ophtha-all Flashcards
Vitreous is also attached to (but less firmly )
Optic disk margin
Macula
Post peripheral surface of lens
Anterior condensation of peripheral vitreous forms
Anterior hyaline membrane
Embryological origin of lens
from ectoderm from lens plate of 2 wk old embryo which becomes lens vesicle
Cells of posterior wall of lens vesicle will become
Primary lens fiber (which begins to fill in the cavity of vesicle to constitute the central region “central dark interval”)
Vitrectomy Thru pars plana
Closed vitrectomy
At old age.. What metachromatic color has difficulty reaching the retina?
Blue and violet metachromatic
It is due to opaque particles in vitreous
Impairment of vision
Factors that contributes to transparency of lens
Regular parallel arrangement of fibers with the nuclei at periphery
Curvature of surfaces
Refractive capsule
Location of geometric center at middle
(And in addition, smooth, gradual blending of refractive indices-capsule,cortex and nucleus)
Extra capsular method procedure that utilizes probe frozen -20 C
Cryoextraction
Second sight is due to
Lenticular myopia form change of index of refraction
Metab changes in lens is due to
Increase in Na and Ca content or
Decrease in K, glutathione ans as orbit acid content
(Which may lead to cataract)
It is due to cast on retina by opacities floating in vitreous
Positive scotoma
Symptom of vitreous opacities
Seeing spots in field of vision to actual diminution of vision of varying degree
Volume of vitreous
4ml
Caused by fine aggregates of vitreous protein due to age or myopia
Musca volitantes
Disparity of image size between 2 eyes
Anisokonia
Hypothyroidism is asso with developmental cataract. What is its essential feature?
Low ration of Ca to P in bld
Management for cataract
Surgical removal
How does cataract formed in changes in ciliary body
Catalytic changes in ciliary body which is responsible for increased formation of aqueous with the aid of carbonic anhydrase
In young, surgery should be done ASAP if..
Both eyes have poor vision
Strabismus sets in
How is accommodation in aphakia
Completely lost
Lost of gel-like consistency or conversion of vitreous into liquid
Vitreous liquefaction (syneresis)
As the secondary vitreous increases in vol, the primary vitreous is forced forward to central position, the site of ?
Cloquet’s Canal
Type of senile cataract which tends to become hard and shrunken
Nuclear cataract
Embryological origin of primary vitreous
Protoplasmic processes of the lens vesicles and inner layer of optic cup
Aka linear extraction because of linear corneal incision
Capsulectomy
IFN pa cities are more numerous and extensive, the fundus reflex is
Lost
Any disturbance such as . . . Will cause lens opacities or cataract
Change in curvature
Insinuation of water between individual fibers
Deposition of substance in capsule
Source of hyaluronic acid and has phagocytic effect
Hyalocytes
Vigorous opacities is caused by
Inflammatory cells (post uveitis, endophthalmitis)
RBC (vitreous hemo)
Saponified Ca soaps (asteroid hyalitis)
Cholesterol crystals (synchisis scintillans)
Tumor cells (RB)
Foreign bodies ff pentrating injury
Optical system of eye
Lens and cornea
Lens has sparse or numerous cells?
Sparsely cellular
By presbyope so who’d discovered that they can read small fine prints without aid of their old reading glass
“Second sight”
At what age will the zonule become hard to break, or be broken?
Before 40 y/o, zonule fibers are hard to break
After 20 y/o, zonules may be broken with aid of alpha-chemo trypsin
Type of cataract asso with local eye pathology (corneal infection, uveitis, glaucoma, vitreous hemo, retinal detachment, retinitis pigmentosa and tumors)
Complicated cataract
Gel-like conversion of colloidal struc of vitreous (which occur on aged, myopic, in trauma and inflammation)
Vitreous liquefaction (syneresis)
Cells of anterior wall of lens vesicle will become
Sub capsular epithelium
Is vision not threatened in vitreous detachment?
Yes. Unless asso with retinal tears, detachment or vitreous hemorrhage
What can u see in ophthalmoscope when the lens is completely opaque
No fundus reflex
In early nuclear sclerosis in cataract
Iris shadow
Extra capsular method procedure which uses lens capsule forces
Forcep extraction
Dz procedure to determine the nature and position of the opacities in lens
Biomicroscopy
Indication for surgical removal of cataract
Inability to perform usual work with aid of spectacles
Development of secondary glaucoma and uveitis
Lens has no blood vessels, nutrition is from..
Aqueous thru selective osmosis
Vitreous has the firmest attachment to the pars plana and retinal periphery
Vitreous base
Spherical protrusion of ant or post portion of lens producing visual impairment
Lentiglobus
Cataract is caused by
Metab changes
Permeability disturbance
Changes in aqueous, vitreous and ciliary body
(Other: heredity, racia predisposition, malnutrition, light, heat, radiation and endocrine disturbance)
Lentiglobus vision is improved by
Refraction or lens extraction
Diagnosis of aphakia
Presence of deep anterior chamber
Tremor of iris (iridodenisis)
Absence of purkinje image
Extra capsular method procedure done in young, where ant capsule is removed ASAP and the hard nucleus is expressed out. Bigger corneal wound is made.
Capsulectomy
S&s in lens dislocation
Blurring
Iridodenisis
Monocular Diplopia (if lens equator is seen at pupil)
Glaucoma (if ciliary body us irritated)
Deep form of ectopia lentis is
Congenital
Occurs as asymmetrical defect of zonule so lens is displaced away from the defective zonule fibers (as seen in semi dilated pupil)
Lens dislocation
Congenital absence of lens charac by small eyes (microphthalmic)
Aphakia
Where does the lens nuclei located?
Equator
If lens dislocation is due to trauma, lens is displaces toward…
Inferior (for zonules affected are superior)
Systemic cataract may be due to
DM
Hypothyroidism
Method of cataract extraction where capsule breaks
Extracapsular extraction
Ophthalmic exam of fudge requires the need of high plus lens, approx..
+10 D
Indentation or defect of lens equator asso with absence of zonule fibers
Lens coloboma
A gradual and progressive dse charac by Any opacity of lens with visual impairment
Cataract
Method of cataract extraction where lens is removed with capsule intact
Intra capsular extraction (not possible if pt is <20 y/o)
What can u see in ophthalmoscope in pathological vitreous
Scattered floater or opacities may appear black against red fundus reflex
This occurs when vitreous liquefaction results to separation of surrounding tissue (esp retina)
Vitreous detachment
Crystalline biconvex structure
Lens
Mesenchymal cells enter the region of optic cup to contribute to ..
Primary vitreous
T/f. In Monocular aphakia, wearing spectacles will not restore the binocular vision
True. Because of disparity of image size (anisokonia) between 2 eyes
Seen as floater spots darting ms and out of field of vision (esp when gazes is focused in an illuminated background)
Musca volitantes
Condensation of fibrillation struc of vitreous or actual fibroblastic or glial proliferation from vascular elements. Pigments epith cells is also the source
Vitreous band and membrane
Vitreous band is commonly seen in
Diabetic retinopathy or ff long standing vitreous hemorrhage
Lens begins to lose its transparency with aging process
Senile cataract
Is visual outcome of lens extraction in complicated cataracts can’t be predicted?
Yes
Young with cataract are prone to complications
Retinal detachment
Uveitis
Glaucoma
Lens dislocation is common in
Arachnodactyly or marfan’s syndrome
Charac by extreme length and thinned of bones, ms weakness and miosis
What can you see in ophthalmoscope in cataract
At distance may show black spots in fundus reflex against orange-red background
Type of cataract which is generally bilateral, opacity localized in ant or post pole and lamella may be involved
Hereditary type of developmental cataract
In microphakia, when the pupil is dilated, the edge of Lens is seen all around the circumference of pupil = highly myopic
Microphakia is hereditary, recessive
Gel-like subs and constitutes the main bilk of eyeball
Vitreous
How does cataract formed in diabetics
Hyperglycemia increases reduced sugar (sorbitol) in aqueous and by osmosis, it withdraw some water from lens.
If lens dislocation is developmental type, lens is displaced..
Upward
Cells of equator of lens vesicle will become
Secondary fibers (which grows to surround embryonic lens)
Vitreous base extends __ mm anterior to ______
And from posterior to _____.
2mm anterior to Ora serrata on pars plana
And from posterior to Ora serrata on peripheral retina
Ant capsule of lens is cut crosswise. The small knife is passed thru small puncture of cornea.
Discission
Part of lens
Central hard nucleus
Peripheral soft cortex enclosed by a capsule
Most common complaint in cataract
Cloudiness of vision
Lens has passive/active metabolism
Active metabolism as shown by its high protein
It is due to much traction and/or prsessure in retina by partially detached vitreous body
Photopsia
What are the conenzymes found in glycolysis during anaerobic condi
ATP
DPN diphosphoridine nucleotide
Lens is held in position by
Zonular fibers (from ciliary body that fused with capsule at region of equator)
Potential space between Lens and anterior hyaloid
Space of Berger
Formed by 9th wk by activity of vitreous and retinal cells
Secondary vitreous
Extra capsular method procedure where special app is that can be introduced anterior and post to lens with their rotating sharp edge slowly tearing the lens capsule and subs into small bits then aspired out
Lensectomy
Extra capsular method procedure which uses metal suction tip
Phakoeresis
In complicated cataract, the opacities begins..
Beneath the capsule (as a result of changes in capsular permeability)
Type of senile cataract where in opacity involves outer layers
Cortical cataract
“After-cataract” “membranous cataract”
Secondary cataract
When ciliary ms relaxes, zonules become tense, lens thinner = focused beyond retina = HYPEROPIA
When ciliary ms contract, zonules loosen, lens thicker = focused beyond retina = MYOPIA
Extra capsular method procedure where ant capsule is ruptured. Lens subs is stirred by the same point instru used in penetrating cornea
Needling
Forms bulk of postnatal vitreous
Secondary vitreous
Produce by margin of growing optic cup which later becomes suspension ligament of lens
Tertiary vitreous
Type of senile cataract where in the oldest fibers in center of lens lose their transparency
Nuclear (sclerotic type)
The cortical or outer layer of vitreous contains Small no of cells called..
Hyalocytes
Light flashes esp on movement of eyeball
Photopsia
Small lens with tendency to be spherical (spherophakia)
Microphakia
Some contraceptive drug have been found to induce cataract formation, such drug as ..
Thalidomide
In old age with change in color perception, the Blue color becomes ___
Green
Color of lens
Pale yellow
Darkens with old age
Sole source of energy of lens
Carbohydrates
Binocular vision is attained only with aid of contraindication tact lens or intra ocular lens
Unilateral cataract
The gel-like consistency, of oddity and viscosity of vitreous is due to
Due to a double fibrillation network system of collagen-like protein and hyaluronic acid which is suspended in large amt of water
Type of cataract with opaque membrane due to incomplete absorption of lens ff trauma or incomplete surgical removal of lens
Secondary cataract
Type of senile cataract tends to swell and liquefy
Cortical cataract
Principal objective sign in cataract
Lens opacity
Post peripheral surface of lens is called
Hyaloidocapsular ligament of Weigert
Thru corneal incision and aphakic pupil
Open vitrectomy
Partial or complete failure of embryonic hyaloid vascular system to regress which produces white pupil in small eye
Persisted hyperplastic primary vitreous
Most common symptom in vitreous detachment
Photopsia or floater
Most common type of hereditary type of developmental cataract
Ant axial embryonal cataract (appearing S&s multiplr fine opacities surrounded by faint halo)
In rubella cataract, surgery is done
After 3 yrs
Microphakia is asso with
Ectopia lentis
Congenital weakness of zonules
It affects pregnant mothers during first trimester (maternal illness during fetal life)
Rubella (lens is isolated for 3 yrs after birth)
Lens used to focus rays of light in retina
Aphakia bifocal lens
Flashing spots in field of vision
Positive scotoma
3 main symptom on pathology of vitreous
Positive scotoma
Photopsia
Impairment of vision
Change in color perception is due to
Accum of metabolizes of aa, tryptophan
Corneal and scleral scar, coloboma of iris and eccentric or irreg pupil may be present
Aphakia
Extra capsular method procedure where it uses special type of app used to dislocate anteriorly, fragments it by ultra vibration and finally aspirated the resulting small particles out
Phacoemulsification
Most common microorganism in bacterial purulent inflammation
Staph aureus
P. Aeruginosa
Proteus
Coli form bacillus
Type of uveitis caused by live microorganism invading the eye
Granulomatous uveitis
Non-granulomatous/granulomatous uveitis.
Posterior synechiae
NG. Very thin
G. Heavy and hard to break
Choroid is supplied by
10-20 short ciliary a. (A branch of ophthalmic a)
COLOBOMA is located inferiorly/superiorly
Inferiorly
Beneficial effects of mydriasis
Breaks post synechiae (which is responsible for 75% of complications that end up in blindness) Reduces volume of iris, consequently decongesting the iris mechanically (which diminishes the vascular exudation of inflammatory cells) Reduces pain (cycloplegic effects)
Portions of iris, ciliary body, choroid or whole uvea is affected. It is charac by failure of optic cup to close completely during fetal life
COLOBOMA
Bilat post uveitis with retinal detachment in young
Harada’s disease
Endophthalmitis may end up into phthisis
Yes
Purulent or non purulent inflammation: caused by bacteria or fungus
Purulent inflammation
Signs seen in uveitis with the aid of magnifying loupe or bio microscope (slit lamp)
Keratic precipitate
Deposition of cells on post surface of cornea
Aqueous flare or trnaslucency caused by increased albumin, aqueous cells, Koeppe’s and Bussaca’s pseudonodules
Iris true nodule and stromal granuloma
Post synechiae or adhesion between iris and cataract cells
It provides nourishment for pigment epith and outer layer of retina
Choroid
Usual known cause of endogenous uveitis. Nematode
Hookworm
Ascaris
First sign in fungus purulent inflammation
Hypopyon
Mydriasis solutions
Soln of atropine 1%
Phenylephrine 10%
Scopolamine 1%
For 1-3 times/d
Usual complaint in Aniridia
Photophobia
TB uveitis affects both ant and post uvea?
Yes
The blood vessels layers are limited by 2 membranes, externally by ____ and internally by ____
Externally by suprachoroid
Internally by Bruch’s membrane
Non-granulomatous/granulomatous uveitis.
Choroidal exudates
NG. None
G. Large
Type of uveitis caused by introduction of inert substances, the composition of living organism, or whole dead organism into the eye
Non granulomatous uveitis
Panophthalmitis is characterized by
Proptosis
Chemosis
Limitation of ocular movement
Treatment for leprosy
Sulfone drugs (promin, promizole)
Non-granulomatous/granulomatous uveitis.
Pigmentation
NG. None
G. Prominent at borders of chordal exudates
Does TB uveitis has tendency for recurrence?
Yes
Common cause of larvae migran syndrome
Larval hookworm and ascaris in dogs and cats
Anterior uvea
Iris and ciliary body
Charac by acute ant uveitis with greasy kp, and pseudo or true iris nodule or circumscribed irreg choroidal exudates
TB uveitis
Special type of uveitis with mild ant or post granulomatous uveitis and violent post uveitis with endophthalmitis
Larvae migran syndrome
Gout attack lasts for ____ leaving come residual post synechiae, pupillary membrane and and later in bans keratopathy
4-10 d
Anterior uvea has 2 circumferential arterial network
- Major arterial circle of ciliary body and part of ant choroid
- Minor arterial circle of iris
Difference in color of iridis of 2 eyes
Heterochromia
Usual known cause of endogenous uveitis. Viral
Herpes simplex Herpes zoster Measles Mumps Lymphogranuloma venerum Cytomegalic inclusion bodies
Pigment proliferation depends on amt of pigment. What has least pigmentation and greatest pigmentation?
Iris has least pigmentation.
Ciliary body more.
Choroid most.
More severe inflammatory reaction
Ciliary body.
Hs greater number of blood vessels and cells
Non-granulomatous/granulomatous uveitis.
Ciliary injection
NG. Severe
G. Mild
Special type of uveitis charac by small peripheral exudates with hemorrhage that ends up as sharply demarcated punched-out scars
Histoplasmosis
Most common org causing foci of infection
B-streptococcus hemolyticus
Secretes aqueous humor and controls accommodation
Ciliary body
When there is pain in purulent inflammation which occurs during the first week in endogenous type and much later in exogenous type
Glaucoma
In acquired type of heterochromia. the light/dark colored type is abnormal.
Darker eye because of pigment proliferation.
It usually follows uveal inflammation
Special type of uveitis confined to ant segment as granulomatous uveitis with whitish nodule in surface of iris
Leprosy
3 types of uveitis believed to be viral in etiology
- Behcet’s disease
- Harada’s disease
- Vogt-Koyanagi disease
Least severe inflammatory reaction
Iris.
Has limited bld supply and few stromal cells
Non-granulomatous/granulomatous uveitis.
Aqueous
NG. Cells plenty
G. Cells few
Mydriasis is done within ____ otherwise synechiae will remain permanent
Done within first 7-10 d
When infection extends to sclera and orbital struc producing proptosis, chemosis and limitation of ocular movement
Panophthalmitis
Behcet’s disease
Appearance of ant uveitis
Hypopyon
Aphthous ulcer on mouth, tongue and genitalia
T/f. Uveitis is a recurring condition
True
To destroy cyst containing trophozoites which when released are responsible for recurrence
Photo coagulation
Cause of uveitis common in Asia and Eastern Europe
TB
The principles of treatment of uveitis can be resolved into
- Mydriasis
- Anti-inflammation
- Specific therapy
Virus that cause ant non-granulomatous type
Herpes simplex
Herpes zoster
Mumps
Lymphogranuloma venerum
Usual known cause of endogenous uveitis. Fungal
Blastomyces Monilia Coccidiodomyces Cryptococcus Histoplasma
Usual known cause of endogenous uveitis. Protozoan
Amoeba
Toxoplasma
Non-granulomatous/granulomatous uveitis.
Vitreous opacities
NG. Thin with few cells
G. Heavy with plenty cells
Most severe inflammatory reaction
Choroid.
Has marked vascularity
In Aniridia, what is present behind the limbus
Iris tag
Non-granulomatous/granulomatous uveitis.
Course
Non granulomatous. Self-limiting (1-2wks)
Granulomatous. Protracted with remission
If there is consistent and prolonged Mydriasis, give
Sub conjunctival injection 0.5mL
Most common microorganism in fungal purulent inflammation
Aspergillus Candida Sporotrichium Cephalosporum Cryptococcus Actinomyces
Regulates size of pupil
Iris
Adhesion between iris and cataract cells
Synechiae
Absence of iris
Aniridia
In glaucoma, there is pain in purulent inflammation which occurs during ___ endogenous type and____ in exogenous type
In glaucoma, there is pain in purulent inflammation which occurs during 1st wk in endogenous type and much later in exogenous type
Specific type of uveitis that has protean manifestation.
TB uveitis
Pigmented vascular middle coat of the eye extending from optic disc to pupil
Uvea
Specific type of uveitis with acute ant uveitis with greasy kp, and post granulomatous uveitis
Lens-induced uveitis
Virus that cause posterior -granulomatous type
Cytomegalic inclusion body
Embryological origin of ciliary body and iris
Have Neuro ectodermal components
In heterochromia, when aging, these 3 appears
Glaucoma
Uveitis
Cataract
Choroidal absence which may be partial or total where only macula is left.
With bight blindness but central vision is retained.
Choroideremia
Cause of uveitis common in Middle East and japan
Viruses
In hereditary type of heterochromia. the light/dark colored type is abnormal.
Light colored eye because if thinning of iris stroma
Accompanied by adjacent notching of lens and Astigmatic refractive errors
Ciliary body coloboma
Cause of uveitis common in central US
Histoplasmosis
Embryological origin of uvea
Mesodermal in origin from tissues surrounding primary optic vesicle
Posterior uvea
Choroid
If condition in purulent inflammation does not improve in 4 days…
Vitrectomy (evacuation of vitreous)
Suppuration in uvea, retina and vitreous setting up
Endophthalmitis
Non-granulomatous/granulomatous uveitis.
Nodules
NG. None
G. Frequent
Endo or exogenous type of purulent inflammation:
Initially hypopyon
Exogenous type
T/f: choroid has tendency to be isolated as well as macula
True. Because of segmental arrangement of choriocapillaries
Non-granulomatous/granulomatous uveitis.
Pain
NG. Present
G. None
Special type of uveitis with post choroidal exudate
Toxoplasmosis
Non-granulomatous/granulomatous uveitis.
Onset
Non Granulomatous: acute
Granulomatous. Chronic
3 parts of uvea
- Choroid
- Ciliary body
- Iris
Usual form of foci of infection
Ant uveitis with fine kp and cells and post synechiae
Reflex pupillary dilation
Mydriasis
Non-granulomatous/granulomatous uveitis.
Keratin precipitates
NG. Small, pin-point
G. Big and greasy
Non-granulomatous/granulomatous uveitis.
Retinal edema
NG. Generalized
G. Localized over choroid all exudates
Anti-inflammation by locally applied steroid utilized in anterior uveitis. Local suspension, ointments , subconj, succinate ans subconj acetate is given every … To obtain adequate therapeutic level in aqueous.
Local suspension. 1-3 hrs
Ointment. 6-8 hrs
Subconj succinate. 3 d
Subconj acetate. 2 wks
Similar with harada’s disease but ends up with an ant granulomatous uveitis with accompanying vitiligo, poliosis, alopecia, dysacusia
Vogt-kayanagi disease
Specific type of uveitis charac by acute ant uveitis with fibrin in anterior chamber I. Young asso with collagen disease
Rheumatoid disease
Endo or exogenous type of purulent inflammation:
Initially vitreous opacities
Endogenous type
T/f: uveitis by itself does not cause blindness
True
Most common org causing foci of infection in Philippines
Alpha strep
Non purulent inflammation
Uveitis
Specific type of uveitis charac with spontaneous or traumatic rupture of lens capsule
Lens-induced uveitis
Special type of uveitis wc is an autoimmune disease with bilateral granulomatous uveitis which follows a perforating ocular injury affecting ciliary body in one eye.
Sympathetic ophthalmia.
Special type of uveitis as acute ant granulomatous uveitis with gelatinous exudate and crystals in ant chamber
Gout
Cause of uveitis common in Western Europe and America
Toxoplasmosis
In Aniridia, the structure behind the cornea is
Black
Anterior uvea is supplied by
2 long ciliary a (branch of ophthalmic a)
Usual known cause of endogenous uveitis. Bacterial
TB Leprosy Syphilis Strep and staph Klebsiella Meningococcus Gonococcus Coliform bacilli
Special type of uveitis with ant granulomatous uveitis ans appears as macular edema
Amoeba
Non-granulomatous/granulomatous uveitis.
Residual damage
NG. None or very slightly
G. Always and marked
Choroid layers of blood vessels
- Outer layer of large veins leading to vortex veins (haller)
- Middle layer of medium veins and some arterioles (sattler)
- Inner layer of choriocapillaries
Accumulation of leukocytes in anterior chamber
Hypopyon
S&s of uveitis
Ciliary injection Fibrin in anterior chamber Small irreg pupil Pupillary membrane Vitreous opacities Choroids exudation
Any black area seen on the reflex in ophthalmoscope means …
Opacity in ocular media
Green vision
Chloropsia
If the iris is pushed backward, the anterior chamber is …
Deep
Sudden/gradual onset of blindness is charac of crao, vitreous hemo, retinal detachment and optic nerve trauma
Sudden onset
The portion in space wherein objects can be seen when gazing at a certain fixed direction.
Visual field
Subjective signs
- Pain (orbital pain, headache)
2. Disturbances of vision
Rainbow colored halo
Glaucoma
Incipient cataract
The peripheral vision is determined by measuring
Visual fields
Dark adaptation
Ophthalmoscope studies the…
Retina
Choroid
Optic disk
Presence of a fast component denotes a labyrinthine etiology. It is caused by poor central vision.
Ocular nystagmus
The smallest print can be read by normal individual at a distance of __cm
25cm (13in)
Temporal to the disc is the
Macula
Headaches that are localized in___ regions are ocular in nature.
Frontal and temporal
Foreign body sensation or sharp pain in the eye occurs when
When lid moves
Soreness or tenderness is elicited by.
Pressing the eyeball
Xanthopsia is due to
Jaundice and carbon monoxide poisoning
White vision is due to
Digitalis poisoning
If the headache is bilateral, it is asso with.
Uncorrected refractive errors or ms imbalances
Caused by dilatation of superficial conjunctival blood vessels
Conjunctival congestion
Red vision
Erythropsia
Visual pigment of rods
Rhodopsin
The most practical way for one to measure the accommodation of a patient is to test his vision for near by what Test?
Jaeger test cards
Defects In the 2 eyes that are not equal in size and shape are termed congruous/incongruous.
Incongruous
The human eye as a sense organ is stimulated adequately by light alone and it sees that portion of energy spectrum whose wavelengths range from..
400-800 millimicra (mu)
Minute irregular curvature of cornea can be detected only by ..
Placido disk or keratometer
Pain sensation in the eye can be tested by looking for ..
By looking for Ciliary tenderness and by checking for corneal sensitivity.
Sudden/gradual onset of blindness is charac of corneal opacities, cataract, optic atrophy and chronic intraocular inflammation.
Gradual progressive blindness
The highest limit of the normal value in applanation tonometer
20mmHg
Redness localized in lateral aspect
Inflammation of lacrimal gland
Violet vision
Ianthenopsia
Temporary dimness sensation is vestibular/ocular in origin and are elicited by turning of eyes vertically or horizontally.
Ocular
The cones/rods are anatomically more separated and 2-4 cones/rods is connected to one ganglion cell.
Rods
Seeing double with only one eye noted when 2 diff retinal areas of an aye subserve 2 diff images
Monocular diplopia
Visual pigment of cones
Iodopsin
The second most frequent abnormal neurologic finding in cerebellopontine angle tumor
Diminution of sensation of eyes
An island of vision surrounded by a sea of blindness.
Visual field
Both eyes may have partial blindness at the same time.
True
Whirling and swaying sensation is vestibular/ocular in origin and are elicited by a sudden movement of the head.
Vestibular
The cones/rods are anatomically closely packed together and each cones/rods is connected to one ganglion cell.
cones
What do u call the reflex when the light is directed to the pupil of one eye, that the pupil will constrict
Direct light reflex
Any gray or bluish area seen on the reflex in ophthalmoscope means …
Retinal lesion
The highest limit of the normal value in indentation or schiotz tonometer.
25mmHg or 5 scales reading
Superior palpebral folds are generally present in the upper lid ___mm above margin
10mm
Generally, upper lid margin is ___mm below upper limbus, while the lower lid margin is just at level of lower limbus.
2mm
Filipinos at age __ have difficulty reading fine prints at a distance of __cm.
37yrs old
28-30cm
Colored vision
Chromatopsia
Central vision is determined by measuring
Visual acuity
Color perception
Erythropsia is due to
Vitreous hemorrhage
Aphakia
It is tested by touching the cornea with a wisp of cotton
Corneal sensitivity
Objective signs
- Redness
- Crust formation
- Secretion (watery secretions, discharges)
- Lumps
- Lid disturbances (malformation,malposition)
- Eyeball disturbance (abn size, malposition, maldirection, malfixation)
Chloropsia and ianthenopsia is due to
Chorio-retinal pathology
Normally a person will start not seeing the colored objects within __sec.
40s. More than this period is abnormal.
It is felt after excessive use of the eyes or when the patient tends to rub the eyes
Itching, smarting or burning sensation
At the peripheral part of the chamber, the iris should be adherent to the cornea
False
What do u call the reflex when the light is directed to the pupil of one eye, that the pupil will constrict and simultaneously the pupil of other eye will also constrict.
Consensual light reflex
Yellow vision
Xanthopsia
Poor near vision
Presbyopia
Redness localized nasally is due to
Inflammation of lacrimal sac
Caused by dilatation of deeper blood vessels of anterior ciliary artery
Ciliary injection
Among Asians the superior PAlpebral fold can be located lower or lost because
Of the absence of cutaneous insertions of elevator palpebral ms
This soln should be placed on the eyes after the examination to avoid an acute attack of glaucoma
Pilocarpine 1%
Cyanopsia is due to
Initial cataract extraction
Blue vision
Cyanopsia
The term hypotropia is not used.
Yes. If right eye is lower, it is recorded as left hypertropia.
The ophthalmoscope is put on. The lens is set at zero. The examiner directs the light at the patient’s eye from a distance of __cm.
5ocm
If the headache is unilateral, it is due to ..
Inflam of orbit, lids or eye and glaucoma
What color has the longer wavelength?
Red
Measured by checking the minimum size of a letter that the eye can recognized at a certain distance under daylight illumination.
Visual acuity
Whitish foamy secretion can be present in
Vit A deficiency
What color has the shorter wavelength?
Violet
The distance between that point and the eye has an equivalent power of accommodation expressed in
Diopter
The presence of the lens can be verified by the appearance of at least 2 light reflexes in the pupillary area (purkinje images). One reflex coming from,, and the other from…
Anterior lens capsule and posterior lens capsule
If the iris is pushed forward, the anterior chamber is …
Shallow
Absence of a reflex occurs when the opacity in the ocular media is
So dense as not to allow the light to penetrate inside
Defects In the 2 eyes that are equal in size and shape are termed congruous/incongruous.
Congruous
The veins are larger in size than arteries. The veins may show pulsation but not the arteries.
True
Hemangioma of Irreg blue red patch of variable size formed by diffuse telangiectasis of mature vessel of dermis
Nevus flammeus
Acute staph infection of asso gland of lids charac with circumscribed red, swollen and tender mass
Hordeolum
Skin deposition of lipid materials in inner part of upper and lower lid. Lesion is yellowish and slightly elevated plaque with sharply demarcated margins
Xanthelasma
What IOM is involved in ptosis
Superior rectus ms
Most common malignant tumor of eyelid
BCC
Small cylindrical benign growth in eyelid
Cutaneous horn
In ulcerative blepharitis, chronically, lid margins hypertrophies and thickens which cause upper lid to droop down giving ruse to sleepy appearance called
Tylosis
Endocrine exophthalmos is a pituitary disfunc wherein an ____ is released initiating cellular filtration of tissue within the orbit
EPS
Hemangioma of soft red lesions which disappears spontaneously
Capillary hemangioma
Retrodisplacement of globe is seen in..
Horner’s syndrome
Local inflam which affects skin of lid
Contact dermatitis
OO has 2 parts. What part is responsible in invol blinking?
Central orbital part of OO
Thyrotoxic exophthalmos is charac by
Slight exophthalmos
Lid retraction
Lid lag
Blinking is a protective mechanism, it involves the contraction of tarsal part of OO lasting
0.3 s every 5s
The orbit extends anterior to the tarsus and can thank ligaments forming
Orbital septum
Passive forward displacement or protrusion of eyeball from its normal place
Proptosis
Symptomatology of orbital pathology
- Proptosis, exophthalmos
- Displacement of globe
- Congestion or edema of lids and conjunctiva
- Bruit and pulsation
Swelling of this hordeolum is at lid margin
External hordeolum
Contains orbital fat that serves as cushion for the eyeball
Peripheral surgical space
BCC of lid spreads by
Hematogenous spread
Thermal burns, lid injuries and skin infection may result in
Ectropion
In ulcerative blepharitis, lashes may be lost due to destruction of hair follicles called
Madarosis
Inability of lids to close due to paralysis of CN7
Lagophthalmos
Swelling of this hordeolum is away from lid margin
Internal hordeolum
In lid, Incision of grayline splits into
Posterior part- tarsal plate and conjunctiva
Anterior part- orbicualris oculi, skin and hair follicles
Rare type in which the affected eyelid elevates when the pt opens his mouth while chewing or laterally moves his jaw. Ptosis reappears when mouth is closed.
Marcus-Gunn or jaw-winking phenomenon
Infection of lids by crab louse (pediculosis pubis or capitis)
Phthiriasis palpebrarum
A difference of __mm between eyes in exophthalmometry is abnormal
> 2mm
Orbital edema has no muscle paralysis.
Yes
Space Between periorbita and bone
Subperiosteal space
True exophthalmos is less frequent than proptosis
True
SCC of lid is common in m/f, lower/upper lid
M, upper lid
Form of verruca that is filiform
Verucca digitala
SCC of lid spreads by
Lymphatic spread
Infection of gasserian ganglion charac by unilateral vesicular eruption along distribution of 1st and 2nd division of CN5
Herpes zoster ophthalmicus
In orbital vein obstruction, what can u find in ophthalmoscope
Venous stasis
Optic atrophy
Notching of defect in continuity if lid margin
Coloboma
Solid tumors ans endocrine exophthalmos do not yield any degree of compressibility.
True
Innervating of eyelid
Upper lid and lateral portion of lower lid - C5-1 (ophthalmic n)
The rest is form maxillary div thru infraorbital n.
Ulcerative blepharitis is caused by what organism
Staph aureus
Hordeolum involving meibomian gland
Internal hordeolum
Loss of elasticity of skin of lids in aging
Blepharochalasis
Each tarsus contains parallel rows of this gland which provides airtight closure of lids and provides rapid evaporation of tears.
Meibomian gland
Red inflamed margins with yellow crust which may become adherent to base of lashes
Ulcerative blepharitis
Abnormal drooping of upper lid due to absence or weakness of levator palpebral ms or lesion to CN3
Congenital Ptosis or blepharoptosis
Chronic inflammation of meibomian gland which is usually bilateral and preceded or asso with blepharitis
Meibomianitis
Lymphatic drainage of eyelid
Medial 2/3 of lower lid and medial 1/3 of upper lid - submaxillary lymph vessel
Lateral 1/3 of lower lid and lateral 2/3 if upper lid - pre-auricular lymph vessel
Exaggerated contraction of orbital part of OO. A marked reflex of blinking.
Blepharoclonus
Result of accidental inoculation or localization of virus in a ore-existing break in skin during period of view is (2-6d ff vaccination)
Lid vaccinia
Ms of eyelid
Orbicularis oculi
Levator palpebral superiosis
Palpebral smooth ms of muller
Decreased compressibility in orbitonometry indicates
Infiltrative or neoplastic lesion
Dehiscence of orbital septum giving ties to localized swelling in lid when orbital fat prolapsed
Baggy eyelid
Entire orbital cavity is lined with periosteum called the
Periorbita
Forcible closure of lids which is usually bilateral caused by marked contraction of OO and corneal lesion
Blepharospasm
OO has 2 parts. What part squeezes the eyelid shut?
Peripheral orbital part of OO
Chronic/acute contact dermatitis with weeping eczema
Acute local dermatitis
Reduced length and width of palpebral fissure
Blepharophimosis
Blinking is absent in infant
True
Form of verruca that is round
Verruca vulgaris
Viral wart of lid that is slow growing and with mild infectivity
Verruca
Orbital hemorrhage is characterized by
Axial proptosis w. Limitation of eye movement
Ecchymosis
Hemangioma wherein the lesion is composed of simple endothelial line spaces larger than capillary hemangioma
Cavernous hemangioma
Marked invol twitching of eyelid caused by eye strain, nervous tension and weakend body resistance
Myokymia
Increased compressibility in orbitonometry indicates
Vascular tumor
Func of eyelids
- Protect the globe for external injury and excessive light
- Distribute tears uniformly over anterior surface of face.
Vertical fold of skin from inner eyebrow to root of nose
Epicanthus
BCC/SCC starts as warty growth with keratotic covering gradually eroding until ulcer develops
SCC
Chalazion can cause glaucoma
True
BCC of lid is common in m/f, lower/upper lid
M, lower lid
Bld supply of eyelids
Lacrimal and ophthalmic arteries
Branch form external carotid artery thru facial, superficial, temporal and infra orbital a.
Central surgical space
Ms cone
Embryological origin of eyelid
From fronto-nasal processes
Hordeolum involving gland of zeiss and moll
External hordeolum
BCC/SCC starts as elevated nodule with central dimple and pearly borders
BCC
Form of verruca that is flat
Verucca plana
Another row of eyelashes, usually towards the cornea
Distichiasis
Chronic granulomatous inflammation of meibomian gland, charac by painless swelling of g without inflammatory signs
Chalazion
Assessment of compressibility of orbital contents
Orbitonometry
Redness limited to lid margins, aggravated by smoke, chemical fumes, and smog, and produce greasy scaling of skin
Squamous blepharitis
Active forward displacement or protrusion of eyeball from its normal place
Exophthalmos
Venous return of eyelid
Cavernous sinus or
Into IJV via SOV and IOV
Blepharitis that is usually secondary to seborrheic dermatitis of scalp and eyebrows
Squamous blepharitis
4 compartments
- Subperiosteal space
- Ms cone
- Peripheral surgical space
- Episcleral space
Lid coloboma usually occurs in
Inner and middle 1/3 of upper lid
Outer and middle 1/3 of lower
Intermittent proptosis, more prominent when bending the head down, blowing nose and during physical exertion
Orbital varices
Small vesicles with clear content due to sweat gland obstruction
Sweat gland cyst
Port wine stain
Nevus flammeus
Yellowish white tumor on tarsal portion of lid. Mistaken for and asso with Chalazion
Meibomian gland Ca
Chronic/acute contact dermatitis with dry skin, indurated and itchy
Chronic local dermatitis
Provides passive ab against vaccinia organism
VIG vaccinia immunoglobulin
Embryological origin of lower lid
Maxillary process
Part of palpebral conj is adherent to bulbar conjunctiva
Symblepharon
Inflammatory condi of lid charac by formation of nodules with umbilicated craters (with waxy materials)
Molluscum contagiosum
Inflam sequela wherein eyelashes are misdirected to cornea
Trichiasis
When upper and lower old are fused after inflammation subsides
Ankyloblepharon
Form of verruca that is threadlike
Verucca filiformis
Small pinhead sized yellowish white elevation due to sebaceous gland retention
Milium
Space formed by recti ms and their intermuscular mem with tenon’s capsule
Ms cone
Bruit/pulsation is seen earlier in aneurysm, while Bruit/pulsation is a later sign.
Bruit is seen earlier in aneurysm, while pulsation is a later sign.
Orbit is pathway of cranial nerves..
CN 2-6
Inflammation of lid margin
Blepharitis
Space between periorbita and ms cone
Peripheral surgical space
Infection of lid characterized by vesicle formation along lash line, edema tours lid margin and dermatitis may appear
Herpes febrilis
Management if blepharitis, hordeolum and Meibomianitis
Warm moist compress
Space between sclera and tenon’s capsule
Episcleral space
Orbital edema is characterized by
Axial proptosis
Venous congestion
Restriction of ocular movements
Scarring of conj and lid margin cause by inflammation, injuries and operation is ff by
Entropion
Entire orbital contents are completely enclosed except
At palpebral fissure
Blinking is diminished in what condition
Hyperthyroidism and Parkinson’s disease
Characterized by pulsationg exophthalmos of rapid onset ff a basal fracture
Carotico-cavernous fistula
Conjunctival growth covering the corneal marginal ulcer. Can grow from any direction besides nasal and temporal region.
Pseudo-pterygium
Lymphomatous tumor of lacrimal, parotid and submaxillary gland
Mikulic’s disease
Viral conjunctivitis caused by adenopharyngoconjunctival virus (APC8)
Epidemic conjunctivitis
Flat diffused conjunctival pigmentation that occurs after age of 40. Sometimes asymptomatic
Melanosis
Non developmental of conj from surface ectoderm. Gland appears as congenital cystic mass which extends posterior to orbital apex.
Cryptophthalmos
A keratoconjunctivitis but only can affect bulbar conj
Phlyctenular conjunctivitis
Bacteria that predominates in conj pathology
Strep
Diphtheria
Staph
Fungus infection of Canaliculi
Actinomycosis
Bacteria that increase in cadaver
Beta hemolytic strep E.coli Klebsiella pneumonia Pseudomonas aeroginosa Flavo bacterium
Dilatation of superficial conjunctival blood vessels.
Conjunctival injection
Other virus that cause viral conjunctivitis
Exenthematous virus (.small pox, chicken pox, measles, German measles)
Herpes virus
Myxovirus (mumps, influenza and new castle disease)
Conjunctivitis commonly found on malnourished children and pulmonary TB
Phlyctenular conjunctivitis
Onward transmission of tears down the duct is due to
Forces of gravity and pumping of sac caused by elastic recoil of its wall after act of blinking
Palpebral and bulbar conjunctiva is separated by
Fornix
Viral conjunctivitis accompanied by marked febrile symptoms
Pharyngoconjunctival fever
Obstruction of upper puncta does not cause epiphora
True
Localized whitish nodule with necrotic excavated center surrounded by conj infection
Phlyctenular conjunctivitis
Negative/positive pressure exists in lacrimal sac when one blinks
Negative pressure
3 mucin secretors
Conjunctival goblet cells
Crypts of Henle
Gland of Manz
Reduces intensity of symptoms and duration of condition by enhancing the immune response even if after onset
Oral Methisoprinol
Most common neoplasm of lacrimal gland
Mixed tumor
Dryness of eye does not occur even if lacrimal glands are removed.
True. As long as basic secretors are normal
Trachoma is common in palpebral/bulbar conj
Palpebral conj
Bilateral enlargement of lacrimal gland with chronic inflammatory lesion of uveal tract that occurs in asso with bilateral inflammatory swelling with facial palsy (heerfordt’s syndrome)
Uveo-parotitis
Dacryo-adenitis may occur as complication of..
Mumps, measles, influenza, thyroid fever
Lymphatic drainage of conjunctiva
Lateral: pre-auricular or superficial parotid lymph node
Medial: submaxillary lymph node
Test for patent drainage
Dropping of saccharine or chloramphenicol soln on conj cul-de-sac. If pt experience bitter taste after 5-15min, passage is open
Viral conjunctivitis that has conjunctival hemorrhage in upper bulBar conjunctiva
Acute hemorrhagic conjunctivitis
Single clue signifying pathology of conj
Foreign body sensation
Reflex secretors
Main lacrimal gland in upper temporal portion of orbit
Adjacent accessory palpebral gland
3 oil secretors
Meibomian gland (25 in upper tarsus; 20 in lower)
Gland of zeiss - at palpebral margin of each eyelid
Gland of molls - at roots of eyelashes
Viral conjunctivitis caused by coxsackie 24 or EV70
Acute hemorrhage conjunctivitis
Basic secretors has no afferent nerve supply
True
Test to determine adequate lacrimal secretion
“Schirmer’s filter paper test”
A filter paper (5x35mm) bent around 5mm at one end and is anchored by hanging over the lower eyelid margin covering the lower puncta. After 5 min, 10mm should be wet.
Lacrimal app is responsible in formation of pre-corneal film which is formed by
Deep mucoid
Middle watery
Superficial oily
Only superficial tissue of body where blood vessels can be seen
Conjunctiva
Always involved primarily on true hypersecretion
Reflex secretors
Other symptoms of conjunctival pathology
Conjunctival injection Lacrimation or discharge Formation of papilla or follicle Hemorrhage Ulceration Growth
Allergic conjunctivitis most produce ____ and this cells are found in discharge
Most produce chemosis
Eosinophils found in discharge
Bld supply of conjunctiva
Palpebral branch of nasal and lacrimal artery at lids
Anterior ciliary artery at limbus
If secondary dacryocystitis is due to infection of adjacent bone, what is the management?
Excision of inflamed sac
Inclusion blenorrhea is common in palpebral/bulbar conj
Lower palpebral conj
Streptothrix infection in upper canaliculus with dilatation of canaliculus with purulent discharge that oozes from puncta
Actinomycosis
Innervation of conjunctiva
Sensory - nasociliary, lacrimal, frontal, infraorbital, ciliary nerve
Sympa- ophthalmic a.
Fleshy mass in bulbar conj that invades the cornea at horizontal meridian
Pterygium
3 organisms producing ophthalmia neonatorum
Chlamydia oculogenitalia
Staph aureus
Neisseria gonorrheae
Viral conjunctivitis is self limiting for how many weeks
1-2wks
Filipino are known to be immune in trachoma and are affected that ends with what stage?
Follicular stage
Conjunctiva has no lymph nodes
Yes. But have lymph vessels.
Tears enter the lacrimal sac partly by..
Capillary attraction and suction
Lower puncta comes forward and away from marginal strip of tear fluid and epiphora results
EVersion of lower puncta
Purulent discharge in conjunctiva is produced by
Neisseria gonorrhea
B-streptococcus
Fibers of OO which surrounding the lacrimal sac
Horner’s ms
Discharge of blenorrhea
Mucopurulent discharge
Dilatation of deeper ciliary blood vessels near the limbus.
Ciliary injection
Chlamydia conjunctivitis
Trachoma
Inclusion blenorrhea
Only this secretors are present during sleep.
Basic secretors
Inclusion blenorrhea is caused by
Chlamydia oculogenitalia
Triangular yellowish mass at bulbar conjunctiva with base towards the limbus. Aggravated by exposure to wind, dust, and sun.
Pinguecula
Reflex efferent pathway for sympa
CN7
Eversion of lower puncta is due to
Senile laxity of lids
Chronic blepharitis
Ectropion
Lacrimal passages
Lacrimal puncta
Canaliculi - upper and lower empties in lateral wall of sac
Lacrimal sac
Lacrimonasal duct
Bacteria that increase in debilitated persons
Pseudomonas aeroginosa
Enterobacter sp
Can arise from chronic dacryocystitis if infection extends beyond the limits of sac and give rise to abscess.
Acute primary dacryocystitis
Fundamental part of secretory system of lacrimal app
Basic secretors
Hereditary form in chronic primary dacryocystitis is common
True
Epiphora is due to
Hyper secretion - due to emotional influence, local irritants in eyes, nose
Drainage interference - due to displacement of lower puncta, obstruction of lower puncta, Canaliculi, sac or duct
Depression between follicles in upper .1/3 of upper palpebral conj and lower 1/3 of lower palpebral conj
Crypts of Henle
Excessive tearing
Epiphora
In chronic primary dacryocystitis, infection may spread into tissues around the lacrimal sac
Peridacryocystitis
3 basic secretors
Mucin secretors
Lacrimal secretors
Oil secretors
Viral conjunctivitis that produces pseudo-membrane in lower and upper palpebral conj
Epidemic conjunctivitis
Inflammation of lacrimal sac
Dacryocystitis
Fold of mucosa which guards the ostium
Hasner’s valve
Reflex afferent pathway
CN5
Chronic primary Dacryocystitis is common in male
Female
3 lacrimal secretors
Microscopic acinotubular gland of Krause (40-50 in upper; 6-8 in lower)
Wolfring gland (3 in upper tarsus; 1 in lower tarsus)
Occasional gland in plica semilunaris or caruncle
In addition to purulent discharge, may produce membranous material
Strep conjunctivitis
Pterygium: bulbar/palpebral conj?
Bulbar conj
Phlyctenular conjunctivitis has immunologic reaction to
Tuberculoprotein
Nevi: bulbar/palpebral conj
Bulbar conj
Drainage of tears is assisted by
Pars marginalis of OO or ciliary bundle of riolan
Venous drainage of conjunctiva
Drains thru post tarsal venous plexuses of eyelid
Dacryocystitis in infant is due to
Incomplete canalizations of lower part of lacrimal duct and/or
Differentiation of valve of hasner in inferior meatal area of nose
Mucopurulent discharge
Hemophilus aegyptius h. Influenza Staph aureus p. Aeroginosa E. Coli Proteus mabilis
Pinguecula: bulbar/palpebral?
Bulbar conj
Acute conjunctivitis with marked chemosis ans watery discharge on exposure to certain grasses, plants and trees
Atopic conjunctivitis
Mucoid discharge is common in (canthus)
Lateral canthus (thus called angular conjunctivitis)
Mucoid discharge is produced by
Moxarella-axenfeld diplobacillus
Discharge of Vernal conjunctivitis
Thick syrupy discharge
Tear secretion
- 2% water
0. 8% solid
Pigmented elevated tumor located at bulbar conj
Nevi
4 stages of trachoma (mcCallan)
- Formation of follicles
- Presence of papillary hypertrophy and transformation of follicles into “sago grain” struc
- Beginning of scarring
- Period of cicatricization when all inflammatory activity end
Infection of lacrimal g due to pyogenic organisms which may lead to Suppuration
Dacryo-adentitis
Mucous gland is found on epithelium of..
Bulbar and tarsal portion of palpebral conj
Lymphatic reaction with neoformation of lymphoid tissue with peripheral vascularization
Follicle
Recurrent condi affecting upper palpebral conj of both eyes during summer
Vernal conjunctivitis
The internal common puncta may be preceded by dilation
Sinus of maier
Vascular reaction charac by neoformation of blood vessels at the center surrounded by lymphoid infiltration
Papilla
Clinical condi with dryness of eye
Xerophthalmia
Sjögren’s syndrome (keratoconjunctivitis sicca)
Steven-Johnson syndrome - erythema multiforme
Riley-day syndrome
Most common org producing mucopurulent discharge
Hemophilus aegyptius
Has big papillae arranged on cobblestone appearance
Vernal conjunctivitis
Due to disease or injury in the neighborhood of lacrimal sac and duct producing interference of tear passage
Secondary dacryocystitis
Trachoma is caused by what organism
Chlamydia trachoma
Acquired from venereal contact and swimming in nonchlorinated pool
Inclusion blenorrhea
If secondary dacryocystitis is duet to trauma of duct, as in fracture, what is the management?
Dacrycystorhinostomy
Chronic primary dacryocystitis is caused by
Streptococci
Pneumococci
Bacterial growth can be prevented by
Low temp
Antibacterial action of lysozyme in tears
Mechanical effect of blinking
Production of antibiotics by some bacteria present in conj
Flushing action of Tear flow
Indications for keratoplasty
Improvement if visual func of opaque or diseased cornea
Correction of severe altered struc
Replacement of active diseased cornea
Improvement if cosmetic appearance of cornea
Multiple minute epith erosion which stains with Fluoroscein
SPK
Corneal staphyloma has no recoverable vision and is painful
True
Softening of cornea
Keratomalacia
Viral keratitis is most common due to what virus
Herpes simplex
If Hassan Henle bodies changes centrally
So renal gluttata
Tunic coat mainly for protection, covered by tenons capsule and conjunctiva
Sclera
Embryological origin of stroma and endothelium
Para-axial mesoderm
Opaque ring within cornea scleral junction charac by lipid deposits demonstrating fat stain
Arcus senilis
Classif, of corneal scared as to density:
Large enough to be seen as gray spot
Macula
Lower lid bulges when pt looks down
Munson’s sign
With history of trauma with vegeteble matter
Fungal keratitis
Characterized with presence of vesicles or bless accompanied by foreign body sensation and pain
Bullous keratopathy
Bilateral, begins as endothelial degeneration ff by stromal and epithelial edema and appearance of bulbar.
Endothelial (fuch’s) dystrophy
Most common agent in bacterial corneal ulcer abroad
Pneumococcus (most common)
Poor axels
P. Aeruginosa
Microcornea
<10mm
Treatment for band keratopathy
O.4-1.8% Ethylene diamine tetra acetic acid (EDTA) as cheating agent ff by scrapping of Ca deposits
Small excrescences in periphery of descemet’s mem.
Hassan Henle bodies
Most common malnutrition blindness in India
Kereatomalacia
Superficial punctuate keratitis (SPK) is caused by what virus
Adenovirus Inclusion Cytomegalic virus Measles Mumps Trachoma
Cornea is rich in _____ this pain is the most common symptom
Sensory nerve supply
Non inflammatory protrusion if center of cornea due to gradual thinning of apex
Keratoclonus
Inflammation of deeper portion of sclera Bluish red in color Most common symptom: severe pain Recurrence ipsi common Young adults
Scleritis
Coin like corneal opacities common in farmers and agricultural workers
Padi keratitis
Megalocornea
> 13.5
Classif, of corneal scared as to density:
Faint cloud like seen with oblique illum
Nebula
Classif, of corneal scared as to density:
Dense and white scar
Leukoma
When iris become
S attached to scar tissue resulting to visual disturbance becoz of diffusion if light and irreg refraction esp located within optical centre of cornea
Adherent leukoma
Org that cause diffused inflammation of cornea
Adenovirus
Vaccinia
Chlamydia
Cornea is a vascular thus dependent on ___ for nutrition
Air, tears and aqueous humor
Clear transparent ocular medium of the eye which is anterior portion of external coat of eye
Cornea
Central corneal opacity which gradually tapers towards periphery. Opacity starts Posteriorly and drags ally involve more anterior layers. Asso with consumption of black rice.
Mindoro corneal opacity
Superficial inflammation of sclera
Lesion appears as flat or raised hard immovable nodule surrounded by far red or purple congestion
Usually at temporal side
Young adults
Episcleritis
Most freq predisposing cause
TB
Sign of active corneal inflammation
Cellular infiltration of stroma
Edema
Neovascularization
Necrosis
Final outcome of severe inflammation in corneal opacity asso with measles
Blindness
Corneal ulcer may end up
Heal without scarring
Penetrate into stroma
Penetrate deeply to expose descemet’s mem
Perforate - Panophthalmitis
Replacement of partial or full thickness of diseased cornea with donor tissue
Keratoplasty
Progressive disease of cornea starting at periphery and progresses centrally
Mooren’s ulcer
Derived from endothelium
Descement’s capsule
Most common agent in bacterial corneal ulcer in Philippines
P. Aeruginosa (most common)
Staph aureus
D. Pneumonia
Derived from corneal subs appearing at end of 5th month
Bowman’s capsule
Hereditary bilateral corneal lesion showing hyaline like deposits in stroma
Familia dystrophy
Calcific degeneration of bowman’s mem. A sequela. Of uveitis, keratitis and long standing glaucoma
Band keratopathy
Appears as white or gray-white elevated hard ulcer with dot like satellite opacities
Fungal keratitis
5 layers of cornea
- Epith - 5 cells thick
- Bowman’ mem
- Stroma / substantia propria - 90% collagen; 5% cells and mucopolysaccharide
- Descemet’s mem
- Endothelium - for corneal hydration
Charac by bulging cicatricix of cornea as a result of perforation and iris becomes adherent to back surface if cornea
Corneal staphyloma
The scarring process on corneal opacities is due to
Collagen formation (which contracts as it matures)
Org that cause fungal keratitis
Fusarium
Aspergillus
Mycelia sterila
Embryological origin of corneal epithelium
Surface ectoderm
Unfavorable factor in keratoplasty
Presence of vascularization
Thinning of apex
Corneal hydrops
Gives rise to superficial ulcer forming branch-like extension (dendritic ulcer) when stained with Fluoroscein
Viral keratitis
Marginal opacification of some superficial peripheral vascularization ff by loss of corneal subs
Senile marginal degeneration (terrien ulcer, gutter degeneration)
Organisms that cause focal central inflammation of cornea
Herpes simplex
Hypes zoster
Bacteria
Fungi
Padi keratitis is caused by
Virus
2 ocular media
Cornea and lens
Refractive power of cornea
43 D (38-47)
Deviation of eye in presence of epicanthis or presence of drooping upper eyelid laterally
Pseudo-strabismus or false squint
Branch of cn7 that supplies the lower portion of OO
Zygomatic branch
Shatter proof lenses. Ordinary lenses given to patient are made of
Crown glass
Objective method if refraction that catches the rays of light reflected at the pt’s retina whose source comes from a mirror near the examiner’s eye
Retinoscope
Deviation that can be corrected by fusion mechanism. Elicited when fusion is partly interrupted.
Heterochromia
Cn3 palsy
Cerebellar ataxia
Nothnagel’s syndrome
Various nuclei are connected cn 6 to higher center responsible for various eye movements thru medial longitudinal fasciculus:
For invol conjugate movement
Vestibular nucleus
An extreme condi of myopia with hyper pigmentation
Myopic crescent
Astigmatism is hereditary
True
Develops due to any interruption of development of binocular vision
Strabismus
Management for astigmatism
Cylindrical lense
Measurement for corneal astigmatism
Keratometry
Para/sympa system: affects the pupil and iop
Sympathetic system
Cn6&7 palsied
Contralat hemiplegia
Muller-gambler syndrome
Concomitant pulling effect that may happen becoz of change of position of eyeball from primary position
Secondary action
Esotropia with high hyperopia (great degree of convergence) and deviation greater when fixing at near than far.
Accommodative esotropia
Astigmatism due to corneal scar or faulty surgical incision
Irreg astigmatism
Additional protection can be given by ___ them which is made possible thru additional heating if ordinary lens ff by cooling
Hardening
Measurement of refraction
Diopter
Cn that closes the lids
Cn7
Intraocular lens is removed after ___ to avoid complication
15 yrs
Method of refraction that administers drugs that paralyze accom
Cycloplegic refraction
Process by which the media alters the course of light
Refraction
Too long eyeball or too strong RP
Myopia
2 images coming from each eye are perceived by brain as one
Fusion
Lesion that involves corticobulbar pathways and upper facial ms is spared
UMN lesion
Lesion that involves the nucleus or facial nerve and the entire half of face is paralyzed.
LMN lesion
Stimulation of nuclei turns the eye to opposite direction (slow component of nystagmus). But cortex sensing this abnormal condi rights them by making he eyes move back to other direction (quick)
Cn8
Inflammation of optic nerve (optic neuritis) localized in optic disc ( sudden blurring if 1 eye)
Pappilitis
Due to too short or too weak RP
Hyperopia
Swollen disc due to some interference of optic nerve circulation
Papilledema or choked disc
Cn6 palsy
Contralat hemiplegia
Raymond’s syndrome
Inflammation of optic nerve (optic neuritis) localized beyond the globe (no ophthalmoscopic finding)
Retrobulbar neuritis
Optic nerves don’t have neurolemal sheath (Schwann)
True
Ametropia is hereditary
True
Management for hyperopia
Convex
Convergent squint
Ant chamber is shallow
Pupil is smaller
Disc is smaller
Hyperopia
Divergent squint
Ant chamber is deep
Wider pupil
Bigger optic disc
Myopia
Used by persons exposed to excessive UV or infra-red rays
Colored lens
Ophthalmic branch
Frontal branch - supra orbital, supratrochlear n
Lacrimal branch
Nasociliary branch - infra torchbearer
Chiasmal lesions are commonly caused by
Pituitary tumors ans craniopharyngioma
Primary position
Straight forward
Oculomotor paralysis
Contralat hemiplegia
Paralysis of tongue and lower part of face
Weber’s syndrome
Mos that fix at an obj for 1-2min
6 mos
Cn that Elevates upper lid, constricts pupil and incites accommodation
CN3
Normal ms balance, when either eye show no deviation when fusion is partly or completely suspended.
Orthophoria
In papilledema, there is visual disturbance and visual field is abnormal
False
Regular/irreg astigmatism: most common, there are only 2 focal lines produced
Regular
Amt that the lenses can help correct When accom is active, it is the diff between latent and total ametropia
Manifest ametropia
Visual acuity at 1year
6/30
Deviation manifested where in the fusion mechanism can not keep the eyes in parallel alignment.
Heterotropia
Hyperemic disc with blurred margin
Dilated blood vessels
Elevated disc
Macular star
Optic neuritis
Semilunar ganglion of cn5 receives 3 main branches
Ophthalmic branch
Maxillary branch - infra orbital n
Mandible branch
Cn5 receives fibers from ___ located outside brain
Gasserian ganglion
Management for myopia
Concave lens
Mos that hold obj
3 mos
Refractive power of lens
17 D (12-22)
Branch ophthalmic common in lesion
Frontal branch
In optic atrophy, when nerve fibers are destroyed , they are replaced by ___ and the finer blood vessels ___
Neuro glial tissue and blood vessels closes
Cn3&4 paralysis
Contralat hemianesthesia
Hemiataxia
Claude’s syndrome
Also caused by centicular sclerosis as in incipient cataract.
Myopia
Deviation due to excessive ms tone or excessive accom
Comitant heterotropia
Lower/Upper portion of optic radiation is involved in temporal lobe tumors and otitis abscess
Lower
CN that do not decussate
CN 6
Exotropia with high myopia (minimal degree of convergence) and deviation greater when fixing at far than near.
Accommodative exotropia
Most common strabismus
Comitant esotropia
Mos that follow large obj
2 mos
Various nuclei are connected cn 6 to higher center responsible for various eye movements thru medial longitudinal fasciculus:
For lateral gaze
Pons
Exotropia due to excessive ms tones of LR.
Either recessed LR or Resected MR
Non accommodative exotropia
Various nuclei are connected cn 6 to higher center responsible for various eye movements thru medial longitudinal fasciculus:
For ff movement of eye
Occipital lobe
Scleral lens whose edges arrest beyond the cornea.
Corrects cornea not higher than 1D
More comfortable to wear and tolerable longer
Hard to sterilize becoz of too many pores
Soft lens
Convergence present at what month
6 mos
Visual cortex
Bowmann’s area 17
Light rays are not focused at a pt but at 2 planes. One or both if which are not at same level as plane of retina.
Astigmatism
Drugs to be uses for cycloplegic refraction for persons >38 y/o
Holm atropine
Cyclopenyolate
Topicamide
Deviation due to paresis or paralysis of one or more EOM
Non-Comitant or paralytic heterotropia
Visual acuity at birth
6/180
Lower/Upper portion of optic radiation is involved in CV accident
Upper
Total refractive power
60 D
Tests for cn 5
Corneal reflex
Blinking reflected
Sensation of touch, pain and temp in lids
Another way is to use ___ which do not break and are of light weight but appears thicker and scratch easily
Plastic lens
Test for cn 3,4,6
Levator function test Duction test Vergence test Pupillary reaction Accom test Diplopia test
It’s vestibular division has connection to medial longitudinal fasciculus for control of conjugate eye movement in relation to movement of head
Cn8
Drugs to be uses for cycloplegic refraction for children <6 y/o
Atropine
Branch of cn7 that supplies the upper potion of OO
Frontal branch
Corneal lens becoz it is smaller than the diameter of cornea.
Corrects corneal astigmatism.
Cheaper and easier to clean
Needs build up period for tolerance
Hard lens
Decreased or loss of power of accom
Presbyopia
Measures angle do deviation in strabismus, 2 dissimilar targets are placed at end of 2 tubes and can be observed separately by 2eyes thru corresponding eyepiece
Amblyoscope
Astigmatism with no accompanying spherical correction
Simple astigmatism
Most common symptom of ametropia which is bilateral situated in frontal or temporal area, and most common in people with small RE.
Headache
Useful in decreasing illum becoz half of light rays are diverted under wards. Consists of 2 laminated lenses.
Polarizing lenses (Polaroid)
Indiv with ametropia complain of blurred vision which is improved with
Pinhole
Esotropia that occurs in 1 y/o, MR is recessed (weakened) or LR is Resected (strengthened)
Non-accommodative esotropia
Stimulation of sympathetic system induces pupillary dilation/constriction
Pupillary dilation
Binocular vision is not present at birth
True
Refractive error of ___ are physiologic variation
<5 D
Various nuclei are connected cn 6 to higher center responsible for various eye movements thru medial longitudinal fasciculus:
For vol conjugate movement
2nd frontal gurus
Visual acuity at 3 yr
6/6
Hard lens is worn only for
8-12hrs with comfort
Amt that accom can help
Latent ametropia
Where optic nerve fuse
Optic chiasm
Total amt of disparity between the length of eye and RO of eye if accom is suspended
Total ametropia
It is due to optical fatigue rather than excessive lighting
Glare
Corresponds to plane of pull of that particular ms
Primary action
One eye can not move in any direction without concomitant movement if the other. In order for both eyes to move in same direction, it will involve the action of at least one ms in each eye.
Yoke ms
Pis lateral oculomotor paralysis
Contralat intention tremors
Benedik’s syndrome
First branch of ophthalmic artery
Central retinal artery
Venous engorgement
Retinal hemorrhage
Hyperemic disk with blurring of margin
Hotdog catsup appearance
CRVO
Common cause of CRVO in young
Phlebitis
Posteriorly, retina converges towards the ____ to form intra ocular portion of _____
Posteriorly, retina converges towards the OPTIC DISK to form intra ocular portion of OPTIC NERVE
Photoreceptors which func at low level of illumination or night vision (scotopic vision).
Rods
Layer of retina where the axons of the ganglion cells converge toward posterior pole of the eye to eventually from the optic nerve.
Nerve fiber layer
Lipoidal infiltration of white streak at side of blood column is seen and called
Pipe stem sheathing (vascular sheathing)
Center of acute vision
Fovea centralis
Seeing flashes of light
Photopsia
Where does retinal detachment occur?
Between pigment epith and the rest of the retina, which has embryological basis.
In region of fovea, the bipolar cells and other elements of inner layer of retina are pushed to the sides, the axons and dendrites in outer plexiform layer take an oblique or tangential course. This unique portion of outer plexiform is called..
Nerve fiber layer of Henle
In arteriosclerosis, when the median streak completely covers the entire bld column, the artery is called
Copper wire artery
Rods and cones layer is composed of outer and inner segments. What segment can you find the light-sensitive photo chemicals?
Outer segment
Has transverse disk which contain the visual pigment concerned in photochemistry of visual process converting light energy into chemical energy of nerve impulse.
How many capillary networks are there in the retina? Where is It located?
Two. One in nerve fiber layer and one in inner nuclear layer.
They are closely interconnected.
Principal symptom of retinal patho
Visual disturbance
Layer of retina in which ganglion cells usually form a monocellular layer throughout most of the retina
Ganglion cell layer
Most common intraocular tumor
Retinoblastoma
As the retinal artery enters the eye, it loses its ____ , and the medial muscular coat becomes ____.
As the retinal artery enters the eye, it loses its INTERNAL ELASTIC LAMINA and the medial muscular coat becomes INCOMPLETE.
The retina gets its bld supply from 2 sources
choriocapillaries supply the outer layer
Retinal arteries supply the inner layer
Effect of iop is ultimately manifested in
Optic disk
Aqueous has access to the anterior chamber angle all the time because there is no ore existing ocular or systemic disease that can be tagged as causative agent. It is symptom-free chronic, slowly progressive condi.
Primary open angle glaucoma
The artery and vein have a common adventitial sheath at their crossings, an important factor in the production of AV crossing changes in what diseases?
Arteriosclerotic and hypertensive retinopathies
Cats eye reflex
Leucocoria
Retinal detachment due to disease process of retina or the vitreous and choroid
Secondary retinal detachment
In arteriosclerotic retinopathy, a Whitish plaque of lipid seen in the wall of retinal artery
Atherosclerosis
Stage of retinoblastoma with soapy white mass in retina
Intraocular stage
Retina artery is very much constricted Optic disc is pale Rest of eye ground is white (due to coag necrosis) Cherry red spot Box car appearance
Crao
In Glaucomatous stage of retinoblastoma, what is the only resor it save the life of the pt
Enucleation
Stage of retinoblastoma with tumor extending out of eyes into orbit via ocular emissaria or thru optic nerve
Extra ocular stage
Glaucoma asso with hereditary or familial disease are not always present at birth
True
The anterior or peripheral portion of the retina is marked by ____ where retina is transformed into nonpigmented epith of ciliary body
The anterior or peripheral portion of the retina is marked by ORA SERRATA where retina is transformed into nonpigmented epith of ciliary body
In what region does the bipolar cells and other elements of inner layer of retina are pushed to the sides, where the axons and dendrites in outer plexiform layer take an oblique or tangential course.
In region of fovea
Photoreceptors which func at high level of illumination or daytime vision (photopic vision).
Cones
Edema of macular region
Central serous retinopathy
Retinal capillaries contains ___ that are located in the basement membrane.
Mural cells
If pigment epith is derived from outer layer of optic cup, then the rest of the retina Comes from
Inner Layer
Glaucoma asso with hereditary disease, a syndrome of arachnodectyly, cardiac anomalies, lens subluxation
Marfan’s syndrome
Layer of retina which is composed of axons of bipolar cells and dendrites of ganglion cells.
Inner plexiform layer
The treatment of Secondary angle closure glaucoma is directed to ocular condition that gives rise to it
Principle of therapy is the same as primary angle closure type
Treatment of primary open angle glaucoma
Medical
Retinoblastoma metastasize to __ via
Long bone via hematogenous spread
Photopsia may be experienced in ___ which causes traction in the retina (Moore’s lightning streaks).
Vitreous detachment
Acute/chronic glaucoma:
Gradual closure of angle and gradual increase in iop, symptoms may be absent
Chronic glaucoma
Photopsia may be experienced in ___ where the retina is mechanically stimulated as it floats or moves in the vitreous.
Retinal detachment
The retina is firmly attached to 2 portions
Ora serrata
Optic disk
Large image
Macropsia
Treatment of infantile glaucoma
Surgical (goniotomy)
Disturbance to floe of protoplasm contributes to glaucoma
True
Rods/cones are concentrated in Fovea centralis
Cones
Photoreceptors for color vision
Cones
Increased iop in glaucoma is due to
Abnormal aqueous outflow
Rarely due to over production
Most rarel py due to nice venous back pressure
External limiting membrane is Formed by junctional attachment between..
membranes of Muller cells and the inner segment of photoreceptors
This is an early stage of silver wire artery where the artery is seen as a solid white cord with no bld column showing through.
Pipe stem sheathing
Layer of retina which constituted by the axons of photoreceptors and the connecting dendrites of bipolar cells
Outer flexiform layer
Elevated retina
Grayish retina
Retinal vessels appear constricted and darker
Retinal detachment
Retinal edema in hypertensive retinopathy is seen as shining reflex from the retinal surface not unlike a wet surface and is called
Retinal sheen
Innermost layer of the eye
Retina
Principle of management of primary angle closure glaucoma
Lower iop
Analgesic
Referral to ophthalmologist
Main cells in retinal periphery
Rods
Drugs used in primary open angle glaucoma
- Miotics - increase outflow
- Carbonic anhydrase inhibitors - decrease aqueous production
- Epinephrine - enhance exit of aqueous
This disease arises because if an inherited a atomic defect that causes a shallow anterior chamber
Primary angle closure glaucoma
Acute or chronic glaucoma:
Severe ocular pain, sudden diminution if vision, seeing haloes around light, ciliary injection, Lacrimation, pupillary dilation
Acute glaucoma
The pigment epith is composed of single layer of ____ cells! with micro villi projecting into the interspace between outer segments of rods and cones.
Polygonal cells
Most common symptom of retinal detachment
Photopsia
Distorted image
Metamorphopsia
Caused by disturbance in the alignments and position of the visual cells, esp macular area as in macular edema, central serous retinopathy or flat retinal detachment
Disturbance of image shape or size
Rods and cones layer is composed of outer and inner segments. What segment contains usual cyto and cytoplasmic organelles esp mito which amplifies the weak impulse into a transmitted current?
Inner segment
Which is connected to the outer by a constriction containing the cilia, which thought to transmit electrical impulse to the finely granular inner segment
Refers to impairment of vision at night or in dim illumination and is present mainly in disturbances of rod func as in pigmentary degeneration of retina and vit A deficiency
Nyctalopia
Glaucoma produces irreversible blindness
True
Common complication of CRVO
Glaucoma (3 mos after onset) has rubeosis iridis
Photoreceptors concerned with peripheral vision
Rods
Pigment epith is derived from
Outer layer of optic cup
Grading of severity in arteriosclerosis
- Slight widening of median reflex with slight compression
- More widening , with more marks of compression
- Copper wire artery
- Silver wire artery
Common cause of CRVO in elder
Endothelial proliferation
Treatment for crao
Dilators - paracenthesis, inhalation of co2 (carbogen)
Drugs - amyl nitrate inhalation, retrobulbar acetylcholine, prescoline
S&s of infantile glaucoma
Lacrimation Blepharospasm Photophobia Corneal enlargement Glaucomatous cuppping
Iop regarded as suspect for glaucoma
21mmHg
It is caused by any stimulus on the eye which results in only one retinal response, and that is seeing light.
Photopsia
Layer of retina which is a fenestrations membrane composed of terminal bars
External limiting membrane
Layer which is source of metabolic enzymes, as well as vit.A needed by visual cells, which is imp in the phagocytosis of degenerated fragments of outer segments.
Pigment epith
Closure of angle brought about by condi in eye that causes the iris to move towards the mesh work. (Eg exaggeration of pupillary block such as uveitis, lens dislocation, bulging hyaloid face)
Secondary angle closure glaucoma
Bld supply of retina
Central retinal artery and vein which enters the eye thru optic disk
In arteriosclerosis, when the sclerosis reaches the advance stage abs reflects back all the light falling on its surface, the artery is called
Silver wire artery
Layer of retina which is composed of the nuclei of the photoreceptors.
Outer nuclear layer
Retinal detachment that is always asso with break in retina
Primary retinal detachment
Visual disturbance may be manifested as..
Visual blurring Photopsia Sector visual field defect Disturbance of image shape or size Nyctalopia
2 sources of symptoms of glaucoma
Increased iop
Disturbance of optic nerve func
Layer of retina which consists if nuclei if several cells, namely bipolar cells, Muller’s cells, horizontal cells, and amacrine cells.
Inner nuclear layer
Layer of retina which is the cuticular derivative of Muller’s cells and serves to delineate the retina from the overlying vitreous.
Internal limiting membrane
Cells the serves as the storehouse of glucose in the form of glycogen
Muller’s cells
The retina is dependent on a continuous supply of ___ for its metabolism.
Glucose
Grading in hypertensive retinopathy
- Narrowing of arteries to 3/4 to 1/2 of corres vein with occasional focal constriction of terminal arterioles
- Narrowing of arteries to 1/2 to 1/3 of corres vein with several focal constriction of terminal arterioles
- Grade 2 + cotton wool exudates with flame shaped hemo
- Grade 3 + mild to mod edema of disk
Visual loss or impairment may involve (central/peripheral vision) if extra macular area (esp rods) is involved.
Peripheral vision
Visual loss or impairment may involve (central/peripheral vision) if macula is involved.
Central vision
Regulation of IOP by
Anterior segment of eye
Usual loos of arterial obstruction
Emboli from a cardiac thrombus
Stage of retinoblastoma with increased iop, ocular congestion nod corneal edema and vitreous filled with tumor mass
Glaucomatous stage
Glaucoma asso with hereditary disease, a syndrome of corneal Arcus (post embryotoxon), ectopia, polycoria, hypoplasia of anterior iris.
Axenfeld syndrome
Only non transparent portion of retina
Blood columns and pigment epithelium
Iop increased because aqueous could not flow to trabecular mesh work due to apposition of iris to the anterior chamber angle
Primary angle closure glaucoma
Layers of retina
(From outer to inner)
- Pigment epith
- Rods and cones
- External limiting membrane
- Outer nuclear layer
- Outer flexiform layer
- Inner nuclear layer
- Inner flexiform layer
- Ganglion cell layer
- Nerve fiber layer
- Internal limiting membrane
Some retinal condi which can produces sector visual field defect
Partial retinal detachment
Large retinal hemorrhage
Branch occlusion of retinal vessels
Actual loss of a part of the field of vision or a sensation of a curtain or a fog covering the involved portions of the field of vision
Sector visual field defect
Treatment of choice for primary angle closure glaucoma
Surgery
Small image
Micropsia
Endophthalmitis causative agent
Meningococcal neisseria
In management of contusion, hyphema is left alone
True. Unless glaucoma sets in
Adenovirus type responsible for pharyngoconjunctival fever
Adenovirus 3,4,7
In iris and ciliary body, the contusion results in
Hyphema
Anti inflammatory drug that Inhibit action of fibrinolysin
Salicylate
Used to treat corneal edema and bullous keratopathy
Dehydrating agents
Anticholinesterase cholinergic drugs
Physostigmine Neostigmine Diisopropyl fluorophosphate (DFP) Alkyl-phosphate Demercarium bromide
Dilute/concentrated acids produces coagulation necrosis
Concentrated acid
When blood sugar is highe, there is the tendency to be myopic/hyperopic
Myopic
Parasympathetic cholinergic drugs that dilates the retinal artery during CRAO
Acetylcholine
Hypersensitivity reaction to drugs like salicylates and is charac by generalized maculopapular rash, severe stomatitis, ans purulent conjunctivitis
EM, Steven Johnson syndrome
Common source of chemical injuries in the eye
Insecticide and aerosol spray
CONTRAINDICATION to intraocular surgery
Beta hemolytic strep
New formed blood vessels that extends to vitreous, fibrous tissue appears
Retinitis proliferans
Ophthalmia neonatorum, purulent discharge in adult and nongranulomatous uveitis causative agent
GONOCOCCAL neisseria
Foreign body in conj is removed by
Wiping it out with wet cotton pledget
Anti cholinergic or prasympatholytic drug use to treat Mydriasis without cycloplegia
Eucatropine
Dilute/concentrated acids produces slight pain, conj congestion and edema of lids, conj and cornea.
Dilute acids
Anti cholinergic or prasympatholytic drug substitute for atropine, has shorter duration
Scopolamine.
Treatment for measles
Vaccination
Drugs used in treatment of contusion which dilates the pupil with aim of removing the pupillary block
Atropine
Foreign body embedded in cornea is removed by
Spud or long hypodermic needle
The effects of radiation to eye parts according to their order of frequency
Lens Conj Cornea Uvea Retina Optic nerve
Contagious venereal disease which appears as vesicle or ulcer in the genitals. It has regional adenitis. May lead to parinauds ocular syndrome.
Lymphogranuloma venerum
Produces pallor of conj, pale fundus and pale tortuous retinal blood vessels
Anemia
Parasympathetic cholinergic drugs
Acetylcholine 1:1000
Metacholine 10-20%
Carbachol
Pilocarpine
Sympatomimetic adrenergic drug used to treat glaucoma in combi with pilocarpine
Epinephrine
Sympatomimetic adrenergic drug of choice for pupillary dilatation
Phenylephrine
Endocrine exophthalmos is not affected by many medical therapy and appears after thyroid surgery
True
Hordeolum/stye causative agent
Staph aureus
Vitreous hemorrhage are removed by
Vitrectomy
Parasympathetic cholinergic drug demonstration the hypersensitivity of the pupil to this drug in Adie’s syndrome
Metacholine
Adult type of chronic inflam and degenerative changes in the joints. The findings of subcutaneous nodules are characteristic and may appear similar to miliary TB
Rheumatoid arthritis
Retinal hemorrhage are left alone
True.
The early ocular changes due to diabetics are the results of
Osmotic changes
In primary lesion of hopes simplex , what is absolutely COntraindicated?
Steroids
Sub conjunctival hemorrhage should be diff with the hemorrhage by skull fracture. Which has bright red in color and anteriorly located?
Subconjunctival hemorrhage
Lid wounds are repaired ASAP to avoid contraction of ms and necrosis of skin at wound edged
Vertical wounds should be sutured eve in they are small for they cause traction and notching of lid.
Horizontal wounds are repaired if they are >1mm.
What is the effect of contusion in the eye if the eyelids are struck first
Ecchymoses or black eye
Anti cholinergic or prasympatholytic drugs
Atropine Scopolamine Homatropine Eucatropine Cyclopentolate Tropicamide
First sign of Lupus erythematosus
Lid edema
Then hyperkeratosis, seborrhea
Finally atrophy of skin
It produces dilation of conj and uveal arterioles, miosis and increased permeability of blood aqueous barrier
Parasympathetic cholinergic drugs
Para/sympa drugs only limited to glaucoma
Parasympathetic cholinergic drugs
Osmotic agent that is safe for diabetic pt
Isosorbide
Adenovirus type responsible for epidemic conjunctivitis
Adenovirus type 8
First step in management of foreign body
Locating the foreign body
Washing agents
Water
Normal saline solution (0.9%)
Boric acid (2-4%)
Drugs applied in conjunctival sac penetrate mainly thru the cornea by selective diffusion
Drugs having Low surface tension, high lipoid solubility ans rapid degree of electrolyte dissociation penetrate more.
Steroids should not be used for a long time
True. For they can suppress immunologic host response and may produce glaucoma
Adrenergic system acts on sympathetic nerve ending or destroys what enzyme
Amine oxidase
Steroids are not given in cases of intraocular viral or fungal infection
True
Vitamin that keeps the itergrity of epithelium of skin and mucous membrane.
Vit A
Dyes are used to stain the breaks in the continuity of epith of cornea and conjunctiva.
Sodium fluorescein 2% - green
Rose Bengal 1%
Methylene blue 2-5%
In acute stage of measles, there is non purulent type of conjunctivitis with red dots surrounding by white areas called
Koplic’s spot
Color identification of ophthalmic drugs: Antimicrobial Steroids Anesthetic Miotic Mydriatic
Antimicrobial-blue Steroids -white Anesthetic-yellow Miotic-green Mydriasis-red
Bam, yanes, ws, gremi, remy
Drugs used in treatment of contusion which constricts the pupil thus opening the anterior chamber
Pilocarpine
Steroid of choice
Methyl prednisolone
Stimulation and blockage of cholinergic system
Stimulation - miosis and increase accom
Blockage - Mydriasis and cycloplegia
Anti cholinergic or prasympatholytic drug used to treat post synechiae and cycloplegic refraction
Atropine
Pseudomem type of conjunctivitis causative agent
Beta-hemolytic strep
Parasympathetic cholinergic drug needed if there is pilocarpine tolerance
Carbachol
Treatment of choice for primary lesion of herpes simplex
Iododioxyuridine (IDU)
Used to treat open angle and aphakic glaucoma
Anticholinesterase cholinergic drugs
Management of chemical injuries
Neutralization
Virus that produces self limited conjunctivitis. The danger occurs if it attacks pregnant women during her first trimester.
Rubella
Produces vesicular Exenthema in eyelid, conj and cornea
Varicella -chicken pox
The most significant ocular manifestation of graves disease
Exophthalmos
In foreign body injury, the eye has to be patched for __ hrs to immobilize the lids so that the regeneration of epithelial defect will not be hindered by blinking
24hrs
Anticholinesterase cholinergic drug for myasthenia gravis that elevates the upper lid temporarily
Neostigmine
The type of toxoplasmosis disease accom by CNS involvement including calcification.
Congenital type
Utilized to lower the iOp in glaucoma tours eyes by decreasing the aqueous formation in ciliary body
Carbonic anhydrase inhibitors
Stimulation and blockage of adrenergic system
Stimulation - Mydriasis
Blockage - miosis
Importanct cause of corneal blindness in underdeveloped countries.
Rubeola (measles )
Osmotic agents
Urea
Mannitol
Glycerol
Isosorbide
New formed blood vessels on retina
Rubeosis iridis
Most frequent form of mechanical injury of the eye
Foreign bodies of the eye
Earliest sign of vit A deficiency
Bight blindness and prolonged dark adaptation
Systemic effects of parasympathetic cholinergic drugs
Hypotension
Vasodilation
Bronchospasm
Increase tone of GI and urinary ms
Contusion may cause deposition of pigment on the surface of anterior lens capsule appearing as a bron ring called
Vossius ring
Use to neutralize histamine or inhibit effects of inflammation
Corticosteroids
In contusion in retina, a milky white area appears at the macula and around the optic disc called
Berlin’s edema
Addison’s syndrome has no effect on vision.. Only hyper pigmentation of skin of lids, conj and uvea
True
Sympatomimetic adrenergic drugs
Epinephrine
Phenylephrine
Parasympathetic cholinergic drug used to treat accommodative esotropia
Pilocarpine
can inhibit vascularization, decrease capillary permeability and prevent immunological reactions
Steroids
Viruses that attacks the nerves tend to produce
Optic neuritis and EOM palsies
Sub conjunctival hemorrhage should be diff with the hemorrhage by skull fracture. Which has purplish in color and Posteriorly located?
Hemorrhage caused by skull fracture
Helpful in preventive vascularization of cornea
EDTA
Daily requirement of vitamin A
5000 IU
Cholinergic system acts on parasympathetic nerve ending or destroys what enzyme?
Cholinesterase
Anti cholinergic or prasympatholytic drug exclusively used to treat refraction
Cyclopentolate
L
The general color of fundus on polycythemia is
Dusky red or cyanotic
Treatment for endocrine exophthalmos
Orbital decompression
New formed blood vessels which later circle the macula
Retinitis circinata
Severe dehydration, sunken eyeball, bluish appearance of lids causative agent
Cholera vibrio
Viruses producing petechiae hemorrhage may manifest with
Subconj hemo and ecchymoses
The sign and symptoms are marked when the foreign body is on
Cornea because of rich nerve supply
An early indication of vit A deficient is the formation go greasy yellowish plaque in temporal conjunctiva called
Bitot’s spot
Parasympathetic cholinergic drug that is widely used for glaucoma. Produces incd permeability of trabecular mesh work and miosis.
Pilocarpine
Chronic vit A deficient sign
Dry mucous mem and tear secretion stops
