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Ocular Phys > B12 > Flashcards

B12 Flashcards

1
Q

For someone with glaucoma, is the AH flow in and out equal?

A

No

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2
Q

Is the uveoscleral pathway the minor or major route /pathway in AH outflow?

A

Minor

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3
Q

Describe how AH flows in the uveoscleral pathway

A

AH enters the connective tissue between the ciliary muscle bundles, through the suprachoroidal space, and out through the sclera

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4
Q

Is the uveoscleral outflow affected by IOP?

A

Nope

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5
Q

The outflow rate through the uveoscleral route tends to ____ with age

A

Decrease

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6
Q

What are the 3 layers of the TM?

A
  • juxtancanalicular
  • corneaoscleral
  • uveal
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7
Q

The corneoscleral pathway is considered the ____ route

A

Major

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8
Q

Describe the flow of AH in the corneoscleral pathway

A

AH passes through the TM, across SC, into its lumen

and into draining collector channels, aqueous veins and episcleral veins

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9
Q

Is the corneoscleral pathway IOP independent or dependent?

A

dependent

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10
Q

An acute rise in EVP results in a ___ ratio of increase IOP

A

1:1

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11
Q

When the aqueous outflow pump receives power from transient increases in IOP such as occur in systole of the cardiac cycle during blinking and during eye movement

A

Pumping model

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12
Q

In the corneoscleral pathway an increase of IOP causes drainage decrease or increase?

A

Increase

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13
Q

What will make schlemm’s canal collapse on itself and obstruct into the venous system?

A

Constant, very high IOP

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14
Q

What 2 fluid compartments is the TM suspended between?

And are these at the same or different pressures?

A

Anterior chamber and schlemms canal

They have different pressures

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15
Q

What 5 things can cause AH outflow obstruction through occlusive angles?

A
  • severe diabetes
  • uveitis
  • hyphema
  • pseudoexfoliative glaucoma
  • pigment dispersion glaucoma
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16
Q

In humans, ___% of the resistance to the AH outflow is localized to the TM, and ___% occurs beyond schlemm’s canal

A

75% to TM

25% to SC

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17
Q

Can an injury to the TM cause an obstruction of AH outflow?

A

It sure can

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18
Q

What are the 3 long term influences on IOP?

A
  • genetics
  • gender
  • refractive error
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19
Q

What are the 6 short term influences on IOP?

A
  • diurnal
  • postural variation
  • lid and eye movement
  • systemic conditions
  • environmental conditions
  • food and drugs
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20
Q

T/F: IOP is under hereditary influence

A

True

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21
Q

Are IOP’s different between men and women in the ages of 20-40?

A

Nope, they are equal

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22
Q

In older age groups, do men or women have a increase in mean IOP?

A

Women

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23
Q

Myopic people have a ____ incidence of open angle glaucoma

A

Higher

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24
Q

T/F: there is a positive correlation between IOP and both axial length and increasing degrees of myopia

A

True

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25
Q

Does IOP change throughout the day?

A

Yep

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26
Q

When is the peak of IOP?

A

In the morning

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27
Q

T/F: IOP decreases changing from sitting to the supine position

A

False, it increases

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28
Q

Patient with systemic hypertension will have a greater IOP increases after ___ min in supine

A

15 minutes

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29
Q

Does blinking raise IOP?

A

Yes, by 10mmHg

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30
Q

How much does hard lid squeezing raise IOP?

A

As much as 90mmHg

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31
Q

In what gaze is there in increase in IOP in normal individuals?

A

Up gaze

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32
Q

Thicker corneas cause artificially ____ readings

A

High

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33
Q

Thinner corneas cause artificially ___ readings

A

Low

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34
Q

T/F: patients with HIV have lower than normal mean IOPs

A

True

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35
Q

Are IOPs increased or decreased during pregnancy?

A

Decreased

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36
Q

Does exposure to cold air increase or decrease IOP? And why

A

Decreases, because episcleral venous pressure is decreased

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37
Q

Does reduced gravity cause an increase or decrease in IOP?

A

Increase

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38
Q

Does alcohol increase or decrease IOP?

A

Decrease

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39
Q

Does caffeine cause an increase or decrease in IOP?

A

Slight transient rise

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40
Q

Does smoking increase or decrease your IOP?

A

Increase

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41
Q

Do heroin and marijuana increase or decrease IOP?

A

Decrease

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42
Q

Does LSD increase or decrease IOP?

A

Increase

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43
Q

Do corticosteroids increase or decrease IOP?

A

Increase

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44
Q

What it the major pathway of AH outflow?

A

Corneoscleral pathway

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45
Q

What AH pathway is IOP independent?

A

Uveoscleral pathway

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46
Q

Does AH pass through the SC in the uveoscleral pathway?

A

No

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47
Q

An acture increase in EVP by 4mmHg will theoretically cause an increase in IOP by?

A

4mmHg

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48
Q

T/F: thicker cornea can cause an artificially high IOP reading

A

True

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49
Q

What is the largest organ of the eye?

A

Vitreous

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50
Q

The vitreous transmits ____ of light

A

90%

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51
Q

The vitreous is located between the ___ and the _____

A

Crystalline lens and the retina

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52
Q

What are the 3 zones of the vitreous?

A 
Outermost zone (vitreous cortex)
Center zone (cloquets canal)
Intermediate zone (inner to the cortex and surrounds the center canal)
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53
Q

The vitreous is attached to what part of the retina?

A

Inner limiting membrane

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54
Q

What attaches the vitreous to the ILM?

A

Anchoring fibrils and the membrane limitans interna (MLI)

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55
Q

What 3 things is the MLI composed of?

A
  • fusing point of the anchoring fibrils
  • lamina densa
  • lamina Lucida
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56
Q

The vitreous base is located at the ____

A

Ora serrata

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57
Q

The vitreous base is ___mm broad annular region

A

1.5

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58
Q

The vitreous base is attached to the ___ and the ____

A

Nonpigmented epithelium of the ciliary body and the internal limiting membrane of the peripheral retina

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59
Q

What is the strongest attachment to the vitreous?

A

Vitreous base

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60
Q

Does the vitreous base decline with age?

A

No

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61
Q

A vitreous attachment that is between the posterior surface and the anterior face of the vitreous

A

Wiegers ligament

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62
Q

Does the wiegers ligament decline with aging?

A

Yes

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63
Q

The vitreous attached around the edge of the optic disc?

A

Peripapillary adhesion

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64
Q

Does wiegers ligament have a firm or medium attachment?

A

Firm

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65
Q

Does the peripapillary adhesion have a firm or medium vitreal attachment?

A

Medium attachment

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66
Q

Is the macular and peripheral retinal attachment firm, medium or weak?

A

Weak

67
Q

What are the 4 vitreous attachements?

A
  • vitreous base
  • wiegers ligament
  • peripapillary adhesion
  • macular and peripheral retinal attachment
68
Q

The gel structure of the vitreous results from the arrangement of collagen fibrils suspended in a network of ______

A

Hyaluronic acid

69
Q

What are the 3 vitreal cells?

A
  • hyalocytes
  • fibroblasts
  • macrophages
70
Q

What 2 things does hyalocytes synthesize?

A
  • HA

- glycoproteins from the collagen fibrils

71
Q

What do fibroblasts synthesize?

A

Collagen fibrils

72
Q

What are the 4 functions of the vitreous?

A
  • support for retina
  • diffusion barrier
  • metabolic buffer
  • transparency
73
Q

What is the strongest vitreal attachment?

A

Vitreous base

74
Q

Does the peripapillary adhesion decline with age?

A

Yes

75
Q

What is the major composition of the vitreous?

A

Water

76
Q

What are the 5 main vitreous components?

A
  • water
  • type 2 collagen
  • HA
  • vitreal cells
  • vitamin C
77
Q

What makes up the majority of the vitreal cells?

A

Hyalocytes

78
Q

What are the 5 support functions of the vitreous?

A
  • prevents retinal detachment
  • reduced mechanical deformation
  • supports the lens during trauma
  • decreases transmission of light at 300-350nm
  • mechanical support of limited significance
79
Q

What is the most common pathological condition of the vitreous?

A

PVD

80
Q

If you have macular edema will you have increased or decreased osmotic pressure?

A

Increased

81
Q

____ traction can cause macular edema

A

Vitreous-retinal

82
Q

T/F: Diffusion is slow and bulk flow is limited across the vitreous

A

True

83
Q

This prevents topically administered substances from reaching the retina and prevents substances in the blood stream from reaching the vitreous center

A

Diffusion barrier

84
Q

What vitamin type does the vitreous have a lot of?

A

Vitamin C

85
Q

In the case of a vitrectomy or full PVD what 3 things could occur?

A
  • nuclear sclerotic cataract (due to oxidative damage)
  • reduce neovascularization in the retina (due to reduced VEGF)
  • neovascular glaucoma (due to no barrier)
86
Q

Does the vitreous have high or low concentration of structural macromolecules and soluble proteins?

A

Low

87
Q

What 2 pathologies can block the transparency of the vitreous?

A
  • synchisis scintillations

- asteroid hyalosis

88
Q

What causes gel structure of vitreous?

A

HA provide spacing and support for the collagen

89
Q

What substance maintains high concentration in vitreous and can be utilized to protect the retina from metabolic and light-induced free radicals?

A

Vitamin C

90
Q

What substance products the retina from oxidative damage?

A

Vitamin C

91
Q

What are vitreous functions?
A. Provides a transparent medium
B. Cushion the globe
C. Storage area of ions and nutrients for the retina and lens

A

All of the above

92
Q

What 4 things make up the transparency of the vitreous?

A
  • Low concentration of structural macromolecules
  • Low concentration of soluble proteins
  • Specific collagen/HA configuration
  • Blood/vitreous barrier
93
Q

A disorder of the tear film caused by tear deficiency
or excessive tear evaporation that causes damage to the interpalpebral ocular surface and is associated with symptoms of ocular discomfort

A

Dry eye syndrome

94
Q

What are the 3 functions of the tear film?

A
  • Provides a smooth refractive surface for clear vision
  • Maintains the health of corneal and conjunctival
    epithelia
  • Acts as the 1st line of defense against microbial
    infections
95
Q

What are the 3 layers of the tear film?

A
  • mucous layer
  • aqueous layer
  • lipid layer
96
Q

High molecular weight glycoproteins that are heavily glycosylated

A

Mucin

97
Q

The mucous layer o the tear film is between what 2 layers?

A

Epithelial layer and aqueous layer

98
Q

The mucus layer of the tear film is composed mostly of what kind of substance?

A

Mucin

99
Q

What are the 2 different types of mucin?

A
  • membrane associated mucin

- secretory mucins

100
Q

Type of mucin: A dense barrier to pathogen penetrance, at the epithelia cell-tear film interface

A

Membrane associated mucin

101
Q

Type of mucin: act as “cleaning crew”, moving through the tear fluid and collecting debris that can be removed via the nasolacrimal duct during blinking

A

Secretory mucins

102
Q

What are the 4 functions of the mucus layer in the tear film?

A
  • Maintain water on the surface of the eye
  • Interacts with tear lipids layer to lower surface tension thereby stablizing the tear film
  • Provides lubrication for eyelid movement
  • Traps exploited surface cell, foreign particles and bacteria
103
Q

What are the 2 sources to the mucus layer?

A
  • goblet cells of conjunctiva

- squamous cells of the cornea and conj

104
Q

What type of neural control of the mucus layer increases the mucus secretion?

A

Parasympathetic nerve

105
Q

What 3 nerves are sources for the mucus layer of the tear film?

A
  • sensory nerves
  • parasympathetic nerves
  • sympathetic nerves
106
Q

The aqueous layer of the tear film is composed of what 7 things?

A
  • water
  • electrolytes
  • proteins
  • peptide growth factors
  • vitamins
  • hormones
107
Q

What are the main contributors to osmolarity of the tear film?

A

Na and Cl

108
Q

Does osmolarity increase or decrease with dry eye?

A

Increases

109
Q

What are the 2 ions that are important for maintaining corneal epithelium health?

A

K and Ca

110
Q

What are the 4 important electrolytes of the tear film?

A
  • Na
  • Cl
  • K
  • Ca
111
Q

What peptide growth factors are in the aqueous layer of the tear film?

A
  • EGF
  • TGF-B
  • HGF
  • Vitamin A
112
Q

What acts as a buffer to maintain constant pH and contributes to maintaining epithelial integrity of the ocular surface?

A

Electrolytes

113
Q

The buffering system allows the eye to tolerate the ophthalmic solution varying in pH from ___ to ___ in the aqueous layer

A

3.5 to 10.5

114
Q

During sleep, does pH increase or decrease?

A

Decreases

115
Q

Does pH increase or decrease in dry eye due to osmolarity increasing

A

Increases

116
Q

What are the 3 functions of the aqueous layer of the tear film?

A
  • strong defense system protecting it from invaders
  • peptide growth factor and vitamin A regulate epithelial proliferation, motility, and differentiation
  • buffering
117
Q

What type of tearing does the main lacrimal glands deal with?

A

Reflex and emotional tearing

118
Q

What type of tearing does accessory lacrimal glands deal with?

A

Maintenance tearing

119
Q

What types of neural control does the main lacrimal glands receive ?

A

Parasympathetic, sympathetic, and sensory

120
Q

What type of neural control do the accessory lacrimal glands receive?

A

Parasympathetic

121
Q

They aqueous layer is between what two layers?

A

Mucous layer and lipid layer

122
Q

What is the lipid layer of the tear film composed of?

A

Meibomian oil

123
Q

What are the 2 phases of the lipid layer of the tear film?

A
  1. ) polar surfactant phase

2. ) nonpolar phase (overlaid polar phase)

124
Q

The polar surfactant phase is primarily composed of what 2 things?

A

-phospholipids and glycolipids

125
Q

This phase acts as a surfactant between the hydrophilic aqueous mucin layers and the thick, nonpolar lipid layer

A

Polar surfactant phase

126
Q

What 3 things make up the nonpolar phase of the lipid layer?

A
  • wax
  • cholesterol esters
  • triglycerides
127
Q

This phase provides the air-tear film interface and is responsible for retarding evaporation

A

Non-polar phase

128
Q

What are the 4 functions of the lipid layer of the tear film?

A
  • Major barrier to evaporation from the ocular surface (slows evaporation)
  • Provides stability to the tear film through interaction with aqueous-mucin phase
  • Provides a smooth optical surface for the cornea
  • Acts as a barrier against foreign particles
129
Q

What is the main sources to the lipid layer of the tear film?

A

-meibomian glands

130
Q

What 2 other sebaceous glands assist the meibomian gland in the lipid layer?

A

Zeis and moll

131
Q

Glycocalyx is produced by what? And what do they do?

A

Corneal epithelial surface cells

They help bind mucins onto the corneal surface

132
Q

What 4 tests are used to evaluate tear secretion?

A
  • schirmer 1
  • schirmer 2
  • phenol red thread test
  • meinscometry
133
Q

What 4 tests are used to evaluate tear film stability?

A
  • TBUT
  • ocular protection index
  • videokeratography
  • tear turnover
134
Q

What 3 tests are used to evaluate tear film osmolarity?

A
  • tear film osmolarity
  • tear ferning
  • tear evaporation
135
Q

What 2 tests are used to evaluate the lipid layer of the tear film?

A
  • infererometry

- meibometry

136
Q

What 3 tests are used to evaluate the ocular surface of the tear film?

A
  • fluorescein
  • rosa bengal
  • lissamine green
137
Q

What is the largest category of dry eye?

A

Tear deficient dry eye

138
Q

If there is a disorder in lacrimal gland function, what type of dry eye will be induced?

A

Tear deficient dry eye

139
Q

A type of dry eye that results in either reduced aqueous tear production and tear flow, or a failure to transfer lacrimal fluid into the conjunctival sac

A

Tear deficient dry eye

140
Q

A type of dry eye where the lacrimal gland function is normal and the volume of lacrimal fluid is sufficient to cover the ocular surface, but another tear abnormality exists that leads to increased tear evaporation.

A

Evaporation dry eye

141
Q

What is the resource in generating mucins in tear film?

A

Goblet cells and squamous cells of cornea and conj

142
Q

What electrolytes are the main contributors for osmolarity of tear film?

A

Na and Cl

143
Q

What is the resource of generating the aqueous layer in the tear film?

A

Main lacrimal gland and accessory lacrimal gland

144
Q

What later is the major barrier to evaporation from the ocular surface?

A

Lipid layer

145
Q

Does the anterior chamber depth increase or decreased with age?

A

Decrease

146
Q

What type of cataract has more of an effect on reducing anterior chamber death?

A

Cortical cataract

147
Q

Is uveoscleral outflow increased or decreased wth aging?

A

Reduced but there is an increase in the amount of connective tissue in the ciliary muscle

148
Q

What are the 4 aging changes in the anterior chamber?

A
  • reduced anterior chamber depth
  • reduced uveoscleral outflow
  • accumulation of extracellular matrix plaque in TM
  • increased outflow resistance in the TM and SC
149
Q

T/F: the gel structure becomes more liquefied with aging

A

True

150
Q

What is the most common cause of a PVD?

A

Vitreous syneresis

151
Q

The breakdown of the vitreous gel and aggregation of collagen fibrils due to increase of liquid portion

A

Vitreous syneresis

152
Q

Change of gel structure is most likely to occur in the periphery or the center?

A

Center

153
Q

Aggregation of collagen fibrils

A

Floaters

154
Q

What are the 5 aging changes of the lacrimal system?

A
  • goblet cell population may decrease
  • reduced tear reflex secretion
  • change in composition of the meibomian secretion
  • increase of plugged meibomian gland pores
  • reduced lacrimal drainage capacity
155
Q

How does B-lysine function to destroy a pathogen?

A

Acts like a detergent and pokes hole in the cell membrane releasing bacterial cytoplasm to the external environment

156
Q

This enzyme binds to the microbial cell membrane, embeds in the membrane, and forms pore like membrane defects that allow the efflux of ions and nutrients

A

Defensins

157
Q

Does a Defensin function like a detergent?

A

No

158
Q

Structurally similar chemicals that have similar activities to defensins

A

Mimetics

159
Q

What is the type of bacteria does lysozyme play major effect on?

A

Gram + bacteria

160
Q

This enzyme breaks bonds between peptidoglycan sugar residues and disrupts cell wall integrity promoting membrane rupture

A

Lysozyme

161
Q

What does lactoferrin bind to?

A

Iron and other metal ions

162
Q

What does lactoferrin do?

A

Takes up nutrients needed for bacterial growth

163
Q

Lactoferrin is associated with what type of cancer?

How?

A

Breast cancer

Because when it is lacking there is an increased risk of infection

164
Q

Lactoferrin is decreased in what type of dry eye disease?

A

Sjögren’s syndrome

Ocular Phys (6 decks)

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