KMK Ocular Disease Flashcards
(305 cards)
1
Q
Sclerotic scatter
A
Evaluate corneal clarity.
illuminate a parallelepiped beam 60 on temporal limbus.
Observe with naked eye.
When someone is naked, people scatter!
2
Q
Specular reflection
A
Evaluate corneal endothelium and lens surfaces.
1mm wide beam, Oculars should be set directly in front of patient and beam should be at 45-60 degree away. Set the beams at equal incidences.
3
Q
Indirect illumination
A
Used to evaluate non-opaque corneal lesions such as micro cysts.
4
Q
Good way to detect fleisher rings in KCN
A
Use cobalt blue filter without dye
Will appear black
5
Q
Alkali burns are __x more common than acidic
-Common agents
A
2x
Alkali: Ammonia, fertilizer, cleaning agents, lye, drain cleaners, magnesium hydroxide, fireworks, lime, cement, airbag residue,
Acidic: Glass polisher, rust remover, battery acid, PAVA spray.
6
Q
Most common cause of alkali burns
A
Calcium Hydroxide
7
Q
K defect with no SEI
A
Corneal abrasion
8
Q
Vossius ring
A
pigment ring on the anterior lens capsule due to trauma. iris smacks lens. Likely will see this with hyphema.
9
Q
Examples of positive forced ductions
A
Graves
Browns
Duanes
Orbital floor fracture
10
Q
Commotio retinae
A
Disruption of RPE and outer segments of PR cells
Resolves within 3-6 weeks
Berlins edema in macula
11
Q
Iridodialysis difference from angle recession
A
Iridodialysis- Disinsertion of the iris root from the CB
Appears as peripheral iris hole on retro
Monitor for angle recession glaucoma due to possible TM damage secondary to trauma
12
Q
What can occur if orbital cellulitis is not treated?
A
Cavernous sinus thrombosis, brain abscess or meningitis.
Diabetics and immunocompromised can develop mucormycosis, an aggressive fungal infection. Black necrotic tissue in mouth and nose.
13
Q
TED is related to what other systemic conditions
A
MG
14
Q
What do these mean in TED
- Von Grafes sign
- Dalrymple’s sign
- Kocher’s sign
A
- Von Grafes sign: Upper eyelid lag during downgaze.
- Dalrymple’s sign: Staring appearance
- Kocher’s sign: Globe lag compared to lid movement when looking up.
15
Q
Hertel Exophthalmometry norms
A
Asians: 12-18
Caucasians: 12-22
AA: 12-24
No more than 3mm asymmetry.
16
Q
Most common benign orbital tumor in children
A
Capillary hemangioma
Rapid growth and spontaneous involution
17
Q
Most common benign orbital tumor in adults
A
Cavernous hemangioma
4th-6th decade, females
Progressive, painless, unilateral proptosis.
Tumor usually arises in the muscle cone.
18
Q
Yellow/white tumor of astrocytes
A
Neurofibroma
19
Q
Optic nerve glioma/juvenile pilocytic astrocytoma
A
Most common intrinsic tumor of the ONH
Common ages 2-6
NF type 1
20
Q
Most common benign brain tumor
A
Meningioma
Middle age women
21
Q
Most common primary and secondary pediatric orbital malignancy
A
Rhabdomyosarcoma
Neuroblastoma- most commonly arises from tumor in the abdomen, mediastinum, or neck (associated horners)
22
Q
Orbital pseudotumor/idiopathic orbital inflammatory syndrome
A
Rare, may be acute, recurrent or chronic.
Young to middle age patients.
Impacts any soft tissue in the orbit. Appearance can vary significantly depending on the orbital tissue involved.
Acute onset of unilateral pain, red eye, diplopia, and decreased vision.
Chemosis without itching Increased IOP Swelling of tendons and muscles Hyperopic shift Lacrimal gland and sac inflammation
Bilateral? Lymphoma or systemic vasculitis (wegener’s, PAN)
23
Q
Chemosis without itching? think
A
Think orbital cause.
Cavernous sinus fistula or IOIS
24
Q
Tolosa Hunt
A
Idiopathic orbital inflammation that can affect the cavernous sinus and SOF
Acute and painful exophthalmoplegia due to ipsilateral palsies of CN 3, 4, and 6.
Loss of sensory innveration may also occur since V1 and V2 travel thru the SOF.
25
Anophthalmos
Absence of ocular tissue within the globe
26
Enucleation, evisceration, and exentration
Removal of globe
removal of inner contents of the eye- leave sclera
Removal of all contents of the orbit, including EOMs and orbital fat.
27
Signs of rosacea
Papules on the cheek and forehead with telangiectasia and rhinopehyma (sebaceous gland hypertrophy of the nose) and facial flushing.
Facial flushing may occur with triggers such as alcohol, exertion, spicy foods, caffeine and increased sun exposure.
can cause ocular rosacea- inspissated meibomian glands, phlyctenules, staph marginal keratitis, SPK corneal neo and dry eye
28
Medications that can cause contact dermatitis
```
Aminoglycosides- Tobragent30
Trifluridine
Cycloplegics
Glaucoma meds
Preservatives
```
PERIORBITAL swelling
29
When do you see periorbital swelling
Contact dermatitis
30
Ocular cicatricial pemphigoid
65 year old female subacute onset
Idiopathic mucous membrane disorder that commonly affects the oral and ocular mucous membranes
Type II hypersensitivity due to autoantibodies targeting conj basement membrane.
Can be induced by timolol, epinephrine or pilocarpine.
Sym/ankyloblepharon
Entropion and trichiasis with ulceration, neo, and keratinization.
31
SJS
Type 3 or 4 hypersensitivity that affects mucous membranes.
Due to sulfa drugs, penicillin, aspirin, barbiturates, tetracyclines, NSAIDs or infections (herpes, adenovirus)
Acute phase 2-4 weeks, can be chronic.
Prodrome, diffuse erythema or bullseye lesions, papule on the palms of hands and feet.
Severe, bilateral conjunctivitis with pseudomembranes.
32
Which 2 syndromes cause symblepharon
```
Steven Johnsons (type 3 or 4)
Ocular Cicatricial pemphigoid (type 2)
```
33
2 types of blepharitis
Staph and seborrheic
Seborrheic is associated with less lid inflammation, more oily, greasy scales with flaking and more eyelash loss.
Patients often asymptomatic, but may report vision that clears after blinking, burning, itching or foreign body sensation.
34
Milia
Due to occlusion of sweat pores or pilosebaceous units
35
Ectropion most common causes and signs
```
Age related (involutional- Loss of muscle tone of the orbicularis oculi)
Bells palsy
```
Signs- exposure keratopathy, epiphora, brow ptosis
36
Entropion signs and causes
1. Involutional
2. Cicatricial:
Trachoma- leading cause of blindness world wide
SJS
OCP
Chemical burns
Mild punctate keratitis to corneal ulceration and panes
37
Floppy eyelid syndrome
Loss of elasticity in the tarsal plate, poor CT. Face down sleeping at night.
Mechanical trauma to arsal plate.
Friction --> papillary conjunctivitis
think LOW O2. this can lead to NTG, NAION
38
Meige's syndrome
Benign essential blepharospasm + lower face abnormalities
39
Most common precancerous skin lesion
Actinic keratosis, precursor to squamous cell
Elevated, pink or red. Scaly lesion on sun-exposed skin that does not heal.
25% develop in SCC
40
Main difference in appearance between basal and squamous cell
Basal cell has telangiectasia, squamous cell does not.
41
Keratocanthoma lifespan
Sun exposed areas with early appearance similar to BCC and SCC (central plaque)
Grow very quickly and then slowly shrink- spontaneously resolve.
42
Sebaceous gland carcinoma. If greater than 2mm, mortality rate is
60%
| Overall is 10%
43
Once a malignant melanoma has been diagnosed, the two most important prognostic factors are
Depth of invasion and size of lesion
44
Dacryoadenitis
| What causes the acute and chronic presentations? Which is more common
Acute- infection
| Chronic- inflammatory disorders such as sarcoid, TB, graves. This is more common
45
S shape ptosis
Dacryoadenitis
46
How to know if actinomycetes israellii caused canaliculitis
Yellow sulfur granules after expression
47
What causes conj concretions
| -other name
Ocular lithiasis
| Friction of mucous and epithelium + calcium
48
Primary Acquired Melanosis PAM
Precursor to malignment melanoma, 30% progress.
Unilateral acquired pigmentation with indistinct margins
on the conj
Common in elderly white people
49
#1 precursor to conjunctival melanoma
PAM
| Primary acquired melanosis
50
Conjunctival intraepithelial neoplasia (CIN)
AKA Bowens
AKA Conjunctival squamous dysplasia
Most common conj neoplasia
premalignant to squamous cell carcinoma (risk is low if BM remains intact)
Elevated, gelatinous mass with neo and keratinization.
95% at the limbus within the interpalpebral fissure.
51
Most common conj neoplasia
CIN
52
What is premalignant to squamous cell carcinoma
CIN
| Conjunctival intraepithelial neoplasia
53
Pyogenic granuloma
Pedunculated, benign, red, vascular lesion of the palpebral conj due to surgery, trauma, or infection.
Pyro think red= pyromaniac
54
What bacteria causes simple bacterial conjunctivitis in adults and kids
Kids- H influenza (gram negative)
| Adults- Staph aureus (gram, catalase, coagulase positive)
55
Most adenovirus infections result from what
Upper respiratory tract or nasal mucous infection.
There are over 45 serotypes 1/3 are associated with eye infections
Transmission occurs from direct contact, ocular secretions, equipment.
56
All 3 adenoviral syndromes are associated with
Follicles, pseudomembranes, and diffuse conjunctival hyperemia.
Most follow from a systemic viral infection.
57
Toxic causes of follicles
Molluscum, parinauds catscratch, phthiriasis palpebraum (public lice)
58
Acute non specific follicular conjunctivitis
| -serotypes
1-11 and 19
Most common
-Diffuse red eye, inf follicles, tearing, mild discomfort
59
PCF viral conjunctivitis
| -Common serotypes
```
Pharyngoconjunctival fever
3-5 and 7
More commonly affects children
HIGHLY contagious
Triad: Fever, follicles, pharyngitis (sore throat)
Rare corneal involvement
```
60
EKC
| -serotypes
Most serious form of adenovirus conjunctivitis.
8,19,37
Pain and corneal involvement !!!!!! Other 2 types of viral conjunctivitis do not have corneal involvement (80%)
pre-auricular lymphadenopathy
Serotype 8, 80% corneal involvement, symptomatic 8 days after exposure, 8 days after that --> SEI's, non contagious.
61
Presence of a palpable node in a patient with suspected adenoviral infection is always pathognomonic for ___
EKC
62
2 types of allergic conjunctivitis
Seasonal and perennial (less common type 1 rxn. Year round response to household allergens like dust)
63
VKC
8 year old boy with asthma or eczema.
Seasonal outbreaks during warm months
Superior HUGE cobblestone papillae that can cause a shield ulcer on the cornea. May also see truants dots- papillae on the limbus.
64
AKC is what type of hypersensitivity reaction
1 and 4
65
do follicles or papillae contain a central vessel
Papillae
serves as the source of infiltration of eosinophils, mast cells, neutrophils and lymphocytes.
Associated with allergies, bacteria, and friction. q
66
GPC is most likely to occur with which CL material
| GPC can occur due to what other sources?
SiHy due to high amount of protein deposits.
But can also occur due to sutures, blebs, scleral buckle, prosthetic.
67
CL solution reactions. What are the two most toxic types
Thimerosal and chlorhexadine
68
3 causes of SLK
CL
Dry eye
Thyroid
** all related to friction ***
69
Classic complication of CLs that ride too high
| Classic complication of CLs that ride too low
High- Corneal warpage
| Low- 3 and 9 o clock staining
70
SEAL: Superior epithelial arcuate lesion
Superior corneal staining
| secondary to tight extended wear hydrogel CLs
71
Keratoconjunctivitis
Implies simultaneous inflammation of the cornea and conj.
72
Adult inclusion chlamydia is due to serotypes ___
| How do you treat?
D-K
1000mg 1 dose
Doxycycline
73
3 conditions with swollen pre-auricular nodes
Gonnorhhea
Chlamydia
EKC
74
Signs of adult inclusion conjunctivitis
```
Inferior follicles + some papillae.
Chronic, lasting 3-12 months.
May spread bilaterally.
Sub epi infilatrates.
Pain with urination
Node inflammation
```
75
Trachoma serotypes and symptoms
```
A-C trAChoma
Bilateral
Superior follicles + some papillae
Arlt's line and herberts pits
Pannus
Node involvement
3rd world country, poor country
```
76
Leading cause of preventable blindness worldwide
Trachoma
77
Phlyctenules
due to what
-location
-what is it made of
Type 4 hypersensitivity reaction to staph
-bleph is the most common culprit
Ask if they have a history of Tb
Can be on the conj or cornea.
Made of lymphocytes
78
Common cause of parinauds ocularglandular syndrome
| -Symptoms
Cat scratch fever is the most common cause- caused by bartonella henselae.
"paranoid about cats"
Unilateral granulomatous, swollen nodes, conjunctivitis.
79
Signs of Phthiriasis palpebrarum
Pubic lice- transparent lice and white nits attached to the eyelashes. Blood tinge debris on lids and lashes
Pre-auricular lymphadenopathy
80
pinguecula/pterygium
- Etiology
- What does it do to the conj/K
UV light exposure or chronic dryness
Degeneration of collagen fibers.
Damages Bowman's membrane on the cornea, leading to WTR astigmatism.
stockers line (iron deposits) may be present at the leading edge
81
Stockers line is seen when
Pterygium
82
Causes of episcleritis and presentation
70% idiopathic
Other causes: Collagen vascular/inflammatory diseases (RA, SLE, UCRAP)
Unilateral, sectoral injection, 80% simple 20% nodular,
83
Groupings of scleritis
1. Necrotizing (15%)
- Necrotizing with inflammation (5%)
- Necrotizing without inflammation (10%)(scleromalacia perforans)
2. Non-Necrotizing (85%)
- Diffuse (60%)
- Nodular (25%)
84
Most common form of scleritis
Diffuse scleritis
85
Worst form of scleritis
33% die within a few years due to autoimmune disease
Signs
Necrotizing with inflammation
| May cause peripheral K melt, keratitis, scleral thinning, anterior uveitis, cataracts, secondary glaucoma.
86
Necrotiazing without inflammation is due to
Chronic RA
| Asymptomatic, gray-blue patches of scleral thinning due to exposure of underlying uvea
87
Episcleritis and scleritis
- Unilat or bilat
- causes
- Onset
Episcleritis is unilateral
- 70% idiopathic, other causes due to collagen vascular diseases like RA, SLE, or UCRAP.
- acute
Scleritis is bilateral.
- 50% due to systemic autoimmune conditions like vascular disease (RA) or Wegener's Granulomatosis.
- Gradual onset
88
What a seg infection has severe, boring pain that radiates to forehead and awakens pt at night
Scleritis
89
Axenfeld loop
LPCN from nasocil (LINES)
| Congenital anomaly. Focal, pigmented, elevated area.
90
What occurs secondary to the breakdown in blood aqueous barrier
Uveitis
91
50% of patients with uveitis are __ positive
HLA-B27
70% if the condition recurs.
Usually related to ankylosing spondylitis.
92
HLA-B27
```
U ulcerative colitis- IBD
C Chrons
R Reiters
A Ankylosing
P psoriatic arthritis
```
93
Acute anterior uveitis is less than __ duration
3 month
94
Why does anterior uveitis cause pain?
Congestion and irritation of the anterior ciliary nerves.
95
Anterior uveitis is based on the presence of
White blood cells in the anterior chamber
96
Anterior uveitis main threats to vision
PS, PAS, CME, cataracts (PSC)
97
Granulomatous uveitis presenttion
Mutton fat KPs- macrophages
Koeppe nodules- granulomatous AND non granulomatous
Busacca nodules
98
Stellate KP's are found in what diseases
Fuch's heterochromic iritis
| Herpetic uveitis
99
Bechet's is common in who
Young adults of asian and middle eastern descent.
Hypopyon, mouth ulcers, genital ulcers.
100
Glaucomatocyclitic crisis/Posner-Schlossman
Unilateral
Mild iritis with recurrent, self limiting episodes of elevated IOP
Secondary to traubeculitis
101
3 major conditions that will present with unilateral cells in the anterior chamber with acute elevated IOP (30-50)
Posner Schlossman
Herpes zoster / simplex
Fuch's
102
Chronic granulomatous uveitis is usually associated with
Sarcoid- AA females, abnormal chest scan, elevated ACE levels.
TB- Positive PPD test, abnormal chest x ray, night sweats.
Herpes simplex/zoster- Stellate KPs
Syphilis: may have interstitial keratitis (stromal inflammation without primary involvement), maculopapular rash
103
Most common cause of interstitial keratitis
Congenital syphilis, TB, and herpes simplex.
Stromal inflammation WITHOUT primary involvement of epithelium or endothelium.
Acute stromal edema and neo
104
Congenital syphilis triad
Hutchinson's teeth (small, widely spaced), deafness and IK
105
Why does posterior uveitis sometimes result in WBCs in the vitreous and sometimes not?
Inflammation of retina--> breakdown in blood retinal barrier --> WBC in vitreous. Pts may have floaters and decreased VA.
Inflammation of the choroid without significant involvement of the retina (like histoplasmosis) does not affect blood retinal barrier and pt will not have a vitritis.
106
Most common cause of posterior uveitis in the US
| How do they contract it
Toxoplasmosis
90% contracted through transplacental transmission if the mother contracts it during pregnancy. May result in convulsions, cerebral calcifications, and retinochoroiditis. Most cases are mild and just have chorioretinal scar.
10% acquired from cat feces and/or undercooked meat.
107
Most common scenario of toxoplasmosis recurrence
Recurrence of an old, stable, congenital lesion is the most common cause of infectious retinitis.
at 25 years old, pt will have unilateral redness, photophobia, floaters, uveitis, vitritis, and decreased VA.
Focal fluffy retinal lesion adjacent to old inactive scar with overlying vitiritis (HEADLIGHT IN THE FOG)
108
headlight in the fog
Toxoplasmosis
109
Sarcoid panuveitis findings
Cotton ball opacities (retinitis)
Candle wax drippings (vasculitis)
```
Others:
Dacryoadenitis
Dry eye
Chronic, bilateral, granulomatous uveitis
CN VII palsy
ON disease !!!!!!!!!!!!!
```
110
Iris coloboma usually located in which quadrant
Inferior nasal
May see coloboma elsewhere- CB, zones, choroid, retina, ON
111
Iris malignancy
| -What layer of the iris, what location and what are concerning signs
Stroma, inferior, feathery margins, greater than 3mm
Can be pigmented or amelanotic
112
Dellen
Area of cornea that wets poorly, leading to stromal dehydration and corneal thinning.
Dye will POOL
Adjacent to areas of elevation
113
Exposure keratopathy is due to which 2 things
CN 7- bells, CVA, aneurysm, MS, herpes
Orbicularis oculi- eyelid surgery, TED, nocturnal lagophthalmos, floppy eyelid
114
Most common cause of filamentary keratopathy
Dry eye
| Composed of degenerated epithelial cells and mucous
115
How does UV keratitis cause damage to the K?
Excessive absorption below 300nm can cause hyperactiviation of K+ Channels (very sensitive to pH)
Loss of intracellular K+ results in cell death
116
Which 2 tests are diagnostic for evaporative dry eye
Meibomography, expression of meibomian glands.
117
All types of dry eye are characterized by which of the following?
Tear hyperosmolarity, tear film instability.
| AKA increased tear osmolarity, decreased TBUT
118
Hydrops vs bullae. What layer are they in?
Hydrops is due to KCN. Tears in descent's membrane that results in edema and rupture of the epithelium.
Bullae is edema in the epithelium due to due Fuchs.
119
Three types of tearing.
| How does Schirmer testing isolate them?
Reflex, basal, emotional
Schirmer 1 is WITHOUT anesthetic and measures all three types of aqueous secretions. Normal is >10mm in 5 mins.
Schirmer 2 is WITH anesthetic and only measures the basal aqueous secretions. Normal is >5mm in 5 minutes.
120
How does an increased in tear hyperosmolarity contribute to dry eye?
Results in an inflammatory cascade that damages the ocular surface and releases inflammatory mediators into the tears.
Both types of dry eye cause hyperosmolarity.
Abnormal: Greater than 308 or 8 difference between each eye.
121
Prolopased orbital fat vs prolapsed SOOF
Steatoblepharob
| Malar bags
122
Pt who wear soft CL and RGPs should discontinue CL wear how many days before surgery
soft Cl- 2 week
| RGPs- 3 weeks
123
An axial length change of 1mm corresponds to how many diopters?
3.00D
124
What drops can be used pre and post op to decrease the risk of CME
NSAIDS
125
Hemolacria
blood in tears
126
Bulbar conj salmon patch
Conj Lymphoma
127
What % of the population has physiologic aniso
15%
128
Primary and secondary sjogrens
Primary- Dry eye, dry mouth, dry eyes.
| Secondary- triad + another autoimmune disease.
129
Non sjogrens aqueous deficient dry eye
Primary lacrimal gland deficiencies-
Age related, the most common type of non-sjogrens dry eye.
Secondary lacrimal gland deficiencies- Think ABC!
A- Attacked glands due to inflammation infiltration: Sarcoid, lymphoma, AIDs
B- Blocked: Trachoma, pemphigoid, thermal burns.
C- Cut nerves: Damage to CNV1 or VII due to CL wear, diabetes, bells palsy.
130
Two forms of evaporative dry eye
1. Intrinsic:
- MGD
- Lid structure: Proptosis, nocturnal lagophthalmos
- Low blink rate: Intense concentration, Parkinson's
2. Extrinsic:
- Ocular surface disease: Vitamin A deficiency, topical anesthetics, topical preservatives.
- CL wear.
131
How many patients with KCN have it by AD inheritance?
| When do symptoms appear
10%
| Condition begins around puberty
132
KCN etiology
Non-inflammatory, progressive and degenerative disease of unknown etiology
Stromal collagen fibril displacement due to loss of adhesion between fibrils, which results in corneal thinning and protrusion due to DEGRADATION OF THE FIBRILS BY MMPS!
133
Ocular conditions associated with KCN
Allergic- VKC, AKC, floppy eyelid
Connective tissue- Fuchs, PPMD, granular dystrophy, lattice
Hereditary- conditions that cause eye rubbing to stimulate vision. Aniridia, RP, Lebers, ROP, cone dystrophy.
134
Systemic conditions associated with TDOME
```
T- Turners
D-Down syndrome
O- Osteogenesis imperfecta
M- Marfans
E- Ehler's Dalos
```
135
Early and late signs of KCN
Early- Fleisher's ring, scissor reflex on retinoscopy, irregular mires on keratometry, and inferior steepening on topography.
Late signs- Vogt's Striae (vertical lines in the stroma that disappear with pressure), munson's sign, Rizzuti's sign (conical reflection on the nasal cornea when a light i shown from the temporal side), and hydros (tears in descemets)
136
pellucid marginal degeneration
Most commonly presents in early adulthood (20-40 years)
Collagen abnormalities that begins in a crescent-shape inferiorly, usually at 4 and 8 o clock. IOP causes the cornea to protrude right above the area of thinning (not within the area of thinning like in KCN)
Pt usually asymptomatic, ATR astig.
137
Similarities and differences of KCN and PMD
PMD- Does not have Fleisher's ring or Vogt's stream.
Both can develop hydrops, which are tears in descent's membrane.
138
Keratoglobus
Onset at birth.
Associated with Ehler's dances syndrome, blue sclera, an leber's
Diffuse corneal thinning from limbus to limbus.
139
EBMD / Cogans
Excessive basement membrane dystrophy
Abnormal epithelial adhesion and excessive BM production
Typically asymptomatic. But can be pain, photophobia, and vision loss.
Charactertized by negatives staining. Too much BM underlying epithelium. Fluorescene slides off.
140
3 main groupings of dystrophies:
Anterior
Stromal
Endothelial/posterior
Anterior:
- EBMD
- Meesman's (snail track) A multitude of ruptured cysts or RCE
- Reis Buckler (replaces bowman with collagen)
Stromal: Marilyn Monroe got hers in LA
- Macular
- Granular
- Lattice
- Schnyders
Endothelial/posterior:
- Fuchs
- PPMD
141
Meeseman's
Multitude of intraepithelial cysts, bilaterally, that spread across the entire cornea.
AD
142
Reis Bucklers Dystrophy
Replaces Bowmans with collagen
| Bilateral, symmetric, sub epithelial grey opacities.
143
Least common but most severe stromal dystrophy that will affect vision much earlier.
Macular dystrophy
144
Signs of macular dystrophy
Diffuse, superficial, central strombe haze between 3-9 years of age.
Progresses to a cloudy cornea with mucopolysaccharide deposits with irregular boarders that are present in all layers of the cornea. Extend limbus to limbus.
145
Most common dystrophies due to the TGFB1 gene
Granular- hyaline deposits (snowflake like) in the stroma.
Avelllino Dystrophy is a rare variant of granular that has granular and lattice like deposits.
Lattice- Amyloid deposits (Branching, lattice like)
146
Fuch's
| What % have a positive family history
30%
| AD, female predilection, more common in 60+
147
Do Fuch's patients have a thick or thin pachymetry findings?
Thick because K edema
148
Concerning endothelial cell count number
500
400-700 required to prevent edema.
Kids have around 3-4k
By 80 years old, down to 1-2k
149
PPMD
| Posterior polymorphous dystrophy
Patch of vesicles that create a band (train track lesions) on descent's and the end.
Metaplasia of the endothelial cells. They have an endothelium that acts like an epithelium. These cells may spread into the angle and cause glaucoma
150
Megalo cornea
X linked
Males
13mm horizontal diameter
Steep Ks
May have Marfans, Ehler's Danlos, or osteogenesis imperfecta.
At risk of developing glaucoma
151
Microcornea
AD inheritance
Less than 10mm horizontal K diameter
Hyperopic
Shallow angle --> Glaucoma
152
Cornea Plana
Corneal curvature equal to the scleral curvature
Bilateral flat Ks, less than 38D
Associated with sclerocorneo (due to bilateral scleralization- opacification and vascularization) and micro cornea.
153
Complications due to aniridia
Autosomal dominant
```
Corneal lesions
Lenticular changes- cataracts
Glaucoma !!!!!! 75%
foveal hypoplasia
disc hypoplasia
```
154
Axenfeld-Rieger Syndrome
Continuum of disorders where patient suffer from anterior seg developmental abnormalities that affect the anterior chamber.
50% develop glcuaom
155
PE
Axenfeld anomaly
Reiger anomaly
Reiger Syndrome
PE- 15% of normal people have. Does not put you at risk for glaucoma.
Axenfeld anomaly- PE + angle abnormalities + glaucoma risk
Reiger anomaly- PE + angle abnormalities + glaucoma risk + iris stromal abnormalities (corectopia, iris hypoplasia)
Reiger Syndrome- PE + angle abnormalities + glaucoma risk + iris stromal abnormalities + systemic abnormalities (mental retardation, skeletal abnormalities)
156
Peter's Anomaly
Patients are born with central white corneal opacities with iris adhesions.
Bilateral.
70% develop secondary glaucoma..
157
An infiltrate without an overlying defect means what
An infiltrate is a sign of your bodies immune system attacking an antigen via antibodies. But no defect means there is no sign of infection.
Sterile infiltrate
158
# Define
Sterile infiltrate
Sterile ulcer
Infectious ulcer
Sterile infiltrate- Infiltrate without epi defect (sign of immune system attacking an antigen with antibodies. Immune mediated, no infection)
Sterile ulcer- infiltrate with epi staining less than infiltrate size.
Infectious ulcer- infiltrate with epi staining the same size as the infiltrate. (bugs attacking K)
159
What 2 scenarios would cause fungal keratitis
| What is the most common fungus
1. Trauma with veg matter
2. Immunocompromised
Both caused by candida
160
Culture fungi on what agar
Sabouraud's agar.
| It's fun to drive a subaru !
161
appearance of a fungal keratitis with aspergillum/fusarium vs candida
aspergillum/fusarium-- Epi defect with underlying grey-white corneal infiltrate with feathery edges
candida- Similar appearance as bacterial ulcer.
162
How to culture acanthamoeba
Non-nutrient agar with heat killed E-coli
163
Early and late signs of acanthamoeba
early- barely any SPK. Severe pain.
late- Radial keratoneuritis (inflammation of the corneal nerves) and patchy stromal infiltrates that progress to form a ring ulcer.
164
Only type of scleritis associated with glaucoma
Necrotizing with inflammation
165
Other name for phthiriasis palpebrarum
pediculosis ciliaris
166
After a thermal/UV burn, symptoms get worse how many hours after the event?
6-12 hours
167
Lab test to run for Sjogrens
Anti SSA, SSB
168
Tumor that pt might have with
Sjogrens
MG
Sjogrens: Non Hodgkin's Lymphoma
MG: Thymoma
169
Corneal ectasias
KCN
PMD
Keratoglobus
170
#1 disease associated with a CRVO
POAG
CRVO occurs because the vein is able to cork on itself. Usually veins are held in place by a thick, strong RNFL. In POAG, the RNFL weakens and the vein is able to cork on itself.
171
Emboli and thrombus. Which is associated with vein and artery occlusions?
Thrombus= Clot that stays where it was formed. Vein occlusion.
HTN/DM --> artery compresses vein --> thrombus
Embolus= Clot moves from where it was formed. Artery occlusion, GCA.
HTN sets pt up for CRVO, BRVO, CRAO, BRVO
172
DR VOS
| -All can lead to what 3 things?
Proliferative retinopathy
```
DM
ROP
Vein occlusion
OIS
Sickle Cell
```
Worried about tractional RD, vitreous hemes, and VEGF getting into the angle
173
Types of epithelial diseases in HSK
Corneal vesicles/punctate keratopathy: Small lesions that represent earliest epithelial signs related to HSK
Dendritic- most common presentation. Boarder stains pink, center stains green.
Geographic- Wider
Marginal ulcer- Located near limbus. SEI + epi defect + limbal injection
174
How can HSK affect the eye
1. Bleph
2. Conjunctivitis
3. Neurotrophic
4. Epithelium- vesicles, dendrite, geographic, marginal.
5. Stroma- IK, necrotizing
6. Endothelium- Disciform
175
Types of stromal diseases due to HSK
1. IK- Inflammation that began in the stroma without primary involvement of the epi or endothelial.
Infiltrate + diffuse neo + stromal thinning + stromal scar + wessley ring (Immune ring)
2. Necrotizing. could occur due to IK or infiltration of the stroma by epi or endo HSK. May lead to thinning and perforation.
176
Types of endothelial diseases due to HSK
Dendritic
Focal, disc shaped stromal edema overlying KPs stuck on the endothelium.
Focal, no neo, no infiltrate, disc shape
177
Difference between IK and Disciform
IK:
Stroma
Diffuse infiltrate
Diffuse neo
Disciform:
- KP on the endothelium
- No infiltrate
- No neo
- Overlying focal stromal edema
- Disc shape
178
What conditions have prodromes
Zoster
| Migraine
179
How do dendrite and pseudodendrites stain
Dendrite:
Rose stains boarders
Fluorescein stains inside
pseudodendrite:
Rose stains entire thing
Fluorescein does not stain well
Pseudodendrite has stuck on appearance, no end bulbs
180
Zoster eyelid signs
```
Trichiasis
Entropion
Ectropion
Madarosis
Poliosis
```
181
Ocular signs of HZV
Could develop episcleritis, scleritis, 40% have uveitis, trabeculitis, cataracts, ARN, optic neuritis, cranial nerve palsies (leads to poor EOM innervation)
182
Post herpetic neuralgia
Pain persisting beyond 1 month after rash onset or rash resolution.
Most common complication post zoster.
Affects 7%
183
What is a macular star
Exudate in Henle's layer
184
What is exudate
Lipoprotein and macrophages leaking out of the deep capillary network
185
retinal edema or exudate first?
Pre existing condition --> Hypoxia --> edema --> exudate
Some type of retinal/vascular compromise breaks down the retinal capillary system and leads to liberation of blood contents.
see exudate? know edema has been there a while.
Exudate is found in the OPL or can spread throughout the inner 1/3 from ILM to ELM
186
Where is acute and diffuse edema located
Acute- INL and OPL
| Diffuse- ILM to RPE
187
What occurs before/after CWS
Significant ischemic event --> CWS --> neo
188
3 conditions that exclusively cause PUK
Mooren's Ulcer
Staph marginal keratitis
Collagen vascular disorders
189
Mooren's Ulcer
```
Need more info !! Idiopathic. No systemic disease!
70 year old male
Unilateral peripheral infiltrate
Mild to moderate symptoms
Could be associated with hep C
```
Vasculitis of the limbal blood vessels --> ulcer on the peripheral cornea that spreads circumferentially. Grey, crescent shape. Ulcer has a huge over hanging edge
190
Ulcer at the limbus that has a huge, over hanging edge
Moorens
191
Staphylococcal marginal keratitis
Causes PUK
Sterile ulcer (due to bugs hanging out, staining is less than infiltrate)
Immune system over reacts to staph wherever lid touches eye (2,4,8,10)
Type III hypersensitivity response
192
Collagen vascular disorder
PUK due to RA, SLE, PAN, or Wegeners.
| Mild symptoms
193
Terrien's Marginal Degeneration
Stuck up 30 year old male (bilateral thinning SN, ATR astigmatism)
No ulcer, idiopathic, non inflammatory.
May lead to perforation. Associated with panus. The rest of the eye is quiet- no AC reaction or conj injection or epi defect.
**mooren's ulcer (causes PUK) is similar but it has an overlying epithelial defect. Terriens does not have an epi defect, just infiltrate.
194
Salzmann's Nodular Degeneration
Mrs. Salzmann, a 60 year old women walking around with a blue bowtie, bowing to people. And she's very happy. Very beat up women, maybe homeless.
-blue grey nodules in bowmans layer composed of hyaline.
Signifiant corneal inflammatory disease- MGD, trachoma, phlycentulosis, VKC, dry eye, IK. but can be asymptomatic.
195
Band keratopahty
- What layer
- what causes it
High serum calcium or phosphorus levels (grout0 and hypercalemia (hyperparathyroidism), renal failure.
After trauma
Uveitis(common in JIA pts) dry eye, exposure keratopathy
196
Arcus begins on what layer of K and moves where
Begins on Descemets--> bowmans --> stroma
197
When is Arcus concerning
Unilateral- carotid disease on the side without Arcus.
| Younger than 50
198
What 2 layers can crocodile shagreen be on?
Descemets (posterior) or bowmans (anterior)
199
Corneal Farinata
Bilateral flour dust deposits in the aroma.
| AD
200
Signs of stromal rejection after a K graft
Krachmer's spots
| SEIs after graft surgery
201
Signs of endothelial rejection after K graft
Khodadoust lines
| WBCs on the endothelium in a line
202
Absolute CI of refractive surgery
Under 18
Unrealistic expectations
KCN, active herpes, CL warpage on K
CT disease (keloids), collagen vascular disease, immunocomp (on systemic steroids)
203
Keratotomy
| Keratectomy
Keratotomy - knife making incisions
| Keratectomy- removal of tissue with laser
204
Main SE from radial keratotomy
Progressive hyperopic shifts
205
PRK
| Photorefractive keratectomy
Corneal epi, bowmans, and superficial stromal tissue is REMOVED.
Excimer laser applied.
400 residual K required after.
1-2 week healing because K epi must regrow.
206
Benefits to PRK
Painful and poor vision for 1-2 weeks after BUT
```
better for people who might damage flap (athletes, boxers)
Less risk of ectasia
Less aberrations
less dryness
Cheaper
```
207
Main differences after PRK and LASIK
After PRK- missing bowmans, 400 residual required, pain and slow healing
After LASIK- thinner stroma, flap, 250 residual required, less pain and fast healing
208
LASIK stands for
Laser- assisted in situ keratomileusis
209
Conductive keratoplasty
Used to tx presbyopia and low hyperopia
| using radio frequencies
210
Refractive surgery allowed with KCN
Intrastromal corneal rings (intacs)
| PMMA rings inserted into stroma to flatten the K
211
Clear lens extraction
Cataract surgery but no cataract.
Remove clear lens and put in an IOL to reduce the refractive error.
No residual accommodation remains.
212
Astigmatic keratotmy
K incisions made with diamond blades to relax the cornea in steep mer.
Similar to RK but just in astig meridians.
213
Most common SE of LASIK
Dry eye since corneal nerves are severed
214
LASIK side effects
```
Pain in 24 hours
Serious infection (usually gram positive)
Flap complications
Corneal ecstasies
Residual refractive error
Glare
Dry eye
Diffuse lamellar keratitis or sands of sahara (fast and furious, 2-3 days PO)
Epithelial ingrowth (slow, 1 month PO)
Corneal haze
```
215
Diffuse lamellar keratitis (sands of the sahara)
```
Fast and furious
Shows up 2-3 days PO
Inflammatory, non infectious reaction that occurs between the K flap and stroma.
Fine, sand like infiltrate
May be response to toxins (blade debris)
```
216
Epithelial ingrowth after LASIK
Slow growth, 1 month PO
Faint grey line within 2mm of flap edge.
Asymptomatic.
Not tx unless progression or visual axis obstructed.
217
Most common LASIK complication after an enhancement
Epithelial ingrowth
218
What 2 measurements are used to calculate the appropriate IOL power
Axial length by A scan and keratometry
219
Average axial length is ____
| If the calculation is off by 1mm, that corresponds to how many D
average is 24
| 1mm difference is 3D error in the calculated IOL power
220
3 classes of medication of concern before cat surgery
Anticoagulants, alpha blockers, prostaglandins
221
Etiologies of CRVO
```
Oral contraceptive pills
POAG (40-60%)
Protein S, C, antithrombin III deficiency
Antiphospholipid antibody syndrome
Collagen vascular disease
AIDS
```
222
Signs of vein occlusion
```
Retinal hemes
Collaterals
dilated tortuous veins
CWS
Optic disc edema
```
223
What are collaterals
Veins that become visible over several weeks-months after vein occlusion.
Often on the disc.
Permit blood flow between the retinal and choroidal circulations, help drain blood and retinal edema into the choroid circulation.
224
What is the leading cause of vision in ischemic and non-ischemic CRVOs
Macular edema
225
2 types of CRVO
Ischemic (33%) - Vision is worse than 20/200, poor prognosis. 10DD or more of non-perfusion.
Non ischemic (67%)
226
60% of BRVO occur in what quadrant
ST at AV crossing since they both share adventitia
| **If it does not occur at an AV crossing, consider a vascular disorder.
227
CRAO has what acuity
20/400
| UNLESS cilioretinal artery is present to spare the macula (present in 15-30% of patients)
228
Which condition has a cherry red spot
CRAO
229
How will the retina appear after the patient has a CRAO/BRAO
The edema and whitening will resolve in weeks, but the retinal tissue remains non-functional and the patient will have permanent visual field defect.
230
High risk characteristics of developing PDR
NNV > 1/4 DD
NVD associated vitreous or pre retinal heme
NVE associated vitreous or pre retinal heme
231
How does macular ischemia appear
Enlarged foveal avascular zone (hypo fluorescent)
232
Macular edema can occur at any stage of diabetic ret.
| What are the criteria for CSME
**based on the presence of retinal thickening within the fovea
1. Retinal thickening within 500 micrometers (1/3DD) of the fovea
2. Hard educates within 500 micrometers of the fovea with adjacent retinal thickening
3. Retinal thickening at least 1DD within 1DD of the fovea
**pt only needs to meet one of these criteria to have CSME
233
A CRAO causes tremendous damage to the retina. How will the Erg of a person who suffered from a CRAO be affected?
A wave will remain since this is the PR supplied with blood by the choroid
The B wave will disappear since this is the bipolar & muller cells that are supplied with blood from the CRA
234
Normal diurnal fluctuation in patients with and without glaucoma
With- variation of 10mmHg
| without- 2-5mmHg variation
235
Difference between PAS and AS
PAS- Iris and TM
| AS- Iris and K
236
Layers of the lens
Nucelus- Embyronic, fetal, juvenile, adult
Cortex
Capsule
237
Fuch's spots
RPE hyperplasia and may be associated with CNV in pathological myopia.
238
Elschnig's spots in the retina
Areas of chorioretinal necrosis due to local occlusion of choriocap
seen in pts with HTN
239
An enlarged blind spot is associated with
Papilledema or peripapillary atrophy
240
Two types of primary angle closure glaucoma are :
What causes secondary angle closure?
Pupillary block
Plaeeau iris
Secondary angle closure glaucoma is due to mechanisms that push or pull the angle closed such as neo or phagomorphism
241
ORBSCAN studies in patients with KCN show
Steepening of the posterior K
KCN is characterized by anterior central or paracentral corneal stromal thinning.
242
Glaukomflecken
ASC opacities that develop secondary to necrosis and ischemia of the lens after an acutely elevated IOP
243
Vitreous condition that is pathognomonic for blunt trauma?
Vitreous base avulsion
244
Central retinal problems in pathological myopia
```
Fuch's spots
Laquert cracks
ERM
macular hole
Pavingstone degeneration
```
245
Most common cause of mortality rate in OIS?
Cardiac disease
246
HTN associated secondary conditions
```
Vascular occlusions (artery pressing on vein --> turbulent blood flow --> thrombus --> CRVO)
Macroaneurysm
NAION
Ocular motor nerve palsies
Worsening of diabetes
```
247
What layers of the retina are affected in macro aneurysms
Multi level- sub retina, intraretina, preretinal and or vitreous heme
surrounding exudate in a ring
Usually located at AV crossing
248
Symptoms of venous stasis ret/OIS
Gradual vision loss
Dull periorbital painm
Amaurosis Fugax
Signs: UNILATERAL dot blot hemes in mid-periph, dilated non-tortuous veins, narrow arteries, NVD/NVE
249
Amaurosis Fugax
Type of TIA characterized by transient MONOCULAR vision loss that typically lasts seconds to minutes.
Vision returns to normal
Common cause: carotid artery embolus
250
TIA
Temporary neurologic defect due to transient loss of blood flow to the brain
Perfusion restored in less than 24 hours (but usually 15 minutes)
251
Most common cause of hyper viscosity retinopathy
Hyperglobulinemia (excess immunuglobulins in blood) making blood more viscous.
This condition is found in Wadenstrom's macroglobulinemia
252
Interferon retinopathy occurs within ___ months after interferon has started.
Patient without retinopathy should be followed how often?
retinopathy will occur within 3-5 months of starting
Follow patient every 6 months
Retinopathy will resolve after treatment is discontinued
253
3 forms of macular telangiectasia
Mac Tel Type 1: Congenital and unilateral. May be a variant of coat's- looks very similar with exudate and hemes.
Mac Tel Type 2: Acquired and bilateral. Middle age and elderly. No exudation. Dilated vessels begin temporal to the macula and may progress to atrophy or macular holes.
Mac Tel Type 3: Occlusive vascular disease
254
Another name for ROP
Retrolental fibroplasia
255
ROP occurs in who
| What part of the retina is most susceptible
premature (32 weeks) or low birth weight (less than 1,500g) who receive oxygen therapy.
Temporal retina- usually finishes development during the 9th month gestation
256
Retinoblastoma
- What causes it
- Hereditary?
- Signs
Mutation in Rb tumor suppressor gene
All bilateral cases are hereditary, 20% of unilateral cases are hereditary
Bilateral cases have 50% chance of passing mutation to children
Leuko, strab
257
Leukocoria DDX
Coats, toxocariasis, retinoblastoma, ROP
258
Another name for abnormal CHRPE that are associated with FAP
RPE hamartomas
Multifocal, bilateral, tear drop shape
70% of people with FAP have RPE hamartomas
259
Orange pigment on a suspicious nevus. What is it and what do you think
It is accumulation of lipofuscin. Sign that nevus has progressed to melanoma
260
Size and depth of nevus that is sus
Greater than 2mm elevation and 6mm in diameter or close to ONH
Not sus- overlying drusen
261
Risk factors of AMD
```
75+
Female
White
Fam Hx
Light iris
cig use (2.5x)
Hyperopes (2.5x more risk of exudative AMD)
```
262
AMD pathogenesis
Nutritional factors and light toxicity
263
% of dry vs wet/exudative AMD
90% dry, 10% wet
264
Dry AMD
- Accounts for what % of AMD
- Appearance
- What % of people go blind
90% of AMD
Characterized by the presence of drusen and RPE abnormalities (mottling, granularity, focal hyperpigmentation)
Most patients do not have severe vision loss but 12% will lose vision due to geographic atrophy
265
4 main risk factors that increases the risk of progression from dry to wet AMD
Multiple soft drusen (esp. if confluent)
Focal hyperpigmentation
HTN
Smoking
266
Exudative/wet AMD
- Accounts for % of AMD cases
- Common symptoms
- Characterized by what
- Incidence of involvement of the fellow eye with wet AMD is estimated to be
10% of AMD
Metamorphopia, central scotoma, rapid vision loss
Characterized by CNV that leak blood or plasma sub retinal or sub RPE. PEDs can occur in dry and wet.
After 5 years, risk of condition becoming bilateral is 40-85%
267
How can a PED present in both dry and wet AMD
Dry- presents as drusenoid PED
| Wet- Serous fluid under RPE
268
Classic vs occult CNV during IVFA patterns
Classic is well defined. Fills space during early phases of FA
Occult is not well defined.
269
Histo and toxoplasmosis differences
Histo- bilateral, multifocal, due to bird or bat droppings (fungus), choroiditis. No vitritis.
Toxo- Unilateral, single lesion due to undercooked meats or cat poop (parasite). Retinitis and vitritis present.
270
Define pathological myopia based on rx and axial length
Rx: Greater than -6.00D
| Axial length: greater than 26.5
271
4 stages of macular hole
1- impending hole with loss of foveal depression. Yellow spot at fovea.
2- Round, small, full thickness hole with pseudo-operculum.
3- Large full thickness hole with operculum. + Watzke-Allen sign
4- Stage 3 + PVD
272
Signs and symptoms of albinism
```
Hypopigmentation
Foveal hypoplasia
ONH hypoplasia
MicroK
Nystagmus
Strab
Misrouting of the temporal ON fibers through the chiasm
```
Symptoms: Photophobia, reduced BCVA
273
Most common retinal dystrophy
RP
274
RP
Most common inheritance pattern
most common associated systemic condition
AD
| Ushers
275
Most common hereditary macular dystrophy
StargARdt's
Onset early in life
Autosomal recessive
276
Signs of Stargardts
Bilateral yellow flecks
Bulls eye maculopathy (beaten bronze)
Salt and pepper
Acanthameoba of the retina
277
What causes Stargardts
AR condition due to a mutation the ABCA4 gene that is a protein responsible for moving all trans retinal from the photoreceptor disc lumen to the cytoplasm.
This leads to degeneration of the PR and RPE.
Variant of same disorder- Fungus Flavimaculatas.
278
Choroidermia
X linked recessive
Deficiency in RGG transferase, enzyme used in membrane metabolism.
Progressive, diffuse atrophy of the RPE and choriocap, exposing the underlying sclera.
Night blindness and peripheral vision loss
279
5 stages of Bests
1. Pre vitelliform. No symptoms but abnormal Arden ratio (below 1.8) on EOG.
2. Vitelliform. 2 egg yolk macular lesions
3. Pseydohypopyon.
4. Vitelliruptive. Scrambled egg
5. End stage. CNV
*Normal ERG, abnormal EOG.
280
Difference between Best's and adult vitelliform
Bests: Onset in childhood
Adults: Onset at 30-50 years. Signs may be similar, but prognosis is better. Minimal metamorphosis, mild acuity loss.
281
Gyrate Atrophy
Symptoms by age 10
Bilateral chorioretinal degeneration due to a deficiency in the mitochondrial enzyme ornithine aminotransferase. The ornithine levels in the body become high, damaging choroid/retina.
282
Most common cause of rhegmatogenous retinal detachment
Myopia
| 40% of RRD's occur in myopic eyes
283
Risk factors for rheg RD
```
Previous ocular surgery
PVD
trauma
Family hx
lattice
**Myopia 40%
```
284
Rheg is defined as
Retinal BREAK due to atrophic holes or tractional tears
285
What causes atrophic holes
Round, small, full thickness defect not associated with traction.
Chronic atrophy of the retina usually located ST
Poor nutrition, common in high myopes with long eyeballs.
286
Retinoschisis
| -2 types and appearances
Occurs in 4-7% of the population, bilateral
```
Bullus elevation is most common
Unlike RD, the retina is immobile
Absolute VF defect
Most pts are hyperopes
Shethed retinal vessels occur in the elevated retinal layer of retinoschisis
```
Typically asymptomatic
Inner and outer wall breaks can occur. Outer breaks are more dangerous and can cause RD.
287
Angioid streak cause
Angiod streaks from the disc
Due to damage of the elastic core of bruch's
50% idiopathic, other causes are systemic
```
Pseudoxanthoma elastic
Ehlers dances
Pagets
Sickle cell
Idiopathic 50%
```
288
APMPPE
Acute posterior multifocal placoid pigment epitheliopathy
Viral posterior uveitis
Good prognosis, resolves.
289
Central areolar choroidal dystrophy
AD condition with bilateral large areas of geographic atrophy in the macula. Will cause vision in the 4-5th decades. Poor prognosis
290
Senile Choroidal atrophy
Choroidal thinning and may cause an exaggerated tigroid fungus appearance as you can see more of the choroidal vasculature.
291
Most common source of optic neuropathy
glaucoma
292
Leading cause of irreversible blindness world wide
Glaucoma
293
Risk factors for conversion of ocular HTN to POAG
```
High IOP
Race- AA 4x more likely
Family Hx
Age 90% over 55
Thin K
```
294
Glaucoma risk based on CCT
High risk if under 555
| Low risk is over 585
295
PXE syndrome demographics
Caucasians, Scandinavian descent
296
PDS is common in what demographics
Bilateral, caucasians, males, myopes, 30s
297
How can angle recession cause glaucoma
Recessed iris and widened CB. Usually due to blunt trauma.
| Although angle is wide open, the TM is damaged and can cause glaucoma.
298
NTG
- What is it
- Demographics
- Risk factors
- SIgns
Type of POAG in which NFL is damaged at lower pressures
IOP less than 21 with open angles and glaucomatous nerve damage.
Females, japanese at higher risk
Other risk factors: Vascular disorders: Raynauds, migraines, Low BP, sleep apnea, taking Bp meds before bed (may decrease ocular perfusion pressure)
Pressure on the high end of normal, drance hemes are more common, dense VF defects closer to fixation.
299
Examples of primary and secondary angle closure glaucoma
Primary- Pupillary block or plateau iris
Secondary- neovascular, uveitic, congenital, ICE, inflammatory (Fuch's, posner schlossman, phacolytic hypermature cataract)
300
Plateau iris
Anteriorly positioned ciliary processes that push peripheral iris forward into contact with the TM
Convex peripheral iris.
PI will not help
301
Greatest threat to vision during acute angle closure
CRAO
| IOP is higher than the perfusion pressure of the CRA
302
Topamax/Topiramate is used for what
| What can it cause
Migraines, weight loss, epilepsy.
| Causes choroidal effusion and can cause bilateral angle closure
303
Buphthalmos
Enlarged eye, K diameter greater than 12mm.
Occurs in patients with congenital glaucoma
Congenital glaucoma and increased IOP ---> enlarges eye
304
ICE syndromes
Abnormal corneal endothelium that grows into the angle, causing secondary open angle glaucoma.
Essential iris atrophy-
Chandler's Syndrome
Iris-Nevus Syndrome (Cogan Reese)
Also abnormal pupil
305
Extent of normal VF
100 degrees temporal, 60 superior and nasal, 70 inferior
