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II. Advanced Ocular Technique > Ocular Adnexal Evaluation (M3) > Flashcards

Ocular Adnexal Evaluation (M3) Flashcards

1
Q

About how many meibomian glands are in the upper eyelid? 1. Lower eyelid? 2

A
  1. 25-30

2. about 20

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2
Q

What are contraindications for punctal plug insertion?

A
  1. allergy to collagen or silicone
  2. active conjunctival infection
  3. dacryocystitis
  4. eyelid inflammation
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3
Q

What is the procedure in which an eyelash is mechanically removed called?

A

epilation

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4
Q

What is the anesthetic procedure preparation of lacrimal sac dilation and irrigation?

A

instill two drops of proparacaine and place anesthetic soaked Q-tip over punctum for a few minutes

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5
Q

When performing the Jones 1 testing, does the lack of of fluorescein mean (+) or (-) result? 1. What does this indicate? 2. What should be done? 3

A
  1. negative
  2. functional blockage
  3. massage lacrimal sac and blow nose then repeat. Then if still positive, do Jones 2
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6
Q

When performing the Jones 2 testing, does the lack of of fluorescein mean (+) or (-) result? 1. What does this indicate? 2

A
  1. negative

2. functional blockage exists nearer to canaliculus and punctum

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7
Q

What is the distance from lid margin to skin fold in primary gaze?

A

pre-tarsal show

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8
Q

When performing the Jones 2 testing, does the presence of fluorescein mean (+) or (-) result? 1. What does this indicate? 2

A
  1. positive

2. functional blockage likely in nasolacrimal duct

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9
Q

What is the margin-reflex distance? 1. What is normal? 2

A
  1. distance from upper lid margin to corneal reflection of penlight
  2. 4-4.5 mm
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10
Q

What is the diameter range of silicone punctal plugs?

A

0.3-0.8mm

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11
Q

What are the lid margin descriptor terms?

A
  1. scalloped/notched
  2. erythematous
  3. telangiectatic
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12
Q

What are the contraindications for meibomian gland expression?

A
  1. acute internal/external hordeolae

2. preseptal cellulitis

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13
Q

What is the measurement of the anterior projection of the cornea relative to the lateral orbital rim called? 1. What tools are used? 2. What are the indications of these results? 3

A
  1. exophthalmometry
  2. Hertal or Luedde
  3. proptosis or enophthalmos
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14
Q

What is the distance of lid margin excursion from downgaze to upgaze called? 1. What is normal? 2. What is good? 3. What is fair? 4. What is poor? 5

A
  1. levator function
  2. over 15mm
  3. 12-14mm
  4. 5-11mm
  5. 4mm or less
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15
Q

What are the grading scale terms used to describe meibum?

A
  1. clear
  2. cloudy
  3. granular
  4. toothpaste
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16
Q

When performing the Jones 1 testing, does the presence of fluorescein mean (+) or (-) result? 1. What does this indicate? 2

A
  1. positive

2. nasolacrimal drainage system is functioning

17
Q

Is proparacaine used for punctal plug insertion?

A

yes

18
Q

What ocular indication does lymph node palpation have?

A

differential diagnosis of red eye (viral conjunctivitis usually PAN+)

19
Q

Which eyelid procedures require anesthetic?

A
  1. double eyelid eversion

2. meibomian gland expression

20
Q

What are possible causes of obstruction along the nasolacrimal drainage system?

A
  1. debris
  2. infection of surround tissue
  3. infection of lacrimal sac
  4. tumor
21
Q

During lacrimal sac palpation and punctal regurgitation, what indicates an obstruction, infection or inflammation of the lacrimal sac?

A

pus or mucus discharge

22
Q

What is the visible difference between acute and chronic dacryocystitis?

A

acute is warm and red with pain (both have mucopurulent discharge)

23
Q

What does the examiner need to beware of when performing double lid eyelid eversion?

A

Bell’s reflex

24
Q

What does meibomian gland expression have the possibility of becoming if lid hygiene isn’t addressed right away?

A

acute internal hordeolum

25
Q

What are the tools used for lacrimal sac palpation and punctal regurgitation?

A
  1. fingers OR

2. sterile cotton-tipped applicator (more precise)

26
Q

What is the distance from lid margin to lid crease in downgaze called? 1. What is normal in men? 2. Women? 3

A
  1. upper lid crease
  2. 8mm
  3. 10mm
27
Q

What is the vertical fissure height? 1. What is normal for men? 2. For women? 3. How is ptosis defined by this? 4. What are the three levels of ptosis (with their values)? 5

A
  1. distance from upper to lower lid margins
  2. 7-10mm
  3. 8-12mm
  4. vertical height difference
  5. mild (2mm), moderate (3mm), severe (over 4mm)
28
Q

What do patients complain of when there is an obstruction of the nasolacrimal drainage system?

A

epiphora

29
Q

What procedure is done to permanently occlude the puncta?

A

punctal cautery

30
Q

What is contraindicated for dilation and irrigation of the lacrimal sac?

A

infection/acute dacryocystitis

31
Q

What most be done before dilation and irrigation is performed?

A

obtain informed consent

32
Q

What are the meibomian gland descriptor terms?

A
  1. clogged
  2. insoissated (clogged)
  3. keratinized
  4. atrophic
33
Q

What is required for reimbursement for dilation and irrigation of the lacrimal sac?

A

documentation of failed treatment plan (warm compress, etc)

34
Q

What are normal values in exophthalmometry for african americans? 1. For caucasians? 2. What difference between OD/OS indicates is significant? 3

A
  1. 12-24mm
  2. 12-20mm
  3. 3mm and over

II. Advanced Ocular Technique (9 decks)

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