Key Points 13 Flashcards
How to manage refractive accommodative esotropia?
In all cases of accommodative esotropia, full hyperopic correction is warranted immediately. Penalization with atropine may be useful in cases of non-compliance with spectacles and/or patching therapy. Bifocals may be of value with high AC/A ratios with a residual turn at near after full distance correction and an acceptable distance alignment.
What are the histopathological findings in Map Dot corneal dystrophy?
thickened epithelial basement membrane, duplication of the basement membrane and fibrillar material between the basement membrane and Bowman’s layer.
What directions of gaze restriction does orbital floor fracture produce?
vertical limitations of gaze
What are ocular features of congenital esotropia?
large angle esotropia, usually greater than 30 PD
onset usually during the first few months, by definition by 6 months of age
cross-fixation may be present
latent nystagmus
dissociated vertical deviation (in up to 60%-70%)
inferior oblique overaction with V-pattern esotropia (in up to 60%-70%)
mild hyperopia, + 1.00 to + 2.00 D
Overall, the risk of an endothelial graft rejection episode following penetrating keratoplasty is:
20%
Features of Wolfram syndrome?
AR inheritance
severe optic atrophy
diabetes insipidus
diabetes mellitus
ataxia
seizures
mental handicap
short stature
endocrine abnormalities
which condition causes a net-like abdominal rash?
Livdo reticularis consists of a mottled reticulated vascular pattern that appears as a lace-like purplish discoloration of the skin, often on the abdomen. It is caused by obstruction of capillaries with thrombi. It may be caused by a number of conditions including connective tissue diseases such as polyarteritis nodosa, SLE, dermatomyositis and rheumatoid arthritis.
A patient suffers a severe road traffic accident requiring intensive care admission but makes a good recovery. He complains of excessive sweating and flushing every time he eats.
What is the diagnosis?
Frey’s syndrome, where there is aberrant regeneration of the 9th cranial nerve, with synkinesis between salivation fibres and sympathetic fibres. This causes flushing and sweating when eating.
Which systemic condition is associated with Fuchs’ heterochromic cyclitis:
Parry-Romberg syndrome (hemifacial atrophy) is found in a small proportion of cases of Fuch’s heterochromic cyclitis.
The most common juvenile-onset macular dystrophy
Figure: Stargardt’s disease showing macula RPE changes and pisciform flecks in the mid-periphery from lipofuscin deposition (fundus flavimaculatus)
A patient has complete inability to recognise faces. A lesion in which area is most likely to explain his symptoms:
prosopagnosia: bilateral inferior occipito-temporal junction
What are the features of X linked juvenile retinoschisis?
cleavage of the retina at the nerve fiber layer
inverted ERG (selective attenuation b wave)
EOG and dark adaptation are normal or subnormal
macular microcysts and radiating retinal folds, but no FFA leakage
peripheral schisis usually develops later
vitreous veils and strands can lead to vitreous haemorrhage
What is the definition of CSMO?
hard exudate within 500 microns of the center of the macula with adjacent thickening of the retina.
an area of retinal thickening >1 disc area, any part of which lies within 1 disc diameter of the center of the macula
any thickening within 500 microns of the center of the fovea.
Which factor is most strongly correlated with the development of choroidal effusion following panretinal photocoagulation?
Shorter eyes have greater resistance to fluid efflux from the suprachoroidal space. The percentage of retinal surface area treated is a very important factor and represents the combined effect of total treatment area and the size of the eye.
Which portion of the iridocorneal angle is usually the easiest for distinguishing landmarks on gonioscopy?
The inferior angle (viewed through the superior mirror on a Zeiss gonioprism lens) is usually the widest and is generally considered the easiest portion for distinguishing landmarks.
What retinal degeneration is LEAST likely to cause a retinal detachment:
Pavingstone degeneration is an innocuous finding, occurring in 25% of normal eyes. Other options can be associated with retinal detachment.
What condition is pigmentary retinopathy seen in?
suggests the possibility of rod-cone dystrophy, which needs to be excluded by electrophysiology. Dark-adapted ERG is the most specific test for rod function.
What are the features of morning glory disc?
unilateral
dense amblyopia
RAPD may be present
excavated optic nerve head
overlying glial proliferation
retinal vessels originating from the periphery of disc radiating out
surrounding retina often thrown into folds
associated with retinoschisis and retinal detachment
What conditions cause RPE degeneration?
Hunter’s, Hurler’s, Sanfilippo’s, and Scheie’s.
Which orbital deposits are hyperintense on T1 images?
blood
melanin
mucous
Which is the most common corneal stromal dystrophy?
Lattice dystrophy
A 26-year-old man suffers a traumatic globe rupture. Following repair, he is left aphakic and with silicone oil in situ for repair of a retinal detachment. On day 3, he develops early pupil block glaucoma.
How would you manage this?
Early pupil block glaucoma may occur following silicone oil insertion, particularly in aphakic patients with an intact iris diaphragm. This can be avoided or treated by an inferior iridotomy to allow aqueous to flow.
What is the most severe form of retinitis pigmentosa?
Autosomal dominant is the most common form of RP and has the best prognosis. AR is less common and has an intermediate prognosis. X-linked is the least common but most severe form, which may result in complete blindness by the third or fourth decades.
The most common pathogen in children with orbital cellulitis is:
S Aureus
Orbital dermolipomas are most commonly found:
present at birth and may enlarge over time but are almost always asymptomatic. They are a pink to yellow, soft, rounded mass located sub-conjunctivally at the upper lateral canthus. It may extend posteriorly or anteriorly toward the limbus.
The most common complication of retinal cavernous haemangioma is:
vitreous hemorrhage, which is presumed to be secondary to traction. Leakeage or exudation from retinal cavernous haemangiomas is very rare.
Where are saccades controlled in the brain?
contralateral frontal lobe.
Where are pursuits controlled in the brain?
ipsilateral parietal lobe.
A 10-year-old boy is noted to be accident prone in the dark. He complains of difficulty with vision in bright lights. The first year ophthalmology resident mentions a peculiar pattern of pigmentation in the retinal periphery.
What is the most likely diagnosis?
enhanced S-cone syndrome. This is an autosomal recessive condition with hyperfunction of the S-cones (short wavelength or blue cones) and variable impairment of L- and M-cone functions and rod dysfunction. Patients present with nyctalopia in childhood and hemeralopia (inability to see clearly in bright light). Some patients have hyperpigmentation at the mid-peripheral retina.
Score: 50 %
The lesions of multiple evanescent white dot syndrome (MEWDS) are best described as:
granular foveal appearance with small (100-200um) gray-white spots at the level of RPE in the posterior pole outside the fovea
