Boards Prep: Ocular Disease: Book Flashcards

Question

Thyroid Eye Dz: Hertel Exophthalmometry Norms for Adults 1. Caucasians? 2. Asians? 3. AAs? 4. What's considered Abnormal?

Answer 1

1. 12-22 mm 2. 12-18 mm 3. 12-24 mm 4. Abnormal if HIGHER OR presence of >3 mm asymmetry.

Answer 2

1. D/t abnormal communication b/w Arterial and Venous Systems 2. Closed Head Trauma. Can happen spontaneously d/t Ruptured Carotid Aneurysm. 3. High Pressure blood from carotid artery builds up in the cavernous sinus. Prevents return of venous blood back to the cavernous sinus. 4. Leads to CHEMOSIS, OCULAR BRUIT, and PULSATILE PROPTOSIS * Any of the CN Palsies could potentially be affected.

Answer 3

1. Cavernous Hemiangioma a. 4th-6th decade; Females b. Painless, progressive U/L Proptosis. Usually starts Posterior to the GLOBE w/in the MUSCLE CONE. 2. Capillary Hemiangioma a. Dx'd by 6 Mos usually. b. Proptosis, and DEPRIVATION AMBLYOPIA; Rapid Growth; Spontaneous Involution, usually by Age 7. 3. Rhabdomyosarcoma a. Destroys the bones pretty quickly. Get progressive U/L Proptosis b. by Age 7. 4. Neuroblastoma a. Usually comes from a tumor in the ABDOMEN!, mediastinum, or neck (Horner's may be seen as well.) 2nd most common overall malignancy after Rhabdo. 5. Optic Nerve GLIOMA a. Symptoms usually seen in 1st decade of life. (2-6 y/o) b. Neurofibromatosis Type 1. 6. Meningioma a. Middle aged women b. Sphenoid ones come from Sphenoid bone; Most common Intracranial Tumor to invade the orbit 7. a. Sup/Temp Quadrant. b. Usually congenital, causes Proptosis. CT Scan shows well-defined mass.

Answer 4

1. Lymphoma 2. a. young/middle aged peeps. b. Benign, Y-W Tumor of ASTROCYTES c. Superior Orbit. d. Neurofibromatosis 3. a. Benign tumor of SCHWANN CELLS b. Young/Middle Aged Adults c. Superior Orbit d. CN 5 e. Painless, progressive proptosis.

Answer 5

Progressive vision loss, Proptosis, diplopia, and an APD.

Answer 6

1. Rare; Acute, Recurrent, or Chronic, Young/Middle-Aged Peeps. 3rd MOST COMMON ORBITAL problem in ADULTS. 2. IDIOPATHIC. Inflammatory. Can hit the Soft tissue. Can look anywhere from T.E.D. to Orbital Cellulitis. 3. Acute onset; U/L Pain, Red Eye, Diplopia, Decreased Vision. Kids: can be B/L and 1/2 of those can have Fevers, Nausea, and Emesis 4. PROPTOSIS, EOM restrictions, Chemosis, Periorbital Swelling, Lacrimal Gland Enlargement, Lid Ptosis, Hyperopic Shift, ON Swelling, Increased IOP on one side. Reduced Corneal Sensation (CN V1 involvement), etc.

Answer 7

1. w/Allergic Symptoms | a. Start thinking IDIOPATHIC Inflammatory condition esp if the Pt is young/Middle Aged.

Answer 8

1. widespread. in all of the orbit, INCLUDES EOMs tendons. | 2. CT/MRI...can see enlarged EOMs/Tendons

Answer 9

1. Rare, Idiopathic, Orbital Inflammation that can hit the CAVERNOUS SINUS and SOF. 2. ACUTE and PAINFUL exophthalmoplegia; Diplopia d/t I/L Palsies of CNs 3,4,6. 3. 3 4. V1 and V2 can be affected too, so u can see decreased sensory innervation in their respected areas.

Answer 10

Systemic Vasculitis (Wegener's, Polarteritis Nodosa) or Lymphoma.

Answer 11

Shrinkage/Atrophy of Globe d/t Trauma, Infection, Sx, Advanced Dz. Associations: Inflammtion, Hypotony, Blind Eye

Answer 12

Retraction of the globe w/in the Orbit, usually d/t Ocular Trauma

Answer 13

1. Removal of GLOBE 2. Removal of INNER Contents of the eye; Sclera and other oribtal stuff still there. 3. Removal of EVERYTHING: includes EOMs and Orbital Fat.

Answer 14

1. Middle Aged Northern Europeans. WOMEN > Men. Men get more severe version though. 10% of population affected w/50% having Acne Rosacea 2. Affects SEBACEOUS GLANDS --> Chronic Ocular Surface Dz. 3. Redness, Burning, FBS, Ocular Irritation 4. Papules on Cheek and Forehead w/TELANGIECTASIA, RHINOPHYMA (sebaceous gland hyperplasia of the nose) and FACIAL FLUSHING (butterfly rash) a. Alcohol, Exertion, Spicy Foods, Caffeine, More sun exposure

Answer 15

1. Inspissated MGs, Blepharitis, Hordeola, Chalazia | a. Ocular Surface Dz (Phlyctenules, Staph marginal Keratitis, SPK, Corneal Neo (greatest inferiorly), DES).

Answer 16

1. Type 4 Hypersensitivity RxN: DELAYED (24-72 hrs later) a. Cosmetics: anything really. b. Aminoglycosides (Gentamicin, Tobramycin), Trifluridine, Cycloplegics/Mydriatics, Glaucoma Meds (like Timolol, Alphagan, Trusopt), and Preservatives (Thimerosol, BAK) 2. Acute Periorbital Swelling, Redness, Itching, Tearing 3. U/L or B/L Erythema and crusting of the lid and periorbital tissues and lots of CONJUNCTIVAL CHEMOSIS

Answer 17

1. Mucus Membrane Disorder! 2. Rare. Females > Males (2:1), Avg Dx Age: 65; can get B/L blindness after ~10-30 yrs after Dx. 3. Chronic, SYSTEMIC, IDIOPATHIC mucous membrane disorder. Usually hits ORAL and OCULAR mucous membranes (CONJ, Mouth, Esophagus). Can be Drug induced (TIMOLOL!, Epinephrine, Pilocarpine) 4. Sub-acute onset of nonspecific symptoms: Redness, Dryness, FBS, Decreased Vision 5. Conj Fibrosis and Scarring (fine white Striae), B/L SYMBLEPHARON (Palp Conj sticks to Bulbar Conj), Ankyloblepharon (Lids stick together). 6. Destroys Goblet Cells, Meibomian Glands, Krause and Wolfring, Ducts of Main Lacrimal Gland --> SEVERE OCULAR SURFACE DISEASE. Late Stage can also show Entropion, Trichiasis, Corneal Ulceration, Neo, Keratinization

Answer 18

1. Type 3 Hypersensitivity RxN (Mucous membrane issue); DRUG INDUCED (SULFONAMIDE most common), Phenytoin, Penicillin, Aspirin, Barbiturates, Isoniazid, Tetracyclines, NSAIDs, Immunizing Vaccinations); Also can be caused by INFECTIOUS AGENTS (HSV, Mycoplasma Pneumoniae, Adenovirus, Streptococcus) *Acute Phase (often self-limiting w/in 2-4 wks) which can lead to a chronic phase 2. Skin Lesions (diffuse erythema, or "bull's Eye" lesions, papules on the palms of hands and soles of feet.) a. Ocular Lesions: Severe, B/L Diffuse Conjunctivitis w/Pseudomembranes b. Bacterial Conjunctivitis can lead to Endophthalmitis in severe cases 3. PRODROME: Fever, Malaise, HA, Nausea, Vomiting 4. a. Entropion, Ectropion, Trichiasis, MG damage b. SYMBLEPHARON, fornices shorten, Conj Keratinization, Limbal Stem Cell Damage --> more corneal pathologies. c. Ulcers, Neo, Scars, Perforation.

Answer 19

1. Common in Old Peeps. 2. Redundant Upper Eyelid Skin from WEAKENED ORBITAL SEPTUM --> Eyelid Ptosis, Pseudoptosis, and a loss of distinct eyelid creases. 3. Can cause an apparent Superior VF Loss. (Lid Droop, Fat Prolapse)

Answer 20

1. STAPHYLOCOCCAL BLEPHARITIS and SEBORRHEIC BLEPHARITIS (Thick Crusting; Greasy; Easy Loss of Lashes) a. Ant and/or Posterior Bleph (Meibomitis) 2. Usually Asymptomatic; Can report that vision clears after blinking, burning, itching, FBS, Tearing, Crusting (esp in morning), and Mild Discharge 3. w/Seborrheic Dermatitis. Associated w/Less lid inflammation, more oily, greasy scales with flaking, more eyelash loss (Madarosis) and/or misdirected growth compared to Staph Blepharitis.

Answer 21

1. Hx of recurrent lesions; Ask about ACNE ROSACEA and Seborrheic Dermatitis 2. Chronic, localized, STERIL INFLAMMATION of a Meibomian Gland d/t retention of normal secretions. 25% resolve w/o Tx. 3. Hard, Painles, immobile nodule w/o redness. Usually on Upper eyelid. Usually Asymptomatic. 4. Eval for SEBACEOUS GLAND CARCINOMAS

Answer 22

1. Hx of recurrent infections (like chalazia) that are successfully self treated. Ask about Acne Rosacea and Sebborheic Dermatitis 2. Acute Staphylococcus Infection of Eyelid Glands. a. Hits Meibomian Glands (White Blister) b. Hits Zeis or Moll. (Aka STYE)...looks like a pimple 3. Tender, Red, Warm area of Focal Swelling on the lid.

Answer 23

1. Benign lesions from epithelium of epidermis and dermal tissues associated with meibomian, sebaceous, and sweat glands of eyelids. * No issues w/VA, No Pain, unless they rupture...can cause inflammatory RxN. Main complaint is POOR COSMESIS 2. Congenital or acquired lesion (trauma or Sx) on lid...usually white d/t accumulation of Keratinous Debris 3. Acquired Lesion on lid and surrounding Adnexal tissue. Can Look White d/t Occlusion of Sweat Pores or Pilosebaceous Follicles 4. Congenital lesion. Firm, immobile. Usually on Superior Temporal or Superior Nasal Eyelid 5. Fluid retention in Glands of Zeis or debris retention in Meibomian Glands. Solitary, Smooth lesions....Yellow or Opaque.

Answer 24

1. Eversion of lid. Most commonly d/t Involutional (age-related) loss of MUSCLE TONE of ORBICULARIS OCULI. a. Mechanical (Tumor-related), Cicatricial (Scar tissue), Paralytic (CN 7 Palsy), Congenital (rare) 2. TEARING. 3. EXPOSURE KERATOPATHY; Epiphora, Brow Ptosis

Answer 25

1. Inversion of eyelid. a. Involutional (age-related), Cicatricial (TRACHOMA, OCP, STEVENS-JOHNSON, Chemical burns, Trichiasis, etc), Congenital 2. Mild Punctate Keratitis to Corneal Ulcers and Pannus 3. Lashes grow inward 4. 2nd row of lashes 5. Corneal ulcers from Entropion and Trichiasis

Answer 26

1. OBESE peeps w/OBSTRUCTIVE SLEEP APNEA 2. Reduced elastin in Tarsal Plate. Usually in FACE-DOWN Sleepers. Mechanical trauma to Tarsal plate. 3. Chronic, B/L (78%) red eyes in the morning, mild mucous discharge 4. Chronic Papillary Conjunctivitis w/loose upper eyelids that evert easily; Punctate Epithelial Keratopathy (50%) and Keratoconus 5. Obstructive Sleep Apnea, HTN, DM, Hyperthyroidism

Answer 27

1. Age: 50-70; F > M (2:1) 2. Repetitive B/L twitching and/or forceful closing of the eyelids...less common during sleep. Involuntary 3. Spasms of Orbicularis Oculi, Procerus, and Corrugator Muscles 4. IDIOPATHIC; 50% of Pts have an Ocular Surface disorder (usually DES) that can be exacerbating symptoms. 5. BEB AND Lower Facial Abnormalities (can't chew right, jaw spasms, jaw pain, etc). 50% of Pts with BEB have MEIGE's SYNDROME. 6. BOTOX

Answer 28

1. U/L TWITCHING of Orbicularis Oculi ONLY. | 2. Sleep deprived, lots of caffeine intake, stress.

Answer 29

1. MOST COMMON Skin cancer. M > F (2:1); MOST COMMON EYELID CANCER (90%). Fair skin, UV Exposure (UV-B (290-320 nm)). Chronic Lesion that does not Heal 2. Malignancy of Basal Cell Layer of the Epidermis. Minimally Invasive. 3. SHINY, FIRM, PEARLY NODULE w/SUPERFICIAL TELANGIECTASIA. Progression --> CENTRAL ULCERATION (RODENT ULCER). Usually on LOWER EYELID and MEDIAL CANTHUS

Answer 30

1. M > F (2:1); 2nd most common eyelid cancer; 40-50x's less common than BCC 2. Malignancy of Stratum Spinosum layer of the Epidermis; UV Exposure (esp. UV-B); ACTINIC KERATOSIS, fair skin; prior radiation; burn scars; chemical exposure (smoking); forms of chronic irritation. 3. ACTINIC KERATOSIS a. Elevated, usually pink or red, scaly lesion that does not heal. b. 25% 3. to Metastasize 4. similar to BCC but NO TELANGIECTASIA. Usually: Erythematous plaque that looks rough, scaly, and/or ulcerated, may be flat or elevated. usually on Lower eyelid/lid margin.

Answer 31

1. Sun exposed areas 2. Usually a Central Plaque or Ulcer like BCCs or SCCs 3. Very fast: Size: 1-2 cm 4. None. Slowly shrink and usually resolve spontaneously.

Answer 32

1. Rare...about the same as SCC. ELDERLY FEMALES; Hx of Chronic U/L Blepharitis or Recurrent Chalazia 2. Neoplasm of Sebaceous Glands (MEIBOMIAN GLANDS and Glands of ZEIS); may be associated w/prior radiation therapy; POOR Px. Lid Lesion is GREATER THAN 2cm, Mortality: 60%; Symptoms MORE than 6 MONTHS, mortality is 38%. Overall Mortality is 10%. 3. Tumor: HARD and YELLOW; Madarosis, Thickened Red Lid Margins (usually on UPPER EYELID). LYMPHADENOPATHY

Answer 33

1. RARE (<1% of all eyelid malignancies); Most LETHAL PRIMARY SKIN CANCER 2. Malignancy of MELANOCYTES. Risk Factors: Age, Skin color, FHx, Repeated irritation, Sun Exposure 3. ABCDE; Depth of Invasion and LESION SIZE = 2 most IMPORTANT Prognostic Factors for this.

Answer 34

1. Children and Young adults mostly 2. Inflammation of Lacrimal Gland 3. Swelling of OUTER 1/3rd of TEMPORAL Upper Eyelid a. S-SHAPED PTOSIS, Temporal upper eyelid pain, redness, swelling, preauricular lymphadenopathy, occasional fever, elevated WBC Count b. Temporal upper eyelid swelling w/less redness, swelling, and pain compared to acute dacryadenitis. Can lead to inferonasal globe displacement and proptosis.

Answer 35

1. Inflammation of Canaliculi d/t Bacterial, Viral, or Fungal Infections; **PUS OUT OF CANALICULI a. ACTINOMYCES ISRAELI (Yellow Sulfur Granules) 2. Smoldering, U/L red eye that's unresponsive to Antibiotic Tx. usually misdiagnosed as Recurrent Conjunctivitis 3. Tenderness of Nasal Part of Upper or Lower Eyelid, SWOLLEN PUNCTA (POUTING PUNCTA), Mucopurulent Discharge w/palpation of lacrimal sac region

Answer 36

1. Ear, Nose, Throat infections 2. LACRIMAL SAC INFECTION d/t Obstruction in Lacrimal Drainage System --> Backflow of bacteria in lacrimal sac from the lacrimal lake. a. Staph Aureus, Staph Epidermidis, Pseudomonas, H. Influenzae in children b. Swelling below medial canthal tendon. Swelling ABOVE medial canthal tendon, think Lacrimal Sac Tumor 3. Pain, crusting and tearing, occasional fever 4. Prominent edema and tenderness over the lacrimal sac area. 5. Epithelial Carcinomas and Malignant Lymphomas. Carcinomas can express blood into the Tear Film with palpation of the lacrimal Sac. 6. this usually has more swelling, tenderness, and pain. 7. DONT refer for Surgery or try to irrigate the lacrimal system during an ACUTE Infection. Tx should be done FIRST.

Answer 37

1. Narrowing or Occlusion of Puncta of the upper and/or lower lids. a. Older Age 2. EPIPHORA

Answer 38

1. Congenital/Acquired. Acquired more often seen in FEMALES 2. a. Most common cause of NLDO in OLDER Pts. Other etiologies in older patients: Chronic Sinus Dz, Dacryocystitis, and Naso-Orbital Trauma b. Most common cause of Congenital NLDO. seen in ~30% of newborns; Spontaneous opening usually after 1-2 months after birth. IF not, digital massage can be performed. 3. U/L Tearing, discharge, crusting, and recurrent conjunctivitis 4. Epiphora, Mucous reflex from the puncta after compression of the lacrimal sac, medial lower eyelid erythema, and mild to no redness or tenderness around the puncta 5. in Congenital NLDO d/t Stagnant tears in the lacrimal sac.

Answer 39

1. Tests Patency of system. Fluorescein instilled in Inferior Fornix...Should drain w/in 5 minutes. + Test: means PATENT SYSTEM 2. Irrigation with SALINE. Reflex of Fluid thru the same punctum = OBSTRUCTION in UPPER or LOWER CANALICULUS (proximal to common canaliculus) Retrograde flow thru Opposite canaliculus and punctum: means NASOLACRIMAL BLOCKAGE (Obstruction distal to Common Canaliculus) Pt Tastes saline or has Gag reflex, Obstruction has been cleared Jones Test II FAILS to open Nasolacrimal drainage system, a DACRYOCYSTORHINOSTOMY (DCR) is the best Treatment Option.

Answer 40

1. Common, benign, fluid-filled sac on conjunctiva. Can cause irritation. a. Inclusion or Retention Cyst 2. Superficial, whitish-Yellow deposits of mucous secretions and epithelial cells in the palpebral conjunctiva. a. Ocular Lithiasis. b. Usually Asymptomatic, but may experience a FBS. 3. Rare, Benign proliferation of Melanocytes that start around puberty or early adulthood. Size and darkness can increase in puberty. a. U/L, Solitary, Flat, Freely Mobile, sometimes non-pigmented. INCLUSION CYSTS w/in lesion are diagnostic for this. b. JUXTALIMBAL AREA, then Plica, then Caruncle 4. a. Rare, U/L, Acquired Pigmentation. Usually in Old Caucasians b. Anywhere. c. Flat, INDISTINCT MARGINS. Benign, but has a PREMALIGNANT POTENTIAL (30% progress to MALIGNANT MELANOMA) * *Increased vascularity to it, or an increased growth rate...suspect possible Malignancy.

Answer 41

1. a. to uncontrolled proliferation of melanocytes b. Caucasians (around age 50) c. Pigmented and Non-pigmented. usually come from PAM. d. THICKNESS of LESION e. LIVER 2. a. Most COMMON CONJUNCTIVAL MALIGNANCY b. Bowen's Dz or Conjunctival Squamous Dysplasia c. U/L, PREMALIGNANT condition. Can progress to SCC (risk is low though). d. Elevated, gelatinous mass w/neo. ~10% have Leukophakia (Keratinization). 95% found at limbus w/in Interpalpebral Fissure. Can progress onto the Cornea.

Answer 42

1. CONJUNCTIVAL MELANOMA | 2. SCC

Answer 43

1. a. Rare, Slow-growing, Malignant tumors. b. Eldery Caucasian Males c. from CIN d. UV Radiation and HPV e. at LIMBUS and may involve the adjacent cornea. f. a FEEDER VESSEL

Answer 44

1. a. Pedunculated, Benign, Red, VASCULAR LESION of the Palpebral Conjunctiva b. Trauma, Surgery, Chalazion, or other sources of Chronic Irriation 2. a. Inflamed area (White, Yellow, translucent, or brown) b. w/in Conjunctival Stromal Tissue c. Retained Foreign Bodies, Surgery, Trauma, Infections (Parinaud's Oculoglandular Syndrome) or associated systemic conditions (Sarcoidosis) d. Can be Asymptomatic or have Ocular Irritation and FBS.

Answer 45

1. Children > Adults 2. H. INFLUENZAE (Gram - ROD)...Most common cause in young kids. Adults: S. Epidermidis and S. Aureus 3. ACUTE ONSET of REDNESS usually one eye, then goes B/L. FBS, Eyelids stuck together when they wake up. Symptoms usually go away after ~10-14 days w/no Tx. 4. DISCHARGE (Mod to Severe), starts SEROUS then becomes more MUCOPURULENT (most common) or purulent. Rare Corneal signs and rare Lymphadenopathy. 5. S. Aureus. D/T high association w/BLEPHARITIS

Answer 46

1. STD...Young adults. Multiple sex partners. Can be passed to infants via birth canal. 2. N. Gonorrhea most COMMON cause. (Gram - intracellular diplococci) 3. THAYER-MARTIN AGAR 4. HYPERACUTE ONSET of SEVERE PURULENT DISCHARGE. Redness, FBS, Eyelids stuck together when they wake up. U/L then becomes B/L usually 5. SEVERE PURULENT DISCHARGE, Conjunctival Chemosis (usually w/PSEUDOMEMBRANES), MARKED PREAURICULAR LYMPHADENOPATHY. Tender and swollen lids. * Severe Cases: N. Gonorrhea can invade intact corneal epithelium and cause an ULCERATION 6. a. Purulent URETHRAL Discharge after ~3-5 days of intubation b. ~50% are asymptomatic. Discharge less common. 7. for CHLAMYDIAL SYSTEMIC INFECTION (co-infection) 8. PREAURICULAR LYMPHADENOPATHY and PSEUDOMEMBRANES which are usually associated with Viral Conjunctivitis.

Answer 47

1. Adults > Children 2. usually d/t URTI's. ~1/3 of serotypes are associated with ocular infections. Transmission = Direct Contact. Highly Contagious for 12-14 days. 3. Acute, Nonspecific Follicular CONJUNCTIVITIS, Phayngoconjunctival Fever (PCF) and Epidemic Keratoconjunctivitis (EKC)

Answer 48

1. a. 1-11 and 19 = Most common type. b. Diffuse Red Eye, Conjunctival FOLLICLES in INFERIOR FORNICES, Tearing, Mild Discomfort; Rare corneal involvement 2. a. 3-5 and 7. b. SWIMMING Pool Conjunctivitis c. Children. Highly Contagious d. Acute Follicular Conjunctivitis (Red Eye); Mild low grade Fever; Pharyngitis (sore throat). Rare corneal involvement 3. a. 8, 19, 37. MOST SERIOUS FORM of Adenoviral Conjunctivitis. b. PAIN and CORNEAL INVOLVEMENT c. seen after 8 days from exposure. SEIs seen in 3rd week when pt is NO LONGER CONTAGIOUS d. PREAURICULAR LYMPHADENOPATHY. May also have pseudomembranes.

Answer 49

1. Rapid onset of redness, tearing, mild discomfort, PREAURICULAR LYMPHADENOPATHY. Starts U/L, then spreads...B/L. 2. ACUTE FOLLICULAR CONJUNCTIVITIS (follicles in Inferior Fornices), Conjunctival Injection, PSEUDOMEMBRANE FORMATION, PREAURICULAR LYMPHADENOPATHY (Classic for EKC) and Diffuse Keratitis (esp in EKC) 3. Infectious (viral, chlamydial, bacterial) or Noninfectious (Graft rejection, solution hypersensitivity, hypoxia) 4. PALPABLE NODE.

Answer 50

1. Rare; Usually in places w/POOR HYGIENE; Children and Young Adults 2. Chronic Infectious skin condition d/t DNA POX VIRUS spread via Direct Contact. Multiple nodes seen...suspect HIV 3. Single or multiple dome-shaped, umbilicated, waxy nodules on Lid or LID Margin. Asymptomatic usually. Rupture --> chronic follicular conjunctivitis and superficial pannus.

Answer 51

1. U/L Follicular Conjunctivitis w/Watery Discharge

Answer 52

1. Type 1 Hypersensitivity (airborne allergens) 2. less common type 1 hypersensitivity...Household allergies (dust mites, animal dander, etc) 3. Conjunctival Chemosis, PAPILLAE, itching, tearing, watery discharge

Answer 53

1. RARE 2. young males; Hot, dry climates. resolves usually by puberty 3. Seasonal. ex: 8 y/o male. Asthma. Huge Papillae on lid eversion each spring. 4. pt is PREDISPOSED to ATOPIC SYSTEMIC CONDITIONS (rhinitis, asthma, etc). SEASONAL OUTBREAKS...WARM MONTHS! 5. INTENSE ITCHING, Photophobia (most common Complaint), Ptosis, THICK MUCOUS DISCHARGE. INITIAL OUTBREAK MOST SEVERE 6. PROMINENT PAPILLAE on Limbus (TRANTAS DOTS) or upper palpebral Conjunctiva (COBBLESTONE PAPILLAE). Cornea: starts w/Punctate Epithelial Keratitis --> coalesces to LARGE EROSION --> Plaque Formation --> LOCALIZED ULCERATION (SHIELD ULCER). a. Conjunctiva and Cornea

Answer 54

1. RARE; Young to middle aged adults (40s). Hx of Atopic conditions, especially ATOPIC DERMATITIS 2. Chronic Eczema (Early infancy). 60% w/in first year of life. Pruritis, Rash. Can get a CATARACT b/w 15 and 30. 3. NOT SEASONAL. KID will ITCH like CRAZY. (Type 1 and Type 4 Hypersensitivity RxN) 4. B/L ITCHING of EYELIDS. watery discharge, redness, photophobia, pain. 5. DENNIE's LINES (extra crease under lower lid d/t periorbital edema); Atopy Shiners (bags under eyes from constant rubbing). Prominent outer eyelid. Periorbital involvement. * Papillae: usually INFERIORLY (Superior Papillae in VKC and GPC). Conj signs can be mild. * Corneal NEO, KERATOCONUS and Cataracts more common in AKC * Symblepharon Formation of Inferior Fornices in severe cases 6. TOXICITY to Topical Medications or CL solutions.

Answer 55

1. inflamed, elevated Conjunctiva w/a Central vessel that's the source of infiltration of Eosinophils, mast cells, neutrophils, and lymphocytes. a. Allergies and Bacteria, but NON-SPECIFIC. 2. a. Avascular, white-gray nodules..usually in Tarsal and Fornix Conjunctiva. FIRM. b. Chlamydia, Toxic, or Viral Infections c. Immature lymphocytes and macrophages in it.

Answer 56

1. Extremely Common 2. 95%: CL Wear; exposed sutures, glaucoma filtering blebs, scleral buckles, ocular prosthetics. EW SCLs main cause. AWT: 8 months before it starts; or as early as 3 wks. 3. Non-Infectious inflammation...usually d/t MECHANICAL TRAUMA and IMMUNE RESPONSE to CL surface deposits or environmental factors. 4. Itching. Early: some mucous discharge; Late: Ropy mucous discharge. Photophobia. 5. Mild-severe papillae in upper conjunctiva. ptosis; mucous in eye. * Papillae >0.3 mm diameter. Giant Papillae (>1.0 mm)...neighboring papillae coalesce after prolonged inflammation.

Answer 57

1. Chlorhexidine or Thimerosal....Conj. Injection and diffuse SPK. 2. Superior Pannus. Corneal neo more than 1.5 mm is a concern. 3. long-term PMMA wearers, GP wearers w/poor fitting lens. a. Vision clear in CL but blurry in glasses. Ghost images and diplopia. *refit and not wearing for a while will fix the problem. 4. CL Hypersensitivity reaction (esp Thimerosal) or Poor CL fit a. Sup Bulbar and upper tarsal conjunctival injection. Papillary reaction and corneal filaments uncommon. 5. a. look like PLAQUES b. look like JELLY BUMPS 6. CL doesn't move w/blinking. Usually High myopes (>-8.00D), hyperopes and aphakes. Lenses too steep or have OAD 15.00 mm. b. Redness. Worsens after lens is removed, hazy vision, halos, dyness. c. mild-severe corneal edema. corneal blebs. injection around limbus. 7. Corneal Warpage 8. 3 and 9 o'clock staining 9. EW Hydrogel lenses fit too tight. Poor lens wettability. 30% asymptomatic. FBS, Irritation, underlying corneal infiltrates (40%) 10. small bubbles trapped under CL (RGP). pushes bubble onto cornea --> divot for fluorescein to pool.

Answer 58

1. Bacterial/Viral Infections, HSV, HZV, Fungal Infections, Atopy, Allergic, Vernal, Toxic Reactions, Factitious Dz.

Answer 59

1. Rare. Sexually active young adults. Most common STD in US. 2. Urogenital disease d/t Chlamydia serotypes D-K. Direct spread. See signs 5-14 days after inoculation. Active Genital Infection. 3. ACUTE FOLLICULAR CONJUNCTIVITIS...gets to be CHRONIC. Starts U/L then goes B/L. 4. FOLLICLES (limbal or palpebral) usually in INFERIOR PALPEBRAL CONJUNCTIVA and FORNICES. Preauricular lymphadenopathy. Scant mucopurulent discharge. matting of lids. Cornea: punctate keratitis, superior pannus, SEIs usually more peripheral than EKC. 5. Acute Cojunctivitis in newborns (HSV, Gonorrhea, chalmydia)...CHLAMYDIA leading cause in US.

Answer 60

1. Most prevalent b/w ages 1-5. LEADING CAUSE of PREVENTABLE BLINDNESS WORLDWIDE. Poor hygiene. Direct spread. 2. Chlamydia Serotypes A-C. ALMOST ALWAYS B/L. 3. a. FOLLICULAR CONJUNCTIVITIS on sup. tarsal conj. mucopurulent discharge, MILD SUPERIOR PANNUS. b. ARLT LINES (white scarring on sup. tarsal conj.) and HERBERT's PITS (depression on limbal conj. after resolution of limbal follicles); *Blindness d/t Corneal ulceration from tarsal conjunctival scarring.

Answer 61

1. Uncommon; Females (3:1); Mean Age: 50. Hx: Recurrent episodes 2. Chronic inflammation reaction associated with Keratoconjunctivitis Sicca (25%), thryroid Dz (20-50%) and CL wear. a. Drying b/w upper eyelid and Bulbar Conj --> more friction --> turnover and replacement of mature sup. conj. cells does not happen. b. continual friction of sup. palpebral conj on sup. bulbar conj d/t tight apposition from exophthalmos c. increased friction --> increased risk of SLK 3. Redness, FBS, frequent blinking, NO DISCHARGE. SYMPTOMS WORSE THAN SIGNS. 4. Thickened, red SUPERIOR Bulbar CONJ prominent at LIMBUS and is B/L usually. w/Adjacent SPK and Filamentary Keratitis. Upper tarsal conj can look velvety d/t diffuse papillary hypertrophy.

Answer 62

1. Teenage; Females; similar eye infections in the past. History of TB. 2. Type-4 HYPERSENSITIVITY RxN to STAPHYLOCOCCUS (Blepharitis most common culprit), tuberculoprotein, and Acne Rosacea. 3. Tearing, FBS, Itching, Conj and Corneal Phlyctenules; Photophobia common w/Corneal Phlyctenules. 4. Phlyctenules on Conj or Cornea. 5. at LIMBUS...look pink, fleshy nodules w/Conj injection 6. Near limbus. Small, White (lymphocytic) nodule w/adjacent conj. Injection.

Answer 63

1. Rare; Childhood 2. Ocular signs of Systemic problem; Associated w/Systemic PLASMINOGEN deficiency. Can affect mucous membranes in the body. 3. Thick, White, "woody" membranous plaque of the superior tarsal conjunctiva 4. Chronic tearing, FBS, photophobia; constant discomfort and cosmetic concerns in advanced disease.

Answer 64

1. Rare; Exposure to cats, dogs, rabbits, squirrels, ticks 2. a. Most common cause; Bartonella Henselae. Cat scratch to eye or thru flea bites to eye. b. ticks, rabbits, squirrels c. TB and Syphilis 3. Red eye, FBS, mucopurulent discharge 4. U/L, GRANULOMATOUS, follicular, palpebral conjunctivitis. SWOLLEN PREAURICULAR/SUBMANDIBULAR LYMPHADENOPATHY. Could have Fever and Rash

Answer 65

1. from Phthirus Pubis (Crab louse) from hair in genital area. Infection of Eyelashes, eyebrows, facial hair via direct contact w/infected peeps or clothing or linen. Can be U/L or B/L. 2. Mild itch to Imflammation w/Burning, itching, tearing, blurred vision 3. Transparent lice and white nits (eggs) on eyelashes; Blood-tinged debris on lids and lashes. Mild-Severe Chronic Follicular Conjunctivitis. Preauricular Lymphadenopathy.

Answer 66

1. Blood under conj. a. VALSALVA; Meds (Aspirin, Coumadin), HTN, Blood Clotting disorder (sickle cell) 2. CBC, PT/PTT, sickledex for idiopathic and recurrent cases esp in African or Mediterranean descent.

Answer 67

1. Degeneration of collagen fibrils w/in Conj. Stroma. 2. Y-W (raised) deposit adjacent to Limbus but not on cornea. 3. Triangular fibrovascular growth of Bulbar Conj. Extends onto cornea. DESTROYS BOWMANs MEMBRANE --> ATR Astigmatism. STOCKER'S LINE (IRON DEPOSIT) can be present at ANTERIOR edge of PTERYGIUM.

Answer 68

1. a. RA, Lupus, Ulcerative Colitis, Crohn's Dz, Reactive Arthritis, AS, Psoriatic Arthritis b. Syphilis, Lyme Dz c. Herpes Zoster, HSV, Mumps d. Gout e. Temporal Arteritis, Wegener's, Behcet's Dz, Polyarteritis Nodosa f. Acne Rosacea 2. Young adults; Frequent Recurrences 3. Benign, self-limiting inflammation; IDIOPATHIC usually; associated with systemic Dzs though. 4. Acute, U/L Red Eye; maybe mild pain 5. Sectoral Injection (70%); Simple (80%), Nodular (20%); Can move the nodule w/a Cotton tip applicator (way to Differentiate from Scleritis)

Answer 69

1. Females; 98% are Anterior Scleritis; 2. a. MOST COMMON TYPE. Most BENIGN form. Least Severe Systemic Conditions. DIFFUSE HYPEREMIA b. DEEP, Focal, Painful, Injected, Immobile Nodule 3. a. WORST FORM; 33% die w/in a few years d/t severe AI Dz. Many lose Vision; Many have ocular or systemic problems (Ant Uveitis, Sclerosing Keratitis, Peripheral Corneal Melt, Scleral Thinning, Cataracts, Glaucoma) b. aka SCLEROMALACIA PERFORANS. usually d/t CHRONIC RA. LACK OF SYMPTOMS. Asymptomatic; maybe GRAY-BLUE PATCHES d/t SCLERAL THINNING (uvea exposed)

Answer 70

1. Granulomatous Inflammation of Sclera w/1/2 having some systemic Dz. 30% d/t a Collagen vascular Dz (RA being most common, then WEGENER's Granulomatosis) 2. SEVERE, BORING, OCULAR PAIN. Wakens pt in night. Radiated pain. Gradual onset of Redness and Decrease in Vision (except for Scleromalacia perforans) 3. Sectoral or diffuse inflammation. Can't be moved w/Cotton swab. THIN SCLERA. usually B/L

Answer 71

Benign, Oval shaped areas of SCLERAL THINNING that happen w/Age.

Answer 72

1. Scleritis: Gradual, but SEVERE OCULAR PAIN and more severe complications. 2. Scleritisi: BLUISH-HUE Episcleritis: RED appearance 3. EPISCLERITIS; still red: 10% phenylephrine will blanch superficial vessels...so EPISCLERITIS will look less red. 4. Scleritis: B/L w/Diffuse Injection Episcleritis: U/L w/Sectoral Injection 5. Episcleritis; Scleritis 6. Scleritis, Uveitis, Acute ACG, Corneal Pathology (abrasions, erosions, ulcers)

Answer 73

1. Focal, Pigmented, Elevated area. | 2. Posterior Ciliary Nerve loops visible in sclera.

Answer 74

1. 15/100,000/yr; 45,000 new cases/yr in US. YOUNG ADULTS; Rare in peeps over 70 (if seen, think Toxoplasmosis or HERPES ZOSTER!) 2. 2ndary breakdown to Blood-Aq Barrier. 50% w/Acute Anterior Uveitis have HLA-B27 (70% if recurs); 50% new onset acute Anterior Uveitis: ASSOCIATED SPONDYLOARTHROPATHY w/80% having AS. 3. IBD (Crohn's, Ulcerative Colitis), Reactive Arthritis (Reiter's Syndrome), AS, Psoriatic Arthritis 4. Crohn's, Reactive arthritis, AS, Psoriatic

Answer 75

1. 75% Anterior (Iritis, Iridocyclitis), 8% intermediate (pars planitis) and 17% Posterior or Panuveitis

Answer 76

1. Less than 3 MONTHS 2. Lasts for more than 3 MONTHS 3. Acute Anterior U/L Nongranulomatous Uveitis

Answer 77

1. PAIN, REDNESS, PHOTOPHOBIA, lacrimation, maybe decreased vision. a. can be Asymptomatic; or have blurred vision or a dull ache. 2. d/t CONGESTION and irritation of ANTERIOR CILIARY NERVES

Answer 78

1. Presence/Absence of WBCs in AC. 2. PS, PAS, Cystoid Macular Edema (CMS), CATARACT FORMATION (usually PSC) 3. Flare, Hypopyon, Circumlimbal inj, decreased IOP (early stages), Keratic Precipitates (KPs on Endothelium) * Decreased IOP d/t CB Inflammation. Increased IOP d/t eye gets better, Trabeculitis, PS (Acute angle closure), PAS (chronic Angle closure), lots of inflammation, Steroid Tx, Chronic TM Damage. 4. Infectious (TB, Syphilis) (signs...Mutton Fat KPs and Iris Stromal Nodules....granulomatous)

Answer 79

1. Macrophages w/Greasy appearance; usually in Middle/Lower cornea 2. Pupillary margin; seen in both gran and non-gran uveitis 3. any part of IRIS STROMA...just not pupillary margin...GRANULOMATOUS etiology. 4. KPs 5. STELLATE KPs

Answer 80

1. B/L w/Posterior Uveitis component. Chronic, intermittent Diarrhea w/alternating episodes of constipation. Uveitis: RARE (2.4%). More common w/Ulcerative Colitis (5-10%) 2. Young Males; URETHRITIS, POLYARTHRITIS, and CONJUNCTIVITIS (w/IRITIS) 3. MALES (3:1), 30s; LOWER BACK PAIN; Symptoms improve w/Exercise 4. Asymmetric, Peripheral, Small Joint Pain, and Psoriatic Lesions on Knees, Elbows, and Scalp 5. Young adults: Asian and Middle Eastern Descent; Acute, Recurrent Hypopyon Iritis and Mouth and Genital Ulcers; Can be associated w/Retinal Vasculitis, Cataracts, and Glaucoma 6. Hx of Tick bites, Skin Rash, and/or Arthritis 7. aka Posner-Schlossman Syndrome: Mild Iritis w/RECURRENT, self limiting episodes of Elevated IOP (30-40s) secondary to Trabeculitis, fine KPs and Open angle on Gonio.

Answer 81

1. Females; AAs; Uveitis: B/L: Posterior or Panuveitis; Abnormal Chest X-Ray; Increased ACE Levels 2. + PPD; Abnormal Chest X-ray; NIGHT SWEATS; can have Posterior or Panuveitis 3. Increased IOP in involved eye. Stellate KPs, Corneal Edema, Maybe epithelial defects; Zoster: Vesicles on Affected Dermatome 4. May have Interstitial Keratitis; Maculopapular Rash (palms/Soles); +VDRL or RPR; and + FTA-ABS or MHA-TP a. Stromal Inflammation W/O Primary involvement of Epithelium or Endothelium * IK: Chracterized by Acute Stromal Inflammatory Edema and Neo; Progresses to Diffuse stromal Neo. * Late Stages of IK: Stromal vessels partially clear, leads to Ghost vessels, Corneal scarring, and Irregular Astigmatism 5. CONGENITAL SYPHILIS (90%), TB and Herpes Simplex; * Stromal Keratitis: Most common sign of Late Congenital Syphilis * ACQUIRED SYPHiliS: rarely causes keratitis; if seen, usually U/L and less severe than Congenital. 6. HUTCHINSON'S TEETH (small, widely spaced), DEAFNESS, and INTERSTITIAL KERATITIS! May also have saddle-nose deformity and Frontal Bossing (Prominent Forehead)

Answer 82

1. Most common cause for Uveitis in KIDS; B/L uveitis in young Girls; NEGATIVE RF factor, but + ANA 2. More common in BLUE EYES; U/L (90%) mild uveitis w/FINE, Stellate KPs, Angle Neo, Iris Heterochromia. Associated w/Glaucoma (15%) and Cataracts (70%). Usually ASYMPTOMATIC. 3. RIFABUTIN, SYSTEMIC SULFONAMIDES, and CIDOFOVIR. 4. Chronic, Intermediate Uveitis; Inflammation of Pars Plana (SNOWBANKING) and Peripheral retina. NOT ASSOCIATED w/SYSTEMIC CONDITIONS.

Answer 83

1. Breakdown of Blood Aq. Barrier --> WBCs w/in VITREOUS. Pts: Complain of FLOATERS and/or DECREASED VISION 2. Rash, tick bites, risk factors for AIDS, breathing problems, Recent travel to Ohio-Mississippi River Valley

Answer 84

1. a. MOST common cause in US b. PARASITIC INFECTION by Toxoplasma Gondii (Obligate intracellular Intestinal Parasite). Congenital or Acquired c. Transplacental Transmission; Most common form (90% of cases); 40% transferred if mother gets an ACUTE FORM during Pregnancy; Infected PRIOR to pregnancy, baby WILL NOT BE INFECTED. 10%: TRIAD: Convulsions, Cerebral Calcifications; Chorioretinitis. Most are mild w/insignificant chorioretinal scars d. Inhaling parasite in CAT FECES and/or eating UNDERCOOKED MEAT. e. Most common cause of infectious Retinitis: recurrence of old, stable, congenital ocular toxoplasmosis lesion; * Young Healthy Pt; recent Onset of U/L Redness, Photophobia, floaters, uveitis, vitritis, decreased vision. Recurrences: ~age 25. f. Focal, Fluffy, Yellow-white retinal lesion adjacent to an OLD INACTIVE SCAR w/overlying VITRITIS. * Lesion usually hard to see cleary d/t dense vitritis. (HEADLIGHTS in the FOG)...basically...active lesion w/WBCs floating in front of it.

Answer 85

1. Choroiditis 2. NO 3. Multifocal, "punched out" yellow-white lesions in PERIPHERY w/Peripapillary atrophy and maculopathy. Common in Ohio-Mississippi River Valley. FUNGUS

Answer 86

1. Granulomatous Panuveitis w/RETINAL VITRITIS (Cotton-Ball OPACITIES: white, fluffy opacities in INFERIOR VITREOUS); and/or RETINAL VASCULITIS: sheathing around retinal veins and yellow-white exudates d/t Periphlebitis (CANDLE-WAX DROPPINGS) 2. 2ndary syphilis can cause ACUTE MULTIFOCAL chorioretinitis w/Vitritis or Panuveitis 3. Most common Ocular Infection and leading cause of blindness in AIDS; White Patches of Necrotic retina w/Hemorrhagic retinitis and vascular sheathing. CD4 LESS THAN 50! DDx from TOXOPLASMOSIS and PORN 4. a. More intravitreal Hemorrhage and less vitritis than Toxoplasmosis b. Minimal amts of Vitritis (similar to CMB) and Hemorrhage (less than CMV)

Answer 87

1. Local defect/Notch in iris: INCOMPLETE CLOSURE of EMBRYONIC FISSURE of OPTIC VESICLE during gestation 2. usually in INFERIOR NASAL QUADRANT (where embryonic fissure is w/in optic vesicle) 3. Full thickness defect; can go from Pupillary margin to Peripheral Cornea (KEY HOLE PUPIL). or involve only pupillary margin (OVAL SHAPED PUPIL) 4. Partial thickness defect: visible as IRIS TRANSILLUMINATION DEFECT on Retroillumination 5. CB, Zonular, Choroidal, Retinal, or ON Coloboma

Answer 88

1. Malignant Tumor. D/t abnormal proliferation of melanocytes w/in iris stromal tissue. Most are though to come from Iris Nevi (2% of cases w/in 5 years) 2. Iris melanomas may be pigmented or amelanotic and are located w/in iris stromal tissue in INFERIOR QUADRANT in 80% of cases. Irregular "Feathery" margins and a diameter greater than 3 mm = classic sign.

Answer 89

1. Area of cornea that wets poorly --> stromal dehydration, corneal thinning w/POOLING of FLUORESCEIN w/in that area. (near pterygia, filtering blebs, tumors, poor fitting RGP lenses). Pts: Asymptomatic or occasional FBS. 2. WORSE in the MORNING a. Abnormal/INCOMPLETE LID CLOSURE d/t Bells Palsy, Eyelid Sx, CVA, Aneurysm, MS, HSV, HZV, TED, FES, etc. b. Redness, FBS, Burning c. Mild SPK (usually inferior 1/3 or Interpalpebral region of cornea) to Corneal Ulceration. Common DECREASED CORNEAL SENSITIVITY

Answer 90

1. a. Chronic irritation/dryness. b. Chronic inflammation of cornea. ex: KERATOCONJUNCTIVITIS SICCA (most common cause), SLK, Corneal abrasions, erosions, CL overwear, Neurotrophic Keratopathy, etc. c. Mild-Severe FBS w/Photophobia, epiphora, blurred vision and Blepharospasm d. DEGENERATED EPITHELIAL CELLS and MUCOUS that remain attached to Epithelial surface. Size: 0.5-10 mm. Short, long, or stringy. Filaments stain w/Fluorescein

Answer 91

1. a. Non-Specific inflammation of Corneal Epithelium d/t CL wear, infections, DES, Blepharitis, etc...tons and tons of reasons. Allergic response to meds, trichiasis, distichiases, FES, FBs, UV exposure, LASIK b. Pinpoint defects in corneal epithelium that stain w/Fluorescein. Asymptomatic, or have blurred vision, irritation, FBS, Photophobia, redness, tearing. 2. a. RARE; ex: 30y/o FBS B/L corneal lesions, minimal inflammation, frequent episodes b. Unkown. Viral or AI. Soft Steroid FEELS REALLY GOOD. c. FBS, Photophobia, tearing, blurred vision. Chronic, B/L, asymmetric. d. B/L, small, multiple, asymmetric Gray-white clusters of Superficial, intraepithelial, raised CENTRAL Corneal lesions (~15-20). Comes and goes w/o serious sequelae for ~10-20 years before finally resolving. a. Acute Attacks (exacerbations): 1-2 months if untreated then resolves. lightly stain w/fluorescein. recurs w/in 6-8 wks b. Remissions: inactive b/w acute attacks. Don't stain w/Fluorescein during remission

Answer 92

1. a. Past Sx procedures, CL wear, systemic Dzs, medications b. CNV1...damage to sensory nerve supply. DECREASED CORNEAL SENSITIVITY. decline in Corneal regeneration and wound healing. c. Common: HSV, HZV, Diabetes, LASIK, CL wear, RCEs, corneal dystrophies. Less common: Tumors (Acoustic neuroma), CVA, meds (Timolol, Betaxolol, Diclofenac Sodium). Surgery: Maxillary fracture repair, trigeminal neuralgia. d. Redness, tearing, decreased vision, FBS, Swollen eyelids. CORNEAL FINDINGS are WORSE than SYMPTOMS. (should feel a lot worse) e. DECREASED CORNEAL SENSITIVITY; SPK w/Perilimbal injection. Inferior OVAL ULCER (late sign)

Answer 93

1. a. Poor Hemidesmosome Attachments to BM; d/t SUPERFICIAL TRAUMA (Corneal abrasions), Corneal Dystrophies (MOST COMMONLY EBMD) and/or Age-related thickening or reduplication of BM. Risk increases for RCE if previous abrasion d/t Organic etiology (wood, fingernail, etc) b. Recurrent episodes of ACUTE PAIN...usually in MORNING AFTER WAKING UP. Lacrimation, photophobia, blurred vision. c. Corneal abrasion.

Answer 94

1. a. Prolonged sun exposure, welding, skiing, sunlamp w/o protective eye wear b. Epithelium and Bowman's layer absorb wavelengths below 300 nm; Excessive absorption --> Hyperactivation of K+ channels --> Loss of intracellular K+ --> Cell death c. Ocular pain, photophobia, blurred vision. usually worse 6-12 hours after incident. d. Confluent SPK w/in interpalpebral region of cornea that stains w/fluorescein.

Answer 95

1. More common w/Aging; Postmenopausal women. 2. a. Atropine, Scopolamine, TCAs b. Antihistamines, Chlorpromazine, Thioridazine, Isotretinoin, B-Blockers, Oral Contraceptives, Hormone Replacement Therapy, ADHD meds, Diuretics 3. TED, Collagen Vascular Dzs (RA, Sjogrens, SLE) 4. Ceiling fans, dusty places, low humidity. 5. Inferior and at 3 and 9 o'clock

Answer 96

1. a. w/o Anesthetic; Measures BASAL and Aq. Tear Secretions b. >10 mm wetting in 5 min c. 5-10 mm wetting d. 5 mm wetting in 5 minutes. 3. Assesses Aq. Tear Production by using Cotton thread w/pH sensitive Phenol red. a. >10 mm of wetting (thread turns red) after 15 seconds

Answer 97

DEAD and DEVITALIZED CONJUNCTIVAL and CORNEAL CELLS, and cells that have lost mucous covering. Fluorescein: pools w/in epithelial defects and aqueous part of tears. useful for evaluating thickness of the tear meniscus.

Answer 98

1. causes inflammatory cascade--> damages ocular surface --> releases inflammatory mediators into TEARS. Aq. tear-deficient Dry eye and Evaporative dry eye can cause this. 2. 2ndary to tear hyperosmolarity or starting event in the disease process. (reduced lipid layer in MGD).

Answer 99

1. a. Aq. Deficient w/symptoms of Dry mouth, decreased salivary secretion. 95% w/this Dry eye are FEMALE. b. Primary Sjogren's w/AI CT Dz (RA, SLE, Polyarteritis Nodosa, Wegener's). ~50% of Dry Eye Syndrome * Sjogrens: 2nd more common AI Rheumatologic Dz (RA is the first) 2. DRY Eyes, Dry Mouth, and AI Dz (usually RA)

Answer 100

1. Lacrimal Gland Dysfunction 2. AGE-RELATED DRY EYE SYNDROME: Most common type. Increased age --> Stenosis, Acinar Cell Atrophy, Ductal Fibrosis. (~5-30% of peeps over 50 years of age) 3. Inflammatory infiltration of lacrimal gland (sarcoidosis, lymphoma, AIDS, Graft vs. host Dz) * Obstruction of Lacrimal Gland Ducts (Trachoma, Pemphigoid, Erythema multiforme, chemical and thermal burns) * Reflex Hyposecretion (CL wear, diabetes, CN7 damage, systemic drugs, Neurotrophic keratitis, infection, corneal surgery (LASIK, PRK, RK) * ~50% of CL wearers have Dry Eye Symptoms

Answer 101

1. Excessive Water loss in presence of normal lacrimal secretory function. Intrinsic and Extrinsic types.

Answer 102

1. Most common CAUSE; MG obstruction --> too much evaporation. 2. a. Posterior Bleph: general term. refers to Inflammatory condition of eyelid. Can be cause by many things. b. MGD: late stages --> Inflammatory signs (redness) are present, MGD-related Posterior Bleph is the right diagnosis 3. Proptosis (TED, Creaniostenosis), Nocturnal Lagophthalmos 4. Intense Concentration, Parkinson's.

Answer 103

1. VIT A DEFICIENCY (Xerophthalmia), Topical Anesthetics, Topical Preservatives 2. Can decrease number and length of meibomian glands. CL w/a lower overall water content are usually more comfortable for Pts w/DES. 3. Goblet cell and Glycocalyx development. Lack of it --> Aq. Tear deficient DES d/t lacrimal gland ACINAR DAMAGE. Associated w/BITOT's SPOTS on the CONJUNCTIVA.

Answer 104

1. 53% of patients reported a history of ATOPY 2. Non-inflammatory, progressive, degenerative Dz. Cause: unknown. Starts by damaging Bowman's membrane. a. d/t loss of Adhesion b/w Fibrils b. Ezymatic (MMPs) degradation 3. Eye rubbing, Atopy, CL wear, Ocular and systemic conditions a. VKC, AKC, FES, Fuch's, Other Dystrophies, RP, Leber's, ROP, Cone, Granular, Lattice Dystrophies. Aniridia b. Turner syndrome, Downs syndrome, Osteogenesis imperfecta, Marfan's syndrome, Ehler-danlos syndrome; also, ATOPIC DERMATITIS and MITRAL VALVE PROLAPSE are additional associated conditions

Answer 105

1. Progressive decreased vision, photophobia, glare, monocular diplopia, ghost images. Acute vision loss and pain from Hydrops 2. Inferior, central, or paracentral stromal thinning. B/L. Asymmetric. Progressive. Irregular Astigmatism. Poor glasses and SCL correction. a. FLEISCHER's RING (iron deposits at base of cone best seen w/Cobalt Blue filter...looks dark), Scissors reflex on ret, Irregular mires on Keratometry, inferior steepening on Topography b. VOGT's STRIAE (vertical lines in DEEP STROMA), MUNSON's SIGN (lower lid protrusion on downgaze), RIZZUTI'S SIGN (conical reflection on nasal cornea), HYDROPS (tears in descemet's that causes in edema and rupture of epithelium). 53% of pts w/Mod to severe keratoconus develop corneal scarring in one or both eyes. 3. a. Less than 48D b. 48-54D c. More than 54D

Answer 106

1. Early Adulthood. 2. Thinnest area of cornea is a CRESCENT SHAPE distribution INFERIORLY; Corneal protrusion occurs right above this area and not w/in the area of thinning as w/Keratoconus. 3. No pain; B/L, inf corneal thinning (4-8 o'clock) 1-2 mm from limbus that leads to high amts of ATR Astigmatism. Corneal Topography: KISSING DOVES or CRAB-CLAWS pattern of inferior thinning. 4. No cone, no fleisher ring, no Vogt striae. Can get sudden vision loss from Hydrops though. (Less common tho). Corneal scarring also less common than in KCN.

Answer 107

1. Rare; Onset: BIRTH; Congenital inheritance (AR) MOST COMMON; can be acquired from advanced keratopathy, trauma, or exophthalmos 2. Associated w/Ehlers Danlos Syndrome, Blue sclera, and Leber's Congenital Amaurosis 3. Diffuse corneal thinning mostly in PERIPHERY causing a GLOBULAR SHAPE. can cause Acute corneal edema d/t rupture of Descemet's, Corneal perforation can happen w/minor incidents of TRAUMA.

Answer 108

1. a. Most common type. AD; Females > Males b. Abnormal epithelial adhesion and EXCESSIVE BM production --> trapped corneal epithelial cells under BM c. Asymptomatic; Usually not progressive; Vision loss, pain, photophobia can happen d/t central corneal changes or RCEs. d. NEGATIVE STAINING of Map-lines, dots, and/ot fingerprints of corneal epithelium. (best seen w/Retroillumination) 2. 10% 3. 50%

Answer 109

1. a. Rare, AD. usually seen w/in 1st year of life b. Asymptomatic; Symptoms can come from ruptured cysts or RCEs (usually not before middle age) c. Extensive (100s), B/L, clear intraepithelial cysts diffusely spread across entire cornea (mostly in Interpalpebral Region)

Answer 110

1. a. Rare, AD. Dx'd early in life d/t OCULAR PAIN b. ABNORMAL development and replacement of BOWMANS LAYER w/COLLAGEN c. Painful d/t RCEs esp in early life; fewer as you age. d. B/L, Symmetric, Sub-epithelial gray reticular opacities mostly concentrated in Central cornea, and that spare the peripheral cornea; opacities get worse with age.

Answer 111

1. a. Rare. AR. Least COMMON, MOST SEVERE. b. Progressive vision loss. Irritation and Photophobia d/t RCEs; Severe vision loss by 20-30. c. Diffuse, superficial, central stromal haze b/w 3 and 9 years of age. Progression causes stromal opacification (cloudy cornea), Stromal thinning, multiple gray-white opacities (MUCOPOLYSACCHARIDE DEPOSITS) w/irregular borders that are seen in all layers of the cornea and extend to the limbus.

Answer 112

1. a. AD. Onset: 1st decade. Loss of vision in middle age b. Small snowflake granules (HYALINE DEPOSITS) in Central stroma. Deposits spread to epithelium and deep stroma. Become confluent. causes decreased VA. RCEs are RARE! 2. Rare variant of Granular dystrophy. Has Granular and LATTICE-LIKE DEPOSITS w/in Central stroma. AKA Granular-Lattice Dystrophy

Answer 113

1. a. AD b. Ant stromal haze w/branching, refractile, lattice-like lines (AMYLOID DEPOSITS). Decreased acuity in 3rd decade d/t major corneal scarring and haze. RCEs are COMMON! 2. Transforming Growth Factor Beta 1 (TGFB1) gene (aka BIGH3) gene mutation causes granular, lattice, and avellino dystrophies. DOES NOT CAUSE MACULAR STROMAL DYSTROPHY though.

Answer 114

1. a. VERY RARE AD. Ask about current/past HIGH CHOLESTEROL b. Strong association w/Hyperlipidemia, Xanthelasma, Corneal Arcus. Non-Progressive. c. Fine Yellow-white ring of stromal crystals w/haze in central stroma. Usually Asymptomatic.

Answer 115

1. Macular-Mucopolysachharide. Granular- Hyaline Lattice-Amyloid

Answer 116

1. DECREASED VISION, and PAINFUL RCEs

Answer 117

1. a. AD. Females. Over 60. 30% have + FHx b. Descemets: Anterior Lamina (made in embryo) and Posterior Lamina (secreted thru life). Posterior Lamina produced in excess...clumps up. Decreased Endothelial Cell Density c. Asymptomatic until later on. Blurred hazy vision that's worse in morning w/pain and glare. (sign for surgery talk). Muro128 buys time. d. seen early in life (30-40). DECREASED ENDOTHELIAL CELL DENSITY w/Pleomorphism and Polymegathism, Endothelial Guttata w/BEATEN METAL appearance w/Thick Pachymetry findings. Stromal Edema usually happens when cell count is 500 cells/mm2 or less. Can spill over into Epithelium --> PAINFUL BULLAE and Scarring. *Cataract surgery can increase Endothelial cell loss, esp if it's less than 1000 cell/mm2.

Answer 118

1. 3k-4k cells/mm2 2. 1k-2k cells/mm2 3. 400-700 cells/mm2

Answer 119

1. a. AD; 2nd-3rd decade. Can be seen at birth but rare...cloudy cornea. b. Slow progressive/Non-progressive and most are asymptomatic. Usually Dx's b/w 30-50. Decreased vision secondary to corneal edema = most common symptoms c. B/L, Asymmetric. At Descemet's and Endothelium. Patches of VESICLES (hallmark); Band Lesions (linear TRAIN TRACK LESIONS) and diffuse opacities. Rare: Severe cases: Corneal edema and Bullae --> Painful vision loss. 2. Metaplasia of endothelial cells and gives an epithelial like endothelium. Can spread over IRIS and Angle, causing angle-closure glaucoma from PAS.

Answer 120

1. a. Rare, X-linked. Mostly Males b. B/L Corneal Horiz. Diameter of 13 mm or MORE. Highly Myopic w/Steep Cornea. Usually have good acuity w/Correction. c. Ocular tissue stretching --> Lens subluxation, angle abnormalities --> Glaucoma d. Marfan's Syndrome, Ehlers-Danlos Syndrome, Osteogenesis Imperfecta, etc. 2. a. Very rare AD or AR. U/L or B/L b. H diameter of LESS than 10 mm c. HYPEROPIC; Risk for Angle closure d/t shallow AC.

Answer 121

1. a. Rare; AD or AR b. Corneal Curvature equal to Scleral curvature is pathognomonic for this. Associated w/Sclerocornea and Microcornea c. B/L Scleralization (opacification and Vascularization) of Peripheral and/or central cornea. 80% association w/Cornea Plana. d. B/L Flat Corneas (LESS than 38D or as low as 20-30D). Hyperopia, Shallow ACs, Increased risk for Angle-closure glaucoma

Answer 122

1. a. Rare, B/L. AD. Partial to total loss of iris tissue. b. Corneal lesions (opacity, microcornea, pannus), Lenticular changes (cataract, lens subluxation), Posterior segment abnormalities (Glaucoma in ~75% of cases, Foveal hypoplasia, disc hypoplasia, choroidal colobomas) 2. a. CONGENITAL GLAUCOMA. Horizontal Cracks (clear parallel lines) in Descemet's form increased IOP.

Answer 123

1. Several disorders. They have Anterior Segment developmental abnormalities that affect AC angle. ~50% w/this get Glaucoma 2. Anteriorly displaced Schwalbe's line. ~15% healthy eyes have PE. No increased risk of Glaucoma 3. PE + Angle abnormalities + Increased Glaucoma risk. (Prominent iris processes that travel to level of PE, usually obscuring SS) 4. PE + angle abnormalities + Increased Glaucoma Risk + Iris Stromal Abnormalities * Iris Stromal issues: Displaced Pupil (Corectopia) and Iris Hypoplasia causing holes w/in Iris Tissues (Polycoria) 5. PE + Angle abnormalities + Increased Glaucoma Risk + Iris Stromal Abnormalities + Systemic Abnormalities * Systemic: Mental retardation, Dental, Craniofacial, Genitourinary, and Skeletal abnormalities.

Answer 124

1. Rare; Born w/CENTRAL WHITE OPACITIES (leukoma) w/Iris Adhesions. 80% are B/L. 2. 50-70%; Corneal edema and Cataracts.

Answer 125

1. Normal dense CT w/hair follicles and sebaceous glands that's displaced to an abnormal location. 2. Inferotemporal Limbus

Answer 126

CL Wear, Dry Eye, Exposure Keratopathy, Neurotrophic Keratopathy, Trauma, Lid abnormalities, and Bullous Keratopathy

Answer 127

1. Most common for INFECTIOUS KERATITIS; CL wear (EW) is most common predisposing factor. a. PSEUDOMONAS AERUGINOSA; Staph (epidermis and aureus), H. Influenzae, Moraxella Catarrhalis 2. Most bacteria need an epithelial defect for invasion and corneal ulceration. 3. SEVERE PAIN, Red eye, Photophobia, Decreased Vision 4. CORNEAL ULCER = corneal infiltrates w/overlying epithelial defect (Have to have both to have an ulcer...)??

Answer 128

1. a. of GRAM (-) pathogen in severe bacterial keratitis. b. TONS of THICK Mucopurulent Discharge (usually green), Hypopyon, Dense stromal infiltrate, and Rapid Progression c. w/in 48 hrs.

Answer 129

1. Corneyobacterium diphtheriae Neisseria Gonorrhea and meningitidis Haemophilus and Listeria

Answer 130

1. FLUORESCEIN STAINING: 1:1 Ratio if corneal ulcer. Corneal infiltrates: staining area is less than the lesion size. 2. CORNEAL ULCERS: MODERATE to SEVERE PAIN w/Mild AC RxN, and DIFFUSE Conj injection. Infiltrates: Less painful w/multiple lesions, no AC RxN, Sectoral Injection

Answer 131

1. Most common type after Traumatic Corneal injury, esp from VEGETABLE MATTER 2. CANDIDA INFECTIONS in eyes w/Chronic Corneal Dz (Chronic Dry Eye, Herpes Keratitis, Exposure Keratopathy), IMMUNOCOMPROMISED or severely debilitated pts. a. Aspergillus and Fusarium Species more common culprits after VEGETABLE MATTER TRAUMA. b. SABOURAUD's AGAR 3. CANDIDA 4. Pain, Photophobia, Tearing, decreased vision 5. Epithelial defect w/gray-white corneal infiltrate with FEATHERY EDGES and may Surrounding SATELLITE INFILTRATES (classic for Aspergillus and Fusarium). Presentation similar to Bacterial corneal ulcer (Classic for CANDIDA). Maybe AC RxN and Hypopyon.

Answer 132

1. Rare. Parasitic; Poor CL hygiene. 2. Most common Protozoa in soil. Found in water and oral cavity in humans. Corneal Epithelium compromised --> It invades Corneal Epithelial and Stromal TIssues. Slow infection progress. Usually misdiagnosed in early Tx. a. Non-nutrient Agar w/Heat-Killed E. COLI 3 Blurred vision, pain, minimal discharge 4. a. Punctate/pseudodendritic epithelial defects (can confuse w/HSK) associated with SEVERE PAIN out of PROPORTION TO THE SIGNS b. Radial Keratoneuritis (corneal nerve inflammation), Patchy Anterior Stromal Infiltrates that progress to a RING ULCER

Answer 133

1. Bacteria 2. Fungi/Yeasts 3. Fungi 4. Haemophilus and Nisseria 5. Aerobic and Anaerobic Bacteria 6. Acanthamoeba

Answer 134

1. DNA Virus; young patients; Hx of past episodes and Cold sores a. Children (6 mos to 5 years). Usually asymptomatic b. Reactivation in TRIGEMINAL GANGLION. Trigger: Physical or emotional stress, sun exposure, fever, etc. 3. Tissue Damage: direct invasion from virus, neurotrophic mechanisms, or by immune system response to HSV 4. DECREASED CORNEAL SENSITIVITY 5. a. Blepharitis and/or Conjunctiviits b. Focal vesicular lesions w/crusting on eyelids and periorbital area c. Acute U/L Follicular Conjunctivitis w/Watery Discharge and Preauricular Lymphadenopathy

Answer 135

1. a. Small epithelial lesions referred to as PUNCTATE EPITHELIAL KERATOPATHY. Represents earliest epithelial signs of reactivated HSV. b. Most common HSV Keratitis. Edges stain well with ROSE BENGAL; Center ulceration stains WELL with FLUORESCEIN c. Like dendritic ulcer but WIDER (not longer linearly); usually d/t previous use of TOPICAL STEROIDS d. Close to limbus; looks like Stromal infiltrate w/overlying epithelial defect and associated limbal injection

Answer 136

1. a. REDUCED CORNEAL INNERVATION, decreased tear secretion, poor wound healing. b. Infectious epithelial keratitis; not immune-mediated or infectious c. OVAL defect with smooth borders. Usually preceded by Punctate epithelial erosions that then form an ulcer. d. Inferior.

Answer 137

1. 2% 2. 20-48% 3. Infiltrate with DIFFUSE NEO, immune ring (WESSLEY RING), Stromal thinning, and subsequent scarring * IK: Stromal inflammation W/O Primary involvement of epithelium or endothelium. a. Antigen-Antibody complement cascade against a live virus or viral antigen w/in Corneal stroma. 4. of CONGENITAL SYPHILIS (90%). 5. RARE; Direct Invasion into STROMA. SEVERE STROMAL INFLAMMATION w/NECROSIS --> Corneal Thinning and Perforation 6. Can cause major Stromal Scarring and Decreased Acuity

Answer 138

1. a. 2ndary stromal edema d/t Immune RxN to a VIRAL ANTIGEN or live virus w/in Corneal Endothelium 2. a. form of endotheliitis. b. Focal, Disc-Shaped, Stromal Edema overlying keratic precipitates. Mild to moderate IRITIS 3. Stromal Infiltrates and NEO.

Answer 139

1. 95% of kids by age 5 in US. Chickenpox. 2. Transported to Trigeminal Ganglia and other neural cell bodies. Dormant. OLDER AGE, trauma, Neurodegeneration, or IMMUNOSUPPRESSION --> reactivation of virus --> HZV infection. 3. Old peeps. Seen in younger than 50, think immunocompromised or pregnant women. 4. Varies. More severe in immunocompromised Pts. U/L INFECTION a. PRODROME (tingling, malaise, fever) b. Skin involvement that respects Dermatomes and DOES NOT CROSS MIDLINE. Vesicles form on LID MARGIN --> BLEPHAROCONJUNCTIVITIS; Episcleritis is common.

Answer 140

1. 65% w/active HZO 2. Punctate Epithelial Keratitis, Pseudodendritic Keratitis, Anterior Stromal Keratitis, Keratouveitis/Endotheliitis, Neurotrophic Keratopathy 3. Exposure Keratopathy, Disciform Keratitis, IK

Answer 141

1. Small, stellate lesions --> PSEUDODENDRITES (tapered ends, NO TERMINAL BULBS) w/"Stuck on" Appearance. Entire lesion stains with ROSE BENGAL. Don't stain well with Fluorescein. 2. 40% w/Acute HZO a. Gran or Non-Gran. Significant KPs, Corneal Edema, PS. 3. Trichiasis, Ectropion, Entropion, Madarosis, Poliosis, Episcleritis, Scleritis, Retinitis, Vasculitis, Optic Neuritis, CN Palsies, Glaucoma, Cataracts

Answer 142

1. a. Pain that lasts for more thant 1 month after rash onset or rash resolution. Most common complication of HZV and hits 10-30% of Pts. b. 7% of Pts. Leading cause of suicide in Pts over 70 years of age with CHRONIC PAIN

Answer 143

1. a. RARE; MEN and Older Pts (40-70; can occur at all ages tho). b. 75%; U/L; Old. Mild-Mod symptoms; Responds well to Tx. c. B/L; Younger pts (esp Black males); SEvere symptoms, Responds POORLY to Tx; Relentless.

Answer 144

1. Painful, Progressive, Chronic vasculitis of Limbal BVs --> Ischemic Necrosis and PUK! a. Mooren's Ulcer: Idiopathic in nature. Occurs INDEPENDENT of any diagnosable Systemic Disorder that could be responsible for the Progressive Corneal Pathology. b. Associated w/Systemic Hep C or Hookworm 2. PAIN (SEVERE usually), Redness, tearing, photophobia. Decreased vision d/t Irregular astigmatism or Iritis, or if ulcer is central. 3. U/L PERIPHERAL CRESCENT SHAPED GRAY INFILTRATE --> progresses to ulcer. Ulcer is concentric to limbus.

Answer 145

1. Common. Hx of similar recurrent acute episodes 2. TYPE 3 HYPERSENSITIVITY to Staph Aureus. See it in Pts w/Chronic Staph Blepharitis. 3. Asymptomatic; or Acute Photophobia, pain, tearing, redness, decreased vision 4. Corneal Stromal Infiltrates (multiple and B/L) in PERIPHERY; Usually at 2,4,8,10 o'clock. Probably Chronic if: Residual thinning, Superficial Neo, and Peripheral scarring

Answer 146

1. that the Pt's immune system is attacking the infection via ANTIBODIES (esp in Staphylococcal Marginal Keratitis...sign of attacking the Staph). In isolation, immune-mediated response is NOT a sign of infection

Answer 147

1. RA, SLE, Polyarteritis Nodosa, Wegener's Granulomatosis. 2. Asymptomatic, or lots of pain, redness and decreased vision 3. Peripheral corneal thinning/ulcers w/or w/o inflammation. U/L or B/L. Ulcers can progress to encompass entire peripheral cornea. Findings: Associated w/Scleritis, Episcleritis, and KERATOCONJUNCTIVITIS SICCA.

Answer 148

1. Seen in FABRY's Dz, and use of Chloroquine, Hydroxychloroquine, Amiodarone, Indomethacin, and Tamoxifen 2. Iron Ring at base of cone in KCN 3. From metallic FBs. 4. Elderly; Iron deposits b/w middle and lower third of cornea; No symptoms and no clinical significance. 5. Iron Deposits on leading edge of Pterygium 6. Iron Deposits on leading edge of Filtering Bleb 7. Copper accumulation in pts w/Liver issues, esp WILSONS DISEASE 8. CALCIUM deposits w/in Bowman's Layer (swiss-cheese pattern...white spots)

Answer 149

1. Rare. Men (3:1); 20-40 y/o 2. Idiopathic; Inflammatory; Degenerative; Slow, progressive PERIPHERAL STROMAL THINNING. Perforates in 15% of cases 3. Asymptomatic; Progression can cause ATR and decreased acuity. 4. SUPERONASAL, B/L, asymmetric, slow, progressive peripheral thinning w/Vascularized Pannus. Usually no AC RxN, No Conj Injection, no overlying epithelial defects. 5. Mooren's ulcer, but has an OVERLYING DEFECT (mooren's)

Answer 150

1. Rare; Females; by 6th decade 2. Degenerative; after episodes of keratitis; SIGNIFICANT CORNEAL INFLAMMATORY DZ, w/MGD, Trachoma, Phlyctenulosis, VKC, KJS, IK, Idiopathic. 3. Asymptomatic; Pain if RCEs start over the nodule. 4. HYALINE PLAQUE DEPOSITS b/w Epithelium and Bowman's Membrane, usually mid-peripheral, elevated BLUE-GRAY or Yellow-white nodular lesions. U/L or B/L; Single or multiple nodules. Nodules usually adjacent or w/in OLD CORNEAL SCAR or CORNEAL PANNUS

Answer 151

1. Age; over 80, ~100% pts affected | 2. B/L Chalk-like linear opacities of Nasal Limbus (usually 3 and 9 o'clock). Pts are asymptomatic.

Answer 152

1. a. ones that cause Chronic Inflammation and Ocular Surface Dz (uveitis, DES, Exposure Keratopathy) b. Increased Serum Calcium or Phosphorous levels, (GOUT (uric acid levels), HYPERCALCEMIA, Sarcoidosis, Renal Failure (BUN and Creatinine) c. TRAUMA (like tons of eye sx's) 2. Asymptomatic cuz Calcium Plaques are peripheral at 3 and 9 o'clock. Plaques could move centrally causing an FBS and decreased vision 3. Calcium deposits on Ant Surface of Bowman's membrane or Sub-epithelial space...look like White Spots w/"Swiss Cheese Pattern" usually w/in interpalpebral region of cornea

Answer 153

1. Most common Peripheral corneal opacity. Old peeps. 100% over age 80. Males and AAs 2. AGING and HIGH CHOLESTEROL. Lipid deposition on Descemet's and subsequently deposited on Bowman's Layer before extending into the stroma. 3. B/L, Symmetric; Circumferential 1mm band w/in Peripheral cornea w/clear zone of separation to the limbus 4. RARE. Associated with CAROTID Dz on the SIDE W/O the ARCUS! In Pts younger than 50, they have an increased risk of CAD. LIPID PROFILE is WARRANTED.

Answer 154

1. B/L, Gray-White, Polygonal Stromal Opacities (Cracked ice appearance) near Bowman's (ANT crocodile Shagreen) or near Descemet's (Posterior Crocodile Shagreen). D/T irregular arranged folds of collagen. 2. Asymptomatic and Benign.

Answer 155

1. B/L "Flour Dust" deposits usually in CENTRAL DEEP STROMA. Could be d/t aging or AD condition. Usually Asymptomatic.

Answer 156

1. Type 4 HYPERSENSITIVITY to donor cornea. 30% of pts have rejection w/in 1 year. Decreased vision, mild pain, redness, photophobia 2. Rare; Looks like elevated, irregular epithelium 3. SEIs (KRACHMER's SPOTS) 4. WBCs on Endothelium...form KHODADOUST LINE.

Answer 157

1. a. Younger than 18 w/unstable RE w/in last year b. Unrealistic Expectations: reduce dependence on glasses (but NOT glasses free). Post-op glare and dryness. c. KCN, Active HSK, CL Warpage d. CT Dz (Keloid formers), Collagen Vascular Dz, Immunocompromised Dz (Chronic Steroid Use) 2. a. Bleph, DES, Chronic eye rubbing, Ocular surface Dz, Large Pupils b. DM c. POAG d. Pregnancy e. Retinal Thinning/Lattice Degeneration can increase risk of Retinal tears. 3. 3-14 days prior 4. 14-21 days prior

Answer 158

1. Radial Incisions w/Diamond Knife. Flatten Peripheral Corneal Stroma. 2. Better options out there. Hard to Titrate. Leads to PROGRESSIVE HYPEROPIC SHIFTS

Answer 159

1. Epi, Bowman's, and Superficial stromal tissue are removed...No Flap...Excimer laser applied directly to CENTRAL CORNEA (Myopia) or Mid-peripheral Cornea (HYPEROPES) 2. -8D to +4D; up to 4D cyl 3. 400 um 4. 1-2 wks. Very poor vision and pain right after. (NSAIDs and BCL help control this) 5. use Mitomycin C during the procedure.

Answer 160

1. Epithelial Flap made w/Microkeratome; Excimer Laser is applied to ANTERIOR STROMAL BED...and the flap is then reattached. 2. -10D to +4D; up to 5D cyl. Can do CLEAR LENS EXTRACTION if Pts exceed these. 3. 250 um under flap; Flap has to be 160-200 um thick. Ablation Depth is 15 um/Diopter 4. 1-2 days, less pain, less post-op haze. 5. 250 um: Total Pach minus flap thickness (160-200 um) minus ablation depth (15 um/diopter) = at least 250 um. 6. Same as LASIK but flat is made with this laser instead. Flap is thinner...so more tissue can be ablated. Removes risk of mechanical malfunction of the microkeratome. Less Post-op dry eye. 7. Same as LASIK but flap is made w/DILUTE ALCOHOL instead of a microkeratome 8. Blunt plastic blade creates the flap.

Answer 161

1. Tx of Presbyopia, Low Hyperopia, Residual Astigmatism after other surgeries. 2. Radio Frequency energy...shrinks collagen fibers in Peripheral Corneal Stroma...lets central cornea steepen. 3. ~2-3 years. 4. Yes 5. +0.75D to +3.00 D w/less than 0.75D of astigmatism

Answer 162

1. PMMA rings-->Insert into Stroma. Flattens the cornea; rings can be removed or exchanged. 2. KERATOCONUS 3. -0.75D to -3 D; No HYPEROPES.

Answer 163

1. Cataract Sz w/o a Cataract. IOL is selected that reduced RE. 2. Large.

Answer 164

1. IOL in a PHAKIC EYE. 2. Peripheral Iridotomy 3. A Larger range or REs compared to Corneal Sx and the IOL is removable.

Answer 165

1. Corneal incisions w/Diamond blades to relax the cornea in the steepest meridian.

Answer 166

1. Reduces Higher order Aberrations (coma, spherical, etc) as well as correcting RE (Lower order aberrations ~90% of all aberrations) 2. LASIK and PRK

Answer 167

1. d/t Corneal wound. Severe pain = dislocation of flap. 2. usually in first 1-3 days. (Gram + or Mycobacteria) 3. Free Caps, button holes, flap folds, irregular flaps, etc.

Answer 168

1. hole in flap. more common w/VERY STEEP corneas and deep set eyes 2. No hinge made. Common w/FLAT CORNEAS and d/t not enough cornea in the ring. 3. 1/2 w/in first hour; 95% w/in first week. Flap Folds are MACROSTRIAE if they're Full-thickness. MICROSTRIAE: Fine, irregular, multi-directional folds in Bowman's. usually resolve on their own. 4. more often seen w/Keratome flaps than w/Femtosecond laser flaps. d/t accidental touch to eye or eyelid.

Answer 169

1. Anterior protrusion d/t thinning. High myopes, KCN, or Forme Fruste are at high risk. 2. Pt may be over or under-corrected or have regression after Sx (usually RE >-8D) * Can fit PTs w/RGPs or reverse geometry lenses after ~8-12 wks. 3. Large pupils, monovision correction, Higher REs, and Small ablation zones. 4. Most common SE from LASIK; Severed Corneal Nerves 5. Rare; Inflammatory, Non-infectious RxN at Lamellar Interface (b/w Corneal flap and Stroma). Fine Granular sand-like infiltrate usually w/in 2-3 days after Sx. 6. Rare; Usually after 1 month. Faint gray line, or white milky deposits w/in 2mm of flap edge. Usually Asymptomatic. Most common issue w/LASIK enhancement. 7. Long-term Haze: 0.1% w/LASIK and PRK: 1% w/REs less than 6D.

Answer 170

1. 3 mos 2. 6 mos 3. >0.75D w/Symptoms 4. >or equal to 0.75D 5. 20/30 or worse

Answer 171

1. Falsely low. d/t thin corneas 2. w/Hx of High Hyper/Myopia repectively.... 3. Eye protections in contact sports.

Answer 172

1. Most common; myopic shift (ATR) 2. Radial spoke-like opacities...Hyperopic Shift 3. Directly underneath Ant Lens Capsule 4. Directly in front of PL Capsule. messes with NEAR VISION > Distance. d/t SYSTEMIC or TOPICAL STEROIDS and X-RAYs a. Significant reduction in acuity. associated w/Worse glare compared to other cataracts 5. Associated: Galactosemia and Rubella. Most common type: Lammellar (zonular) cataract: Lens opacity around the Embryonic Nucleus 6. Congenital; Rarely affects VA. Tiny dot-like or flake-like white or bluish-green opacities

Answer 173

1. Assoc: DM, Myotonic Dystrophy (PSC Christmas Tree cataracts), Wilson's, Hypocalcemia, Atopic Dermatitis 2. Rossette catracts. looks for a Vossius ring 3. Ant Subcapsular effects: Chlorpromazine (Stellate Cataracts), Amiodarone (deposits), Miotics Vacuoles), Gold Salts (Gold Deposits) Post Subcapsular: Corticosteroids 4. Chronic Ant Uveitis (most common), High Myopia, RP, Gyrate Atrophy 5. Residual remnants of tunica vasculosa lentis and looks like small, star-shaped, pigmented deposits on ant capsule of the lens.

Answer 174

1. determines impact on acuity d/t lens changed. predicts VA post-op 2. tests glare disability 3. A-Scan. Helps determine IOL Power needed 4. Used to look for Post seg abnormalities w/a person w/a Dense Cataract 5. 24 mm; 1 mm error in length = 3 D error in calculated IOL power.

Answer 175

1. Age of pt...determine if it would affect Accommodative status for pt. 2. Severity of Cataract vs. risk/benefit ratio to the pt. 3. Meds: ANTICOAGULANT (Coumadin), ALPHA BLOCKERS (Flomax), PROSTAGLANDINS 4. Hx of Acute/Chronic Uveitis, Severe Bleph, Fuch's, Pseudoexfoliation 5. Alpha Blocker; FLOPPY IRIS SYNDROME

Answer 176

1. Lens and capsule removed; Lg incision; Aphakia; Need CATARACT GLASSES; Higher risk of RD. Needs a Peripheral Iridotomy to prevent Vit Prolapse and Pupillary Block 2. Lens removed; Still large incision; IOL inserted; 3. Type of ECCE; Fragment lens w/Ultrasound then remove; Smaller incision. 4. Newer Tx; Use: Corneal incisions, Anterior Capsulorhexis, and Lens fragmentation

Answer 177

1. Corneal edema. Descemet folds; resolved w/in a few days; 2. Rare; 1/1000; 50% become blind; Symptoms: w/in 2-4 days; 70% Gram (+): Staph Epidermidis (most common), staph aureus; 3. Symptoms: 1 wk to 1 month after; FUNGAL Post-op is usually a delayed complication. 4. STERILE INFLAMMATORY REACTION --> Toxic Damage to Ant Seg Structures. Cause: Chemical Exposure during surgery. Usually 12-48 hrs after. NO VITRITIS, INCREASED IOP. 5. Rare. PXF/Marfans: D/t Pupillary capture and Poor capsular support. Trauma: Most common cause. 6. Most common Complication after CATARACT Sx. ELSCHNIG PEARLS is a type of PCO is most common in children w/Cataract Extraction. 7. MOST COMMON REASON for decreased acuity after Cataract Sx. IRVINE-GASS SYNDROME (buzz word for Post-Cataract Sx w/CME). Peak Incidence: 6-10 WEEKS. Usually resolves w/Tx in 6 mos. 8. RD, Wound Leak, Suprachoroidal Heme, Increased IOP, Corneal Edema, Diplopia, Ptosis, UGH (Uveitis, Glaucoma, Hyphema Syndrome), Induced Corneal Astigmatism, and Iritis.

Answer 178

1. DR 2. RVOs 3. Uveitis 4. RP 5. ARMD 6. ERM 7. Retinal Vasculitis (Sarcoidosis, Behcet's) 8. Coat's Dz

Answer 179

1. a. Noncontact exam of Optic Disc, Macula, Posterior Pole, Central Vitreous b. Stereoscopic, Erect, Magnified image 2. a. Retina exam: Optic disc to Ora Serrata. Peripheral concerns, Hx of blunt trauma, risk or with symptoms of Retinal Break/Detachment b. Stereoscopic, reversed, magnified image, 180 degrees from mirror position c. 73 degrees from corneal plane; EQUATOR d. 67 degrees; ANTERIOR Equator and Ora Serrata e. 59 degrees; AC angle and Ora serrata 3. a. Routine Post Seg eval. Easier than Hruby lens and 3 mirror. FOV directly proportional to Pupil diameter and Dioptric power of the lens. b. Real, inverted, reversed magnified image. 4. a. indications: look at 3 mirror. b. real image; Magnifiied, reversed and inverted.

Answer 180

1. a. age b. Asymptomatic c. tons of small, yellow-white, refractile particles (Calcium-Phosphate Soaps) attached to collagen fibrils in normal vitreous. U/L in 3/4 of cases. 2. a. Rare; happens after: Chronic Uveitis, Vit Heme, trauma b. U/L, Golden Brown, Refractile CHOLESTEROL CRYSTALS. usually settle inferiorly

Answer 181

1. a. Females > Males; older = more likely. Earlier in Myopes; Risk Factors: DM, Sx, Inflammation, Vit Heme, Trauma b. Liberated collagen contracts --> Posterior Hyaloid to detach from retina. Pockets of Liquefaction c. Acute floaters, photopsia, decreased vision. d. WEISS RING; Possible Vit Heme/Tobacco dust/Shafer's sign. e. Epiretinal Membrane, Macular Holes, Vit and Retinal Hemes, Retinal Breaks.

Answer 182

1. a. Trauma, Ocular and Systemic Dzs (DM and HTN are big ones) b. d/t Trauma or from other things that cause NEO. c. DR, RVO, Sickle cell retinopathy, ROP, OIS. NEO is PRERETINAL in ALL OF THESE. d. Pre-Ret Heme: Asymptomatic unless macula is involved. Vit Heme: Sudden, Painless Vision Loss and/or Black Spots e. PRERETINAL HEME; VIT HEME; B-Scan is INDICATED if fundus can't be seen thru the Vit Heme.

Answer 183

1. a. CRVOs: 3rd most common vascular cause of VISION LOSS (DR is most common). b. HTN (big one), DM, Cardiovascular Dz, Open-Angle Glaucoma c. Glaucoma d. BIRTH CONTROL, Deficiencies in protein S/C/Antithrombin 3, Factor 12, Collagen vascular Dz, AIDS e. CRVOs: Compression of artery on a vein --> turbulent BF, venous vessel wall damage --> THROMBUS FORMATION usually at or near Lamina Cribosa. f. Sudden, U/L, Painless vision loss (90% > 50 y/o pts) g. Thrombus --> Ischemia --> release of VEGF --> ret hemes, collaterals, dilated tortuous veins, CWS, Optic Disc Edema h. on disc. seen wks-mos after CRVO. Help increase drainage of excessive fluid. i. NEO GLAUCOMA j. MACULAR EDEMA k. 10 DD or more of non-perfusion on FA. 90% have VA of 20/200 or worse. Poor Px.

Answer 184

1. MOST COMMON RVOs. 2. HTN, Cardiovascular Dz, Increased BMI at 20 yrs, OAG. 3. d/t THROMBUS after artery compression on a vein at AV crossing. MAIN LOCATION: SUP/TEMP QUADRANT! 4. VASCULITIS 5. Sudden, U/L, Painless VF Loss. Blurred vision OR no symptoms 6. Dilated tortuous retinal veins, CWS, Collateral Vessels, and Intraretinal Hemes 7. MACULAR Dz (ischemic, edema, intramacular hemes) and NEO (--> Preretinal and Vit Hemes)

Answer 185

1. Transient Vision loss (AMAUROSIS FUGAX); Old peeps; 10% risk of it happening in other eye. 2. HTN, DM, COD. Cardiac valve dz. 3. IV drug use, Birth control 4. a. CALCIFIC EMBOLI (large, dangerous from calcified heart valves) b. CAROTID EMBOLI (small cholesteol plaques: aka, HOLLENHORST PLAQUES). 5. Carotid Doppler (Carotid Artery), EKG/Echo (cardiac dz) 6. GCA, ACUTE increased IOP, Collagen vascular Dzs, IV drug use, Sickle-cell dz, Syphilis. 7. Acute, major VA loss, unless CILIORETINAL ARTERY is there. VA is LP or worse...consider Ophthalmic Artery Occlusion 8. whitening of inner retinal layers; CHERRY RED SPOT in FOVEOLA. APD.

Answer 186

1. Similar to CRAO 2. 90% d/t Retinal Emboli (Hollenhorst Plaques (most common), Calcium, Fibrin, Platelet emboli) 3. Asymptomatic. Maybe VF defect or sudden U/L Vision loss w/no pain. 4. Whitening of retina in affected area. (90% are temporal vessels). PERMANENT VF DEFECT

Answer 187

1. a. 1st exam w/in 3-5 YEARS of Dx of Type 1, and AT TIME of Dx for Type 2. b. No DR, repeat exam every year c. Mild-Mod DR: exam every 6-12 mos d. Severe NPDR or PDR: exam every 2-4 mos. 2. DR: Leading cause of new blindness in US. DURATION OF DZ = MOST IMPORTANT RISK FACTOR a. 2% b. 50% will have DR c. 90% will have DR 3. D/t Loss of pericytes and damage to Retinal capillary BM --> breakdown of Blood-retinal barrier.

Answer 188

1. a. 5% b. 15% c. 52% 2. a. Severe Ret HEMES in 4 QUADRANTS b. Venous beading: 2 Quadrants c. IRMA: 1 Quadrant 3. 75% risk to getting PDR. Pt has 2 or more of the 4-2-1 rule.

Answer 189

1. 5% a. NEO 2. a. NEO (NVD) more than 1/4 of DD w/in 1 DD of ON. b. Any NVD or NVE w/an associated Vit or Preretinal Heme 3. Pts: usually asymptomatic. May have Blurred vision and Metamorphopsia 4. Numerous signs of DR. Most important: MACULAR Dz and NEO

Answer 190

1. FA can differentiate b/w Ischemia and Edema. (Ischemia: looks like an enlarged foveal avascular zone) 2. Most common cause of legal blindness in DR. Any stage of DR. CSME: based on 3 criteria. 3. a. Retinal thickening w/in 500 um of Foveal center b. Hard exudates w/in 500 um of foveal center w/adjacent retinal thickening c. Retinal thickening at least 1 DD in size w/in 1 DD of the center of the fovea. 4. a. Preretinal/Vit Heme (Most common) b. NEO Glaucoma c. Tractional RD

Answer 191

1. 60 million; AA 2. Retinal arteries autoregulate diameter based on BP. 3. Asymptomatic; Possible Macular edema (macular star), Papilledema, Serous RD, Vein occlusion 4. B/L; Asymmetric a. Mild-mod diffuse narrowing of retinal arteries b. Stage 1 + focal constriction of the retinal vasculature (AV Nicking) and exaggerated ALR. c. Stage 2 + Ret Hemes, CWS, Hard exudates (star) w/in OPL, Retinal edema d. Stage 3 + PAPILLEDEMA (MALIGNANT HTN); Pts w/this have to be hospitalized immediately d/t a HIGH RISK of STROKE. BP is usually >220/120 5. Vascular Occlusions, Retinal Macroaneurysm, NAION, OMN Palsies, Diabetes. 6. Choroidal Infarcts that happen in SEVERE HYPERTENSIVE RETINOPATHY

Answer 192

1. Elderly women w/HTN or Atherosclerosis 2. Asymptomatic; maybe gradual vision loss d/t Macular Edema or Sudden VL from Vit Heme. 3. U/L Focal area of dilation in a retinal artery w/multi Hemes from a RUPTURED ANEURYSM w/surrounding circinate exudates; usually at an AV crossing.

Answer 193

1. Men. 50-80. 2. d/t occlusion of ICA/Ophthalmic Artery, secondary to ATHEROSCLEROSIS; can also happen d/t GCA 3. GRADUAL VL (90%), dull periorbital pain or HA (40%), Amaurosis Fugax 4. U/L (80%) dot/blot Hemes in MIDPERIPHERAL FUNDUS, dilated non-tortuous retinal veins, narrowed retinal arteries, and possible neo of the disc. a. VENOUS STASIS RETINOPATHY: Has these findings and CAROTID ARTERY OBSTRUCTION and NO ANT SEGMENT SIGNS. b. Post and Ant Segment Signs and Symptoms = OIS. 5. Transient Monocular VL (seconds to minutes). Vision then returns to normal. Carotid Artery Embolus is the most common cause.

Answer 194

1. increase in resistance to BF 2ndary to elevated plasma proteins, RBCs, and/or WBCs --> decreased BF --> vessel walls damaged. 2. HYPERGLOBULINEMIA. (found in Multiple myeloma, RA, SLE, HIV, Waldenstrom's Macroglobulinemia) 3. Retinal venous dilation, Ret hemes, CWS, Exudates

Answer 195

1. looks like DR; usually seen w/in 3-5 mos after starting Interferon. Resolves w/o Tx once stopped. F/u every 4-6 mos 2. B/L in IV drug users using talc as a filler. Gets stuck in Retinal Capillaries. --> Capillary Occlusion and Retinal Ischemia

Answer 196

1. Inflammatory; Exudates around vessels; Retinal edema, ischemia, Hemes. Vessel walls stain on FA. CAUSEs: SYPHILIS, SARCOIDOSIS (Candle wax drippings), Pars Planitis, Sickle Cell Dx.

Answer 197

1. abnormal perifoveal capillaries w/in Juxtafoveal region. 2. men; 4th decade; VA: 20/25-20/40 3. Middle-aged men; 20/25 or better 4. Equal sex distribution in 5th or 6th decades. Poor visual Px. 5. Decreased vision 6. Right Angle Venules and Dilated Tortuous Vessels, Hemes, varying degrees of exudate, w/in or nearby the fovea, macular edema, and/or CNVM.

Answer 198

1. Males; under 20. 2/3: Onset at age 10. Rapid progression if starts under age 4. Can look like Retinoblastoma 2. Idiopathic peripheral vascular dz. untreated --> total exudative RD. 3. Decreased vision, Strab, leukocoria. 4. U/L, telangiectatic dilated vessels ("Lightbulb" appearance), Progression can lead to MARKED HARD EXUDATES, intraretinal hemes, exudative RD, Neo glaucoma, etc.

Answer 199

1. Premature infants (under 36 wks) or Low bw infants who got O2 therapy. 2. Immature BVs vasoconstrict and stop developing d/t high O2 concentration --> Proliferative retinopathy. Vision threats: Preretinal/Vit Hemes and Tractional RD 3. Leukocoria, strab, vitreoretinal traction, PRERETINAL/VIT HEMES, and TRACTIONAL RD 4. ANTERIOR TEMPORAL RETINA (last to get mature vascular development)...NEO and Tractional RDs here.

Answer 200

1. Most common intraocular Malignancy in KIDS, 2nd most common of all age groups (choroidal melanoma MOST COMMON) 2. tumor made form retinoblasts d/t mutation of Rb tumor suppressor gene. a. 40%: All B/L and some U/L cases are hereditary. 50% chance of passing it on to each child b. 85% U/L are this. Won't pass on to their offspring. 3. LEUKOCORIA, STRABISMUS, intraocular inflammation, decreased Vision.

Answer 201

Coats' Dz, Toxocariasis, Retinoblastoma, ROP

Answer 202

1. Congenital. 2. Benign, Pigmented, non-progressive lesions. Sharp borders. Central Hypopigmented Lacunae If B/L and Multifocal...associated w/GARDNER's SYNDROME

Answer 203

1. Rare. Whites 2. Benign focal accumulation of melanocytes w/in Choroid. ``` 3. Thickness (elevation >2mm) Fluid (subretinal) Symptoms (blurred vision, floaters) Orange Pigment (lipofuscin on surface of lesion) Margins (irregular borders) UH: Ultrasonographic hollowness Halo Absence ``` Diameter more than 4DD or 6mm or close to ON...then send it out. 4. Flat or slightly elevated, less than 5 mm in size w/overlying drusen. 5. Choroidal Melanoma.

Answer 204

1. 6.4% of pts 65-74 and 19.7% >75 y/o had signs of ARMD 2. Age, Caucasians, + FHx, Light iris color, cigarette smoking, Hyperopia (>0.75D), HTN, Hypercholesterolemia, Female, Cardiovascular Dz

Answer 205

1. 85-90% 2. DRUSEN; RPE abnormalities (Mottling, granularity, focal hyperpigmentation) 3. Metamorphopsia, gradual VL (months to years), Blurred vision 4. 12%; GEOGRAPHIC ATROPHY 5. a. MULTIPLE SOFT DRUSEN b. FOCAL HYPERPIGMENTATION c. HTN d. SMOKING

Answer 206

1. 88% 2. Metamorphopsia, Central Scotoma, Rapid VL 3. DRUSEN associated w/signs of CNVM. They can leak BLOOD or Plasma into 2 major places (Sub-RPE or Subretinal space) 4. a. SUBRETINAL HEME b. SUB-RPE HEME c. SUBRETINAL DETACHMENT (Serous RD) (Plasma under the retina) d. Sub-RPE Detachment (Plasma under RPE aka PIGMENT EPITHELIAL DETACHMENT (PED))

Answer 207

1. d/t build-up of confluent soft drusen on Bruch's membrane. Creates a space b/w RPE and choroid. It's a Sub-RPE detachment called DRUSENOID PED 2. a. CLASSIC CNVM: well defined membrane that fills w/dye during early phases of FA. b. OCCULT CNVM: poorly defined membrane w/LATE appearing and less intense leakage. 3. It's fairly high.

Answer 208

1. young/middle-aged men; Type A; Stress, pregnancy, steroid use, hypochondriasis, HTN 2. Unknown. Causes RPE/Choroidal Dysfunction --> submacular serous fluid. 3. U/L sudden onset of blurred vision (20/20 to 20/200), Metamorphopsia, and Relative scotoma can happen. 4. Localized MACULAR SEROUD DETACHMENT; FA: Gradual pooling into PED (90%) or SMOKESTACK appearance (10%); OCT to Dx/monitor. Can have HYPEROPIC SHIFT and loss of FLR. 5. Yes. w/in macula. Most improve w/o Tx in 1-3 MONTHS. 94% get 20/30 or better acuity.

Answer 209

1. Rare in AA. Ohio-Mississippi River VALLEY. 2. d/t Histoplasmosa Capsulatum...FUNGUS in soil and in BIRD or BAT DROPPINGS 3. happen in preexisting Histo Spots 4. Asymptomatic unless Maculopathy develops. Earliest symptom is Metamorphopsia. 5. CHOROIDITIS; Clinical triad of Peripapillary Atrophy of ON, Multifocal lesions in the periphery, and Maculopathy (including CNV). Vitreous is always clear in Histoplasmosis

Answer 210

1. Genetic. 2% of US pop. WOMEN in young adulthood. 2. RE >-6.00 D w/axial length >26 mm --> Scleral thinning and Choroidal Atrophy 3. Asymptomatic or decreased vision and metamorphopsia 4. POSTERIOR STAPHYLOMA (hallmark)...POSTERIOR bulging of Weakened sclera. Other signs: Oblique insertion of Optic Disc, Fuch's Spots, LACQUER CRACKS, macular holes, premature cataracts (NS and PSC), extensive vitreous syneresis, PVD, Peripheral retinal degenerations (lattice, snail-track, pavingstone), retinal breaks, RDs 5. ~5% of high myopes; Fine, yellow, irregular lines = Large breaks in BRUCH's. Choroidal neo can happen --> Severe VL. usually young males. 6. Discrete, circular areas of yellow-white chorioretinal atrophy in retinal periphery. AKA Cobblestone degeneration. Predisposing for RD.

Answer 211

1. Females (3:2), Age; 2% older than 50, 20% older than 75. a. Idiopathic; can be d/t PVDs, retinal breaks, cataract or other Sxs. Trauma. 2. GLIAL CELL PROLIFERATION on ILM. Can be d/t Vitreal traction from Posterior Hyaloid (back of vitreous) on ILM. 3. Asymptomatic or have decreased vision and/or metamorphopsia 4. Mild ERMs: Fine, glistening membrane (cellophane maculopathy). Advanced ERM: Thick, gray-white membranes w/associated retinal folds (Macular Pucker)

Answer 212

1. most d/t aging. WOMEN 2. d/t Posterior vitreous traction on macula. Idiopathic (age), Trauma, surgery, CME, inflammation can cause them. B/L onset in 1/4. 3. Decreased vision and/or metamorphopsia. Full thickness macular holes associated w/20/20 or worse acuity 4. Round, red, well-delineated spot in macula. a. Impending hole w/loss of foveal depression and a YELLOW SPOT or ring at the fovea. b. Round, small, full-thickness hole w/Pseudo-operculum c. Large, Full-thickness hole w/an Operculum. Pts report POSITIVE WATZKE-ALLEN SIGN (shine light on macula...missing part of the light/line) d. Stage 3 PLUS PVD 5. Pt has BCVA; Shine bright light 10 seconds at 2 cm from pt. See how long it takes to get to one line less than his/her BCVA. Normal recovery time: 60 seconds.

Answer 213

1. waves w/in choroid, bruch's membrane, and RPE that form d/t mechanical stress on or w/in the choroid. 2. Alternating light and dark striations w/in the fundus. 3. Metamorphopsia and reduced VA. 4. Ocular or systemic conditions that cause mechanical stress on the choroid.

Answer 214

1. Mutation of genes that make MELANIN. Affect skin and eyes (oculocutaneous albinism) or eyes only (ocular albinism) 2. Hypopigmentation of skin and fundus, iris translucency, FOVEAL HYPOPLASIA, nystagmus, strabismus, mis-routing of temporal optic nerve fibers thru optic chiasm. 3. Photophobia and reduced VA. 4. Severe systemic conditions: Hermansky-Pudlak and Chediak-Higashi Syndrome

Answer 215

1. MOST COMMON Retinal Dystrophy. USHERS SYNDROME (5%). Avg Dx: 9-19 y/o 2. AR w/CONGENITAL HEARING LOSS 3. Rods and cones involved. Rods more damaged. varied presentation 4. NIGHT BLINDNESS; PERIPHERAL VL (in dim light in early stages). Takes years or decades for symptoms to develop. at 30 years, ~75% are asymptomatic 5. Bone Spicules, VESSEL ATENNUATION, Waxy Optic Disc Pallor. Other signs: PSC, Optic Disc Drusen, Macular Changes, KCN, Myopia, Progressive contraction of VF. Annular Scotomas --> central VL. 6. ERG (Early stages, SCOTOPIC ERG is REDUCED), but Photopic ERG is fairly normal.

Answer 216

1. MOST COMMON HEREDITARY MACULAR DYSTROPHY. Onset: 1st-2nd decade of life; AR; M = F 2. Fundus Flavimaculatus and Stargardt's Dz are considered variants of the same disorder. a. Fundus Flav: No Macular dystrophy signs. Later in life (4th-5th decade); Asymptomatic. 3. Fast VL, Color Vision abnormalities; Level of decreased vision is usually worse than fundus findings. Acuity: 20/200 by 3rd Decade, stable/slowly progressive after this. 4. B/L yellow flecks in Pisciform (fish-tail) configuration in Posterior Pole and Mid-Periphery. Non-Specific RPE mottling of the macula can be apparent. Late Stages: Classic "Beaten Bronze" macular appearance (bull's eye maculopathy), Salt and Pepper pigmentary changes in periphery. 5. Normal in early stages of dz, then gets abnormal.

Answer 217

1. X-LINKED RECESSIVE. 1st decade 2. lack of Rab Geranyl-Geranyl Transferase (enzyme for membrane metabolism) 3. Night-blindness and Peripheral VL. Night-blindness: early on then goes to total night-blindness w/in 10 years. Good vision until 50-60 y/o. Females: Benign and non-progressive. 4. B/L; Progressive; Atrophy of RPE and Choriocapillaris --> Sclera exposure. Macula...affected in late stages. Optic Disc and Retinal BVs are normal. 5. RP, GYRATE ATROPHY, and CHOROIDEREMIA

Answer 218

1. Onset: 1st-3rd decade. Usually AD inheritance 2. Slow, progressive decrease in Central Vision; Severe: Photophobia and Color VL. Worse during day. VA: 20/400 by 4th decade 3. a. Normal fundus; Abnormal Cone function on ERG b. Central geographic atrophy of RPE w/Bull's Eye Maculopathy, Vessel attenuation, Temporal Pallor of Optic Nerve (like RP) w/Severe DEUTAN-TRITAN color defects; Abnormal Photopic ERG and fine nystagmus 4. Stargardt's Dz, Progressive Cone Dystrophy, Chloroquine, Hydroxychloroquine Toxicity, THIORIDAZINE Toxicity

Answer 219

1. AD; Early childhood. (Child, Mild VL, BID MACULAR SIGNS) 2. d/t abnormal accumulation of material (maybe lipofuscin) in RPE 3. little to no symptoms. Eventually it's Decreased vision 4. B/L, Yellow, round, subfoveal (egg-yolk) lesion. 5. a. Abnormal EOG w/Normal fundus in Asymptomatic pt b. Egg yolk macular lesion; Age: 3-15 c. Lesion can become absorbed w/little to no effect on vision d. Egg yolk starts to break up and looks more like "scrambled egg" appearance. Mild VL expected e. Mod-Severe VL d/t Choroidal Neo, Hemes, Atrophy, and/or Macular Scarring 6. Normal ERG, ABNORMAL EOG 7. Onset: 30-50; Similar to Best's Dz. Px is better. Normal EOG and ERG; maybe small Tritan color defect

Answer 220

1. AR; Symptoms by age 10 2. B/L Choroiretinal Degeneration d/t deficiency in Mitochondrial Enzyme (ORNITHINE AMINOTRANSFERASE) High Ornithine blood plasma levels. 3. Nyctalopia, Decreased Vision, Constricted VF 4. Several, well-defined, scalloped areas of peripheral chorioretinal atrophy; Lesion starts in Midperiphery then coalesces to covering the entire PP w/Macula spared until 4th-7th decade. PSC, High Myopia and Astigmatism associated.

Answer 221

1. Males; Over 45. 2. Previous Ocular Sx; PVD; Trauma; FHx; Myopia; Lattice Degeneration 3. D/t RETINAL BREAKS (full-thickness). Vitreous goes into Subretinal space --> separation of sensory retina from RPE. (Atrophic holes, and vitreo-retinal traction tears) 4. small, full-thickness, round. Not d/t Vitreoretinal traction. Low risk for detachment. d/t CHRONIC ATROPHY of sensory retina. Most often seen in TEMPORAL RETINA (Sup > Inf) 5. d/t VITREOUS TRACTION a. d/t UNEVEN VITREOUS TRACTION which continues -> higher risk of RD. b. Symmetrical vitreoretinal traction. After tear is formed, Vitreous pulls away, and traction is gone. Lower risk for RD. 6. Floaters, Photopsia, Curtain or veil over vision, decreased acuity. 7. a. Convex undulating retina w/clear subretinal fluid that doesn't shift with body position. Shafer's sign can be seen. Maybe Mild Iritis, and Lower IOP in the affected eye. b. PIGMENT DEMARCATION LINE. Intraretinal Cysts (takes a year to form), Fixed folds, and/or subretinal precipitates.

Answer 222

1. 6-10% of population. 2. 20-33% of RRD pts have it. only 1% of pts w/Lattice actually get an RD. 3. Peripheral retinal thinning. Usually circumferential (cigar-shaped) and concentric w/the Ora Serrata 4. inner part: Atrophic; Outer margins: firm adhesion to vitreous. Most do not have a criss-cross pattern of white sclerosed vessels (classic appearance). B/L and usually Temporal and Superior. 25% have Atrophic holes. 5. Marfan's, Stickler, Ehlers-Danlos syndromes. 6. Small focal areas of Vitreous traction in periphery. 2nd most common peripheral retinal lesion associated w/RDs.

Answer 223

1. Serous (exudative) RDs and Traction RDs. These are NOT CAUSED by RETINAL BREAKS. 2. d/t subretinal disorders that damage RPE and let fluid accumulate under the retina. ex: ARMD (most common), inflammatory stuff, Vascular stuff, neoplasms, and others. Usually Asymptomatic. 3. usually d/t PDR, ROP, and Proliferative Sickle Cell Retinopathy. Rarely complain of flashes and floaters. Maybe decreased vision or progressive VF defects

Answer 224

1. 4-7% of pop. usually 40 or older 2. Split of OPL and INL --> elevation of inner retina. Looks like an RD. 3. Asymptomatic. Rare VL. 4. Dome-shaped bullous elevation in Inf/Temp most likely. Retina won't move. B/L. Absolute VF defect corresponds to area of elevation. 5. Most are Hyperopes; Snowflake or Frosting and sheathed retinal vessels in elevated retinal layer; Inner and outer wall breaks can happen. Outer wall breaks are more DANGEROUS (look "Pockmarked on scleral depression). Sometimes laser Tx done to prevent RD.

Answer 225

1. Large breaks in Bruch's d/t damage of elastic core of Bruch's. 50% idiopathic. Rest d/t Systemic Dzs. 2. PSEUDOXANTHOMA ELASTICUM (most common), Ehlers-Danlos, Paget's Dz, Sickle-Cell Dz, and Idiopathic (50%) 3. Asymptomatic or major VL d/t Choroid Neo (CNVM). Most will have some form of VL. 4. Spoke-like around Optic Disc; Linear, Well-demarcated red/orange or brown lines w/in elastic core of Bruch's membrane

Answer 226

1. Toxara Canis or Cati; Children/Young Adults from eating dirt, vegetables, meat, water, or infected cats/dogs; Larvae penetrate intestinal wall and travel to various organs. 2. Floaters and Blurred Vision 3. Ocular infections --> U/L Inflammatory response --> Optic Nerve Edema, RD, Vitritis, Endophthalmitis, Subretinal Granulomas. Large, White Chorioretinal scars seen after active infection is gone. 4. Type of Post. Uveitis. Inflammation of Choroid and Retina. a. Toxoplasmosis, Toxocariasis, Sarcoid, Syphilis, CMV, Serpiginous Choroidopathy, Birdshot Chorioretinopathy, Tb, and Onchocerciasis.

Answer 227

1. YA, usually after a Viral illness 2. B/L, Yellowish, Flat, Subretinal Lesions. Disc Edema and RD can also occur. 3. Resolves w/o Tx in a few wks.

Answer 228

1. AD 2. B/L. Lg areas of Geographic Atrophy in Macula. VL by 4th-5th decade. Poor Px. 3. Choroidal Thinning. Can look like Exaggerated TIGROID FUNDUS appearance d/t increased visibility of choroidal vasculature.

Answer 229

1. Vascular birthmarks. High Association with IPSILATERAL GLAUCOMA (45%). Rarely associated w/Systemic stuff. but most common is Sturge-Weber Syndrome (~5%)

Answer 230

1. Age-related SYSTEMIC CONDITION. Caucasians, Scandinavian descent. Most common identifiable cause of Elevated IOP 2. ABNORMAL, WHITE, FLAKY DEPOSITS (TM). 3. Deposits on Pupillary margin. Lens Capsule (BULL's EYE PATTERN), on Lens Zonules, and TM. 4. SAMPAOLESI's LINE d/t accumulation of pigment from rubbing on Post Iris Epi. (Basically, an increased pigmentation ant to Schwalbe's Line). 5. Poor pupil dilation, risk of lens subluxation, Cataract Sx complications d/t weak lens zonules. 6. U/L or B/L asymmetric Pseudoexfoliative Glaucoma. Risk: 15% w/in 10 years of getting glaucoma.

Answer 231

1. Caucasians, Young, Myopes. 2. Asymptomatic; Maybe blurred vision and halos around lights after exercising or pupil dilation. 3. B/L. Higher AC Pressure --> Excessive BOWING of the IRIS POSTERIORLY --> more contact b/w iris and lens zonules. 4. TIDs, Krukenberg's spindle (vertically oriented pigment lines on Corneal Endothelium), pigment on Ant Capsule of lens and Iris surface, and TM hyperpigmentation. 5. 5 years: 10%; 15 years: 15%

Answer 232

1. Wide open angle w/Recessed Iris and Widened CBB. U/L and d/t Blunt Trauma. Even w/Wide angle, TM is damaged --> Increased risk of glaucoma over time. 10% of pts develop it if 2/3 of angle is recessed.

Answer 233

1. type of POAG. NFL damage at lower pressures. (IOP < 21). 2. Females; Japanese; Vascular disorders = higher risk (Raynaud's, Migraines, LBP, Sleep Apnea, Hypercoagulation, Taking BP meds before bed...can decrease Ocular perfusion pressure) 3. Take diurnal IOP readings. 4. DRANCE HEMES more common in NTG. VF defects start out as FOCAL usually but more dense. Closer to fixation d/t Temporal and inferotemporal rim tissue being more commonly affected first compared to POAG.

Answer 234

1. Acute/Intermittent; d/t Post pressure in PC pushing Peripheral iris Anteriorly into contact w/TM. 2. PUPILLARY BLOCK and PLATEAU IRIS SYNDROME (less common) 3. Anatomically narrow angles (hyperopes) when aq. flow thru pupil is blocked (usually d/t lens). MOST AT RISK after pupil hits mid position after coming down from dilation. (Risk: Hyperopes, ADVANCING CATARACTS, Asians, Eskimos, Lens subluxation). 4. Anteriorly positioned ciliary processes that push the peripheral iris forward into contact w/the TM. SLE: flat iris plane, normal central AC depth, convex peripheral iris. 5. partial angle closure --> increased IOP w/o Symptoms. More common. Chronic angle closure expected w/an Occludable Angel. PAS, Progressive ON damage 6. Angle closure (No TM seen) --> Increased IOP (50-100 mmHg) and Pt Symptoms (emesis, eye pain, HAs, Nausea, VL). Signs: Hazy cornea, mid-dilated pupil w/poor response to light, ciliary flush, Glaucomflecken. 7. AC opacities d/t Lens epithelial cell ischemia and necrosis 2ndary to high IOP. 8. CRAO (IOP higher than PP of CRA). 9. TOPAMAX (topiramate). usually w/in 1st month of use or if dosage is increased.

Answer 235

1. CRVO (1st) then PDR 2. CAD and CRAO 3. RUBEOSIS of the IRIS 4. Anti-VEGF; then PRP.

Answer 236

1. If there's 360 degrees of attachment b/w Iris and Lens. (IRIS BOMBE and Pupillary Block, moving Iris anteriorly into contact w/TM).

Answer 237

1. Birth to 3 months onset. B/L. Males. 2. Abnormal AC development 3. enlarged eye w/corneal diameter >13mm. d/t elevated IOP.

Answer 238

1. Abnormal Corneal endothelium that grows on iris or in angle, increases risk for glaucoma. 2. Corneal edema, iris atrophy, PAS, angle closure. 3. Females. Pts age 20-50. 4. Iris thinning. causes Hetereochromia, polycoria, corectopia, and Ectropion Uvea 5. Corneal endothelium has "beaten Metal" appearance w/Corneal edema and corectopia 6. Nodules on Anterior iris surface

Answer 239

1. AKA: Posner-Schlossman Syndrome. ACUTE TRABECULITIS --> Acute IOP increase (40-60 mmHg). Some cells in AC. Gonio: OPEN ANGLE. Young-middle aged. RCEs that burn out over time 2. Chornic, Non-granulomatous, low grade anterior uveitis w/Stellate Keratic Precipitates. Iris Heterochromia and Iris/Angle Neo. Increased GLAUCOMA RISK d/t chronic TM damage and CATARACTS d/t Chronic Inflammation 3. HYPERMATURE CATARACT that leaks lens material into AC --> Aq flow blockage in TM. Cells, Flare, Iridescent lens particles in AC.

Answer 240

1. uses scanning laser polarimetry to detect thinning of RNFL 2. optical coherence tomography 3. confocal scanning laser ophthalmoscopy for a topographical evaluation of ON and Peripapillary retina.

Answer 241

1. Humphrey VF most popular 2. Yellow background w/blue stimuli to detect early damage in glaucoma that cant be seen with SAP 3. fast screening w/Sinusoidal gratings as stimulus. 4. 15 degrees temporal and ~7.5 degrees in diameter