome?

A

Sjögren syndrome

68
Q

Rx for Dry eye syndrome

A

depend on degree and causes

  1. artificial tears
  2. lubricating ointment
  3. life style
  4. Cyclosporine 0.05% (chronic, severe, inflamed)
  5. punctal occlusion
  6. permanent lateral tasorrhaphy
69
Q

define Pterygium and Pinguecula

A

3- or 9-o’clock perilimbal (Related to sunlight exposure and chronic irritation. )
• Pterygium: Wing-shaped fold of fibrovascular tissue arising from the interpalpebral conjunctiva and extending ONTO the cornea. There is no associated thinning of the cornea below these lesions. Usually nasal in location.
• Pinguecula: Yellow-white, flat or slightly raised conjunctival lesion, usually in the interpalpebral fissure adjacent to the limbus, but NOT involving the cornea.

70
Q

define Pannus

A

Blood vessels growing into the cornea,

-Usually at the level of Bowman membrane with minimal to no elevation

71
Q

clinical findings of keratitis

A
  • corneal stroma infiltrate, epithelial defect, stromal thinning,
  • stromal edema, mucopurulent discharge, folds in Descemet membrane, AC reaction, hypopyon, conjunctival injection, upper eyelid edema
  • severe: Posterior synechiae, hyphema, ↑IOP
72
Q

most common cause of infectious keratitis

A 
Bacterial organisms (until proven otherwise)
-Staphylococcus, Pseudomonas, Streptococcus, Moraxella, Serratia
73
Q

can topical corticosteroids be used in Infectious keratitis?

A

Infectious keratitis may worsen significantly with topical CS (esp fungus, atypical mycobacteria, or Pseudomonas.)

74
Q

what agents can help suppress connective tissue breakdown and prevent the perforation of the cornea?

A

-matrix metalloproteinase inhibitor (e.g., doxycycline )
-collagen synthesis promoter eg.systemic ascorbic acid (e.g., vitamin C )
[eye shield w/o patch]

75
Q

when Systemic antibiotics are needed in infectious keratitis?

A
  • scleral extension
  • frank or impending perforation
  • Neisseria, Haemophilus infections
76
Q

which organism is involved in patients w/ history of swimming and/or hot tubbing while wearing contact lenses?

A

Acanthamoeba

77
Q

Previous LASIK has been implicated as a risk factor for ______________ infections.

A

atypical mycobacteria

78
Q

why IOP should be measured in keratitis?

A

inflammatory open angle glaucoma

79
Q

how to distinguish acute IOP ↑ from chronic IOP↑?

A
  1. corneal edema
  2. pain
  3. visual sx
80
Q

what ddx can be difficult to differentiate from Inflammatory open angle glaucoma?

A

Steroid-response open angle glaucoma

[significant inflammation→ assume inflammatory→use steroids]

81
Q

which conditions result in Inflammatory open angle glaucoma?

A
  1. Uveitis
  2. Keratouveitis, esp.HSV
  3. Trauma/surgery
82
Q

Rx for Inflammatory open angle glaucoma

A
  1. Topical steroid(e.g., prednisolone acetate 1%)
  2. Mydriatic/cycloplegic
  3. IOP ↓:
    - Topical β blocker
    - Topical α-2 agonist
    - Topical CAI/oral CAI
    - Mannitol
    - AC paracentesis
  4. underlying
  5. surgery: tube shunt; trabeculectomy
  6. antiviral for HSV
83
Q

differences between HSV and VZV infection on the face(vesicular skin rash distribution)

A
  1. HSV:
    - concentrated around the eye;
    - oft involves both upper and lower eyelids
  2. VZV:
    - along V1 nerve.
    - not crossing the midline
    - spares the lower eyelid.
84
Q

pathogenesis of Neurotrophic keratopathy

A

Occurs in eyes with diminished or absent corneal sensation. →
Denervation causes the corneal epithelium and tear film to become abnormal and unstable. →
impaired healing→an epithelial defect (not treated)→stromal lysis and possibly perforation

85
Q

what infection desensitize the cornea?

A

HSV/VZV

86
Q

how to treat sterile corneal ulcer?

A
  1. Abx ointment q2h
  2. tarsorrhaphy
  3. sutureless amniotic membrane tissue, sutured/glued amniotic membrane graft, or conjunctival flap
    - Oral doxycycline (100 mg b.i.d.),
    - Systemic ascorbic acid (e.g., vitamin C 1 to 2 g daily)
    - Autologous serum, albumin, or umbilical cord serum eye drops
87
Q

which oral Abx has good eye wall penetration?

A

Oral fluoroquinolones

88
Q

infiltrates in fungal keratitis

A
  • commonly have feathery borders
  • surrounded by satellite lesions
  • candida mimic bacterial ulcers
89
Q

1st ddx of Acanthamoeba Keratitis

A

HSV (pseudodendrites in early stage)

90
Q

Ring-shaped corneal stromal infiltrate is seen in ________

A

late stage (3-8wks) of Acanthamoeba Keratitis

91
Q

radial keratoneuritis can be seen in _________ keratitis

A

Acanthamoeba

92
Q

how to diagnose Acanthamoeba Keratitis?

A
  1. Corneal scrapings and stains and cultules
  2. corneal biopsy
  3. cultures and smears of contact lens and case
  4. Confocal biomicroscopy
93
Q

define dendritic and geographic epithelial defect

A
  1. dendritic: a thin, linear, branching epithelial ulceration with club-shaped terminal bulbs at the end of each branch
  2. geographic: a large, amoeba-shaped corneal ulcer with a dendritic edge
94
Q

characteristics of neurotrophic corneal ulcer

A
  1. oval
  2. smooth border
  3. interpalpebral fissure
  4. may progress to stromal melting and perforation
95
Q

Hutchinson sign

A

vesicular rash involves tip of the nose in the distribution of the nasociliary branch of V1

96
Q

pseudodendrites can be seen in ________ keratitis

A
  1. VZV
    2.Acanthamoeba
    [-raised mucous plaques.
    -no true terminal bulbs
    -not typically stain well with fluorescein.]
97
Q

how can corneal stain help detect HSV corneal lesions?

A
  1. rose bengal or lissamine green: edges of herpetic lesions heaped up with swollen epithelial cells
  2. fluorescein: the central ulceration
98
Q

what are the signs of HSV corneal epithelial disease?

A
  1. macropunctate
  2. dendritic
  3. geographic
  4. stains
  5. ↓corneal sensitivity
  6. Subepithelial scars and haze(ghost dendrites) aft resolution
99
Q

2 forms of HSV Corneal Stromal Disease

A
  • Disciform keratitis (nonnecrotizing keratitis):

* Necrotizing interstitial keratitis (IK) (uncommon):

100
Q

Keratic precipitates

A

Recollections of inflammatory cells on corneal endothelium.

Eye (3 decks)

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