Ocular Disease Flashcards

Question

Define iridodialysis

Answer 1

trauma where iris root separates from ciliary body

Answer 2

do NOT order an MRI if it is a metal FB order CT scan/B scan

Answer 3

symptoms: pain, decreased vision signs: transillumination defect (TID), distorted pupil, hyphema, decr IOP, (+) seidel sign, microcystic edema of the peripheral cornea, inflamamtion

Answer 4

Symptoms: pain, binocular diplopia, cerpitus on palpation of the medial orbital area signs: subconj heme, enopthalmos, diplopia, step-off fracture of the orbital rim, globe ptosis, infraorbital hypoesthesia, asymmetric monocular PDs (>3mm difference), hyphema, angle recession (nonexhastive list), trapped inf rectus or inf oblique (limits upgaze & downgaze), damage to infraorbal nerve causing hypoesthesia, periorbital creptius (aka orbital emphysema)

Answer 5

4 weeks after trauma pt should avoid blowing nose within 48 hours of trauma in order to limit risk of orbital infection (cellulitis)

Answer 6

Graves ophthalmopathy Orbital floor fracture Brown syndrome Duane retraction syndrome eye CANNOT be moved

Answer 7

CN nerve palsy eye CAN be physically moved

Answer 8

causes disruption of the RPE and photoreceptors outersegment. Signs: gray-white discoloration, retinal heme, choroidal rupture Symptoms: asymptomatic, acute vision loss if trauma occurs with the macula aka Berlin's edema if located in the macula

Answer 9

3-6 weeks, permanent vision/visual field loss may occur

Answer 10

disinsertion of the iris root from the ciliary body, appears like a retinal hole that's best seen with retroillumination monitor for angle recession glaucoma due to possible TM damage 2' to trauma

Answer 11

pigment ring on the surface of lens from the posterior pigment iris 2' to trauma

Answer 12

Retinopathy associates with acute chest compression trauma Characterized by diffuse reitnal heme, exudates, CWS

Answer 13

acute pancreatitis, renal failure, long bone fractures (among others)

Answer 14

occur in 5-10% of blunt ocuclar trauma single area or multiple areas of subret heme, usually within the temporal posterior pole, with crescent shaped tears concentric to the ONH associated with CNVM at the margins of the tear (occurs in 5-10%) of pt

Answer 15

bruise or black eye 2' to trauma from leaky blood vessels in the subcutaneous tissue look for underlying ocular damage

Answer 16

seidel's test to determine if an open globe wound is present good prognosis unless laceration involves the visual axis

Answer 17

CHBALA Choroid rupture Histoplasmosis Best disease AMD Lacquer cracks Angioid streaks

Answer 18

Aging can weaken the orbital septum causing extraconal fat to prolapse into the UL and LL and surrounding skin Signs: outpouching of skin of the UL and LL and adnexa with soft palpitation, lid malformation Symptoms: asymptomatic, irritation, tearing, blurred vision, redness

Answer 19

infection of the anterior orbital septum. more common in young adults and children during the winter months Signs: eyelid edema, erythema, ptosis, warmth, no pain to w/ mild tenderness, hard bump on eyelid (NO ORBITAL CONGESTION)

Answer 20

1. ocular infection: acute hordeolum, dacryocystitis 2. systemic infection: nearby upper respiratory tract or middle ear infection 3. skin trauma: puncture wound, insect bites

Answer 21

orbital cellulitis

Answer 22

fever, sinus/dental infection, recent trauma

Answer 23

infection of the posterior orbital septum 1. sinus infection: especially ethmoid sinusitis 2. orbital infection: dacryoadentitis, dacryocystitis, progression of preseptal cellulitis 3. orbital fracture 4. dental infection diabetics worse (mycormycosis) worry about meningitis, proptosis can lead to optic atrophy

Answer 24

fever, EOM restriction, pain, proptosis, decreased VA signs: eyelid edema and redness symptoms: red eye, pain, decreased vision, HA, fever, general malaise, reduced color vision, APD and diplopia with pain on eye mvmt due to EOM restrictions

Answer 25

can cause serious infection that can result in a cavernous sinus thrombosis, brain abscess, and/or meningitis if not caught early and managed appropriately Diabetics and immunocompromised pt with orbital cellulitis can develop mucormycosis, an aggressive fungal infection that can be-life-treahtening; these pts have a characteristic "black eschar" (black necrotic tissue) in their mouth and nose

Answer 26

Preseptal will NOT have decreased vision, proptosis, fever, pain on eye mvmt, or EOM restrictions, all of which are common in orbital cellulitis

Answer 27

smoking cigarette 2-9X greater risk female predilection 8:1, 4th-5th decade of life, 1% will develop myasthenia gravis

Answer 28

Autoimmune disease characterized by TSH receptor antibodies directed against the EOMs and orbital tissue, causing fibroblast proliferation and significant inflammation and thickening of EOMs that results in ON compression in the late stage of the disease can cause hyperthyroidism

Answer 29

symptoms: prominent eyes, chemosis, FBS, tearing, photophobia, pain, diplopia, decreased vision, and color vision loss signs: unilateral or bilateral (often asymmetric), proptosis, UL retraction, eyelid erythema, edema, conjunctival/caruncle injection and edema, decreased color vision, EOM restrictions and APD. IOP may be elevated in primary and up gaze

Answer 30

Thyroid eye disease

Answer 31

grading system of thyroid related ophthalmopathy N - no signs or sx O - only signs, no sx (lid retraction, dalrymple's sign) S - soft tissue involvement such as lid edema and conj chemosis P - proptosis E - EOM involvement, diplopia, IR affected first (IM SLO) C - corneal involvement (punctate keratitis, SLK, ulceration) S - sight loss due to optic nerve compression)

Answer 32

inferior rectus (IM SLO)

Answer 33

optic nerve compression due to enlarged EOMS

Answer 34

(+) Forced duction CT/MRI to view enlargement of EOMs Exophthalmometry to measure proptosis VF to detect ON compression Blood work (T3/T4/TSH) to measure thyroid function look for: VG sign: UL lag during downgaze Kocher's sign: globe lag compared to lid mvmt when looking up Dalrymple's sign: lid retraction resulting in a stare apperance

Answer 35

12-22mm caucasians 12-18mm asians 12-24mm AA abnormal if higher OR presence of >3mm asymmetry. make sure to record the base (19)!

Answer 36

abnormal communication between the arterial and venous system Head trauma, spontaneously (from ruptured internal carotid aneurysm), high pressure blood from the carotid artery builds up in the cav sinus and impedes return of venous blood back to the cav sinus = build up of pressure behind the globe causing a clincal triad of chemosis, pulsatile proptosis, ocular bruit

Answer 37

pulsatile, chemosis, ocular bruit, proptosis episcleral venous congestion, periorbital tissue swelling, elevated IOP, diplopia 2' to 3,4,6 palsies and loss of lid/face sensation on the affected side due to CN 5 palsy

Answer 38

capillary hemangioma

Answer 39

6 months after birth

Answer 40

Capillary hemangioma - dx by 6 months - blanches with pressure - mainly in children - gradually involute by age 7 - can cause proptosis and deprivation amblyopia if the visual axis is blocked

Answer 41

- benign orbital tumor in adults - occurs 4th - 6th decade - F>M - progressive, painless, unilateral proptosis as the tumor most commonly arises posterior to the globe within the muscle cone

Answer 42

Dermoid cyst - usually located S/T quadrant - dx 1st decade - noticeable proptosis - CT scan will show a mass

Answer 43

children, adults

Answer 44

Neurofibroma - yellow/white tumor of astrocytes - common in young to middle aged adults - assoc w/ neurofibromatosis - CT scans shows a mass that's located in the superior orbit - unilateral or bilateral or isolated

Answer 45

- tumor of the schwann cell - common in young adult to middle age - located in the superior orbit - develops within the first division of CN 5 - gradual onset of painless, progressive proptosis

Answer 46

Optic nerve glioma (juvenile pilocytic astrocytoma) - symptoms within 1st decade of life (ages 2-6) - Infant cases w/ optic nerve glioma are associated with neurofibromatosis type 1 in up to 30-50% of cases (NF type 1)

Answer 47

meningioma - typically occurs in middle aged women

Answer 48

sphenoid meningioma from the sphenoid bone

Answer 49

Rhabdomyosarcoma - rapid bone destructing tumor that causes progressive unilateral proptosis - avg age of dx is 7 yo "starts in the orbit and travels elsewhere"

Answer 50

Neuroblastoma most commonly arise from a tumor in the abdomen, mediastinum, or neck (may have associated horner's syndrome) " starts elsewhere and travels to the brain" "blast to the brain"

Answer 51

Lymphoma - APD and insidious progressive proptosis - 60% 5-year survival rate -proptosis in one eye **salmon patch**

Answer 52

** GRADUAL ** progressive vision loss, proptosis, diplopia, APD

Answer 53

70 yo = lymphoma (unilateral) 40 yo = TED (unilateral or bilateral)

Answer 54

orbital pseudotumor ( Idiopathic orbital inflammatory syndrome) - rare condition - young to middle age pts - may be acute, recurrent, or chronic

Answer 55

Symptoms: acute onset of unilateral pain, red eye, diplopia, and/or decr vision, may be bilateral in children, 50% of affected children will have fever nauea, and vomiting signs: - lid ptosis - periorbital swelling - lacrimal gland enlargement - conjunctival chemosis - reduced sensation due to CN V1 involvement - incr IOP on the affected side - Optic nerve swelling - EOM restrictions (causing external ophthalmoplegia) and proptosis due to inflammation of orbital contents

Answer 56

chemosis can be due to allergic conjunctivits but if it's unilateral thin of idiopathic orbital inflammation as a DDx (IOI) esp in young to middle aged pts esp if it's without itching

Answer 57

cavernous sinus issue or inflammation and the SOF

Answer 58

acute and painful exopthalmoplegia and diplopia due to ipsilateral palsies of CN 3,4,6 V1 and V2 damage can cause loss of sensory innervation to their areas of distribution may also occur

Answer 59

CN 3,4,6, V1, V2

Answer 60

systemic vasculitis (Wegner's granulomatosis, polyarteritis nodosa, or lymphoma

Answer 61

Phtisis Bulbi shrinkage and atrophy of globe as a result of trauma, infection, surgery, or advanced dz assoc with inflammation, hypotony, and a blind eye

Answer 62

absence of ocular tissue within the globe, primary cases are very rare

Answer 63

microphthalmos small globe, congenital in nature

Answer 64

Enophthalmos retraction of the bloge within the orbit due to trauma

Answer 65

methyl methacrylate, usually fit in pts with anopthalmos 2' to surgical procedure

Answer 66

enucleation

Answer 67

evisceration

Answer 68

externation

Answer 69

ocular rosacea - affects the sebaceous gland (MG) - F>M, but men have it worse - middle-aged adults - Northern European ancestry

Answer 70

Symptoms: redness, burning, FBS, ocular irritation Signs: telangiectasia, rhinophyma, facial flushing (malar butterfly rash)

Answer 71

- alcohol - exertion - spicy foods - increased sun exposure

Answer 72

Basal cell Acne rosacea coats disease (unilateral)

Answer 73

phlyctenules, spha marginal keratitis, SPK, corneal neo (inf), and dry eye syndrome

Answer 74

type 4 hypersensitivity rxn - delayed T cells - develop 24-72 hours after exposure - makeup, shampoo, soaps, hairspray, fingernail polish, perfumes, jewelry, poison ivy, cls solution - medications: aminoglycosides, trifluridine, cycloplegics/mydriatics, glaucoma meds, preservatives

Answer 75

tobramycin, gentamicin

Answer 76

Alphagan, timolol, trusopt

Answer 77

thimerosol BAK

Answer 78

Symptoms: acute periorbital swelling, redness, itching, tearing Signs: unilateral or bilateral erythema and crusting of the lid and peri orbital tissues and significant conjunctival chemosis

Answer 79

Ocular cicatricial pemphigoid (OCP) idiopathic mucous membrane disorder, chronic autoimmune affecting the ocular and oral membrane - rare conditions that affects F>M - avg age 65 yo - sig # of these pts develop bilateral blindness ~10-30 years after dx - type 2 hypersensitivity reaction

Answer 80

- timolol - epinephrine - pilocarpine

Answer 81

Symptoms: redness, dryness, FBS, decreased vision Signs: conjunctival fibrosis and scarring (seen as fine white striae), bilateral symblepharon, ankyloblepharon, stretched inferior fornices due to shortening of the conj tissue

Answer 82

disease results in destruction of the goblet cells, MG, and glands of krause and wolfring, main lacrimal gland, and severe ocular surface dz late stage findings include entropion, trichiasis, w/ resulting ulceration, neo, keratinization

Answer 83

type 3 or type 4 hypersensitivity that affects mucous membranes most commonly drug-induced, infectious agents

Answer 84

sulfonamides (most common) phenytoin, penicillin, aspirin, barbituates, isoniazid, tetracyclines, NSAIDs, immunizing vaccinations

Answer 85

HSV, mycoplasma pneumonia, adenovirus, streptococcus species

Answer 86

Acute signs: fever, malaise, HAs, nausea, vomiting, skin lesions (diffuse erythema - target or classic bulls-eye lesions and papules on the palms of hands and soles of feet) ocular lesions - severe bilateral, diffuse conjunctivitis assoc. w/ pseudomembranes - bacterial conjunctivitis can progress to endopthalmitis in severe cases

Answer 87

Chronic signs/symptoms: Eyelid pathology: entropion, ectropion, trichiasis, MG damage Conjunctival pathology: symblepharon, foreshortening of fornices, conjunctival keratinization, limbal stem cell damage, which leads to subsequent corneal pathology Corneal pathology: ulcers, neo, scars, perforation

Answer 88

redundant upper eyelid skin, weakened orbital septum often causing ptosis, pseudoptosis, and loss of typical distinct eyelid creases can cause superior VF loss in severe cases

Answer 89

staphylococcal blepharitis seborrheic blepharitis

Answer 90

often asymptomatic, may report vision clears after blinking, itching, FBS, tearing, crusting (esp in the AM), and mild discharge seborrehic blepharitis is frequently assoc. with seborrheic dermatitis

Answer 91

chalazion - chronic, localized, sterile inflammation of MG due to retention of normal secretions - resolves spontaneously w/o tx - ask about acne rosacea and seborrheic dermatitis

Answer 92

hard, painless, immobile nodule without redness that is most commonly located on UL pts are most likely asymptomatic

Answer 93

possible malignancies, sebaceous gland carcinoma

Answer 94

hordeolum is an infection vs chalazion is non-infectious inflammation

Answer 95

staphylococcus infection

Answer 96

internal = MG external = zeis and moll

Answer 97

external hordeolum

Answer 98

tender, red, warm area of focal swelling of the lid

Answer 99

epithelium of the epidermis and dermal tissues (often assoc. with meibomian, sebaceous and sweat glands of the eyelids)

Answer 100

most common complaint is cosmesis

Answer 101

- inclusion cyst: congenital or acquired lesion. Appears white due to the accumulation of keratinous debris. - milia: an acquired lesion, appear white due to occlusion of sweat pores or pilosebaceous follicles - dermoid cyst: congenital lesion that is firm and immoble, located on S/T or sup nasal eyelid - sebaceous cyst: retention of fluid within the glands of zeis or debris in MG . They are solitary, smooth lesions that are yellow or opaque

Answer 102

Ectropion eversion of the eyelid away from the globe due to loss of muscle tone of the OO mostly age related

Answer 103

mechanical (tumor), cicatricial (scar tissue, trauma, chemical burns, skin dz, previous lid sx), paralytic (facial nerve palsy), congenital signs/sx: exposure keratopathy, epiphora, brow ptosis

Answer 104

Entropion inversion of the eyelid against the globe - age-related (involution), most common

Answer 105

Age related cicatrical (SJS, cicatricial, OCP, chemical burns, previous lid sx, trichiasis, distichiasis) congenital can cause pseduotrichiasis

Answer 106

mild punctate keratitis, corneal ulcer, pannus

Answer 107

corneal ulceration 2' to entropion and trichiasis

Answer 108

Floppy eyelid syndrome most common in obese men with obstructive sleep apnea - reduce elastin within the tarsal plate, predominantly in face-down sleepers (mechanical trauma) from eyelid and pillow contact

Answer 109

spontaneous lid eversion, papillary conjunctivitis (from friction) assoc w/ obstructive sleep apnea, diabetes, hyperthyroidism, HTN symptoms: chronic, bilateral, red eyes in the AM upon wakening w/ mild mucus discharge signs: chronic papillary conjunctivitis w/ loose UL that evert easily, punctate epithelial keratopathy and keratoconus are noteworth corneal assoc.

Answer 110

FES, RCE, exposure keratopathy

Answer 111

- mainly in pts 50-70 yo - 2X more common in F

Answer 112

Sx: Involuntary, sustained, repetitive bilateral twitching or forceful closing of the eye Signs: spasm of the procerus, corrugator, orbicularis oculi muscles

Answer 113

50% of pts with BEB have an ocular surface disorder that may be exacerbating the spasms 50% of pts w/ BEB have meige's syndrome - characterized by BEB and lower facial abnormalities (difficulty chewing, oepning mout, jaw spasm, jaw pain, etc)

Answer 114

unilateral twitching of the orbicularis oculi, doesn't affect the corrugator or procerus muscles commonly caused by sleep deprivation, too much caffeine, and/or stress

Answer 115

BEB = bilateral, uses 3 muscles (OO, procerus, and corrugator) myokyma = unilateral, uses 1 muscle (OO)

Answer 116

1. Basal cell carcinoma (BCC) 2. Squamous cell carcinoma (SCC) 3. Sebaceous gland carcinoma 4. Malignant melanoma

Answer 117

BCC - M>F (2:1) - sun/UVB exposure (290-320) - chronic bleeds and will not heal - minimally invasive - affects the stratum basal

Answer 118

- shiny, firm, pearly nodule, superficial telangiectasia, rodent ulcer commonly on the LL and medial canthus

Answer 119

squamous cell carcinoma - affects stratum spinosum - M>F (2:1) - 2nd most common eyelid cancer but 40-50x less common than BCC - UVB exposure (290-320) - precursor is actinic keratosis - prior radiation, fair skin, burn scars, chemical exposure (smoking), other forms of chronic irritaton

Answer 120

actinic keratosis - pink red scaly lesion on sun exposed skin that does not heal - 25% develop into SCC

Answer 121

often present similar to BCC but without surface telangiectasia. classically described as erythematous plaque that appears rough, scaly, and or ulcerated, and may be flat or elevated. most commonly located on the LL or lid margin

Answer 122

SCC has not telangiectasia

Answer 123

can appear very similarly to BCC and SCC usually found in sun-exposed areas and has an early appearance that is similar to BCC and SCC these tumors can grow very quickly to a large size 1-2cm before they slowly shrink and often spontaneously resolve

Answer 124

Sebaceous gland carcinoma - more common in elderly F - hx of chronic unilateral blepharitis or recurrent chalazia - neoplasm of the sebaceous gland

Answer 125

poor, if the lid lesion is >2cm the mortality rate is 60% if present longer than 6 months, the mortality rate is 68% overall mortality rate is 10%

Answer 126

tumor is often hard and yellow assoc w/ madarosis, thickened and red lid margins, common on the UL and lymphadenopathy

Answer 127

malignant melanoma - most lethal skin cancer - malignancy of the melanocytes

Answer 128

age, skin, color, fam hx, repeated irritation, sun exposure

Answer 129

A - Asymmetry B - Border irregularity C - Color differences D - Large diameter E - Enlargement of the lesion

Answer 130

depth and size of the lesion

Answer 131

Dacryoadenitis - inflammation of the lacrimal gland - more common in young adults and children - ask if there's any hx of fever or systemic infection

Answer 132

Acute infections: staph aureus, neisseria gonorrhoeae, streptococci Viruses: mumps, mononucleus, influenza, herpes zoster Chronic infections: sarcoidosis, tuberculosis, graves dz, idiopathic orbital inflammation, 25% of pts with orbital inflammation will have lacrimal gland involvement

Answer 133

Swelling of the outer 1/3rd of the temporal UL acute: S-shaped ptosis, temporal upper eyelid pain, redness, swelling, preauricular lymphadenopathy, occ fever, elevated WBC count chronic: temporal UL swelling w/ less redness, swelling, and pain compared to acute dacryoadenitis. chronic cases may lead to inferonasal globe displacement and proptosis

Answer 134

most common culprit is actinomyces israelii which is characterized by yellow sulfur granules after expression of the canaliculi other culprits include staph aureus, candida albicans, aspergillus, nocardia asteroides, herpes simplex, herpes zoster

Answer 135

sx: smoldering, unilateral red eye unresponsive to antibiotic tx, often misdx as recurrent conjunctivitis signs: tenderness over the nasal portion of the UL and LL, pouting puncta, dacryoliths, mucopurulent discharge that occurs w/. palpation over the lacrimal sac region "a lot of canals in Israel w/ yellow rocks"

Answer 136

Dacryocystitis: lacrimal sac infection - ask about concomitant ear, nose, throat infection - characterized by swelling below the medial canthal tendon - TREAT FIRST, do not attempt sx or irrigation w/ acute cases

Answer 137

obstruction of the drainage system causing a backflow of bacterio from the nasolacrimal duct into the lacrimal sac staph aureus, staph epidermis, pseudomonas, H. influenzae in children

Answer 138

lacrimal sac tumor

Answer 139

epithelial carcinomas and malignant lymphomas carcinomas can express blood into the tar film with palpitation of the lacrimal sac

Answer 140

sx: pain, crusting and tearing, occ fever signs: prominent edema and tenderness over the lacrimal sac

Answer 141

dacryocystitis

Answer 142

NLD is the #1 cause

Answer 143

age causing narrowing (or occlusion) of the puncta of the UL and LL

Answer 144

less than 0.3 mm or inability to intubate the puncta with a 26 gauge cannula

Answer 145

epiphora, ocular irritation

Answer 146

- congenital or acquired (acquired is more common in F). - older pts = commonly caused by involutional stenosis. chronic sinus dz, dacryocystitis, nasoorbital trauma - Young pts = blockage of the valve of hasner

Answer 147

1-2 months after birth digital massage

Answer 148

sx:unilateral tearing, discharge, crusting, and recurrent conjunctivitis signs: epiphora, mucus reflex from puncta after compression on the lacrimal sac, medial lower eyelid erythema, mild to no redness or tenderness around the puncta secondary dacryocystitis can occur in cases of congenital NDLO due to stagnant tears in the lacrimal sac

Answer 149

evaluate the ability of tears passing through the lacrimal drainage system

Answer 150

(+) jones 1: presence of fluorescein in the back of the throat or after blowing their nose only performs jones 2 if jones 1 is negative (+) jones 2: if pt tastes saline, performs gag reflex, or if fluid is recovered from the nose, the obstruction is cleared

Answer 151

Dacryocystorhinostomy DCR

Answer 152

same punctum = obstruction within the upper or lower canaliculus retrograde flow through the opposite canaliculus and punctum = obstruction distal to the common canaliculus

Answer 153

aka retention cyst/inclusion cyst common, benign, fluid filled sac on the conj that may cause irritation

Answer 154

superficial, white-yellow deposits of mucous secretions and epithelial cells in the palpebral conj calcium

Answer 155

- benign proliferation of the melanocytes - begin around puberty or early adulthood (within 1st decade of life) - unilateral, solitary, flat, feely mobile, inclusion cyst within the lesion

Answer 156

juxtalimbal followed by plica and caruncle

Answer 157

unilateral acquired pigmentation with indistinct margins that is more common in elderly white pts - can be benign or have premalignant potential (30% cases progress to malignant melanoma) - nodular region, increased vascularity, and increased growth are suspects for malignancy - needs biopsy

Answer 158

- 2' to uncontrolled proliferation of melanocytes - found almost exclusively in Caucasians and usually develop around age 50 - can be pigmented or non-pigmented - most commonly arise from PAM, less commonly from a pre-existing nevus

Answer 159

Conjunctival intraepithelial neoplasia (CIN) aka bowens disease or conjunctival squamous dysplasia - most common conjunctival neoplasia in the US - unilateral, premalignant condition that can progress to squamous cell carcinoma - appearance = elevated mass w/ neo, most of them are found at the limbus but can progress to the cornea

Answer 160

UVB exposure, smoking, exposure to petroleum derivatives, fair skin, xeroderma pigmentosa, HIV, HPV

Answer 161

conjunctival melanoma conjunctival squamous cell carcinoma

Answer 162

Conjunctival squamous cell carcinoma - rare, slow-growing, malignant tumors that typically present in elderly caucasian males - most commonly derived from CIN - usually found limbus and may involve adjacent cornea - commonly contains feeder vessel - associated with UV radiation and HPV

Answer 163

- pedunculated, benign, red, vascular lesion of the palpebral conj - caused by trauma, sx, chalazion, or other sources of chronic irritation

Answer 164

- inflamed area (white, yellow, transulucent, or brown) - located within the conj stroma from retained FB, sx, trauma, infections (Parinaud's oculoglandular syndrome) or associated systemic conditions - asymptomatic or c/o ocular irritation and FBS

Answer 165

More common in children than adults children - H. influenzae adults - S. aureus, S. epidermidis

Answer 166

sx: acute onset of redness that begins in one eye and becomes bilateral, FBS, eyelids stuck together upon wakening sx subsides 10-14 days w/o tx Signs: discharge, mucopurulent, corneal signs and preauricular lymphadenopathy are rare

Answer 167

H. influenzae (gram -) N. Gonorrhea (gram -) "Hersheys & Nestles chocolate"

Answer 168

1. corynea bacteria 2. H. influenazae 3. N. gonnorrhea 4. Listeria "CHaNeL"

Answer 169

cephalosporin higher generation ceftriaxone (3rd) - attacks gram -

Answer 170

- sexually transmitted dz most common in young adults w/ hx of multiple sex partners - transmitted in infants as they pass through the vagina during birth - dx w/ chocolate agar (Thayer-martin agar)

Answer 171

sx: hyperacute onset of severe purulent discharge, redness, FBS, eyelids stuck upon wakening, becomes bilateral over time signs: severe purulent dischare, conj chemosis (often with psudeomembranes), severe papillar rxn, marked preauricular lymphadenopathy, tender, swollen eyes, corneal ulcers (can invade) Systemic sx Men = purulent urethral discharge 3-5 days after incubation Women = discharge less common, asymptomatic **ALL PTS SHOULD BE EVALUATED FOR CO-EXISTING CHLAMYDIA**

Answer 172

N. gonorrhea

Answer 173

- adults > children - due to upper respiratory tract or nasal mucosal infection

Answer 174

2 weeks (12-14 days)

Answer 175

acute nonspecific follicular conjunctivitis, pharyngoconjunctival fever (PCF), and epidemic keratoconjunctivitis (EKC) follicles, pseudomembranes, conjunctival hyperemia,

Answer 176

1. acute nonspecific conjunctivitis - serotypes 1-11 and 19 - most common type of adenoviral infection - presents with diffuse red eye, conj follicles in the inferior fornices, tearing, mild discomfort, corneal involvement 2. PCF - serotypes 3-5, 7 - aka swimming pool conjunctivitis - children > adults - low-grade fever, pharyngitis, corneal involvement is not common 3. EKC - most serious type of adenoviral conjunctivitis - serotypes 8,19,37 - pain and corneal involvement - clinical sx occur 8 days after initial exposure to the virus - superficial keratitis common during acute phase - SEIs occur 3rd week - pt is no long contagious at this point - always presents with preauricular lymphadenopathy

Answer 177

acute nonspecific follicular conjunctivitis, serotype 1-11, 19

Answer 178

EKC, serotype 8,19,37 remember rules of 8: - caused serotype 8 - sx 8 days after exposure - SEIS 8 days after onset of sx

Answer 179

sx: rapid onset of redness, tearing, mild discomfort, preauricular lymphadenopathy, starts in one eye and spreads to the fellow eye signs: acute follicular conjunctivitis in the inf fornices,pseudomembrane formation, preauricular lymphadenopathy, diffuse keratitis ALWAYS CHECK NODES

Answer 180

Molluscum contagiosum Rare. common in communities with poor hygiene. - mot common in children and young adults - infection of the skin caused by DNA pox virus via direct contact - if multiple nodules are present consider HIV or other immunodeficiency conditions

Answer 181

single or multiple dome-shaped, umbilicated, waxy nodules located on the lid margin - usually asymptomatic or complains of mild mucus discharge - rupture may lead to follicular conjunctivitis and superficial pannus

Answer 182

molluscum contagiosum, herpes simplex

Answer 183

western blot or ELISA

Answer 184

1. seasonal allergic conjunctivitis (pollen) 2. perennial allergic conjunctivitis ( mites, dust, animal dander)

Answer 185

chemosis, papillae, redness, itching, tearing, watery discharge

Answer 186

- affects young males under the age of 10 that live in hot, dry climates - 2-10 years before resolving around puberty - occurs in pts w/ predisposed atopic systemic conditions (rhinitis, asthma) - 40-75% of patients w/ VKC have eczema or asthma, 40-60% of fmhx of atopy - common in warm months but may have sx year round

Answer 187

sx: intense itching, photophobia, thick mucous discharge, proptosis - initial outbreak is the most severe and decreases in intensity over time Sign: prominent papillae on limbus (trantas dots) or UL palpebral conjunctiva (cobblestone papillae) - corneal involvement punctate epithelial keratitis > large erosions, leading to plaque formation and localized ulcer

Answer 188

VKC is predominantly on the conjunctiva and cornea

Answer 189

- most common in young to middle-aged adults w/ hx of atopic conditions, esp atopic dermatitis - NOT seasonal, type 1 and type 4 hypersensitivity mechanism

Answer 190

sx: bilateral itching of eyelids watery discharge, redness, photophobia, and pain signs: - scaly thickened swollen eyelid - Dennies lines - atopy shiners (eye bags from constant rubbing) - papillae (more prominent inf) - corneal neo, cataracts are more common in AKC - symblepharon formation in inf fornices may occur in severe cases and mimic ocular cicatricial pemphigoid

Answer 191

the type of chronic eczema that starts in early infancy, 60% dx within first year of life - hallmark signs = pruritis and rash - 10% develop shield cataracts between ages 15 and 30

Answer 192

Papillae: - contain central vessels as source for infiltration of eosinophils, mast cells, neutrophils, lymphocytes - small in size <1mm - associates w/ bacterial or allergic conjunctivitis - nonspecific sign of inflammation Follicles - Avascular, white-gray nodules typically located in the tarsal and fornix conjunctiva - immature lymphocytes and macrophages concentrate in the center of the nodule - CHAT with your follicles chlamydia, herpes, adenovirus, toxic

Answer 193

non-infectious inflammatory disorder associates with friction and immune response to cls surface deposits or environmental factors - caused by silicone hydrogel cls, exposed sutures, blebs, buckles, prosthetics - allergies - most commonly assoc w/ extended wear of soft cls - ask about the replacement schedule, cleaning system, and recent switch to silicone hydrogel lens - avg length of time of cls wear before development of GPC is 8 months, may develop as early as 3 weeks

Answer 194

- subtle signs and symptoms after switching to a new cls cleaning system - most often due to chlorhexidine or thimerosal

Answer 195

sx: redness, burning, reduced cls wear time due to dryness or discomfort - esp after cls insertion after cleaning signs: follicular conjunctivitis, diffuse conjunctival injection, and diffuse SPK

Answer 196

1.5mm this is due to chronic hypoxia, watch for sup neo pannus

Answer 197

alteration in corneal shape due cls material that is classically seen in long-term PMMA wearers or GP wearers with poorly fitting cls in rare cases, it can be seen with poorly fitting cls (typically low Dk, extended wear, and/or cls

Answer 198

pts often report vision is clear in cls but blurry in gls, ghost image, diplopia irregular astig, can mimic keratoconus, on topo, a high riding cls can cause inf steepening over time

Answer 199

corneal warpage can be distinguished in that corneal warpage will not have other corneal findings consistent with keratoconus and will improve with discontinuing/refitting cls

Answer 200

Due to cls hyperesnitivity rxn or poor cls fit cls/ wear thyroid eye disease dry eye

Answer 201

signs: superior bulbar, upper tarsal conjunctival injection. Papillary rxn, corneal filaments are uncommon, unlike SLK in thyroid disease

Answer 202

common cls abusers who are not replacing lenses on schedule or who are not cleaning their lenses properly if deposits are ONLY on the back surface - pt may be cleaning cls incorrectly, reinstruct pt to use finger and palm of hand for digital cleaning a stronger cleaner or weekly enzyme cleaner should be considered

Answer 203

GP lens - plaque soft cls - jelly bumps

Answer 204

occurs when a cls fitting is too tight, resulting in poor mvmt with blink (appears stuck on the cornea) most common in high myopes (>-8.00) cls that are too steep, or abnormally small (<13mm) or large (>15mm) OAD less common in hyperopes and pahkes

Answer 205

Sx: redness that worsens after cls are removed, hazy vision, halos, dryness Signs: injection or indentation around limbus and distorted k mires that clear with blinking - severe cases may result in mild to severe corneal edema or corneal blebs and an anterior chamber rxn - corneal abrasion may occur after removal of cls

Answer 206

3 and 9 o'clock staining - classically due to low-riding GP cls that do not adequately cover the cornea - poor spreading of the tears across the exposed corneal surface - chronic 3 and 9 o clock staning may lead to dellen formation, pseudopterygia, corneal neo pt may be asymptomatic or complain of horizontal redness

Answer 207

corneal warpage

Answer 208

3 & 9 o'clock staining

Answer 209

- arcuate shape of sup corneal staining within 1 mm of the limbus - mostly occurs due to 2' tight extended wear hydrogel cls. Loose cls that chafe or cls with poor wettability may also cause SEAL - ~30% cases are asymptomatic

Answer 210

sx: FBS, irritation, and corneal subepithelial infiltrates sign: superior corneal staining 1mm froml imbus

Answer 211

- characterized by small depression within the cornea that pool fluorescein - caused by small gap bubbles that become trapped underneath a cls (most often GP lenses)

Answer 212

simultaneous inflammation of the cornea and conjunctiva can be caused by bacterial infection, viral infections, herpes simplex, zoster, fungal infection, atopy, allergic, vernal, toxic rxns, factitious dz

Answer 213

- multiple sex partners - pain during urination occurs predominantly in you adults who are sexually active

Answer 214

1. adult inclusion conjunctivitis - serotypes D-K - spread via direct inoculation (swimming pool, sharing cosmetics) - ocular manifestations begin 5-14 after inoculation 2. trachoma - most prevalent between ages 1-5 yo - leading cause of preventable blindness - 3rd most common causes of blindness world wide after cataracts and glaucoma - primary risk factor is living in a community with poor hygiene - most infections spread eye to eye (fomites, flies, shared cosmetics are other routes of infection)

Answer 215

cataracts glaucoma trachoma

Answer 216

sx: acute follicular & papillary conjunctivitis that become chronic, most infections begin unilaterally, but bilateral involvement develops - infection can persist for 3-12 months if not tx signs: follicles (limbal or palpebral) AND papillae that are mostly concentrated in the inf palpebral conjunctiva and fornices, preauricular lymphadenopathy, scant mucopurulent discharge, matting of the lids, corneal involvement 30-85% of pts include punctate keratitis, superior pannus, and subepithelial infiltrates (more peripheral in location compared to EKC)

Answer 217

chlamydia (other causes HSV, gonorrhea) acute conjunctivitis in newborns

Answer 218

doxycycline and azithromycin

Answer 219

AIC - serotypes D-K - unilateral - papillary and follicular rxn predominantly on INF - preauricular nodes trachoma - serotypes A-C - bilateral - papillary and follicular rxn predominantly SUP - ultimately spreads thru entire conjunctiva both cause follicular conjunctivitis

Answer 220

Early: Follicular conjunctivitis predominantly on sup conjunctiva, mucopurulent discharge, lymphadenopathy, and mild superior pannus Late: Arlt lines (white scarring of the sup tarsal conjunctiva) and herbert's pits (depression of limbal con after resolution of limbal follicles); progressive tarsal conjunctival scarring can lead to distortion of the eyelids and subsequent corneal ulceration from trichiasis

Answer 221

- chlamydia (trachoma and inclusion conjunctivitis) - parinauds oculoglandular syndrome - EKC - gonococcal conjunctivitis - phthiriasis palpebrarum

Answer 222

- mostly affects females around 50yo - chronic inflammatory rxn mot commonly associated with k sicca, thyroid dz, cls wear, flare-ups, and remissions that eventually cease over time - cause: anything that involves friction, cls, TED, cls wear

Answer 223

sx: redness, FBS, frequent blinking, no discharge. signs: thickened, red, superior bulbar conj that is most prominent at the limbus, bilateral, with adjacent SPK and filamentary keratitis, the upper tarsal conj can have a velvety appearance as a result of diffuse papillary hypertrophy

Answer 224

- most common in teenage years with higher occurrence in females - ask if pt has had a hx of TB - most commonly a result of type 4 hypersensitivity to staph (blepharitis is the most common culprit), TB protein, and acne rosacea

Answer 225

Sx: tearing, FBS, itching associated with conjunctival and corneal phlyctenules, significant photophobia common with corneal phlyctenules signs: phlyctenules can be located on the cornea or conjunctiva 1. conjunctival phlyctenules: occurs mostly at the limbus w/ pink fleshy nodules with conjunctival injection 2. corneal phlyctenules; commonly occur near limbus as small, white (lymphocytic) nodule with adjacent conj injection

Answer 226

48-72 hours type 4 hypersensitivity (T cells, delayed)

Answer 227

"PLASMINOGEN deficiency" - rare, starts during childhood - systemic disorder - may affect mucous membranes throughout the body (mouth, ear, vagina)

Answer 228

signs: thick, white, "woody" membranous plaques of the superior tarsal conjunctiva LIG rhymes with TWIG = woody plaques sx: chronic tearing, FBS, photophobia, constant discomfort and cosmetic concerns in advance stages

Answer 229

plasmin derives from plasminogen - plasmin catalyzes break down of fibrin stopping unwanted clot formation within the healthy vessels throughout the body "PREVENTS CLOT"

Answer 230

" CAT SCRATCH" - rare, exposure to cats, dogs, rabbits squirrel and ticks - common causes: cat scratch fever (bartonella henselae), tularemia (via ticks rabbits, squirrels), TB and syphylis

Answer 231

sx: red eye, FBS, mucopurulent discharge signs: unilateral, granulomatous, follicular, palpebral conjunctivitis, preauricular/submandibular lymphadenopathy, fever, rash

Answer 232

aka crab louse - found in hair follicles of genital region - infection of eyelash, eyebrows, facial hair - unilateral or bilateral

Answer 233

sx: mild itching of eyelids, marked inflammation with burning, itching, tearing, blurred vision signs: transparent lice and white nits (egg sacs) attached to the eyelashes, blood-tinged debris on lids and lashes, mild to severe chronic follicular conjunctivitis, preauricular lymphadenopathy Associated w/ follicles due to toxicity (CHAT)

Answer 234

demodicosis

Answer 235

- caused by valsalva, medications (aspirin, coumadin), HTN, blood clotting disorder (Sickle cell) - order CBC, PT/PTT, and Sickledex for idiopathic and recurrent cases, especially in pts of african or Mediterranean descent

Answer 236

- associates with UV exposure and environmental exposure; common in individuals who work outdoors, - UV exposure and chronic dryness are believed to have cause degeneration in the collagen fibrils within the conjunctival stroma

Answer 237

sx: range from asymptomatic to irritation, redness, decreased vision (depending on location of the pterygium) signs: both located at 3 and 9 o'clock - pingueculum: yellow-white deposit next to the limbus - pterygium: triangular fibrovascular growth of bulbar conjunctiva that extends onto the cornea, destroying bowman's membrane and often leading to WTR astig due to flattening of horizontal meridian, stocker's line maybe present at the anterior edge of the pterygium

Answer 238

- most common in young adults (around 2nd-4th decade), Hx of frequent occurrences is common - benign, self-limiting, often idiopathic, can be associated with systemic dz

Answer 239

- collagen vascular/inflammatory dz: RA, lupus, UCRAP - spirochetes: lyme, syphilis - Virus: zoster, HSV, mumps - metabolic dz: gout - vasculitic dz: temporal arteritis, wegener's granulomatosis, behcet's dz, polyarteritis nodosa - Dermatological dz - acnea rosacea

Answer 240

sx: acute unilateral, red eye, mild pain signs: mostly sectoral injection (or simple, nodular), nodule can be slightly moved with cotton tip applicator

Answer 241

- F>M - 4th to 6th decade - less common than episcleritis - anterior scleritis can be divided into non-necrotizing and necrotizing scleritis

Answer 242

Diffuse: most common and most benign, Nodular: deep, focal, painful injected immobile nodule

Answer 243

Necrotizing with inflammation: WORST form, 33% of pts may die as a result of severe autoimmune dz, ocular or systemic complications including anterior uveitis, sclerosing keratitis, peripheral corneal melt, scleral thinning, cataracts, secondary glaucoma Necrotizing without inflammation (scleromalacia perforans): typically result of RA, complete lack of sx and minimal injection, asymptomatic, large, gray-blue patches of scleral thinning (due to exposure of uvea)

Answer 244

scleritis topical steroids minocycline

Answer 245

RA followed by wegener granulomatosis (collagen vascualr dz)

Answer 246

sx: severe, boring ocular pain (hallmark), that radiates to the ipsilateral forehead, brow, jaw, and awakens pt during the night. gradual onset of redness and decrease in vision (except for scleromalacia perforans) signs: sectoral or diffuse inflammation of the large, deep vessels that cannot be moved with a cotton swab. Edematous or thin sclera with a classic bluish hue under natural light. typically bilateral (episcleritis is unilateral)

Answer 247

scleromalacia perforans

Answer 248

benign, oval-shaped areas of scleral thinning that occur with age and allow underlying visibility of the uvea

Answer 249

Scleritis - gradual onset - more significant ocular pain - bluish hue due to scleral thinning - bilateral - more commonly associated with systemic disorder episcleritis - acute onset - asymptomatic - red eye - unilateral and sectoral - more common 2.5% phenylephrine will result in conjunctival blanching in a pt with episcleritis

Answer 250

scleritis anterior uveitis corneal abrasion, erosion, ulcers acute angle closure glaucoma "CASA" corneal pathology, abrasion, scleritis, angle closure

Answer 251

congenital anomaly characterized by focal, pigmented, elevated are where the posterior ciliary nerve loops are visible in the sclera can be painful LPCA - branch of nasociliary of V1

Answer 252

break down of the BAB - occurs more in younger adults - peak incidence 2nd-4th decade, rarely above 70 yo - 50% with acute anterior uveitis is due to HLA-B27 -50% of new acute anterior uveitis have associated spondyloarthropathy; 80% of these pts have akylosing spondylitis

Answer 253

UCRAP ulcerative colitis crohns dz reactive arthritis ankylosing spondylitis psoriatic arthritis

Answer 254

sx: pain, redness, photophobia, lacrimation, decreased vision (esp with CME), chronic anterior uveitis may be asymptomatic or report blurred vision/dull ache **pain is due to congestion and irritation of the anterior ciliary nerve** signs: dx based on presence or absence of WBC in the anterior chamber, PS, PAS, cataract formation, CME, flare, hypopyon, circumlimbal injection of conj vessels, decreaed IOP in the involved eye, KPs

Answer 255

ciliary body inflammation increase in IOP can occur in later stages because of PS, PAS, steroid tx, chronic TM damage

Answer 256

cyclitic membranes - fibrovascular membranes that extend from the CB into the posterior chamber and may involve the lens

Answer 257

KPs - characteristic of non-granulomatous etiology - Koeppe nodules granulomatous (TB, syphylis) - mutton fat KPs: greasy appearance, loc middle and lower cornea - Koeppe nodules: WBC located on pupillary margins - Busacca nodules: WBC located on the iris stroma EXCEPT the pupillary margin stellate KPs around found in fuch's heterochromic iritis and herpetic uveitis

Answer 258

UCRAP - inflammatory bowel dz: usually bilateral w/ posterior uveitis. characterized with diarrhea with alternating episodes of constipation. rare in ulcerative colitis but more common with crohns dz - Reactive arthritis: young males with urethritis, polarythritis, and conjunctivitis "cant see cant pee cant climb a tree" - ankylosing spondylitis: M>F, in 3rd decade, lower back pain that improve with exercise - psoriatic arthritis: asymmetric, peripheral small, joint pain, and psoriatic lesions on the knees elbows and scalp - Behcet's dz: most common in young adults of Asian and middle eastern descent, acute recurrent hypopyon iritis and mouth and genital ulcers. may also be associated with retinal vasculitis, cataracts and glaucoma - lyme dz: hx of tick bites, skin rash, and/or arthritis, may cause non-gran or granulomatous uveitis - Glaucomatocyclitic crisis: unilateral, mild iritis with recurrent, self-liming episodes of elevated IOP (30-40s), 2' to trabeculitis, fine KPs, and open angle on gonio

Answer 259

Posner schlossman syndrome: rare to mild AC, everything else looks normal HSV or HZ: reduced corneal sensitivity, concurrent corneal edema, dendrite or pseudo dendrite, vesicular rash along the affected dermatome that respects the vertical midline Fuchs heterochromic iridocyclitis: rare to mild cells in AC, NVA is often present on gonioscopy, significant iris atrophy and cataracts

Answer 260

- sarcoidosis: AA, F>M, bilateral, may be posterior or panuveitis, abnormal chest radiograph and increased and increased ACE levels - TB: +PPD test, abnormal chest x-ray, night seats, may have posterior or panuveitis - HSV/HZ: incr IOP in involved eye, stellate KPs, corneal edema, and/or epithelial defects, zoster will present with vesicles along affected dermatome - Syphilis: assoc interstitial keratitis, maculopapular rash, +VDRL,RPR and FTA-ABS or MHA-TP, Interstitial keratitis (stromal inflammation without involvement of epithelium or endo) - JIA: most common cause of uveitis in children, bilateral uveitis in young girls, (-)RF (+)ANA - Fuchs' heterochromic iritis: most common in pts with blue eyes, unilateral mild uveitis w/ fine, stellate KPs, angle neo, iris heterochromia, associated with glaucoma/cataracts, often asymptomatic

Answer 261

congenital syphilis (90%), TB, HSV - IK is characterized by acute stromal inflammatory edema and neo --> progress to diffuse stromal neo sparing the line of sight - Late stages stromal vessels clear leading to ghost vessels, corneal scarring, irregular astig

Answer 262

Hutchinson's teeth, deafness, interstitial keratitis additional signs include: saddle-nose deformity and frontal bossing (prominent forehead)

Answer 263

fuch's heterochromic iritis and herpes

Answer 264

FALSE chronic intermediate uveitis characterized by inflammation over the pars plana (aka snow banking) and peripheral retina; it is NOT associated with systemic conditions

Answer 265

- Toxoplasmosis - sarcoidosis - syphilis - CMV posterior uveitis is the inflammation of the retina, choroid, or both

Answer 266

may or may no have WBC in the vitreous (break down of BAB), floaters/decreased vision often asymptomatic unless the macula is involved ask about rashes, tick bites, risk factor for AIDs and breathing difficulties

Answer 267

Toxoplasmosis

Answer 268

Parasitic infection caused by toxoplasma gondii may be congenital or acquired (eating undercooked meat or inhaling cat feces)

Answer 269

congenital via transplantal transmission accounting for 90% of cases severe systemic involvement results in the triad of convulsions, cerebral calcifications, and retinochoroiditis. Most cases are mild and leave insignificant chorioretinal scars

Answer 270

acquired and reactivated congenital lesion is the most common cause of infectious retinitis - young pt, unilateral redness, photophobia, floaters, uveitis, vitritis, decreased vision - avg onset 25 yo - focal, fluffy, yellow-white retinal lesion adjacent to the old inactive scar with an overlying vitritis "head-lights in a fog"

Answer 271

NO, it causes choroiditis without vitritis multifocal punched out yellow-white lesion in the periphery with associated peripapillary atrophy and maculopathy; common in the Ohio-Mississippi River valley

Answer 272

toxo - retinovitritis - parasite - unilateral - unifocal -25 yo histo (CHBALA = break in bruchs) - choroiditis - fungal - multifocal - peripapillary - CNVM - atrophy maculopathy, histo spots in the periphery

Answer 273

- Retinal vitritis: cotton ball opacities inf vitreous - Retinal vasculitis: candle-wax droppings - sheathing around retinal veins and yellow-white exudates caused by periphlebitis - chronic dacryoadenitis - dry eye - CNV 7 palsy - chronic, bilateral, anterior granulomatous uveitis - Retinal vasculitis - Vitritis - Optic nerve dz (unilateral optic disc edem, papilledema

Answer 274

2' syphilis may result in acute multifocal chorioretinits with vitritis or panuveitis

Answer 275

- white patches of necrotic retina with hemorrhagic retinitis and vascular sheathing - occur in pts with CD4 counts <50 - toxoplasmosis and progressive outer retinal necrosis (PORN) - more intravitreal heme and less vitritis compared to toxo -PORN has minimal amts of vitritis (similar to CMV) and hemorrhage (less than CMV)

Answer 276

- localized defect or notch in the iris tissue resulting from incomplete closure of embryonic fissure of the optic vesicle during gestation - typically located in the inf nasal quad

Answer 277

- typically located in the inf nasal quad - Complete iris coloboma: key-hole pupil (extend from pupil margin to peripheral cornea) - Incomplete iris coloboma: iris transillumination defect on retroillumination - often assoc. with other ocular colobomas (CB, zonular, choroidal, retinal, ON)

Answer 278

- Malignant tumor that arises from abnormal proliferation of melanocytes within the iris stroma - most are thought to arise from iris nevi

Answer 279

- pigmented or amelanotic - loc within the stromal tissue in the inf quadrant - irregular feathery margins and diameter greater than 3mm any iris lesion in yonger pts (<40 yo) with high risk characteristics including associated hyphema, ectropion, uveae, angle involvement, inf iris loc, diffuse feathery margins, should be evaluated for potential iris melanoma

Answer 280

- an area of the cornea that wets poorly, leading to stromal dehyration, corneal thinning, with resulting pooling of fluorescein within the affected area - adjacent to pterygia, filtering blebs, tumors, poor fitting RGP lens - asymptomatic or FBS or other dry eye sx

Answer 281

abnormal or incomplete lid closure due to an issue with CN 7 or the orbicularis oculi CN 7 issues = bells palsy, CVA, aneurysm, MS, HSV, HZ OO issues: eyelid sx causing ectropion, TED, nocturnal lagopthalmos, floppy eyelid syndrome

Answer 282

Sx: redness, FBS, burning, sx worse in the AM signs: mild SPK on inf 1/3rd of cornea, corneal ulceration, decr corneal sensitivity

Answer 283

chronic sx of irritation and dryness are common, hx of multiple episodes caused by chronic inflammation of the cornea and/or any disorder that disrupts the ocular surface - K sicca (common causes: FES, SLK, corneal erosions, penetrating keratoplasty, cls overwear, neurotrophic keratopathy

Answer 284

sx: Mild to severe FBS with photophobia, epiphora, blurred vision, blepharospasm signs: filaments composed of degenerated epithelial cells and mucous that remain attached to the epithelial surface. RAnge in size 0.5 to 10mm and may appear short, long or stringy. Filaments will stain with fluorescein Filaments = FRICTION late = stringy early = comma s -shaped

Answer 285

- Cls wear - corneal infections - DES - blepharitis - corneal exposure 2' to lid malposition ( CN 7, palsy ectropion, TED) - chemical burns - allergic response to topical meds (BAK aminoglycosides) - Trichiasis, distichiasis - FES - superficial FB - exposure to intense UV light - LASIK (due to decr corneal sensation)

Answer 286

- pinpoint defects on the corneal epithelium that stain with fluorescein - asymptomatic in mild cases or blurred vision, irritation, FBS, photphobia, redness, tearing

Answer 287

- most common 2nd to 3rd decade - recurrent

Answer 288

Sx: FBS, photophobia, tearing, occasional blurred vision, eye is relatively quiet, chronic and bilateral Signs: bilateral, small, multiple, asymmetric, gray-white of superficial, intraepithelial, raised central corneal lesions - acute attacks: last 1-2 months before resolving, stain lightly with fluorescein, exacerbation often recur 6-8 weeks - remission - period of inactive dz in btw acute attacks, do not stain with fluorescein during remission

Answer 289

V1 damage, reducing corneal sensitivity BIG ULCER = NO PAIN - ask about past surgical procedures, medications, cls wear, systemic dz

Answer 290

Directly affect V1 - HSV, HZ, diabetes, lasik, cls wear, conditions that causes corneal epithelial injury (RCE, corneal dystrophies), surgeries (ablative procedures for trigeminal neuralgia, maxillary facial repair), meds (timolol, betaxolol, diclofenac) damage to CN 7 (due to impaired reflex tearing), tumors, CVA, bells palsy, surgeries (removal of acoustic neuroma), or other conditions that damages CN 7

Answer 291

NFL nasociliary - cornea & tip of nose frontal - supratrochlear and supraorbital lacrimal - lateral

Answer 292

sx: redness, tearing, decr vision, FBS, swollen eyelids, corneal findings are worse than what sx indicate signs: decreased corneal sensivity**, SPK, perilimbal injection, sterile inferior olva ulcer (often assoc. w/ iritis), without sig inflammation non-healing epithelial defects which can ulcerate if not treated, corneal perforation

Answer 293

- poor hemidesmosomes attachment to the underlying BM in pts with hx of corneal abrasion or EBMD

Answer 294

sx: recurrent episode of acute pain that mostly occurs upon awakening signs: corneal abrasion that stains with fl

Answer 295

less than 300nm UV light - hx of prolonged sun exposure, welding, skiing, or sunlamp use w/o protection - epithelium and bowmans layer absorb wavelengths below 300nm, excessive absorption of wavelength can cause hyperactivation of K+ channels, with resulting loss of intracellular K+ and cell death

Answer 296

- pain, photophobia, blurred vision, sx worse 6-12 hrs after incident - signs: confluent SPK w/ fl stain

Answer 297

Anticholinergic effects - ASHCT - Antihistamines "phen" & promethazine - Antipsychotic: chlorpromazine, thiordiazine - Antidepressants: TCAs (amitriptyline, imipramine), MAOI (phenelzine), SSRIs (fluoxetine, escitalopram) - anti-anxiety: diazepam - muscle relaxant: cyclobenzaprine - Ipratropium Additional drugs - isoretinoin - b-blockers - oral contraceptives - hormone replacement therapy - ADHD - diuretic

Answer 298

TED, collagen vascular disease (ex. RA, sjogren's, SLE)

Answer 299

burning, dryness, tearing, itching, increased blinking, photophobia, cls intolerance, FBS, sx worse at the end of the day signs: - decr TBUT and increased tear osmolarity - Aqueous deficient: thin tear meniscus (<0.2mm), decr schirmers, and decr phenol red thread

Answer 300

schirmers 2 allows for isolation of basal tearing Schirmer 1: without anesthetic Normal >10mm wetting within 5 mins Abnormal <5mm wetting within 5 mins Schirmer 2: with anesthetic Normal >5mm within 5 mins

Answer 301

reflex, meotional, basal

Answer 302

normal result is >10mm of wetting after 15 sec

Answer 303

- TBUT less than 10 sec - Poor expression of the MG (toothpaste consistency) - MG atrophy on meibography other signs: - conjunctival hyperemia - debris in the tear film - corneal filaments - signs of underlying conditions (acne rosacea, blepharitis) - variable corneal and/or conjunctival staining with fl and lissamine green staining

Answer 304

>308 mOSm/L or >8 mOSm/L difference between the eyes tear "hyper"osmolarity

Answer 305

dry eye and dry mouth 2nd most common autoimmune rheumatologic dz (RA is the first)

Answer 306

dry eye, dry mouth, and autoimmune connective tissue dz (RA, SLE, polyarteritis nodosa, wegener's granulomatosis)

Answer 307

attacked glands - sarcoid, lymphoma, AIDS, graft vs host dz Block gland ducts - trachoma, pemphigoid, erythema multiforme, chemical and thermal burns Cut nerves - corneal sx (LASIK, PRK, RK), diabetes, cls, bells palsy, systemic drugs, neurotrophic keratits, infection (HSV, HZ),

Answer 308

Intrinsic: - MGD and excess tear evaporation(most common), -proptosis (TED, craniostenosis), - nocturnal lagophthalmos - low blink rate (increase concentration w/ phone use) - parkinsons dz ( decr dopanergic neuron) Extrinsic - vit A deficiency (xerophthalmia) - topical anesthetics (red blink rate, red reflex lacrimal gland secretion) - topical preservatives (BAK) - cls wear

Answer 309

- aqueous deficient dry eye - bitot spot Vit A is important goblet cell and glycocalyx development

Answer 310

- AD - commonly begins around puberty - ask about frequent changes in eye prescription or hx of eye rubbing (atopy) - initial damage to bowmans - stromal collagen fibril displacement due to loss of adhesions of fibrils causing corneal thinning and potrusion (degradation of fibrils by MMP)

Answer 311

atopy, cls wear, ocular and systemic conditions, TDOME - Allergic (VKC, AKC, FES) - Connective tissue (Fuch's endothelial dystrophy, posterior polymorphous dystrophy, granular dystrophy, lattice dystrophy - Hereditary (aniridia, RP, lebers congenital amaurosis, ROP, cone dystrophy) TDOME - turners syndrome -down syndrome - osteogenesis imperfecta - Marfans syndrome - Ehlers danlos

Answer 312

Sx: Progressive decreased vision, photophobia, glare monocular diplopia, and ghost images, acute vision loss if hydrops develop signs: inferior, central or paracentral stromal thinning that is typically bilateral, asymmetric, and progressive, irregular astig that is poorly corrected with gls or cls

Answer 313

Early: fleischer's ring, scissor reflex, irregular mires on k's, inf steepening on topo late: Vogt's striae, munson sign, Rizzuti's sign, hydrops

Answer 314

mild - < 48D moderate - 48-54D severe - >54D

Answer 315

most common in early adulthood (20-40 yo) - possibly due to collagen abnormality, protrude ABOVE the area of thinning

Answer 316

- bilateral, painless, corneal thinning 4-8 o'clock, high ATR astig , kissing doves or crab claws on topo

Answer 317

Keratoconus - fleischer's ring - cone - vogt striae - corneal scarring more common - protrusion within the thinned area PMD - sudden vision loss from hydrops (less common than keratoconus) - kissing doves - protrusion above thinning

Answer 318

- onset typically at birth - may be acquired from advanced keratopathy, trauma or exophthalmos - Associated with ehler's danlos syndrome, blue sclera, lebers congenital amaurosis

Answer 319

- Diffuse thinning, most concentrated in the periphery - globular shape cornea - can result in acute corneal edema due to rupture of descemet's membrane - corneal perforation can occur with minor trauma

Answer 320

- most common anterior dystrophy - AD - Females - abnormal epithelial adhesion and excessive BM production (trapping mature cells underneath BM)

Answer 321

sx: asymptomatic, not progressive, vision loss, pain, photophobia can result from corneal changes or RCE signs: negative staining of maplines, dots, and/or fingerprints (best seen with retroillumination)

Answer 322

- AD - notable within 1st year of life

Answer 323

sx: asymptomatic, sx may occur due to ruptured cyst or RCE (both likely to occur before middle age) signs: extensive, bilateral, clear intraepithelial cysts that are diffusely spread across the cornea (most dominant in the interpalpebral region)

Answer 324

- EBMD - meesman dystrophy - Reis-Buckler dystrophy

Answer 325

- AD, dx early due to ocular pain - abnormal development and replacement of Bowman's layer with collagen

Answer 326

Sx: painful episodes due to RCE common in early life, few recurrent episodes as we age signs: Bilateral symmetric, subepithelial gray reticular opacities that are most concentrated in the central cornea and spare the peripheral cornea, these opacities typically get worse with age

Answer 327

- Macular dystrophy - Granular - Schnyder - Lattice "Mary Got So Laced"

Answer 328

- AR - least common of the stromal dystrophies and affect VA much earlier

Answer 329

sx: progressive vision loss and episodes of irritation and photophobia (2' to RCE), severe vision loss occurs by age of 20-30 signs: diffuse superficial stromal haze between 3 and 9 yo, diffuse stromal oppacification, stromal thinning, multiple gray-white opacities (mucopolysaccharides deposits) with irregular borders that are present in all layers of the cornea and extends to the limbus

Answer 330

- AD - onset 1st decade but will not experience vision loss until middle age

Answer 331

small snowflake granules (hyaline deposits), in the central stroma, deposits eventually spread towards the epithelium and deep stroma, becoming confluent and resulting in decr VA RCE rare

Answer 332

rare, aka granular-lattice dystrophy in the central stroma

Answer 333

AD - Anterior stromal haze w/ branching, refractile, lattice-like lines (amyloid deposits) - decreased VA, 3rd decade - result from sig corneal scarring and haze - RCEs common

Answer 334

Transforming growth factor beta 1 (TGFB1) Macular dystrophy is NOT a TFGB1 factor****

Answer 335

- AD, ask abt hx of or current high cholesterol - strong association with hyperlipidemia, xanthelasma, corneal arcus, non-progressive - characterized by fine yellow-white ring of stromal crystals with ahze in the corneal stroma - pts are usually asymptomatic

Answer 336

"Marilyn Monroe Got Hers in LA" Macular- Mucopolysaccharide Granular- Hyaline Lattice - amyloid

Answer 337

decreased vision painful recurrent corneal erosions

Answer 338

- AD - F>M - 60 yo or older - 30% have a fam hx - posterior lamina of descemet's is produced in excess and is seen as clumps (guttata) - decreased endothelial cell density (hallmark of fuch's)

Answer 339

sx: - asymptomatic until later in life 50-60s yo - progression results in hazy vision that is worse in the AM w/ pain and glare signs: - apparent in early 30-40s - decreased endothelial cell density associated with pleomorphism and polymegathism - endothelial guttata (beaten metal appearance) - thick pachys - stromal edema (most concerning), it can spill over into the epithelium, leading to painful bullae and scarring

Answer 340

500 cells/mm2

Answer 341

cataract sx, esp at endothelial cell counts less than 1000 cell/mm2

Answer 342

3000-4000 cells/mm2

Answer 343

1000 cells/mm2

Answer 344

400-700 cells/mm2

Answer 345

- AD - occurs within 2nd-3rd decade of life , may manifest a cloudy cornea at birth

Answer 346

sx: - slowly progressive or non-progressive - most pts are not dx until 30-50 yo - decreased vision 2' corneal edema signs: - bilateral, often asymmetric, findings that occur at descemet's membrane and endothelium - patches of vessicles (hallmark), band lesions (linear train track lesions, diffuse opacities, - in severe cases (rare), corneal edema and bullae lead to painful vision loss

Answer 347

PPD results in metaplasia of the endothelial cells, these cells have the potential to spread over the iris and angle resulting in angle-closure glc from PAS formation

Answer 348

PPD endothelial cells grow into the angle

Answer 349

- rare, X-linked condition that always affects males - bilateral corneal horizontal diameter of 13mm or greater, highly myopic with steep corneas, but often have good acuity with correction - stretching of ocular tissues can lead to lens subluxation and angle abnormalities, resulting in glaucoma - Systemic associations include marfan's syndrome, Ehlers-danlos syndrome, osteogenesis imperfecta

Answer 350

- rare AD or recessive inherited condition that may be unilateral or bilateral - characterized by horizontal diamter of <10mm - usually hyperopic and at risk for 2' angle closure glc due to shallow AC

Answer 351

- Rare AD or autosomal recessive inherited condition - corneal curvature is equal to the scleral curvature (hallmark) - associated with sclerocornea and microcornea - bilateral flat corneas (less than 38D and often as low as 20-30D) - hyperopia, shallow AC, increased risk of 2' AC

Answer 352

- Rare bilateral condition, AD - degree can vary from partial to complete loss of iris tissue - corneal lesions (opacity, microcornea, pannus), lenticular changes (cataract, lens subluxation), and posterior segment abnormalities (glc ~75% of case, foveal hypoplasia, disc hypoplasia, choroidal colobomas)

Answer 353

- results from congenital glc - characterized by horizontal cracks (parallel lines), lenticular changes in descemet's membrane from increased IOP vs vertical cracks from forceps delivery during birth)

Answer 354

- characterized by a continuum of disorders = posterior embryotoxin, axenfeld anomly, reiger anomaly, riegers syndrome - these pts suffer from ant seg developmental abnormalities that affect the ant chamber angle - 50% of pts with this condition develop glc

Answer 355

anterior displaced schwalbes line hallmark of axenfeld-reiger syndrome - these pts are not at risk for glc

Answer 356

PE + angle abnormalities + increased glc risk - angle abnormalities include prominent iris processes that travel to the level of PE, often obscuring scleral spur

Answer 357

PE + angle abnormalities + increased glc risk + iris stromal abnormalities - iris stromal abnormalities include displaced pupil (corectopia) and iris hypoplasia iris hypoplasia with resulting hole within the iris tissue (polycoria)

Answer 358

PE + angle abnormalities + increased risk of glc + iris stromal abnormalities + systemic abnormalities - systemic abnormalities include mental retardation, dental, craniofacial, genitourinary, and skeletal abnormalities

Answer 359

- rare condition in which pts are born with a central white corneal opacity (leukoma) with iris adhesion - 80% bilateral - 70% develop 2' glc, pts may also develop edema and cataracts

Answer 360

- normal dense connective tissue with hair follicles and sebaceous glands that is displaced in an abnormal location - usually inferotemporal limbus

Answer 361

contact lens wear, dry eye, exposure keratopathy, neurotrophic keratopathy, atopathy, trauma, lid abnormalities, bullous keratopathy

Answer 362

- most common cause is cls wear esp extended-wear - most common microbes involved are psuedomonas aeruginosa, staph epidermidis, staph aureeus, haemophilus influenzae, moraxella catarrhalis

Answer 363

Pseudomonas gram (-) characterized by significant thick mucopurulent discharge, hypopyon, dense stromal infiltrate, rapid progression (can perforate the cornea within 48 hours)

Answer 364

CHaNeL Corynebacterium Haemophilus Neisseria gonorrhea and menigitidis Listeria

Answer 365

Sx: severe pain, red eye, photophobia, decreased vision sign: a corneal stromal infiltrate with an overlying epithelial defect, infectious corneal ulcer

Answer 366

pts immune system is attacking an antigen via antibody aka sign of infection

Answer 367

infiltrate with an overlying epithelial defect

Answer 368

infectious corneal ulcer

Answer 369

sterile corneal ulcer

Answer 370

sterile infiltrate

Answer 371

- most common type of corneal ulcer after traumatic corneal injury from vegetable matter - candida infections = often in chronic corneal dz, immunocompromised or severely debilitated pts (in normal human flora but deadly if infection in immunocompromised pts) - aspergillus and fusarium = more common after vegetable matter trauma

Answer 372

sabouraud's agar

Answer 373

sx: pain, photophobia, tearing, decreased vision sign: Aspergillus/fusarium = epithelial defect w/ underlying gray-white corneal infiltrate, feathery edges, possible surrounding satellite infiltrates candida = similar appearance to a bacterial ulcer

Answer 374

- parasitic infection w/ bad cls hygiene ( tap water, homemade saline solution, swimming, hot tub while wearing cls) - most common protozoa found in soil and water and within oral cavity of humans

Answer 375

heat-killed E.coli

Answer 376

Signs: Early: punctate or pseudodendritic epithelial defects, associated with severe pain w/ out of proportion signs Late: radial keratoneuritis (inflammation of the corneal nerves) and patchy anterior stromal infiltrates that gradually progress to form a ring ulcer Sx: blurred vision, pain, minimal discharge

Answer 377

Gram stain (smear) - bacteria KOH or Giemsa stain (smear) - fungi/yeast Sabaroud's agar culture plate - fungi Chocolate agar culture plate - haemophilus and Nisseria Thioglycolate culture broth - aerobic and anaerobic bacteria Non-nutrient agar culture plate with E.coli overlay - acanthamoeba

Answer 378

- DNA virus most common in young patients. Ask about hx or previous cold sores - Primary exposure: occurs in children 6 months - 5yo, may experience mild virus-type syndrome - Recurrent HSV: latent infection in the trigeminal ganglion, can be triggered by physical or emotional stress from sun exposure, fever, and immunosuppression (non-exhaustive list) - Tissue damage from HSV is due to direct invasion, neurotrophic mechanisms or by the immune system response to HSV

Answer 379

sx: pain, redness, serous discharge, tearing, photophobia and decreased vision signs: decreased corneal sensitivity is common *peform cotton swab test* acute unilateral anterior granulomatous uveitis, trabeculitis, acute retinal necrosis

Answer 380

conjunctivitis or blepharitis

Answer 381

Epithelial Neurotrophic Keratopathy Stromal dz Endotheliitis

Answer 382

Corneal vesicles: aka punctate keratopathy, earliest signs of reactive HSV Dendritic ulcers: stains well w/ fl and rose bengal Geographic ulcers: wider than dendritic ulcers, associated with use of topical steroids Marginal ulcers: loc close to limbus as a stromal infiltrate with overlying epithelial defect and associated w/ limbal injection

Answer 383

reduced corneal innervation, decr tear secretion, leading to poor corneal wound healing - occurs in pts who have had infectious epithelial keratitis - neurotrophic ulcer appears as an oval defect with smooth borders, often preceded by punctate epithelial erosions that progress to an ulcer

Answer 384

Neurotrophic ulcers are located inf and oval appearance with smooth borders vs. Geographic ulcers result in irregular epithelial defects w/ scalloped borders

Answer 385

Interstitial keratitis (IK): - infiltrate with diffuse neovascularization, an immune ring (Wesley ring), stromal thinning an subsequent scarring -IK is stromal inflammation WITOUT primary involvement of epithelium or endothelium - result from antigen-antibody complement cascade against a live virus or viral antigen retained within the corneal stroma Necrotizing stromal keratitis - result from direct invasion of the stroma - severe stromal inflammation with necrosis that can lead to corneal thinning and perforation

Answer 386

- Disciform keratitis: immune rxn against viral antigen or live virus within the corneal endothelium - Disciform endotheliitis: most common form of endotheliitis. characterized by focal, disc-shaped, stromal edema overlying keratic precipitates. often accompanied by mild to moderate iritis

Answer 387

- VZV is the initial invading organism - primary infection (chicken pox) - VZV is transported to the trigeminal ganglia and other neural cell bodies where it becomes dormant - affecting 95% of children by the age of 5 - old age, trauma, neurodegeneration, immunosuppression may contribute to reactivation of the virus resulting in HZV

Answer 388

check for immunosuppression HZV is contagious in those who have not had chicken pox

Answer 389

- signs are more severe in immunocompromised pts - unilateral - pre zoster = tingling, malaise, fever (prodrome) - active zoster = vesicular rash that does not cross the midline, blepharoconjunctivitis if vesicle is present on the lid margin -post-zoster = post herpetic neuralgia and depression

Answer 390

Eyelid = trichiasis, ectropion, entropion, madarosis, poliosis Corneal = punctate epithelial keratitis, psuedodendritic keratitis, anterior stromal keratitis, interstitial keratitis, endotheliitis, keratouveitis, neurotrophic keratopathy, exposure keratophathy episcleritis, scleritis, uveitis, can be gran or non-gran, associated w/ sig KPs, corneal edema, and posterior synechiae trabeculitis cataracts acute retinal necrosis optic neuritis CN palsies

Answer 391

stain w/ fl or rose bengal, pseudodendrites w/ NO terminal bulb

Answer 392

rash on the nose indicates high risk of ocular involvement of HZV

Answer 393

pain persisting beyond 1 month after rash onset or rash resolution - most common complication of HZV - severe onset can lead to suicide in pts over 70 yo w/ chronic pain

Answer 394

- more common in men 40-70 yo (but may occur in all ages) - benign and malignant mooren's ulcer - painful, progressive, chronic vasculitis of the limbal blood vessels that lead to ischemic necrosis and peripheral ulcerative keratitis - idiopathic - autoimmune - associated w/ hep C viral infection or hookworm infestation

Answer 395

Benign (typical or limited) - unilateral - affects the elderly - mild to mod sx - responds well to tx Malignant (atypical) - bilateral - affects younger pts (esp black males) - severe sx - responds poorly to tx & progresses relentlessly

Answer 396

- often severe pain, redness, tearing, photophobia - decreased vision due to irregular astig - associated iritis or ulcer is in central location Sign: - unilateral peripheral crescent-shaped gray infiltrate in an older pt that progresses to an ulcer - ulcer may be self-limited or spread circumferentially and/or centrally in the late stages of the condition

Answer 397

- ask about a hx of similar recurrent episode - Type 3 hypersensitivity to staph aureus, usually occur in pts with chronic bleph

Answer 398

- asymptomatic, acute photophobia, pain, tearing, redness, decreased vision signs: - stromal infiltrate ( multiple and bilateral) loc in the periphery - classically occur at 2,4,8,10 o' clock where lid margins touch the limbus - look for phlyctenules, blepharitis, acne rosacea - residual, thinning, superficial neo, peripheral scarring

Answer 399

immune-mediated response NOT infectious

Answer 400

RA, SLE, polyarteritis nodosa, Wegener's granulomatosis - asymptomatic, pain, redness, decreased vision - peripheral corneal thinning/ulcers with or without inflammation - unilateral or bilateral - may be associated with scleritis, episcleritis, keratoconjunctivitis sicca

Answer 401

- fabry's dz w/ use of chloroquine, hydroxychloroquine, amiodarone, indomethacin, tamoxifen CHAI-T

Answer 402

iron ring at the base in keratoconus

Answer 403

metallic FB

Answer 404

common in elderly, iron deposits found in the middle and lower third of the cornea

Answer 405

iron deposit found at the edge of a pterygium

Answer 406

iron deposit on the leading edge of a filtering bleb

Answer 407

accumulation of copper that occurs in pt with liver disorders and Wilson's dz

Answer 408

Calcium deposits in Bowmans layer (white swiss cheese pattern)

Answer 409

- most common in men 20-40 yo - Idiopathic non-inflammatory degenerative condition that results in slowly progressive peripheral stromal thinning, perforation in 15% of pts

Answer 410

- asymptomatic, progression can lead to irregular astig (ATR) and decreased acuity Signs: - superonasal, bilateral (typically asymmetric) - slowly, progressive, thinning with an associated vascularized pannus - no AC rxn, no conj injection, no overlying epithelial defect

Answer 411

Mooren's ulcer has an overlying epithelial defect

Answer 412

- female predilection, 6th decade - degenerative dz that follow episodes of keratitis - associated with sig corneal inflammatory dz including MGD, trachoma, phlyctenulosis, VKC, keratoconjunctivitis sicca, interstitial keratitis, can be idiopathic

Answer 413

Sx: - asymptomatic, pain if RCE develops in epithelial cells overlying the nodule, reduced vision if nodule is located within the visual axis Signs: - Hyaline plaque deposits between epithelium and bowmans - midperipheral, elevated blue-gray or yellow-white nodular lesions - unilateral or bilateral - nodules often located within or adjacent to old corneal scar or pannus "60 yo F w/ bad dry eye, wears a blue bow tie, and likes to get high (hyaline)"

Answer 414

- age related condition that is very common - 40-60 yo, nearly 100% over 80 yo - signs/sx: bilateral, chalk-like linear opacties of nasal limbus (3 and 9 o'clock). Pts asymptomatic

Answer 415

- chronic inflammation and ocular surface dz (uveitis, dry eye, exposure keratopathy) - trauma - systemic conditions: incr calcium or phosphorous levels, gout, hypercalcemia, hyperparathyroidism, renal failure, sarcoidosis

Answer 416

often asymptomatic, FBS, decreased vision (if calcium plaques move centrally) Signs: - Calcium deposits on ant bowman's or subepithelial space - appears like a swiss cheese pattern within interpalpebral portion of the cornea

Answer 417

- most common peripheral corneal opacity - 100% over 80 yo - assoc with aging and high cholesterol - signs: bilateral and symmetric circumferential 1mm band within the peripheral cornea, with a clear zone of separation to the limbus

Answer 418

- Unilateral arcus and associated with carotid disease on the side WITHOUT arcus - younger pts <50 yo associated with an increase risk of coronary artery disease, lipid profile is warranted in these cases

Answer 419

- bilateral, gray-white polygonal stromal opacities "cracked ice appearance" either near bowmans layer or occasionally near descement's - caused by irregularly arranged folds of collagen asymptomatic and benign

Answer 420

- bilateral flour dust deposits that are most commonly located in the central deep stroma - Aging or AD asymptomatic

Answer 421

type 4 hypersensitivity response to the donor cornea

Answer 422

epithelial - elevated, irregular epithelium stromal - subepithelial infiltrate (Krachmer's spot) endothelium - WBC on endothelium that form a khodadoust line

Answer 423

associated with endothelium rejection

Answer 424

- younger than 18 yo - unrealelistic expectations - Keratoconus, active HSV, cls warpage - CT dz (keloid formers), collagen vascular dz, immunocompromised dz (chronic steroid user)

Answer 425

- blepharitis, DES, chronic eye rubbing, ocular surface dz, large pupils - DM (3 months of stabilization) - POAG - if not well controlled - pregnancy - retinal thinning/lattice degeneration

Answer 426

3-14 days 14-21 days for RGPs

Answer 427

Radial incisions made with a diamond knife to flatten the the peripheral corneal stroma - Causes progressive hyperopic shift

Answer 428

corneal epithelium, bowmans, and stromal tissue are removed (No flap), excimer laser used on the central corneal or mid peripheral cornea Tx range: -8D to +4D, up to 4D of cyl 400um residual cornea is required after tx - use of mitomycin C during the procedure reduces stromal haze

Answer 429

PRK has a longer healing time 1-2 weeks vs 1-2 days for lasik lasik = less pain and less post-op haze compared to PRK

Answer 430

PRK because there is no flap complication PRK has less risk for corneal ectasia, less induction of higher order aberrations, less post-op dryness, requires less corneal thickness, cheaper compared to lasik

Answer 431

epithelial flap made with amicrokeratome, an excimer laser is applied to the anterior stromal bed and then flap is reattached Tx range: -10D to +4D, up to 5D cyl (clear lens extraction can be performed on pts who exceed LASIK RE requirements)

Answer 432

250um must remain under the flap to maintain corneal integrity flap is 150um thick ablation depth is 12um/diopter Total pachy - flap thickness (160-200) - ablation depth (12um/diopter) = 250 or greater

Answer 433

same procedure as lasik but flap is made with a femtosecond laser creating a thinner flap (100um) it removes the risk of mechanical malfunction of the microkeratome and is associated with less post-op dry eyeLaser

Answer 434

flap made with diluted alcohol instead of microkeratome

Answer 435

blunt plastic blade is used to create an epithelial flap

Answer 436

tx presbyopia, low hyperopia and residual astig after previous sx - uses radiofrequency energy to shrink collagen fibers in the peripheral corneal stroma, allowing central cornea to steepen - regresses in about 2-3 years, sx can be repeated Tx range: +0.75D to +3.00D with less than 0.75D of astig

Answer 437

PMMA rings are inserted into the peripheral stroma to flatten corena (shortens the corneal arc length); rings can be removed or exchanged approved for keratoconus Tx: -0.75 to -3D, does not tx hyperopia

Answer 438

Cat sx without cataracts IOL selected reduces the RE - no accommodation remains unless use of multifocal or accommodating lens - Large tx range

Answer 439

- IOL implants in phakic eye, used to alter power of total eye - IOL is angle supported iris supported, or sulcus supported -REQUIRES LPI - can be used to tx larger range of RE compared to corneal sx and IOL is removable. Also preserves natural accommodation (unlike CLE)

Answer 440

Corneal incisions are made with diamond blades to relax the cornea in the steepest meridian

Answer 441

- Reduces higher corneal aberration (ex. coma, spherical) in addition to correcting RE (ex. lower aberrations which acct for 90% of all abberations) - Can be done with LASIK or PRK = better quality in vision and improved contrast and acuity and less glare

Answer 442

Pain, serious infection, flap complications, corneal ectasia, residual refractive error, glare, dry eye, DLK, epithelial ingrowth, corneal haze

Answer 443

Button holes = cap perforation, hole in flap, common in steep cornea or deep set eyes Free caps = no hinge, common in flat corneas Flap folds - macrostriae = full thickness w/ undulating, parallel stromal folds from slippage or mal positioning during sx. typically require tx by lifting and repositioning - microstriae = fine, irregular, multi-directional folds in bowmans layer that typically resolve on their own, only tx if it's visually significant Flap dislodgement = more common with keratome flaps than femtosecond laser due ot accidentally touching the eye, or form fruste keratoconus are more at risk.

Answer 444

anterior protrusion of the cornea due to thinning Pts with high myopia, undetected keratoconus, forme fruste keratoconus are more at risk corneal ectasia may occur at anytime after sx

Answer 445

- pts may be over or under-corrected or may have regression after sx (more common in RE >-8D) - Pts can be fit with GPs or reverse geometry lenses after 8-12 weeks (may fit sooner w/ soft cls) refractive sx enhancement may be considered

Answer 446

Worse glare is expected with small ablation zone, large pupils, monovision correction, and higher refractive errors

Answer 447

- most common side effect of LASIK, aqueous deficient nonsjogren's - corneal nerves severed = decreasing sensitivity and neural feedback to the lacrimal gland - often improves 1-2 months

Answer 448

- inflammatory, non-infectious reaction that occurs at the lamellar surface (between the flap and the stroma) - characterized by fine, gramnular, sand-like infiltrate that typically present 2-3 days after sx - possibly due to response to toxins but unsure of etiology - DLK is less common with disposable microkeratomes

Answer 449

asymptomatic, photophobia, blurred vision, FBS, and pain can lead to vision loss (from scarring and corneal melt) if not properly managed

Answer 450

Epithelial ingrowth

Answer 451

Lasik complication commonly observed at 1 month post-op as a faint gray line or white, milky deposits within 2mm of the flap edge interface asymptomatic and condition is not tx unless the visual axis is obstructed, 2mmingrowth occurs from the flap edge, or results in corneal astig

Answer 452

risk increases w/ higher RE normally present for several weeks after PRK

Answer 453

The earliest time for retreatment is 3 months but 6 months is preferred - Astig >0.75 causing sx - Astig greater or equal to 0.75D from target in an unhappy pt - Uncorrected VA of 20/30 or worse in an unhappy pt

Answer 454

most likely lower due to thin corneas

Answer 455

- NS - myopic shift, improved reading "second sight"

Answer 456

radial spoke like opacities - induce hyperopic shift

Answer 457

located underneath the anterior lens capsule

Answer 458

located directly in front of the posterior lens capsule - affects near vision > distance - usually caused by steroids (systemic or topical) - WORST glare compared to other cataracts

Answer 459

galactosemia or rubella

Answer 460

lamellar (zonular) cataract (surrounds the embryonic nucleus)

Answer 461

cerulean cataract

Answer 462

associated with diabetes mellitus, myotonic dystrophy (PSC christmas tree cataract), Wilson's dz, hypocalcemia, and atopic dermatitis

Answer 463

rosette also look for vossius ring

Answer 464

- chlorpromazine (stellate cataracts) - amiodarone (deposits) - miotics (vacuoles) - gold salts (gold deposits) - used to tx RA

Answer 465

corticosteroids

Answer 466

- anterior uveitis - myopia - RP - gyrate atrophy

Answer 467

epicapsular stars - remnants of the tunica vasculosa lentis

Answer 468

- blurred vision -glare - reduced contrast - RE shift - difficulty with ADL (reading, recognizing faces, watching TV, driving)

Answer 469

Potential acuity meter (PAM): can help determine how much lenticular changes are impacting acuity to better predict post-op VA Brightness acuity tester (BAT): assess glare disability Axial length: determined by A-scan or IOL master (usues partial coherence interferometry); axial length and K measurements are used to calculate appropriate IOL power B-scan ultrasound: evaluate post seg if cataracts are too dense

Answer 470

Axial length and K's

Answer 471

24mm 1mm error in axial length measurement corresponds to 3D error in the calculated IOL power

Answer 472

anticoagulants (coumadin) alpha-blockers (Flomax) - cause floppy iris syndrome prostaglandins

Answer 473

- acute/chronic uveitis - severe blepharitis - Fuch's endothelial dystrophy (bullous keratopathy) - pseudoexfoliation

Answer 474

entire lens and capsule removed - requires a large incision - higher risk of RD - resulted in aphakia and need for "cataract glasses" (~+12D) - also required surgical PI to prevent vitreous prolapse and pupillary block this sx is not done any more, "ICE age"

Answer 475

lens is removed but capsule remains - incision is large b/c lens is removed as a whole - IOL is inserted into the capsule sx done today!

Answer 476

- osin drugs terazosin, prozosin, tamsulosin

Answer 477

form is ECCE where lens is fragmented with an ultrasound before removal - smaller incision that rarely requires sutures - aqueous will push against the flap to close it - utilizes clear corneal incision for lens removal

Answer 478

- used to make corneal incisions (including relaxing incisions for astig), anterior capsulorhexis, lens fragmentation (makes phacoemulsification easier)

Answer 479

- Striate keratopathy - Acute post-op bacterial endophthalmitis - Delayed post-op bacterial endopthalmitis - Toxic anterior segment syndrome (TASS) - lens subluxation - PCO - CME - RD - Wound leak - suprachoroidal heme - elevated IOP - corneal edema -diplopia (pre-existing strab, EOM restriction/paresis, monocular diplopia, central fusion disruption, idiopathic) - ptosis (lid speculum) - uveitis, glaucoma, hyphema syndrome (UGH) - ill-fitting ACIOL rubbing on iris, can cause elevated IOP - induced corneal astig (pre-existing or 2' to wound leak) - Iritis - 2' to sx trauma, retained lains material, endophthalmitis, eye predisposed to uveitis and aggravated by sx

Answer 480

post-op corneal edema and folds in descemet's membrane, resolves without tx within days

Answer 481

sx occurs 2-4 days of the procedure and includes progressive decr vision, redness, and increasing eye pain - mostly gram (+) bacteria: staph epidermidis, staph aureus - sig AC reaction which can be accompanied by hypopyon, vitritis, chemosis, eyelid edema, fibrous exudate, mucous discharge, corneal edema, and reduced red reflex

Answer 482

- sx occur within a week to 1 month after the procedure - vision loss is insidious and pain gradually worsens - Fungal post-op endopthalmitis is also a commonly delayed complication

Answer 483

sterile inflammatory reaction that leads to toxic damage to the ant seg structures - due to chemical exposure during sx (denatured viscoelastic, preservatives, bacterial endotoxins, cleaner, etc) - present 12-48 hrs post op with decreased vision, no to mild pain, diffuse limbus to limbus corneal edema, hypopyon, fibrous membrane, no vitritis (or mild spillover), and increased IOP **MUST RULE OUT INFECTIOUS ENDOPHTALMITIS**

Answer 484

Marfans and PXF Trauma (#1 cause) Ehlers danlos, Weill Marchesani syndrome, homocystinuria

Answer 485

T-DOME (all affect type 1 collagen) Turner syndrome Down syndrome Ostogenesis imperfecta Marfans Ehlers danlos (cause RD)

Answer 486

keratoconus, blue sclera, megalocornea, ehlers can cause lens subluxation marfans can cause retinal detachment - and cause more serious ocular complication

Answer 487

- most common post-op complication following cat sx - equatorial epithelial cells migrate to cover the posterior capsule 2-6 months after sx - Elschnig pearls type of PCO most common in children who undergo cat sx

Answer 488

- most common reason for decreased VA after cat sx - DME, CRVO/BRVO, RP, ARMD, ERM, retinal vasculitis (sarcoidosis, behcet's syndrome) and coats - inflammation due to trauma from sx - Irvine gass syndrome: CME after cataract sx - 6-10 weeks after sx - hyperfluorescent on FA (petaloid pattern) around macula and ON - most resolve within 6 months

Answer 489

- high myopia - lattice degen - hx of RD in the fellow eye - fam hx of RD

Answer 490

- occurs in the early post-op period, initiated by Valsalva maneuver, trauma, or suture failure - (+) seidel sign, hypotony, iris prolapse, (will point towards the wound), choroidal detachment (fluid accumulates in the suprachoroidal space), shallow AC - pts with an open wound are at risk for endopthalmitis - tx promptly!

Answer 491

retained viscoelastic, steroid response, inflammatory debris or RBC clogging the TM, pupillary block, retained lens material

Answer 492

- characterized by folds in descemet's, bullae, and/or microcysts that slowly resolve - High IOP can cause microcystic edema - Low IOP can cause descemet's folds - surgical trauma can casue edema due to shock wave from phaco or intraoperative use of viscoelastic material -pre-existing corneal dz - bullous keratopathy - more common w/ aphakia and AC IOLs - Haptic rubbing on endo can cause damage and edema

Answer 493

noncontact examination of the optic disc, macula, posterior pole and central vitreous provides stereoscopic, erect, and magnified image

Answer 494

performed in pts with peripheral retinal concerns like peripheral vascular disease, hx of blunt trauma, at risk w/ RD stereoscopic, reversed and magnified image of retina 180 deg away from the position of the mirror Trapezoidal mirror = 73 degrees, evaluate equator region square mirror = 67, ant equator and ora serrata Bullet mirror = 59 degrees, eval AC angle and ora serrata

Answer 495

real, inverted, reversed image

Answer 496

magnified, reverse, and inverted

Answer 497

eval NFL, choroidal lesions, small hemes

Answer 498

disappears

Answer 499

allows oblique viewing of the retina (similar to 3 mirror)

Answer 500

any perforation of the eye , surgery, hyphema, ruptured globe