Ophthalmic Patient Services and Education

Question 1

A patient who has an upper blepharoplasty has been treated for:
A. chalazion
B. epicanthal folds
C. dermatochalasis
D. brow ptosis

Answer 1

C
An upper blepharoplasty (“lid lift”) is the procedure used to treat dermatochalasis or redundant skin of the eyelids.

Question 2

Ptosis surgery is done to repair which of the following?
A. strabismus
B. drooping upper lid
C. lax lower lid
D. redundant skin and fat

Answer 2

B
Ptosis is a drooping upper lid

Question 3

The procedure for removing growth from the eyelid is:
A. excision
B. incision
C. decompression
D. biopsy

Answer 3

A
A procedure to remove a growth or other tissue is an excision. An incision is cutting into, but not necessarily removing, anything. A biopsy is when tissue is removed and sent to a lab for identification. A biopsy might be done once tissue us excised.

Question 4

The most common surgical treatment for a chalazion is:
A. cautery
B. electrolysis
C. incise and drain
D. probe and irrigate

Answer 4

C
A chalazion is often incised (cut into) and drained. Although not mentioned here, curettage may also be preformed, where the exposed tissue is scrapped.

Question 5

A patient wants to have an upper blepharoplasty to improve his looks. This type od surgery is termed:
A. functional
B. cosmetic
C. mandatory
D. sight-threatening

Answer 5

B
Surgery to improve appearance is cosmetic. Insurance is not likely to pay for it.

Question 6

The main purpose of a biopsy is to:
A. determine the type of lesion
B. determine the effectiveness of surgery
C. determine the expected outcome of surgery
D. identify malingerers

Answer 6

A
In a biopsy, tissue is sent to a lab for identification. Usually, the concern is whether or not the tissue is malignant (cancerous).

Question 7

The surgical procedure where skin or other tissue is transplanted from one part of the body to another is a(n):
A. flap
B. incision
C. graft
D. implant

Answer 7

C
Removing tissue (such as skin) from one part of the body and transplanting it onto another area is a graft. (Note: when a flap is performed , the tissue to be transplanted is not totally removed, but left partially attached and rotated to cover the adjacent area needing repair.)

Question 8

The surgery to fix an in-turned eyelid is:
A. epilation
B. frontalis sling
C. blepharoplasty
D. entropion repair

Answer 8

D
An inward-turned eyelid is called an entropion; thus, the surgery is an entropion repair.

Question 9

The surgery to fix and out-turned eyelid is:
A. ptosis repair
B. trichiasis repair
C. ectropion repair
D. iridotomy

Answer 9

An outward-turned eyelid is called an ectropion, so this surgery is an ectropion repair.

Question 10

When repairing a lower lid laceration in the area of the punctum, tissue alignment is especially critical because:
A. the lacrimal drainage system is involved
B. the tear- producing ducts are involved
C. infection may set in
D. eyelash alignment may be affected

Answer 10

A
If a laceration involves the lower lid, next to the nose, the tear drainage system is involved. Permanent tearing may result if the drainage ducts are not properly aligned.

Question 11

An infant with a blocked nasolacrimal duct might initially need which of the following procedures?
A. dacryocystorhinostomy
B. removal of the tear gland
C. punctal dilation
D. probe and irrigation

Answer 11

D
During fetal development, there is a membrane covering the nasolacrimal duct in the tear drainage system. This membrane usually disappears before birth, but sometimes remains. In this case tears do not drain properly, an an infection can easily develop. The treatment is to open the membrane with a probe (thin wire) and then flush the drainage system with saline.

Question 12

A patient with dry eyes might have which of the following procedures
A. lacrimectomy
B. cyclocryo
C. punctal occlusion
D. punctal dilation

Answer 12

C
Punctal occlusion is sometimes used to prevent tears from draining off the eye’s surface.

Question 13

The grafting of corneal tissue from one human eye to another is a(n):
A. enucleation
B. keratoplasty
C. dacryocystorhinostomy
D. corneal topography

Answer 13

B
Another name for a corneal graft or transplant is keratoplasty.

Question 14

Each of the following might be associated with a corneal transplant except:
A. follow-up radiation treatment
B. tissue rejection
C. irregular astigmatism
D. 12-month recovery time

Answer 14

A
Radiation is not used with a corneal transplant.

Question 15

Which of the following might need to be surgically removed because it is growing across the cornea?
A. pingueculum
B. punctal plug
C. pterygium
D. xanthelasma

Answer 15

C
A pterygium is a piece of fleshy tissue that grows from the conjunctiva onto the cornea. An “active” pterygium continues to grow and may need to be removed before it gets to the center and obscures vision.

Question 16

Recurrent corneal erosion might be treated by:
A. corneal scraping
B. punctal occlusion
C. enucleation
D. corneal transplant

Answer 16

A
In the case of recurrent corneal erosion, the eroded area is carefully scraped. The idea is to create a smooth surface so the cornea will be able to heal normally.

Question 17

Surgery that is performed in order to correct hyperopia, myopia, and/or astigmatism is classified as:
A. amniotic membrane transplant
B. refractive surgery
C. corneal transplant
D. corneal endothelial correction

Answer 17

B
Logically, refractive errors are corrected using refractive surgery. Technically, any surgery that purposely alters the eye’s refractive status could be considered refractive surgery, making cataract extraction with intraocular lens implant the most-performed refractive surgery.

Question 18

A popular technique for correcting refractive errors using laser technology is:
A. laser-assisted in situ keratomileusis (LASIK)
B. radial keratotomy (RK)
C. astigmatic keratotomy (AK)
D. corneal implants

Answer 18

A
RK and AK are performed with blades, not laser. Corneal implants are done by conventional surgery.

Question 19

Which of the following refractive surgeries does not involve creating a corneal flap?
A. epi-LASIK
B. photorefractive keratotomy (PRK)
C. laser-assisted subepithelial Keratomileusis (LASEK)
D. LASIK

Answer 19

B
PRK involves removing the corneal epithelium (compared to creating a flap that is later replaced) and shaping the underlying corneal layer.

Question 20

Which laser is most commonly used in refractive surgery?
A. yttrium-aluminum-garnet (YAG)
B. argon
C. krypton
D. excimer

Answer 20

D
The excimer laser is used in refractive surgery. The YAG is a cutting laser, used for capsulotomy, adhesions, and iridotomy. The argon and krypton lasers are used in retinal vascular disease and in glaucoma procedures.

Question 21

Anesthesia for laser refractive surgery is usually:
A. local
B. general
C. topical
D. not needed

Answer 21

C
Topical anesthesia is used for refractive surgery.

Question 22

A person with esotropia might have what kind of surgery?
A. trabeculectomy
B. recession and resection
C. blepharoplasty
D. ptosis repair

Answer 22

B
In strabismus (esotropia, exotropia), the condition is often corrected by moving the location where the extraocular muscles attach to the eye and/or shortening a muscle. One muscle is recessed (its insertion moved farther back on the eyeball) and the other resected (part of it removed, making it shorter).

Question 23

The purpose of extraocular muscle (EOM) surgery as a child might include all of the following except:
A. prevention/resolution of amblyopia
B. cosmesis
C. correction of anisometropia
D. establish stereo vision

Answer 23

C
Anisometropia is a refractive problem where the refractive difference between the two eyes is 2.00 D or more. Strabismus surgery cannot change this; it must be resolved with optical correction. It is generally recommended that EOM surgery be done prior to a child’s entering kindergarten so that the “crossed eyes’ are no longer noticed (ex. for cosmetic reasons). The main hope, however, is that by aligning the eyes, they will quickly learn to “lock” together, resulting in stereo vision. This, in turn, can help prevent or resolve amblyopia.

Question 24

A cataract is a:
A. growth on the lens
B. clouding of the cornea
C. lens opacity
D. growth on the retina

Answer 24

C
By definition, a cataract is an opacity of the crystalline lens; it is not a growth.

Question 25

Symptoms of cataract include:
A. halos
B. floaters
C. flashes
D. foreign-body sensation

Answer 25

A
Light entering an eye with a cataract is scattered and may result in halos around lights because the light is broken into its component colors.

Question 26

Symptoms of cataract include:
A. becoming more nearsighted
B. becoming more farsighted
C. early presbyopia
D. discharge

Answer 26

A
As the lens opacity gets denser, the eye generally becomes more nearsighted or myopic. This can even happen in a farsighted/hyperopic eye and is known as a myopic shift. A person who needed glasses to read may now find he or she no longer needs them. This phenomenon is known as “second sight” or the “honeymoon” stage of cataracts.

Question 27

Symptoms of cataracts include:
A. ghost image
B. vertical diplopia
C. stabbing pains
D. lid twitch

Answer 27

A
See answer 25. The scattered light can cause objects to appear doubled, although “ghost image” is usually a better description.

Question 28

Symptoms of cataracts include:
A. tearing
B. ptosis
C. increased contrast sensitivity
D. change in color vision

Answer 28

D
Cataracts tend to cause a yellowing to a person’s color vision. Often, after cataract surgery, a patient will notice that the colors are more vivid.

Question 29

Symptoms of cataracts include:
A. granulated eyelids
B. looking through a fog
C. dull ache
D. pressure sensation

Answer 29

B
A cataract may cause a general haze to the vision, as if looking through waxed paper.

Question 30

The most common cause of cataract is:
A. smoking
B. aging
C. hypertension
D. eye strain

Answer 30

B
It is current theory that every person will get cataracts if he or she lives long enough. It just may be that mine may be ready to be removed when I am 57 (which I am not yet!), and you may be 91 and not need yours removed yet.

Question 31

Cataracts can bbe caused by all of the following except:
A. exposure to ultraviolet light
B. injury
C. open-angle glaucoma
D. diabetes

Answer 31

C
Having open-angle glaucoma does not predispose one to cataracts.

Question 32

A cataract that occurs due to some other condition or medication is known as:
A. secondary
B. subcapsular
C. congenital
D. Lenticular

Answer 32

A
A secondary cataract is caused by something else, such as trauma (including ultraviolet light), disease (ex. diabetes), or medication (ex. steroids)

Question 33

Current, accepted treatment of a cataract is:
A. “eye vitamins”
B. laser ablation
C. homeopathic eye drops
D. surgical extraction

Answer 33

D
Surgical extraction is the only current method of treating cataracts. Generally, a small opening is made in the eye just at the limbus. The cataract is broken into pieces using ultrasound, and the pieces are drawn out with suction. A clear plastic lens implant is then put in the place of the crystalline lens that was removed. Stitches are generally not needed.

Question 34

Your patient says his neighbor had her cataracts removed with laser and wants to know if his will be taken off in the same way. You tell him:
A. “Yes, we only use the latest technology.”
B. “No, she’s probably referring to the way we use ultrasound to break the cataract into tiny pieces. It’s not actually a laser.”
C. “Yes, it’s called the YAG laser.”
D. “No, she doesn’t know what she’s talking about.”

Answer 34

B
Because laser is used to treat postoperative capsule opacity, people often think that the cataract is removed that way as well. Answer d is not recommended; you can educate that patient without implying that someone is ignorant! (By the way, the length of answer b should have clued you in that is was probably the correct answer!)

Question 35

The vision a patient may have after cataract surgery can be estimated with:
A. potential acuity meter (PAM; Marco Technologies Inc, Jacksonville, FL)
B. brightness acuity tester (BAT)
C. pinhole
D. accurate refractometry

Answer 35

A
A PAM is used to estimate what vision will be once the cataract is removed. For other questions regarding the BAT, see Chapter 16, the section titled Glare Testing.

Question 36

Postoperative cataract surgery vision might not be substantially improved in a patient with:
A. ptosis
B. small pupils
C. macular degeneration
D. strabismus

Answer 36

C
A patient who has macular degeneration may not notice much improvement after cataract surgery; the PAM may be able to help predict this. Explain it to the patient like this: If you have a great camera but the film is not good, you will not get a good picture regardless of the quality of the lens. The eye is like that. The lens is the implant, and the film is the retina. If the retina is diseased, having cataract surgery with a lens implant will not help much. (Exception: Sometimes, cataract surgery is performed for a patient with macular degeneration to improve his or her “getting around” vision, rather than the central vision.)

Question 37

A preoperative B-scan might be required in which cataract patient?
A. diabetic retinopathy
B. macular degeneration
C. extremely dense cataract
D. pterygium

Answer 37

C
A dense cataract makes it difficult for the physician to see inside the eye to judge the health of the retina. A B-scan ultrasound might be done to make sure that the retina is not detached not has any gross abnormality that might prevent vision improvement if the cataract was removed.

Question 38

Prior to cataract surgery, an A-scan is used to:
A. measure the length of the eye
B. establish postoperative vision
C. evaluated the corneal endothelium
D. evaluate retinal health

Answer 38

A
The A-scan ultrasound is used to measure the axial length of the eye prior to cataract surgery. It is one of several variables in determining the power of an IOL implant to be used once the cataract has been removed (see Chapter 16, the section titled IOL Power Calculation).

Question 39

Specular microscopy (“cell count”) might be needed prior to cataract surgery if the patient has:
A. corneal dystrophy
B. Grave’s disease
C. astigmatism
D. dry eye

Answer 39

A
Cataract surgery invariably “bumps” the single-cell-layered corneal endothelium, which is already diseased in corneal dystrophy. Specular microscopy (also known as a cell count) may be done to evaluate the corneal endothelium prior to attempting cataract surgery to make sure it is healthy enough to withstand the operation.

Question 40

Which gives the most accurate idea of a cataract patient’s visual disability?
A. pinhole vision
B. standard Snellen vision chart
C. PAM
D. BAT

Answer 40

D
Of the tests listed, the BAT gives the best evaluation of what a patient with cataracts actually sees now. The results can indicate a level of disability that is not evident on testing with the regular Snellen eye chart. Cataracts that are dense in the center can often cause vision to worsen in bright light because the pupil constricts. The BAT gives an actual measurement of how much worse the vision is in such bright conditions.

Question 41

A cataract is often removed when;
A. vision is reduced to below 20/200
B. the cataract is “ripe”
C. the patient fails a color vision test
D. the patient notes impairment of daily living

Answer 41

D
Years ago, a cataract was not removed until it was “ripe.” But with modern technology, a cataract can be removed whenever the patient notices that his vision decrease is interfering with his activities of daily living.

Question 42

Preoperative cataract surgery measurement of a patient’s corneal curvature is known as:
A. keratometry
B. exophthalmometry
C. interferometry
D. tonometry

Answer 42

A
Keratometry is used to measure the curvature of the cornea prior to cataract surgery. It is one of several variables used in determining the power of the IOL implant to be used once the cataract has been removed. (see Chapter 6, Keratometry, as well as Chapter 16, the section titled IOL Power Calculations.)

Question 43

Each of the following is used in intraocular lens implant calculations except:
A. K reading
B. desired postoperative refraction
C. A-scan
D. intraocular pressure

Answer 43

D
The patients intraocular pressure does not figure into the formula used to determine the power of an IOL implant.

Question 44

Medications of concern for the preoperative cataract patient include all of the following except:
A. those containing aspirin
B. those for erectile dysfunction
C. estrogen-based hormones
D. blood thinners

Answer 44

C
Estrogen-based medications do not have any known effects on cataract surgery. Aspirin and blood thinners can cause operative and postoperative complication of floppy iris syndrome.

Question 45

Your patient wants to know if she will have stitches in her eye after cataract surgery. You tell her:
A. :No, cataract surgery is always ‘stitchless’ now.”
B. “No, cataract surgery is done with laser.”
C. “No, unless something changes during surgery.”
D. “Yes, stitches are a safeguard against wound gape.”

Answer 45

C
Answer a might be tempting, but it sounds too much like a guarantee. Although unlikely, there could be some type of intraoperative complication where the surgeon will suture the wound.

Question 46

Currently, the most commonly used type of anesthesia for cataract surgery is:
A. topical
B. retrobulbar injection
C. intravitreal injection
D. general

Answer 46

A
The most commonly used type of anesthesia for cataract surgery is topical.

Question 47

Reducing a cataract into small pieces by use of ultrasonic energy is termed:
A. can-opener method
B. open sky technique
C. phacoemulsification
D. intracapsular extraction

Answer 47

C
Phacoemulsification uses sound waves to break the cataract into small pieces, which are then removed by suction through a small tube.

Question 48

Your patient asks if he will still need glasses after cataract surgery. You tell him;
A. “No, the intraocular lens implant will allow you to see normally.”
B. “No, everyone gets specialty implants now so you don’t need glasses.”
C. “Probably, just to fine-tune either distance or near vision.”
D. “No, all patients having cataract surgery see 20/20 after the procedure.”

Answer 48

C
Answers a and d are patently incorrect and sound like a (dangerous) guarantee that the patient will see perfectly without correction once the cataract has been removed. Answer b is incorrect as well, because not everyone gets a “specialty” IOL (ex. multifocal or toric). Answer c is the only safe answer. ( Note: While the use of “specialty” IOLs and monovision IOLs may obviate the need for glasses, that was not given as an option here.)

Question 49

Which of the following are general restrictions immediately following cataract surgery?
A. No bathing
B. Do not bend over or lift anything heavy
C. Keep the eye patched at all times
D. Keep the head elevated when reclining

Answer 49

B
Patients are generally told not to bend over (ex. bending at the waist so that the head is in a dangling down). Inclining the head to read is okay, and it is fine to kneel to pick something up. Patients are also told not to lift anything heavy. Bathing is allowed, although the patient is cautioned not to get any water in the eye.

Question 50

Symptoms of a posterior subcapsular opacity:
A. mimic those of a cataract
B. mimic those of angle-closure glaucoma
C. include flashes and floaters
D. can be alleviated with artificial tears

Answer 50

A
When a cataract is removed, the back part of the capsule that encloses the eye’s natural lens is left in place to support the IOL. The capsule membrane is polished, but sometimes gets cloudy after surgery (a few months to a few years). The symptoms of a posterior subcapsular opacity are pretty much the same as those of a cataract: blurred/foggy vision, ghost images, and problems with glare.

Question 51

The term “secondary cataract” is a misnomer because:
A. most cataracts are congenital
B. once removed, a cataract cannot frow back
C. it actually occurs in the IOL implant
D. it is actually an opacity of the cornea

Answer 51

B
Another name for a posterior capsule opacity is “secondary cataract,” but this is a misnomer. Once removed, a cataract cannot grow back.

Question 52

A posterior capsule opacity is treated by performing a:
A. cryo-capsulotomy
B. laser iridotomy
C. surgical capsulotomy
D. laser capsulotomy

Answer 52

D
Posterior capsule opacity is treated with a YAG laser, which is used to make an opening in the center of the capsule. This clears the visual axis, improving acuity.

Question 53

Insertion of a phakic IOL would be done for the purpose of:
A. cataract removal
B. correction of refractive error
C. preventing cataracts
D. intraocular medications

Answer 53

B
A “phakic IOL” is inserted into the eye without removing the natural crystalline lens. It is done for the purpose of correcting refractive errors.

Question 54

In which of the following surgical procedures might a drainage implant be placed in the eye?
A. cataract surgery
B. nasolacrimal surgery
C. strabismus surgery
D. glaucoma surgery

Answer 54

D
The aim of all glaucoma treatment is to decrease intraocular pressure. This is generally done in one of two ways: increasing drainage/outflow or decreasing production/inflow of aqueous humor. Thus, glaucoma surgery might involve placing an implant devised to drain aqueous fluid out of the eye.

Question 55

The aim of most types of glaucoma surgery is to:
A. increase aqueous production
B. improve optic nerve help
C. increase aqueous outflow
D. avoid medication use

Answer 55

C
See answer 54

Question 56

Laser treatment for primary/chronic open-angle glaucoma is a(n):
A. valve implant
B. iridotomy
C. iridectomy
D. trabeculoplasty

Answer 56

D
The laser surgery for open-angle glaucoma is trabeculoplasty. The laser beam is aimed into the angle of the eye (between cornea and iris root). The theory is that when the tissue heals, the scarring pulls the trabecular meshwork open, increasing aqueous outflow.

Question 57

A surgically created, conjunctiva-covered, external opening through which aqueous can drain is a:
A. bleb
B. seton
C. drainage implant
D. sebaceous cyst

Answer 57

A
In glaucoma surgery using a valve, a “bubble” or blep is created between the conjunctiva and sclera as a site for venting aqueous from the eye.

Question 58

Angle-closure glaucoma is most often treated by performing a:
A. surgical trabeculoplasty
B. valve implant
C. laser iridotomy
D. surgical iridectomy

Answer 58

C
In angle-closure glaucoma, the iris butts up against the anterior lens surface and is then pushed into the angle of the eye, blocking drainage of aqueous from the eye. A laser iridotomy is done to create an opening in the iris to allow the aqueous to drain even when the angle is blocked.

Question 59

The removal of the jelly-like substance in the back of the eye is a(n):
A. centesis
B. vitrectomy
C. evisceration
D. enucleation

Answer 59

B
Removal of the vitreous is a vitrectomy (the suffix~ ectomy refers to removal).

Question 60

Laser photocoagulation might commonly be used to treat all of thee following except:
A. hypertensive retinopathy
B. hyphema
C. diabetic retinopathy
D. macular degeneration

Answer 60

B
Laser photocoagulation is frequently used to seal, especially blood vessels. Answers a, c, and d are all retinal conditions that may respond well to photocoagulation. A hyphema is blood in the anterior chamber, which is not treated with laser.