Opto prep Flashcards
what conditions is tilted disc syndrome seen in?
Crouzon and Apert syndromes
Crouzon syndrome inheritance and what is it and to how to treat it?
AD
results in proptosis b/c of :
shallow ocular orbits,
maxillary hypoplasia
abnormal craniofacial formation,
hypertelorism
potential strabismus
treat the exposure keratopathy
what is Oculoglandular syndrome ?
unilateral follicular conjunctivitis + lymphadenopathy on the same side as affected eye
what is Sjogren’s ? what is it associated with?
dry eye and dry mouth, either from destruction tear and salivary glands, or from infiltration with lymphocytes.
It is associated with autoimmune diseases of the rheumatic or collagen vascular variety.
what VF defect is seen in those with tilted disc syndrome?
bilateral superior and temporal
what ocular anomaly is associated with a tilted disc?
sinus inversus
what is situs inverses?
retinal blood vessels emerge from the disc and first go nasally before going to their natural destination
when performing direct opthalmoscopy. How will the refractive error of the patient (if left uncorrected) alter the image?
pt’s RE:
OD: - 7.00 -1.25 x175
OS: -6.75 -1.00 x 174
magnification = power of the eye (D) / 4
60 D of power in eye
myopes add power
hyperopes remove power
60+7 = 67
67/4 = 16.75x
what is the average axial length?
24 mm
how does an increase in axial length affect power in the eye?
1mm increase causes a myopic shift of 2.5 D
if hyperopic patient, the axial length would shorten theoretically
what refractive power is associated with those with tilted discs?
myope
what type of lens do you give a patient who is bothered by fluorescent light?
rose tint + AR coating
what is the best way to prescribe prism in aspheric glasses?
grind them in
pincushion
edges less magnified
distortion due to plus lenses
barrel
edges more magnified
distortion due to minus lenses
what are aspheric lenses? what type of coating must you have with it?
must have anti-glare coating with it
they have abase curve that changes progressively form the center to the edge of the lens.
makes them thinner and lighter
(+) lenses - flatten to periphery
(-) lenses steepen to periphery
What is this?
herpes Zoster keratitis
- no terminal end bulbs, because more tapered , more infiltrative
how to differentiate from herpes simplex vs herpes zoster?
zoster - shingles (Varicella virus) - located at one dermatome on one side of the body
- dendritic lesions stain with both NaFL + rose bengal
- more infiltrate vs. ulcerative
HSV - becomes active during stress, everyone is exposed to it. Uni follicles + lymph + decreased corneal sensitivity + skin vesicles
- bulbs stain with rose bengal and main part stains with NaFl
what does Behçet’s disease cause?
bilateral non-granulamatous uveitis
best’s disease treatment
none - monitor with amsler
- changes may indicate CNVM
best’s disease inheritance
AD
A PVD decreases the risk of developing what?
macular hole
what is this?
chorioretinal coloboma
what complication can develop secondary to a chorioretinal coloboma?
RRD
what condition are coloboma most frequently seen with?
Microphthalmia
what is one and a half syndrome ?
bilateral condition where one eye can’t move laterally at all
other eye can only move out (with nystagmus upon abduction - contra to the lesion)
convergence is spared
ex. right side lesion
- both eyes can’t look right, but OS can look left , with left beat nystagmus
what can you add to amoxicillin to increase its effectiveness to penicillin? and its MOA
clavulanic acid = inhibits beta lactamase - preserves the beta lactase ring of amoxicillin maintaining its effectiveness
clavulanic acid + amoxicillin = augmentin
what is this?
posterior embryotoxin = prominent and anteriorly displaced schwalbe’s line
what is this?
agenfeld anomaly = peripheral iris strands attached to the posterior embryotoxcin
what complication is axenfeld anomaly associated with?
glaucoma
what is Rieger anomaly ?
axenfold anomaly + iris thinning _ corectopia (displaced pupil)
what is Peter’s anomaly
central corneal opacity + iris strands adhering to the opacity margin -> looks like a donut
what is antimetropia?
one eye is myopic and the other is hyperopic
what is aniseikonia? Symptoms
size difference of perceived images between the eyes
will be symptomatic - HA, diplopia, dim vision, nausea etc.
what is the racial predilection for posterior embyotoxin?
none
how do you measure the trifocal segment height for glasses?
lower edge of the pupil margin - 1 mm
how should you measure add power in glasses
Turn the glasses around backward. remeasure distance sphere power at a point above the optical center and them measure the sphere power through the near segment
abbe values of polycarbonate
30
abbe value of trivex
43-45
abbe value of Cr-39
58
abbe value of crown glass
58
what is Charles Bonnet syndrome?
see hallucinations - nonthreatening , know not real
most common hallucination = smiley faces
blink a lot to clear the faces
what ocular condition has the highest association with Charles bonnet?
age-related macular degeneration
what is this?
angioid streaks
conditions causing angioid streaks
Pseudoxanthoma elasticum (most common)
Ehler-Danlos syndrome,
Paget’s disease of bone,
Sickle cell disease
Idiopathic
what is the pathophys of angioid streaks?
small dehiscences in the collagenous and elastic portions of Bruch’s membrane
what are common ocular findings associated with angioid streaks?
peau d’ orange
optic disc drusen
how do you treat/ manage angioid streaks?
FA
acids vs alkaline burns pathophys
alkaline burns occur more often and continue to penetrate the cornea after the initial trauma.
acidic burns - coagulate protein and the epithelium
corneal treatment post chemical burn
- irritate with saline
- cyclo for pain (NO phenyl because of vasoconstriction)
- antibiotic
- steroid - to decrease inflammation
in severe cases can use:
ascorbic acid - promotes collagen growth
citric acid - decreases inflammation
tetracyclines - decrease inflammation and ulceration
aspirin contraindications
any GI issues , can increase GI bleeding
how to calculate seg inset?
(Patient’s distance PD - near PD )/2
how to calculate minimal blank size
(frame pd - patient’s pd) + ED
hand neutralization
plus lens spherical = against motion
- need minus lens to neutralize
minus lens spherical = with motion
when sphere is neutralized - then will see no motion
same for cylinder
how to determine if prescription glasses you are wearing are polarized ?
place in front of a liquid crystal display - ex. phone, tv - when oriented perpendicular - should blacken out
how to insert a lens into a polycarbonate frame
- cannot heat frame!
- insert temporal first, then nasal from front of the frame
what frames cannot be heated?
polyamide
copolyamide
carbon fiber graphite
polycarbonate
what causes toxocariasis ?
round worm found in puppy poop
what is Gilbert’s syndrome and how does it affect the eyes?
AR condition that makes too much bilirubin leading to jaundice - so see yellow sclera
what are risk factors fro COPD?
low birth weight
frequent childhood infections
an alpha-1 antitrypsin deficiency
dusty work environment
smoking !!
damp housing quarters
pollution
what is toxocariasis treatment?
corticosteroids
what is toxoplasmosis treatment?
pyrimethamine and sulfadiazine + corticosteroids (treated in immunocompromised patients
note not everyone needs to be treating - self limiting
antihistamine side effects
ex. pataday
HA, bad taste
what is this?
lens subluxation
what conditions do you see lens subluxation in?
marphans
homocystrinuria
Weill-marchesani syndrome
ehlers-danlos
crouton disease
syphilus
anairidia
what is ectopia lentis?
bilateral lens subluxation
what is posterior lenticonus?
when the posterior aspect of the lens bulges into the vitreous
how does the lens subluxate in homocystinuria?
Inf and nasal
what is iridodonesis?
caused by ruptured/damaged zones leading to lens lents movement and quivering or the iris
what is phacodonesis?
movement/ vibration of the lens
how do you treat lens subluxation and symptoms?
- monitor usually unless causes high astigmatism, diplopia monocular, glaucoma or inflammation
- glasses to neutralize astigmatism
opaque iris cls - prism ballast soft lens with a decentered pupil
- rarely - pilo
what is the most common cause of lens subluxation?
trauma
what is this?
posterior capsular opacification
SE of a yag laser?
lens pitting/ damage to IOL
increase in IOP
CME
retinal detachment
what glaucoma drops have sulfa in them?
dorzolamide and diamox, cosopt
what is dermatochalasis?
extra skin
what is the most appropriate first line treatment for the acute signs and symptoms of vernal KCS?
Alex = loteprednol
what layer is arcus found in?
stroma
lastacaft dosing?
ohs
what causes a pupil sparing CN 3 palsy?
microvascular disease - HTN, DM
CN 3 anatomy
pupil fibers located superior medial
compression/anurysm -> pupil involving CN 3 palsy b/c of location of pupil fibers
vasa nervous fibers -> do not contain pupillary fibers -> affected by microvascular disease (HTN/DM)
CN3 palsy treatment
monitor if not pupil involving -> resolution typically can occur w/o treatment
A1c to sugar levels
A1c 5 = 100mg/dL
for every increase by 1 increases blood sugar by 30
what is this refractive surgery
CK
What RE does CK treat? CT and VA
< 3 D hyperopia
<-0.75 D astig
CT = 560 microns
VA 20/40 or better
good for mono vision and emmetropia presbyopes
what does CK do to the cornea?
central steepening and mid-peripheral flattening
what is this?
reticular pigmentary degeneration
How do you modify the GP lens via a 3 inch drum tool to add minus power?
to add minus power:
hold suction cup (attached to the concave side of the lens) cover side is in contact with the sponge - rotate counterclockwise
concave side is up
DK and lens GP lenses
as you increase the DK/ O2 permeability decreases the durability of the lens
- to counteract this can add fluorine
what is associated with aniridia?
lens opacities
glaucoma
strab
nystagmus
pannus
foveal hypoplasia
what is this?
interstitial keratitis
what is the most common cause of interstitial keratitis? what are other causes?
syphilius
HSV
HSZ
Lyme
leprosy
TB
epstein barr
parasites -> microsporidia
HSV interstitial keratitis presentation.
unilateral
red, photophobic painful eye
congenital syphilus interstitial keratitis
10-20yo
bilateral ‘
triad: deafness, Hutchinson’s teeth, interstitial keratitis
DFE -> optic atrophy & salt/pepper fundus
leprosy
loss of outer third of eyebrow
loss of lashes
areas of hypopigmentation
thickened skin folds
corneal nerves look like beads on a string
iris nodules
cogan syndrome
what systemic condition is it associated with?
bilateral interstitial keratitis
hearing loss, vertigo, tinnitus
associated with systemic vasculitis like polyarteritis nodosa
Lyme disease
fatigue, HA, fever
red rash with bull’s eye appearance = erthyma migrains
patient usually denies any skin rashes
what is interstitial keratitis?
stromal neo + corneal edema.
usually doesn’t involve epithelium or endothelium , but may see A/C run in acute phase - with tiny kps
how to treat interstitial keratitis?
topical steroids, cyclo if photophobic, and treat underlying cause
- valtrex for HSV
- IV penicillin for syphilus
- oral doxy for Lyme
when to f/u with patient with interstitial keratitis after starting tx?
3-7 days
epinephrine
like a topical glaucoma drug
- decreases IOP by increasing uveoscleral and TM outflow.
SE: dilation, irritation, redness, follicle conjunctivitis, eyelid retraction, CME, black adrenchrome deposits in the inferior palpebral conj/fornix
what is this?
band keratopathy
what is band keratopathy?
calcium deposits in Bowman’s layer
- look like Swiss cheese
what are DD for band k?
- interstitial keratitis
- spheroidal degeneration
- salzmann nodular degeneration
what is spheroidal degeneration?
also causes opacification of the anterior cone that begins at the peripheral interpalpebral area.
- bilateral with amorphous globules of protein deposited in Bowmans
- advanced lesions look nodular
what is this?
salzmann nodular degeneration
what is salzmann nodular degeneration?
non-inflammatory process that results in the emergence of peripheral white nodules that may be raised.
pressents in older patients who might be asymptomatic
what causes band k?
chronic disease (anterior uveitis, glaucoma, keratitis)
systemically:
hyperparathyroidism
sarcoid
renal diseases
how to treat band k?
mild -> ATs , ointment, and/or bandage cls
severe (ie. obscures vision and causes chronic irritation - remove calcium by chelation using EDTA
- residual stromal haze can be removed by PTK to improve vision
what is this?
coats disease
symptoms of coats disease?
leukocoria and strab are most common
- some may complain of decreased VA, pain, nystagmus, heterochronic (due to iris neo)
clinical findings of Coats? Retina and ant seg
ant seg = normal, may see corneal edema, NVI, A/C cholesterosis
post seg - retinal telangiectasis (inn and temporal in the periphery) , significant sub retinal and intraretinal exudation
what is this?
cholesterol in the A/C
who gets coat’s disease
5 year old males
who gets retinoblastoma
by age 2
pathophys of coat’s disease
abnormal permeability of the retinal vessels endothelium causing a breakdown of the BRB and leakage of lipid-rich exudates
pathophys for eales’ disease
peripheral capillary non perfusion leading to neo, recurrent vitreous heme and potential TRD
bilateral
how to treat coat’s disease
photocoagulation
coats disease education
- idiopathic
- not heredity, can’t pass it on
- mostly affects 1 eye
- end stage complications if not treated TRD, NVG leading to a blind painful eye - may need enucleation if this occurs
what is this?
choroidal melanoma
in a choroidal melanoma, what associated findings increase the likelihood of requiring treatment?
lipofusion of the surface of the lesion
where is the most common site of choroidal melanoma mestastsis?
liver
where is the most common sites of metastasis from other sites to the choroid?
Breast in women and bronchus in men& women
RP what magnification should you give them in devices?
do not want to give them too much because it decreases their FOV. around 2->3
what do you use yolked prism glasses for?
sectoral VF loss or midline shift
what is a closed circuit TV used for?
cctv is used for near vision.
if young and and can accommodate not needed
can you use implantable telescopes for RP patients?
no
how to calculate JND based on VA. What lenses would you use for trial frame refraction? example VA = 20/100
must be in 20 foot acuity
20/100
JND = 1.00 D
use half the JND fro TF refraction +/- 0.50
what inheritance pattern is ushers?
AR
what is legally blind?
20 degrees or less VF
20/200 VA
what should all AA with trauma + hyphema be screened for?
sickle cell
when do CHRPE appear?
birth
what is the most common site for CHRPE?
temporal
what condition is most frequently associated with myelinated fibers?
myopia
amblyopia
strab
nystagmus
optic neuritis
neo of the retina
the condensing lens is below the common Visual axis
how does patient accommodating affect BIO
over accommodation of the patient causing a blurry image
when this patient look 7mm down from the optical center. How much prism is induced?
d=cF
c in cm
here the patient is looking through BD prism OU- so the prism is canceled
Pd = 0.7(-4.00) = 2.8 BD OD
pd = 0. 7 (-7.50) = 5.25 BD OS
5.25 -2.8 = 2.45 BD OS
given that the patients’s bifocals are properly aligned and adjusted what is causing his double vision? how to resolve this?
when the patient looks down through the bifocal portion of lenses, a vertical imbalance is created caused by his anisometriopia resulting in diploia.
to fix it add slab off prism to the most minus lens (or least plus) because minus lenses are the thicker at the edges. Slab off prism is BU and this minimizes the thickness differences between the edge and center of the lens
what is reverse slab off
adding BD prism over the more + eye to help decrease the vertical imbalance
what does increasing panto do the prescription?
increase the sphere power and increase astigmatism in the same axis of rotation. induced astigmatism will have the same sign as the sphere. ex if (+) sphere -> induces more (+) sphere and and (+) cyl
ex. face wrap induce astigmatism in 90 axis
panto induces sphere in the 180 axis
is lasik a good option for those with anisometropia?
yes
what describes the most likely origin ode holenhorst plaques come from?
carotid bifurcation
what tests should you do for a holenhorst plaque ?
FBS + lipid panel
carotid artery ultrasound
electrocardiogram
50-90%
what is this?
hx. painful, blurry vision, deep ache
cataract surgery 2 days ago
Seidel sign leading to hypotony
what is hypotony?
low IOP
can occur secondary to trauma, eye surgery (usually glaucoma), uveitis, RD, pharmacologic (CAI + B blocker), vascular occlusive disease
dehydration , myotonic dystrophy
what is Posner schlossman syndrome?
= glaucomatocyclitic crisis
recurrent unilateral rise in IOP (40-60) with minimal intraocular inflammation
- ciliary flush
slug/dialted pupil
mild Ac run
how do you treat hypotony caused by a small leak secondary to eye surgery?
pressure patching - if would fails to be closed after pressure patching -> suture
what is this?
phthiriasis
what is phthiriasis?
caused by pubic crab lice
- might see small brown deposits on the lid margin (feces), dried blood, circular clear nits (eggs), might see them on the eyelashes.
- focclicles, pre auricular lymphadenopathy , marginal keratitis (extreme cases)
what is pediculosis pubis?
also like phthirus, but more mobile. ie. moves to scalp and other hair bearing structures
pthirus transmission
due to over-crowding ( must in close contact), or poor hygiene
- in a child -> look for sexual abuse
treatment of pthirus
mechanical removal of all nits and lice -> place on alcohol
bacitracin post removal
all clothes, towels, bedding msuct be washed and dried in high heat then sealed in a bag for 14 days. let any sexual partners from previous know
refer to PCP b/c it is a sexually transmitted disease
basic esophoria
eso at D & N , equal in magnitude or within 5 PD
avg Ac/A
decreased (-) fusional vergences at D and n
Ac/A ratio
excess -> high Ac/A ration
basic - average
insufficiency -> low Ac/A ratio
Average - 3-5
help us determine if magnitude of (+) lenses will help. higher the Ac/A the more effective lenses will be
calculating Ac/A = PD(in mm) + wd(in m)*(near-distance phoria)
ex 2/1 ratio = Ac/A -> rxing 1 D will change the phoria by 2
red lens + light suppression
- ideally want to see pink light or 2 lights
suppression at 40 cm = peripheral suppression
suppression at 6 = central suppression
suppression in moderate light, but not dim = shallow
suppression in dim = deep
what is this? why does it occur?
PPM
due to failure of the fetal fissure to atrophy
what is this?
lattice dystrophy
what is lattice dystrophy ? Inheritance?
Stroma
what is this
epicapsular stars
what are epicapsular stars
what is posterior polymorphous dystrophy? Prognosis? Treatment? Complication?
what is this?
posterior polymorphous dystrophy?
what is this?
conjunctival nevus
what is this?
melanocytoma
what is this?
conjunctival melanocytoma
what eye?
OS
what eye?
OD
where is the lesion if you see a complete homonymous hemianopic VF defect?
cannot determine
CVA
patients that went through a stroke will have VF loss contralateral to the stroke and hemiparesis contra to the stroke
warfarin MOA
inhibits the synthesis of vitamin K dependent clotting factors
patient has pseudo-exfoliation syndrome
or excessive glare
+ acute angle closure
acute angle closure - lens can move forward
IOP in pseudo exfoliation?
undergoes large fluctuations
macolides
erythromycin
azithromycin
bind 50 s subunit of lysosomes
in kids what condition is usually observed with bacterial conjunctivitis ?
otitis media
Lyme disease treatment
doxy, tetra, or amoxicillin
if allergic erythromycin
aminoglycosides
tobramycin
gentamicin
neomycin
inhibit protein synthesis of bacteria and create openings in their cell membranes
what infections do you report to the CDC?
syphilus
gonorrhea
chlamydia
what is this?
marginal keratitis
what is phlyctenulosis?
small white nodules at the limbus
associated with corneal epithelial ulceration , can migrate into the central cone leaving corneal scarring and neo behind the leading edge of the phlyctenule
what is thygesons spk?
chronic bilateral condition with exacerbations and remissions
macropunctate grey-white corneal epithelial opacities that look slightly elevated and stain centrally with NaFL
- no other inflammatory signs noted
what is this?
thygesons spk
what organisms can penetrate an intact corneal epithelium?
gonorrhea
corneabacteium diptheriaw
n meningitdis
listeria
shigella
how do you treat marginal keratitis
treat the blepharitis + steroid (if symptomatic)
if the marginal keratitis was left untreated what would happen?
it would resolve
variable tranaglyphs training
= vectrograms
target becomes larger as it moves father away (divergence)
target becomes smaller and moves closer to the patient (convergence)
SILO
if see opposite , means parent is using apparent cues and not vergence cues
prism needed in order for comfortable binocular vision
2/3 phoria - 1/3 compensating fusion mergence they have
treatment for eso at distance
BO prism is the best
hard to do Vision therapy
calculate the mergence demand of a vectrogram
demand = target separation in cm/ training distance in meters
DEM analysis
low score vertical test - indicate problem with naming numbers (automaticity)
low score on horizontal (trouble with automaticity or oculomotor)
- normal ratio: problem is automaticity
- abnormal ratio (large ratio- worse on horizontal than vertical - problem is both automaticity and oculomotor)
48 YO AA female
blurry distorted vision OU (straight lines appear wavy OS)
polypoidal
what systemic condition is associated with polypoidal and can increase its severity
HTN
how to manage/test polypoidal?
ICG - affects choroid
which population has the highest predilection for polypoidal?
do allergies cause palpable nodes?
no
completing a cls residency
what is this
Terrien’s marginal degeneration
when can you do corneal cxl
35 or younger
max K under 65
corneal thickness greater than 400
VA 20/30 or worse
what is the double Maddox rod test
what is parry Romberg syndrome?
what is this?
BRAO
which is more common BRAO or CRAO?
CRAO more common
are temporal or nasal arteries more frequently involved in BRAO?
temporal
BRAO prognosis
serveral days have passed since the onset of symptoms - so irreversible damage has occurred.
if occur acutely should be considered an ocular emergency - 90-120 mins to cause permanent damage
- tx: ocular massage , anterior chamber paragenesis , acezolamide to decrease IOP, hyperventilation (acidosis )
what is a cluster HA? Symptoms? Duration? Association? Trigger?
extremely intense unilateral pain located orbital, supraorbital to temporal.
- feels like a red hot poker inserted into the eye
- duration of each attack 15-18 mins and occur several times a day at a precise time
- associated with mild ptosis, miosis, injection, lacrimation, and runny nose ipsilateral
- occur for a period of several weeks followed by a free period lasting weeks, months, or years. small % can be chronic
- associated with Horners
- alcohol and nitroglycerin can promote the HA
why does a cluster HA occur?
hypothalamus causes the wall of the cavernous sinus to become inflamed -> triggering the trigeminal nerve
aslo involves the sphenopalatine ganglion - why you get tearing and a runny nose.
how do you treat a cluster HA?
oxygen therapy
why shouldn’t aspirin be used in kids?
Reye’s syndrome
what is reye’s syndrome?
fatal condition, affects all organs due to abnormal accumulation of fat along with a severe increase in the pressure in the brain.
what is Raynaud’s syndrome?
what is Steven- Johnson’s syndrome?
