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253 Cards in this Set

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  • Back
Elderly get (decr/incr) peri-orbital fat thus results in (exo/enophthalmos).
decr, enophthalmos
Elderly get (incr/decr) in horizontal palbebral aperture because lateral canthus goes (inward/outward)
decr, inward
Elderly get (incr/decr) vertical palpebral aperture due to ____ and ____.
decr, decr fxn of levator, flaccidity of eyelids/skin
T/F - Elderly get decr production of all components of tear film.
True - mucin, tear, and oil all decr production
Contraction of orbicularis oculi causes ___ of caniliculi which leads to...
shortening and compressing; leads to dilation of lacrimal sac thus suck in tears.
The orbicularis is attached to the ____ which is attached to the ____ which is attached to the ____.
medial palpebral ligament, lacrimal fascia, lacrimal sac
Elderly get (incr/decr) orbicularis force due to...
decr, due to anatomical changes (decr dist b/w pretarsal and preseptal areas of orbicularis)
T/F - Elderly have displaced lacrimal puncta which causes epiphora
T/F - Eyelashes get thicker in older people.
False - thinner
Orbit fat prolapse in elderly results in...
bulge at inner half of upper lid
T/F - Conj thickness is stable in elderly.
False - thinner
T/F - Elderly have higher tendency for subconj hemes.
True - capillaries more fragile
Elderly get (incr/decr) corneal sensitivity.
Elderly get an increase in this kind of astigmatism.
What is the cause of the yellowish tinge of the sclera in the elderly?
Due to dehydration + lipid deposits.
What is the cause of the brownish tinge of the sclera in the elderly?
UV light, wind, dust exposure
What is the cause of the bluish tinge of the sclera in the elderly?
scleral thinning
What happens to the size of the ant chamber in elderly? Why?
more shallow b/c incr lens thickness
Describe the TM changes in the elderly.
hylanization and loss of endoth lining
What naturally happens to the iris in the elderly?
Iris atrophy - collagen fibers hyalinize which causes decr elasticity thus pupil more rigid
Pupil is (less/more) reactive to light in elderly. Why?
less; both sphincter and dilator muscles weaken, collagen fibers hyalinize which decr elasticity causing pupil become more rigid
What kind of Sx are assoc w/ the pupils of the elderly?
Complaints that objects are not as bright, bright light may be too bright, decr night vision
T/F - Elderly pupils results in bright light that may be too bright.
Which specific muscle of the ciliary muscle atrophies in the elderly?
circular muscle
IOP incr ___% in the elderly due to..
25%, due to incr aqueous production by CB, blockage of Schlemm's canal
T/F - Aqueous composition in ant chamber of elderly does not change.
Describe the lens changes in the elderly mentioned in the packet.
Sclerosis of lens substance, decr elasticity of capsule, incr lens weight
T/F - Lens weight remains stable despite being thicker in the elderly.
False - lens weight incr
Vitreous is __% water, __% solid.
99, 1
Vitreal solids are mainly composed of...
collagen filaments, hyaluronic acid molecules
In the elderly, what happens physiologically to the vitreous?
Syneresis: depolymerization of hyaluronic acid thus water molecules released; lacunae formation (pockets of liquified vitreous); collagen filaments come together to form fibrils thus further vitreal structure collapse.
How does a PVD occur according to the packet?
All lacunae come together, causes shrinkage and contraction of vitreous thus resulting PVD
T/F - Elderly lose the foveal reflex
T/F - Choroid thickness is stable in elderly.
False - decr
In elderly, choroid pigment (incr/decr), and RPE pigment (incr/decr).
decr, decr. . (RPE hypopigmentation)
Elderly have decr night vision due to...
poor pupil dilation, decr retinal illum, cataract, incr light scatter, uncorr myopia, decr dark adaptation (decr photoreceptor processing)
Phorias in the elderly shift to...
more exo (ciliary muscle atrophy)
T/F - Contrast sensitivity in elderly decr.
T/F - Elderly have decr sensitivity to blue colors only.
False - decr sensitivity to blue, green, red
Elderly tend to have a ___ colored lens so have trouble seeing ____ colored objects, i.e. ____ wavelengths.
yellow, blue, short
Normal VF in elderly decr ___ degrees per decade.
Elderly have a (incr/decr/stable) ability to attend to one object in presence of multiple objects.
Elderly have (incr/decr/stable) hyperopia.
What is a brow ptosis?
drooping of eyebrows due to aging + gravity + loss of elasticity
T/F - Brow ptosis is usually asymptomatic.
True - but if symptomatic, get brow ache, loss of superior field
What develops on the forehead due to brow ptosis?
Furrows b/c trying to lift up eyebrows
Tx brow ptosis?
Brow lift
If the measurement b/w the ___ to the ___ is less than ___mm, you have a brow ptosis.
inferior limbus of cornea, center of brow, 22 mm
T/F - Papillomas are non-viral benign epithelial lesions.
T/F - You see more papillomas with age.
T/F - Papillomas typically present with irritation.
False - asymptomatic
In your diabetic patient, you see a brown, soft, lobular lesion that is asymptomatic; you suspect...
Papilloma (commonly seen in diabetics)
Tx papilloma?
Hyperkeratosis causes...
cutaneous horns
*What is an important observation that you must do with cutaneous horns???
May be a basal or squamous cell carcinoma at the BASE of the horn (20% of the time) - squamous cell is the most common type
You find a carcinoma at the base of a cutaneous horn - what kind of carcinoma is it, most likely?
most likely squamous cell; may be basal
Tx cutaneous horn?
excision w/ biopsy
Keratoacanthoma = benign or neoplastic?
You see a dome-shaped lesion with a keratin-filled center on your patient. He said he noticed it about 3 weeks ago. You suspect...
You must DDx ____ vs Keratoacanthoma.
squamous cell carcinoma (does not develop as fast as Keratoacanthoma)
Tx keratoacanthoma?
Excision w/ biopsy
Keratoacanthomas grow (slow/fast) and typically resolve in ___ months.
fast (2-3 wks), 4-6 mos
What lid lesion is associated with smoking?
T/F - Lentigo maligna, despite its name, is not malignant.
False - it is premalignant, dev into lentigo maligna melanoma
Lentigo maligna is due to...
sun exposure
Describe what Lentigo maligna looks like
flat, dark 'stain' (tan-brown with diff shadings)
T/F - Actinic keratosis is premalignant
True (squamous cell carcinoma)
What is the biggest risk factor for Actinic keratosis?
excessive sun exposure when young
Describe what Actinic keratosis looks like and its cause
dry, rough, scaly lesions eventually turns into a hard wart like surface; damage to keratinocytes (major component of epidermis), secondary to UV light
Tx Actinic keratosis?
sunscreen, biopsy, 5-fluorouracil cream (anti-metabolite), cryotherapy
Where do sebaceous adenocarcinomas come from?
sebaceous glands of lid (incl meibomian glands and glands of zeiss)
T/F - sebaceous adenocarcinomas are benign
False - maligant/fatal/very aggressive
T/F - sebaceous adenocarcinomas are more common in the upper lid
T/F - Sebaceous adenocarcinomas are flat, brown patches on the skin.
False - firm, slowly enlargening nodule (remember, sebaceous and mistaken for chalazion hence nodule)
Recurrent chalazion can be a possible sign of...
Sebaceous adenocarcinoma
T/F - Sebaceous adenocarcinomas are associated with hair loss or ulceration at the lid margin.
T/F - Sebaceous adenocarcinomas are often mistaken as recurrent chalazions or unilateral blepharitis
Tx Sebaceous adenocarcinoma?
excision w/ biopsy
What is xanthelasma?
Yellowish plaques that typically occur in medial upper lids
T/F - Xanthelasma does not cause ptosis.
False - can cause ptosis (think of mass bearing weight/gravity?)
Xanthelasma are composed of...
xanthoma cells (macrophages containing lipids)
T/F - Xanthelasma is usually assoc w/ high cholesterol
False - only assoc w/ high cholesterol 50% of time
T/F - Risk of high cholesterol increases if you see Xanthelasma in a younger pt
What are the causes of Xanthelasma?
high cholesterol (50%), DM, liver problems
T/F - Liver problems can cause Xanthelasma.
Tx Xanthelasma?
excision, trichloroacetic acid, laser, cryo
What is floppy eyelid syndrome?
Extreme eyelid laxity (decr in elastin and also may be due to chronic rubbing)
T/F - Floppy eyelid syndrome can be due to chronic eye rubbing.
T/F - Floppy eyelid syndrome is assoc w/ keratoconus
What conditions are assoc w/ Floppy eyelid syndrome?
obesity, sleep apnea, keratoconus
Tx Floppy eyelid syndrome?
water-based ung (lacrilube), tape lids, eye shield, surgery
T/F - Involutional/spastic entropion involves only vertical eyelid laxity.
False - both horz and vert
What causes Involutional/spastic entropion?
vert and horz eyelid laxity + orbicularis override (orbicularis overtakes action of lower eyelid retractors)
What is the 'cycle' in Involutional/spastic entropion?
Eyelids are pushed in, leads to trichiasis, irritation, thus further inward turn of eyelids due to forced blinking/lid closure
What causes involutional ectropion?
Eyelid laxity both vert and horz WITHOUT orbicularis override (not strong enough to push lid inward) causes the ectropion
T/F - Involutional ectropion involves orbicularis override.
False - no orbicularis override in ECtropion, but present in ENtropion
What kind of lesion is a Sebeorrheic keratosis?
benign epithelial tumor (benign proliferation of keratinocytes and melanocytes)
T/F - Sebeorrheic keratosis is benign.
This lesion begins as light tan and flat, but then becomes more pigmented and elevated with a warty surface with age; looks like it's stuck on the skin.
Sebeorrheic keratosis
T/F - Sebeorrheic keratosis are mostly found on the upper lid.
False - lower lid
Tx Sebeorrheic keratosis?
electrocautery, cryo, excision
Most common type of benign tumor in elderly?
Sebeorrheic keratosis
Most common type of ptosis?
Aponeurotic ptosis
What is the etiology of Aponeurotic ptosis?
Disinsertion of levator aponeurosis (small tendon connecting levator to lid) due to aging, stretching
T/F - Aponeurotic ptosis involves abnormal levator fxn.
False - normal levator fxn
T/F - Aponeurotic ptosis involves a high upper eyelid crease.
When is a superior field 36 indicated?
To see if ptosis surgery is medically necessary; measure field with lids taped and untaped to see diff b/w the two. Use w/ Aponeurotic ptosis, dermatochalasis
Tx Aponeurotic ptosis?
Most common cause of pseudoptosis?
What causes Dermatochalasis?
loss of elasticity from aging, uv light
T/F - Dermatochalasis can be caused by UV exposure
What is madarosis? What ocular dz is it assoc w/ as mentioned in the packet?
lose lashes; blepharitis/MGD
What is poliosis? What ocular dz is it assoc w/ as mentioned in the packet?
white lashes; blepharitis/MGD
What is tylosis? What ocular dz is it assoc w/ as mentioned in the packet?
thickened lashes; blepharitis/MGD
Where/what is a collarette found in blepharitis/MGD?
ringlike formation on BASE of lash due to staph
'Scurf' is associated with...
Seborrheic blepharitis - sticks to lash or can get sleeves along lashes
Seborrhea causes (incr/decr) oil production.
Decr - initially start with incr oil production, then formation of crusty debris around oil glands, thus blockage, thus causing decr oil production
How does damage to the cornea occur from blepharitis/MGD?
Bacterial exotoxins (lipases break down cholesterol into FFAs) damage the cornea
What ABs are indicated for blepharitis/MGD?
Doxy and tetra (decr lipase which decr FFAs - remember the reason for toxicity to cornea is FFAs)
What type of lesion is a squamous cell carcinoma?
malignant tumor of epithelial keratinocytes
Squamous cell carcinoma is the (#) most common eyelid skin cancer.
T/F - Males are at higher risk for Squamous cell carcinoma.
T/F - Exposure to UV light as a child puts you at higher risk for Squamous cell carcinoma.
T/F - Hx of immunosuppresion puts you at higher risk for Squamous cell carcinoma.
For Squamous cell carcinoma:. Differentiated = (firm/soft). Undifferentiated = (firm/soft)
Differentiated = firm. Undifferentiated = soft
Describe how a Squamous cell carcinoma looks like.
Ulcerated lesion with bleeding
T/F - Squamous cell carcinomas often metastasize.
False - but aggressive locally
Most common type of eyelid skin cancer?
Basal cell carcinoma
T/F - Basal cell carcinoma is benign.
False - malignant, but rarely metastasizes, unless along medial canthal area (can invade orbit)
Basal cell carcinomas arise from...
pluripotential cells of epidermis
T/F - Basal cell carcinomas typically metastasize.
False - rarely metastasizes, unless along medial canthal area (can invade orbit)
Basal cell carcinomas typically occur on (upper/lower) lid.
T/F - You have a higher risk for Basal cell carcinomas if you had a lot of UV exposure as a child
What type of lesion does this describe?. . Round lesion with depressed center, possibly ulcerated; teleangiectasia around lesion, pearly appearance, raised borders.
Basal cell carcinoma
What is a Plasmacytoma?
Mass of plasma cells that occur in the bone and can spread into the soft tissue (can involve orbit, push globe out thus proptosis and ON compression)
When a Plasmacytoma becomes systemic, it is called...
multiple myeloma
Plasmacytoma = benign or malignant?
Signs of Plasmacytoma?
Proptosis, displacement of globe, ON compression (remember, orbital tumor)
Tx Plasmacytoma?
Biopsy, systemic workup, radiation, chemo, CT scan
What is a damaged sinus ostium due to trauma or chronic sinus disease?
Mucocele (sinus ostium = connection of sinus to nasal cavity)
Mucocele leads to a _____ that can expand into the orbit.
mucous filled sinus
T/F - Mucoceles involve infection
Signs of Mucocele?
proptosis, displacement of globe, ON compression
A frontal mucocele has what ocular presentation?
push eye down
An ethmoid mucocele has what ocular presentation?
push eye out
A maxillary mucocele has what ocular presentation?
push eye up or in
A sphenoid mucocele has what ocular presentation?
compress nerve
Tx mucocele?
Lymphomas = benign or malignant?
What is lymphoid hyperplasia? Is it benign or malignant?
Benign precursor to lymphoma
Ocular signs of lymphoma?
proptosis, globe displacement
Majority of lymphomas are what type?
non-hodgkins lymphoma
This type of tumor is difficult to differentiate b/w malignant vs benign.
Tx lymphoma?
biopsy, systemic work-up, chemo, radiation
What is Mucomycosis?
Fungal infection by inhalation of spores; life threatening
Mucomycosis has a tendency in what kinds of patients?
Very sick people, uncontrolled DM, dialysis pts
Why are dialysis pts susceptible to mucomycosis?
Pts receive iron overload during dialysis, which promotes fungal growth
Signs & Sx of mucomycosis (early and late)
Pain, fever, proptosis (looks similar to orbital cellulitis); visual loss due to thrombosis of retinal artery/fungal invasion. . Late finding: black dead tissue in palate/nasal mucosa
Prognosis of mucomycosis?
Tx mucomycosis?
IV amphotericin B, debride necrotic tissue
#1 male metastatic cancer? Female?
male = lung. female = breast
Sx of metastatic orbital tumor?
Ptosis, proptosis, decr ocular motility, decr VA
Tx metastatic orbital tumor?
biopsy, Tx primary malignancy, radiation and chemo for orbit
What autoimmune disease describes the unregulated secretion of T3 and T4 of the thyroid due to antibodies?
Grave's disease
What is the ocular pathophysiology of Grave's disease?
The same antibodies that attack the thyroid also attack the orbital fibroblasts of the EOMs and orbital fat; leads to production of hyaluronic acid thus incr water absorption, swelling. More swelling/fibrosis due to inflammation causing deposition of GAGS in soft tissue
Ocular Signs/Sx of Grave's?
Lid retraction (see sclera at top), proptosis, puffy lids, lagophthalmos, diplopia (inf rectus affected 1st), exposure keratitis, ON compression, true Von Graefe's sign
What EOM is affected first in Grave's?
inferior rectus
Tx Grave's?
ATs, lacrilube, systemic steroids, orbital decompression, stop smoking
T/F - You should tell your Grave's patients to stop smoking.
Acquired nasolacrimal duct obstruction is due to...
blockage secondary to aging changes in the lacrimal duct and sac
Acquired nasolacrimal duct obstruction leads to...
infections, epiphora
How can you test Acquired nasolacrimal duct obstruction?
disappearance dye test, dilation/irrigation, dacryocystography (x-ray)
Tx acquired nasolacrimal duct obstruction?
dacryocystorhinostomy - new tear channel created
Dacryocystitis is caused by...
nasolacrimal duct obstruction - fluid stays in lacrimal sac and leads to infection
T/F - Dacryocystitis expresses pus if you press on the sac.
T/F - To locate the blockage in Dacryocystitis, you can dilate and irrigate the puncta.
False - never dilate/probe/irrigate Dacryocystitis!
Tx Dacryocystitis?
Systemic antibiotics (Augmentin), dacryocystorhinostomy
What ocular disease involves an autoimmune process where the antibodies bind to the conj basement memb and cause inflammation, scarring?
Ocular pemphigoid
This autoimmune disease involves conj scarring, entropion, trichiasis, symblepharon, ankyloblepharon, and corneal damage (pannus, ulcers, dry eyes).
Ocular pemphigoid
T/F - Ocular pemphigoid can involve corneal ulcers.
What is symblepharon?
Bulbar and palpebral conj stick together
What is ankyloblepharon?
Upper and lower lid stick together
Tx Ocular pemphigoid?
Doxy (mild), immunosuppresants (severe); once inflammation reduced, need surgery; also need ATs
Conjunctival lymphoma = progressive or rapid onset?
Conjunctival lymphoma color?
salmon colored lesion
Conjunctival lymphoma location (be specific)?
bulbar or palpebral conj
Conjunctival lymphoma due to (Hodgkins/Non-Hodgkins) lymphoma?
Tx Conjunctival lymphoma?
excision w/ biopsy, systemic work-up, CT to assess orbital involvement
Hyalinization of the sclera (thinned sclera) due to aging is called...
Senile scleral plaque
Senile scleral plaque lies...
along horz recti (combo of sun exposure + stress put on by horz recti)
Pingueculas are due to...
chronic wind exposure (dryness) and sun exposure
Pingueculas cause...
degenerative changes in the conj w/ incr fibrovascular tissue
Concretions are composed of...
mucin secretions and degen epith cells
Concretions may be secondary to...
dry eyes and allergies
You see a line leading a pterygium...what is this called?
Stocker's line
T/F - Warfarin can be the culprit of a subconj heme.
How long do subconj hemes usually last?
2 wks
T/F - Necrotizing scleritis is an autoimmune process.
True - inflammation of scleral tissue
What is the most severe form of scleritis?
Necrotizing scleritis
What signs/Sx present with Necrotizing scleritis?
avasc patch of tissue over scleral necrosis, more apparent uvea, painful, high chance of vision loss
Tx Necrotizing scleritis?
Oral NSAIDS for a week; if no improvement give systemic steroids; if no improvement again, IV steroid or immunosuppressive Tx
What Tx is contraindicated in Necrotizing scleritis?
No topical steroids (vascular system already compromised), no injection (thin sclera, can perf globe)
T/F - Scleromalacia perforans is an inflammatory scleritis.
False - no inflammation
T/F - Scleromalacia perforans does not involve scleral thinning
False - thinning occurs, revealing uvea
Tx Scleromalacia perforans?
Tx underlying cause (almost always RA), protective eyewear, ATs
What autoimmune disease is often associated w/ Scleromalacia perforans?
Rheumatoid arthritis
Which type of cataract involves vacuoles early on?
T/F - Corneal arcus always involves high cholesterol.
False - in older caused by degeneration; if younger, then must be due to high cholest
Where does Corneal arcus typically start? Where next?
inferior, superior, rest
Corneal arcus can involve thinning cornea (with intact epith) at the area of clearing between the arcus and the limbus; what is this called and what is it assoc with?
Furrow degeneration, may be assoc w/ RA
This corneal disease is unilateral in the elderly, painful, inflammatory, and corneal tissue damage begins at periph cornea, progressing to the center; may lead to perf.
Mooren's ulcer
Mooren's ulcer has been associated with this disease.
Hep C
In Mooren's ulcer, corneal damage begins where?
Peripheral cornea (nasal or temporal)
Limbal girdle of Vogt = bilat or unilat?
Limbal girdle of Vogt is located...
nasal and temporal (perilimbal area)
Limbal girdle of Vogt is due to...
elastic degeneration
Crocodile shagreen = bilat or unilat?
Crocodile shagreen = dystrophy or degeneration?
What corneal signs typically occur due to use of Amiodarone? What is this called?
Corneal verticillata (vortex keratopathy) - brown epithelial deposits in a swirl pattern; called Amiodarone keratopathy
T/F - Amiodarone keratopathy is permanent.
False - goes away when drug is stopped
Band keratopathy is due to (this deposit) and is usually located in which layers?
calcium deposits; in superepithelium, bowman's, ant stroma (anterior corneal layers)
T/F - Band keratopathy starts central then goes nasal/temporal.
False - vice versa
T/F - You can DDx Band keratopathy vs corneal arcus since there is no area of clearing separating it from the limbus.
False - there is an area of clearing
What does Band keratopathy look like?
Small holes/clefts (where nerves go thru Bowman's); looks like a band of swiss cheese looking spots going across the cornea
T/F - Band keratopathy can be caused by dry eyes.
T/F - Band keratopathy can be caused by acute ocular inflammation.
False - chronic (uveitis)
T/F - Band keratopathy can be caused by low systemic calcium.
False - hypercalcemia
T/F - Band keratopathy can be caused by kidney failure.
What corneal disease can be caused by gout?
Band keratopathy
T/F - Band keratopathy can be caused by ocular surgery.
T/F - Band keratopathy can be caused by chemical exposure.
Tx Band keratopathy?
ATs, EDTA (binds to calcium) w/ scraping, keratectomy
What corneal disease involves EDTA as the Tx?
band keratopathy (EDTA binds to calcium, then scrape)
What is Hutchinson's sign?
HZV vesicles on the nose; you have a 75% chance of getting ocular involvement
T/F - HZV involves persistent endothelial defects.
False - persistent epithelial defects
What is disciform keratitis?
inflammatory response to HZV; central stromal/epithelial edema, KPs, limbitis, uveitis, scarring
Tx disciform keratitis?
Topical steroids, viroptic
This corneal disease involves an epithelial defect that never heals with poor corneal sensitivity; it has multiple causes.
Neurotrophic keratopathy
Neurotrophic keratopathy causes?
HSV, HZV, topical NSAIDs, timolol, anesthetic, stroke, diabetes, ocular surgery
T/F - Neurotrophic keratopathy can be caused by topical NSAIDs.
T/F - Neurotrophic keratopathy can be caused by HSV but not HZV.
False - can be caused by either
Timolol can cause this corneal disease that involves poor corneal healing and decr corneal sensitivity
Neurotrophic keratopathy
What is guttata?
Depositied portion of descemet's resulting in endothelial dropout and endothelial cells trying to get bigger to cover up; results in pump dysfxn
Appearance of guttata?
beaten metal appearance
Bullous keratopathy is due to...
stromal edema in cornea, begins as sub-epithelial bullae
What is the main Sx of Bullous keratopathy?
Pain (due to bullae bursting) and dry eyes
Tx Bullous keratopathy?
Muro (wait until bullae heals), ABs, transplant
What is more common in the lid - squamous or basal cell carcinomas?
Basal cell carcinomas
T/F - Dermatochalasis can be caused by UV light exposure.
Trichloroacetic acid is used to Tx...
T/F - Metastatic orbital tumors can cause proptosis and not ptosis.
False - can cause either
How does the ON get involved in this hyperthyroid autoimmune disease?
(Grave's) - ON compression
Baggy eyelids can be an indication of what organ failures?
Kidney or heart failure