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Ophtha Notes Flashcards

1
Q

Hard exudate

A

Deep yellow with sharp margins, often circinate Diabetes, hypertension, von Hippel Lindau disease, radiation

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2
Q

Rhegmatogenous

A

with a retinal break, tear or hole associated with formation of a retinal periphery associated with peripheral retinal thinning of high myopia

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3
Q

inner blood retina barriers

A

attributed to the tight endothelial cell junctions of the retinal capillaries.

Any disturbance - leads to oozing of fluid and/or blood, as well as lipids and proteins from the retinal vascular tree

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4
Q
A

Soft Exudates

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5
Q

Retinal detchment

A

condition where retinal pigment epithelium is separated from the inner retinal layers, with accumulation of fluid in the subretinal space

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6
Q
A

keratoconus

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7
Q

Posterior portion of the uveal tract, located between the retina and the sclera

A

Choroid

Blood from the choroidal vessels drain via the FOUR VORTEX VEINS

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8
Q

fascia behind the the portion of the orbicularis muscle that lies between the orbital rim and the tarsus

A

Orbital septum

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9
Q

Condition wherein parallel light rays do not fall into a pinpoint focus on the retina

A

Ammetropia

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10
Q

lie at the junction of the peripheral cornea and the root of the iris SCHWALBE’s line: trabecular meshwork which overlies the schlemm’s canal and the scleral spur

A

Anterior chamber angle

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11
Q

Anti-glaucoma drug which decreases aqueous production acts on the epithelial cells of the

A

PARS plicata

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12
Q

fascial reflections that become continuous with the fascia of the muscles and the fused fascia sends out expansions to the surrounding structures and to the orbital bones

A

check ligaments

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13
Q

Lesion on the optic nerve

A

Central Scotoma

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14
Q

Thickened fold of bulbar conjunctiva at the inner canthus

A

Semilunar folds

corresponds to the nictittaing membrane

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15
Q

Dermoid choristoma

A

congenital

inferotemporal limbus smooth elevated, tan to fleshy color, round to oval solid mass embedded in the superficial cornea and sclera

dermoids are composed of fibrous tissue and hair with sebaceousglands that is convered with conjunctival epithelium

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16
Q

Choroidal capllary heamngioma

A

benign, isolated, round, well circumscribed reddish orange tumors under the retina, of varying sizes, u

sually discovered as an incidental finding during a routine eye examination.

TX: laser treatment, cryopexy, photodynamic therapy, external beam irradiation and transpupillary thermotherapy

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17
Q

Volume of orbit

A

30 cc in adults

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18
Q

First of the ten layers of the Retina Outermost

A

Retinal pigment epithelium

adjacent to the choriocapillaries of the CHOROID and is separated by the BRUCH’s MEMBRANE

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19
Q

Commonly known as nearsightedness..

focus at a point in front of the retina

A

Myopia

eyeball longer than average

Corneal curvature steeper than average

use DIVERGENT LENS (Negative or biconcave lens)

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20
Q

Corneal scars

A

Tan to white color formed after an inflammatory process when fibrosis sets

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21
Q

Fibers of the optic nerve

A

Visual fibers : 80% synapse in the lateral geniculate body of neurons whose axons terminate in the visual cortex of the occipital lobe

Pupillary fibers: 20%. bypass the geniculate body en route to the pretectal area

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22
Q
A

Central retinal artery occlusion

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23
Q

Amacrine cells

A

horizontal cells allow multiple photoreceptors to plug into a smaller number of bipolar and ganlion cells

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24
Q

Floaters (muscae volitantes)

A

black to gray spots and/or fibers that move about in the field of any vision of the patient.

commonly observed after the age of 45 -50 when vitreous liquefaction and vitreous collapse and or detachment have begun

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25
Q

Ciliary Body

A

consists of

2 zones

  • PARS PLICATA 2 mm wide ciliary processes arise 2 layers (internal non pigmented layer and the external pigmented layer)
  • PARS PLANA 4mm flattened posterior zone
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26
Q

Types of Astigmatism

A

Simple Myopic - One image on the retina, one image in front

Simple Hyperopic - one image on the retina, ome image behind the retina

Compound myopic - both images in front of the retina

Compound hyperopic - both images at the back of the retina

Mixed astigmatism - one image in front, one image at the back

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27
Q

curvature of the cornea of the lens is not the same in different meridians.

A

Astigmatism

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28
Q

5 layers of the cornea

A
  • Epithelium (5-6 layers of cell, continuous with the bulbar conjunctiva)
  • bowman’s membrane (clear acellular layer)
  • Stroma (90% of corneal thickness)
  • Descemet’s membrane (basal lamina of corneal epithelium)
  • Endothelium (single layer of cells, responsible for maintaining deturgescence of the cornea)
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29
Q

2 parts of conjunctiva

A

Palpebral - posterior surface of he eyelid and is adherent to the tarsus

Bulbar conjunctiva - loosely attached to the orbital septum in the fornices and is folded many times

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30
Q

Standard distance of the patient from the chart

A

20 ft or 6 meters

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31
Q

Arterial supply of the lacrimal gland and upper

A

lacrimal artery

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32
Q

Central Retinal Artery Occlusion

A

sudden painless loss of vison

Vison loss is sevre, and residual vision just after the episode is usally in the area of light perception to count fingers

Retina is very pale so that the usually darker macula becomes more prominent and is described as cherry red spot HOLLENHORST PLAQUE

treatment must be instituted within 5 minutes

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33
Q

Fundus fluorescein angiography

A

proedure that involves the injection of a dye, sodium fluorescein, into the antecubital vein.

outlines the retinal and choroidal vascular system

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34
Q

has an adenoid layer and fibrous layer

A

conjunctival stroma

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35
Q

Cataract

A

any opacity in the lens that precludes optimal vision.

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36
Q

Pterygium

A

conjunctival disorde

r benign conjunctival lesion that behaves malignantly

wing shaped or triangular fold of conjucntiva anf fibrovascular tissue with its apex invading the superficial cornea

Strong correlation with UV exposure

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37
Q

Arterial supply of the sclera

A

Muscular branches to the muscles contnue to form the anterior ciliary arteries

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38
Q

Age related Macular degeneration

A

over 50 years of age

2 types: non -Neovascular and vascular

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39
Q

Inferior Oblique

A

O: Behind Lacrimal Fossa

I: Posterior to the equator in infero-temporal quadrant

A: Extorsion, elevation, abduction

N: III

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40
Q

Preferred method for IOP mesurement with patients with corneal scar

A

Indentation tonometry affected by scleral rigidity

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41
Q

Bitot Spots

A

Keratinization of areas of the conjunctiva

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42
Q

Nerve supply to the lacrimal glands is by

A

Lacrimal nerve

great superficial petrosal nerve

Sympathetic nerve

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43
Q

hallmark of proliferative stage

A

growth of abnormal vessels either on the disc or on the retina

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44
Q

fibrous membrane covering the globe from the limbus to the optic nerve.

A

Tenon’s capsule

Tennon’s capsule and episclera are fused together

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45
Q

flat surface with a central opening.

A

Iris

2 pigmented posterior layers of the iris represent anterior extensions of the neuroretina and the retinal pigment epithelium

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46
Q

Superior Rectus

A

O: AOZ

I: 7.7 mm from superior limbus

A: Elevation, intorsion, Adduction

N: III

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47
Q

Posterior subcapsular cataracts

A

affect the region near the central posterior capsule

begin in the center, they usually cause early visual symptoms in the form of night time glare/haloes around the lights and poor vision under bright illumination

more commonly associated with diabetes, trauma, corticosteroid use, inflammation, and exposure to ionizing radiation

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48
Q

Funch’s Endothelial dystrophy

A

after age of 50

Females> males

abnormally high rate of endothelial cell loss

initially present with central corneal guttata.

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49
Q
A

Corneal staining due to heme

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50
Q

Most common cause of cataract

A

Aging

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51
Q
A
  • A = Fungal keratitis
  • B = Bacterial Keratitis
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52
Q
A

PDR with retinal hemorrhages and extensive fibrovascular membranes (white arrows) with vitreoretinal traction

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53
Q

Red Anomaly

A

Protanomalous

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54
Q
A

Toxoplasmosis scar

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55
Q

Cataracts are best viewed via

A

slit lamp biomicroscope

visualization of the layers

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56
Q
A

Hard exudates

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57
Q

Most common type of cataract

A

Nuclear cataract

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58
Q

Indocyanine Green Angiography

A

similar to FA but uses indocyanine green dye instead of sodium fluorescein

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59
Q
A

Blot Hemmorhages

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60
Q

Bleeding from superficial retinal vessels on a fibrovascular stalk extending into the vitreous Diabetes, hypertension, trauma

A

Vitreous hemorrhages

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61
Q

Inferior Rectus

A

O: AOZ

I: 6.5 mm from the inferior limbus

A: Depression, Extorsion, Adduction

N: III

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62
Q

Neovascular type ARMD

A

choroidal neovascular membrane grows under the retina and causes scarring and extensive damage of the retina above it

causes sudden onset of central visual problems such as blurry vision, metamorphosia and scotomas

Management: thermal laser treatment to the abnormal vascular complex (extrafoveal) Intravitreal injections of anti vascular endothelial growth factors (subfoveal)

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63
Q

Bleeding from superficial pre-capillary arterioles, small veins Hypertension, retinal vein occlusion, blood dyscrasia, trauma

A

Flame hemorrhages

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64
Q

Bedside examination most useful for evaluating and prognosticating catracts

A

Swinging flashlight test

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65
Q

Dot hemorrhages

A

Bleeding from capillaries Diabetes

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66
Q
A

Retinitis pigmentosa

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67
Q

Basic principles of retinal reattachment surgery

A
  1. find the break
  2. close the break
  3. seal the retinal breaks
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68
Q
A

PDR high risk with pre retinal hemorrhages (white arrows, NVDs (black), NVEs (yellow)

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69
Q
A

Retinal detachment

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70
Q

biconvex, avascular clear structure which is 4mm thick and 9mm in diameter. consist of 65% water and 35% protein

A

LENS

anterior to the lens is the AQUEOUS

posterior : VITREOUS

semipermeable membrane (water and electrolytes)

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71
Q

Vogt-koyanagi- harada syndrome

A

rare and unusual form of diffuse granulomatous uveitis

bilateral disease

sudden onset of blurry vision, photophobia, perhaps floaters, sometimes with headache, neck stiffness and/or tinnitus yellow white patches

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72
Q

Cortical cataract

A

affect the outermost and youngest layers of the lens

Lens hydration changes produce clefts in a radial pattern around the equatorial region

This can result in glare, seeing haloes around the lights and monocular diplopia

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73
Q
A

Cataract

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74
Q

condition wherein parallel light rays fall into a pinpoint focus on the retina

A

Emmetropia

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75
Q
A

Central retinal vein occlusion

76
Q

keratomalacia

A

Diffuse corneal necrosis

77
Q

Clear, avascular body, coprising 2/3 of the volume and weight of the eye.

A

Vitreous

Hyaloid membrane: outer surface of the vitreous is in contact with the posterior lens capsule

78
Q
79
Q

Lateral rectus

A

O: AOZ

I: 6.9 mm from lateral limbus

A: Abduction

N: VI

80
Q

Superior Oblique

A

O: orbit apex above Annulus of Zinn

I: Posterior Equator at superotemporal quadrant

A: Intorsion, depression, Abduction

N: IV

81
Q

Acid chemical Burn

A

denaturation and precipitation of the collagen and lead to scar formation

82
Q

Soft exudate

A

Fluffy gray-white; usually near optic disc Hypertension, diabetes, connective tissue disease, HIV

83
Q

Blue Anomaly

A

Trianomalous

84
Q

Vitreous syneresis

A

degeneration of the vitreous gel (liquefaction of the gel) with eventual detachment of the vitreous from the retina

45-50 years old

85
Q

Endothelial dystrophy

A

infants with bilateral diffuse corneal haziness and ground glass appearance, thickened cornea with normal corneal diameter and eye pressure and absence of birth trauma

86
Q

consists of 2-5 layers of stratified columnar epithelial cells. the superficial part consists of mucous secreting goblet cells basal cells are deeper and may contain pigments near the limbus

A

Conjunctival epithelium

87
Q

fibrous outer layer of the eye consisting mainly of collagen thinniest at the insertion of the recti muscles (0.3mm)

88
Q
A

Corneal and conjunctival neoplasia

89
Q

HIV retinopathy

A

may affect the eye directly

CMV retinitis, toxoplasmosis, candida retinitis, Pneumocystitis carinii

90
Q

Corresponds to the termination of the corneal endothelium.

A

Schwalbe’s line

91
Q

Optical coherence Tomography

A

Scan of the retina

92
Q

Arterial supply of the ciliary body

A

Long posterior ciliary arteries 2 forms the major arterial circle of the iris

93
Q

Medial Rectus

A

O: Annulus of Zinn

I: 5.5 mm from medial limbus

A: Adduction

N: III

94
Q

Amsler grid

A

a black and white card with a fine grid and a fixation point use to detect and quantify central visual changes

95
Q

Corneal intraepithelial neoplasia

A

translucent, gray, or frosted epithelial sheet starting from the limbus and extending onto the cornea with fimbriated or scalloped borders

Blurring of vision will occur once the growing epithelial sheet reaches the central area

96
Q

Peter’s anomaly

A

central corneal leukoma with defects in the posterior stroma.

97
Q
A

Calcific band keratopathy

98
Q

Corneal trauma

A

Mechanical and chemical require surgical treatment

99
Q
A

Exposure Keratitis

100
Q

MAchine that takes IOP readings by calculating the maount of corneal flattening by the fixed air puff pressure

A

Air puff noncontact tonometer

101
Q

located approximately 2.5 disc diameters temporal to the optic disc. There are no blood vessels in the area and it appears darker than the surrounding retina

A

Macular area

102
Q

Green anomaly

A

Deuteranomalous

103
Q

Lesion on the optic chiasm

A

Bitemporal Hemianopsia

104
Q

Lesion on the opic radiation (Parietal)

A

“pie in the floor”

105
Q

provides quantitative method for determination of IOP by measuring the amount of pressure required to indent the cornea with the use of SCHIOTZ TONOMETER

A

Indentation tonometry

106
Q
108
Q
A

NPDR with hard exudates (black arrows), microaneurysms (red arrows), dot and blot hemorrhages (yellow arrows), Soft exudates (white arrows)

109
Q

mechanism throgh which the ye is able to increase its dioptic power allowing it to focus on a nearby object

A

Accomodation

110
Q

Two stages of Diabetic Retinopathy

A

Non proliferative

Proliferative

111
Q

thin transparent mucous membrane covering the globe anteriorly

A

Conjunctiva

112
Q

Metastatic Choroidal tumor

A

Metastatic tumors to the uveal tract are the most common intraocular malignancies.

113
Q

Only treatment option for cataract

114
Q

unit of measurement of lens power

A

Diopter

D=1/f

115
Q

The tennon’s capsule fuses with the fascia of the inferior rectus and inferior oblique to form…..

A

suspensory ligament of Lockwood

116
Q
117
Q

Thin, semi transparent, multilayered sheet of neural tissue that lines the inner wall of the posterior 2/3 of the eye

A

Retina

Extends anteriorly as the ora serrata

118
Q

Layer of the retina that receives its oxygen supply from the choriocapillaris is the

A

photoreceptors

119
Q

10 layers of the retina

A
  • Internal Limiting Membrane
  • Nerve fiber layer
  • Ganlion cell layer
  • Inner plexiform layer
  • Inner nuclear layer (bipolar cell bodies)
  • Outer plexiform layer
  • Outer nuclear layer
  • External limiting memberane
  • Photoreceptor layer
  • Retinal pigment epithelium
120
Q

Lens Anatomy

121
Q

Arterial supply of the retina

A

Central retinal artery

122
Q
A

Dermoid choristoma

123
Q

total converging power of the eye

A

60 diopters

cornea - +40

Lens - +20

124
Q

Normal cup to disc ratio

125
Q

Bleeding from large superficial retinal veins into the space between the retina and vitreous; sometimes this break into the vitreous cavity Trauma, blood dyscrasia, sudden increase in intracranial pressure

A

Boat hemorrhages

126
Q

Blood retina barriers

A

Inner Blood Retina Barrier

Outer Blood Retina BArrier

127
Q

Central retinal vein occlusion

A

Ischemic vs non-ischemic (stasis retinopathy)

ISCHEMIC

  • the fundus is covered with multiple splinter and bot hemorrhages
  • Cotton wool
  • Very poor vision
  • Tx: retinal photocoagulation

NONISCHEMIC

  • fewer retinal hemorrhages
  • no soft exudates
  • definite retinal venous tortousity and dilation
  • Tx; no definite ocular treatment but the primary cause must be identified
128
Q

Esotropia

A

Inward misalignment

129
Q

Arterial suuply of the choroid and part of the optic nerve

A

Short posterior ciliary arteries

130
Q

Hypotropia

A

downard misalignment

131
Q

composed of the iris, ciliary body, and the choroid

A

Uveal tract

132
Q

Main functions of the cornea

A

Transmission of light

Refraction of Light

133
Q

Toxic keratitis

A

microtrauma to the corneal surface epithelium scondary to contact with chemicals or topical medications

134
Q

Near visual acuity should be performed only for patients (age)

A

35 years old

135
Q

Muller cells

A

structural cells of the retina

136
Q
A
  • A = Corneal scar (typical)
  • B = hypertrophic corneal scar
137
Q

Retinitis Pigmentosa

A

family of heredo-degenerative disease characterized by progressive degeneration of the rods and cones. migration of pigment epithelial cells into the retina

Sx: Night blindness or nyctalopia for most cases of type I, progressive contraction of peripheral visual fields, blurring of vison in some cases, development of cataracts

Usually bilateral disease

138
Q

Infection, which causes inflammtion of the yellids and periorbital structures

A

preseptal cellulitis

139
Q

Alkali chemical Burn

A

corneal destruction is more severe since it causes corneal necrosis and melting due to its ability to penetrate deeply into the cornea

140
Q

Drusen

A

Clusters of yellow orange spots, usually centered aound the fovea

Age related MAcular degenreration

141
Q

Loss of focusing or accomodative power of the human lens

A

Presbyopia around 40 years of age

142
Q

Arterial supply arteries to both eyelids

A

Medial palpebral arteries

143
Q

normal pupil size

144
Q

Arterial supply of the fovea

A

choriocapillaries

susceptible to irreparable damage when the macula is detached

145
Q

Causes of corneal scars

A

Mircrobial keratitis

Corneal Trauma

Exposure Keratopathy

Lid margin and lash disorders

Congenital corneal scars

146
Q

Flashes (photosopsias)

A

caused by retinal problems

described as arcuate lightning like streaks of bright light in the periphery noted with or without eye and/or head movements

147
Q

Layers of the eyelid

A

Skin

Orbicularis oculi muscle

Areolar tissue

Tarsal Plates — main support of the eyelids

Palpebral conjunctiva

148
Q

Phacoemulsification

A

form of ECCE

utilizes an ultasonic probe to break up the cataract into smaller pieces which can be removed by aspiration

149
Q

Laser MArks

A

clusters of yellow white spots, usually uniform in size and regularly distributed in entire retina or around macular area Post retinal photocoagulation

150
Q

Herpes simplex virus

A

commonly affect the trigeminal ganglion which is the main source of sensosry nerve supply to the cornea.

the cornea exhibits hypoesthesia at the ulcer site

151
Q

Standard near vision chart

A

14 inches or 35 cm

152
Q

Exotropia

A

Outward misalignment

153
Q

Rate of production of the aqueous

A

2.5uL/min

subject to diurnal variation

154
Q

Ciliary muscle fibers

A

CIRCULAR FIBERS: contraction and relaxation of the zonular fibers that alters the capsule of the lens

LONGITUDINAL FIBERS: insert to the trabecular meshwork, influencing its pore size RADIAL FIBERS

155
Q

commonly known as farsightedness… focus at point behind the retina

A

Hyperopia

Eyeball is shorter than average

Corneal curvature is flatter

use CONVERGENT LENS (positive or biconvex lens)

156
Q

Lipid Keratopathy

A

seen in vascularized corneal scars of various etiologies Invasion of blood vessels into the cornea will lead to leakage and eventual deposition of glycoproteins, cholesterol and neutral fat into the cornea.

Yellow or cream colored lacated at the corneal stromal layer

157
Q

NON-Neovascular type ARMD

A

more common and visual loss is not as severe.

Accumulation of cellular debris and formation of “drusen” under the retina.

There is accompanying atrophy of the retinal pigment epithelium.

causes gradual painless detrioration of central vision

158
Q
A

Leukocoria

159
Q

Normal IOP

A

10 - 21 mmHg

and the difference in IOP between 2 eyes does not exceed 2 mmHg

160
Q

Vitamin A deficiency

A

Xerophthalmia

Prolonged Vit. A deficiency can lead to external eye involvement including xerosis, metaplastic keratinization of areas of the conjunctiva (Bitot spots)

161
Q

Mircobial keratitis

A

infections of the cornea

corneal tissue necrosis,

melting and rupture

Natural course of the disease: redness and other symptoms will disappear except for blurring of vision

162
Q

Exposure keratopathy

A

cornea is prone to dessication exposed cornea

163
Q

Bleeding from choroidal vessels under the fovea Age related macular degeneration

A

Submacular/foveal hemorrhage

164
Q

Orbital walls

A

Roof: frontal bone, lesser wing of the sphenoid bone

Lateral wall: greater wing of the sphenoid bone, zygomatic

Floor: maxillary bone, zygomatic bone, palatine bone

Medial bone: ethmoid bone , lacrimal bone, frontal bone, maxillary bone

165
Q

Modified sweat glands; ipen in a row near the base of the eyelashes

A

Gland of Moll

166
Q

Corneal edema

A

corneal epithelium is the single most imporatant structure of the cornea when cell density dips below a critical level, the direction of flow of water is reversed and the cornea will retain water and swell like a sponge

167
Q

Causes of corneal edema

A

Endothelial dystrophy

surgical trauma

Increased IOP

168
Q

Lesion on the Optic Radiation (temporal)

A

“pie in the sky”

169
Q

Ocular B scan Ultrasonography

A

useful tool to evaluate the anatomic relationships among the VITREOUS, RETINA, and CHOROID

170
Q

Axons comprising the optic nerve come from which cells in the retina?

A

Ganglion cells

171
Q
A

Congenital hereditary endothelial dystrophy

172
Q

Hypertropia

A

upward displacement

173
Q

Modified sebaceous glands; open onto hair follicles at the base of eyelashes

A

Glands of Zeis

174
Q

Calcified Band Keratopathy

A

seen in eyes with chronic inflammation like anterior uveitis and in patients with HIGH SERUM CALCIUM and disorders in phosphate metabolism

Calcium hydroxyapatite particles deposit at the Bowman’s layer

175
Q

Type of cataract surgery that will routinely require aphakic lenses for visual correction

176
Q

considered as gold standard of IOP determination

A

Applanation

177
Q

Corneal staining

A

Hyphema (blood in the anterior chamber)

178
Q

Synkinetic triad

A

Accomodation covergence miosis

179
Q

clear fluid that fills the anterior and posterior chambers of the eye.

Produced by the ciliary epithelium

A

AQUEOUS

230 uL

180
Q

Tonometer used in Applanation tonometry

A

Goldman Applanation Tonometer

cannot be used with patients with corneal abnormalities

181
Q

Lesion on the occipital lobe

A

Homonymous Hemianopia

182
Q

Outer blood Retina barriers

A

found in the RPE zonula occludens

keep the RPE leak proof form the highly vascular choriocapillaries

183
Q

Lesion on the temporal optic tract

A

Homonymous hemianopsia

184
Q

Keratoconus

A

central or paracentral cornea undergoes progressive thinning and bulging

185
Q

is a transparent tissue inserted at the limbus.

A

Cornea

Thicker at the periphery (0.65mm) center (0.52,,) h

oriontal diameter 11. 75 cm vertical diamter 10. 6mm

high yield concepts (21 decks)

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