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Opthalmology > Lens and Cataract > Flashcards

Lens and Cataract Flashcards

1
Q

The lens is suspended by a thin filament of zonules from the ___ to the ___ anteriorly and ___ posteriorly

A

ciliary body, iris, vitreous

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2
Q

Back area is the most important area which contains the retina and its ____

A

photoreceptors

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3
Q

Outer part and engulfs the whole lens structure

Elastic membrane containing the cortex nucleus.

A

Lens capsule

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4
Q

Middle part of lens

A

Cortex

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5
Q

Central part of Lens

A

Nucleus

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6
Q

Thin filamentous fibers mainly hold the lens in place

attaching it to the ciliary body

A

Suspensory zonules of Zinn

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7
Q

The Lens capsule is line by ___________ and they continuously
produce lens fibers that is why the lens continuously increase in size, length,
and weight through the years

A

epithelial cells anteriorly

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8
Q

Function of lens

A

Refraction and Accommodation

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9
Q

To focus the light exactly at the retina

Bending of light rays that passes through one medium to another
refractive medium

A

Refraction

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10
Q

Physiologic interplay of the ciliary body, zonule and lens that results in focusing of near objects upon the retina.

A

Accommodation

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11
Q

The muscles are relaxed, the zonules are taut, and the lens as a whole is flat.

A

No accommodation,

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12
Q

The ciliary body contracts, zonules relax, and the lens assumes a more globular formation

A

There is accommodation

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13
Q

4 types of errors of refraction

A

Myopyia
Hyperopia
Presbyopia
Astigmatism

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14
Q

Term used for a normal refractive index

A

Emmetropia

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15
Q

Physiologic error

Loss of accommodation due to aging

Inability to read fine print or discriminate fine close objects to about age 40

A

Presbyopia

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16
Q

Irregular vision

A

Astigmatism

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17
Q

Nearsightedness

A

Myopia

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18
Q

Farsightedness

A

Hyperopia

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19
Q

Diopter in lens of Adolescents

A

12-16 D

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20
Q

Diopter in lens of 40 yrs old

A

4-8 D

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21
Q

Diopter in lens of >50 yrs old

A

<2 D

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22
Q

Treatment of Presbyopia

A

Corrected by plus lenses

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23
Q

Inability to perform near tasks
• Accommodation starts to fail, lens loses its ability to resolve, separate,
distinguish, and refract the light rays causing blurring of vision.
• Due to irregular refraction within the lens, they may have multiple
images, stardust, or difficulty of driving at night.

A

Presbyopic Symptoms

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24
Q

Most common cause of loss of lens transparency (Overall)

A

Age related

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25
Q

Most common cause of loss of lens transparency/ blindness by metabolic disorder

A

Diabetes

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26
Q

Blurring of vision, glare, second sight and color discrimination

Trauma, drug related, systemic, or metabolic such as diabetes

With lens becoming more yellow to brown in color, objects appear darker
in color that color discrimination becomes more difficult.

A

Loss of lens transparency

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27
Q

Patients will complain of decreased vision,

glare, and image distortion.

A

Subcapular lens opacity

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28
Q

Patients have increased refractive power because of a

denser nucleus, developing ?

A

Lenticular myopia

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29
Q

Lenticular myopia as progressively become more
myopic, such that they can read without the glasses they normally need in a
phenomenon called?

A

Second sight

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30
Q

Patients have increased refractive power because of a denser nucleus, developing lenticular myopia. They progressively become more
myopic, such that they can read without the glasses they normally need in a
phenomenon called second sight.

A

Nuclear Sclerosis

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31
Q

Refractive symptoms

Most likely from trauma

A

Dislocation

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32
Q

Condition where there is tremulousness in the iris or

vibration or agitated motion of the iris with eye movement

A

Iridodonesis

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33
Q

Peripheral dark reflex with central orange

red reflex

A

Spoke-wheel sign

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34
Q

Signs of dislocation

A

Whitish pupillary reflex
Iridodenesis
Opthalmoscopic signs: (+) central dark reflex and spoke-wheel sign

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35
Q

True or False

Examination of the lens is best done with dilated pupil

A

True

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36
Q

You can use Penlight/slitlamp/ophthalmoscope

A

Dense Cataract

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37
Q

You can use Slitlamp/opthalmoscope

A

Less dense Cataract

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38
Q

If the lens is dense enough such that the ophthalmoscope will
not allow for the retina and the optic nerve to be viewed, a ____ may be required.

A

B scan

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39
Q

Assessment of the red-orange reflex will assist on the

identification of ______

A

Posterior subcapsular cataract

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40
Q

Provides a magnified view of the lens to describe the type, severity, and location of the cataract.

A

Slit lamp

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41
Q

Used to evaluate the optic nerve and retina to detect the eye problems that could affect visual acuity such as macula; especially when the patient reports metamorphopsia or
difficulty with near objects.

A

Opthalmoscope

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42
Q

Any opacity of the lens

A

Cataract

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43
Q

Causes of cataract

A

Acquired and Childhood

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44
Q

Cause of Acquired Cataract

A 
• Age related
• Traumatic/Radiation
• Ocular disease (uveitis,
glaucoma etc)
• Systemic diseases (DM very
quick, etc)
• Previous eye surgeries
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45
Q

Pathophysiology of cataract

A

Product of Protein denaturation and oxidative stress from subsequent hydrolysis

Decreased glutathione concentration and oxidation of methionine and cysteine

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46
Q

Biochemical changes in Cataract

A

❖ Increased sodium and insoluble protein
❖ Decreased soluble protein
❖ Bound water reflecting loss of binding sites

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47
Q

Classification of cataract according to opacification

A 
Immature
Intumescent
Mature
Hypermature
After cataract
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48
Q

Opacity can be observed, but no opacity in between

Transparent lens fibers are present

Opacity is located centrally

Little clarity of cataract

A

Immature

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49
Q

Swelling of the lens with the presence of fluid clefts

Opacification of all lens fibers is observed

A

Intumescent

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50
Q

Whole lens homogenously opacified, appears as a
white pupil

Opacification of all lens fiber

A

Mature

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51
Q

Liquefaction of opaque lens fibers (Morgagnian)

Nucleus is not centrally located (Inferiorly)

Waited for a few months or years then becomes
liquefied to the point that the nucleus becomes
mobile

Some of the lens fibers have liquefied, with calcific
areas

A

Hypermature

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52
Q

Opacification of the posterior capsule after cataract
surgery.

Primary complication of cataract surgery

A

After cataract

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53
Q

Lens liquefaction has caused the lensnucleus to go down

A

Morgagnian lens

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54
Q

Classification of cataract according to location

A

Nuclear
Cortical
Posterior subscapular

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55
Q

Classification of cataract according to location:

Hard

A

Nuclear

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56
Q

Classification of cataract according to location:

Soft

A

Cortical and Posterior Subscapular

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57
Q

Classification of cataract according to location:

Appears gold white granules

A

Posterior Subscapular

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58
Q

Classification of cataract according to location:

Myopic shifts and better vision

A

Nuclear

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59
Q

Classification of cataract according to location:

Does not liquefy that much

A

Nuclear

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60
Q

Classification of cataract according to location:

More or the inside part

A

Nuclear

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61
Q

Classification of cataract according to location:

Opacity of lens fibers in spoke like pattern

A

Cortical

62
Q

Classification of cataract according to location:

More of the intermediate part

A

Cortical

63
Q

Classification of cataract according to location:

Almost always granular

A

Posterior Subscapular

64
Q

Classification of cataract according to location:

Decreased vision disproportionate to size

A

Posterior Subscapular

65
Q

Classification of cataract according to location:

Located in the cortex adjacent to the posterior capsule.
Always at the back

A

Posterior Subscapular

66
Q

Classification of cataract according to location:

Common cataract of diabetes, taking steroids, radiation, trauma

A

Posterior Subscapular

67
Q

Poor hue discrimination or mononuclear diplopia

A

Nuclear sclerosis

68
Q

True of False

Most nuclear cataracts are bilateral but may be asymmetric

A

True

69
Q

Earliest symptom of nuclear sclerosis

A

Improved near vision without glasses/ Second sight

70
Q

Occurs from an increase in the refractive power of the central lens, creating a myopic (nearsighted) shift in refraction

A

Nuclear Sclerosis

71
Q

True or False

Nuclear sclerosis is normal condensation process of the lens that occurs after middle age

A

True

72
Q

Changes in the hydration of lens fibers creates clefts in a radial pattern
around the equatorial region

A

Cortical Cataract

73
Q

True of False

Most cortical cataracts are bilateral and often symmetric

A

False (Assymetric)

74
Q

Visual function is variably affected, depending on how near the opacities
are to the visual axis

A

Cortical Cataract

75
Q

They tend to cause visual symptoms earlier in the development owing to
the involvement of the visual axis.

A

Posterior subscapular

76
Q

Common symptom of Posterior subscapular cataract

A

Glare, reduced vision under bright lighting condition

77
Q

True or False

Pos. subscapular cataract are painful

A

False

78
Q

Presence of spots in the visual field

A

Posterior Subscapular

79
Q

Contusion may produce a cataract months after the event

A

Traumatic cataract

80
Q

Extrusion of lens material into the anterior chamber

A

Traumatic cataract

81
Q

Rupture of the lens capsule

A

Traumatic cataract

82
Q

Lens induced ocular disease

A

Phacomorphic or Phacogenic Glaucoma

Phacolytic Glaucoma

Lens induced uveitis

Lens particle Glaucoma

83
Q

Rapid swelling of lens follows hydration of lens fibers in intumescent
cataract

A

Phacomorphic or Phacogenic Glaucoma

84
Q

May follow surgical or accidental rupture of lens capsule

A

Phacomorphic or Phacogenic Glaucoma

85
Q

In Phacomorphic or Phacogenic Glaucoma, there is an increases AP dimension of the lens causing?

A

Pupillary block with forward

movement of the iris

86
Q

What type of glaucoma can phacomorphic or phacogenic glaucoma can cause?

A

May result in secondary angle closure glaucoma

87
Q

Lens is really hard to the point that it disrupts the point of AC hence
creating increased pressure and provides more inflammation

A

Phacomorphic or Phacogenic Glaucoma

88
Q

True or False

Phacomorphic or Phacogenic Glaucoma is painless

A

False

89
Q

Main treatment for Phacomorphic or Phacogenic Glaucoma

A

Decrease the pressure by taking out the lens

90
Q

Leakage of lens proteins from a hypermature cataract cause uveitis

A

Phacolytic Glaucoma

91
Q

Uveitic type of inflammation but can also increase the intraocular
pressure

A

Phacolytic Glaucoma

92
Q

Presence of macrophage plugging the trabecular meshwork

A

Phacolytic Glaucoma

93
Q

Main treatment for Phacolytic Glaucoma

A

Immediate Surgery

94
Q

Accidental rupture of the lens capsule

liberates lens proteins

A

Lens induced uveitis

95
Q

True or False

Lens induced uveitis sometimes occurs with glaucoma

A

True

96
Q

Treatment of Lens induced uveitis

A

Lens extraction

Corticosteroid administration

97
Q

Pathognomonic of Lens induced uveitis

A

Mutton-fat precipitates, posterior
synechiae (adhesions) and pupillary
membranes

98
Q

Following a penetrating lens injury or surgical procedure, particle of lens
cortex migrates to the anterior chamber obstructing the trabecular
meshwork

A

Lens particle Glaucoma

99
Q

Occurs within weeks to months or years

A

Lens particle Glaucoma

100
Q

Treatment of Lens particle Glaucoma

A

Lower IOP and Corticosteroid administration / surgical

removal of retained lens material

101
Q

Metabolic cataracts

A 
Diabetes
Wilsons disease
Mytonic dystrophy
Galactosemia
Hypocalcemia
102
Q

Sunflower cataract

A

Wilsons disease

103
Q

Christmas tree appearance

A

Mytonic dystrophy

104
Q

Drug indiced/ Toxic Cataracts

A 
Corticosteroids
Anticholinesterase/Myotics
Amiodarone
Statins
Phenothiazines
105
Q

Posterior subcapsular opacification (PSC)

A

Corticosteroids

106
Q

Anterior subcapsular opacification (ASC)

A

Miotics like Achtylcholinesterase

107
Q

Stellate anterior axial pigment deposition

A

Amiodarone

108
Q

2 types of childhood cataract

A

Acquired

Congenital

109
Q

Adverse effect of Lasik

A

Bursting of Cornea

110
Q

Lesion >2mm with visual impairment

A

Surgery

111
Q

Surgery can prevent what disease in childhood cataract?

A

Amblyopia or Lazy eye

112
Q

Most common childhood infection to cause congenital cataract

A

Rubella

113
Q

Most common childhood cataract

A

Congenital

114
Q

Most common congenital cataract

A

Hereditary

115
Q

Lens development anomalies

A

Ectopia Lentis
Sherophakia
Lenticonus
Aphakia

116
Q

Displacement or malposition of the eye’s crystalline lens from its normal location

A

Ectopia Lentis

117
Q

Signs and Symptoms of Ectopia

lentis

A

Iridodonesis

Decreased vision

118
Q

Major syndromes associated with

Ectopia Lentis

A

Marfan syndrome
Homocystinuria
Weill-Marchesani syndrome

119
Q

Ectopia Lentis:
some zonular fibers remain attached acting as hinge (lens
subluxated from usual position)

A

Subluxation

120
Q

Ectopia Lentis:

Loses entire support of zonular fibers

A

Dislocation

121
Q

True or False

Subluxation in Spherophakia is uncommon

A

False

122
Q

Increased curvature leading to Myopia

A

Spherophakia

123
Q

Small lens with increased anterior and posterior curvatures

A

Spherophakia

124
Q

Rare; Cone-shaped anterior pole of the crystalline lens

A

Lenticonus

125
Q

Marked thinning of anterior lens capsule

A

Lenticonus

126
Q

Condition where the lens is not present

A

Aphakia

127
Q

Term who have artificial lenses

A

Pseudophakia

128
Q

Methods of correction of Aphakia

A

Spectacles
Contact Lens
Intraocular lens
Lasik

129
Q

Indications of cataract surgery

A

Lens threatens to cause secondary glaucoma or uveitis

Visual defect interferes with patient’s vocation

Permit fundus visualization to monitor glaucoma

Permit adequate visualization of the fundus for retinal/vitreous conditions

As a refractive measure

130
Q

2 Techniques of Cataract Surgery

A

Intra-Caps. Cataract Extraction (ICCE)

Extra-caps. Cataract Extraction (ECCE)

131
Q

• The entire lens is removed
• Make an incision take
everything out

A

Intra-Caps. Cataract Extraction (ICCE)

132
Q

• Nucleus and cortex removed, capsule

is intact

A

Extra-caps. Cataract Extraction (ECCE)

133
Q

Types of ECCE

A

Traditional ECCE

Manual small incision cataract
surgery (MSICS)

Phacoemulsification – UTZ

Laser assisted cataract surgery

134
Q

Surgery with highest and quickest recovery rate, you can do this in 8
minutes and earn 6 figures by melting and suctioning the cataract in place

A

Phacoemulsification

135
Q

An incision is made at the limbus either superiorly or temporally. An opening is
created in the anterior capsule (anterior capsulorhexis), and the nucleus and
cortex of the lens are removed. An intraocular lens is placed in the empty
“capsular bag” thus supported by the intact posterior capsule.

A

Traditional ECCE

136
Q

In Traditional ECCE:

An incision is made at the limbus either ___ or ___

A

superiorly or temporally

137
Q

In Traditional ECCE:

An opening is
created in the _____ and the nucleus and
cortex of the lens are removed.

A

Anterior capsule (anterior capsulorhexis), and the nucleus and cortex of the lens are removed.

138
Q

Nucleus is

removed intact, using a small incision. Cortex is removed by manual aspiration.

A

Manual Small Incision Cataract Surgery (MSICS)

139
Q

Indicated for dense cataracts unsuitable for phacoemulsification

A

Manual Small Incision Cataract Surgery (MSICS)

140
Q

Now the most common form of ECCE in developed countries

A

Phacoemulsification UTZ

141
Q

. Uses a handheld
ultrasonic vibrator to disintegrate the hard nucleus. Nuclear material and cortex
are aspirated via a 2.5 – 3 mm incision then insertion of foldable intraocular
lenses.

A

Phacoemulsification UTZ

142
Q

If you correct the patient the patient can only see one

vision either far or near

A

Monofocal

143
Q 
Several focalities (far, near, immediate, at the same
time)
A

Miltifocal

144
Q

Improves your accommodation

A

Accommodative

145
Q

Designed for people with astigmatism

A

Toric

146
Q

Infection of the globe that leads to inflammation

A

End opthalmitis

147
Q

Whole globe is affected, one of the most common

complication even if you did the surgery well

A

Panendopthalmitis

148
Q

Corneal decompensation because of so much
power and heat, because the cornea has a delicate
structure

A

Retinal

detachment

149
Q

Once you rupture the capsule the vitreous goes out, it is another factor why we keep the capsule in place

A

Vitreous loss

150
Q

It can happen when the surgery is very long and the

pressure drops then you can have hemorrhage

A

Cystoid macular

edema

151
Q

Cloudiness post-operatively, because of the
retained inflammatory materials (happens 2-3 years
after surgery) treated only with laser.

A

After cataracts

Opthalmology (3 decks)

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