Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
145 Cards in this Set
- Front
- Back
|
Where do you perform selective suture removal?
|
Steep axis
|
|
|
What is classic etiology of infectious keratitis after refractive surgery?
|
Mycobacterium
|
|
|
What is classic etiology of angular blepharitis?
|
Moraxella
|
|
|
Name all treatment modalities for atopic keratoconjunctivitis?
|
Patanol
Restasis Tobradex FML Azithromycin Allegra |
|
|
What is risk of malignancy in primary acquired melanosis?
|
50% if atypia is present
|
|
|
What is range for PRK?
|
-10.00 to +4.00
6D of cyl |
|
|
What should you tell transplant patients about vaccinations?
|
Ok, but increase pred forte to BID for a couple months
|
|
|
What is name of transplant rejection line?
|
Khadodust line
|
|
|
Acanthamoeba often occurs with...
|
HSV
|
|
|
How do you know if stitch is ready to be removed?
|
White hue to the graft host interface
|
|
|
What are typical K pro meds?
|
Vancomycin
Zymar Pred forte Doxycycline Medroxyprogesterone |
|
|
What is purpose of medroxyprogesterone and doxycycline in K pro patients?
|
Inhibits collagenase
Decreases risk of corneal melt |
|
|
What is difference between Type I and Type II Boston K Pro
|
The stem of Type II pokes through skin/lid
|
|
|
What is MC complication of K Pro?
|
Retroprosthetic membranes (25%)
|
|
|
Why is IOL calc difficult after Lasik?
What should you do? |
Because central optical zone of Lasik is not measured accurately by IOL master
Get pre-Lasik Ks and MRx OR do pentacam |
|
|
Prolate vs Oblate cornea, Q value?
|
Prolate = flat periphery, Q < 0 (normal)
Oblate = steep periphery, Q > 0 |
|
|
Topography vs tomography
|
Curvature (power) vs shape (thickness)
|
|
|
What is significant about african americans and PKP?
|
3-4x rejection rate
|
|
|
What is a major drawback of alpha cor K pro?
|
frequent calcium deposits
|
|
|
What is major drawback of trifluridine vs acyclovir?
|
epithelial toxicity (should stop about 10-14 days)
|
|
|
How does primary HSV usually present in the eye?
|
Conjunctival or epithelial (not stromal or uveitis)
|
|
|
What did HEDS study show about oral prophylaxis?
|
Decreased recurrence by 50%
|
|
|
How does the presentation of congenital syphillis differ from acquired?
|
Interstitial keratitis vs. uveitis or retinitis
|
|
|
What is the differential for stomal infiltrates without epithelial defect?
|
- HSV interstitial keratitis
- Fungal keratitis after penetrating trauma - Acanthamoeba - Crystalline keratopahty |
|
|
What is the average post-PK astigmatism?
|
+4.00
|
|
|
What is the average thickness of a DSAEK graft?
|
About 100 microns (includes some stroma)
|
|
|
What is herpetic disciform keratitis
|
Endothelitis causing:
- Disc shaped edema - KP - Iritis |
|
|
What are three types of stromal HSV keratitis
|
- Interstitial
- Disciform - Necrotizing |
|
|
How do you treat HSV epithelial keratitis?
|
Acyclovir or valacyclovir and debridement
- No steroids |
|
|
What does tectonic PK mean?
|
Structural need (perforation, thinning)
|
|
|
How do you treat HZO
|
Acyclovir (best before 72 h)
No topical antiviral Topical PF if uveitis |
|
|
Name characterisitics of VKC?
|
- Springtime (vernal)
- Male - Atopic children - Horner Tranatas dots - Papillary rxn - Pannus - Shield ulcer |
|
|
Name characteristics of AKC?
|
Like VKC except:
- Year round - Older - Smaller papillae - K vascularization |
|
|
What are three indications for cyclosporine?
|
- Aq tear deficiency
- K vascularization - Atopic disease |
|
|
Name 3 types of patients most likely to develop crystalline keratopathy (milder immune response)?
|
- Transplant patients
- Chronic steroid and CL use - DM patients with ocular surface dz |
|
|
Name 3 possible combinations of antibiotics for broad spectrum coverage?
|
- Ceftazidime (3rd) and cefazolin (1st)
- Vanc and tobra - Fluroquinolone monotherapy |
|
|
What is typical setting for mycobacterium infection?
What is stain? What is tx? |
- Post refractive
- Acid fast or lowenstein jensen - Clarithro, moxi, or gatiflox |
|
|
What is treatment for fungal keratitis?
|
- Topical ampho B
- Oral voriconazole (good ocular penetration) - Topical voriconazole (if unresponsive) |
|
|
What are 1st order aberrations and what are significance?
|
- Prism, piston
- Not visually significant |
|
|
What are 2nd order aberrations?
|
- Myopia, hyperopia, regular astigmatism
|
|
|
What are most significant 3rd order aberrations?
|
Coma - one edge first
Tetrafoil |
|
|
What are most significant 4th order aberrations
|
Spherical aberration (night myopia, halos)
Quadrafoil |
|
|
What is topographic appearance of keratoconus vs. pellucid marginal?
|
Inferior thinning
Crab caw |
|
|
What is RSBT and what is goal?
|
Residual stromal bed thickness (pachy minus flap minus ablation)
250 microns |
|
|
What are average K values?
|
40 to 48
|
|
|
How do you prevent corneal haze s/p PRK?
|
Use mitomycin-C
|
|
|
What is LASEK?
Does it work? |
Loosen and fold back epithelium with 20% alcohol
No |
|
|
What is epi-LASIK?
Does it work? |
Use microkeratome for epithelial removal
- No better than PRK |
|
|
Etiology:
Epi defect centered over stromal infiltrate? Decentered? |
Centered: bacterial keratitis
Decentered: HSV necrotizing stromal keratitis |
|
|
HSV endothelitis, what is the appearance of KP
|
Out of proportion to AC reaction
|
|
|
How do you summarize HEDS study into 4 words?
|
Steroids treat, acyclovir prevents
|
|
|
What are names of ATs with lipid?
|
Soothe XP, Systane Balance
|
|
|
What glaucoma med should not be used with K Pro?
|
latanaprost (K melt)
|
|
|
Child with recurrent corneal dendrites, suspect?
|
tyrosinemia
|
|
|
What are the inheritance patterns of the corneal stromal dystrophies?
|
All are autosomal dominant except macular - which is autosomal recessive
|
|
|
Ddx for verticillata
|
- Amiodarone
- Fabry - Hydroxychloroqine - Indomethacin - Phenothiazines |
|
|
Name features of Fabry's disease
|
- Corneal verticillata
- Conj aneurysms/telangiectasia - Spoke-like PSC - Venule tortuosity - X-linked - Heart/kidney |
|
|
What is the intermarginal sulcus of von Graefe?
|
the gray line that runs horizontally along the margin of the eyelid, posterior to eyelash follicales and anterior to meibomian gland orifices
Represents the most superficial portion of orbicularis oculi muscle |
|
|
what is the muscle of Riolan?
|
the orbicularis oculi muscle
|
|
|
What does anterior lamella of eyelid contain?
|
Eyelashes
Follicles sebaceous glands of Zeis sweat glands of Moll |
|
|
What does the posterior lamella of eyelid contain?
|
sebaceous meibomian glands
Tarsal plate |
|
|
what are two types of sebaceous glands in the eyelid?
|
Zeis (empty into hair folliclces)
Meibomian glands (open onto posterior surface of eyelid) |
|
|
Two types of hordeolum
|
External (stye) - Zeis gland
Internal (acute chalazion) - meibomian gland |
|
|
What is a "stye?"
|
external hordeolum
|
|
|
Hordeolum vs chalazion vs acute chalazion
|
Hordeolum = acute lesions caused bacteria or extruded lipid inflammation
Chalazion = subacute/chronic granuloma surrounding lipid Acute chalazion = internal hordeolum |
|
|
Folliculitis
|
Acute abscess of eyelash follicle
|
|
|
How to tell staphylococcal vs seborrheic vs demodectic blepharitis
|
Staph - collarettes = honey colored flakes surrounding eyelashes
Seborrheic - "scurf", dandruff like flakes randomly around eyelashes Demodectic - "cylindrical cuffs or sleeves |
|
|
What cause of blepharitis makes sleeves around lashes
|
Demodex folliculorum
|
|
|
Posterior blepharits is caused by what, more common in patients who have ____
|
caused by meiobomian gland inflammation (hypersecretion)
more common in rosacea patients |
|
|
3 signs of long-standing staph blepharitis
|
Madarosis - loss
Poliosis - white Trichiasis - misirection |
|
|
Giant conj papillae
- definition - cause |
>1 mm diameter
- vernal (chronic allergic) and atopic conjunctivitis (CL, prostheses, sutures) |
|
|
Conj papillae vs follicles
|
Follicles (lymphoid) do not contain central vascular core, vessels are pushed upward to seem to course over the surface
|
|
|
Conjunctival follicles sign of
|
- Normal in older children/adolescents
- Limited dx: chlamydia, adenovirus, HSV, molluscum, certain topical meds |
|
|
Granulomatous conjunctivitis
- appearance - sign of |
- like chalazia, but more polypoid, large, polygonal, central pallor, assoc follicles
- MC cat scratch disease (also TB, syphillis) |
|
|
Causes of conjunctival membranes and pseudomembranes
|
Herpes simplex, chlamydia, strep, chemical burn, erythema multiforme
|
|
|
Difference between conjunctival membranes and pseudomembranes
|
Pseudo - does not involve conj epithelium and can be removed without bleeding
|
|
|
Ciliary flush =
|
hyperemic vessels extending out from limbus 1-2 mm
|
|
|
Horner-Trantas dots
|
Yellow-white
1-2 mm focal masses of eosinophils on top of limbal conjunctival papillae Usually indiate vernal or atopic conjunctivitis |
|
|
Herbert's pits
|
Limbal scar
only in Trachoma Healed, scarred, limbal follicles, necrosis and depression |
|
|
Catarrhal means
|
Old term for mucopurulent (less than fully purulent)
|
|
|
Watery
Mucoid Serous Mucopurulent Purulent |
Watery- secretion from lacrimal gland
Mucoid- secretion from goblet cells Serous- discharge or proteinaceous fluid (mild conj'itis) Mucopurulent- neutrophils + mucus Purulent- neutrophils, frank infection |
|
|
Difference between limbal and bulbar conj
|
Limbal has septae
|
|
|
Chemosis =
|
swelling underneath conj
|
|
|
Blenorrhea
|
flow of pus
|
|
|
MC location of telangiectasias
|
Bulbar conj
|
|
|
4 rare diseases with telangiectasias
|
Ataxia-telangiectasia
Fabry Sturge Weber Osler-Weber-Rendu |
|
|
Hyperemia vs ciliary flush
|
Peripheral vs peri-limbal (different blood supply)
|
|
|
Conjunctival vessels (vs scleral vessels)
|
- Finer, less tortuous
- Hyperemia red Instead of violet - Movable - Affected more by vasoconstrictors |
|
|
3 features of scleritis not found in episcleritis
|
- Tenderness
- Ciliary pain (or photophobia) - Cell and flare in AC |
|
|
MC causes of scleritis
|
- Idiopathic (50%)
- CTD - Gout / hyperuricemia - Syphillis / TB |
|
|
Staphyloma =
|
Scleromalacia perforans
Bluish, grape-like Scleral thinning with uveal tissues behind |
|
|
4 types of anterior scleritis
|
Diffuse
Sectoral Nodular Necrotizing |
|
|
MCC of Necrotizing scleritis without inflammation (scleromalacia perforans)
|
Chronic RA
|
|
|
Axenfeld's nerve loop
|
Blue-black spot in superficial sclera 3-4 mm from limbus
Branch of long ciliary nerve/anterior ciliary artery (with uveal pigment) |
|
|
Layers of tear film
|
1. Oil - superficial
2. Water and mucin ("third" layer is water and mucin, but much higher concerntration of mucin) |
|
|
Source of tear film components
|
1. Oil - eyelid sebaceous glands
2. Mucin - eyelid conjunctival goblet cells 3. Water - lacrimal gland |
|
|
Normal tear breakup time
|
10 seconds
|
|
|
5 layers of cornea
|
Epithelium
Bowman's Stroma descemet's Endothelium |
|
|
PEE vs PEK
|
PEE only visible with staining
PEK visible with/without statining, may not stain |
|
|
Name for early epithelial edema which appears as many tiny clear bubbles of fluid
|
Bedewing
|
|
|
Name for whorl-like pattern of normally clear epithelial cells
|
Cornea verticillata
|
|
|
Ddx for Cornea verticillata
|
extensive PEK
deposition of medications (amio) Fabry disease |
|
|
Name when pigment from racial melanosis extends in swirling pattern onto cornea in area of inflamm or trauma
|
Striate melanokeratosis
|
|
|
Horizontally oriented line of iron deposition, normal in old age, located at junction of upper two and lower one thirds of cornea
|
Hudson- Stahli line
|
|
|
Name of iron deposition in cornea around keratoconus
|
Fleischer ring
|
|
|
Name of iron deposition in cornea around filtering bleb
|
Ferry line
|
|
|
Name of iron deposition in cornea around head of pterygium
|
Stocker line
|
|
|
Name for superficial corneal vascularization/fibrosis
|
pannus
|
|
|
Pannus vs micropannus
|
>1.5 mm onto cornea
|
|
|
Bowman's layer is composed of
|
Irregular stroma. (Actually not a membrane)
|
|
|
What layer of cornea does pannus develop in
|
Bowman's
|
|
|
Where does calcium deposit in cornea
|
Bowman's
|
|
|
Fibrosis of bowman's layer occurs spontaneously in what hereditary disorder
|
Reis Bucklers corneal dystrophy
|
|
|
Name for most severe type of corneal scar
|
Leukoma
|
|
|
Name for least severe and intermediate severity corneal scar
|
Nebula - least
Macula - intermediate |
|
|
Why does band keratopathy have swiss cheese apperance?
|
Calcium tends not to deposit around corneal nerves coursing through bowman's layer
|
|
|
Normal corneal thickness =
|
540 to 560 micrometers
|
|
|
Name of Type III sterile corneal infiltrate (hypersensitivity to bacterial conjunctivitis) typically located inside the limbus
|
Catarrhal (marginal) infiltrate
|
|
|
Name for type IV corneal infiltrate, more scarring and vascularization than catarrhal
|
Phlyctenule
|
|
|
What are corneal ghost vessels
|
Old stromal vascularization, now devoid of blood
|
|
|
How to detect early stromal edema
|
Fine, undulating striae in deep stroma and descemet's membrane (deep striate keratopathy, DSK)
|
|
|
What are the 3 most common diseases that cause corneal deposits?
|
1. Macular dystrophy (GAGs)
2. Lattice dystrophy (amyloid) 3. Granular dystrophy (protein) |
|
|
How to tell corneal nerves vs ghost vessles
|
Nerves are in anterior-two thirds
Ghost vessels are posterior |
|
|
Name of thickened ridge of descemet's membrane found in congenital glaucoma
|
Haab's striae
|
|
|
Name for normal corneal guttae found with aging in periphery
|
Hassall-Henle bodies
|
|
|
Name for congenital anomaly with anteriorly displaced schwalbe's ring in
|
posterior embryotoxon (Axenfeld anomaly, syndrome if glaucoma present)
|
|
|
Name for ridge-like termination of descemet's
|
Schwalbe's ring
|
|
|
Where does copper deposit in Kayer Fleischer ring
|
Peripheral descemet's membrane
|
|
|
Name for pigmentation on corneal endothelium from pigment dispersion syndrome
|
Krukenberg's spindle
|
|
|
Name for accumulations of inflammatory cells on the corneal endothelium
|
Keratic precipitates
|
|
|
Name for line of keratic precipitates in corneal transplant rejection
|
Khodadoust rejection line
|
|
|
Condition with corneal leukoma attached to cataractous lens (or iris) by fibrous band
|
Peters' anomaly (congenital)
|
|
|
What does rose bengal stain
|
Abnormal, devitalized epithelial cells
Mucus Keratin |
|
|
What color light to use with rose bengal
What does it look like |
Greed (red free) filter
Red |
|
|
Epithelial microcysts - think?
|
Meesman's corneal dystrophy (AD)
|
|
|
Name differences between crocodile shagreen and central cloudly corneal dystrophy of francois
|
- C Shagreen: peripheral, older patients (degenerative)
- CCCDF - autosomal dominant |
|
|
What is incidence of recurrence after pterygium surgery: conj autograft vs. AMT? (according to Wagoner)
|
- Conj: 2.6%
- AMT: 10% |
|
|
What is a tx for OCP? What are its side effects? What should be tested for before starting? What monitoring should be done?
|
- Dapsone (antibiotic with antiinflammatory properties)
- Start 25 D, then increase to 100-150 QID - Hemolysis - G6PD deficiency - CBC weekly while increasing dose, 3-4w until stable, then monthly |
|
|
Describe Dr. Chodosh's 4 categories of HSV and their tx
|
1. Epithelial - Antiviral (topical or oral) OR debridement
2. Stromal without ulceration - Topical steroid + oral antiviral prophylaxis 3. Stromal with ulceration - Topical steroid + Oral antiviral (therapeutic dose) 4. Endothelial keratitis - Topical steroid + oral antiviral (therapeutic dose) |
|
|
What is Ddx for bacteria that can penetrate intact corneal epithelium?
|
- Neisseria gonorrheae
- Neisseria meningiditis - Shigella - Corynebacterim diphtheria |
|
|
Name the 4 types of corneal dystrophies that are not AD
|
- Macular
- Lattice type 3 - Gelatinous - CHED type 2 (nystagmus) |
|
|
Which corneal dystrophies extend to the limbus?
|
- Meesman's
- Macular - Fleck - CHSD - CHED |
|
|
What is ddx for symblepharon (per wagoner)
|
1. Trauma
2. Surgery 3. AKC (age 40-50) 4. OCP (age >60) |
|
|
What is the purpose of cyclosporine in lipid keratopathy?
|
- Anti-vascular
|
|
|
What are rejection rates of different corneal grafts?
|
PK - 10%
DSAEK - 8% DMAEK - 4% DMEK - 2 % |
