Inservice 2015 (general review)

Question 1

Trauma to medial eye with Epiphoria concerning for lacrimal injury. How do you test this?

Answer 1

Jones testing - for checking for obstruction of lacrimal system. Positive = it is open (no obstruction)

* I = fluorescein into eye, check for fluor in inferior meatus in nose, 
* II = saline into ducts, check for saline in nose

 Tx: Dacryocystorhinostomy = makes a connection between the lacrimal sac and nose

Question 2

Positive Jones testing. What does it mean?

Answer 2

Positive = it is open (no obstruction)

Question 3

You are evaluating a patient for ptosis. What is normal levator function?

Answer 3

> 10mm

5-10 is fair

Question 4

Treatment for severe ptosis and poor levator function

Answer 4

Frontalis suspension

Question 5

Treatment of moderate ptosis and fair levator function

Answer 5

Levator advancement

Question 6

Treatment for mild ptosis and good to fair levator function

Answer 6

Muller muscle resection

Question 7

Treatment for mild ptosis and good levator function

Answer 7

Fasanella-Servat = resection of the posterior lamella

Question 8

What are the types of ptosis?

Answer 8

Involutional/senile - (most common)
Mechanical - edema or tumor
Neurogenic (CNIII palsy, Horner Syndrome, Marcus Gunn jaw-winking syndrome)
Myogenic (Myasthenia gravis, myotonic dystrophy, mitrochondriopathy)
traumatic
congenital
neurotoxic (snake bites, botulism)

Question 9

What are the characteristics of involutional ptosis?

Answer 9

elderly, high crease, thinned upper eyelid, lid drop on downward gaze

Question 10

Botox injection causing lid drop. tx?

Answer 10

Apraclonidine - alpha2 receptor agonist to increase muscle tone of Muller muscle to compensate for paralyzed levator

Question 11

The layers of tears

Answer 11

Tears are trilaminar

1. Precorneal - mucin goblet cells - mucin promote dispersion
2. Middle - lacrimal gland - aqueous layer with water and proteins to promote osmotic regulation and antimicrobial properties
3. Outer - Meibomian gland lipid layer to prevent evaporation

Question 12

Jones 1 is performed and no fluoresceine is seen in the inferior meatus. What does this mean?

Answer 12

Jones 1 negative = no fluorescein in the inferior meatus = there is an obstruction in the nasolacrimal duct. There is a high rate of false-negatives so a Jones 2 will need to be performed to test this

Question 13

Jone 2 is performed and fluoresceine is seen in the inferior meatus. what does this mean?
Fluor is seen refluxing through the superior punctum?
Saline irrigation is seen at the inferior meatus but no dye?
Saline refluxing around the irrigator?

Answer 13

1. There is a partial obstruction somewhere
2. There is an obstruction at or distal to the lacrimal sac
3. No dye reached the lacrimal sac so there is an obstruction of the punctum or cannaliculus
4. Obstruction at the cannaliculus