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1
Q

What is the clinical triad for carotid-cavernous fistula?

A
  1. Chemosis
  2. Pulsatile exophthalmos
  3. Ocular bruit
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2
Q

What is the most common cause of unilateral or bilateral proptosis in young and middle aged patients?

A

Thyroid eye disease (TED)

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3
Q

How is CCF treated?

A

Balloon embolization of the internal carotid

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4
Q

What systemic symptoms are associated with TED?

A

Heart palpitation
Weight loss
Heat intolerance
Hair loss

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5
Q

What are the classic signs/symptoms of orbital cellulitis?

A 
Exophthalmos
Lid edema
Pain/restrictions on eye movement
Fever
Decreased VA
Conj injection and chemosis
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6
Q

What 3 meds can cause pseudotumor?

A

Tetracyclines
Accutane
Contraceptives

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7
Q

In CCF, on MRI and angio, what would suggest CCF?

A

Asymmetrically enlarged cavernous sinus, or superior ophthalmic vein

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8
Q

What tests can be run to evaluate for TED?

A 
Orbital CT (EOM enlargement w/o tendon involvement)
T3 and TSH testing (High T3, low TSH)
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9
Q

What other types of pathology can TED cause?

A

SLK
Exposure K
Optic neuropathy
Restrictive myopathy

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10
Q

How is optic neuropathy from TED treated?

A

Immediate oral steroids (Pred 100mg QD 2-14 days)
OR
Orbital decompression

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11
Q

What risk factor significantly increases the likelihood of ophthalmic findings in TED?

A

Smoking

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12
Q

What is the Tx for orbital cellulitis?

A

Hospitalization
IV ABx (ceftiraxone or nafcillin)
Followed by oral ABx (augmentin, ceclor, bactrim)
Topical bacitracin or erythromycin if conjunctivitis or exposure are present.

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13
Q

What causes molluscum contagiosum?

A

DNA pox virus

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14
Q

What ocular reaction does molluscum contagiosum cause?

A

Follicular conjunctivitis

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15
Q

What is the typical presentation of molluscum?

A

Waxy, dome-shaped papules with central umbilication

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16
Q

What is the classic presentation of seborrheic keratosis?

A

Elevated, “stuck-on”, crusty, greasy, or plaque like lesion

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17
Q

What is the typical age range for seborrheic keratosis?

A

Elderly

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18
Q

What is the typical presentation of a keratoacanthoma?

A

Small, dome-shaped tumor on sun exposed skin, the progress to large lesions with central ulceration

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19
Q

What causes papillomas?

A

HPV

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20
Q

Follicals are associated with what 3 things?

A

Viral
Chlamydia
Toxic

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21
Q

What is the classic presentation of basal cell carcinoma?

A

Firm, pearly nodule with superficial telangiectasia.

May progress to central ulceration “rodent ulcer”

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22
Q

What is the most common type of skin cancer?

A

Basal cell carcinoma

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23
Q

What is the 2nd most common type of skin cancer?

A

Squamous cell carcinoma

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24
Q

Which is more likely to metastasize: Basal cell or squamous cell?

A

Squamous cell

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25
What is the typical presentation of a sebaceous gland carcinoma?
Yellow, hard tumor on the upper eyelid that causes madarosis and thickened lid margins
26
What is the most lethal type of skin cancer?
Malignant melanoma
27
What is the typical presentation of malignant melanoma?
Irregular borders with rapid growth and color changes
28
What is the common precursor to squamous cell carcinoma?
Actinic keratosis (elevated scaly, pink/red lesion)
29
A Fleischer ring is an indicator of what condition?
Keratoconus
30
What is a Fleischer ring made of?
Iron deposits
31
What are the late stage signs of keratoconus?
Vogt striae Munson's sign Hydrops
32
What are Vogt's striae?
Vertical lines in deep stroma | V for Vertical lines
33
What is the classic presentation of staph marginal keratitis?
Stromal infiltrates in the periphery secondary to chronic bleph, without epi defect
34
RCE occurs most commonly in pts with a history of what?
``` Trauma (abrasions) Corneal dystrophies (ABMD) ```
35
What is a corneal ulcer?
Epi defect with associated stromal infiltrate
36
What are the UCRAP (HLA-B27) conditions?
``` Ulcerative colitis Crohn's Reactive arthritis Ankylosing spondylitis Psoriatic arthritis ```
37
What are the causes of granulomatous anterior uveitis?
Syphilis Lyme TB Reactivated herp
38
What is the Tx for staph marginal keratitis?
ABx/roid combo Q4Hs | -Tobradex, zylet (lotepred, tobramy)
39
When using doxy for posterior bleph, what is the typical dosing?
100mg BID for 4 weeks, then QD for 3-6 months
40
What type of drug is natamycin?
Antifungal
41
What is the Tx for RCE?
``` Debridement Cyclo ABx Topical NSAID if needed BCL ATs ```
42
What Tx can be used to decrease recurrences of RCE?
Oral doxy 50mg BID x 2 months | Muro 128 ung QHS x 3 months
43
What is the classical presentation of fungal keratitis?
Gray-white corneal infiltrates with feathery edges and satellite infiltrates
44
What are 2 common topical antifungals?
Amphotericin B | Natacin
45
What are 2 systemic antifungals?
Ketoconazole | Itraconazole
46
What it the typical recall for staph marginal keratitis?
4 days | Then 3 weeks or so
47
What percent of newborns have congenital nasolacrimal duct obstruction?
5%
48
What is the typical presentation for dacryocystitis?
Epiphora Edema over lac sac Severe pain
49
What is the most common cause of an acquired nasolacrimal duct obstruction?
Idiopathic obstruction
50
What is the most common cause of congenital NLD obstruction?
Failure of the valve of Hasner to completely open by birth
51
What is the typical age of AKC?
Young to middle age
52
What are the common signs of AKC?
Corneal neo Cataracts Keratoconus Milky edematous bulbar conj
53
VKC typically effects whom?
Young boys
54
What are the classic symptoms of VKC?
``` Intense itching Thick mucous Lacrimation Photophobia FBS Prominent papillae (cobble stone or Trantas dots) ```
55
Atopic dermatitis is what type of hypersensitivity reaction?
Type 1
56
What are the 2 cataracts associated with atopic dermatitis?
Shield cataract | PSC
57
What is the main cause of visual impairment in AKC?
SPK (interpalpebral)
58
What are the 3 mast cell stabilizers?
Alocril Alomide Alamast
59
When do mast cell stabilizers need to be used in order to be effective?
Prior to histamine release
60
What is the predominant area of ocular involvement in adult inclusion conjunctivitis?
Inferior
61
SLK is associated with what systemic condition?
Thyroid disease (50% of cases)
62
SLK can be cause secondary to what?
Contact lens wear
63
What is the typical presentation of SLK?
Thickened, red, sup bulbar conj Velvety sup tarsal conj Often bilateral, with adjacent SPK and filamentary keratitis
64
What is the most common cause of viral conjunctivitis?
Adenovirus
65
Viral conjunctivitis is more common in who, adults or kids?
Adults
66
Pharyngoconjunctival fever is cause by which serotypes of adenovirus?
3,4,5,7
67
What are the typical findings in pharyngoconjunctival fever?
Follicular conjunctivitis (occasionally hemorrhagic) Low grade fever Mild sore throat
68
What serotypes of adenovirus cause EKC?
8,19,37
69
What are the common findings of EKC?
+ PAN SPK SEKs in the 3rd week Pseudomembranes
70
Are the majority of bacterial conjunctivitis cases cause by gram + or gram - bacteria?
Gram + (staph)
71
What gram - bacteria can cause bacterial conjunctivitis?
H. influenza | Moraxella catarrhalis
72
Which 2 bacteria are the most common causes of conjunctivitis in kids?
Strep pneumonia | H. influenzae
73
What are the common findings in gonococcal conjunctivitis?
``` Hyperacute discharge Conj chemosis w/pseudomembranes Papillary reaction Marked PAN Pain on urination Purulent urethral discharge ```
74
What is a possible severe consequence of conococcal conjunctivitis?
Corneal ulceration
75
What is another name for adult inclusion conjunctivitis?
Chlamydial conjunctivitis
76
What is the typical presentation of chlamydial conjunctivitis?
Unilateral giant follicals (limbal or palpebral), most concentrated in inferior fornices Chronic red eye for weeks to months
77
What is the most common cause of preventable blindness worldwide?
Trachoma
78
What causes trachoma?
Chlamydia trachomatis serotypes A-C
79
What is the common presentation of trachoma?
Follicles in the form of Arlt lines (superior tarsal scarring) and Herbert's pits Follicular and papillary conjunctivitis of superior tarsal conj Scaring of eyelids and ulceration from trichiasis
80
If you diagnose a non-CL wearer with SLK, what subsequent testing is warranted?
T3 and TSH
81
What is the frontline Tx for mild SLK?
ATs Q2Hrs
82
What is the additional Tx beyond ATs for mod/severe SLK?
Silver nitrate 0.5-1.0% applied to superior tarasal and bulbar conj, followed by irrigation and ABx ung
83
What is the Tx for filamentary keratitis?
Acetylcysteine 10% gtts, 3-5x/day | Mucomyst
84
What supportive measures can be taken for a pt with an adenovirus infection?
Cold compresses Mild vasoconstrictors ATs IF SEVERE: mild steroid (lotemax) during first 1-2 weeks
85
What can be used to treat an adult with bacterial conjunctivitis?
5-7 days of QID of any of the following: 1. Fluoroquinolones 2. PolymyxinB/trimethoprim (polytrim) 3. Tobramycin
86
What can be used to treat a child with bacterial conjunctivitis?
5-7 days QID of either: 1. PolymyxinB/trimethoprim (polytrim) 2. Bacitracin + polymyxin B (polysporin ung)
87
In cases of bacterial conjunctivitis with SPK, what medications are not recommended due to corneal toxicity?
Aminoglycosides (gentamicin, tobramycin)
88
What are the Tx options for chlamydial conjunctivitis?
1g azithromycin PO all at once | 100mg doxycycline BID x 10 days
89
What is the Tx for a cornea involving gonococcal conjunctivitis?
Ceftriaxone IV (1g) 12-24hrs
90
What is the Tx for gonococcal conjunctivitis w/o corneal involvement?
1g ceftriaxone IM injection
91
What is the most common infectious cause of neonatal conjunctivitis?
Chlamydia
92
What is the Tx for Trachoma?
``` "SAFE" Surgery for trichiasis Antibiotics Facial hygiene Environmental hygiene ```
93
Patients with what 2 conditions present with pain out of proportion to findings?
SLK | Acanthamoeba
94
A lipid tear film deficiency results from what?
Blepharaitis
95
An aqueous layer deficiency is termed what?
Keratoconjunctivitis sicca
96
During what part of the day are KSC symptoms worse?
End of day
97
During what part of the day are MGD symptoms worse?
Morning
98
What 3 drug classes/types are associated with KCS?
Beta blockers Oral antihistamines Hormone replacement therapies
99
Name 3 collagen vascular diseases that are associated with KCS?
Rheumatoid arthritis Sjogren's Lupus
100
A deficiency in what causes bitot spots?
Vitamin A
101
What is the typical demographic for KCS?
Women over 50
102
What is the typical demographic for Salzmann's?
Female over 50
103
Salzmann's is typically associated with what conditions?
Trachoma Phlyctenulosis KCS
104
What is the classic appearance of Salzmann's?
Smooth, opaque, elevated, blue-gray stromal opacities
105
What ocular manifestation is associated with gout?
Band K
106
What is the common demographic for SLE?
Female, teens-20's
107
What ocular findings may be seen in SLE?
Disc edema Dry eye Photophobia Malar rash
108
What is the typical Tx for mild Salzmann's?
ATs
109
What Tx can be utilized for acne rosacea?
``` Doxy 100mg BID with taper Omega-3's Metronidazole Warm compresses lid scrubs Topical abx ```
110
When does posterior polymorphous dystrophy typically get identified?
30's-50's
111
What is the most common symptom of posterior polymorphous dystrophy?
Decreased vision from edema
112
What occurs in the endothelium in posterior polymorphous dystrophy?
Metaplasia and overgrowth of endo cells
113
What is the classic presentation of posterior polymorphous dystrophy?
Bilateral, asymmetric patches of vesicles | Band-like lesions and geographic gray hazy areas at Descemet's membrane
114
What is the inheritance pattern of Fuch's endothelial dystrophy?
AD
115
Fuch's endothelial dystrophy is most common in what demographic?
Post-menopausal women
116
An endo cell count of less than what will typically lead to edema?
<500 cells/mm^2
117
Disciform keratitis most commonly occurs in what condition?
Herpes simplex keratitis
118
What is the typical presentation of disciform keratitis?
Round area of central/paracentral edema with a clear demarcation between involved and uninvolved cornea Scatterek KP may be present
119
What is the inheritance of macular dystrophy?
AR | "macul-AR"
120
When does macular dystrophy occur?
In the first decade of life
121
What is the typical presentation of macular dystrophy?
Child with diffuse corneal haze and irregular gray-white spots (mucopolysaccharide deposits Decreased VA Possible corneal erosions
122
What is interstitial keratitis?
Stromal inflammation without primary involvement of the epi or endo
123
90% of interstitial keratitis cases are aquired how?
Congenital syphilis
124
What is the clinical appearance of interstitial keratitis?
``` Salmon patch lesions (stromal neo) Stromal edema Conj injection AC reaction KPs ```
125
What is the clinical triad of congenital syphilis?
1. Interstitial keratitis 2. Hutchinson's teeth 3. Deafness
126
Papilledema and optic neuritis are found in which form of syphilis?
Tertiary
127
What are the Tx options for Fuch's endothelial dystrophy?
NaCl 5% gtts QID or UNG | Glaucoma meds for IOP
128
What is the Tx for disciform keratitis?
Pred forte QID | Viroptic QID
129
What is the Tx for interstitial keratitis?
Topical steroieds
130
What medication can cause pigment deposition on the corneal endo?
Chlorpromazine
131
Malignant melanoma of the conj typically arise from what?
Primary acquired melanosis (PAM)
132
What is the most common conj malignancy in the US?
CIN
133
CIN gives rise to what malignant condition?
Squamous cell carcinoma
134
What is the typical presentation of CIN?
Elevated, gelatinous mass with neo
135
30% of primary acquired melanosis progresses to what?
Malignant melanoma
136
Primary acquired melanosis is caused by a proliferation of what?
Intraepithelial melanocytes
137
What is the typical presentation of a conj lymphoma?
Smooth, fleshy, subconj salmon-colored patch
138
What typically causes pyogenic granulomas?
Trauma | Surgery
139
What is the most important prognostic indicator of progression from PAM to malignant melanoma?
Thickness of the lesion
140
What 3 drugs can cause nystagmus?
Phenytoin (dilantin) Phenobarbitol (luminal) Salicylates
141
Which drug can cause blue/yellow color defects?
Digoxin
142
What type of cataracts can chlorpormazine cause?
Stellate cataracts
143
Amiodarone can cause deposits where?
Lens
144
What is the Tx for pyogenic granuloma?
ABx-steroid combo | tobradex, maxitrol
145
Pilocarpine can potentially cause what severe ocular side effect?
Retinal breaks
146
A history of cold sores and an increase in stress could lead to what ophthalmic condition?
Herpes simplex keratitis
147
Herpes simplex hides in which ganglion?
Trigeminal (gasserian)
148
What things may trigger recurrent HSK infections?
``` Stress Sun exposure Fever Trauma Immunosuppression ```
149
Which herpes simplex virus is most commonly responsible for HSK, type 1 or type 2?
Type 1
150
What is the early acanthamoeba presentation?
Epi defects ranging from SPK to whorl-like defects, to pseudodendritic lesions Pain > signs
151
If left to grow, what is the more advanced presentation of acanthamoeba?
Patcy anterior stromal infiltrates that become confluent to form a ring ulcer
152
What are the Tx options for an HSK dendrite?
Viroptic | Zirgan
153
Why might Zirgan be preferred to treat an HSK dendrite over Viroptic?
Thimerosol toxicity of Viroptic
154
What is the typical presentation of Thygeson's?
Small, bilateral, multiple, asymmetric, gray-white crumb-like clusters, central lesions White, quiet eye Look like SEIs, but more superficial Stain minimally with NaFl
155
What are the 4 forms of ocular herpes simplex infection?
Epithelial keratitis Disciform keratitis Blepharoconjunctivitis Keratouveitis
156
What is the Tx for HSK?
Viroptic Q2H for 5-7 days, then 5x/day for 7 days | NO STEROIDS on HSK (will work for stromal keratitis, though)
157
What is the Tx for herpes simplex stromal keratitis?
Pred forte QID | Viroptic QID
158
For recurrent HSK, what oral med can be prescribed?
Acyclovir 400mg BID
159
What is the Tx for herpes zoster ophthalmicus?
Acyclovir 800mg 5x/day OR | Valacyclovir 1000mg TID
160
What is the Tx for Thygeson's?
ATs for mild severity Severe: Mild steroids (FML, loteprednol QID x 1 week) Bandage SCL
161
What is the most common anterior corneal dystrophy?
ABMD (AKA EBMD, map-dot-fingerprint, Cogan's dystrophy)
162
ABMD is slightly more common in which gender?
Female
163
What things characterize Von Hippel-Lindau disease?
Retinal capillary hemangioblastomas
164
What are the 5 drugs that can cause whorl keratopathy?
``` CHAI-T Chloroquine Hydroxychloroquine Amiodarone Indomethacin Tamoxifen ```
165
A cortical cataract can cause what type of refractive shift?
Hyperopic
166
A nuclear cataract can cause what type of refractive shift?
Myopic
167
PSC can be caused by what 2 things?
Steroids | X-rays
168
Which systemic condition may result in "Christmas tree cataracts"?
Myotonic dystrophy
169
What are the characteristics of myotonic dystrophy?
``` Miotic pupils External ophthalmoplegia Christmas tree cataracts Pigmentary retinopathy Muscle wasting and weakness ```
170
What is the inheritance of Wilson's disease?
AR
171
Wilson's disease results in an increased deposition of what?
Copper
172
In Wilson's disease, where is copper most concentrated?
Liver Brain Cornea (Kayser-Fleisher Ring)
173
What signs/symptoms characterize Wilson's disease?
``` Wrist tremor (asterixis) Basal ganglia degeneration Cirrhosis Corneal deposits Cataracts Carcinoma Dementia ```
174
What is the most common cause of pre-senile cataracts?
Diabetes
175
Severe atopic dermatitis can result in which 2 cataracts?
Shield cataracts | PSC
176
What type of cataract forms due to acutely high blood sugar?
Snowflake cataracts
177
What type of cataract is found in Wilson's disease?
Sunflower cataract
178
What would differentials for glare or halos be?
Cataracts Angle closure Corneal edema Corneal haze
179
Sildenafil carries a slight risk of developing what ocular condition?
NAION
180
What ocular side affect may occur from Digoxin use?
Blue-yellow defect Entoptic phenomena Retrobulbar optic neuritis
181
What is the average axial length of the eye?
24mm
182
A 1mm change in axial length of the eye results in what dioptric power?
3D
183
How thick must the remaining "bed" be for LASIK?
250microns
184
What is the formula for LASIK calculations?
Flap (120mu) + ablation (15mu per D) = >250mu (bed)
185
How much cornea is ablated per diopter for LASIK?
15microns per 1 diopter
186
What is the Tx for deep lamellar keratitis post LASIK?
``` Topical steroids (Pred 1%) If severe, flap needs to be lifted and irrigated ```
187
How long after LASIK does DLK usually appear?
Days right after surgery
188
How long after LASIK will epithelial ingrowth occur?
around 1 month post-op
189
What is the preferred time period to wait before re-treating LASIK or PRK?
6 months - earliest is 3 months
190
LASIK can cause a false high or low IOP?
False low
191
Positive Seidel's sign after cataract surgery puts a patient at risk for what 5 complications?
``` Endophthalmitis Hypotony Iris prolapse Choroidal detachment Shallow A/C ```
192
What are the typical signs and symptoms of endophthalmitis?
``` Severe pain Loss of vision Corneal edema Injection Severe A/C reaction w/ possible hypopyon Vitreous cells Mucus discharge ```
193
What is the management for endophthalmitis?
Immediate referral to surgeon for aggressive ABx treatment
194
At what pressure does hypotony become a problem?
Under 6mmHg
195
Why does a choroidal detachment occur with low IOP?
Fluid accumulates in the suprachoroidal space
196
Why might diplopia occur after cataract surgery, and then resolve spontaneously?
Retrobulbar anesthesia
197
How can you manage cataract post op bullae?
Bandage CL if epi is intact
198
How long after cataract surgery does Irvine Gass typically set in?
3 months
199
What causes Irvine Gass?
Anterior seg inflammation migrating to the posterior seg, leading to breakdown of the blood-retinal barrier, causing vessel leakage
200
Where does fluid accumulate in Irvine Gass?
Outer plexiform layer
201
If topical steroids and NSAIDs are not effective for Irvine Gass, what may be indicated?
Periorbital steroid injection
202
ACIOLs have a higher risk of causing UGH syndrome. Why?
Haptic rubbing on iris causing hyphema and uveitis, clogging the TM
203
Is scleritis a granulomatous or non-granulomatous inflammation?
Granulomatous
204
50% of cases of scleritis are associated with what?
Underlying systemic disease - mostly collagen vascular disease (30%)
205
What is the most benign form of Scleritis?
Non-necrotizing diffuse scleritis
206
What is another name for necrotizing scleritis without inflammation?
Scleromalacia perforans
207
Scleromalacia perforans is typically a result of chronic what?
Rheumatoid arthritis
208
What is the worst form of scleritis?
Necrotizing with inflammation
209
What are the conditions that cause non-granulomatous uveitis?
``` UCRAP Ulcerative colitis Crohn's Reactive arthritis Ankylosing spondylitis Psoriatic arthritis ```
210
What lab will come back increased in Reiter's syndrome?
Increased ESR
211
What are the typical signs/symptoms of Reiter's syndrome?
Urethritis Polyarthritis Conjunctivitis (with iritis) Increased ESR
212
What is the most common cause of uveitis in children?
Juvenile rheumatoid arthritis
213
What is the most common cause of posterior uveitis in adults?
Toxoplasmosis
214
What characterizes toxoplasmosis?
Unifocal yellow-white lesion obscured by overlying vitritis | "Headlights in the fog"
215
What characterizes histoplasmosis?
Multifocal punched-out yellow-white lesions Peripapillary atrophy Maculopathy Ohio-Mississippi river valley
216
What are the typical signs of ocular sarcoidosis?
Granulomatous panuveitis Retinal vasculitis White, fluffy opacities of inverior vitreous
217
Posterior uveitis occurs in which stage of syphilis?
Secondary syphilis
218
What are the typical signs of secondary syphilis?
Acute multifocal chorioretinitis Vitritis Salt and pepper fundus Flame hemes
219
Which condition results in "snow banking"?
Pars planitis - intermediate uveitis
220
Which test is used to see if a patient has ever had syphilis?
FTA-ABS
221
What is the typical Tx for uveitis?
Pred 1% Q1Hr with slow taper | Cycloplegic BID
222
What class of drug is brompheniramine?
Anti-histamine
223
What is the classical presentation of an iris cyst?
Globular, dark-brown structure that transilluminates | -don't typically grow
224
What are Lisch nodules?
Small, round, lightly pigmented hamartomas of the iris | Typically bilateral and inferior
225
95% of the time Lisch nodules are found in what condition?
Neurofibromatosis
226
On what part of the iris are Koeppe nodules found?
Pupil margin
227
Where are Busaca nodules found?
Iris surface
228
In what condition might Koepe and Busaca nodules be found?
Granulomatous uveitis
229
What systemic conditions can cause granulomatous uveitis?
Sarcoidosis TB Syphilis
230
Episcleritis is usually idiopathic, but 40% of the time it is related to what?
Collagen vascular diseases
231
What is the classical presentation of episcleritis?
Younger pt with unilateral sectoral injection | No to mild irritation
232
Phlyctenular keratoconjunctivitis results from what type of hypersensitivity?
Type 4 - delayed
233
What is the most common cause of phlyctenular keratoconjunctivitis? What is the second most common cause?
Staph from blepharitis | TB
234
What simple test can be done to differentiate episcleritis from scleritis?
Phenylephrine 2.5% blanching
235
What is the purpose of amiodarone?
Anti-arrhythmic
236
At what dose of amiodarone is corneal verticillata inevitable?
400mg/day
237
What 3 ocular side affects may be caused by amiodarone?
Verticillata/whorl K Anterior subcapsular cataract NAION
238
What is the Tx for mild episcleritis?
ATs Cold compresses Topical decongestants if desired
239
What is the Tx for moderate to severe episcleritis?
Topical steroid (lotemax) or oral NSAID for 5-10 days
240
What is the Tx for pingueculitis?
Mild topical steroid (FML, lotemax, etc)
241
What is the Tx for phlyctenular keratoconjunctivitis?
Mild: topical decongestants Mod-Severe: Topical steroids, or steroid/abx combo
242
Addison's disease is caused by what?
Too little corticosteroid in the system
243
What 3 things do you need to know about your patient before prescribing oral steroids?
Pregnancy Peptic ulcer Diabetes
244
What is the inheritance pattern of oculocutaneous albinism?
AR
245
What is the inheritance pattern of ocular albinism?
X-linked | Less commonly AR
246
What is ectropion uveae
Proliferation of iris posterior pigmented epithelium onto the surface of the iris
247
What is the cause of ocular albinism?
Decreased number of melanosomes
248
What typically causes the vision loss in ocular albinism?
Foveal hypopigmentation (hypoplasia)
249
What is the most significant threat to vision in a patient with ectropion uveae?
Secondary angle closure glaucoma due to iris ectropion and/or high iris insertion
250
Why should a patient with oculocutaneous albinism be referred to hmatology?
To rule out Chediak-Higashi and Hermansky-Pudlak syndromes, as they are potentially lethal
251
What are the 4 TB drugs?
``` RIPE Rifampin Isoniazid Pyrazinamide Ethambutol ```
252
What is a serious potential side effect of ethambutol?
Bilateral, retrobulbar optic neuritis
253
Minocycline and corticosteroids have what potential ocular side effect in common?
Blue sclera
254
What are the vision threatening complications of a retinal vein occlusion?
Macular ischemia and edema | Neovascularization - heme, glaucoma, RD
255
What is the leading cause of vision loss in CRVOs?
Macular edema
256
What is the clinical definition of an ischemic CRVO?
10DD or more of non-perfusion on FA
257
90% of cases of CRVO present with what reduced acuity?
20/200 or worse
258
What are the risk factors for CRVO?
Hypertension (61%) Diabetes CV disease Open angle glaucoma
259
What is the most common vascular cause of vision loss?
Diabetic retinopathy
260
Which quadrant is most common for BRVOs?
Superior/temporal quad (60%)
261
What is the clinical appearance of a retinal vein occlusion?
Hemes CWS Mac edema
262
What are the risk factors for CRAO?
Hypertension (67%) DM Carotid disease Cardiac valve disease
263
CRAO may be preceded by what?
TIAs/amaurosis fugax
264
90% of BRAOs are caused by what?
Emboli
265
What are the 4 types of emboli?
Cholesterol Calcium Fibrin Plateles
266
What is the classic example of optic neuritis?
``` Young female Sudden vision loss APD Pain on EOM Vision loss worsenes for 2 weeks, then stabilizes and improves ```
267
What is the classical presentation of AAION?
``` Sudden, unilateral vision loss Disc edema Over 55 years old Temporal headache Scalp tenderness Jaw claudication Malaise ```
268
CRVOs and BRVOs result from what?
Compression of an artery on a vein leading to thrombus formation
269
What most commonly causes a CRAO?
Calcific emboli from heart valves OR Hollenhorst plaque from carotid
270
If a young patient presents with a CRVO, what might be the etiology?
``` Oral contraceptives Factor XII deficiency Collagen vascular disease AIDS (among others) ```
271
What is the most common cause of AAION?
GCA
272
What is GCA?
Systemic vasculitis of medium and large blood vessels
273
In AAION, what arteries become occluded?
SPCAs
274
What is the typical final acuity after a CRVO?
Similar to what the acuity was on initial presentation
275
When is PRP indicated after a CRVO?
``` Any of the following: Rubeosis is > 2 clock hours Angle neo Neo glaucoma Any posterior seg neo ```
276
How should mac edema after CRVO be treated?
Intravitreal steroids (according to SCORE study)
277
How often should patients be followed after a CRVO? What procedures should be done?
Every 6 months Gonioscopy BP
278
If neo arises after a BRVO, what is the Tx?
Sector laser of area of the occlusion
279
What is the Tx for persistent mac edema after BRVO?
Focal laser of the macula
280
How often should a patient be followed after BRVO?
1-2 months | Look for mac edema and neo
281
What test should be run in an older patient presenting with a CRAO to rule out GCA?
ESR
282
When should a PPV be considered after a non-clearing diabetic vit heme?
1 month
283
What is the Tx for demyleniating optic neuritis?
IV steroids for 3 days | Followed by oral pred for 11 days
284
What is the Tx for AAION?
High-dose steroid Tx
285
What are the typical findings in retinitis pigmentosa?
``` Waxy optic disc pallor Midperipheral pigment clumping Attenuated arterioles Hyaline bodies of the optic nerve PSC Keratoconus ```
286
Which type of photoreceptor suffers more damage in RP, rods or cones?
Rods (think night blindness)
287
What is the average age of diagnosis of RP?
9-19
288
What is choroideremia?
Diffuse, progressive atrophy of the choriocapillaris and RPE
289
What is the inheritance pattern of choroideremia?
X-linked recessive
290
Choroideremia has similar symptoms to what condition, but with a different fundus appearance?
RP
291
Fundus albipuncataus results in what symptoms?
Stationary night blindness
292
What is the characteristic appearance of fundus albipuncataus?
Numerous small, yellow-white dotlike lesions of the RPE in the midperiphery (spare the macula)
293
What macular changes may occur in RP that cause vision loss?
CME ERMs Atrophy
294
Pigmentary retinopathy is a side effect of what 2 antipsychotics?
Thioridazine | Chlorpromazine
295
Tamoxifen is known to have what ocular side effect?
Crystalline retinopathy
296
Roughly what percentage of patients with an acute, symptomatic PVD with have a retinal break?
10-15%
297
Where is the most common location for atrophic holes?
Temporal retina | sup>inf
298
What is the most likely area for a tractional retinal tear?
Superior temporal
299
What 2 things are defined as non-rhegmatogenous RDs?
``` Exudative RD Tractional RD (no retinal break) ```
300
Which is a bigger risk factor for RD, white without pressure or lattice degeneration?
Lattice
301
What is the most common cause of a tractional, non-rhegmatogenous RD?
Proliferative DM
302
What type of cells are proliferating in an ERM?
Glial cells in ILM
303
Who is the typical patient with CSR?
Male 20-50 with type A personality
304
Who is more at risk of developing wet AMD, myopes, or hyperopes?
Myopes
305
What is the end stage of dry AMD?
Geographic atrophy
306
What are the 4 risk factors that increase the likelihood of progression to wet AMD?
Multiple soft drusen Focal hyperpigmentation Hypertension Smoking
307
What is a Lacquer crak?
Spontaneous, large linear break in Bruch's membrane
308
What is the 5 year risk for developing wet AMD in the fellow eye?
40-85%
309
What is the change of CSR recurrence?
40%
310
At what VA should an ERM be treated?
20/50 or worse (>20/40)
311
What is the management for dry AMD?
Daily Amsler High-dose antioxidants for cat 3-4 AMD Low-dose antioxidants for cat 1-2 AMD Smoking cessation
312
What are the Tx options for wet AMD?
Thermal laser photocoagulation Photodynamic therapy (PDT) Anti-vegF (mainstream managment)
313
What retinal findings are present in stage 3 HTN retinopathy?
CWS | Hard exudates
314
Where are CWS typically found in HTN?
within 3DD of the nerve
315
HTN retinopathy results from a breakdown of what?
Blood-retinal barrier
316
A/V nicking would be given what HTN retinopathy grade?
Grade 2
317
What retinal findings are seen in stage 4 HTN retinopathy?
CWS Hard exudates Nerve swelling
318
What are Elschnig spots?
Focal areas of choroidal atrophy (white spot with black center)
319
What causes Elschnig spots?
Past occurrences of acute HTN
320
What is the main difference between diabetic retinopathy and hypertensive retinopathy?
Hypertensive usually presents with a "dry retina" - few hemorrhages, rare edema, but more CWS and vessel attenuation
321
CMV retinitis is most common in patients with a CD4 count less that what?
50
322
What is the classical presentation of CMV retinitis?
Hemorrhagic retinitis Thick, white-yellow patches of necrotic retina Vascular sheathing Hemes and CWS
323
In which retinal layer are flame hemes found?
NFL
324
In which layer of the retina are hard exudates found?
Outer plexiform layer
325
At what diastolic pressure should a pt be sent to the ER?
110-120
326
What 3 drugs have NAION as a potential side effect?
Sildenafil (Viagra) Sumatriptan (Imatrex) Amiodarone (Codarone
327
What are the common side effects of topical B-blockers?
``` Dry eye Depression Impotence Bradycardia Bronchoconstriction ```
328
What is the most common intraocular malignancy in children?
Retinoblastoma
329
What is the most common intraocular malignancy in all age groups?
Malignant melanoma
330
What is Coat's disease and its presentation?
``` Idiopathic peripheral vascular disease Unilateral telangiectatic, dilated vessels (light-bulb appearance) Marked hard exudates Intraretinal hemes Exudative detachment Neovascular glaucoma ```
331
Retinoblastoma arises due to a mutation of what gene?
Rb - retinoblastoma tumor suppressor gene
332
What are the 3 most common presenting signs of retinoblastoma?
Leukocoria Strab Iris neo
333
What finding in retinoblastoma increase the mortality rate?
Optic nerve invasion
334
How are large retinoblastomas treated?
Chemotherapy and enucleation
335
How are small retinoblastomas treated?
External beam radiotherapy Laser photocoagulation Brachytherapy Cryotherapy
336
Your patient presents with a focal, fluffy, yellow-white retinal lesion adjacent to an old scar with an overlying vitritis, what is the most likely Dx?
Toxoplasmosis
337
What type of organism is toxoplasmosis gondii?
Intestinal parasite
338
How is toxoplasmosis acquired?
Undercooked meet | Unpasteurized cheese
339
What is the triad for congenital toxoplasmosis?
Convulsions Cerebral calcifications Chorioretinitis
340
In Best's disease, which test will be abnormal?
EOG
341
What is the typical presentation of dominant (familial) drusen?
Scattered drusen throughout the posterior pole First 3 decades of life Bilateral and symmetric Appear at macula and around optic nerve head Pt is asymptomatic
342
When is the typical onset of Stargardt's?
Ages 6-10
343
What is the most common hereditary macular dystrophy?
Stargardt's
344
What is the typical presentation of Stargardt's?
Early stage: mild mottling and loss of FLR with VA decreased out of proportion to signs Late stage: Fish tail shape of yellow flecks leading to beaten-bronze macular appearance (Bull's eye maculopathy) Possible salt and pepper in the periphery
345
Which test is abnormal in later stages of Stargardts?
ERG
346
What is the difference between fundus flavimaculaltus and Stargardt's?
Fundus flavimaculatus doesn't have the macular dystrophy, but the other signs are present Patients are typically asymptomatic
347
What is the Tx for toxoplasmosis?
Oral pyrimethamine Systemic steroieds Folinic acid Sulfadiazine OR Clindamycin OR azithromycin
348
Indomethacin is known for what ocular side effect?
Pigmentary retinopathy
349
What are the 3 typical symptoms of ocular ischemic syndrome?
Gradual vision loss Dull periorbital pain/headache Amaurosis fugax
350
What are the 4 typical signs of ocular ischemic syndrome?
Unilateral dot/bot hemes in midperiphery Dilated, non-tortuous veins Narrowed arteries NVD and NVI
351
What is venous stasis retinopathy?
OIS without anterior segment findings (rubeosis)
352
What is the typical demographic for OIS?
Male, 50-70 years old
353
Total cholesterol should be less than how much?
200
354
What is the normal level of HDL?
40 or higher
355
What is the normal level of LDL?
<100
356
What is the normal triglyceride level?
<150
357
What are the high risk characteristics in diabetic retinopathy?
Neo of the disc > 1/4 DD | Any NVD or NVE with a vit heme
358
What is the leading cause of legal blindness in diabetes?
Macular edema
359
What is the ETDRS definition of CSME?
Retinal thickening within 500um of the foveal center Hard exudates within 500um of the foveal center Retinal thickening of at least 1DD
360
ETDRS recommends what Tx for CSME?
Focal argon laser
361
Patients with severe NPDR have a 10-50% chance of progression within the next __months.
12 months
362
What causes OIS?
Carotid or ophthalmic artery blockage >90%
363
What is the Tx for OIS?
PRP if any neo is present | Carotid Doppler and endarterectomy if needed
364
What is the prognosis for OIS?
Poor - Count fingers or worse after 1 year
365
What percent of eyes with CRVO's develop rubeoisis? When is it most likely to occur?
50% 2-4 months (think 90 day glaucoma)
366
What is Adie's tonic pupil?
Acute, dilated pupil with possible ciliary body impairment
367
What is the typical demographic for Adie's tonic pupil?
Female 20-40 | Possible complaints of light sensitivity and near blur
368
Argyll Robertson and Horner's pupils will demonstrate the most anisocoria in what lighting conditions?
Dark
369
A pre-ganglionic Horner's will dilate with what drug?
Cocaine
370
IIH can present with what signs/symptoms?
Headache CN 6 palsy Transient visual obscurations Enlarged blind spot
371
What 4 things may possibly cause IIH?
``` CANT Contraceptives Vitamin A Naladixic acid Tetracycline ```
372
What are Tx options for IIH?
Oral acetazolamide | weight loss
373
What is a potential serious side effect of oral acetazolamide?
Aplastic anemia
374
Oral acetazolamide can cause what type of refractive shift?
Transient myopic shift
375
What is the typical presentation of optic neuritis?
Young female Sudden, unilateral vision loss (mild to severe) APD Pain on EOM (90%) Visual field defect (usually central scotoma) Uthoff's sign
376
What conditions can cause optic neuritis?
``` MS Syphilis Cat-scratch disease Lyme Meningitis Sarcoidosis SLE Devic's disease ```
377
What is normal sed rate for a female?
(age + 10) / 2
378
What is normal sed rate for a male?
age / 2
379
What is the normal level of C-reactive protein?
0-1.0mg/dl
380
How is Leber's optic neuropathy inherited?
Mitochondrial DNA
381
How does Grave's disease cause vision loss?
Optic nerve compression from thickened EOMs
382
What is the Tx for optic neuritis?
IV steroids and Interferon beta
383
After an acute bout of optic neuritis, when does the vision generally return to normal?
2-3 months
384
While vision will return to normal after acute optic neuritis, what are the lasting effects?
Reduced contrast sensitivity | Optic nerve head pallor
385
What causes internuclear ophthalmoplegia?
Lesion of MLF
386
What is the presentation of INO?
Adduction deficiency on affected side | Abduction deficit on contralateral side
387
What is the typical demographic of Grave's disease?
Middle aged to elderly female
388
What are the classical signs of Grave's?
Dry, red eyes Conj injection Proptosis Diplopia
389
What are the systemic symptoms of hyperthyroid?
``` Weight loss Nervousness Heat intolerance Heart palpitations Increased bowel movements Breathlessness ```
390
What testing should be done for Grave's disease?
``` TSH, T3 and T4 levels Orbital CT or MRI, looking for inflamed EOMs Exophthalmometry VF, looking for optic nerve compression Forced ductions ```
391
Brown's syndrome will cause diplopia in what gaze?
Upgaze, especially in adducted upgaze
392
In what order are the EOMs restricted in Grave's?
``` IMSLO Inferior rectus Medial rectus Superior rectus Lateral rectus Obliques ```
393
What is Kocher's sign?
The stare appearance in Grave's
394
What is Gunn's sign?
Retinal crossing changes, typically found in HTN retinopathy
395
What is the primary Tx for early Grave's?
Ocular lubricants
396
What is the Tx for late stage Grave's?
Orbital decompression, radiation, steroids (oral or IV)
397
What are the signs of Grave's disease, in order as they occur?
``` NO SPECS No signs/symptoms Only signs of lid retraction/lag/stare Soft tissue signs/symptoms (lid edema, lag, chemosis) Proptosis EOM enlargement Corneal involvement Sight loss - optic nerve compression ```
398
What class of medication is Verapamil?
Ca channel blocker
399
What conditions is verapamil indicated?
HTN Angina Arrhythmia
400
What is the Tx for AAION?
IV or oral steroids long term, tapered over 3-6 months
401
What are the classic signs/symptoms of AAION?
``` Unilateral, profound vision loss Swollen optic nerve Jaw claudication Scalp tenderness Malaise Anorexia Temporal headache ```
402
What is the typical demographic for AAION?
Over 55
403
Which condition typically has a "disc at risk", AAION or NAION?
NAION
404
Sed rate and CRP will be normal in which condition, AAION or NAION
NAION
405
What is the typical VF loss in NAION?
Altitudinal
406
If GCA is not treated, what sequelae is most common?
Progression of vision loss to the other eye
407
What are the potential side effects of oral steroids?
``` Poor BS control IOP spike Cataract Cushing's syndrome Poor wound healing Risk of secondary infections ```
408
What demographic does ocular myasthenia typically effect?
Young women | Old men
409
When are ocular MG symptoms the worst?
End of the day
410
What are the ocular signs/symptoms of MG?
Diplopia (EOM involvement) | Ptosis (levator involvement)
411
What are the potential systemic signs of MG?
Dysarthria (difficulty talking) Dysphagia (difficulty eating) Difficulty holding head upright Respiratory failure
412
What class of medications can make MG worse?
Beta-blockers
413
Internuclear ophthalmoplegia is usually found in patients with what systemic condition?
MS
414
If a patient has a superior oblique palsy, which way will their head be tilted?
Away from the affected side
415
What test is done to confirm ocular MG?
Tensilon test
416
What medication is used in the Tensilon test?
Edrophonium
417
What is the antidote for the Tensilon test, should a patient have an adverse reaction?
IV atropine
418
Why should thyroid testing be done in a patient with MG?
Thyroid disease occurs in about 5% of MG patients
419
What class of medication is tamsulosin?
Alpha-1 blocker
420
What is the Tx for MG?
Pyridostigmine and/or immunosuppressants
421
A chiasmal lesion can result in what VF defect?
Bitemporal hemianopsia | can be inferior, superior, central, or complete
422
Why does a chiasmal lesion typically cause bitemporal involvement?
Compression of nasal fibers
423
What are the most common causes of chiasmal lesion?
Suprasellar meningiomas Aneurysm of ICA Craniopharyngioma Glioma
424
Where would a lesion be located that is causing a homonymous inferior quadrantonopsia?
Parietal lobe
425
Where would a lesion be located that is causing homonymous superior quadrantanopsia?
Temporal lobe
426
What VF defect would be expected in toxic/nutritional optic neuropathy?
Central or centrocecal
427
If a patient has an occipital lobe lesion, what VF defect would you expect?
Homonymous and congruous
428
What VF defect may be present due to tilted disc syndrome?
Pseudo-bitemporal hemianopsia that does NOT respect the midline
429
What type of lesion will give a VF defect that respects the midline?
Chiasmal
430
What lesion would cause a macula only homonymous VF defect?
Lesion at tip of occipital lobe
431
What is the typical demographic for pigment dispersion syndrome?
20-45 year old myopic male
432
What is the typical presentation of Posner Schlossman syndrome?
Open angle Few cells IOP >40
433
What findings characterize Fuch's heterochromic iridocyclitis?
Non-granulomatous, fine KPs | Low grade, asymptomatic chronic uveitis
434
What is the MOA for prostaglandin analogs?
Increased uveoscleral outflow
435
What is the MOA for Beta-blockers?
Decreased aqueous production
436
What is the MOA for Alpha-agonists?
Decreased aqueous production | Increased uveoscleral outflow
437
What is the MOA for Pilocarpine in glaucoma?
Increased TM outflow
438
What is the MOA for CAIs ?
Decreased aqueous production
439
Which glaucoma gtts should not be used in patients with a sulfa allergy?
CAIs
440
How should pigmentary glaucoma be treated?
IOP lowering gtts - but may be harder to control, as the amount of pigment being disbursed varies ALT is very effective
441
What is the cause of glaucoma in pseudoexfoliation syndrome?
Deposits accumulating in the TM
442
A patient with lung problems and glaucoma should not be given which class of IOP meds?
Beta-blocker
443
What does a high PSD on VF indicate?
"lumpy" hill of vision with focal loss
444
What is the default spot size in VF testing?
III
445
After 5 years, what is the chance of progression from ocular hypertension to POAG?
9.6%
446
Which has a larger treatment spot size, ALT or SLT?
SLT
447
Drance hemes are typically associated with which type of glaucoma?
NTG
448
What steroid is found in Maxitrol?
Dexamethasone
449
Which cranial nerve is most susceptible to trauma?
CN 4
450
What is the initial Tx of an orbital blow-out fracture on day 1?
Nasal decongestants (don't blow nose!)
451
What is absolute hyperopia?
The amount that can't be overcome by accommodation
452
Which of the topical steroids is ester based?
Lotoprednol
453
How long does it typically take for a steroid response to occur?
30 days
454
NTG can be associated with what type of headaches?
Migraines
455
NTG is more common in persons of which decent?
Japanese
456
Which class of IOP lowering drop is contraindicated in a patient with a history of HSK, CME, or complicated cataract surgery?
Prostaglandin analogs

KMK Part 2 (1 decks)

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