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PPO2 Flashcards

1
Q

ARCUS

Type, Mechanism, Layer, Prevalence, Mgmt

A

Degeneration
STROMA
60% (40-60), 90% (70-90)
No mgmt

Abnormals - serum lipid profile (young/thick)

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2
Q

LIMBAL GIRDLE OF VOGT

Type, Mechanism, Layer, Prevalence, Mgmt

A

Degeneration
SUB EPI collagen (UV)
60% (40-60), 90% (70-90)
No mgmt

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3
Q

HUDSON-STAHLI LINE

Type, Mechanism, Layer, Prevalence, Mgmt

A

Degeneration
BOWMAN’S
20% (20’s), 60% (60’s)
No mgmt

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4
Q

DECEMET’S STRIAE

Type, Mechanism, Layer, Prevalence, Mgmt

A

Degeneration
DESCEMETS
Normal unless large - (+) pachymmetry stromal edema
No mgmt

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5
Q

MOSAIC SHAGREEN

Type, Mechanism, Layer, Prevalence, Mgmt

A

Degeneration
STROMA
Normal unless trauma - (+) pachymmetry stromal edema
No mgmt

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6
Q

HASSAL HENLE BODIES + GUTTATA

Type, Mechanism, Layer, Prevalence, Mgmt

A

Degeneration
Henle - peripheral, Guttata - central
Raised bits of DECEMETS into endothelium, stroma
70% (40’s)
No mgmt unless pigment, edema, fuchs - (+) pachymmetry stromal edema

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7
Q

CORNEAL FARINATA

Type, Layer, Prevalence, Mgmt

A

Degeneration
STROMA lipofusin
Normal bproduct of age
No mgmt

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8
Q

SALZMANN’S NODULAR DEGEN

Type, Mechanism, Layer, Prevalence, Mgmt

A

Degeneration
Rare ~old keratitis, mucopolysaccharides, osteoporosis, pterygium
Plaque between EPITHELIUM + BOWMAN’s
Mgmt:
monitor yearly, if (+) epithelial breakdown:
rewetting drops, mytomycin C, PTK

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9
Q

BAND KERATOPATHY

Type, Mechanism, Layer, Prevalence, Mgmt

A

Degeneration
Gray calcium/phosphate salts 3/9oclock
STROMA
Normal in elderly, unless longstanding inflamm/glaucoma/hyperPTH/RA/vit D toxicity
No mgmt unless above:
serum Ca/Mg levels, Uric acid (gout), N2, Creatinine, ACE (sarcoid)
Va affected = chelating agent + scraping

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10
Q

DELLEN

Type, Mechanism, Layer, Prevalence, Mgmt

A

Rare Finding
Thinning cornea next to raised area
STROMA
Mgmt: TREAT to prevent scar/neo, remove cause, lubricate

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11
Q

KAYSER-FLEISCHER RING

A

Rare finding - WILSON’S D+ copper ring
DECEMETS
Mgmt: REFER to internist, low Cu+ diet

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12
Q

Kayser-Fleisher Ring

A

Rare finding - WILSON’S D+ copper ring
DECEMETS
Mgmt: REFER to internist, low Cu+ diet

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13
Q

PANNUS

A 
Normal finding in small amounts
Limbal vessels 1-2mm (micro), 2< (gross)
Mgmt: FIND CAUSE
micro - conj, staph bleh, CL wear, acne roseaca
gross - (+) trachopa, atopic keratoconj
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14
Q

POSTERIOR EMBRYOTOXIN

A

Congenital finding, Rare = glaucoma
DESCEMETS (Schwalbe’s line)
Mgmt: DDX GLAUCOMA
IOP, gonio, iris/corneal changes

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15
Q

KRUCKENBERG SPINDLES

A

Abnormal finding
ENDOTHELIUM
Mgmt: DDX GLAUCOMA
IOP, gonio, iris transillumination, PXE/PDS

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16
Q

VORTEX KERATOPATHY

A 
Other finding
EPITHELIAL+STROMA
Mgmt: 
Drugs (plaquenil/amiodarone) = normal
Fabry's D+ = abnormal - refer for enzyme replacements
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17
Q

FLEISCHER’S RING

A

Fe ring at base of cone in keratoconus

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18
Q

FERRY LINE

A

Fe ring around filtering blep

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19
Q

STOCKER’S LINE

A

Fe at the head of pterygium

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20
Q

COAT’S RING

A

Fe around FB

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21
Q

AXENFELD LOOPS

A

loop of nerve from anterior ciliary body ~12% eyes

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22
Q

OCULARMELANOSIS

A

extra pigment in the eye

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23
Q

EPICAPSULAR STARS

A

remnant of TUNICA VASCULOS LENTIS. star shaped distn of brown flecks on anterior capsule

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24
Q

Y SUTURE

A

anterior Y, posterior flipped

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25
Q

ZONULAR OPACITIES

A

embryonic opacity affecting only innermost lens

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26
Q

CORNEAL SCAR

A

injruy to Bowman’s/Stroma

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27
Q

CORNEAL SCAR

A

injruy to Bowman’s/Stroma

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28
Q

3 types of corneal dystrophies

A

keratoconus, fuch’s dystrophy, epithelial/BM disorders

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29
Q

3 Hallmarks of Keratoconnus

A

irregular astigmatism, apical protrusion, paracentral stromal thinning

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30
Q

Munson’s sign

A

keratoconus - convexivity of lower lid on downgaze

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31
Q

Fleischer’s ring

A

keratoconus - Fe at base of cone

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32
Q

Vogt’s striae

A

keratoconus - vertical striae posterior stroma

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33
Q

Corneal hydrops

A

keratoconus - due to breaks in decemets membrane. Decrease vision, cause pain, edema in stroma. T(X) cycloplegics + hypertonics

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34
Q

Mechanism of keratoconus?

A
  • unable to eliminate ROS/NO- = oxidative damage
  • poor collagen x-linking = Bowman’s fibrillates
  • causes epi to be in contact with stroma
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35
Q

T(X) keratoconus?

A

glasses
rgp’s, scleral CL’s, piggyback lenses*
corneal x-linking (riboflavin + UV)*
keratoplasty (transplant)

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36
Q

Prevalence of Fuch’s Epithelial Endothelial dystrophy?

A

Autosomal dominant, slow progression, bilateral, females

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37
Q

Ocular signs of Fuch’s dystrophy?

A

Early - guttata: change sin endo due to dec ability to act as a pump

Progression - stromal edema, corneal scarring, epithelial edema, bullous keratopathy

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38
Q

Complications of Fuch’s?

A

2˚ glaucoma - same mechanism that destroys endo prob destroys trabecular meshwork

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39
Q

T(X) fuch’s?

A

Hairdryer in morning
5% NaCl hypertonic drops, ointment at night
BCL’s
PTK for corneal scarring
Decemet stripping automated endothelial keratoplasty (DSAEK) in severe cases

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40
Q

Prevalence of Epithelial BM dystrophy

A

40’s to 70’s, women

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41
Q

Causes of epithelial BM dystrophy?

A

Problems with the BM: thickening causes Epi to unadhere from stroma = melformed hemidesmosome connections

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42
Q

4 ocular findings of epithelial BM dystrophy?

A

dots (microcysts in epithelium)
fingerprints (projections of BM into epi)
maps (thick BM overlying epi)
blebs (mounts of granular tissue bw bowman’s + BM)

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43
Q

best way to view findings of epithalial BM dystrophy?

A

direct retro for opacifications in corneal epithelium and BM!

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44
Q

Complications of epithelial basement membrane dystrophy?

A

Increase chance of erosion

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45
Q

Epithelial BM Dystrophy T(X)

A 
No S(X) = monitor
DE = lubricate
Erosions = ointment, pressure patch, NaCl- agents
PTL on Bowman's to help healing
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46
Q

Loss of Corneal claricity is caused by 4 things

A

NISE

neo, injury, scarring, edema

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47
Q

How long for epithlium to regen?

A

24-48 hrs, total cycle is 7-14 days

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48
Q

How long for BM to regen?

A

6-8 days

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49
Q

Where does neo happen = loss of claricity

A

Surface + Stroma

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50
Q

Diff between surface + stromal neo?

A

Superficial neo - tight CL’s, trachoma, superior limbal keratitis
Deep stromal neo - infection, usually Syphilis, TB, mumps, interstitial keratitis

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51
Q

5 symptoms of corneal injury

A 
PPHVL
Pain
Photophobia
Halos
dec VA
Lacrimation
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52
Q

Causes of corneal injury

A

abrasion, bullous keratopathy, trauma

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53
Q

DDx Ulcer vs Abrasion

A

Ulcer = (+) history, pain, wbc’s, epithelium and stroma, takes up NaFl

Abrasion = epithlium, NaFl stays in would, red, no discharge

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54
Q

How do you T(x) a corneal abrasion?

A

antibiotics + cycloplegia

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55
Q

How do you treat a recurrent corneal erosion?

A

pressure patch, scrape epi to improve healing, BCL

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56
Q

How do you treat a FB in the cornea?

A

irrigate, alger brush, then treat as if abrasion (lub, BCL’s, antibiotics, cyclo)

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57
Q

Explain epithelial edema

A

Cause: PMMA’s, rbcs,abrasion, swimming, scatters light >5%
Sign: sclerotic scatter = dark
S(X): dec VA, halos, spec blur
Mgmt: hypertonic NaCl, hair dryer, lower IOP, remove cause

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58
Q

Explain stromal edema

A

Cause: Soft CL’s, Fuch’s, surgical, trauma, ulcers, IOP, glaucoma
S(X): glare
Mgmt: pachymetry, DSAEK, steroids

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59
Q

8 layers of the lid

A

eyelashes, skin, vasculature, muscles, grey line, orbital septum, tarsal plate, conjunctiva

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60
Q

Glands in the eyelashes

A

glands of moll (sweat), glands of zeiss (sebaceous)

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61
Q

innervation to eyelid

A

orbicularis oculi (CN7) - close shut
muellers (SNS) - tonic elevation
levator (CN3) - open

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62
Q

Where are the glands of moll?

A

eyelashes

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63
Q

Where are the glands of zeiss?

A

eyelashes

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64
Q

where are the meibomian glands?

A

tarsal plate

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65
Q

Components of anterior lid

A

eyelashes, skin, vasculature, muscles, grey line

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66
Q

components of posterior lid

A

tarsal plate, conjunctiva

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67
Q

dividing line of the lid

A

physical: orbital septum
surgical: gray line

68
Q

Poliosis

A

whitening of the lashes

69
Q

Trichiasis

A

Misdirection of the lashes

70
Q

Madarosis

A

Partial loss of lashes

71
Q

Alopecia

A

complete loss of lashes

72
Q

lid coloboma

A

congenital abnormality
gaps in lid
congenital
oculoplasty

73
Q

epicanthal folds

A

congenital abnormality
autosomal dominant in asians
DDX: pseudo-ET
oculoplasty

74
Q

distichiasis

A

extra row of lashes instead of meibomian glands
rare autosomal dominant
FB trackstaining inferior cornea
T(X): BCL, epilation, electrolysis, chyrotherapy (N2)

75
Q

blepharophimosis

A

small lid fissures
~ epicanthal folds/levator not working
autosomal dominant
oculoplasty

76
Q

blepharochalasis

A

idiopathic acute lid swelling

when D+ quiet, oculoplasty

77
Q

dermatochalasis

A 
redundant skin, thin, loss of elasticity
normal in elderly
causes dry eye, pseudoptosis
DDX: pseudoptosis
T(X): blepharoplasty
78
Q

ectorpion

A

eyelid eversion, puncta displaced, reflex tearing, inferior hyphema
due to: congenital, involutional, paralytic, idiopathy, acoustic neuroma, hcronic allergies, mechanical
T(X): surgery, AT/lube, BCL

79
Q

Entropion

A

eyelid inversion, tearing, FB sensation, irritation
find track staining, trichiasis
cause: age, congenital, spastic
T(X): surgery, AT, BCL, remove lashes (epilation, electrolysis, chryotherapy)

80
Q

Congenital ptosis

A

(+) history, lack tarsal fold
~ marcus gunn jaw winking syndrome (V/III)
- damae to CN3

81
Q

Acquired ptosis

A

(-) history, (+) tarsal fold

-trauma, horner’s, cn3 palsy diabetes

82
Q

Testing a ptosis

A

hold frontalis muscle, measure movement up and down (8-15mm)

Grade;
mild - top edge of pupil
mod - 1-2mm down
severe - halfway or more covering pupil

83
Q

Nevus

A

benign, flat, congenital, uniform pigmentation.

Document

84
Q

Papilloma

A

Benign lid lesion
upward proliferation of epithelial cells.
Elevated, focal lesions, smooth, non-infectious
Caused by UV
MGMT: doc, monitor, surgery, bichloracetic acid

85
Q

Xanthelasma

A

yellow raised deposits, bialteral women

Doc, medically evaluate, surgery, serum cholesterol profile maybe

86
Q

Pseudoriferous cyst

A

plugged gland of Moll - clear fluid
focal elevation, taut surface
T(X): excision with drainage, (+/- prophylactic antibiotic)

87
Q

Sebaceous cyst

A

plugged Meibomian gland - yellow fluid
focal elevation, taut surface
T(X): excision with drainage, (+/- prophylactic antibiotic)

88
Q

Basal cell carcinoma

A 
lower, medial, insidious
same color as skin
slow growing, non-metastisizing
progresses laterally = dip in the middle
- nodular, ulcerative, sclerosing, multicentric
89
Q

T(X) basal cell carcinoma

A

biopsy, excision (mohr’s technique), frozen section surgery, radio-therapy, cryosurgery

90
Q

staph blepharitis - difference bw acute and chronic appearance

A

acute: sudden uni–> bilateral
inflammed margins, collarettes at base, lids stuck in the morning, hyperemic conj

chronic: (+) history, rosettes, ulceration of lid margins, lids stuck often

91
Q

T(X) acute staph blepharitis vs chronic staph bleph

A

acute: hot compress 10min, lid scrubs (5:1) bidx2weeks, antibiotics (topical bid 1 week)
chronic: everything (+) throw out makeup, (+) broadspectrum antibiotics, (+) steroid if inflammed, (+) pulse treatment

92
Q

Seborrheic blepharitis

A

dandruf-like collarettes suspended on lashes
oily looking
NO INFLAMMATION
alcoholics - zinc sulphate
T(X): lid scrubs, hot compress, broad antibiotics if combined with staph

93
Q

Meibomian gland dysfunction

A

dry eye, inflamed margins, capped orifices, dry eye

lid hygiene, hot compress, express glands with Q tip

94
Q

external hordeolum

A

staph infection @ gland of Zeiss
acute inflamm = HOT, RED, TENDER, ELEVATED
sudden onset with pus point

T(X) hot compress to accelerate infection
prophylaxis antibiotics bid 1 week

95
Q

internal hordeolum

A

staph infection @ meibomian glands
acute inflamm = HOT, RED, TENDER, ELEVATED

T(X) hot compress to accelerate infection
prophylaxis antibiotics bid 1 week

DDX pre-septal cellulitis
-infection has spread to anterior lid (+) oral antibiotic

96
Q

DDIX pre-septal cellulitis vs orbital cellulitis

A

Orbital septus has decreased vision, decreased EOMs, narrow fissure. OCULAR EMERGE!

97
Q

hordeolum vs chalazion

A

hordeolum: HOT, ELEVATED, TENDER, RED, INFALMMED. ACUTE
chalazion: H(X) of previous infection, not tender or hot, slow onset, progressively enlarging

98
Q

chalazion

A 
noninfections, non inflammatory
SLOW onset
chronic, reoccuring
focal internal lesion NOT WARM/TENDER
progressively enlarges

MGMT: hot compress
biopsy/excision (DDX sebaceous cell carcinoma)
DDX internal hordeolum

T(X): steroid injection to get rid of inflamm components

99
Q

demodex

A

8-legged
tubular sleeve of collarettes at BASE of lashes
1. brevis - sebaceous gland
2. follicularum - hair follicle

S(X): itchy in the MORNING, BURNING, SORE lids

T(X): remove excess, smother in ointment + steroids, confirm: 4 lashes > 6 demodex

100
Q

Phthiris Palpebraum

A

6-legged, darker, longer

S(X): itchy ALL DAY, rubbing, burning

T(X): a/b steroid qid 1 week, come back after 2 days, remove nits, contact family doctor

101
Q

Molluscum contagiosum

A

DNA Pox virus
-follicualr conjunctivitis
certain size, stays there, cheesy appearance

T(X): cauterization when D+ quiet, self-dissolving, excision

102
Q

Verruca

A

HPV, broccoli looking appearance, multilobulated (vs papilloma)
S(X): painless
T(X): cauterization, self dissolving

103
Q

Contact dermatitis

A

allergic reaction - conjunctivitis (follicular)
S(X) swelling, red, eventually flakey, itchy, epiphora, red
T(X) determine allergin, cold compresses, topical steroid, antihistamines

104
Q

Conjunctival follicles

A

pink, watery, elevated, shiny bumps “blistery”

Causes - hypersensitivity, viral conjunctivitis

T(X) - resolves on own.. find cause

105
Q

Conjunctival papillae

A

red, bumpy dilated vessels (PMN’s, wbc’s)

Causes - bacterial, CL wear, allergic, prosthesis

T(X) - find cause

106
Q

Retention cyst

A

clear vacuole like, spherical, interpalpebral space, asymptomatic

Cause - cellular degen due to DE

T(X) - lancing

107
Q

Xerosis

A

yellow opaque, flat keratinization on bulbar conj

S(X) severe dry eye + night blindness

Cause: vitamin A deficiency

T(X): lubrication, treat deficiency

108
Q

Pinguecula

A 
UV = fibrovascular degeneration
Mechanical rubbing (CL's)

surgery, wear sunscreen, lubricate

109
Q

Pterygium

A

Flsehy, vascularizaed trnagular growth, apex on cornea, destroy’s BOWMAN’s layer caused by UV

S(X) blurry vision, FB sensation, diplopia, DE
Stocke’s line: Fe at head of pterygium

T(X): remove + beta radiation 1xweek/3weeks

110
Q

Concretion

A

Small yellow-white opaque deposits due to age/degeneration + allergies

S(X) FB sensation, asymptomatic
T(X) loosen with Q tip

111
Q

Adenochrome deposits

A

Black deposits found on lower side that are reversible. Acquired secondary due to glaucoma meds NE

MGMT: doc, monitor

112
Q

Melanoma

A

A/B/C? asymmetrical, bleeding, color? vascularized.

from nevus or spontaneously due to UV. REFER!

113
Q

Subconj heme

A

S(X): painless, upserficial, bleeds laterally, aviods limbus

Due to coughing, trauma, birth, medication (blood thinner)

MGMT: TRAUMA H(X)? check ant seg - workup VA, SLE, Pupils, EOMs, IOP, DFE

114
Q

Broad signs of conjunctivitis

A
  • BV dilation = red + hyperemia
  • Cellular infiltrates (wbc’s and exudates)
  • Edema = chemosis
  • Discharge (watery or mucopurulent)
  • Papillae (bacterial)
  • Follicles (viral)
  • Pre-aurricular nodes (viral)
  • Cornea involvement
  • Collarettes (bacterial)
115
Q

Acute Bacterial Conjunctivitis

A

Unilateral to bilateral in 2-3 days, H(X)?
S(X) - lashes matted in morning, red, no pain
Causes - s. aureus/epidedermis, strep, h. influenza
Signs:
-mucopurulent discharge
-hyperemic bulbar conj @ FORNIX
-palpebral papillae dark red
-cornea +/- SPK @ BOTTOM / FOCAL
-scrape/smear = (+) PMN’s
- (-) pre-auricular node

116
Q

Treat acute bacterial conjunctivitis?

A

discard makeup
lid scrubs
warm compress
topical broad spectrum antibiotic

if non resolving… compliance? cultures? sensitivity? second opinion..

117
Q

Chronic bacterial conjunctivitis

A

usually accompanies corneal + lid inflammation
S(X): burning, FB, (+) H(X)
Signs:
-Lids (tyalosis, madarosis, poliosis, collarettes)
-Lumps/Bumps (hordeolum, chalazion)
-Cornea (PERIPHERAL SPK + SEI**)
- (-) pre-auricular node

118
Q

Two types of adenoviruses

A

Pharyngoconjunctival fever (PCF) + Epidemic keratoconjunctivitis (EKC)

119
Q

Pharngyoconjunctival fever

A

DNA adenovirus
S(X): red eye, discharge, uni–> bilateral, fever, sore throat
Signs: follicles, watery, no collarettes, smear = lymph, cornea = CENTRAL SEI, DIFFUSE SPK
(+) pre-auricular nodes
pseudomembranes
T(X) cold compresses, H(X)

120
Q

Epidemic keratoconjunctivitis

A 
DNA adenovirus
S(X) malaise, tired, fever, unilateral --> bilateral
Signs: week of 7
week1: 
-acute follicular conjunctivitis
-discharge --> pseudomembrane
-diffuse hyperemia
-watery
-smear = lymph
-cornea = diffuse SPK
-(+) preauric nodes
week2: elevated lesions (-) NaFl
week3: central SEI
121
Q

Treating EKC

A

remove pseudomembrane
cold compresses
topical steroids for SEI when VA is down (Pregnenalone)
Betadine - offuse 4-5 drops 1 min, wash off

122
Q

Treating Sub-epithlial infiltrates

A

Steroids ie pregnenalone acetate
tapered:
qidx1week, bidx3days, qidx2 days, etc

123
Q

SPK in chronic bacterial infections vs acute/hyperacute?

A 
acute = top/bottom focal SPK
chronic = peripheral SPK
124
Q

SPK in bacterial infections vs viral?

A

bacterial = focal SPK

viral + chronic bacterial conj= diffuse SPK

125
Q

Herpes Zoster is caused by what virus

A

Varicella virus (Shingles)

126
Q

Signs of herpetic viral conjunctivitis

A
  • unilateral vesicular eruption
  • ophthalmicus nerve
  • hutchingson’s sign: 40% chance if involves nose will involve eye
  • viral signs: (+) chemosis/water/preaur node
  • cornea (+) SPK (+) PSEUDODENDRITES (rose bengal)
  • uveitis
  • trabeculitis (2˚ glauc)
  • episcleritis
  • INCREASED CORNEAL sensitivity
127
Q

Treatment of herpetic viral conjunctivitis

A
  • atlernative meds ie acupuncture
  • oral antivirals = Acylovir 5xweek 7-10days
  • preventative: zostavax vaccine
  • steroids for anti-inflammation
128
Q

Jones test

A

Patency bw puncta + inf meatus (blow nose test/q-tip)

129
Q

Regurgitation test

A

Patency bw puncta + nasolac sac (squeeze sac and water back thru puncta)

130
Q

Tear prism

A

tear volume - look at lid margin - tear meniscus height should be 0

131
Q

phenol red thread test

A

tear volume - normal is 10mm in 15s

132
Q

shirmer’s test

A

tear volume - with/without anesthetic

133
Q

TBUT

A

tear stability <5mm (little)
SPK - few cells damaged
punctate erosions - lots of areas
geographic areas - huge

134
Q

Mires

A

Non-invasive TBUT
measures when mires distort
abnormal <10s

135
Q

Lactoferrin immunological test system

A

Osmolarity test

Abnormal if ring doesn’t increase in size

136
Q

Biomarker analysis

A

Osmolarity - increased = the goblet cells are affected

137
Q

Line of marx

A

tear film analysis - mucocutaneous, border moves anterior, thicker, irregular

138
Q

Meibomian expression

A

Lipid layer measure
-no inflamm
apply stable force to mimic blink

139
Q

Cause + Mgmt: Punctum Stenosis

A

age/inflamm - surgery probing

140
Q

Cause + Mgmt: Punctum eversion

A

age/inflamm - surgery

141
Q

Cause + Mgmt: Stenosis of canaliculus

A

age/inflamm - surgery, probing, antibiotics if infection*, warm compresses

142
Q

Cause + Mgmt: Dacryocystitis

A

infection/inflamm of lac sac SECONDARY TO OBSTRUCTION/INFECTION
-unilateral
DDx internal hordeolum/chalazion
-infants - wait 6mo-1 year for probing antiobiotics

143
Q

Mechanism Allergic Dry eye

A

INFLAMM = goblet cell death = DE

144
Q

Mechanism Blepharitis-causing Dry eye

A

EVAPORATION = impaired lipid layer

  • anterio bleph = staph bleph/seborrheic bleph
  • posterior bleph = meibomian gland disfunction
145
Q

Mechanism eye drops causing Dry eye

A

INFLAMM = cytotoxic PT’s damage mucin/goblet cells

146
Q

Mechanism Viral conjunctivitis

A

INFLAMM = cytokines damage mucin/goblet cells

147
Q

Some causes of dry eye? and Mechanism?

A

EVAPORATION + INFLAMM
CL’s, Environment
aging, Aging, Hormones (androgens dec inflamm)
systemic D+ sjogren’s, RA, Graves, Gout
Meds: anti HT, anti H, preservatives (BAK)

148
Q

Treating Dry eye

A 
NPAT/AT
Warm compresses 10min
Lid scrubs 5:1
Blinking exercises
Punctal occlusion
NSAIDs (Restasis + Lotemax)
149
Q

Artificial Tears for DE

A

help only with S(X)
tear vol replensihment + stabilization
protect cornea
dec osmolarity

150
Q

corticosteroids for DE

A

antiinflammatory (taper)

151
Q

NSAIDS for DE

A 
Restasis(immunosuppressant) + Lotemax(steroid)
day 1: lotemax prn
day 14: lotemax bid + restasis bid
day 60: restasis bid
6mo: monitor progression
152
Q

Punctal occlusion for DE

A

1-2mm down, collagen or silicone

153
Q

maskin probes for DE

A

evacuate meibomian glands

154
Q

When would you R(X) a small prescription?

A

Adults - task specific, antimetropia

155
Q

How much change in cyl can an adult tolerate?

A

15˚ axis, 0.75D

156
Q

Rules of myopes and presbyopes in prescribing?

A

don’t take away minus frm myope or NN from presbyope (NN = D + Add)

157
Q

Children <5 how do you prescribe

A

bold + caution. Amblyopia vs emmetropization

 Aniso     Iso H     >1       >5 A     >3       >8 M   >1.5    >2.5
158
Q

How much anisometropia induces vertical phoria?

A

> 1.0 D in DOWNWARD GAZE

159
Q

Aniseikonia’s experience vertical phoria where?

A

all gazes.. play with BC, centre thickness, n, aspherics

160
Q

How much antimetropia induces vertical phoria?

161
Q

Anisophoria: their NVP is 10cm
OD = -5.00sph
OS = -2.00 sph
How much prism should be put on glasses and what eye?

A

F(OD = 5(0.1) = 0.5∆ BD OD aka 0.5∆ R. hypophoria

Therefore.. 0.5∆ BU OD
or, 0.25 BU OD + 0.25 BD OS

162
Q

Malingering

A

figure out their goal.. want glasses? $? attn?

163
Q

Clinical hysteria

A

psychological acute stress/trauma
R/O organic pathology
Reassure
Refer to psychologist

164
Q

Streff (Non-malingering)

A

kids 8-18
Bilateral loss at distance + near (with Rx)
reassure
refer

165
Q

Dispenasary hocus focus

A

vague complaints about glasses/Rx that don’t make sense cuz of external factors

166
Q

Munchausen (by proxy) syndrome

A

Attn munching!

MANDATED report + refer for mental health

PPO2 (1 decks)

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