Questions 2 Flashcards
lincoff’s rules (4)
- ST or SN RDs primary breaks are within 1:30 clock hours of highest border
- total or superior RDs crossing 12 oclock. break is at 12 oclock or in a triangle
- inferior RDs higher side of RD indicates side of optic disc primary break is one
- inferior bullous RDs. break is superior.
Alstrom syndrome. ocular manifestation and systemic
dilated cardiomyopathy
cone rod dystrophy
congenital ectropion uveae is associated with what condition
NF, Rieger syndrome
what is harada ito procedure?
advancement of superior oblique tendon’s anterior fibers to strengthen it. increases torsion without significant ipsilateral hypertropia.
monocular oscillopsia. cause. treatment.
caused by superior oblique myokymia. terat with phenytoin, topical timolol, carbamazepine.
ophthalmodynamometry. what is it?
used to measure retinal artery pressure. can distinguish CRVO from ocular ischemic syndrome.
fluorophotometry. what is it
measures aqueous humor formation.
I:S ratio in keratocnus
> 1.4
treatment for hydrops
hypertonic saline, patching, cycloplegia, aq suppressants
gas in AC (pneumatic decemetopexy)
CMV response to antivirals is gauged by what
how big the size is and how much activity there is at the edge of the lesion
three most likely broad etiologies for color loss?
macular dz, parietal lobe dz, optic neuropathy
RPE abnormalities in AMD?
geographic atrophy, non geographic atrophy, and focal hyperpigmentation
causes of leukocoria?
Rb, congenital cataract, coat’s disease, retinal detachment, PHPV, coloboma, ROP, toxocariasis
what are three ways of measuring corneal power on topography?
- axial curvature: takse a Sagitta cut through line of site. better at estimation of central K
- instantaneous radius of curvature- takes just one point. better at peripheral estimation
- mean curvature-this uses best fit sphere method. also better for peripheral K
SAC TIP (sagittal axial central; tangential instantaneous peripheral)
according to ONTT, what appearance of the optic nerve is associated with least likelihood of MS?
very edematous with hemorrhages.
what gauge needles do you use for AC tap vs vitreous tap?
30 gauge for AC
25 gauge for vitreous
What medicine can you use to cause miosis in scotopic conditions? why is this useful
brimonidine can be used to cause miosis in apodized multifocal IOLs or s/p LASIK to decrease scotopic glare
endogenous fungal Endophthalmitis. risk factors without overt known fungemia??
recent GI surgery, prolonged indwelling catheters
How do you treat endogenous fungal endophthalmitis without systemic infection?
oral fluconazole or voriconazole if retinal alone.
vitrectomy with intravitreoal vori or ampho
what is the 5 year risk of contralateral involvement in GCA?
54-95%
what’s the 5 year risk of contralateral involvement of NAION?
15%
what’s the indication for phakic IOLs?
young patients who cannot undergo corneal refractive surgery and desire to be spectacle free
posterior chamber depth for phakic IOLs?
250-750 microns. 1.0 +/- 1.00 corneal thickness.
this allows the lens to be vaulted to prevent pupillary block, iris chaffing, and anterior capsular cataract.
most common cause of endogenous endophthalmitis in Asia?
klebsiella liver abscess
most common cause of endogenous endophthalmitis in IV drug users?
bacillus species
what is heavy eye syndrome in high myopia?
elongation of globe herniates between superior and lateral rectus. eye deviates infra nasally.
at what age do children peak in terms of hyperopia?
age 6-8
what’s the pathophys of dellen?
raised conj…leading to drying of adjacent cornea… leading to thinning of epithelium and stroma. Rehydration would lead to reformation of area.
siderosis on ERG?
A wave initially is more negative with nl B wave. then B wave disappears with time.
what’s the power of a Hruby lens
55D. attached to slit lamp to give a upright image that is very restricted in field of view.
tonic pupil pathophys
disruption of post-ganglionic parasympathetic pupillomotor fibers.
idiopathic is most common.
orbital tumors, VZV, orbital trauma, giant cell arteritis, DM, amyloidosis, syphilis.
which study established tight glycemic control is effective to reduce microvascular damage?
UK prospective Diabetes study (UKPDS)
Macular Dystrophy MARKS the cornea limbus to limbus
Macular
AR auto recessive
KS keratan sulfate
limbus to limbus
how many percent of people with symptomatic PVD will have a hole/tear?
15%
how many percent of people with hemorrhagic PVD will have a hole/tear?
50-70%
how many % of patients with ankylosing spondylitis have HLAB27 positivity?
90%. preferred treatment is TNFa inhibitors such as infliximab
monocular elevator deficiency with chin up position and hypotropia…how can you correct
if there’s restriction–release it.
if not knapp procedure by borrowing medial or lateral rectus portions to superior rectus
what is the Hummelsheim-type procedure?
similar to knapp procedure for elevator defect. it’s for CN VI palsy by borrowing fibers from superior/inferior rectus
common features of congenital esotropia?
<6 months of age cross fixation DVD latent nystagmus angle is usually large possible V pattern
three types of glycosminaglycans in the corneal stroma
dermatan, keratan, chondroitin sulfate
what distance should be in between the two lenses of telescopes?
the addition of the two focal lengths
Ishihara plates tests for what kind of color deficiency?
red-green deficiency only!
use Anthony tritan plates for blue yellow. Farnsworth panel D-15, lathery desaturated 15 hue test, or farnsworth-munsell 100-hue test for detailed testing
Best disease gene?
VMD2 gene for bestrophin
what does EOG measure
TransRPE potential
what are paraxial rays?
rays coming in near the center of the optical center of the lens and is not refracted very much
features of hemangiopericytomas?
well circumscribed tumors with or without pain.
pericytes with “stag horn” blood channels. reticulin deposits surround each cell
what are neutral density filters?
put it over the good eye to quantify APD
in a DCR…what is 8 mm medial to the medial canthus?
angular artery and vein
what is angle alpha and angle kappa and angle gamma?
alpha is: optical center, and visual center (AOV)
Kappa: is pupillary center and visual center (KPV)
Gamma: is optical and fixation axis (GOF)
what is angle alpha most important in ?
alpha is important for multifocal IOL placements. if too large then they’re not a good candidate
what is angle kappa most important in?
kappa is important for corneal refractive surgery
refractive index of cornea?
1.376
exudative retinal detachments can occur with PRP. how do you treat this?
treat by steroids and observation. will spontaneously resolve.
hypo pigmented iris spots seen in Down syndrome are called what
Brushfield spots (similar Wofflin nodules can occur with normal individuals)
due to stromal hyperplasia
polypoidal choroidal vasculopathy characteristics
mostly older F blacks/asians.
present with serous or hemorrhagic RD.
Tend to be around peripapillary areas
ICG is most helpful
other than central retinal artery…what other artery is seen in 15-30% of people in the retina?
cilioretinal artery (from posterior ciliary arteries)
GCA patient who is on steroids….how long do you have until temporal artery biopsy is no longer valid
1-2 weeks
Bardet-Biedl syndrome
intellectual disability, hypogonadism, renal failure, poly dactyl, obese, nyctalopia, macular mottling, pigmentary retinopathy
Alsotrome syndrome
autosomal recessive, retinal degeneration, obesity, DM, hearing loss, renal failure, dilated CM.
which are the septet fungi?
FACtSeptate
fusarium, aspergilis, curvularia
pigment dispersion syndrome. other than glaucoma and zonular instability… what other complications do they have
RD
unilateral optic neuropathy with disc swelling and APD. do FA and there’s no leakage…what’s the diagnosis
Leber’s hereditary optic neuropathy.
other findings include peripapillary telangiectasia
most commonly used isotope for treating choroidal melanoma in the US
iodine 125
which wall of the orbit has the shortest length (anterior posterior length)
floor. it does not extend to apex and stops at the pterygopalatine fossa
treatments for acanthomoeba keratitis?
biguanide, PHMB/propamidine, chlorhexidine,
corneal power estimation s/p refractive surgery…
Kestimated=Kpre+Rpre-Rpost
What corneal thickness/endothelial count is at risk for poor outcome after cataract surgery
thickness >600 and endo count <1000
what are optociliary shunt vessels?
retinochoroidal collaterals due to chronic poor central retinal vein drainage. These are from the arachnoid.
causes: optic sheath meningioma, gliomas, chronic Papilledema, glaucoma, old CRVO/BRVO
retinal hemorrhage in a few day old baby..what should you do
observe…can be due to birth trauma.
how many milliliters is the avg eye
7 ml (5ml is vitreous)
Risk factors for AMD
Female, age, light iris, caucasian, HTN, CAD, HLD, FMHx
Smoking and hyperopia
Alagile syndrome?
JAG1 mutation
broaden forehead, pointed chin, betterfly hemivertebrae, developmental delay, jaundice, cardiac defects, POSTIOER EMBRYOTOXON
don’t give doxycycline to which patients?
- women of reproductive age
- breast cancer hx
- liver disease
- on AC
- children
epithelial dystrophies in order of increasing recurrence s/p graft
Let’s Graft More
lattice, granular, macular
progression of epithelial dystrophies in increasing order?
May like to grow
Mac, lattice, granular
chalmydia trachoma…classic findings
Herbet pits (from gimbal follicles), tarsal conj scarring, panus at superior limbus, follicles/arlts line at superior limbus
AREDS are beneficial to
eyes with intermediate AMD, advance unilateral AMD, non subfoveal geographic atrophy
uveitis and facial paralysis ddx?
sarcoid vs lyme
neurosarcoid usually involves what nerve
CN VII and II
hemifacial spasm that doesn’t go away when sleeping
facial nerve compression via ecstatic vertebral or AICA arteries.
sx control with botox OR Janetta procedure done by neurosurg (place sponge between nerve and vessel.
squamous cell carcinomas should be excised with what margin?
4mm
iron filings on lens capsule?
pseudoexfoliation
dominant optic atrophy AKA Kjer optic atrophy
temporal pallor with area of triangle excavation
- slow loss of vision
- no nystagmus
- ble yellow (titan) dyschromatopsia
- OPA1 gene
- generally will progress to 20/200 vision and stop
Behr optic atrophy
childhood on set of visual loss, ataxia, intellectual disability, urinary incontinence.
how is macular edema in CRVO treated
antiVEGF or IV steroids
laser doesn’t improve VA according to CVOS
Type 1 unilateral parafoveal telangiectasia (Leber Miliary Aneurysms)
macular Coats-like exudates
usually in males
edema responds to PRP.
Type II parafoveal telangiectasia does not work with laser.
Enhanced S-Cone syndrome
apparent macular edema on OCT but more truly represents macular schisis.
oculomasticatory myorhythmia
whipples disease
What’s absolute hyperopia?
manifest hyperopia?
facultative hyperopia
latent hyperopia?
-absolute hyperopia: (noncycloplegic) minim plus correction needed for clear distance vision
-Manifest hyperopia: max noncycloplegic plus the eye can accept without blurring vision
-Facultative hyperopia: manifest hyperopia-absolute hyperopia
latent hyperopia: cycloplegia hyperopia-manifest hyperopia
the two antibodies for myasthenia?
anti ACH R and anti MuSK
cogan’s lid twitch?
lid retraction s/p lateral gaze and returning to primary gaze. Associated with myasthenia
what is Q value?
the asphericity of the cornea.
Q value 0= spherical K
Q value < 0 is prolate
Q value > 0 is oblate
what are the three layers of the sclera?
episclera, stroma, lamina fusca (uveal is attached at lamina fusca)
Melkerson Rosenthal syndrome
recurrent facial paralysis
orofacial edema
lingual plicate/ fissured tongue
-granulomatous infiltration. Treat with cortical steroids/immunomodulatory agents
which type of UV ray tend to reach the lens to cause oxidative damage?
UVA.
UVB is generally filtered out by the cornea and aqueous.
non pigmented epithelium of the ciliary body. characteristics?
lens zones originate from basal laminae of these cells
- aqeous is produced here
- tight junctions make up blood aqueous barrier
- apart of neuroectoderm and continues to be connected to posterior pigmented epithelial layer of the iris
spiral of tillaux
5.5,6.5, 6.9, 7.7
bitot spot
seen in vitamin A deficiency–> loss of goblet cells. Bitot spot are foamy lesions made of keratinized epithelium, debris, inflammatory cells, and corynebacterium xerosis
congenital glaucoma
M>F, 2/3 are bilateral
what makes up primary vitreous
hyaloid artery, vasa haloidea propria, mesenchymal cells, tunic vasculosa lentos
what does tertiary vitreous consist of?
zone fibers
features of atopic keratoconjunctivitis
small papillae, K vascularization, year round disease, PSC, anterior sub capsular cataract
-depressed cell mediated immunity and Increased risk of HSV keratitis
optic nerve passes through optic canal–which is located in which part of the sphenoid?
lesser wing
corneal transplant graft…which type of rejection is worst in prognosis
endothelial cell rejection as endothelial cells cannot be replaced.
is there any difference in graft donors <66 y/o vs >66 y/o for PKs?
no they both had the same failure rate in the Cornea Donor Study
whats % of patients develop visually significant cataracts 2 years after vitrectomy?
90%
Pyogenic granuloma
actually reactive hemangioma–fibroblasts and proliferating capillaries. Histologically has “spoke wheel” vascular pattern. 3-4 weeks s/p surgery. treat with intralesional steroid , cautery
Jones I
Jones II
JOnes III
Jones I is testing the nose after a fluorescent disapeance test.
Jones II is using irrigation after a jones 1 with saline to flush out any potential blockage
Jones III s/p DCR. dye disappearance test then swab middle meatus
cholesterolosis (aka synthesis scintillatingans)
yellow crystals in the inferior vitreous space in eyes that have under gone trauma
retinoscopy is done at what distance for a working distance subtract of 1.50 for final refraction
66cm; 2/3 of a meter
retinoscopy – you want to make all meridians to what motion first?
add minus so all meridians are with motion
Sildenafil gives blue vision due to cross reactivity between PDE5 and PDE6. What is another ocular side effect of sildenafil
NAION
hidrocystomas include fluid from what structure
apocrine glands of moll
promethazine (antiemetic) should not be used in what group of patients
Peds under age of 2. can cause severe respiratory depression
Scheie syndrome. mucopolysaccharidosis.. what’s the enzyme not broken down?
lysosomal alphaL iduronidase
(mildler Hurler’s syndrome)
both are type 1 MPS
major ocular finding in Hunter’s syndrome
retinal degeneration
MPS2
indication of enucleation in Rb
tumor occupying >50% of globe
optic nerve involvement
anterior segment involvement
What is type 1 choroidal neovascularization
vessels from choroiocapillais grow through a defect in Bruch’s membrane in to sub RPE space.
- poorly delineated with late staining on FA
- “Occult” CNV
what is type II choroidal neovascularization
Abnl vessels from choriocapillaris penetrate through RPE–between RPE and outer segments of retina.
- FA shows well demarcated vascular pattern on early phase.
- lacy gray-green appearance on funds exam
- “classic” CNV
what is type 3 CNV?
originates from blood vessels of the deep capillary plexus of retina and grow downward to RPE
“retinal angiomatous proliferation.”
CN V1 divides in to frontal, nasociliary, and lacrimal.
What are the two subdivisions of frontal nerve
what are the two subdivisions of nasociliary
frontal: supratrochlear and supraorbital
nasociliary: ethmoidal and long ciliary nerve (to iris, cornea, and ciliary body, and nose skin)–thus Hutchinson’s sign
What percentage of PAM with atypic will progress to melanoma?
47%;
if there’s PAM with atypic with pagetoid spread or full thickness epithelial involvement then it’s 75-90%
causes of crystalline retinopathy
tamoxifen, antifreeze (ethylene glycol), talc, Bietti crystalline dystrophy, nitrofurantoin, methoxyfurane
what kind of cells are rhabdomyosarcoma derived from
undifferentiated mesenchymal cells. NOT muscle
echothiophate. should not be given together with what. what are other side effects and how to prevent?
do not give with succinylcholine
SE: iris cyst, ectopia uvea–prevent with phenylephrine
two types of degenerative schisis
Typical and reticular (splitting at RNFL)-ppx treatment is not recommended if asymptomatic
choroidal melanoma…which cell type has worse pox
epitheliod
sx of hyperparathyroidism
bones, stones, psych overtones
Bowmans is what collagen type
I and V
when is AC wash out indicated in hyphemas?
IOP >60 for 2 days, IOP >35 for 7 days, IOP >25 for 1 day with sickle cell
also corneal endothelial staining
CD45
immature lymphocyte marker
extra ocular muscle blood supply?
ophthalmic artery–> lateral muscular branch and medial muscular branch.
lateral musc branch: lateral R, superior R, superior oblique, levator palpeerde.
Medial muscular branch: inferior rectus, medial rectus, inferior oblique muscles.
Riley Day syndrome
familial dysautonomia.
-ashkenazi family hx, skin blotching, neurotropic keratopathy with decreased tearing.
enlarged corneal nerves
what are angioid streaks?
breaks in Bruch’s membrane–can lead to spontaneous sub retinal hemorrhage and sometime CNV (which then causes permanent vision loss)
what are associations of angioid streaks
B PEPSI: beta that, pseudoxanthoma elastic, ehler danlos, paget bone disease, sickle cell, idiopathic
megalocornea definition? inheritance?
X linked.
>/=13mm in diameter
associated disorders with megalocornea?
marfan’s
Down syndrome
alport
osteogenesis imperfecta
most common condition leading to corneal transplant in children?
Peters anomaly
FEVR
genetic disorder of retinal blood vessel development–results in vitreous traction, peripheral exudation, peripheral breaks, incomplete retinal vascularization. similar to ROP
autosomal dominant
incontinenential pigmenti (IP)
AKA Block-Sulzberger syndrome (x linked dominant; lethal in homozygous male) skin bull on extremities, hyper pigmented bascules on trunk. microcephaly, seizures. ROP-like funds with incomplete peripheral vascularization. leading to CNVM and detachment,
DUSN. what are the the organisms? what’s the clinical presentation? treatment?
organisms: Baylisascarias procyonis, ancylostoma, toxocara
PresentatioN: multifocal choroiditis, mild optic nerve swelling, mild vitirits. retinal arterial narrowing, RPE changes.
treatment is PRP the nematode that can be seen under the retina
peripheral retinal findings with increased risk of tear and RD?
- cystic retinal tufts
- zonular traction retinal tufts
- lattice degernation
- meridional folds
- encoded ora bays
- peripheral retinal excavations
peripheral findings NOT predisposed to tears/and RD?
-noncystic retinal tufts
-cobble stone degernation
RPE hyperplasia
RPE hypertrophy
peripheral cystoid degernation
what is the fasanella-servat procedure?
tasoconjunctival mullerectomy
- generally not the choice of therapy due to the fact it removes tarsus
- good only for mild ptosis with good amount of elevator function
blue light forms what phytotoxic compound leading to oxidative RPE damage?
A2E
Stargardt
AR, ABCA4 beaten bronze Mac atrophy funds flamimaculuatus dark choroid on FA lipofuscin
Avoid vit A due to increased lipofuscin accumulation
holes of V1,2,3
Standing Room Only
sup orbital fissure
foramen rotundum
foramen ovale
gyrate atrophy
OAT mutation
elevated plasma ornithine
choroideremia
x linked
CHM gene–geranylgeranyl transferase
–scalloped RPE and choriocapillaris loss–> tunnel vision
retinal vessels remain normal
homer wright rosettes
neuroblastoma
retinoblastoma
medulloblastoma
psammoma bodies
meningioma
Rosenthal fibers
optic gliomas, pilocytic astrocytomas
post orbital Surg pain… think what?
retrobulbar hematoma. due to perforating arteries (from infraorbital artery) in the infra temporal quadrant
