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AOptometry > Optom General > Flashcards

Optom General Flashcards

1
Q

Prevalence of glaucoma in Oz by age

A

1.8% in those <60 years,

3.0% in those aged 60–69 years,

4.2% in those aged 70–79 years and

6.7% in those aged ≥80 years

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2
Q

Near phoria: normal ranges

A

1eso - 4exo

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3
Q

Near BO ranges

A

30/25 break/recovery

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4
Q

Near BI Ranges

A

12/10 break/recovery

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5
Q

NPC jump

A

10cm, held

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6
Q

Accommodation flippers norms

A

Flippers Clears -3.50 and +2.00 Cycles on +/-2.00

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7
Q

AC/A normal

A

3:1

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8
Q

Distance vergence norms

A

5BI and 15BO

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9
Q

Gls to CL’s. What are the effects on acc/verg?

A

Exo shift and more acc required (inc lag) for myopes

Vice Versa for Hyperopes

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10
Q

Premyopes (High risk of developing myopia) have…

A

Higher AC/A ratios Greater variability in accommodative responses.

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11
Q

I-Care tends to…

A

Overestimate at low IOPs and vice versa

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12
Q

CTT less than…. is a risk factor for POAG

A

555um

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13
Q

What % of OHT develop POAG?

A

9.5%

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14
Q

VF indicies must be below this percentage to be reliable…

A

FL < 33%, FN and FP <20%

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15
Q

Sensitivity v Specificity

A

Sensitivity is the ability of a test to correctly identify those with the disease (true positive rate)

Specificity is the ability of the test to correctly identify those without the disease (true negative rate)

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16
Q

Amblyopia Tx in 3-6yo. What to tell parents.

A

Average improvement is 3logMar lines for both moderate and severe amblyopia.

Tell parents 80% achieve maximum acuity by 4/12; 97% by 8months;

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17
Q

Amblyopia Tx in 7-17yo. What to tell parents.

A

Average improvement is 3logMar lines for both moderate and severe amblyopia.

Tell parents Max acuity achieved (ie. ~3lines improvement or >= 6/7.5) in 83% by 10wks (2.5months); 97% by 20wks (5months).

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18
Q

moderate v severe amblyopia and tx;

A

Moderate amblyopia ie. 6/12 – 6/30 -> 2hrs patching/day or weekend atropine

Severe Amblyopia ie. >6/30 – 6/120 -> 6hrs patching/day or daily atropine

Prescribe near activities ie. Colouring, reading etc.

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19
Q

recurrence rate for moderate amblyopia.

A

25% of mod amblopyia that is txed will recur

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20
Q

optical correction alone is enough in what percentage of 7 to 17yo?

A

optical correction alone is enough in 25% of 7 to <18yo.

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21
Q

ipen results

A

ipen results: Mild: 300-320; Moderate 320-340; Severe 340+

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22
Q

Monash Eye Centre (public system)

A

search: Ophthalmology - monash health; click on referral guidelines

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23
Q

Shanisha smith’s parents?

A

Paulina and jason

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24
Q

What does MPS 1 stand for?

A

Mucopolysaccharidosis Type 1

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25
Q

MPS1 criteria for suspicion?

A

Widespread stromal corneal dystrophy in children and adolescents

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26
Q

MPS1 in absence of corneal clouding can still be suspected if child has at least two of…

A

Papilloedema, optic atrophy, pigmentary retinopathy

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27
Q

Fabry disease main criteria for suspicion

A

Corneal verticillata: eccentric corneal scar.

Does not usually affect vision.

Yellowish brown colour

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28
Q

Fabry disease lesser criteria

A

in the absence of verticillata, at least two of…

anterior cortical cataract

retinal vascular lesions: retinal vascular tortuosity at posterior pole

conjunctival vascular lesions: tortuosity or MA in conj vessels.

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29
Q

If suspect MPS1 or Fabry disease refer to…

A

Metabolic Specialist: Dept of Nephrology, Royal Melb Hospital

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30
Q

mean CCT in normal v keratoconus

A

Normal: 550um +/- 35

Keratoconus: 448 +/- 58

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31
Q

Osmolarity cut-off

A

>=317mOsmol/L

Sensitivity : 96%

Specificity: 67%

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32
Q

NIBUT cut-off

A

<=5s

Sens: 95.9%

Spec: 90.8%

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33
Q

Rate of DR within 20 years?

A

Almost all type 1 diabetes and more than 60% of type 2 diabetes will develop diabetic eye disease within 20 years of diagnosis.

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34
Q

Rate of >40yo with DM+ who have DR?

A

almost one-third (29.1%) of Australians with diabetes

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35
Q

SES: Sagging eye syndrome prevalence?

A

SES: Sagging eye syndrome.

~25% of >60yr old w diplopia have SES (Sagging eye syndrome) as cause of their diplopia.

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36
Q

SES: Sagging eye syndrome signs/sx’s?

A

Sx: Acute/Chronic horizontal/vertical diplopia.

Non-commutative version (looking diagonally to the up/left or up/right) is higher than a consecutive version (looking left the up or right then up).

divergence paralysis” esotropia for distant targets

SES may asymptomatically and symmetrically reduce supraduction

Bilaterally asymmetrical LR pulley sag results in hypotropia and excyclotropia of the eye with the greater sag, causing symptomatic cyclovertical diplopia

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37
Q

how does BP affect risk for glaucoma?

A

low BP and long term high BP are risk factors for glaucoma

don’t just ask about hypertension

understand BP duration, severity and medical therapy

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38
Q

WHat are two modifiable factors to reduce risk of glaucoma?

A

Diet, exercise are modifiable factors

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39
Q

alpha and beta zones difference.

A

Parapapillary atrophy can be differentiated into an outer “alpha” and inner “beta” zone that borders the optic disc. The outer alpha zone may be characterized by irregular hypo- and hyperpigmentation, followed by the inner beta zone, which reveals sclera at the optic disc border as well as large visible choroidal vessels.

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40
Q

what is the significance of beta zone in glaucoma?

A

Glaucoma is associated with a larger beta zone compared w normals.

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41
Q

Evaporative dry eye is a feature in what % of DED?

A

86%

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42
Q

Grading MGD expression

A

Grade0: clear fluid expressed
Grade1: greasy, slgithly turbid fluid expressed.

Grade2:opaque expression

Grade3:semi-solid substance expressed
Grade4:waxy substance if anything at all expressed

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43
Q

When to refer for tropias reference location?

A

dropbox SRC 2019 Day 1 Session 1.8

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44
Q

Birth to <3mo ocular development

A

Horizontal Saccades

Vertical Upgaze

Pursuits 12deg object, slow moving

Fixation/saccade to face

OKN

VOR (Vestibular ocular reflex)

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45
Q

What is standard parameters for Frame Fit for Zeiss?

A

PT 9

Wrap 6.5

BVD 12

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46
Q

Zeiss MF’s Frame Fit parameters req’d for the designs…

A

Superb and Individual

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47
Q

Pure comes in corridor lengths of …

A

10

12

14

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48
Q

Pure Plus comes in corridor length of …

A

10 to 16

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49
Q

Individual comes in 3 designs which are…

A

Balanced (dist bias)

Intermediate bias

Near bias

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50
Q

What is Zeiss luminous technology and which lenses have it?

A

Takes into account large pupil size for night time

Drivesafe and Individual have it

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51
Q

If rx is plano, +2.00 Add and p uses VDU a lot then use zeiss…

A

Superb/Individual as will give wider Int

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52
Q

What is the Dye Disappearance Test?

A

Instil NaFl in both eyes and check for drainage after 5min. (especially obvious if unilateral blockage)

If not draining then do irrigation to check for blockage.

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53
Q

Causes of Epiphora

A

PLOPCDN
Overproduction: Dry eye/Exposure

Poor Drainage: Conjunctivalchalasis

Lids

Punctal Stenosis

Canaliculitis

Dacryocystitis

NLDO

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54
Q

the 2 categories of tear deficiency?

A

Sjogren’s and Non-Sjogren’s

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55
Q

2 categories of Sjogren’s

A

Primary and Secondary

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56
Q

4 Categories of Non-Sjogren’s

A
  1. Primary lacrimal gland deficiency
  2. Secondary lacrimal gland deficiency
  3. Obstruction of lacrimal gland ducts
  4. Reflex Hyposecretion
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57
Q

2 Caterogories of Evaporative dry eye

A

Intrinsic and Extrinsic

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58
Q

Sjogren’s profile and Dx

A

91% Female av age 51

Dx: any 2 of…

Postiive Blood Test

Ocular Staining Score >=3 (SICCA)

Salivary Gland Biopsy

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59
Q

4xIntrinsic causes of evap DED

A

Intrinisic: picture arrow pointing INto..
1. MGD… Meibomian Gland
2. Disorders: expand gland to look like a messy and disorderly room
3. Low: MG filled with Meibum but has flashing sign saying low.
4. Drug: needle sticking into MG injecting drug.
MGD, DisLoD

  1. MGD
  2. disorders of lid aperture
  3. Low Blink Rate
  4. Drug Action: Eg Accutane
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60
Q

4x Extrinsic causes of DED

A
  1. Vit A deficiency
  2. Topical Drugs Preservative
  3. CL Wear
  4. Ocular Surface Disease Eg. Allergy
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61
Q

What is the rate of PCO following cat surgery?

A

~20%

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62
Q

Jones 1 Test

A

Check difference in drainage of NaFl after 5min

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63
Q

Lacrimal lake should be…

A

~1mm is normal

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64
Q

LG method

A

Examine eye immediately after LG instilled.

Make sure to get p to blink several times

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65
Q

SICCA Ocular Staining Score. Scoring system for cornea is…

A

Cornea:

G0:0

G1: 1-5

G2: 6-30

G3: >30

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66
Q

SICCA Ocular Staining Score. Scoring system for LG conjunctiva…

A

G0: 0-9

G1: 10-32

G2: 33-100

G3: >100

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67
Q

SICCA Ocular Staining Score. Scoring system for extra points:

A

cornea only: +1 for each of…

  • patches of confluent staining
  • staining in pupillary area
  • 1 or more filaments
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68
Q

DED % breakdown into type

A

35% EDE

10% ADDE

25% both

30% neither

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69
Q

Red lid margins give…

A

Hycor ointment

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70
Q

DED w red eyes give…

A

FML qid for 2wks, then bid for 4wks. Rev at 2wk and 6wk mark.

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71
Q

for scleral fits, aim for PLTT (post lens tear thickness) of…

A

immediately: 200um

after 30min: 150um

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72
Q

floppy eye lid syndrome is associated with…4things

A

obesity, obstructive sleep apnea, Down syndrome, and keratoconus.

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73
Q

Moisture chamber goggles can be used for… 6things

A

nocturnal lagophthalmos,

compromised lid seal,

floppy eye syndrome,

recurrent corneal erosions,

air travel,

CPAP eye protection.

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74
Q

WWOP Mx:

A
  • rev 1-2yrly depending on risk
  • rev 6/12ly posterior borders scalloped and extensive vitreous degeneration.
  • p’s in 40s/50s, have increased risk of associated retinal breaks and detachment because of increased vitreous liquefaction and/ or vitreous detachment (PVD).
  • high myopia is a risk
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75
Q

Risk factors for DR

A

Chol

BP

Insulin

pregnancy

renal disease

Indigineous/non-english speaking background

retinal arteriorlar tortuosity

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76
Q

Infants >3mo norms

A

FiVeS-Co

Fixation to: lights, visual/auditory objects

Vertical downgaze

Saccade to penlight

Co-ordinated head-eye movents

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77
Q

eye movements that are abnormal at any age… x3

A

Asymmetries in…

  1. binocular OKN
  2. Smooth Pursuits
  3. Nystagmus
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78
Q

What % of OSA have NTG?

and vice versa?

A
  1. 7%
  2. 7%
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79
Q

Conjunctivalchalsis mechanism

A

Friction->exposure-> Inflamm->worse reflex tearing

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80
Q

Conjunctivalchalasis tx

A

drops, steroids, surgery

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81
Q

Congenital NLDO is estimated to occur in …% of infants? and usually resolve in…?

Mx?

A

Congenital NLDO is estimated to occur in 20% of infants and most commonly resolve in 1 year.

If doesn’t resolve by 6mo then refer for NLD probing.

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82
Q

3 Possible outcomes of lavage if open…

A

• BLOCKAGE NOT PRESENT AND ANOTHER CAUSE OF

EPIPHORA SHOULD BE EVALUATED
• BLOCKAGE WAS RELEASED DURING lavage

• POSSIBLE FUNCTIONAL BLOCKAGE

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83
Q

Outcomes of lavage if blocked…

A

DIFFICULTY DEPRESSING PLUNGER OR FLUID MAY REGURGITATE FROM INFERIOR OR SUPERIOR PUNCTA

  • INFERIOR REFLUX: INFERIOR CANALICULUS BLOCKAGE
  • SUPERIOR REFLUX: COMMON CANALICULUS OR LACRIMAL

SAC

• IF THIS OCCURS, PRESS SUPERIOR PUNCTUM AGAINST ORBITAL RIM TO OCCLUDE AND IRRIGATE AGAIN

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84
Q

What is a functional block of drainage?

A

FUNCTIONAL BLOCKAGE

  • PATENT SYSTEM UNDER HIGH-PRESSURE IRRIGATION
  • PATHWAY COLLAPSES UNDER LOW-PRESSURE SITUATIONS

OF NORMAL TEAR DRAINAGE

• JONES DYE TESTS USED TO HELP DIFFERENTIATE FUNCTIONAL BLOCKAGE VS. PATENT SYSTEMS -> refer if suspect functional block.

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85
Q

If questioning by non-eye care professionals suggests DED, but recommended treatments do not result in a marked improvement in symptoms within…, a detailed eye examination is recommended.

A

about a one-month period

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86
Q

staining procedures results +ve for DED…

A

nafl: >5 corneal spots (view after 1min)

LG: >9 conj spots (view after 1min)

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87
Q

LWE procedure and outcome

A

LG: 2drops per strip x2;

+ve is >=2mm length and/or

>= 25% sagittal width

view after 3min

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88
Q

Diff Dx of disc edema and pseudopapilledema…

A

+ve is OCT nasal RNFL > 86um,

gives 80% sens and spec

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89
Q

Triaging Q’s for dry eye x9

A

Six Dioptres of Long Vision in One eye. It Can Grow Muck

  1. How severe is the eye discomfort?
  2. Do you have any mouth dryness or swollen glands?
  3. How long have your sx’s lasted and was there any triggering event?
  4. Is your vision affected and does it clear on blinking?
  5. Are the sx’s or any redness much worse in one eye than the other?
  6. Do the eyes itch, appear swollen or crusty, or have given off any discharge?
  7. Do you wear CL’s?
  8. Have you been Dx’d with any GH conditions (incl recent respitory inf) or
  9. are you taking any meds?
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90
Q

ipen how to use:

A

close eyes for 30s, depress just 2-3mm below lid margin at angle of 30deg.

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91
Q

The normal spontaneous blink rate is…

A

reported to occur from 10 to 15 blinks per minute

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92
Q

OSDI Scoring

A

Normal 0-12

Mild 13-22

Moderate 23-32

Severe 33-100

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93
Q

TNO cut off

If fails then implies…

A

240” ie. Test Plate V

If fails -> possible amblyopia/squint

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94
Q

Titmus Norms

A

5yo 70-100”

6yo 40”

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95
Q

Titmus Wirt rings Number and disparity

A
  1. 800 2. 400 3. 200
  2. 140 5. 100 6. 80
  3. 60 8. 50 9. 40
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96
Q

Anterior Chamber Angle Structures x5

A

Schwalbe’s line

Anterior TM (non-pigmented)

Posterior TM (pigmented)

SS

CB

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97
Q

Shaffer Grading system for gonio

A

G0: Closed Schwalbe’s line not visible

G1: Schwalbe’s line visible

G2: Ant TM visible

G3: SS visible

G4: Ciliary band visible

G0+G1: high risk

G2: Medimum risk

G3-4: lower risk

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98
Q

PXF risk for glaucoma

A

50% eventually develop glauc

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99
Q

3 things that differentiate allergic from DED

A

CONEYECON

conjunctival chemosis,

eyelid edema

conjunctival papillae

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100
Q

allergic rhinitis is present in more than what % of ocular allergy cases

A

80% of ocular allergy;

but is not a symptom known to be associated with DED

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101
Q

Other findings frequently detected in ocular allergy include…3things

A

“Family atop as”

family history,

atopic dermatitis

asthma

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102
Q

For px’s taking oral antihistamines be aware that….

A

AntiH can cause dry eye -> reduced tear volume -> more allergans -> more ocular allergy.

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103
Q

Prescribing Add for accomm lag:

Mx for the following flipper/MEM results…

A
  1. Fast to clear -3.50/-2.00 and MEM+1.25/+1.50 -> no add req’d.
  2. slow/fail -3.50 + fast -2.00 + MEM(+0.50 to +1.50)
    - > Rev 6/12ly watch for decomp
  3. slow/fail -3.50 and -2.00 + MEM(+1.25/+1.50)
    - > needs add
  4. MEM >= +1.75 (give Add)
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104
Q

normal accommodative lag falls between …

A

normal accommodative lag falls between +0.50 and +1.00 inclusive,

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105
Q

accommodative facility vision training (VT)…

A

reading through plus/minus flippers for 20 minutes per day, flipping every sentence to challenge the accommodative response to demand (use +/-2 Flippers)

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106
Q

key differentiating findings b/w DED and GPC

A

include large upper tarsal papillae and hyperemia with usually minimal corneal or bulbar conjunctival involvement

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107
Q

Optos channels. Red is for… Green is for…

A

Red is for choroid.

Green is for sensory retina

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108
Q

What is FAF?

A

Autofluorescence imaging is a brightness map reflecting the distribution of lipofuscin and other ocular fluorophores and reflects how the RPE is functioning

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109
Q

FAF: hyper/hypo fluorescence indicates…

A

 Hyperfluorescence indicates metabolic compromise, “sick” RPE under stress  Hypofluorescence indicates dead or absent RPE

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110
Q

Krimsky what and how…

A

Quantify Hirschberg test when squint present.

Place increasing prism powers in front of fixating eye so that both eyes have symmetric hirschberg reflexes. This gives estimate of magnitude of deviation.

For esoT, use BO prism.

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111
Q

Bruckner Test how to…

A

Use ophthalmoscope at 1m in dark room.

Don’t use if <8months old.

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112
Q

Visuoscopy: When to use and how…

A

If suspect microtropia

Shine grid on child’s hand and ask to touch the center.

MUST occlude other eye

Dim ophthalmoscope.

Sometimes easier if dilated.

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113
Q

Grading of ACR

A

G0 = zero

G0.5+: 1-5

G1+: 6-15

G2+: 16-25

G3+: 26-50

G4+: >50

114
Q

optic disc hemorrhaging Diff Dx…

A

P-HOARD

Numerous other conditions, such as Posterior vitreous detachment, hypertension, optic neuropathy, anemia, retinal vascular disease, diabetes.

115
Q

what is the significance of seeing a Disc Haemorrhage? 2 points.

A
  1. The observation of a disc hemorrhage should prompt a thorough investigation for glaucoma, and individuals with disc hemorrhages should be considered glaucoma suspects.
  2. In individuals with known glaucoma, a disc hemorrhage may be a sign of active disease and progression. Thus, while a disc hemorrhage does not need to be treated, per se, its presence may signal the need to initiate or intensify IOP-lowering therapy.
116
Q

A study at University of Tokyo found that Disc haemorrhages have a prevelance of…

A
  1. 4% in normals
  2. 5% in low tension glaucoma
  3. 2% in POAG
117
Q

PDS % that become OHT/Glauc?

A

PDS 30% become OHT/Glauc

118
Q

AKC v DED?

A

C-PACKS

Conjunctivitis (potentially cicatrizing),

Periorbital eczema,

Anterior polar cataracts

Corneal neovascularization that could lead to eventual conjunctivalization of the cornea,

Keratoconus

Symblepharon

119
Q

Types of RD

A

Rhegmatogenous and

non rhegmatogenous

120
Q

Types of non-rhegmatogenous RD

A

Tractional: Scar-related, Vitreo-retinopathy

Exudative: Mass, inflamm, posterior scleritis

121
Q

Types of rhegmatogenous RD

A

Atropic Holes: retinal thinning

Retinal Tears: Vitreous traction -> Operculated or flap tears

122
Q

How to measure magnitude of Strab?

A

ACT and prism over the non-fixating eye to neutralize.

123
Q

simultaneous prism cover test: how and when to use…

A

how: place neutralizing prism over non-fixating eye while covering the fixating eye simultaneously. Do so briefly to prevent dissociation.
when: Only used to measure small angle tropias

124
Q

VKC v DED

A

Vernal keratoconjunctivitis (VKC) signs…

Same: Rapid fluorescein breakup time, SPK associated with sodium fluorescein staining and increased conjunctival lissamine green staining

PIECoB

Diff: intense Itching, Burning, Epiphora, Conjunctival injection and Photophobia

MaCHS

VKC: younger Male patients most notably those under age 18

large Cobblestone papillae and/or

Horner-Trantas dots

Shield ulcers and scarring

125
Q

RD v Retinoschisis:

location, Commonest location

Appearance, Refractive error

Monocular/bilateral

Tobacco dust, flashes & floaters

Associated field defect

A

Location: Neurosensory retina separates from RPE v Within neurosensory retina between inner/outer layers
Commonest location Superior temporal v Inferior temporal
Appearance
Rippled, irregular, drifts with eye movements v Smooth, shiny, stationery
Refractive error Myopes over-represented v 70% in hyperopes
Monocular/bilateral Tends to be unilateral (or at least one eye at a time) v
Tends to be bilateral
Tobacco dust, flashes & floaters: Present v Absent
Associated field defect Relative, progressive v Absolute, stable

126
Q

If Pass TNO then…

A
  1. rules out constant strab
  2. If intermittent strab then implies good sensory fusion when straight
127
Q

Viral Conj v DED

A

MUCO

Morning crusting is also common.

recent Upper respiratory tract infection

close Contact with someone with a red eye.

redness and irritation in One eye initially, often spreading to the fellow eye within a few days.

PreWERM

Preauricular lymphadenopathy is also commonly present, watery, edematous, red lids, mucoid discharge

128
Q

For atrophic holes…

more likely to refer if…

A

SOMSS

Significant sub-retinal/serous fluid (say more than one disc diameter)

overlying vitreous on edges of the hole

More highly myopic patient,

symptomatic,

superior location

129
Q

For atrophic holes…

less likely to refer if…

A

PIG-HOLE

Pigmentation evident around edge of hole

Hole has been present for longer time

130
Q

Atrophic hole v Operculated Tear v Flap tear..

Shape

Vitreous Traction

Retinal or vitreous haemorrhages

Sx’s

Incidence of detachment

Referral/treatment

A

Atrophic hole v Operculated Tear v Flap tear

Shape: Round or oval v Round, disc-shaped operculum floating above
v U-shaped with central flap
Vitreous traction None v
Initially created the break, but absent once the operculum has separated
v Usually continuous
Retinal or vitreous haemorrhages
Never v Rarely v Often
Symptoms
Only if clinically significant detachment v
Possible in traction phase, or if clinically significant detachment v
Frequent in traction phase
Incidence of detachment Uncommon but possible v

1 in 6 (less if asymptomatic) v 1 in 3
Referral/treatment :
Generally monitor, but refer if symptomatic or significant localised detachment v Generally monitor, but refer if symptomatic or significant localised detachment
v Always refer promptly, treat with barrier laser

131
Q

What 3 Peripheral degenerations are associated with retinal detachment in high myopia

A

Lattice degeneration,

white without pressure and

posterior vitreous detachments

132
Q

Lattice Degen:

Occurs in…

w/ PVD -> incr risk of RD up to ….%

Mx: Refer if…

A

occurs in young/myopic eyes, 6-10% of normal pop

40% risk

refer if Flashes/floaters else annual review.

133
Q

OPTOS WWOP is more apparent on…. channel

A

green

134
Q

x2 Benign peripheral retinal degen…

A

snowflake/microcystic degen

Reticular/Honeycomb degen (common in elderly)

135
Q

Tip for Diff Retinoschisis v RD

A

Get 90D and shine a v small light on affected area.

If can’t see it then it is schisis

136
Q

EKC sx’s and signs.

A

EKC is when adenovirus invades cornea -> corneal infiltrates -> irritation/pain/vision blur lasting months/years.

Periorbital edema and inflamm which may involve EOMs.

Early stage has PAN on ipsilateral side of red eye, 1wk later corneal infiltrates start.

137
Q

CHRPE:

Significance

Appearance

Results in…

Association…

A

Congenital Hypertrophy of the Retinal Pigment Epithelieum (CHRPE)
Significance: Common benign lesion
Can appear as pigmented, with lacunae, or become depigmented over time
Result in RPE defects
Association of CHRPE-like lesions with familial links to bowel cancer (FAP)

If see 4+ CHRPE then screen for cancer.

138
Q

Choroidal naevi

Incidence

Rate that transform into melanoma?

A

Choroidal naevi
Incidence of choroidal naevi in Caucasians estimated to be 5-8%, in Asians 1.5%
1 in nearly 9,000 naevi transform into melanoma

139
Q

Choroidal Melanoma Mneumonic

A

Choroidal Melanoma – “To Find Small Ocular Melanoma Using Helpful Hints Daily”
Thickness >2mm
Fluid (sub-retinal)
Symptoms
Orange (lipofuscin) pigment
Margin within 3mm of disc
Ultrasonic Hollowness
Halo absent (unlike naevus)
Drusen absent

140
Q

Choroidal Nevus/Melanoma/CHRPE

seen on…

Red/Green/AF?

A

Red: All visible

Green: All visible except nevus

FAF: Nevus: not visible except drusen

Melanoma: Hyper/Hypo

CHRPE: Black

141
Q

Birdshot Choroiditis. What is it?

A

inflamm of choroid

small, yellowish choroidal spots and vitreous inflamm

FAF shows hyper spots

142
Q

MEWDS: what is it?

A

Multifocal Evanescent White Dot Syndrome

White dots in deep retina caused by inflamm

FAF shows hyper dots in central and peripheral retina.

143
Q

W4D response of 4dots seen indicates…

A

normal fusion or AC

to differentiate, do UCT while p fixates white dot (tell p to look by position rather than colour). If there is refixation of either eye on covering fellow eye -> Strab+AC

If no mvt then normal fusion.

144
Q

PCF

What is it?

Signs/Sx’s

A

Pharyngoconjunctival fever: Caused by adenovirus

acute high fever, pharyngitis, bilateral follicular conjunctivitis, PAN

Often in children and those living in close quarters

Self-resolves in 1wk

145
Q

Uveitis and FAF

A

Areas of hypo and hyper can be seen

146
Q

How long does it take to reach end-stage for glaucoma?

A

Most are slow taking 20years.

~10% are fast and takes 10years.

147
Q

Retinal Toxicity 3 drugs and FAF

A

Hydroxychloroquine

Didanosine (HIV drug)

Thioridazine (Schizophrenia)

FAF shows hyper ring around macula

148
Q

Detecting VF progression. 3main changes in order of frequency…

A

Deepening > enlargement > new defect.

149
Q

If (diastolic BP - IOP) < …. then high risk of glaucoma progression

A

50

150
Q

Should decisions on VF progression be made by comparing only the most recent VF with the one before?

A

No

151
Q

VF Baseline Testing protocol…

A

Baseline Data –first 2 years –At least 2 reliable VF within the first 6 months • 3 within first 6 months when there is a high likelihood of visual disability –

At least 2 further VF within the next 18 months –VF testing should be repeated sooner than scheduled if possible progression is identified –SIX VF within the first 2 years allows the clinician to identify rapid progression

152
Q

After 2yrs VF frequency should be… in low/moderate risk and high risk px?

A

In low‐and moderate‐risk: yearly

(Sooner if possible VF progression –OR‐on other clinically tests)

high risk: 6monthly

153
Q

What is event analysis?

A

Event analysis (EA): change from baseline greater than a predefined threshold based on test‐retest variability according to the level of damage

154
Q

What is Trend analysis?

A

Trend analysis (TA) (VFI): rate of change over time; significance is determined by both the magnitude of change and the variability of the measurement

155
Q

When to use Event Analysis?

A

In general, event analysis is used for follow‐up when fewer VF are available –When suspected progression is identified, at least TWO further tests should confirm that

156
Q

When to use trend analysis?

A

In general, trend analysis (rate) is used

later in the follow up (later than 2 years)

157
Q

Event Analysis Pearls…

A

About 5% chance that a single point will fall outside the expected change on a single test –Much less likely that same point will do the same in a subsequent test

If point is in same region of VF as existing defect –much more likely to be “real” change –Point in central 10 degrees exceeding expected change is much more likely to be “real” change

158
Q

Prostaglandin Analogs (PGAs) •

Mechanism of action:

Effect:

Dosing:

Side effects:

A

Prostaglandin Analogs (PGAs)

Mechanism of action: increase uveosceral outflow

Effect: excellent (25-35% reduction)

Dosing: once daily (doesn’t matter am/pm)

Side effects: – Minimal systemic

Ocular: (3Hyper-Deep)

Hyperemia • Hypertrichiasis •

Hyperpigmentation –iris and periorbital skin •

deepening of upper eyelid sulcus

159
Q

When to reconsider using PG?

A

• When to reconsider: ACUPUN

Acute rise in IOP

CME Hx or risk of CME (ok in DM+)

Unilateral therapy

Pregnancy

Uveitic glaucoma (???)

Neovascular glaucoma (???)

160
Q

If VF progression then must consider cause….

optical is more likely if…

A

Optical explanation MORE LIKELY if…

No increase in PSD, in cases where MD is better than -10dB

161
Q

New baseline VF’s when…

A

target IOP is adjusted or

significant change in therapy

Last 2 tests that confirmed progression can be

new baseline exams

Frequency of testing needs to increase again

162
Q

Which VF indicies if high, them must discard test?

A

False Positives.

163
Q

GPA can’t be used once MD gets to…

A

~20

164
Q

beta blockers

action:

Efficacy

dosing

side effects

A

beta-adrenergic antagonists (beta blockers) •

Mechanism of action: decrease aqueous production •

Efficacy: very good (25-30% reduction)

  • Dosing: once vs twice daily
  • Side effects: – Minimal ocular side effects –

Systemic: • Bradycardia • Bronchial constriction •

** CHECK EXISTING MEDS, VITALS •

Short term escape (days-weeks)

& long term drift (months-years)

165
Q

Bacterial Conjunctivitis

A

More or Less a wet uni more

More Common in children

Less common v viral/allergy

Wet DC v dry and crusty esp in morning (matted lashes)

Unilateral or bilateral

More conjunctival injection v DED/viral

166
Q

Beta-Blockers: when to use…

A

When to use: – First line therapy for patients with

contraindications to prostaglandins

– Need rapid lowering of IOP –

Cost (generic is cheap) –

Added drug for prostaglandin users •

Different mechanism of action •

167
Q

Beta Blockers When to reconsider…

A

When to reconsider:

  • Heart Disease
  • Pulmonary Disease Eg. Asthma

– Patient on oral bb (+/-)?

– Normal tension glaucoma

(may reduce perfusion to ON)

168
Q

Beta blockers: available drugs

A

–timolol maleate (Timoptol, Timoptol-XE)

non-selective (better option) 29% reduction

–betaxolol(Betoptic, BetoQuin) 26% reduction

selective beta1 receptor blocker

fewer systemic side effects not causing

bronchospasm.

169
Q

Accommodative Insufficiency Mx

A

Correct even small refractive errors as even small amounts can cause fatigue.

Correcting differences b/w eyes recovers normal accomm-verg in 63% of cases.

Give ADD

170
Q

ONH Hypoplasia

A

MoPS, R, 3VC

Most common OD anomaly.

Peripapillary Halo (yellowing, mottled)

Small ONH (pink, grey or pale)

Ring of incr/decr pigm bordering halo (‘double ring’ sign)

Veinous tortuosity

VA: 6/6 to NLP

VF defect possible

CNS abnormalities (strong association) -> MRI req’d

171
Q

Glaucoma –alpha-adrenergic agonist

mechanism

efficacy

dosage

side effects

A

Glaucoma –alpha-adrenergic agonist •

Mechanism of action: – Decrease in aqueous production

– Increase in uveoscleral outflow •

Efficacy: good (20-25% reduction) •

Dosing: tid vs bid

• Side effects:

– Systemic: DiDS

  • Somnolence (sleepiness)
  • Dry mouth
  • Dizziness/fainting

– Ocular: • allergy

172
Q

alpha agonist trade name

A

Alphagan

Alphagan-P (Preservative Free) -

use for those allergic to preservative.

173
Q

PseudoesoT

Tests to do:

Mx:

A

Tests: hirschberg, Bruckner, TNO (if old enough),

wise to do cyclo Ret

Mx: rev 3-4mo;

if at review normal then rev 6/12 after this.

174
Q

IOP Asymmetry

A

Absence of IOP asymmetry between the fellow eyes is associated with a 1 percent probability of having glaucoma. A difference of 3 mmHg is associated with a 6 percent probability and a difference of >6 mmHg with a 57 percent probability of having glaucoma

175
Q

When to use brimonidine

A

RAPP

Rapid IOP lowering (esp in combo)

  • Additivity: Excellent additivity with prostaglandin/Good with beta-blocker

– Preservative toxicity/allergy

– Pregnancy Category B -can use in 1st trimester

(discontinue in breastfeeding)

176
Q

Setting Target IOPs

A

Target IOP –2 methods

• Stage of Disease:

–Mild: ~30% IOP drop from highest IOP

–Moderate: 30-40% drop

–Severe Loss: 40-50% drop •

Stage of Disease:

–Mild: high teens

–Moderate: mid teens

–Severe loss: low teens

177
Q

Which glaucoma med is neuroprotective in NTG?

A

Brimonidine

(alpha-agonist)

178
Q

Glaucoma –carbonic anhydrase inhibitors

  • Mechanism of action:
  • Efficacy:
  • Dosing:
  • Side effects: – Topical:
A

Glaucoma –carbonic anhydrase inhibitors

  • Mechanism of action: decreased aqueous production
  • Efficacy: excellent (oral –40-50%+); good (topical –15-20%)
  • Dosing: bid –tid
  • Side effects: – Topical:
  • Bitter taste
  • Stinging • Hyperemia
  • Corneal endothelial probs (if lots of guttates don’t use CAI)
179
Q

AMD rate in Australia

A

55yo+: prevalence of AMD is 3%

40+ yo: 10% have some signs of AMD (whether early/intermediate/late)

180
Q

Glaucoma -CAIs • When to consider:

When to avoid:

• Available as:

A

Glaucoma -CAIs • When to consider:

– Good addition to prostaglandin

– Brimonidine allergy

• When to avoid: – Fuchs corneal endothelial dystrophy

– Pregnancy – Sulfa allergy (???)

• Available: – Dorzolamide (Trusopt, Trusamide, APOdorzolamide)

– Brinzolamide (Azopt, BrinzoQuin)

181
Q

Glauc - oral CAI

Name:

Dose:

When to use:

A

Glaucoma -acetazolamide (diamox)

  • Typically used in emergency/acute situations rather than long term due to systemic side effects:
  • Typical use: – Post-surgical IOP elevation

– Acute angle closure (NON-PUPILLARY BLOCK ONLY)

– Extremely elevated IOP

• Dosing: – 250 mg tablets qid(generic)

– 500 mg time-released capsules (Sequels ®, generic) bid

182
Q

Glaucoma -pilocarpine •

Mechanism of action

Efficacy:

Dosing:

Side effects:

• Use:

A

Glaucoma -pilocarpine •

Mechanism of action –increase trabecular outflow

  • Efficacy: good (25%)
  • Dosing: qid
  • Side effects: – Accommodative spasm – Browache – Bronchial constriction
  • Use: acute angle closure with pupillaryblock(low concentration)
183
Q

Fixed Combination Medications

• (Azarga)

A

Fixed Combination Medications

• CAI + timolol –Brinzolamide/timolol (Azarga)

184
Q

(Cosopt, Cosdor)

A

–Dorzolamide/timolol (Cosopt, Cosdor)

185
Q

(Combigan)

A

• Brimonidine + timolol (Combigan)

186
Q

Simbrinza

A

• Brinzolamide + brimonidine (Simbrinza)

187
Q

(Ganfort, Ganfort PF)

(Xalacom, Xalamol, Lantim)

(Duotrav)

A

• PGA + timolol

–Bimatoprost + timolol (Ganfort, Ganfort PF)

–Latanoprost + timolol (Xalacom, Xalamol, Lantim)

–Travoprost+ timolol (Duotrav)

188
Q

Disc Haemorrhages w/ Glaucoma rev in..

A

3months as new RNFL dropout may be seen.

189
Q

Frame standard dimensions for caucasian…

ie. wrap, PT, BVD

A

standard dimensions PT 7, wrap 5, BVD 13mm

190
Q

Cycloplegic refraction in

infants ie. 0-12months old

and

>=1yr old

A

Use 0.5% in 0-12months old.

Instil one drop in both eyes twice 5mins apart.

(Clinician to do it as must observe for adverse affects within 30min)

Note: Blond hair/blue eyes particulary susceptible.

examine after 30min.

for >=1yr old use cyclo 1%

191
Q

For high powers remember to give the lab…

A

BVD of glasses and BVD of phoropter so they can compensate

192
Q

If same prescription and going from a frame fit or

Incr BVD and/or decr PT

need to compensate by…

A

increasing the corridor length.

193
Q

Mohindra Retinoscopy

wd?

adjustment?

A

wd 50cm

  • 0.75 for <2yo
  • 1.00 for over 2+yo
194
Q

Orbital Cellulitis

Signs

A

CCOPP

Chemosis of lids

conjunctival injection

ON dysfunction: VA down, CVD, RAPD

Painful Ophthalmoplegia (EOM paralysis)

Proptosis

195
Q

For short people, when fitting MF’s need to consider…

A

PT very different when standing vs sitting.

They tend to tilt head back to look up at people when standing.

It can be as much as 10deg and 5mm Ht diff

196
Q

When fitting SV or SVN with vertical prism must take…

A

Heights!! Else unwanted prism can be induced as lab will fit it on datum.

197
Q

When measuring prism with trial frame, make sure to compensate for deviation of the eye by….

A

vary the PD of the trial frame 0.3mm for every prism diopter

away from the base.

Eg. RE 8BO prism -> reduce the pd in that eye by 2.4mm

198
Q

Standards for cyl axis

A
  1. 25 +/-16
  2. 50 +/-9
  3. 75 +/-6
  4. 00 to 1.50 +/-4
  5. 75 to 2.50 +/-3

>2.50 +/-2

199
Q

What affect does the following have on a MF reading zone?

PT?

BVD?

A

PT: Incr tilt -> drops the near zone lower and increases effective VF.

BVD: Incr BVD -> lifts the near zone higher and reduces effective VF.

200
Q

Central Serous Chorioretinopathy CSCR Tx options

(2 broad categories)

A

Observation

or

Tx

201
Q

CSCR

Observation if…

A

First Stop Cushing’s Sleep

First acute episode in a young patient and less than 3 months onset

  • STOP corticosteroids!: oral, nasal sprays, joint injections, skin ointments
  • Consider Cushing’s Disease: A condition that occurs from exposure to high cortisol levels for a long time. (Signs are a fatty hump between the shoulders, a rounded face and pink or purple stretch marks.)
  • Treat sleep problems: shift work, sleep apnea
202
Q

CSC (Central Serous Chorioretinopathy)

tx if…

A

SOC 40

Severe Vision loss

  • Occupational need for excellent binocular vision
  • Chronic sub-retinal fluid (3-6 months)
  • > 40 years of age
203
Q

Try and aim for a spectacle magnification difference between the eyes of…

A

<= 1.3%

204
Q

Medmont binocular driving test

  • roving v fixating
A

Use roving if central VF defect

for everything else use fixating

205
Q

Medmont binocular driving test

When printing results remember…

A

LAANN

Level map

124 Numeric

Numeric Tic Marks

Annotations

Attributes

206
Q

Anisocoria Evaluation protocol

1st step

and implication

A

Is it worse in light or dark? also check light reaction.

Implication: worse in light and poor light reaction in one eye means the more dilated pupil is abnormal.

worse in dark and good light reaction means the smaller pupil has problems dilating.

207
Q

Anisocoria: If worse in the dark check for…

and what are the implications

10% cocaine test results

A

dilation lag (dodgy pupil takes about 10-15sec to dilate cf normal pupil which takes 3-5sec)

Implications: If dilation lag is absent then it is physiologic anisocoria. (Dilation occurs with 10% cocaine)

If dilatation lag present -> Horner’s syndrome (dilation doesn’t occur with 10% cocaine).

208
Q

Explain 10% cocaine test in Dx Horner’s: How and interpretation

A

How: Instill cocaine drops in both eyes.

Cocaine stops the reuptake of Nor-Adrenaline and therefore prolongs the affect of dilation (as there is more NA binding with he a1-receptor causing dilation).

In normal -> this will cause dilation in both eyes.

In Horner’s: there is disruption of the nerve pathway and therefore less/no NA has been released at the synapse and therefore no dilation will occur. The normal pupil will dilate but the Horner’s pupil will not dilate.

209
Q

Horner’s Syndrome: Sx’s and Signs

A

Miosis (also Dilation Lag)

Anhydrosis (lack of sweat of affected side)

Ptosis (Affected side)

Heterochromia (Affected iris lighter)

210
Q

Explain how to Dff Dx pre/post-ganglionic Horner’s

A

Use Paredrine (1% Hydroxyamphetamine) in horner’s eye.

paredrine acts to release NA from nerve terminal.

Pre-ganglionic Horner’s: Dilation occurs as the 3rd order nerve is normal and still has NA to be released.

Post-ganglinic Horner’s: Dilation does not occur

as the 3rd order nerve is abnormal and has no NA to be released.

211
Q

Anisocoria: If worse in lit room, then check…

A
  1. S/L exam of iris
  2. Check Near constriction
  3. Consider 0.125% pilocarpine test
212
Q

What is Light/Near Disocciation and what are it’s implications?

A

L/N Dissociation has..

Quick NR but no/sluggish LR

If see this… REFER!!

could be Parinaud’s Syndrome or Argyll-robertson pupil

213
Q

first time myopes in PAL’s use…

A

While first time wearers will most often be placed in a softer design it may prove beneficial to implement a harder design for first time myopes in PAL’s.

214
Q

myopia stabilization stats…

A

48% by age 15 years;

77% by age 18 years;

90% by age 21 years;

96% By age 24 years,

215
Q

Adie’s Pupil Signs

A

STonCon

Sector iris palsy (Iris streaming)

Tonic near constriction (Delayed NR)

Constriction w 0.125% pilo (cholinergic supersensitivity)

216
Q

Anisocoria: 3rd NP test results…

A

round pupil

poor near constriction

no constriction with 0.125% pilo

constriction with 1%pilo

Eyes down and out

217
Q

Anisocoria: Pharmacologic Pupil Dilation

A

Round Pupil

Poor NR

No constriction w 0.125% pilo

No constriction w 1% pilo

218
Q

Anisocoria: Traumatic Iris Damage

A

Torn Pupillary Border

Sluggish NR

219
Q

If VA is down and no obvious cause do…

A

check pupils for RAPD

colour vision

220
Q

RAPD indicates…

A

Abnormality along Optic Nerve most commonly and rarely at the optic tract.

It may also indicate wide-spread retinal damage.

221
Q

How to measure RAPD

A

Place neutral density filter over good eye and then retest MG+

Increase density until MG disappears.

Make sure to quickly ‘bleach’ both eyes b/w increases so as to equalise the LR

search youtube under “how to measure the rapd moran core”

222
Q

How to estimate ACD

A

In lit room, get p to look straight ahead,

over the other eye, use iphone with a flash from the side.

ACD(mm) = -3.3(E:Z) + 4.2,

where E is limbus to centre of pupil and

Z is limbus to cornea.

<2.5mm is high risk for AGC

223
Q

Prism Balance Point with anisometropia and MF’s.

What to do….

A

Go to AAOO calculator under oblique astigmatism tab

Enter dist rx and corridor lenght in cm

Work out net vert prism and trial frame this with the add.

If p able to fuse then don’t compensate for it, else ask the lab to compensate.

224
Q

Anisometropia greater than how many dioptres may cause problems?

A

>1D

225
Q

If you suspect anisometropia is causing problems Eg. Diplopia, what simple test can you do?

A

Get the p to look eccentrically to induce diplopia.

226
Q

Anisometropia: Ask this Q… and implications.

A

Are you susceptible to motion sickness?

Higher rate of rejection of MF and BF’s (especially BF’s)

227
Q

OrthoK

Flat K’s: There is a trend towards undercorrection of myopia if K’s <…

and avoid flat corneas that are…

A

<43.5D

flatter than 8.5mm

or orders w BC>9.2mm

228
Q

Subconj haem: if nasal and 24hrs after head inj then…

A

strongly associated w fractures of the base of skull.

Must ask if there is a recent head injury.

229
Q

Be careful of this potential side-effect of brimonidine…

A

Brimonidine Uveitis.

Can occur even after using it without problems for a long time eg. 10months.

230
Q

Possible side-effect of topical dorzolamide…

A

periorbital dermatitis. Can cause hypersensitivity after taking topical dorzolamide and become allergic to BAK and so must use non-preserved.

231
Q

DVP is ?% more scracth resistant than glass

A

35%

232
Q

HC has ?% more reflections than MC

A

40%

233
Q

Muscle Contraction (Tension) HA’s;

px setting:

A

PX setting: any age; 70-80% Female; FH in 40-50%; often emotional factors

234
Q

Muscle Contraction (Tension) HA’s;

H/A setting:

A

strong boo versus lazy imps with nits

steady, non-pulsatile dull ache - back, neck/bitemporal/bilateral

  • bilateral in 90% radiating to neck, temples, shoulders
  • variable severity; build slowly to peak (hours)
  • lasts hours upto 1 day, over several months; rarely interrupts sleep
  • improved w analgesics, sedatives, rest, massage
  • worse w activity/stress
  • Neuro sx’s in 10%; maybe nausea/light-headed
235
Q

Migraine: Px setting

Frequency

M/F Ration

FH

age

other:

types:

A

Very common 12-35% of general population

70% Females

FH in 65-90%

Usu begins age 5 to 30

Emotional factors operative

Types include: common (80%), Classic (12%),

Complicated (3%), Cluster (5%)

236
Q

AMD wet v dry percentage

A

dry 85-90%

remainder wet

237
Q

A spectacle magnfication difference of ? to ? is generally accepted as a point of non-fusion

A

3% to 7%

238
Q

Smith’s technique for ACD with SL

A

This technique should be carried out in a dark room

Set the patient up at the slit-lamp and advise them to fixate straight ahead

Lock the illumination at 60° temporally to the patient

The viewing microscope should be set straight ahead

Set the magnification to 10-16x

Use a thin 1-2mm beam and turn it horizontally

Place the beam over the temporal pupil margin, focused on the cornea

A second beam on the iris/anterior lens will be visible on the nasal pupil margin

Increase the height of the beam until the edges of the two beams just touch

The illumination must be rotated 60° to the other side to measure the other eye

239
Q

Smith’s technique ACD.

how to calculate

average ACD

ACG risk if <….

A

SL measurement x 1.31

average is 3.15

ACG risk if <2.5mm

240
Q

Anisometropia MF’s: Solutions

see emails Optometry: Anisometropia and work out an eg. with AAOO v4 excel spreadsheet

A

changing script,

manipulating corridor length and

moving the prism balance point

or a combination of these

241
Q

Which frame paramenter has greatest affect on lens performance?

A change from standard of only 3° will cause a drop in lens performance of…

a face form angle of 10° (which is only 5° different to standard) causes a drop to less than…

A

Wrap.

25%

50% in the performance of a progressive lens that does not take account of individual parameters.

Individual progressive lenses still have a performance of almost 100%.

242
Q

For PD’s…. should consider zeiss individual else inset will be out.

A

>73mm (they will converge too much for the near zone)

<58mm (they won’t converge enough for near zone)

243
Q

Centre distance CooperVision Biofinity multifocal lenses with a +2.50D slows progression of myopia by…

A

43%

244
Q

CooperVision MiSight reported less myopia of ….

A

59%

245
Q

Dff Dx of Transient Vision Loss for…

Migraine v Carotid Disease (TIA) v Vertebrobasilar Insufficiency

Onset/Age

Duration

Field Loss

Featuers

Medical Risk Factors

A

Migraine: Gradual, 20-30min, binocular, homonymous, march with time (spread), flickering lights, photophobia. No med risk factors.

Carotid Disease (TIA): Sudden, mid-aged and older, 1-7min, monocular, stationary, total or partial “grey-out”, “black-out”, “shade” or “veil”, med risk factors present

v Vertebrobasilar Insufficiency: Sudden, older, 1-7min, binocular, stationary, total or partial “grey-out”, “black-out”, “shade” or “veil”, med risk factors present

246
Q

Classic Migraine

A

Severe, Unilateral, pulsatile, visual disturbance, prodrome 20-30min,

contralateral HA to sx’s in 80%;

Occurs after stressful stiuation Eg. weekends;

HA lasts hrs and in cycles which may last over days

Neurological sx’s: nausea, vomiting, photophobia

Triggers: stress, depression, menopause, menstruation, CP, histamines in choc, wine, nuts; tyramine in cheese, nitrates in meat;

247
Q

Common Migraine

A

Similar to classic migraine except HA is main sx

Vague or absent prodrome

Neurologic sx’s rare

248
Q

Cluster Migraines

A

20-50yo males M/F 5/1;

emotional factors present

unilateral; knife-like pain around eye, v intense

radiates to temple, maxilla, gum

sweat/heat imbalance

worse w stress/alcohol

clusters of 1-6/day lasting 10-60min starts early 4am

occurs at intervals of 1-3months

ipsilateral, facial flush, nasal congestion, horner’s (33%), sweating

249
Q

Complicated Migraine

5 forms

A

HOOBA

  1. Hemiplegic - gives paresis in some body part
  2. Ophthalmoplegic: gives paresis of EOM
  3. Acephagic - HA is absent w only visual sx’s
  4. Ocular: transient monocular vision loss, may or may not be mild HA (dx of exclusion) Cf. TIA’s: in older people w vascular disease.
  5. Basilar: 20-40mins: black/grey outs, usu young Females w severe occiptal HA.
250
Q

When to refer migraine sufferer

A

If 30+yo and presents w 1st severe migraine

251
Q

Trigeminal Neuralgia (Tic Dolereaux)

dolereaux: “Dol-a-rose”

A

40-50yo; F/M 3/2; MS approx 15%

sharp, quick, unilateral

sudden, sec-minutes;

occurs in spasms but w sx free periods

V1-V3 distribution, but may radiate

trigger points (eye/nose/mouth/teeth), worsens w cold,food etc

Carbamazepine (80%), Phenytoin improves it.

252
Q

Hysterical HA

A

TDHS Clever Boo Needs Breakfast Daily

20-50F; c/o multiple somatic sx’s and lots of ops,

depression/anxiety Insomnia
HA: bizarre, ‘band-like’, squeezing, extreme psychological probs

severe pain but indifferent

constant 24/7, days to months

bizarre radiation,

nothing helps worse w stress

blindness, fainting, paralysis

Dx of exclusion

253
Q

Child <10yo + has myopia >-5D need to….

A

refer to ophthalmologist to rule out syndromic conditions.

254
Q

MYOPIA CONTROL

MF’s only useful if…

what add to give?

A

esoP or Accomm lag

give +1.50 or +2.00 Add

255
Q

What is the “rule of the pupil”?

A

The rule states that when aneurysms compress the oculomotor nerve (CN3), the iris sphincter will be impaired, leading to a dilated or sluggishly reactive pupil.

256
Q

What is the chance of a child being myopic based on having 2 myopic parents?

A

If a child w 2myopic parents is +0.75D or less at age 6, they have a 75% chance of being myopic by age 13.

257
Q

What are 2major risk factors for myopia at age 6?

A
  1. myopic parents
  2. <=+0.75D
258
Q

When measuring eye protrusion, if the measurements are different by …. mm the patient should undergo additional evaluation.

A

>=2mm

259
Q

OCT and Glaucoma: What 3 attributes have good diagnositic accuracy?

A

Several studies have suggested that (in order of importance)

  1. mean RNFL thickness
  2. inferior quadrant thickness,
  3. followed by superior quadrant thickness,
260
Q

What is the lowest refraction you can start at for myopia control?

A

-0.50D

261
Q

NaFl TBUT cut off?

gives a sens/spec of….

A

a cutoff of 8.0 seconds has 78% sensitivity and 72% specificity for diagnosing DED against tear hyperosmolarity

262
Q

If eye itching is in the canthal region what is likely cause?

A

allergic conjunctivitis

263
Q

A poor blink can be caused by…5 things

A

VCLIP
Person trying to blink but blocked by VCLIP
Vdu computer reduced blink rate
Cosmetic: on the vdu screen is someone having cosmetic surgery
Laxity: botched surgery leads to lax lids!!
Incomplete: lid closure now as they try to blink
Partial: blink action sometime full sometimes half.

long hour on VDU (reduced rate)

Cosmetic surgery,

Lid laxity,

Incomplete lid closure

Partial blinking,

264
Q

How does a poor blink cause MGD?

A

our blink is essential to naturally expressing meibum.

So anything that prevents a proper blink is likely to be a cause of MGD.

265
Q

What is one of the best tests for incomplete lid closure?

A

the Korb-Blackie Light Test.

266
Q

How to perform the Korb-Blackie Light Test?

A

In your darkened room,

instruct the patient to close their eyes as if sleeping,

but not squeeze.

Place the transilluminator on the closed upper eyelid

and look for light escaping

from the bottom between the eyelids.

267
Q

Protocol for diabetic macular edema

A

If VA is 6/7.5 or better, even with CSME, observation v invasive tx gives same VA outcome after 2years. Therefore just observe.

268
Q

how to Dff DX DED EBMD

A

Look for consistently blurred vision without dry eye signs,

or a TBUT that consistently breaks up in the same place to be a possible EBMD presentation.

269
Q

Recommendations for MDEYES and study results

A

INTERMEDIATE AND ADVANCED AMD (NON-CENTRAL GEOGRAPHIC ATROPHY IN ONE OR BOTH EYES) -> reduces the risk of progression of the disease and loss of visual acuity by about 25% over five years

270
Q

Anterior Uveitis: Define ACUTE, RECURRENT & CHRONIC

A

Acute: Totally resolved within 3mo, not caused by another pathology of cornea or post pole. Persistent > 3mo duration.
Recurrent: Repeated episodes, but no recurrence for >=3mo w/o tx in b/w.
Chronic: Recurs <3mo of ceasing tx. Higher risk of vision loss.

271
Q

Ant Uveitis Mx:

A

If mild ie. ACR G1 -> PF qid
If severe PF q15 for 1hr then q1h, x2 stat bedtime;
rev 24hrs
If post synechiae: soak cotton tip in atropine 1%, put into inf fornix 15min, repeat in 1hr, then rx: atropine 1% bd/tid
When ACR drops a grade reduce PF to q2h-3h (q2h for 2d, then q3h for 3d) and atropine to qd; then stop atropine.
rev daily until ACR back to G1, then PF qid for 1w, then if G0-0.5 taper ie. reduce 1drop/week;

272
Q

When to refer AAU…

A

Paediatric
Atypical, complicated, severe
Non-responsive
Intermediate/Posterior
Chronic
Bilateral
Endophthalmitis possibly
Granulomatous

273
Q

CL + red eye always…

A

rev in 24h to ruleout early MK, then again in 1w

274
Q

MK: send for culture when…

A

“1223C”
1+ ACR
2mm+ in size
2+ adj lesions
<=3mm from corneal centre
culture cornea, if CL wearer then culture CL and case
Note: if culture required then fortified Ab will be needed therefore send to RVEEH as well

275
Q

MK: Refer to hospital if…

A

Sig corneal thinning
Large Area
Compliance concern
Culture required

276
Q

Episcleritis: use this drop to help diff dx from scleritis

A

2.5% PNL

277
Q

Congenital NLDO conservative tx…

A

Do crigler massage 10-15x/d

278
Q

How to test VA in 2.5yo+? v <2.5yo+?

A

2.5yo+ try LEA
<2.5yo use preferential looking/electrophysiology

279
Q

If suspect accomm esoT what tip can be used to try and ‘bring it out’?

A

Check CT in all directions using -2 Flipper for D and N (as it stimulates accommodation)

280
Q

Which group of paediatric population is AccFac no reliable?

A

Young astigmats (everything is blurry to them)

AOptometry (1 decks)

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