Ocular Disease Testing

Question 1

Corneal Abrasion

Answer 1

• Fluorescein staining

Question 2

Corneal Foreign Body

Answer 2

• B-Scan ultrasonography to r/o intraocular foreign body

Question 3

Traumatic Iritis

Answer 3

• 1 month post-trauma perform gonioscopy to check for angle recession and BIO/Scleral depression to check for RD

Question 4

Traumatic Hyphema

Answer 4

• Sickledex screen to r/o sickle cell disease/trait
• B-Scan Ultrasonography if fundus view is poor
• CT scan of orbits/brain to r/o orbital fracture

Question 5

Corneal Laceration

Answer 5

• Seidel test to determine if full or partial-thickness/self-healed full-thickness

Question 6

Ruptured Globe / Penetrating Ocular Injury

Answer 6

• CT scan of brain/orbits to r/o intraocular foreign body
• gentle B-scan ultrasound to localize posterior rupture sites and r/o non-metallic/wood intraocular foreign bodies

Question 7

Putscher Retinopathy

Answer 7

• CT of head, chest, or long bones to r/o compression injury or fracture
• CBC, Rheumatologic (CRP, ESR, RF, ANA) to r/o systemic cause
• FA to identify areas of nonperfusion in the regions of retinal whitening

Question 8

Superficial Punctate Keratopathy (SPK)

Answer 8

• Fluorescein staining to evaluate staining pattern

Question 9

Recurrent Corneal Erosion (RCE)

Answer 9

• Fluorescein staining to visualize abnormal basement membrane lines

Question 10

Dry Eye

Answer 10

• Fluorescein staining to check ocular surface and TBUT
• Schirmer’s test to measure basal tearing
• MMP-9 to determine tear osmolarity

Question 11

Filamentary Keratopathy

Answer 11

• Fluorescein staining to observe epithelial mucus strands

Question 12

Exposure Keratopathy

Answer 12

• TSH/T3/T4 to r/o thyroid disease
• Corneal sensitivity testing to r/o neurotrophic causes
• Fluorescein staining to assess corneal integrity

Question 13

Neurotrophic Keratopathy

Answer 13

• Corneal sensitivity testing to confirm neurotrophy
• Fluorescein staining to assess corneal integrity

Question 14

Bacterial Keratitis

Answer 14

• Fluorescein staining to assess corneal integrity
• Corneal scraping for culture to determine the infectious organism (esp if larger than 1-2 mm)

Question 15

Fungal Keratitis

Answer 15

• Fluorescein staining to assess corneal integrity
• Corneal scraping for culture to determine the infectious organism (esp if larger than 1-2 mm)

Question 16

HSV Keratitis

Answer 16

• Check corneal sensitivity which may be decreased in HSV
• Fluorescein staining to check for dendrites
• Viral PCR/culture to confirm HSV infection

Question 17

VZV/HZO

Answer 17

• Check corneal sensitivity which may be decreased in HSV
• Fluorescein staining to check for pseudodendrites
• Viral PCR/culture to confirm VZV infection

Question 18

Interstitial Keratitis

Answer 18

• FTA-ABS + RPR/VDRL to r/o syphilis
• PPD to r/o tuberculosis

Question 19

Phlyctenulosis

Answer 19

• PPD/Chest X-Ray to r/o TB

Question 20

Giant Papillary Conjunctivitis

Answer 20

• No testing

Question 21

Keratoconus

Answer 21

• Corneal topography to assess elevation and thinning
• Corneal keratometry to assess irregular mires and steepening

Question 22

Fuchs Endothelial Dystrophy

Answer 22

• Corneal pachymetry to determine central corneal thickness
• Specular microscopy to evaluate endothelial cells
• Corneal tomography to monitor disease progression

Question 23

Bullous Keratopathy (Pseudophakic/Aphakic)

Answer 23

• OCT-Macula to r/o CME