Fundamentals/Miscellaneous Flashcards
• Associations for microphthalmos:
dwarfism, intellectual disability, trisomy 13.
• Ductions v versions
ductions are monocular (duck under cover!), versions are binocular (like the word convergence)
• Lidocaine
add sodium bicarb to help with the pain, add hyaluronidase to help with dispersion, add epinephrine to increase elimination time.
• Basic secretion test
drop of anesthetic then filter paper x 5 minutes. Abnormal is <3 mm. Equivocal is 3-10 mm. Normal is >10 mm.
• Schirmer 1:
same as basic secretion test but no anesthetic <5.5 mm after 5 minutes is considered abnormal. Tests basic secretion AND reflex tearing.
• Schirmer 2:
same as Schirmer 1 but also stimulate nasal mucosa. Tests reflex secretion only .<15 mm after 2 minutes is considered abnormal.
• Dye disappearance test:
put fluorescein and see if it disappears from the ocular surface. Indicates it went through the nasolacrimal system. Results less certain.
• Jones 1
put fluorescein in then check with cotton swab to inferior meatus at 2 and 5 minutes to see if fluorescein is there. If so then + jones 1 test and at least partial patency.
• Jones 2:
irrigate lacrimal system with cannula. Collect fluid in the nose with swab. Some people have negative jones 1 but positive jones 2 indicating a functional obstruction.
• Risk of uveal melanoma with ocular melanocytosis
1 in 400
• Hypersensitivity reactions
o Type 1: anaphylaxis (allergic/atopic conjunctivitis)
o Type 2: cytotoxic antibodies (ocular cicatricial pemphigoid)
o Type 3: immune complex reactions (scleritis)
o Type 4: cell-mediated reactions (contact dermatitis, corneal graft rejection, SJS)
o Type 5: stimulatory hypersensitivity (MG, TED)
• Parameters for ALT:
50 micron spot, 0.1 s duration, power between 300-1000 mW
• Laser lengths
o excimer laser: 193 nm, photoablation;
o ND-YAG laser: 1064 nm, photothermal disruption
o Femtosecond laser 1053 nm, photodisruption
• For alkaptonuria
treat with high dose vitamin C
• Transillumination defects:
peripheral associated with PDS, marginal associated with pseudoexfoliation syndrome
• Embryology—neuro-ectoderm
“really really obvious” RPE, Retina, Optic nerve, axons and glia
• Embryology—neural crest
corneal stroma, corneal endothelium, iris pigment epithelium, sclera (also mesoderm), TM, Bones/cartilage, ciliary ganglion, choroidal stroma, extraocular sheaths and tendons, optic nerve sheath, fat (also mesoderm), melanocytes. “Neural crest creates cornea, is super terrific for bones and cartilage, can create sheaths and tendons, and fat melanocytes.”
• Surface ectoderm embryology
lens, vitreous, conjunctival epithelium, lacrimal drainage system and lacrimal gland, cilia of skin of eyelids and caruncle, sweat glands. “Helps us cry (lacrimal), sweat (glands) and see (lens and vitreous).”
• Mesoderm:
EOMS, fat (also neural crest) iris stroma, iris sphincter, iris dilator, temporal sclera, vitreous (also surface ectoderm), and vascular endothelium. (Think muscles and vessels, you will have to randomly remember vitreous and temporal sclera.)
• Gland types:
meibomian = holocrine; lacrimal = merocrine, Krause/wolfring = merocrine; moll = apocrine
o Culture media thioglycolate broth:
best for culturing anaerobic bacteria
o Culture media blood agar, chocolate agar or thioglycolate broth
best for culturing aerobic bacteria
culture media Lowenstein Jensen
best for culturing mycobacteria
o Culture media nonnutrient agar with e coli overlay
best for culturing acanthamoeba
o Culture media sabourad’s
best for culturing fungi
• Meds not to use in someone with CME
dont use nonselective adrenergic agonists including epinephrine and the pro drug, dipivefrin. +/- don’t use prostaglandin analogs (like latanoprost)
• Accomodation amplitudes
lose approx. 1 D q4years until age 40. Then you have approx. 6D left of accommodation. From 40-48 you lose 1.5D every 4 years. At 48 you have approx. 3 D of accommodation left. You then lose 0.5D q4years after that.
