Theory and methods quizlet exam 1 - Sheet1 Flashcards
Tan-
Antimicrobials
Vitreous Cortex
Shell of condenses vitreous that surrounds gel; Anterior hyaloid face starts 1.5mm anterior to ora serrata; Posterior hyaloid face adheres to internal limiting membrane of retina. Made mostly of intensely packed collagen fibrils
Paremyd
0.25% tropicamide and 1% hydroxyamphetamine which is a Sympathomimetic, good for dilation with minimal accommodative effect. More expensive. Mydriasis and weak cycloplegia
Tropicamide Hydrochloride
Muscarinic Antagonist. Causes Mydriasis and cycloplegia. Used in clinic for: Routine dilation, Cycloplegic “damp” refraction, Pre and Post Operative Surgery. Side effects: Photophobia, blurry vision, lasts 6 hours, unknown effect in pregnancy
Phenylephrine Hydrochloride
Direct-acting sympathomimetic. Contracts radial muscle of iris for dilation. Causes mydriasis, no cycloplegia. Used in clinic for: 0.12% solution for allergies OTC; 2.5% solution for routine eye exam dilation. Pre and Post operative surgery exams: 10% solution to break posterior synechia. Adverse effects: stinging, headache, tears, photophobia, possible sympathetic reactions, blanching in eyes, lasts 6 hours, unknown effect in pregnancy. Caution for cardiac disease, severe HTN, aneurysms. Very expensive
Reticular/ Bullous Retinschisis
Splitting of nerve fiber layer; 0.95% prevalence of population; taut ballooning of tissue as blister, reticular pattern due to sclerosed scleral vessels; outer layer shows honeycomb pattern and reduced choroidal detail; 1/3 associated with retinal detachment; 3/4 have snowflake bodies; Blister thought to be filled with hyaluronic acid
Fluramene.
Combo of Lissamine and fluorescein sodium. Allows tear film and corneal assessment in one drop, Viscosity designed to not break up tear film
Diffuser SL Filter
Used for general, non focal illumination, for anterior segment. Low magnification, used for gross examination of lids and skin, max width and height
Green-
Miotics
How much of an eye drop is typically absorbed in the eye?
5%
Cobalt Blue BIO filter
Autofluorescence of optic disk; drusen
Best place to introduce an ophthalmic preparation.
Lower eyelid cul-de-sac
Rose Bengal Vital Dye
Surface integrity evaluation for damaged or dead cells; 1% 1.3 mg paper strip; Stains vivid magenta for about 5 minutes, stings significantly; Used for dry eye and herpes keratitis evaluations; May be hard to differentiate red dye and inflammation;
CHRPE
Solitary pigmented lesion w/ or w/o a hypopigmented halo; Bear tracks; Atypical pigmented lesions; Hyperplasia of the RPE; “freckle of the eye”
Ophthalmic Suspension
Solid particles in a liquid; Must be shaken before dispersed for homogeneity
Sclerotic Scatter
Light is directed to limbus and indirect illumination highlights subtle findings of cornea
Haag Streit illumination
Vertical illumination with bulb at top of tower
Vogt (Kohler) Illumination
Homogeneous beam
Corona ciliaris
Anterior portion of ciliary body; 2mm wide; probably won’t see this on BIO; Contains 60-70 ciliary processes
Pars Plana
Broad, flat, pigmented band about 4-5mm wide of ciliary body
At risk for angle closure
Less than grade 2 van Herick; Half or less of trabecular meshwork seen in all four quadrants
Why do we dilate?
Look at retinal periphery: retinal tears and detachments, infection, inflammation, neoplasm; Look at lens for cataracts
Pink
Anti-Inflammatories
Ora Serrata
Junction of neural retina and ciliary body, Has ciliary processes and corrugated appearance nasally
Ophthalmic Ointments
Non-aqueous; Base is oily chemical like petroleum, paraffin oil, or lanolin; Sterile preparations must be prescribed that way for eye use, OTC versions are not sterile
Sodium Fluorescein Dye
2% solution, Comes in 1 mg filter paper strip or single dose sterile pipettes. Used with cobalt blue filter to assess integrity of cornea and conjunctiva. Conjunctiva will stain orange, cornea and anterior chamber will be green. Marks damaged areas. Fluorescence affected by pH, concentration, other things in solution. Other uses: TBUT, Goldmann tonometry, detecting foreign bodies or wounds, Jones test 1 or 2. May sting or cause yellowed vision
Vitreous base
Area at ora serrata where the vitreous adheres firmly to retina; Vitreous fibrils originate here; May be hyperpigmented; There is almost never a detachment here
Lissamine Green Vital Dye.
Bluish-green alternative to Rose Bengal with much less discomfort. Same instillment and uses as Rose Bengal
Zeiss illumination
Round housing unit at middle of instrument with bulb encased
Aqueous Ophthalmic Solutions
Saline and salts to maintain pH 5.0-8.0, 2 year shelf life
Interpupillary Distance of BIO
15mm, created by prisms
Red
Mydriatics & Cycloplegics
Weiss’ Ring
Ringed floater from where the vitreous used to attach to the optic nerve. Shape changes over a long period of time because of gravity
Slit Lamp Magnification Systems
Grenough/Flip-type, Galilean rotating barrel, Zoom
What can you do to decrease systemic absorption of an ophthalmic drop?
Hold punctum for 1-3 min
3 Things You Should Check Before Instilling a Drop
Brand Name, Concentration, Expiration Date
Ocular Melanosis or Perilimbal Pigment
Common in people with darker skin, extra pigment in conjunctiva, Increases with age, Cannot be removed, Benign
Who are considered “at risk” patients for BIO exams?
Patients w/ diabetes or HTN; Family History of disease; Occupation with high visual demand or hazardous; Taking medicine with ocular side effects; Wearing contact lenses; Those who had eye surgery;
Retinal Equator
Imaginary circle that runs along the retina to intersect all of the vortex veins. Separates the anterior and posterior poles
Long Posterior Ciliary Nerves
Yellow projections seen at the midline 3 & 9 o’clock, separate the retina into superior and inferior
1 Cause for Malpractice in Optometry.
Misdiagnosis of intraocular disease: Open Angle Glaucoma, Retinal Detachment, Tumors. Because doctors did not use diagnostic dilation drops
Properties of +20D BIO Condensing Lens
50mm diameter; 3x image magnification; 46 degree field of view; 43cm working distance;
Drugs used to break posterior synechia
Scopolamine, Phenylephrine
White without Pressure (Ww/oP)
White/gray area between equator and ora serrata; Vitreous adheres strongly to retina and retina appears thickened; 2.3% Caucasians, 23% Blacks, increases with age-common at 40-50; May be associated with tractional retinal tears; No visual field defect
What is the longest you should look at one area with the BIO at a time?
40 seconds
Yellow Wratten Filter
Enhances fluorescein color. Not attached to slit lamp, is hand-held
Orange-
CAIs
Cyclopentolate
Antimuscarinic. Used for: Cycloplegic Refraction; Pupil Dilation; Uveitis-prevent posterior synechia, immobilize iris, and stop pain. Could take up to 45 minutes to go into effect and could last a full day. Adverse effects: blurred vision, photophobia, stinging, clumsiness, nausea, antimuscarinic side effects, unknown effect in pregnancy
Fluress/Fluorox/Flucaine
P-aminobenzoic acid ester. 0.4% benzoxinate, 0.25% fluorescein sodium. Adverse effects: stinging, bruning, red eye, rare blurry vision. Shelf life 18 months. Used for tonometry and assessing integrity of cornea and conjunctiva
Proparacaine Hydrochloride
M-aminobenzoic acid ester,0.5% ophthalmic solution. Fast-acting topic anesthetic, decreases blink reflex and touch sensation. Lasts 10-20 min. Blocks sodium ion permeability to inhibit action potential Uses: Tonometry, Gonioscopy, Corneal and conjunctival procedures, Punctal plug insertion/removal, Cataract extraction, NOT necessary for dilation. Adverse Effect: Stinging, Possible Hypersensitivity, Overdose can cause corneal opacification and vision loss. Can kill epithelium and cause to slough off; Category C: unknown affect on pregnancy
Purple-
Adrenergic agonists
Vitreoretinal symphysis
Area of vitreous base that straddles the ora serrata
Short Posterior Ciliary Nerves
Perpendicular to ora serrata; At 6 and 12 positions; 10-20 nerves per eye in other areas; Surrounded by choroidal pigment
4 Things for Documenting Drug Instillation
Drug Name; Concentration; # drops instilled; Time of Instillation
Vitreous Body
2/3 of globe, mostly collagen type 2, 98% water, contains hyaluronic acid
White with Pressure (Ww/P)
Optical phenomenon of retina causes by use of scleral depressor by physician; Histologically similar to Ww/oP; Thought to have less potential to cause retinal breaks
Tests to do BEFORE dilation
Visual Acuities, Pupils, Intraocular Pressure, Angles -Gonioscopy(van Herick or Shadow test)
Slit Lamp Illumination Systems
Vogt (Kohler), Haag Streit , Zeiss
Ophthalmic Color Codes
Red- Mydriatics & Cycloplegics. Pink- Anti-Inflammatories. Tan- Antimicrobials. Gray- NSAIDs. Green- Miotics. Turquoise- Prostaglandin analogs. Purple- Adrenergic agonists. Orange- CAIs. Blue/Yellow- Beta Blockers
Case History Flags for No Dilation
History of angle closure attack: -reported seeing halos, -intermittent eye pain when changing lighting, -intermittent blur, redness, nausea
Ophthalmic Gels
Highly viscous solution with aqueous saline and special polymer; Increases contact time on ocular surface
Vortex Veins
4-15 choroidal tributaries that drain into the ophthalmic veins
Gray-
NSAIDs
Single-Dose Unit
Should be discarded after one use; No preservatives to stop bacterial growth
Pavingstone Degeneration
Primary chorioretinal atrophy, cobblestone degeneration; Choriocapillaris occlusion with RPE and retinal tissue death, but neural sensory retina is still good; 0.1-1.5mm nonpigmented areas between equator and ora serrata, for 5-7 o’clock area; Some have RPE hyperplasia around them; 30-70% become bilateral with age
Blue/Yellow-
Beta Blockers
Tractional Retinal Holes
From abnormal vitreoretinal adhesion; Round red hole with overlying floating fragment of tissue; Between equator and ora serrata; May have localized retinal detachment; Can occur near or away from vitreous base
Mutliple-Dose Unit
Intended for repeat use; Contains preservatives to limit microbial growth or kill microbes
If you decrease the BIO condensing lens’ power, what will happen?
Magnification increases; Field of view decreases; Working distance increases
Strong mydriatics and cycloplegics.
Homatropine: 1-3 days. Scopolamine: 3-7 days -also for breaking synechia. Atropine: 7 days. Unknown safety in pregnancy, all good for uveitis treatment. Same side effects as Cyclopentolate
Firmest attachments of Vitreous Cortex
Vitreous base; Optic disk; Macula; Retinal Blood Vessels
Retinal Tuft
Granular retinal tissue; Gray/White lesions in periphery, usually between equator and ora serrata; Typically bilateral, cause floaters, in 15% of population
What children are considered “at risk” for BIO exams?
Prematurity, complications at birth; Family History of retinoblastoma, congenital cataracts, or metabolic/genetic diseases; Infection of the mother during pregnancy; Difficult labor associated with fetal distress of low APGAR; High refractive error; Strabismus; Anisometropia; Known or suspected central nervous system defect
Atrophic Retinal Holes
Retinal break without vitreoretinal traction; 2-3% of population; Usually between equtor and ora;
Typical/ Flat Retinoschisis
Splitting of neurosensory retina at outer plexiform layer; 0.7% of population, 38-82% bilateral, increases with age; Usually asymptomatic but shows as scotoma on visual fields test;
Turquoise-
Prostaglandin analogs
Benign Choroidal Melanoma
Choroidal Nevus; Hyperpigmentation of choroid; Flat, gray lesion, 1.5mm thick and 6mm wide; Isolated retinal detachment may occur; May spread or become malignant with pregnancy
