Ocular Disease Final

Front 1

what is the Hudson Stahli Line?
when is it seen?

Back 1

1. line of iron deposition
2. located in deep epithelium at the line of palpebral closure
3. tear film mostly like source of iron

Front 2

Coat's White Ring

Back 2

1. small oval ring made up of discrete white dots
2. INFERIOR
3. associated with previous corneal metallic foreign bodies

Front 3

White Limbal Girdle of Vogt

Back 3

1. fine white lines that fun radially in the periphery of the cornea
2. similar to corneal arcus
3. subepithelial hyperelastosis and mild hyaline degeneration

Front 4

Corneal Arcus

Back 4

1. grayish white/yellow deposits, made of fine dots, separated from the limbus by a clear interval (0.2-0.3mm wide)
2. HYPERLIPIDEMIA if pt is <30-40 yrs

Front 5

Calcific Band Keratopathy

Back 5

1. result of inflammatory and degenerative conditions
2. 3:00 and 9:00 regions
3. separated from limbus by CLEAR ZONE
4. in severe cases: treat with chelation

*associate with chronic uveitis, chronic glaucoma, corneal edema, and elevated serum calcium

Front 6

Salzmann's Nodular Degeneration

Back 6

1. elevated blue/gray fibrous lumps in the superficial stroma just beneath epithelium
2. more common in females

Front 7

Terrien's Marginal Degeneration

Back 7

1. bilateral/asymmetrical thinning of the peripheral cornea
2. epithelium remains INTACT

MUST BE DISTINGUISHED FROM MOOREN'S ULCER!!

Front 8

what are the THREE syndromes of Iridocorneal Endothelial Syndrome

Back 8

UNILATERAL
1. Chandler's Syndrome: iris is normal or has mild stromal atrophy
2. Progressive Iris Atrophy: iris shows extensive change with marked atrophy and hole formation
3. Cogan-Reese: iris nodules and HIGH atrophy

Front 9

what can microcornea be confused with?

Back 9

blephariphimosis:
abnormally small interpalpebral fissure opening

Front 10

patients with megalocornea usually presents with?

Back 10

1. bilateral
2. high myopia/astigmatism
3. marfan's syndrome?
4. X-LINKED (MALE)!!

Front 11

patients with microcornea are more susceptible to...

Back 11

angle closure glaucoma in later years as lens get larger

Front 12

what is keratoconus

Back 12

1. progressive
2. non inflammatory ectasia and thinning of central and paracentral cornea which assumes a CONICAL configuration

Front 13

what are the clinical signs of keratoconus (10)

Back 13

1. irregular astigmatism (axes not 90 degs apart)
2. egg shaped mires
3. scissoring on ret
4. high myopia
5. not correctable to 20/20
6. Fleischer's ring
7. Vogt's striae
8. Munson's Sign
9. Rizzuti's Sign
10. HYDROPS

Front 14

what are some treatment options for keratoconus

Back 14

1. rigid contact lenses
2. corneal collagen crosslinking
3. PKP, in severe cases
4. for acute HYDROPS: pressure patch or soft CL, cyclo, analgesics

Front 15

how would you describe SCLEROCORNEA

Back 15

1. diffuse marble like white opacification of the entire stromal thickness
2. usually involves peripheral 1-2mm (sometimes entire central cornea)
3. BOWMANS ABSENT

Front 16

sclerocornea + extremely flat cornea=...

Back 16

1. cornea plana
2. often associated with angle closure glaucoma

Front 17

what is meesman's dystrophy

Back 17

Juvenile Hereditary Epithelial Dystrophy
1. rare
2. bilateral
3. no corneal staining unless cyst rupture

TREAT: supportively, soft CL
*superficial keratectomy if symptoms severe

Front 18

what are the THREE different forms of epithelial basement membrane dystrophy

Back 18

1. MAPLIKE: areas of central ground glass appearance often punctuated with clear luncae...NEGATIVE staining
2. DOTS: pseudocysts
3. FINGERPRINTS

*these are projections of basement membrane thickening into the epithelium

Front 19

treatment for corneal erosion...
SEVERE
MODERATE
MILD

Back 19

severe:
Tobrex ung, Atropine 1% (in office), PP
RTC: Next Day

moderate:
Vigamox, IBU and BSCL

mild:
Azasite, IBU, AT

DEBRIDE RAGGED EDGES

Front 20

what are the EARLY and LATER signs of Reis-Buckler's Dystrophy

Back 20

early:
fine reticular opacities at BM; BM degenerates and is replaced by collagen and microfibrils

later: irregular corneal surface with varying thickness of epithelium (NO EDEMA)

Front 21

what type of dystrophy has a CROCODILE SKIN APPEARANCE

Back 21

anterior mosaic dystrophy

Front 22

what are the THREE stages of FUCH'S DYSTROPHY

Back 22

1. Guttata
2. Stromal/Epithelial Edema (BULLOUS KERATOPATHY)
3. Subepithelial Scarring

Front 23

how do you treat Fuch's Dystrophy

Back 23

1. 5% NaCl drops/ointmant qhs and in the morning
2. hair dryer
3. topical beta blocker to reduce IOP

Front 24

what is the most common systemic disease associated with episcleritis and scleritis

Back 24

**Rheumatoid Arthritis**

other diseases:
1. Lupus
2. Giant Cell Arteritis
3. Polyarteritis Nodosa
4. Sarcoidosis
5. Thryotoxicosis
6. HZV
7. TB
8. Syphilis
9. Gout
10. Lyme Disease...etc

Front 25

what are some characteristics of SIMPLE EPISCLERITIS

Back 25

1. wedged shaped sectoral involvement
2. mild discomfort
3. conjunctival injection and chemosis
4. WOMEN
5. usually unilateral (2/3)
6. NO A/C, NO DISCHARGE, NO STAINING

Front 26

what are the characteristics of nodular episcleritis

Back 26

1. inflamed nodule near the limbus
2. no staining
3. mild A/C

Front 27

what is the treatment for episcleritis

Back 27

OPTIONAL (depends of pts)
1. CC
2. vasoconstrictor
3. NSAIDs (drops/oral)
4. mild/strong steroid
5. 3+ recurrences, systemic workup (co-manage with internist, rheumatologist, PCP)

Front 28

what are some complications of scleritis

Back 28

1. uveitis
2. glaucoma
3. keratitis
4. vision loss
5. retinal detachment
6. ONH involvement

Front 29

treatment for scleritis

Back 29

1. targeted workup
2. Pred Forte q1h
3. Moltrin 800mg q4h
4. co-manage with PCP and rheumatologist

Front 30

name the anterior scleritis from least to most severe

Back 30

1. diffuse: most common, deep and superificial vessel engorgement, pain
2. nodular: one or more immovable nodules of inflamed sclera with adjacent edema and injection
3. necrotizing: localized, acute congestion of vessels which become distorted or occluded

Front 31

what are the two type of keratic precipitates in uveitis

Back 31

1. NON-GRANULOMATOUS: small, dry, discrete white cells on the corneal endothelium
2. GRANULOMATOUS: large, wet, "mutton-fat" clusters of white blood cells on the endothelium (Koeppe's and Busacca Nodules)

Koeppe: cluster on pupillary border of iris
Busacca: cluster on anterior iris surface

Front 32

what are four ways to classify uveitis by their pathophysiological mechanism

Back 32

1. trauma (+/- surgical)
2. infecton (viral, bacteria, etc)
3. immunological disorder (I-IV hypersensitivity)
4. masquerade (vascular, infectious, congenital, metabolic, neoplastic)

Front 33

what are cells and flares

Back 33

1. cells: inflammatory (WBC) and pigmented cells from uveal vessels in AC
2. flare: milky protein transudate from uveal vessels in the AC

Front 34

IOP in relation to uveitis

Back 34

1. LOWER IOP: acute uveitis from DECREASED AQUEOUS PRODUCTION
2. HIGHER IOP: herpetic cases from TRABECULITIS

Front 35

what are the absolute contraindications for NO STEROIDS

Back 35

1. first day, keratitis w/ ulceration
2. during treatment of fungal infection (and before 2 weeks of treatment)
3. during treatment of acanthamoeba
4. during treatment of active HSV
5. any time cornea is at risk

Front 36

weakest to strongest cycloplegic agents

Back 36

1. cyclopentolate 1%
2. homatropine 2% or 5%
3. scopolamine 0.25%
4. atropine 0.5% or 1%

Front 37

what are the FOUR notable diseases associated with ACUTE NONGRANULOMATOUS UVEITIS

Back 37

1. reiter syndrome
2. ankylosing spondylitis
3. trauma
4. toxoplasmosis

Front 38

what are the TWO notable diseases associated with CHRONIC USUALLY NONGRANULOMATOUS

Back 38

1. juvenile rheumatoid arthritis
2. Fuch's heterchronic iridocyclitis

Front 39

what are the FOUR notable diseases associated with CHRONIC USUALLY GRANULOMATOUS UVEITIS

Back 39

1. Sarcoidosis
2. Syphilis
3. Tuberculosis
4. SLE (LUPUS)

Front 40

what are the OTHER SIX conditions that could also cause an AC reaction

Back 40

1. rhegmatogenous retinal detachment
2. posterior segment tumor
3. juvenile xanthogranuloma
4. intraocular foreign body
5. sclerouveitis
6. HIV!!

Front 41

treatment for anterior uveitis

Back 41

1. address underlying and/or accompany infections (co-manage)
2. CYCLO: atropine 1% QD
3. STEROID: prednisolone acetate 1% (1qt q2h)

Front 42

what are the most common etiologies of uveitis

Back 42

1. IDIOPATHIC
2. HLA-B27 related diseases

Front 43

Treatment for Adult Inclusion Conjunctivitis

Back 43

Zithromax 1g QD x 1 dose

OR

Doxycycline 100mg BID 1st day
then 100 mg QD x 21 days

Front 44

Treatment for Neonatal Inclusion Conjunctivitis

Back 44

1. Oral erythromycin 50mg/kg/day divided into four doses for 10-14 days
2. NO CYCLINES
3. topical erythromycin ung adj therapy

Front 45

what are the FOUR stages of Trachoma

Back 45

1. Incipient: immature follicles on superior tarsus, minimal papillary hypertrophy, may see early SPK or Pannus
2. Florid or Established: Follicular and Papillary Hypertrophy
3. Cicatrizing: Herberts Pits (DIAGNOSTIC) and Arlt's Line
4. Healed: no follicles nor papillae, no SEI (this stage may lead to blindness)

Front 46

Treatment for Trachoma

Back 46

1. Zithromax 1g QD x 1 dose

2. Doxycycline 100mg BID 1st day
then 100 mg QD x 21 days

Front 47

what are the presentations fo superior limbic keratoconjunctivitis (SLK)

Back 47

1. chronic inflammation @ 10/2
2. hyperemia, thickening, irritation of cornea/conj.
3. abnormal density of goblet and epithelial cells
4. PAIN, FBS, photophobia
5. BILATERAL

Front 48

Treatment for SLK (mild to severe)

Back 48

1. AT, punctal occlusion, PULSE STEROID
2. acetylcysteine drops
3. cromolyn sodium drops
4. mast cell stabilizers
5. 0.5% silver nitrate
6. BSCL
7. thermal cautery and surgery

Front 49

what is not usually used in SLK for treatment

Back 49

CORNEA NOT AT RISK!!

1. ANTIBIOTICS NOT USED!!
2. COMBO NOT USED!!

Front 50

what are the two forms of Phlyctenulosis

Back 50

1. CONJ.: focal nodule of limbal tissues...STAPH BLEPH!!! less common TB
2. CORNEAL: whitish plaque on cornea

Front 51

Treatment for Phlyctenulosis

Back 51

1. treat staph bleph...LID HYGIENE
2. if TB get CXR (refer out)
3. vasoconstrictor
4. topical steroid (combo if staph bleph)
5. topical cyclosporine A

Front 52

what are the FIVE classes of ophthalmia neonatorium

Back 52

1. chemical (associated with silver nitrate use)
2. Chlamydial
3. Gonococcal
4. Non-Gonococcal
5. Herpetic/Viral

Front 53

treatment for Gonococcal Ophthalmia Neonatorium

Back 53

1. ceftriaxone IV or IM 30-50 mg/kg/day in divided doses
2. topical erythromycin ung
3. frequent lavage

Front 54

treatment for NON Gonococcal Ophthalmia Neonatorium

Back 54

DISTINGUISH FROM GONOCOCCAL INFECTION:
1. erythromycin or bacitracin ung for gram (+)
2. gentamicin or tobramycin drops for gram (-)

Front 55

treatment for Herpetic/Viral Ophthalmia Neonatorium

Back 55

1. Viroptic 1% q2h
2. taper according
3. treat 3 weeks for SIMPLEX
4. Ilotycin ung QID

Front 56

what is used as a prophylaxis against ophthalmia neonatorium

Back 56

MANDATORY
1. erythromycin 0.5% ung
2. Crede's: 1% Silver Nitrate
3. AZASITE

Front 57

what is neurotrophic keratopathy?
causes?

Back 57

loss of innervation to corneal tissue causing epithelial defects

1. S/P infection by HZV, HSV
2. Stroke
3. Tumor (acoustic neuroma)
4. CN V surgery complications
5. complications of irradiation to eye or adj structures

Front 58

treatment for neurotrophic keratopathy?

Back 58

1. mild: lubricant only
2. corneal defect: antibiotic drops, SCL, cyclo
3. if sterile ulcer gets infects, treat as infectious ulcer
4. tarsorrhaphy (suture outsides of lids together)

Front 59

treatment for UV keratopathy

Back 59

1. cyclo
2. bandage SCL and prophylactic antibiotic

*bandage SCL one eye, pressure patch the fellow eye if one eye is worse than the other
*pressure patch both eye is ideal

Front 60

what are the notable signs and symptoms of thygeson's superficial punctate keratopathy

Back 60

1. photophobia, FBS, tearing
2. PEK stain with RB
3. microerosion stains with NaFl
4. BILATERAL
5. QUIET WHITE EYE
6. NO STROMAL INVOLVEMNT

Front 61

treatment for thygeson's superficial punctate keratopathy

Back 61

1. Alrex QID
2. discontinue CL
3. antibiotics NOT NECESSARY

Front 62

what are the definitive diagnosis for syphilis?

treatment:

Back 62

1. FTA-ABS: (+) if pt has ever had syphilis
2. VDRL
3. RPR

treatment: IV or IM Penicillin with probenecid

Front 63

what is the first sign of ocular cicatricial pemphigoid?

other FOUR stages

Back 63

FIRST SIGN:
chronic, recurrent unilateral conjunctivitis

1. subepithelial fibrosis
2. fornix foreshortening
3. symblepharon
4. ankylobepharon and surface keratinization

Front 64

management of a lid lacerations

Back 64

1. betadine scrub: injury and surrounding tissue
2. irrigate the wound with sterile saline
3. topical antibiotic ung
4. cover wound
5. referral optional

Front 65

management of conjunctival abrasion and laceration

Back 65

1. lavage w/ sterile saline
2. small: vigamox TID and AT
3. large: antibiotic ung and PP

Front 66

management of corneal abrasion

Back 66

1. debride
2. cycloplege
3. <50%: vigamox TID
4. >50%: BCL and vigamox TID
*RTC: next day

Front 67

management of corneal laceration/perforation

Back 67

1. FOX SHIELD
2. PHOTODOCUMENTATION
3. REFER IMMEDIATELY

Front 68

treatment of traumatic uveitis

Back 68

1. PRED FORTE (q15min to q3h)
2. RTC: next day
3. check baseline IOP
4. ATROPINE
5. gonio check for angle recession

Front 69

management of hyphema

Back 69

1. NO ASPIRIN NOR IBU
2. bedrest, angle head at 30deg
3. FOX SHIELD
4. ATROPINE in office
5. Pred Forte QID

Front 70

two systemic conditions associated with lens subluxation

Back 70

1. marfan's syndrome
2. homocysteinureia

if dilated risk of lens dislocating into ant/post chamber

Front 71

what will an anterior lens dislocation cause?
posterior?

Back 71

1. anterior: cause acute angle closure glaucoma and endothelial damage
2. posterior: cause functional aphakia, intraocular inflammation and retinal complications

Front 72

management of lens subluxation

Back 72

1. monitor vision and lens position
2. low conc. Pilocarpine (decrease diplopia and stabilize refraction due to pinhole effect)
3. cataract surgery

Front 73

management of lens dislocation

Back 73

anterior chamber:
1. endothelial, corneal edema and opacification risk is HIGH
2. DILATE PUPIL
3. RECLINE PATIENT
4. chronic low conc. Pilocarpine

Front 74

what is the only exam where the VA's are not the first thing done

Back 74

CHEMICAL INJURIES!!

LAVAGE FIRST then VA