Slit Lamp Exam (diseases)

Question 1

the most common lid disease is

Answer 1

blepharitis

Question 2

what causes blepharitis?

Answer 2

staph bacteria that is normally on skin but builds up

Question 3

sign of blepharitis is

Answer 3

flakes like dandruff

Question 4

meibomitis is:

Answer 4

congestion of the meibomian glands from retention and over-production of oils

Question 5

how do you grade meibomitis?

Answer 5

there are 3 stages and it is related to dry eye

Question 6

what is trichiasis and what can it causes?

Answer 6

it is interned lashes that can cause foreign body sensation, increased tearing, and scratches that lead to corneal scarring (blindness)

Question 7

what is a chalazion? what are some possible symptoms and side effects?

Answer 7

non-infectious granuloma from clogging of zeiss or meibomian glands
-should be no pain and possible induced astigmatism if pushing on cornea

Question 8

what causes a hordeolum “stye”?

Answer 8

staph infection affecting zeiss, moll, and meibomian glands

Question 9

what is different about a hordeoum versus a chalazion?

Answer 9

hordeolum is acute, painful red, hot and infectious but a hordeolum can turn into a chalazion

Question 10

types of conjunctiva

Answer 10

• palpebral (underside of eyelid)

- bulbar (white part of eye, on the globe)

Question 11

what is a pinguecula?

Answer 11

degeneration of elastic tissue, fragmentation of collagen fibers often caused by UV and wind exposure

Question 12

what is the appearance and signs of pinguecula?

Answer 12

whitish/yellowish elevation that has a nasal/temporal “base in” (wider towards cornea)

Question 13

what is a pterygium?

Answer 13

a fibroelastic ingrowth that invades into the peripheral cornea at level of Bowman’s layer

Question 14

what are the signs and results of pterygium?

Answer 14

it can induce astigmatism, it is mostly nasa/temporal, and it can cause drying in adjacent area

Question 15

what is axenfeld’s loop?

Answer 15

black ciliary nerve loops on scleral surface, benign (no need for documentation in chart)

Question 16

what is melanosis?

Answer 16

extra melanocytes (pigmentation) 
-document ABCDEs

Question 17

what is subconjunctival hemorrhage?

Answer 17

loose blood in the bulbar conjunctival space

from trauma or valsalva maneuver

Question 18

how can hyperemia/injection be graded?

Answer 18

localized, diffuse, sector, circumlimbal, 1+ to 4+

caused by: infection, inflammation, foreign body, toxic, allergy

Question 19

what is chemises and what is it associated with?

Answer 19

it is temporary breakdown of cellular structure (edema, swelling) associated with allergy

Question 20

what are follicles?

Answer 20

infiltration of lymphocytes (WBCs) that look like cobblestone and have vessels surrounding the mound

Question 21

what are follicles associated with?

Answer 21

viral infection “pink eye” and toxic eye conditions

Question 22

what are papillae?

Answer 22

inflammatory cells that look like “goose bumps” and have a central vascular core

Question 23

what are papillae associated with?

Answer 23

immune response to bacteria or allergens

Question 24

GPC is associated with

Answer 24

CL wear or sutures

they can be >0.5mm to 3mm

Question 25

what are concretions?

Answer 25

yellow/white degenerations from keratin, calcium and epithelial debris commonly seen (esp. in elderly)

Question 26

what are inclusion cysts?

Answer 26

lymphatic, water fluid cyst usually in the palpebral conjunctiva that are translucent and clear

Question 27

how do you view the episclera/sclera?

Answer 27

manual oscillation and blanch with 2.5% phenylephrine because episclera blanches and sclera won’t

Question 28

what is superficial punctate keratitis and what are some causes?

Answer 28

it is epithelial surface irregulars, edema, pinpoint cysts, infiltration of WBC, proteins, debris, cells that results in decreased VAs and irritated feeling

Question 29

what is a dellen?

Answer 29

a dry, thinned, depressed spot at the peripheral cornea that is 0.5-1 mm

Question 30

what other things can dellen be associated with?

Answer 30

dry eye, SPK, and surface irregularity

Question 31

what beam set up is the best to view corneal stroma?

Answer 31

parallelepiped or optic section to determine depth (optic section best)

Question 32

what are some things to determine is someone has an abrasion/ penetration/ perforation?

Answer 32

determine depth, stain, look for Seidel sign, check IOP

Question 33

cornea stroma scars pass through what layer?

Answer 33

Bowman’s membrane

Question 34

what are subepithelial infiltrates and what causes them?

Answer 34

diffusion and accumulation of WBCs that move to site of antigen (think viral)

Question 35

what is unique about the subepithelial infiltrates?

Answer 35

does not stain in fluorescein (mostly true)

Question 36

what is the definition of a pannus?

Answer 36

a superficial vessel tuft grows over cornea in response to inflammation or as an immune response to infection

Question 37

what is the definition of neovascularization?

Answer 37

new blood vessel growth in response to hypoxia from CL wear or staph infection

Question 38

what are keratitic precipitates?

Answer 38

accumulation of WBC and epitheliod cells at level of corneal endothelium associated with inflammation

Question 39

what is krunkenberg’s spindle?

Answer 39

linear/vertical spindle on corneal endothelium, deposition of pigment by convection current

Question 40

what is krukenberg’s spindle associated with? what are the signs?

Answer 40

pigment dispersion syndrome, signs: transillumination defects, pigment in the angle, glaucoma

Question 41

when guttata is advanced what is it known as?

Answer 41

Fuch’s dystrophy

Question 42

what is guttata?

Answer 42

depression of endothelium from loss of cells because the corneal endothelial pump is compromised

Question 43

how is guttata best viewed?

Answer 43

by specular reflection

Question 44

angle estimation is a comparison of the:

Answer 44

depth (width) of the anterior chamber with the thickness (width) of the cornea through which the beam travels