QUESTIONS Flashcards
How do you treat post op pupillary block
cycloplegia, LPI
How do you treat post op ciliary block?
cycloplegia, LPI (to r/o pupillary block), aqueous suppression
patients with elevated IOP from ICE syndrome…what is best therapy?
tube shunt vs trabeculectomy. laser angle surgery doesn’t work due to angle abnl
What serologic markers are most associated with uveitis in JIA patients?
postive ANA with negative RF
First line treatment for fungal keratitis?
natamycin–only available topical anti fungal in US
When should you consider giving steroids in EKC?
SEIs or pseudomembranes
prostaglandin ocular side effects?
macular edema, uveitis
topical carbonic anhydrase ocular side effects?
K edema
laser trabeculoplasty is good for patients for what kind of angle structure?
open angles such as in pseudo exfoliation syndrome
what is Kasabach Merritt syndrome?
infantile hemangioma on organs leading to thrombocytopenia due to sequestration
anterioposterior width of lens at birth and in adult?
3.5 mm and 5 mm in adults
what’s the width of a phase tip?
1.6mm
what optic disc features are seen in NTG?
larger CDR, sloping, PPA, disc hemorrhage
what is scleromalacia perforans?
necrotizing scleritis WITHOUT inflammation. Associated with RA and is painless. High mortality–manage with a rheumatologist
redundant periumbilical fold is associated with what condition?
axenfeld rieger
interrupted PKP sutures are best for what kind of patients?
inflamed K, children, thin cornea, and vascularized corneas.
allows sutures to be removed individually if needed
rubella infection of second trimester is associated with what?
retinopathy
rubella of first trimester is associated with sequestration of virus in lens leading to cataracts… what other association is almost never seen at the same time with cataracts in these patients
congenital glaucoma
myasthenia gravis is also associated with what comorbid condition?
Graves and thymoma
Get TSH and CT chest/neck
salt pepper fundus
congenital rubella mostly associated with second trimester infection
describe Lisch Epithelial Corneal Dystrophy?
X link dominant condition with micro cysts in epithelium forming whirl like pattern. Similar to Meesman’s
definition and width of perifovea
1.5 mm, area of the very peripheral macula
width of parafovea
0.5mm, area surrounding fovea. It is where ganglion cells are the thickest
foveola definition. width of foveola?
area where there’s only cones.
250 microns
where is foveola in relations to optic nerve?
0.4mm temporal, and 0.8mm inferiorly
What is the width of fovea?
1.5mm–aka 1 disc diameter
thickness of K epithelium?
50 microns
thickness of Bowman’s layer?
8-14 microns
Thickness of decedent’s membrane?
3 microns at birth —increases to 10 microns in adulthood
nevus of Ota is associated with what condition?
glaucoma in 10% pts
Feldenstrucktur muscle is at what NMJs for what movements
at En grappe NMJs for smooth pursuits
Fibrillenstruktur muscle is at what NMJs for what movements
en plaque NMJs for saccades
Cidofovir ocular side effect?
uveitis, hypotony
what conditions are associated with enlarged K nerves/
neurofibromatosis 2
MENIIB
leprosy
MeN2 large k nerves
how many % of melanomas come from PAM (with atypic)? de novo? nvus?
70% from PAM. de novo 20% rest from nevus
dieffenbachia plant exposure causes what?
corneal calcium oxalate crystals called raphides
treatment for toxo?
oral: pyrimethamine, sulfadiazine, folic acid…(triple therapy)… then later on prednisone
or IV of clindamycin and dexamethasone
LASIK. what organisms are common infections in <10 days post op? what about >10 days post op?
Gram + <10 days
Fungal or atypical mycobacteria >10 days
Lens capsule is thickest where?
posterior pre equatorial 23 microns
anterior lens capsule thickness?
14microns
direct eye lid closure is used for what size of eye lid defects?
<33%
how do you close lid defect 33-50%?
lateral canthotomy then rotate flap (Tenzel flap)
what is Cutler-Beard procedure?
for UPPER lid defects of >50% by using lower lid as flap
What is the modified Hughes procedure?
to fix lower lid defects >50% with upper eyelid flap to construct posterior lamella
what is echothiophate?
indirect Miotics. Do NOT give succinylcholine with it as it may prolong paralysis
What is central cloudy dystrophy of Francois?
exactly the same appearance as crocodile shagreen. Except for crocodile shagreen develops over time and central cloudy dystrophy of Francois is from birth (it’s a dystrophy)
what are the two flattest quadrants of the cornea?
superior and nasal
fovea size
1.5mm same as ON
microscopic breaks in bowman’s layer is associated with early stages of what condition?
Keratoconus
What is the difference between CHED and CHSD?
CHSD is extremely rare –there is no corneal edema, but there’s thickening with flaky stromal lesions.
what is astigmatism keratotomy?
parallel corneal incisions about 1mm from apex in order to flatten steep meridian and steepen the flat meridian (coupling)
what effect do radial incisions on the cornea have on the curvature?
radial incisions flatten both the meridian at hand as well as 90 degrees from it
Cidofovir is used for CMV retinitis. what are its side effects?
anterior uveitis.
hypotony
renal toxicity
what is the only medicine proven to reduce rebleed s/p traumatic hyphema?
aminocaproic acid
christmas tree cataract are associate with what two conditions?
myotonic dystrophy
hypoparathyroidism
what kind of collagen is associated with decemet’s membrane
type IV
corneal power total? anterior? posterior?
total is 43. anterior is 48, posterior is -6
sudden vision loss with disc edema/peripapillary telangiectasia. waht condition? pattern of inheritance?
Leber hereditary optic neuropathy. mitochondrial
symptomatic patients and what % of carotid occlusive disease should get CEA? what’s the periop risk of stroke in CEA? how does stenting compare?
70-99%. Periop risk of stroke for CEA is 6%. vs higher with stenting
ONTT. how many % of patients with optic neuritis had pain with EOM?
92%
square wave jerks. associated with what condition? it’s nystamoid movement but not nystagmus because?
parkinson’s and cerebellar/pontine disease.
It is saccdic intrusion and does not have fast/slow phase.
How many posterior short ciliary arteries enter the globe around the optic nerve? how many posterior short ciliary nerves?
20 arteries
10 nerves
what’s the length of intraorbital portion of optic nerve?
what’s the length of intrascleral portion of optic nerve?
what’s the length of intra canal portion of optic nerve?
24mm
1mm
10mm
whats the difference between prolapsed orbital fat and lipodermoid
lipodermoid is choristoma present at birth vs prolapse happen with age
rate of aqueous production
2 microliters/min
what substances are at increased concentration in Aqueous than blood
vit C, hydrogen, chloride
type 2 parafoveal telangiectasia is associated with what lab test finding?
impaired glucose tolerance
Duane type 1. preferred surgical procedure?
medial rectus recession
Duane type 2. preferred surgical procedure?
lateral rectus resection
the orbits are separated by how many mm?
25
light induced scotoma that improves with laying down. dx? diagnostic studies?
ocular ischemic syndrome. also could present as hypotony and mid-peripheral DBH
can do FA, CTA, MRA, carotid doppler–carotid endarterectomy
volume of vitreous cavity
5ml
volume of AC
200 microliters
which immunemodulator is associated with drug induced lupus?
infliximab
vitrectomy induces what kind of cataract?
nuclear
silicon oil induces what kind of cataract
PSC
average power of the lens is how many diopters?
20
ectopia lentis et pupilae. mode of inheritance
autosomal recessive
what is the most common cause of congenital unilateral cataract?
persisting fetal vasculature (PFV)
how often is Rb bilateral
1/3 of the time
beer belly cornea, crab claw on keratometry. Dx?
pellucid marginal degeneration
what is snowflake degeneration?
degenerative changes to PMMA IOLs.
IOL calcifications happen with what kind of IOL material?
hydrogel
glistening occur with what kind of IOL material
hydrophobic
encephaloceles are associated with what two optic nerve abnormalities?
morning glory nerve
optic nerve hypoplasia
what is Heerford syndrome?
It’s uveitis, parotidis, and fever (uveoparotid fever)
can be a presentation of sarcoid
What is Lofgren’s syndrome?
erythema nodosum, hilarious LAD, and arthritis
what are the signs of intraoperative suprachoroidal hemorrhage?
tense eye, shallowing AC, loss of red reflex.
What do you do in the case of intraoperative suprachoroidal hemorrhage.
close wound with suture
the two oblique muscles are at how many degrees from visual axis?
51 degrees
the superior and inferior rectus muscles are at how many degrees from visual axis?
23 degrees
What is spherical aberration?
4th order aberration. Due to stronger focusing at peripheral corneal vs central. Risk factors: young, large pupil, myopic corneal ablation
night myopia is a side effect
What is coma?
coma and trefoil are 3rd order aberrations.
Coma is due to eccentric light focusing causing light to look like a comet
what are second order aberrations?
myopia (positive defocus) and hyperopia (negative defocus)
What are first order aberrations?
prisms.
What are ophthalmoplegic migraines?
intermittent 3rd nerve palsy. Almost always in Peds.
Always a diagnosis of exclusion (lymphomas, sarcoid..etc). enhancement on MRI is seen
what are the three FA patterns seen with central serous chorioretinopathy— in order of most common to least common?
expansile dot pattern, smoke stack (10%), diffuse
CN with the longest intracranial course?
CN 4
which sub nuclei of CN III are fused (and thus supplies both eyes)?
levator palpebrae
which EO muscle receives innervation from both ipsilateral and contralateral nerve fibers?
Superior rectus… from both CNIII fibers
Saltzmann’s nodules are in what layer of the K?
Bowman’s.
Middle age women–trachoma/interstitial keratitis/phlyctenules
most common hormone deficiency in de Morsier syndrome?
growth hormone
what is a contraindication to azathioprine?
hx of treatment with alkylating drug or hx of allergy
What is Foster-Kennedy Syndrome vs Pseudo Foster-Kennedy Syndrome? How do you distinguish?
Foster Kennedy syndrome: mass compression induced optic neuropathy/atrophy. Then compression of CSF flow results in unilateral papilledema in other eye.
PSeudo Foster Kennedy syndrome: sequential NAION at least 6 weeks apart. One nerve is atrophic already and one is swollen.
Both have one atrophic and one swollen nerve
distinguished by VF defect of the swollen side–> pseudo Foster Kennedy will have altitudinal or arcuate defect like NAION. Pseudo FK will have only enlarged blind spot
latent nystagmus is associated with what kind of deviation? when does it occur?
congenital estropia with fast beats AWAY from viewing eye.
Occurs when binocularity is disrupted.
What settings of PRP increase chance of choroidal neovascular membrane?
higher power, longer duration, and SMALLER spot size (breaks through Bruch’s membrane)
what’s the magnification of a simple magnifier equation?
Msimple magnifier=D x distance
what is oscillopsia?
subjective sensation that environment is moving in patients with nystagmus or nystamtoid eye disorders
what are some drugs that causes uveitis?
rifabutin, bisphosphonates, sulfonamides, OCPs
What meds are associated with uveitis
metoprolol, travaprost.
proliferative sickle cell retinopathy should be treated how?
low intensity PRP to ischemic regions
benefits of YAG contact lens?
stabilizes eye, reduces depth of field, and magnifies image.
Bacterias that can penetrate intact K epitheliuM?
No Hard or Soft Contact Lenses
Neisseria (both), Haemophilis aegyptus, Shigella, Corynebacterium, Listeria
What is Sherrington’s law? what condition violates Sherrington’s law?
When one rectus muscle contracts the opposite muscle relaxes. Duane’s violates Sherrington’s thus the globe retracts
What is Herring’s law?what condition violates this?
The two eyes are yolked together. so refixation of a hyperopic eye should result in corresponding downward movement of the other eye. Dissociative vertical deviation (DVD) violates this
What is the lens maker’s equation?
Power (D)= (n’-n)/r
n’=index of refraction of lens. n=index of refraction of air. R is focal length
how many degrees do you treat when doing CPC?
270 –so that 90 degrees are spared–decreases anterior segment necrosis risk.
Plateau iris is diagnosed s/p doing LPI and pressure is still elevated. What should you do to treat plateau iris?
ALT
Touton giant cells are associated with what condition?
Erdheim-Chester (two tons of chest nuts)
Associated with early cardiac disease
Skin findings of Juvenile Xanthogranuloma (little red bumps)
yellow iris lesions
Unilateral ischemic eye disease with mid periphery retinal hemorrhage seen on exam. What condition is this? what’s the work up?
Ocular ischemic syndrome.
You need to do carotid US
Neuroblastoma associations in children?
periorbital ecchymosis
Horner’s syndrome
Forster Fuch’s spots. what are they. what condition do you seen them in?
RPE changes/hyperpig spots. In high myopia
Dalen Fuch’s spots. What conditions do you see them in?
Sympathetic ophthamia
VKH
neuroretinitis with macular star and papilledema. What’s the organism that causes this?
Bartonella
magnification of image with a lens is calculated how?
Mag=power of eye/power of lens
Bird shot chorioretinitis is characterized by what HLA marker
HLA A29
best tested with ERG and VF
Young child who has bilateral ptosis and cannot look up.
congenital fibrosis extra ocular muscle syndrome 1. autosomal dominant hesitance of muscle fibrosis.
chandler’s
iris atrophy, k edema
energy pathway of the lens? (glucose)
anerobic glycolysis
what is pseudoxanthalasma elasticuma?
xanthalasmas on skin
Fundus has angio streaks and peau d’orange appearance. These eyes are prone to CNVM, choroidal hemorrhage.
how do retinoblastoma escape the eye and disseminate?
via optic nerve
what is bilateral diffuse uveal melanocytes proliferation (BDUMP)
leopard spots withOUT leakage on FA. associated with lung cancer.
uveal effusion syndrome
leopard spots WITH. leakage on FA
not associated with lung cancer
uncontrolled IIH with progressive vision loss–tx? uncontrolled HA–tx?
optic nerve fenestration for vision loss.
lumboperitoneal shunt for headache
When you do surgery on the inferior rectus the lower eye lid tend to go in the direction where you move it. Recession –> lower lid retraction, Resection –>lower lid elevation
dieffenbachia house plants can cause what complication?
corneal crystals. painful
dorsal midbrain syndrome (parinaud’s syndrome) symptoms?
can’t look up
convergence-retraction nystagmus with OKN drum moving down
light-near dissociation
eyelid retraction (collier’s sign)
causes of parinaud’s syndrome?
pinealoma, aqueduct stenosis, midbrain stroke
order of occurrence of basal cell carcinoma in terms of location
Inferior>medial>superior>lateral.
I aM So Large
what’s the cause of benign intermittent mydriasis?
migraines. does not have to be temporally related to headaches.
what procedure do you do to fix astigmatism in PKP patients?
arcuate keratotomy
to fix corneal astigmatism with incisional relaxation…which axis (steep or flat) do you incise?
steep axis
risk factors for failed trabeculectomy?
younger age, aphakia/pseudophakia prior conj procedures african american active inflammation
how long does it take cornea to be in its final refraction after LASIK?
2-3 months
myotonic dystrphy patiens tend to have low IOPs because?
ciliary body detachments
which EOMs have tertiary actions? what are they?
vertical recti muscles and oblique muscles have tertiary actions.
obliques are adduction. verticals are aBDuction
vascular congestion over rectus muscle. What are the two differentials and how to separate them?
TED vs dural shunt.
TED will be located just next to the EOM insertion.
dural shunt will be congested from EOM insertion all the way to the limbal area.
what is WAGR
Wilms, aniridia, genitourinary defects, retardation.
if aniridia you should order abd US
What is Gullstrands ratio
an assumed relationship between anterior and posterior cornea.
In patients s/p refractive surgery (PRK and LASIK only) this would be off as anterior surface has been manipulated.
Brown syndrome?
restricted elevation on ADDuction.
“V” pattern–victor brown
Brown syndrome?
restricted elevation on ADDuction.
“V” pattern–victor brown
you should get CT to rule out physical impingement
what gene is associated with congenital glaucoma
CYP1B1–baby cyps
what gene is associated with pseudo exfoliation glaucoma
LOX1
what gene is associated with POAG?
TIGR/MYOC–tiger out in the open
what are the typical immunosuppressants for intermediate uveitis?
cyclosporine, methotrexate, and subT steroids
what immunomodulator worsens MS?
Infliximab
what’s the mechanism of pilocarpine?
muscarinic agonist. It causes longitudinal ciliary muscles to contract and then opens up TM and increases drainage.
what are the conditions leading to false positives in RPR and VDRL
SLE/antiphospholipin
pregnancy
liver disease
other treponemal disease (lyme)
how long should temporal artery biopsies be?
2-3 cm
pigmentary retinopathy is the MOST COMMON manifestation in congenital rubella. What is the vision like usually?
good. usually not affected by retinopathy
how can you tell the difference between diffuse lamellar keratitis (DLK) and infection in LASIK patients?
DLK presents <24 hours s/p procedure and only involving flap interface. infection is few days later and more painful and can be anywhere
what is photostress recovery time test
shining light in to eye for 10 seconds then measuring when vision comes to baseline (poor man’s ERG)… >90 seconds is abnormal.
what is potential acuity meter
testing for visual acuity in the setting of cataract or unclear media
VIP study vs TAP study
TAP: classic CNV in AMD–no difference in PDT vs placebo
VIP: occult CNV in AMD <4 disc areas benefited from PDT
treatment progression for CSCR?
if vision is good–observe
if vision is involved or if doesn’t resolve in 3-4 months and is >500 microns away from central macula– focal laser
if center involving and doesn’t resolve–PDT
antiVEGF doesn’t work unless there’s CNVM
You MUST control diabetic macular edema prior to cataract surgery. what are the treatment options?
- Lucentis is preferred
2. focal laser then wait 3 months and if ME has regressed then do cat surg
if patient is on X mg of prednisone for chronic uveitis then they need to be on a immunomodulator… what is the X mg?
10 mg
if both eyes are equally esotropic then you don’t get ambyopia due to development of what phenomenon?
cross fixation where adducted eye is viewing contralateral temporal field
white streak on DFE s/p trauma to the eye… what’s the diagnosis?
choroidal rupture.
observe first… then if CNVM develops (sub retinal bleed)… then do VEGF
circle of zinn Haller supplies what portion of the optic nerve?
laminar
Sigiura sign
perilimbal vitiligo in VKH
nystagmus types are defined fast or slow phase?
slow. fast phase is physiologic and always the same
infantile nystagmus is associated with acceleration or deceleration of slow phase?
acceleration
idiopathic justafoveal telangiectasia group 1 vs group 2 vs group 3 characteristics
Group 1: unilateral, male, macular edema
Group 2: bilateral, female, retinal atrophy/NV, most common
Group 3: rare. progressive vascular obliteration
prisms (with apex angle >0) always bends light toward apex or base?
base
timolol has what effect on LDL and HDL?
raises LDL and lowers HDL.
timolol is yellow so it increases bad lipids
how many mm of medial rectus recession to do for 15 diopters of eso?
3mm
4mm for 25, 5mm for 35
how many mm of lateral rectus recession to do for 15 diopters of eso?
4mm
5mm for 25, 6mm for 35
associations with nanophthalmos
hyperopia, short axial length, strabismus
ocular side effects of topical epinephrine drops
conj hyperpigmentation, macular edema
minimum endothelial count for corneal transplant graft
2000
latent nystagmus features
horizontal nystagmus TOWARD uncovered side and head turn toward covered side.
Decelerating in slow phase beat
Associated with eso and only present when one eye is covered
latent nystagmus features
horizontal nystagmus TOWARD uncovered side and head turn toward uncovered side
Decelerating in slow phase beat
Associated with eso and only present when one eye is covered
spasm nutans. the triad? why might you want to image these kids?
- head nodding
- asymmetric nystagmus or monocular nystagmus (called shimmering)—usually horizontal but can but otherwise
- Torticollis
4-14 months olds
can be associated with parasellar mass
what are the uveitis conditions that immunomodulation should be started early
VKH
sympathetic ophthalmia
Bechet’s
necrotizing sclerouveitis
how many percent of people have a common canaliculus
90%
Frequency doubling technology visual field tests what cells
M cells
Frequenting McDonalds Seems Krazy
SWAP visual field tests what cells
konicellular
Frequenting McDonalds Seems Krazy
where is sclera thickest and thinnest?
thickest: around ON insertion (1.0mm)
thinnest: immediately posterior to EOMs
avg:0.3mm
see saw nystagmus is associated with what kind of lesions
parasellar/midbrain… classically craniopharyngiomas in kids
opsoclonus is associate with what kind of CNS lesions
neuroblastoma
downbeat nystagmus is associated with what kind of CNS lesions?
cervicomedullary (chiari malformation)
upbeat nystagmus is associated with what kind of CNS lesions?
cerebellar, midbrain, medullar
periodic alternating nystagmus is associated with what kind of CNS lesions?
cervicomedullary junction
what gases are used in excimer laser
argon and fluorine
what is the AGIS finding of ALT vs trabeculectomy sequence in white and black patient
black patients: ATT (alt, trab, trab)
white patients: TAT (trab, alt, trab)
PDR is defined as presence of what 3 features?
NV, traction membranes, VH
Intacts are good for keratoconus patients with what features
low myopes with steep corneas
SSRI is associated with what ocular complications
angle closure glaucoma
what risk factor is associated with CRVO and not BRVO… what is associated with BRVO and not CRVO
CRVO is associated with DM… not BRVO
CAD is associated with BRVO and not CRVO
why is anterior phimosis associated with conditions of increased zonular laxity
loose zonule allow the capsule to contract
NF1 with what feature is associated with increased glaucoma risk
plexiform neurofibroma
Pressure induced stromal keratitis in LASIK. what is it?
prolonged use of steroids s/p LASIK leads to corneal edema and elevated IOP (but falsely lowered due to edematous K)
myelinated retinal fibers are seen in what condition?
Basal cell nevus syndrome (Gorlin-Goltz)–multiple basal cell CA
also amblyopia, unilateral high myopia, and NF1
BPES (blepharophimosis, ptosis, epicanthus inversus syndrome) type 1 is associate with what
premature ovarian failure
Crosslinking minimal corneal thickness?
400 microns as the UVA light penetrates to 300
what’s the distinguishing feature of PUK vs Mooren’s ulcer?
mooren’s ulcer is more in the cornea. PUK can involve sclera
retrobulbar block involves what nerves:
II, III, V1, VI. Note 4 is not in the cone
small optic disc drusen are associate with what conditions?
retinitis pigments, Pseudoxanthogranuloma elasticum
dacryocystocele management?
without signs of infection or distress –gentle massage x1-2 weeks then surgery/probing
If infected or distress–immediate probing.
fetal alcohol syndrome associations
strabismus, epicanthus, blepharoptosis, cataracts, axenfled-riger, PHPV, optic nerve hypoplasia
treatment for squamous cell carcinoma of conj?
excise, cryo, with antimetabolite
what are the stages of VKH?
prodromal (viral like, aseptic meningitis like)
Uveitic
Convalescent (orange sunset glow, perilimbal vitiligo, alopecia, poliosis, serous RD)
Chronic recurrent
associations of Gillespie syndrome
Aniridia, intellectual disability, ataxia
Louis Barr syndrome (ataxia-telangiectasia syndrome). what ocular association do they have? systemic?
cannot initiate saccades
breast cancer and leukemias
miotic glaucoma agent side effects (pilocarpine or echothiophate)
brow ache, inflammation, RD,
bones of superior orbital wall
Front Less –frontal and lesser wing of sphenoid
bones of medial orbital wall
SMEL: sphenoid, maxillary, ethmoid, lacrimal
bones of orbital floor
MoP Z Floor; Maxillary, Palatine, Zygomatic
bones of lateral orbital wall
Great Z: greater wing of sphenoid and zygomatic
treatment of TASS?
- r/o endophthalmitis. 2. intensive steroids 3. controlling IOP
brown mcclean syndrome–peripheral corneal edema starting inferiorly moving around. orange hue to K. What is associated with this syndrome?
intracap cat surgery
HIV patients with CD4<50 are at risk of CMV retinitis. How does the CMV infection get there?
hematogenous spread
birdshot is responsive or not responsive to steroid
not responsive. needs immunotherpay
what medication causes miosis but preserves accomodation?
dapiprazole
steep cornea risk for lasik
flat cornea risk for lasik
steep-button hole
flat- free cap flap
what med is used to treat microsporidium keratitis?
topical fumagillin
keratoconus is due to fragmentation of what layer of cornea?
bowman’s
what is Balint syndrome?
bilateral parietal occipital atrophy.
1. optic ataxia (poor eye hand coordination)
acquired ocular motor apraxia (can’t imitate saccades), and Simultanagnosia (unable to understand pictures although able to see they mages)
myelinated RNFL is associate with what conditions?
amblyopia, NF, myopia
what’s the difference between peripheral CN VI lesion vs CNVI nuclear lesion?
peripheral will be isolated ipsilateral abduction deficient.
CN VI nuclear lesion would result in inability to abduct ipsilaterally and inability to adduct contra laterally (due to the fact that CN VI and contract CNIII are connected via the MLF)
ALSO ipsilateral CN VII palsy are seen in CN VI nuclear lesions.
poly arthritis, GI symptoms, and panuvieitis. dx?
Whipple dz
what bleb location has the highest infection rates?
inferior
what is brown syndrome?
Brown syndrome is SO restriction. hallmarks include: inability to look up. negative positive forced duction V pattern NO superior oblique overaction no torsion negative head tilt test
characteristics of Merkle cell CA of the lid?
fusiform progressively growing fusiform lesion. palpable LNs. caucasian males are most frequent
what type of collagen is in vitreous?
type 2 is in the Goo
EVS showed which patients would benefit from immediate vitrectomy as opposed to tap and inject?
LP or worse
DR4 is associate with what conditions?
VKH, sympathetic ophthalmia
Birdshot HLA type?
A29
Behçet diasese HLA association?
B51, B12
PERK study showed what?
RK leads to hyperopic shift
what’s the differentiating features of CAR and MAR.
CAR affects mostly CONES, likely already has cancer diagnosis.
MAR affects mostly rods, more likely to be the initial symptom
both have photopsia, nyctalopia, initially will have Nl DFE then will have RPE and ON atrophy
ocular histoplasmosis syndrome… does it have vitirits?
no. if there’s vitrifies think Multifocal Choroiditis and Panuvititis (MCP) white dot syndrome
What is Terson syndrome?
Terson’s is VH/subhyaloid hemorrhage due to Subarachnoid hemorrhage
Reiter syndrome is associated with what organisms
chlamydia trachoma’s, shigella, salmonella, yersinia, campy
What is apert syndrome?
craniosynestosis similar to Crouzon syndrome. Both have FGFR2 mutations. Apert is associated with SYNDACTYLY
reactivation toxoplasmosis doesn’t have to be treated if inflammation is mild and pt is asymptomatic. However, it should always be treated in what population?
infants, preggos, and immunocompromised
paradoxical inversion of OKN response is seeing what condition
congenital motor nystagmus…this is the ONLY occasion that you see this
what’s a medication that increases aqueous production?
Ibopamine. increases aqueous 4 fold
wreathlike clusters on FA is associated with what white dot syndrome
MEWDS
quenching on FA is seen in what condition? what is quenching?
birdshot.
it means leakage of fluorescein out of vessels quickly
plateau iris… how is it diagnosed? how is t treated?
diagnosed s/p still narrow AC/elevated IOP s/p LPI.
Treated with laser iridoplasty
Can use pilo to help in the mean time
sine wave sign at the angle is characteristic of what condition?
plateau iris
pattern of PAS formation in plateau iris?
starts at Schwalbe line and extends posteriorly
DCR inserts in to what space?
middle meatus. NOT middle turbinate
conductive keratoplasty what does it do?
it steepens cornea…aka makes it more myopic.
who is good for conductive keratoplasty
mild hyperopes/presbyopes with mild or no astigmatisms.
Rb patients most frequently get what other tumors?
osteosarcomas and melanomas
decemet’s layer has banded and non banded layers… where is each located
anterior is banded, posterior is non banded
babies start fixing at what age
6 weeks
Trilateral lesion…what is the disease and where’s the third laterality
Rb. third is in pineal gland
early treatment of glaucoma trial showed what
62% progression of untreated
45% of progression with betaxolol +laser trabeculoplasty at 6 year follow up
solar retinopathy is associated with what meds?
Psoralen
Tetracycline
what is Hermansky-Pudlak syndrome?
oculocutaneous albinism, platelet dysfunction, in puerto ricans
Chediak-Higashi syndrome
oculocutaneous albinism, recurrent pyogenic infections
NS gives second sight to what population
presbyopes –can see better at near due to induced myopia
hyperopes will have better distance vision due to induced myopia
Pars planitis. laterally, complications?
usually bilateral (80%) and will have tractional RD, CME, VH
Hutchinson’s sign involves what nerve
nasociliary
ophthalmia neonatorum has follicles or papillae?
papillae
Congenital fibrosis syndrome features?
congenital onset of trouble looking down due to fibrosis. distinguishing feature from TED is congenital onset
Suture placed at 180 degrees does what to theK?
steepens K at 180 (bc it squeezes the K)
visual cycle
- 11 cis retinal stimulation via photon and isomerize to all trans retinal
- all trans retinal attaches to opsin activations G protein signaling
- ion channels close and hyper polarization occurs
What is the only light sensitive molecule in the visual cycle?
11 cis retinal.
what is hemeralopia
deterioration of vision in higher light environments . Cone dystrophy
what’s Palinopsia
recurrent images s/p object being removed
strongest attachment points of sclerouveal attachment?
anterior to ciliary body
major emissaries canals
aphakic glaucoma occurs most in what population
microcornea s/p congenital cat extraction early in life
what is the tissue of origin for storm, endothelium, and iris pigment
neurocrest
HLA DR4 associations
VKH and sympathetic ophthalmia
treatment for pubic lice on eyelashes
10 days of ointment. high heat dry all clothes
what is encephalotrigeminal angiomatosis
storage weber
Wyburn Mason syndrome’s other name?
Bonnet-Dechaume-Blanc syndrome
Racemose angioma
Tuberous sclerosis other name
Bouneville disease
associations of Palinopsia
- parietal-occipital lesions
- LSD/mushrooms
- topiramate
- stroke
- CLomiphene
- trazodone
how do you treat herpes zoster in immunocompromised patients
IV acyclovir–prevent encephalitis
How do you treat VZV
- valacyclovir 1000mg TID
OR acyclovir 800mg 5x a day for 7-10 days - PF and cyclo if there’s ocular inflammation
- abx for skin–NO topical eye abx.
aqueous production during night compared to day?
night (1 micrometers per min) is about half as day (2microliters/ min)
what is perceptual completion
brain’s ability to fill in the blanks so that most people won’t notice scotomas
increased ICP is associated with what medication
cyclosporine
Syndromes presenting with CPEO?
Kearn-Sayers
oculopharyngeal dystrophy (French Canadian)
myotonic dystrophy
What is optic atrophy of Schnabel?
optic atrophy with mucopolysaccharide deposition in optic nerve. associated with atherosclerosis
what axial length is associated with RD s/p CE?
> 25mm
fundus findings of cat-scratch?
neuroretinitis (macular star, disc swelling)
fever, malaise, LAD, parinaud oculoglandular syndrome, granulomatous palpebral conj nodules
What is oculopalatal myoclonus?
bilateral acquired vertical/pendular nystagmus with facial spasms that occurs months to years s/p brains stem (tegretal) stroke at the “triangle of Guillain-Mollaret” (cerebellar flocculus, inferior olivary nucleus of medulla, and red nucleus of midbrain.
what is per fluorocarbon liquid used for and what complication is associated with it?
It’s used for complex retinal detachment surgeries. Complication is subfoveal per fluorocarbon liquid that can lead to vision loss duet to retinal toxicity
segmental optic nerve hypoplasia is associated with what?
maternal DM
usually VA is conserved
where is the CNS lesion for ocular bobbing?
brainstem
what did the silicon oil study find regarding SF6, C3F8 and silicon oil?
SF6 is INFERIOR to tamponading with C3F8 or silicone oil.
what is Gorlin syndrome?
multiple basal cell CA’s and jaw tumors.
What is viscmodegib used for
Gorlin syndrome (multiple basal cell CA’s). it acts in the Hedgehog pathway
What are the randleman criteria for?
ectasia risk assessment prior to LASIK
what is cerebral visual impairment (CVI?)
impairment in the visual system posterior to lateral geniculate nucleus. Often seen in premature babies with periventricular leukomalacia
power mapping of the cornea–two methods?
SAC: sagital=axial measures central K
TIP: tangential=instantaneous measures peripheral K
Optic nerve fenestration approaches.
medial–direct but have to take down MR
epibulbar
supranasal lid crease
temporal
in which approach for optic nerve fenestration would there be the highest likelihood of damaging the ciliary ganglion? what would be a physical exam finding?
lateral approach. The pupil will be mydriatic but vision will be good.
what’s different in AREDS vs AREDS2? what’s in both?
both have Zinc oxide, cupric oxide, vitamin E, vitamin C
AREDS have beta carotene
AREDS do does not have beta carotene but does have Zeaxanthin and Lutein
when is there highest number of axons in the optic nerve? how many are there?
what does it become on maturation?
highest amount is 3.7 million at 16 weeks
Then becomes 1.1 million at 33 weeks
ALT settings? size, duration, and power
50 micron size, 0.1 sec duration, and 300-1000mW
what is another name for autosomal dominant optic atrophy? what gene is affected?
Kjer’s disease
the gene is OPA1
what is Wolfram’s syndrome?
DM, DI, optic atrophy, neurosensory deafness
What law does Duane syndrome violate?
Sharrington’s law stating that there’s an antagonist action of opposing muscle for every agonist action of a muscle
What law does DVD violate?
Herrington’s law–stating that yoked muscles receive equal innervation with an action (such as superior gaze both eyes receive equal innervation)
What is Alexander’s law?
nystagmus is more pronounced with gaze to fast beating direction
What is paradoxical pupillary reaction?
pupil constriction immediately after turning the light off…
highly suggestive of early onset retinal and optic nerve disease
differential for paradoxical pupillary reaction?
COLD ARAB
Congenital Stationary Night blindness (CSNB)
Optic hypoplasia
LHOA
DOA
congenital Achromatopsia
RP
Albinism
Best
breast cancer mets to the orbit causes what kind of displacement of the globe?
exophthalmos
Fluocinolone implants are used to treat what? how long does it last?
it’s used to treat noninfectious posterior uveitis. lasts for 30 months
What role does topical steroid treatment play in HSV corneal conditions
do NOT give if there’s any active epithelial keratitis… this is from active viral replication
Give for stromal keratitis and endotheliitis given these are due to immune response—> should be given in combo with antivirals.
valacyclovir is associated with what condition in HIV patients?
HUS/TTP
avg axial length of new born eye?
15-17mm
avg corneal diameter of new born eye?
9-10mm
what is the definition of a prism diopter?
decentration (in meters) at 1 meter away
a patient becomes 20/20 after LASIK but then again becomes myopic… what is the most likely cause?
remodeling and scarring–epithelial cells grow in and fills in the gap thereby taking away some of the effect of the ablation
what is Gillespie syndrome?
aniridia
ataxia
mental retardation
–dizzy Gillespie on AM radio
how long after a uveitic episode should you wait before doing any intraocualr surgeries
3 months
what is the SRK formula?
Aconstant-2.5AL-0.9Kavg= lens power
differential for scrolled up decemet’s on pathology
keratoconus s/p hydrops, Haas striae, terrien marginal degeneration
most common cause of dacryoadenitis?
EBV
What is a hot mirror?
What’s a cold mirror?
Hot mirror: reflects infrared and transmits visible light
Cold mirror: reflects visible lights and transmits infrared
what’s a gaussian filter?
blurs image to make the details less
what are the three main patterns of congenital nystagmus?
Pendular (VA usually at least 20/200), Jerk, Searching (VA usually worse than 20/200)
which muscle is most affected in TED?
inferior>medial>superior>lateral
PPMD features?
endothelial vesicles, glaucoma/PAS
Similar to ICE but is bilatera
autosomal dominant.
what percentage of microvascular CN III palsies involve pupil? and what should you do?
about 20%. However, whenever there’s anisocoria you must work it up with MRA or CTA
What is Refsum disease? how do you treat it?
it’s RP, anosmia, hearing loss, cardiomyopathy, ataxia.
low phytanic acid diet
nyctalopia (Pigmentary retinopathy), foul smelling stools, growth retardation is what condition?
abetaproteinemia.
supplement vitamin DEAK
Von Kassa Stains calcium. What other stain stains calcium?
Alizarin Red
what combination of hemoglobinopathies results in the most severe ocular complications?
SC and Sthal
what is latanoprostene bunod?
it’s prostaglandin and nitric oxide… thereby increasing uveal scleral and trabecular meshwork drainage.
hard contacts cause what corneal abnl
central k edema
within 1-2 weeks of PRK/LASIK… if the patient has been mildly over corrected… what is one way that you can try to mitigate the over correction?
taper off the steroids faster to let the stroma recover to decrease ablated effect.
MLF is located in what structure?
pons
chemical ophthalmia neonatorum timeline?
24 hours
gonorrhea vs chlamydia ophthalmia neonatorum timeline?
gonorrhea 3 days
chlamydia 7 days
differential for inclusion/follicular conjunctivitis
Molluscum
Chlamydia
HSV
drug toxicity
features of: trichoepithelioma trichofolliculoma tricholemma pilomatrixoma
- trichoepithelioma resembles basal cell CA (epithelial)
- trichofolliculoma appears umbilicate (like a follicle)
- Tricolemma is warty like a lemon
- pilomatrixoma is purple and red in color
radial corneal incision induces flattening or steepening in meridian and 90degrees away?
radial incisions lead to flattening BOTH in meridian and 90 away
arcuate incisions flattens along meridian of incision and steepens 90 away
inheritance pattern of megalocornea?
x linked. maternal carriers have slightly larger K diameters
scleralmalacia perforans is associate with what serology marker
RF (RF is IgM against IgG)
which Volk indirect lens has 1:1 magnification
the super 66
in Internuclear ophthalmoplegia… the affected eye is usually also affected in what way other than unable to abduct?
CN III is usually involved and therefore causes Hypertropia and intorsion of the affected side
anterior persistent fetal vasculature associations?
microphthalmos, long ciliary process, shallow chambers/glaucoma
when is grid PRP recommended in the BRVOS
chronic macular edema >3 months WITH retinal perfusion with VA worse than 20/40…
gridding improves VA about 2 lines
lithium toxicity causes what kind of nystagmus?
downbeat
dapipirazole effects
causes miosis without affecting ciliary muscle/accomodation or changing intraocular pressure.
arnold chiari causes what kind of nystagmus?
down beat
flurbiprofen effects/use?
it’s an NSAID. prevents intraoperative prostaglandin induced miosis
which prostaglandin drops are prodrugs
latanoprost and travaprost. needs corneal esterase to work
bimatoprost is NOT a prodrug
what is Aicardi syndrome?
oval choroidoretinal lacunae, corpus callosum agenesis, and infantile spasms
what’s the mode of inheritance of Aicardi syndrome
x-linked dominant (lethal in males other than kleinfelters)
what are two conditions with corpus collosum agenesis
aicardi syndrome and de morsier
findings of ocular toxocariasis?
leukocoria
retinal granuloma
Batten’s disease?
optic atrophy, pigmentary deposits, low ERG, neuronal lipofuscinosis–can have seizures
inheritance chance of Rb in unilateral Rb patient versus bilateral (or unilateral with retinocytomas)
unilateral: 15% chance as it’s not a germline mutation
bilat or unilat +retinocytoma: 45% as it’s a part of the germline
what is sands of sahara?
DLK. diffuse sand like appearance on exam.
what are the 4 stages of DLK? and treatments?
stage 1: granular cells in peripheral only (topical steroids)
stage 2: granular cells in center as well. topical steroids
Stage 3: (threshold DLK) dense clumps centrally. You need to lift the flap/scrape then start topical steroids
Stage 4: stromal melt/scarring (mud cracks)–poor px
IOLs with highest PCO rate?
P, Si, O
PMMA, Silicone, Ocrylic
what environmental stressor triggers HSV reactivation?
nothing! according to HEDs
what % of the time can medical therapy alone resolve aqueous misdirection
50% of the time
medical management of aqueous misdirection? surgical?
mydriasis/cycloplegia, aqueous suppression, and hyperosomotic. PPV
why is accutane use important for possible LASIK candidate?
destroys the lacrimal gland
which CN III subnuclei is fused bilaterally
levator palpebrae
which CN III subnuclei crosses to innervate bilaterally?
superior rectus
EKC adenovirus is associated with what serotype
subgroup D
wide set eyes, ectopia lentis, seizures… what condition is this
sulfite oxidase deficiency
what’s the difference between illusions and hallucinations?
illusions are destorted external images. Hallucinations are without any external stimuli
what is pulfrich phenomenon?
when an object appears to be traveling perpendicular when actually moving toward someone. occurs in pt’s recovering from optic neuritis
what is micropsia
things appear smaller than they are. “alice in wonderland”.. macular OR parietal pathology
which goniolens cannot be used for dynamicl gonioscopy?
Goldmann bc it’s radius is larger than the K radius
what does the dorsal ophthalmic artery become?
What does the ventral ophthalmic artery become?
dorsal: becomes the ophthalmic artery –> posterior short, central retinal, and temporal long ciliary artery
ventral becomes the nasal long ciliary artery
features of gyrate atrophy?
It’s an AR condition involving OAT gene.
Findings of cobble stone RPE lesions that coalesce to form “scalloped borders” between normal and abnormal regions. Associations with PSCs, high myopia.
Metabolically there’s an accumulation of ornithine and tx includes low arginine diet with B6 supplementation
what is the most common cause of posterior uveitis in the US?
toxoplasma chorioretinitis
What is the concept of Murlynn’s formula for LASIK?
It generally states that the larger optic zone used for myopic ablation the more tissue has to be removed to achieve the desired power.
why is hx of HSV keratitis a relatively strong relative contraindication for refractive surgery?
thought is that the UV rays of excimer laser is associated with reactivation
what are Cowdry bodies?
HSV and VZV inclusion bodies
What are Halberstaeder-Powazek bodies?
inclusion bodies associated with trachoma
Where is first order neurons of sympathetic nerves that can lead to Horner’s syndrome?
Second order?
Third order?
1: starts in posterior lateral hypothalamus and decend down medulla/brainstem–first order lesion can be 2/2 wallenberg
2. sympathetic chain from C7-T2
3. Internal carotid artery
what is Lowe’s syndrome?
oculocerebrorenal syndrome.
glaucoma, cataracts, keloids, renal tubular dysfunction
what gene is Weil marchansani syndrome associated with
ADAMTS10, fibrillin
oculodermal melanocytosis (nevus of Ota) is associated with uveal melanoma. At what frequency?
1/400
sarcoidosis iris nodules
Koeppe, Busacca, and Berline nodules on iris
sarcoid. most common ocular site and orbital site?
ocular: uveal tract
orbital: lacrimal gland
Worth 4 dot. how does it work
OD is red, OS is green
distance: 4 is normal. if 2lights then OD dominant, if 3lights then OS dominant. (both 2-3 means suppression scotoma is present)
near: if becomes nl then then it’s monofixation syndrome. if stays at 2 or 3 dots then it’s dense ambyopia
what is sattler’s veil?
K edema associated with hard contact lens use
Meige syndrome. is it present during sleep?
bilat bleph spasm associated with facial spasms. not present during sleep
beign essential blepharospasm– is it prsent during sleep?
no
which blepharospasm disorder is present during sleep?
hemifacial syndrome
which vertical rectus muscle surgery is most associated with undesired eyelid position post op?
inferior rectus surgery.
IR recession pulls lower lid down
IR resection allows lid to ride up
what is the only AR inherited corneal dystrophy?
macular
how do you diagnose CPEO?
skeletal muscle biopsy to look for ragged red fibers
candle wax dripping is associated with what
it’s periphlebitis of posterior uveitis. buzz word associated with sarcoid.
what is the most sensitive test for r/o sarcoid
cxr
spiral of tilleaux.
M 5.5
I 6.5
L 6.9
S 7.8
what is visual confusion vs diplopia?
visual confusion is seeing overlapped two different objects.
Diplopia is seeing two of the same object
whats’ the difference between central suppression and peripheral suppression?
central suppression suppresses visual confusion
peripheral suppression suppresses diplopia
what is facultative suppression vs obligatory suppression
facultative is intermittent suppression when eye is turned abnl. obligatory is constant suppression bc the eye is constantly turned abnormally (like in amblyopia)
congenital IV palsy. do these patients have small or large fusional amplitudes?
large. because they’re so used to fusing
how can you distinguis Pressure induced stromal keratopathy (PISK) from diffuse lamellar keratopathy (DLK) s/p lasik?
get anterior segment OCT–you can see interface fluid in PISK
DLK is days after LASIK. PISK is 2ish weeks after
PISK features?
timeline is 2-3 weeks
diffuse haze. interface fluid.
IOP is falsely wnl
DYNAMIC CONTOUR tonometry gives you the best IOP estimation
thickness of sclera at posterior muscle
0.3mm
pt should stay out ofthe sun for how long after PDT
5 days
meibomian gland number on upper lide? lower lid?
upper 30-40 lower 20-30
vitiligo chorioretinitis refers to waht condition
birdshot
opsins?
they are attached to photoreceptors in combo with 11-cis-retinaldehyde to form rhodopsin. responsible for color and has S, M, L varieties
what is chromatic aberration?
bending of light through medium-short wave lengths are slwoed down much more than long ones
test points in HVF are how many degrees apart
6
meds associated with poor K healing
topical antiviral, beta blocker, NSAID
Tyndall effect
flare
which betablocker is not associate with pulm side effects (topical)
betaxalol, carteolol is next best
which isolated ocular finding is asosciated with binocular diplopia?
ERM. dragged foveal syndrome.
What are findings of CNIV palsy?
adduction and intorsion are decreased on affected side.
hyperopia on down gaze.
Also there’s a V pattern of gaze if bilateral since superior oblique abducts eye on down gaze
strabismus surgery for horizontal deviation does the medial or lateral rectus need to be moved more?
lateral bc it’s a long muscle and dose response is less.
Lat 4mm moved for every 15 PD
Med 3mm moved for every 15 PD
pleomorphic adenoma of the lacrimal gland is the most common benign pathologic finding. what’s the history look like?
glands, stroma, and cartilage
at what endothelial count will PBK be a high risk?
<1000
What is coefficient of variation (CV)?
the measure of mean cell area/mean area… CV >0.40 is abnormal–polymegathism– meaning that cell size is highly variable and pt is at risk for post op K edema
approx size of endothelial cells?
200 microns
hexagonality–what value lower limit?
<50% means corneal endothelial morphology is Abel
ocular side effect of chlorpromazine?
pigment deposition to endothelium and anterior lens capsule
RPE loss and nummular lesions, retinopathy
spasm of near reflex–triad
excessive convergence, miosis, accommodation
what is apical alignment, apical bearing, apical clearance?–in relation to rigid gass perm CLs
apical alignment means base curvature of CL fits K. this with under lid with good movement is ideal
- Apical bearing is CL rests at apex of K–too flat
- Apical clearance is CL is steeper than K and is too tight.
what is Kestenbaum’s rule for low vision patients?
initial add for reading will be the inverse of the visual acuity (20/40–>+2.00 ADD) in the BETTER SEEING EYE
what is Kestenbaum’s rule for low vision patients?
initial add for reading will be the inverse of the visual acuity (20/40–>+2.00 ADD) in the BETTER SEEING EYE.
Occluding worse eye also helps low vision patients.
ideal soft CL fit?
3 point touch with light limbal touch on both sides and light touch at the apex
what kind of images do convex mirrors form?
VERMIN. virtual and minified. ALWAYS. diopter of convex mirrors are always negative
what does the keratometer measure and what does it calculate?
It measures the REFLECTING POWER of the cornea and calculates the 1. Radius of curvature and 2. refractive power of the K
90% of cones are in or out of the macula?
outside
what structures are formed by each of the three waves of neurocrest cells?
first wave: endothelium
second wave: iris and pupillary membrane
third wave: stroma and sclera
ideal therapy for toxo? PO alternatives?
ideal: pyrimethamine, sulfadiazine, steroids, folate
Alternatives: Bactrim +/- clind
valacyclovir vs acyclovir dosing for HSV?
which is better at preventing postherpetic neuralgia?
acyclovir is 800 mg 5 x a day for 7 days
valacyclovir is 1g TID
valacyclovir is better at prevention of post herpetic neuralgia.
general rule for follow up for amblyopia?
1 week for every year of age. so a 4 year old should be seen every 4 weeks
acute hemorrhagic conjunctivitis is caused by what viruses?
enterococcus subgroup 70
coxackie virus A24
s/p LASIK – cornea power calculation per “clinical history” method?
Kpower= Preop K + Sph E - Refraction post
What are ocular associations of NF2?
wedge cataracts/ PSCs
retinal/RPE hamartomas.
bilateral schwannomas/hearing loss
leber’s congenital amaurosis–intellect of these patients are…?
normal nondegenerative–unlike LCA-like syndromes such as refsum/Batten
ONTT–what is the 10/20/40/60 rule
10 year risk for MS is 20% in isolate optic neuritis patients. 40% on avg, and 60% if there are ANY white matter lesions intracranially
main other ocular associations with aniridia>?
angle closure glaucoma progressive K opacification (limbal stem cell deficiency) cataracts nystagmus foveal hypoplasia
Lupus retinopathy is most associated with what other systemic symptoms of SLE?
seizures/strokes
what anesthetic is contraindicated for globe rupture cases? why is that?
succinylcholine.
depolarization of muscles can cause contraction and extrusion of globe contents
whats normal vertical fusion?
1-3 prism diopters
brimonidine (alpha 2 agonists) should not be used with tricyclic antidepressants or MAOI why?
risk of hypotension
where are optic pits usually located?
Infratemporally… VF defects are usually paracentral, arcuate scotomas
retinoschisis. what’s the most common location? what layers are separated?
inferior temporal. outer nuclear layer
retinoschisis. what are the two kinds?
typical degenerative
reticular degenerative
retinoschisis. how can you tell it’s retinoschisis vs RD? 5
schisis is smooth domed, no vitreous hemorrhage/pigment, having absolute scotoma, reaction to photocoagulation, no shifting sub retinal fluid
Gradenigo syndrome?
inflammatory mastoiditis: ipsilateral facial pain, CN VI and VII palsy
macrostriae vs microstriae s/p LASIK
macro–large full thickness slippage. need to reflect
micro–small wrinkles in bowman’s. if vision is good then observe. only refloat flap if vision is compromised.
Anton syndrome
cortical blindness due to impairment of retrochiasmal optic pathway.
Pulfrich phenomenon?
illusion that an object moving perpendicular to a person’s line of sight is moving toward or away from them.
optic neuritis
Riddoch phenomenon?
cortical blindness where patient can only see moving objects and not stationary ones.
what is a wessely ring?
white ring in cornea caused by neomycin. type III hypersensitivity–local ab deposition
cyclic eso. treatment?
surgery
effect of Arcuate keratotomy?
coupling. flattens meridian at hand and steepens 90 degrees away
what muscle makes up the gray line?
pretarsal orbicularis aka muscle of riolan
Keratoglobus features?
present at birth
correlates with ehler dances, deafness. strong risk of perforation
corneal dystrophy frequency by age? by frequency?
age: my little granny (Mac, latt, granular)
occurence: may grow lovingly (Mac, granular, and lattice.
anatomical/imaging abnormality noted in duane’s syndrome?
missing CN VI nucleus
collier’s sign
bilateral lid retraction with upgaze
convergence retraction nystagmus is seen in what condition?
parinauds’
what color laser for retina should you use to minimize pain?
green
what color retinal laser should you use with VH?
red
what color retinal laser should you use for coat’s disease
yellow
what are hyaloidretinopathies? which ones do these include?
these are a group of diseases with optically empty vitreous (aka premature vitreous degeneration) leading to high RD risk.
Wall Street Journal Primarily Republicans (Wagner, Stickler, Jansen, Pierre, Robins).
oculomanifestation of lowe’s. systemic symptoms
dense discform cataracts in all patients
glaucoma in 50%
hypotonia aggression
fanconi renal tubular acidosis
what size are intermeediate drusen?
64-124 microns
corneal stroma is what type of collagen?
type I; 70% by weight
fuchs heterochromic iridocyclitis is associated with what virus?
rubella
how to reduce effect of anisokonia?
contact lenses
how to reduce effect of anisometropia?
reducing vertex distance
reducing surface refractive power
reducing central thickness of glasses
what are the three types of magnificatioN?
transverse: the ratio
angular: simple magnifier; =power/4
axial aka longitudinal: transverse squared
where does the EOMs penetrate the tenon’s capsule?
10 mm from insertion
contraindication of cyclosporine?
uncontrolled HTN?
most common cause of recurrent RD s/p repair?
PVR. exposure of RPE to glial cells causes fibrotic reaction
most common corneal manifestation of EBV?
EBV often presents as multifocal infiltrates in K.
Also most common cause of dacryoadenitis.
Conj melanomas tend to spread to where?
nodes
uveal melanoma tend to spread to where?
liver
what did the diabetic retinopathy vitrectomy study show? (DRVS)
typeONE diabetics benefit from early vitrectomy for VH when vision is 20/200 or worse
what did the diabetic retinopathy vitrectomy study show? (DRVS)
typeONE diabetics benefit from early vitrectomy for VH when vision is 5/200 or worse
what mimicks terrien marginal degeneration and is seen in children?
fuch’s superficial marginal keratitis
lower lid defect…how should you close the wound?
vertical closure with horizontally oriented sutures. avoids tension to pull the lid down
A pattern is significant at what prism diopters
What about V pattern
A is 10 diopters (10A)
V is 15 diopters
CD45 is what kind of cell marker
immagture B cells
holmium: yag is associated with phototermal effect for what condition
low hyperopia
nystagmus with head turn. how should you orient prisms to fix the nystagmus vs how should you fix via surgery?
prisms should shift image toward null zone.
surgery should pull eyes away from null zone
does systemic antihelminth work with for ocular cysticercosis?
no
BK is deoposition of calcium but also could be deposition of what substance
urate
bilateral symmetrical bulls eye maculopathy with temporal optic nerve atrophy
cone dystrophy
oncocytoma?
dark pigmented lesion w/o significant growth. can mimick melanoma
whats the difference between ductions and versions?
duction is monocular testing
versions is binocular testing
what cells does ethambutol effect? what kind of vf defect?
mitochondria of the gangioncells , cecocentral
is rhabdomyosarcoma usualy painful?
no
transpupillary thermal therapy can be used for what
for choroidal melanomas… it doesn’t damage ovelryingretina and RPE very much
best IOL for uveitis patients
acrylic
wavelength of femtosecond
1053
wave length of eximer
193
two types of blood vessels for choroidal circulation
haller (large vessels); sattler (small vessels)
how many percent of TAo patients have been hyperthyroid at some point
90%
how many percent of hyperthyroid patients develop TAO
30%
whats a normal CDR in new borns
<0.3; reversal of cupping can occur with surgery for congenital glaucoma
location of berlin, busacca, and koeppe nodules
berline angle, busacca mid, koeppe pupil
geneva study
ozurdex is safe for mac edema in vein occlusions
how should you fix an enucleated eye due to melanoma
don’t open the eye at all and fix in formalin for 24 hours. formalin penetrates at 1mm per hour
three types of melanoma cells per Callendar classification
Spindle A, Spindle B, epithelioid
spread via vortex veins to outside of sclera
