Eye Diseases (Harper)

Question 1

this condition is one of the principle indications of corneal transplant, and is caused by loss of endothelial cells, which results in stromal edema and bullous keratopathy

Answer 1

fuchs endothelial dystrophy; early disease shows raised wart like growths of endothelial cells called guttata (below)

Question 2

these diseases occur primarily in underdeveloped countries due to poor diet, and results in lack of tear film production and corneal damage; transplant is not usually successful

Answer 2

vitamin A deficiency and xeropthalmia

Question 3

collagen like mutation that commonly occurs in marfan’s and down syndrome, resulting in progressive thinning and distension of the cornea which leads to a cone shape; corneal transplant highly successful

Answer 3

keratoconus

Question 4

metabolic diseases that are characterized by deposition of compounds in various parts of the body (ie, cornea) where they should not be; corneal transplant or stem cell transplant may improve clarity

Answer 4

Hunter’s and Hurler’s syndromes

Question 5

what is the main adverse outcome for artificial cornea (Boston Keratoprosthesis, aka KPro)?

Answer 5

certain glaucoma and risk for retinal detachment

Question 6

loss in lens transparency that is attributed to multiple causes: genetic, infections, diabetes, biochemical disorders, etc

Answer 6

cataracts

Question 7

disease marked by an increase in intraocular pressure that occurs in the anterior chamber of the eye, but affects the retinal ganglion cells and the optic nerve, resulting in peripheral to central vision field loss

Answer 7

glaucoma

Question 8

True or false: glaucoma is diagnosed based on the intraocular pressure value (IOP)

Answer 8

False. IOP is only a risk factor for glaucoma. Actual diagnosis is obtained by standard fundus exam.

Question 9

type of glaucoma that leads to buildup of iop in front of the eye due to lack of proper drainage from the canal of schlem; often caused by a genetic mutation

Answer 9

primary open angle glaucoma

Question 10

type of glaucoma in which angle is open but may be excluded, such as in pseudoexfoliation glaucoma

Answer 10

secondary open angle glaucoma

Question 11

more common in younger children and generally congential, this type of glaucoma is caused by an obstruction that prevents aqueous fluid from getting to the iritic corneal angle

Answer 11

primary angle closure glaucoma

Question 12

glaucoma that is a medical emergency, in which the iris is drawn over the trabecular meshwork of the eye

Answer 12

secondary angle closure glaucoma

Question 13

All of the following are approved treatments for glaucoma EXCEPT:

A. Beta blockers and alpha agonists

B. Cell replacement therapies and neuroprotectants

C. Laser trabeculoplasty and iridotomy

D. Carbonic anhydrase inhibitors

E. Prostaglandin analogs

Answer 13

B. Cell replacement therapies and neuroprotectants are being investigated for usefullness but are not currently an approved treatment for glaucoma.

Question 14

this disease affecting the central visual field may present with neoangiogenesis in its “wet” form and with drusen deposits (shown below) in its “dry” form

Answer 14

Age related macular degeneration. No treatment for the dry form. Wet form (below) can be treated with injectable VEGF antagonists in the vitreous humor.

Question 15

disease that occurs by damaged blood vessels that spill exudates in the outer plexiform layer (looks similar to age related macular degeneration)

Answer 15

diabetic neuropathy

Question 16

condition that is typically associated with trauma and is often successfully repaired using laserpexy, cryopext and gas

Answer 16

retinal detachment

Question 17

inherited condition which first affects peripheral vision and night vision, with general progression to central field, and involves the cones, then rods and macula

Answer 17

retinitis pigmentosum; there is currently no treatment for this

Question 18

what is the main giveaway finding in retinal artery occlusion?

Answer 18

cherry red spot (fovea); vein occlusion shows more evidence of hemorrhaging

Question 19

compressive optic neuropathy results from swelling that puts pressure on the optic nerve and is associated with what disease?

Answer 19

Grave’s disease (or a neoplasm); is treated with either removal of the neoplasm and/or corticosteroids to control inflammation

Question 20

loss of vision secondary to demyelination and inflammation of the optic nerve and common in multiple sclerosis

Answer 20

optic neuritis; also caused by infection, autoimmune disorders and drug-induced causes. no long term benefit with corticosteroids

Question 21

All of the following are characteristic of non-arteritic anterior ischemic optic neuropathy EXCEPT:

A. presents with optic disc edema

B. usually unilateral and presents with gradual worsening vision loss

C. non-arteritic form is more common than arteritic form

D. occurs as a result of an isolated white matter stroke in the optic nerve

E. most cases are idiopathic but cardiovascular risk factors may contribute in those with crowded optic discs

Answer 21

B. It does occur unilaterally but is characterized by sudden onset of visual loss. Arteritic anterior ischemic optic neuropathy, in contrast, usually occurs with advancing age and may progress from one eye to the other if not treated.

Question 22

disease of exclusion that occurs in patients with high blood pressure, diabetes and smokers; it is abrupt and painless and may occur as a complication of spinal surgery

Answer 22

posterior ischemic optic neuropathy

Question 23

All of the following statements are true EXCEPT:

A. A minimum of 3 neurons are involved in converting a light stimulus on the retina into a neurological impulse

B. The retinal pigment epithelium phagocytoses the outer segments of photoreceptors and converts all-trans-retinal back to 11-cis retinal

C. Carefully examining the pupils for evidence of a relative afferent pupillary defect is a rapid and reliable way to evaluate the function of the retina and the optic nerve

D. Homonymous visual field defects suggest lesions within the eye while altitudinal defects suggest lesions behind the chiasm

E. The retinal vasculature is the primary site of injury in diabetic retinopathy and atherosclerotic disease

Answer 23

D. The opposite is true - homonymoous visual defects suggest a lesion behind the optic chiasm and altitudinal defects suggest those within the eye.

Question 24

this is the most common cause of severe vision loss in the developed world, and is characterized by the accumulation of extracellular lipid and protein deposits (drusen) beneath the retinal pigment epithelium

Answer 24

Age related macular degeneration

Question 25

Decreased aqueous humor outflow leads to increased intraocular pressure which can injure the optic nerve; this is known as what?

Answer 25

glaucoma