Ophthoquestions Flashcards
What was the main conclusion of CIGTS?
Initial medical and surgical therapy resulted in similar visual field outcomes after 5 years of f/up
what does the outer layer of the optic cup develop into?
RPE
What was the conclusion of EMGT?
62% of untreated patients vs 45% of treated patients showed progression on their visual fields
What is an appropriate indication for a Gunderson flap?
Eye with poor visual potential. Gunderson involves incising and rotating piece of conjunctiva so that it covers cornea and can’t be done in eyes where exam needs to be performed.
Where are the nerves to the recti and superior oblique in relation from muscle origin to insertion?
Nerves are 1/3 of the distance from the muscle origin to the insertion
What are risk factors that increase risk of RD in eyes with lattice?
high myopia, history of RD in fellow eye, presence of flap tears within the lattice, aphakia
What structure is at same plane of optic nerve as it passes through optic canal on axial CT?
anterior clinoid process
How many days prior to cataract do you stop aspirin, plavix, vitamin E? What about coumadin?
10 days for aspirin, plavix, or vitamin E, 3-5 days for coumadin
What is the triad of Melkersson-Rosenthal?
Recurrent facial paralysis, orofacial edema, lingua plicata. Biopsy -> granulomatous infiltration
What can congenital iris ectropion syndrome be associated with?
NF, primary facial hemihypertrophy, Rieger anomaly, and Prader-Wili
Which gene has been implicated as conferring to naturally immune HIV infection?
CCR5
What is Munnerlyn/s formula?
optical zone squared times spherical power of myopia divided by 3
What are indications for frozen section?
Determining whether margins are clear, providing fresh tissue for flow cytometry, to determine whether representative tissue has been biopsied, to ensure tissue conservation
What length ACIOL do you use?
Horizontal white to white distance plus 1mm
What refractive error are iris claw lenses approved to treat?
high myopia
What is the most common cancer in women 15-34?
Cervical
Name three findings of Vernal Conjunctivitis. How long do mast cell stabilizers take to reach effect?
GPC, Horner-Trantas dots, Shield ulcer. Mast cell stabilizers take 2 weeks to reach effect
What distinguishes LCA from LCA-like disorders like Batten and Refsum?
presence of seizures and mental deterioration in LCA-like disorders
What is a cause of compact stroma with epithelial edema after cataract surgery in acute post-op period? What is a common cause of this?
High IOP, commonly caused by retained cohesive viscoelastic like Healon
What drugs can cause corneal verticillata?
amiodarone, chloroquine, suramin, tamoxifen
Where does seesaw nystagmus localize?
diencephalon and chiasm (look for perichiasmal mass)
Where does convergence retraction nystagmus localize?
dorsal, rostral midbrain (pineal mass)
Where does dissociated (abducting eye) nystagmus localize?
MLF (image brainstem)
What can produce a pseudo-INO?
mysathenia gravis
WHere does periodic alternating nystagmus localize?
caudal medulla
Where does downbeating nystagmus localize?
cervico-medullary junction (chiari malformation)
Where does gaze evoked, slow in one direction, faster small amp in other nystagmus localize?
extra-axial mass compressing brain stem on side of slower nystagmus (acoustic neuroma cerebellar hemisphere tumor)
WHere does gaze evoked, spontaneous in one direction nystagmus localize?
acute loss of vestibular function (quick component to normal side)
Where does upward jerking in upgaze only nystagmus localize?
drug intoxication
Where does course upbeat, present in primary position, increasing on up gaze, decreasing on down gaze nystagmus localize?
anterior vermis of cerebellum as in infiltrating tumors, fourth ventricle mass, MS, nutritional cerebellar degeneration
Where does fine upbeat in primary, less in upgaze more in downgaze nystagmus localize?
medullary lesions (as infarction)
Where does positional nystagmus, if persistent when head placed in optimum position localize?
posterior fossa
Where does ocular myorythmia/myoclonus (associated with synchronous palatal movement) nystagmus localize?
bilateral pseudohypertrophy of inferior olivary nucleus, lesions of central tegmental tracts or dentate nucleus
Where does opsoclonus “saccadomania” nystagmus localize?
neuroblastoma
What type of RD occurs with pars planitis?
RRD and TRD
Which refractive procedure uses a blunt microkeratome to remove only the epithelium and then ablating the stromal bed?
Epi-LASIK
Which refractive procedure uses alcohol?
LASEK
Which procedure involves scraping the epithelium with a brush or spatula?
PRK
How can you differentiate retinoschisis from RRD?
smooth-domed, absence of VH, absolute scotoma, reaction to photocoagulation, absence of shifting sub retinal fluid
What are the treatments for rosacea?
Topical steroids, topical flagyl, and systemic tetracyclines
What is the best agent for Behcet’s?
Chlorambucil
What is the mildest craniosynostosis?
Saethre-Chotzen with plagiocephaly, brachydactyly, and mild syndactyly
What is congenital fibrosis syndrome and what is the treatment?
congenital fibrosis of levator and SR b/l, can’t advance levator because it’s fibroses so need frontalis sling.
What is CL method of calculating lens measurement?
Power of CL + base curve of CL + over refraction with CL - sph without CL
What deficit can recover in adults s/p CVA?
gaze deviation due to infarct of FEF
What is Brown-McLean Syndrome?
clear central K with peripheral K edema starting inferiorly, usually after intracap CE
What is largest number of axons in ON and when is it achieved?
3.7 million at 16 weeks
What % of Peters are bilateral or have systemic problems?
60%
What type of cataract is seen in Wilson’s?
Sunflower cataract
What does the ventral ophthalmic artery become?
Nasal LPCA
What do you need to rule out in Brown syndrome?
Sinusitis with CT
What happens when Brown patient adducts?
abrupt downshoot
What do fixed retinal folds imply in RD?
PVR
What PGA require esterase to work?
Latanoprost and travoprost
Which peripheral retinal abnormalities are associated with increased risk of RD?
Meridional folds
What is the average depth of the AC?
3mm
What medicine can increase IOP?
Ibopamine, a dopaminergic medication
What were conclusions of ETDRS?
early scatter PRP -> small reduction in risk of severe visual loss, focal increased chance of vision gain and reduced risk of moderate VA loss
What is first step for presumed keratoacanthoma?
incisional biopsy, then complete surgical excision
Compare 5FU vs MMC disadvantages:
5FU has more corneal toxicity, MMC has higher risk of bleb leaks, ischemic blebs, and infections
Where is the uveal tract attached to the sclera?
scleral spur, vortex veins, peripapillary tissue
Contrast limbal based vs fornix based blebs:
fornix based have more wound leak, produce lower, more diffuse blebs, scar is anterior to scleral flap promoting fluid flow posterior to the flap
What are the last parts of the visual field affected by OAG?
central island and inferotemporal
What are iris mammillations associated with?
Oculodermal melanocytosis
What is first line of therapy for CME from pars planitis?
sub-Tenon’s steroids
What is the cause of superior oblique myokymia?
vascular compression of CNIV
What gives sunflower cataracts?
Wilson’s or chalcosis (copper)
What are eye findings of NF2?
PSC, wedge cortical cataracts, retinal hamartomas
Where are the strongest sclerouveal attachments?
Major emissaries canals and anterior base of ciliary body
What is associated with blue sclera?
Osteogenesis imperfecta I, Ehlers-Danlos VI, brittle cornea syndrome
What infectious agents are implicated in Bell’s palsy?
VZV, mycoplasma, Lyme
Posterior pigmented iris is continuous with what of CB?
nonpigmented epithelium, which is continuous with neurosensory retina
What glaucoma med do you avoid in pars planitis?
miotics
What are the ocular complications of aniridia?
chronic ACG, progressive K opacification, nystagmus, foveal hypoplasia, cataracts
What is abnormally produced in Reis-Buckler’s?
Keratoepithelin
What are associated with microphthalmos?
Trisomy 13, MR, dwarfism
What is an association with hard CL overwear?
Central epithelial edema
What are the dimensions of the palpebral fissure?
27-30mm horizontal, 8-11mm vertical
What is the average A-P depth of the lens at birth and in adult?
3.5 & 5 mm
Describe the characteristics of FA wavelengths and filters
excitation light is 465-490, fluorescein fluoresces at 520-530, the barrier filter is yellow-green
What is the treatment for filtering blebs from leaky extracap wounds?
autologous blood into the conj, wound revision, scleral patch graft, chemical cautery
What disease has undetectable flicker pattern on ERG?
Rod monochromatism
What diseases have a flat pattern on rod specific response ERG?
Complete CSNB or RP
What disease has undetectable transient photopic response ERG?
Rod monochromatism
What disease has electronegative maximum scotopic response ERG?
Complete CSNB
What diseases have moderate reduction in maximum scotopic response ERG?
Rod monochromatism and cone dystrophy
What diseases have negative waveform scotopic ERG?
XLRS and CSNB
Monovision LASIK aims the non dominant eye at what refraction?
-1.75 sph
What are the differences between ocular toxoplasmosis in AIDS vs immunocompetent?
Multifocal retinochoroiditis is more common, size of lesion is larger, less vitreous inflammation, lesion arises de novo
Which immunosuppressive can not be used in children?
Cyclophosphamide - bone marrow suppression, infertility, infection, malignancy
What can cause acquired Brown syndrome?
trauma, inflammation from IOI, RA, Sjogren’s, neoplasm
What is the defect in hyperlysinemia?
Defect in alpha aminoadipic semialdehyde synthase
What are the associations of Peter’s?
ARS, CRS, Microphthalmia with linear skin defects (MLS), Pfeiffer syndrome, Kivlin syndrome, trisomies 13-15
Where do the EOMs penetrate Tenon capsule?
10 mm posterior to their insertions
What does the inner marginal zone of the primitive retina become?
NFL
Where do primary CNS lymphomas go in the eye?
Retina and vitreous (Visceral or nodal lymphoma go to the uveal tract)
Describe the difference between the structure of the OS of the rods vs cones
Rod disks are not attached to the cell membrane whereas cone disks are
What layer of the retina does CAR affect?
INL
What arteries branch off of ophthalmic artery once it has entered the muscle cone?
CRA and 2 LPCA
What is a common complication after cataract surgery in FHIC?
AC hemorrhage or hyphema (long and fragile vessels that cross the angle)
How does Skew deviation commonly present, where does it localize, and what nystagmus is associated?
Weakness of IR muscle, cervicomedullary junction, downbeat
What glaucoma medications have BAK free forms?
brimonidine, timolol, travoprost
What side effect may occur with fingolimod?
Macular edema
What can affect A-scan measurements?
posterior staphylomas, silicone oil or gas in the eye
Explain the relationship between DM, BMI and vein occlusions
BMI predisposes to BRVO only, DM predisposes to CRVO and HRVO only
Which viscoelastic agent is dispersive?
Viscoat
What size needle is typically used to create a sclerostomy in GDI surgery?
23G
What are risk factors for expulsive choroidal hemorrhage?
older, glaucoma, myopia, HTN, arteriosclerosis, bleeding diathesis, active inflammation, anticoagulation, prolonged hypotony
What is the cardinal feature of INO?
Slowed adducting saccadic velocity
What causes fibrovascular tissue between corneal epi and bowman?
Trachoma, CL overwear, chemical injuries, chronic blepharoconjunctivitis
What are associations with enlarged corneal nerves?
Riley-Day, Refsum, MEN2B, Acanthamoeba, Leprosy, NF
What are associations with more visible corneal nerves?
Keratoconus, ichthyosis, Fuchs, congenital glaucoma, corneal edema
What is the differential for corneal crystals?
Macular/lattice/granular, Schnyder’s, Bietti, ciloxan, infectious, cystinosis, MM, MGUS
Where in the CB is the blood-aqueous barrier?
Zonulae occludens of the apical border of the inner, nonpigmented epithelium
What are the most prevalent adrenergic receptors in the ciliary epithelium?
Beta 2
What strabismus situations are botox not useful for?
Large deviations, A/V patterns, DVD, chronic paralytic, oblique muscle dysfunction, or restrictive
What glaucoma do patients typically not get PAS?
Pseudoexfoliation
What are secondary causes of osteoporosis?
Hyperthyroidism, multiple myeloma, cushing’s, paget.
At what age should infants with b/l cataracts have surgery?
3 months, then less than 2 weeks for children less than 2 years and less than a month for older than 2 years for 2nd one.
At what age should unilateral cataracts be operated on?
Before 6 weeks.
What drugs fulfill proposed criteria for causing uveitis?
metipranolol and bisphosphonates
What are associated signs of anterior PFV?
microphthalmos, shallow AC, long ciliary processes
What substances raise IOP:
LSD, Ketamine
What differentiates blue cone from rod monochromatism?
Blue cone is XR, Rod is AR
Where is the ciliary ganglion?
1cm anterior to zinn between ON and LR
What is the PAS pattern in pupillary block?
starts at Schwalbe and extends anteriorly
What is the PAS pattern in Plateau iris?
starts at Schwalbe and extends posteriorly
Primary congenital glaucoma affects which gender more? Uni or bilateral?
Males 66%, bilateral 66%
What standard glaucoma drop causes miosis?
Brimonidine (alpha)
What findings are associated with disc edema?
macular edema, chorioretinal folds, impaired axoplasmic flow in ganglion cells
What do oval chorioretinal lacunae suggest?
Aicardi syndrome
What is the triad of Aicardi syndrome?
chorioretinal lacuae, agenesis of the corpus callosum, infantile spasms
What is best way to treat postop astigmatism in PKP patients?
arcuate keratotomy in graft centered around axis of astigmatism in the manifest refraction
What immunomodulator may worsen multiple sclerosis?
infliximab
What is the average corneal fibril diameter?
30 nm
What genes are affected in Meesman?
KRT3 or KRT12 (keratin)
What medications commonly cause punctual stenosis?
Oral chemotherapy
Describe the layers of the epithelial lining of the inner portion of the ciliary body:
Double layer of epithelial cells; inner non pigmented and outer pigmented layer
What constitutes the blood aqueous barrier?
tight junctions between cells of the non pigmented epithelium of the ciliary body at the apical border
What constitutes the inner retinal blood barrier?
Tight junctions between nonfenestrated endothelial cells of the retinal blood vessels
What threshold corneal thickness portends poor corneal prognosis after cataract surgery?
<650 um
When do you consider medial infracture the inferior turbinate?
inflamed nasal mucosa
What medications should be discontinued prior to general anesthesia?
Nicotinic acid, MAOI, echothiophate iodide (not chloride)
What wavelength of light is rhodopsin most sensitive?
510 nm
Where is the choroid thickest?
Posterior pole (0.25mm)
Which clues tell you the lower eyelid retractors may be disinserted?
White subconjunctival line below the tarsus, deep inferior fornix, reverse ptosis of lower eyelid, little movement of the lower eyelid with downgaze
Name 3 associations with morning glory discs
Serous RD, transsphenoidal basal encephaloceles, moyamoya disease
What causes gaze-evoked nystagmus and rebound nystagmus?
Cerebellar disease
What complications after CE do nanophthalmic eyes get?
Chorodial detachments and hemorrhages
In the lower face, does the facial nerve lie deep or superficial to the SMAS?
Deep
In the upper face, does the facial nerve lie deep or superficial to the SMAS?
Superficial
What does CONGENITAL nystagmus consist of?
Convergence and eye closure dampen, Oscillopsia absent, Null zone present, Gaze doesn’t change direction, Equal amplitude and frequency in each eye, Near VA good, Inversion of OKN, Turning head -> better VA, Absent during sleep, Latent nystagmus occurs
How many SPCA enter the globe around the ON? SPC nerves?
20 arteries, 10 nerves
What is superior segmental ON hypoplasia most associated with?
children of Diabetic mothers
What medications are optic nerve hypoplasia associated with?
phenytoin, LSD, quinine, alcohol
What is defined as the area where the INL and RGC are absent?
Foveola
What is the waveform of latent nystagmus and which way does the fast phase go?
Exponential decrease in slow phase velocity, fast phase towards eye that is not occluded
What is Raymond-Cestan syndrome?
INO + contralateral hemiparesis (MLF and corticospinal)
Where do the most aggressive BCC arise from?
medial canthus
What enzyme is deficient in tyrosinemia?
Tyrosine aminotransferase (Pseudodendrites)
How much temporal lobe can be sacrificed without causing visual field deficit?
2.5 cm
What is ocriplasmin and what does it treat?
protease targeting fibronectin and laminin, treats 26% of VMT
Where does the vitreous base attach in relation to the ora serrate?
2 mm anterior to the ora serrata and 4 mm posterior to the ora
What structures around the ON help identify the horizontal meridian
2 long ciliary arteries and nerves
What are common causes of Salzmann?
IK, chlamydia trachoma (A-C), phlyctenulosis
Neomycin can cause what side effect on the cornea, and what type reaction is it?
Peripheral corneal infiltrates called Wessely immune rings, type 3
What condition mimics Terrien marginal degeneration but is in children?
Fuchs superficial marginal keratitis
Where is the thinnest location of the cornea?
Temporal to the geographic center
What is the minimal acceptable endothelial cell density for a donor cornea?
2,000 cells/mm2
What are primary causes of limbal stem cell deficiency?
congenital aniridia, ectodermal dysplasia, sclerocornea, KID syndrome, congenital erythrokeratodermia
What are secondary causes of limbal stem cell deficiency?
alkali burns, SJS, ocular surgery, trachoma
What are the indications for anterior washout after hyphema?
IOP > 60 for 2 days, > 35 for 7 days, > 25 for 1 day with SC, K blood staining
What are complications of MMC use after trab?
non-healing K epithelial defect, infectious sclerokeratitis
What is the reflectance equation?
R = ((n1-n2)/(n1+n2))^2
What are causes of crystalline retinopathy?
canthaxanthine, talc, ethylene, hyperoxaluria, Bietti, tamoxifen, methoxyflurane, nitrofurantoin
