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Clinski > resd > Flashcards

resd Flashcards

1
Q

Evaluation of Optic Disc:

A
  • CDR: < 0.5, asymmetry of 0.2
  • NRR: ISNT, notching
  • ONH: Distinct, within 2.5DD (2mm)
  • PPA: no beta atrophy
  • RNFL: vertical thinning
  • BVs: Nasalation, bayonetting
  • Color: Pink

Risk signs

  • Drance haem
  • Laminar dot
  • Cupping
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2
Q

Assessment of tear film:

A
  • Hx: DEQ-5/OSDI
    More than 5/ >12>22>32>100
  • TFBUT: NaFl-Wratten/Placido-disc
    Seconds > 10 > 15
  • Tear production: Schirmers/Phenol-red
    Wo/ Anesthetic: 15>10> Less than 10mm in 5min
    Anesthetic: 10>5> Less than 5mm
  • Tear outflow: Jones dye
  • Tear quality: Osmolarity
    Greater than 308mOsm/L
  • MGD: Red-free/Meibometry/Expression
    Clear fluid, uniform glands
  • Ocular surface: NaFl/meniscus
    SPEE, lid wiper epitheliopathy, TMH > 0.2mm
  • MMP testing
    Positive for inflammation
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3
Q

Assessment of the conjunctiva:

A
  • Hyperemia: diffuse/Circumlimbal
  • Discharge: watery/mucoid/purulent
  • Chemosis
  • Lesions: OSSN/Pterygium
  • Papillae/Follicles: Tarantas/GP
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4
Q

Assessment of the cornea:

A
  • Corneal sensation:
    Neuropathy
  • Staining:
    SPEE, Ulcers
  • Topography: Placido disc
    Irregular astigmatism
  • Pachymetry: CCT
    540-560um
  • Anterior-OCT
    Depth of lesions
  • Corneal nerve size
    DM, keratoconus, acan.
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5
Q

PDX and PDS signs:

A

PDX:

  • Exfoliative material on pupil margin
  • Iris tranillumination defect at pupil ruff
  • Three ring sign
  • Pigment in TM

PDS:

  • Mid-peripheral iris transillumination defect
  • Heavy TM pigment
  • Krukenberg spindle
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5
Q

Signs of the cornea:

A
  • KP’s: Uveitis
  • Mutton KP’s: Granulomatous uveitis
  • SPEE: DED, CL’s
  • Fleischer: Metal ring
  • Krukenberg spindle: PDS

Ulcers/Infiltrates

  • Dendritic: HSV
  • Disciform central: Bacterial
  • Ring: Acan.
  • Pannus: NV from lumbus

Keratopathy

  • Bullous: endothelial decomposition
  • Edema: Glaucoma
  • Hydrops
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6
Q

Assessment of the anterior chamber:

A
  • Gonio: TM and structures
    CBB, TM<+1
    Indentation > PAS
    Plateau iris (double hump)
  • AS-OCT: Depth, Iris
    Shallow > PACG
    Deep > Marfans
  • Ultrasound biometry: Ciliary body
  • Van-herick: 1:1
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6
Q

Signs of the anterior chamber:

A
  • Cells/Flare
    SUN grading
  • Hyphema
    Trauma/NV
  • Hypopyon
    Infectious keratits, uveitis, endophthalmitis
  • Pigmented cells
    PDS/PDX
  • Posterior synechiae
    Uveitis
  • PAS
    NV glaucoma, Chronic ACG
  • Angle recession (CB tear)
    Trauma
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7
Q

OCT assessment:

A

RNFL Optic disc cube:

  • Average thickness
    <80<70<50< Mild/Moderate/Severe
  • Quadrant Thickness
    Sup/Inf: <100
    Nasal/Temp: <50
  • ONH
    Disc Area: <>1.5-2.5mm
    Rim area: < 1-2mm
    Cup volume: >0.1-0.3mm
    Vertical CD: > 0.65
  • Deviation map
    Asymmetry; focal/diffuse
    Arcuate, correlated to VF defect

GCL macular cube:

  • GCL+IPL thickness average
    70-90
  • Sectoral GCL:
    70-100
  • Macula thickness: Edema/Atrophy
    250-310
  • Deviation map
    Asymmetry
    Early superior/inferior loss
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8
Q

Corneal topography assessment:

A
  • Axial map: Symmetrical Bow-Tie <47 steepest K
    KC > Inferior steepening, K>47
  • Tangential: Smooth curvature
    KC > Localized steepening, asymmetry
  • Elevation map: Smooth
    KC > Significant inf elevation
  • Indices:
    Inf./Sup. (I-S): >1.50D
    Surface asymmetry (SAI): >1.0
    Surface irregularity (SRI): >0.80
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9
Q

Accomodation assessment:

A
  • Amplitude: Push-up
    18-(0.3 * age)
  • NPA:
    10>25>100cm for 20>40>60
  • NRA/PRA: +/- until near blur
    +2.00-2.50 / -2.00-3.00
  • Accom. facility: +/-2.00 flipper clearance
    12cpm mono
    8cpm bino
  • Accom. lag/lead: Fused cross/cyl and MEM
    Lag of +0.25
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10
Q

CVD test pass/fail:

A
  • Ishihara/HRR
    3 Probable > 5 Definite
    2 probable > 2 definite
  • Farnsworth D15
    2 Crossings
  • Medmont: women carriers of protanopia
    Minus (protan) plus (Deutan)
  • Anomaloscope: Red-Green
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11
Q

Vergence assessment:

A
  • NPC: Break/recovery
    5-10cm / <5 from break
  • Phoria: Howells/Von graefe
    Near: 6 Exo to 3 Eso
    Dist: <2 exo
  • N/P Fusional vergence: Risley/Prism bar
    PFV: 15/25/20 (+-10)
    NFV: 10/15/10 (+-3)
    Vertical: <3
  • AC/A: Gradient (Howell/Flipper), Calculated (Cover/Prism)
    4:1
  • Fixation disparity: Mallet unit
  • Vergence facility: 3BI/12BO
    10-15cpm
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12
Q

Clinical response to older Px for poor reading:

A

Age based table:
- From 40/45/50/55/60 > +1/1.25/1.75/2.25/2.5
- Amp norm is 5/3.25/2/0.75/0
Plus build up W/age norm in trial frame
- Provides Amp
Convert Amp to proportion of amplitude
- Reading add should allow half accom. at habitual
Using found Add, blur check with fused-cross
- -0.50 at 90, w/+2.50 fog
- reduce power until equalised

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12
Q

Convert N5 and 40cm to snellen:

A

If N8 = 1M, N1 = 0.125M
N5 = 0.625M
40cm/0.625M = 0.4/0.625 = 6/9.375

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13
Q

Suppression assessment

A
  • Worth 4 lights:
    5 (manifest), 3 (RE sup), 2 (LE sup)
  • Sterio: Randot/Steriofly
    20-40 arcsecs
  • 4BO: Observed vergence
14
Q

CVD causes:

A

Protan/Deutanopia: X-linked recessive
- Red (L-cones), or green (M-cones) completly missing
- P/D-anomaly > mild form where photopigments are altered
Tritanopia: Autosomal recessive
- Blue (S-cones)
Acquired:
- Cataract (contrast loss)
- Glaucoma/MS (blue yellow loss)
- AMD (contrast loss)
- DR (blue/yellow > red/green)
- RP

15
Q

Dissociated phoria tests:

A

Cover-uncover:
- Tropia > uncovered eye moves
- Phoria > covered eye moves when uncovering
Alternating cover:
- Determines degree of phoria
Phi phenomenon: subjective
Prism cover test:
- amount of prism required to remove phoria or tropia
Maddox rod: Vertical streak (horizontal phoria) or horizontal streak for vertical
- Used in case of suppression
- Eso if Px sees line left of light source
Vone graefe: 6BU and 15BI
- Decrease horizontal OR vertical to determine horizontal or vertical phoria
Howel phoria card

15
Q

Soft contact lens selection and example order:

A
  1. Material > Spherical/aspheric
    - Hydrogel: ^comfort for short term wear
    - Silicone hydrogen: ^O2 permeability for long term wear
  2. SCL 2mm larger than HVID (keratometry/slit)
  3. Base curve 0.6mm flatter than mean K (keratometry)
    - Flat K + 0.6mm
  4. BVP from refraction
    • 4D > +0.25
    • 6D > +0.50…
      - If > 1 DC, use toric

Example order: Acuvue Oasys 8.4/14.0/-2.00D (BC/TD/BVP)

16
Q

Cause of deviations:

A

Comitant:
- Congenital strabismus (Tropia)
- Accomodative esotropia (hyperopia)
- Intermittent exotropia
- Genetic/anatomical factors
Incomitant:
- CN 3/4/6 palsy
- TED
- MG
- Chronic progressive external ophthalmoplegia

17
Q

Incomitant deviation clinic:

A
  1. Cover test: measure deviation of each eye while the other if fixing > Greater deviation in non paretic eye (herring’s law of equal innervation)
  2. Hess screen: R/G dissociation > R fixation and G pointer > Px marks where the fixation light is
    1. Smaller chart is parietic eye
    2. Degree of disparity gives angle of deviation
  3. Parks 3 step: determines parietic muscle from Rectus or Oblique muscles
    1. Which is hyper (Hyper eye’s IR/SO, or Hypo eye’s IO/SR)
    2. Worse on R/L gaze (Gaze’s IR/SR, or opposite’s IO/SO)
    3. Worse on R/L tilt (Tilt’s SR/SO, or opposite’s IO/IR)
18
Q

Clinical management of phoria:

A

Sheards criterion > Opposing fusional reserve must be at least twice the phoria
- If 6 exo
- PFV > 12 BO, phoria is compensated
- PFV = 8 BO, a 2 BI lens in required (is now a 4PD exo)
Percival’s criterion > PFV+NFV = 10
- PFV ~20 BO
- NFV ~ -10 BI

19
Q

DED management:

A

DEWS step 1:
- Educate: DED lifelong
- Environment (masks, computer time)
- Diet change
- Cease offending medications
- Ocular lubricants
- Lid hygiene, warm compress
- 45’ towel, reheated every 2 mins for 10 mins
Step 2:
- Non-preservative tears
- Tea-tree oil for demodex
- MG expression
- short term cortico.
- FML QID shown to reduce symptoms and increase goblet density
- Immunomodulatory drugs
- Ciclosporin to prevent T-cell activation
Step 3:
- Autologous serum drops
- BCL
- Soft > comfort
- RGP scleral > tear repository
Step 4:
- Long term cortico.
- Amniotic membrane graft
- Surgical occlusion

20
Q

Poor near vision DDX:

A

Accom insuf: Blur/Asthenopia at near

  • Low amplitude
  • Cover test: Esophoria at near
  • Poor facility clearance on minus lenses

Accom excess: Dist. blur after near (Latent hyperope)

  • Variable VA/ret
  • High amplitude
  • Poor facility clearance on plus lenses
  • Esophoria at near

Accom infacility: Blur/asthenopia at near, poor target switching

  • Poor mono and bino facility on both lenses

Convergence insuf: Diplopia at near

  • Poor NPC
  • Exo at near
  • Poor fusional reserve and AC/A

Convergence excess: Diplopia at near

  • Eso at near
  • High AC/A
21
Q

Penetrating injury procedure:

A

Assessment:

  • Optic section of cornea
  • Iris and lens

Removal:

  • dilate metal-on-metal
  • Use needle 25 gauge

Cleaning: rust rings
- Alger brush

Therapetics:

  • NEVER patch
  • Chlorsig 0.5 QID unless vegetive
  • topical NSAID for pain
  • BCL
22
Q

Red eyes:

A

VA (unless chemical)
Hx

  • DEQ-5/OSDI

MG assessment

  • Red-free
  • Meibometry
  • Expression

Tear film:

  • TBUT
  • Osmolarity

Lids:

  • Double-/Eversion
  • Papillae/follicles
  • Puncta/Lacramal lavage
  • Lash/trichiasis

Conjuntiva:

  • Schirmers
  • Lid wiper epitheliop

Cornea:

  • Seidels sign
  • NaFl, Rose Bengal

AC:

  • Gonio/VH
23
Q

Lid assessment and signs of associated conditions:

A
  • Exposure/lagophthalmos: closure/damage
  • Muscle function: LPS/Orbicularis
  • MGD: count, expression, capping

Associated:

  • Xanthelasma: DM/HL
  • Blepharitis: Atopy
  • Madarosis: Trichiasis, chronic bleph
  • Floppy lid: Sleep apnea

Clinski (8 decks)

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