Ocular Disease Final

Front 1

which condition has large follicles, inferior>superior?; what is it caused by?

Back 1

adult inclusion conjunctivitis; chlamydia (papillae will also be present)

Front 2

what should you suspect of chronic red eyes non-responsive to traditional therapy?

Back 2

chlamydia infection (adult inclusion)

Front 3

what's the tx for adult inclusion conjunctivitis and trachoma?

Back 3

Azithromycin (Zithromax) 1g (1 dose) OR Doxycycline 100 mg BID for the 1st day and 100mg QD x 21 days

Front 4

In trachoma, what are: scarring of necrotic follicles at the limbus? superior tarsus conjunctival scarring causing entropion and trichiasis?

Back 4

Herbert's pits; Arlt's line

Front 5

if neonatal conjunctivitis is caused by herpes, how will you know?

Back 5

it may be preceeded by lid vesicles

Front 6

what is used for prophylaxis against ophthalmia neonatorium?

Back 6

erythromycin 0.5% ointment (effective against chlamydia and gonococcus)

Front 7

what is the tx for neonatal conjuncitivis caused by chlamydia?

Back 7

Oral erythromycin 50mg/kg/day divided into 4 doses for 10-14 days; topical erythromycin can be added; a second course of tx is often needed

Front 8

what is the tx for neonatal conjunctivitis caused by gonorrhea?

Back 8

ceftriaxone IV or IM, 30-50mg/hg/day in divided doses with topical erythromycin ung with frequent lavage

Front 9

what is the tx for neonatal conjunctivitis caused by non-gonococcal/non-chlamydial?

Back 9

gram + and gram - coverage: erythromycin and bacitracin ung for gram + ; tobramycin and gentamycin drops for gram -

Front 10

what is the tx for neonatal conjunctivitis caused by herpes?

Back 10

same as adult...Viroptic q2h and taper according to response and treat for 3 weeks for herpes simplex only

Front 11

what is tx for toxic follicular conjunctivitis?

Back 11

1. supportive tx (ATs)
2. remove offending antigen (cat hair, smoke, perfume, medication...)
3. Encourage better hygiene (ex: heavy makeup users)

Front 12

will you see +PAN in toxic follicular conjunctivitis?

Back 12

NO (not viral and not bad enough to cause PAN)

Front 13

what condition is a result of goblet cell density disproportion between bulbar and palpebral surfaces?

Back 13

superior limbic keratoconjunctivitis

Front 14

what is the systemic condition that superior limbic keratoconjunctivitis is associated with?

Back 14

reduced thyroid dysfunction

Front 15

what condition would you see staining with Rose Bengal and NaFL from 10-2 o'clock in the conjunctiva and limbus area?

Back 15

superior limbic keratoconjunctivitis

Front 16

what is the tx for superior limbic keratoconjunctivitis (non-recurrent)?

Back 16

1. ATs
2. Steroids (usually not in combo form since cornea is minimally effected)
3. Check thyroid function

Front 17

what is the tx for superior limbic keratoconjunctivitis (recurrent)?

Back 17

Refer for one of these:
1. Silver nitrate 0.5% (dessicates bad conj. so good conj. can grow back....needs prophylactic Ab)
2. Bandage SCL
3. Thermal cautery
4. Conjuntival flap sx

Front 18

what is seen as a long-term consequence of untreated staph bleph? if staph bleph isn't around, what would you suspect this is from?

Back 18

phlyctenule (inflamm. nodule); tuberculosis

Front 19

what is tx for a phlyctenule?

Back 19

1. Treat staph bleph if it's around (lid hygiene, combo if mild staining is involved)
2. order PPD and/or chest x-ray if TB is suspected
3. If it's from TB: anti-TB meds and steroids

Front 20

what are 5 things that can cause neurotrophic keratopathy?

Back 20

1. s/p infxn (HSV and HZV)
2. stroke
3. surgery (CN V involved)
4. radiation
5. tumor (acoustic neuroma)

Front 21

what is the tx for neurotrophic keratopathy?

Back 21

1. Protect the cornea (ATs, Ab prophylactically)= mild
2. May need tarsorrhaphy
3. If corneal defect is present, tx as corneal abrasion: Ab ung, cycloplege, pressure patch OR Ab drops, BSCL, cycloplege PLUS pain meds PRN
4. If corneal ulcer develops, tx like a corneal ulcer!

Front 22

UV keratopathy is also associated with what term? what are the clinical findings?

Back 22

droplet keratopathy (yellow oily deposit in subepithelial cornea and conj.); copius, confluent, profound PEK in interpalpebral area (+A/C rxn, conj. injection, eyelid edema, miotic pupils)

Front 23

how do you tx UV keratopathy?

Back 23

tx as corneal abrasion:
1. Protect cornea (ATs, Ab prophylactically)
2. cycloplege (if significant)
3. BSCL or PP if significant....(drops BSCL and ung PP)

Front 24

what is this: multiple stellate-shaped infiltrates (very tiny and appearing like larger infiltrates) that stain with Rose Bengal and NaFL? does this condition have a red, chemotic conj. or a white, quiet eye?

Back 24

Thygeson's SPK; quiet, white eye

Front 25

what is the tx for thygeson's spk?

Back 25

1. Weak topical steroid ex: Alrex QID for 3-4 days and then quickly tapered

Front 26

what is tx for interstitial keratitis?

Back 26

Herpetic:
1. Steroids PLUS Viroptic in same dosing schedule as steroid OR Zirgan (ex: QID Steroid and TID Zirgan)

If pt had no history of eye infxn (non-herpetic):
1. Send pt for TB/Syphilis testing
2. Keratoplasty if vision impaired
3. Steroids needed for 1-2 years in active IK
4. Cycloplege acute flare-ups
5. IDENTIFY AND TX SYSTEMIC INFXN

Front 27

what is this: there are 4 stages: subepithelial fibrosis, fornix shortening, symblepharon, and ankyloblepharon with surface keratinization?

Back 27

ocular cicatricial pemphigoid ( an autoimmune disorder)

Front 28

what is the tx for ocular cicatricial pemphigoid?

Back 28

1. refer for possible surgical management
2. Dry eye: ATs
3. Topical Vit. A ung (if it helps)
4. Chronic bleph: lid hygiene, oral doxycycline, topical Ab
5. Oral steroids (Prednisone 1mg/kg/day, eventually tapered over a 8-16 wk period)
6. Topical steroids
7. Chemotherapy (when steroids don't work...usually oral steroids are good enough) (ex: Cyclophosphamide, Dapsone) (these pts would be referred for close monitoring)

Front 29

a mucosal inflammation in response to either drug administration or a systemic disease process (Erythema multiforme) is what?

Back 29

Stevens-Johnson syndrome (a hypersensitivity rxn)

Front 30

what is tx for Stevens-Johnson?

Back 30

Tx aggressively with topical steroids and oral steroids...pt may need Sx referral

Front 31

hyperemia of lid margins, FBS, burning, and recurrent chalazia are symptoms/signs of what condition? (hint: it's a general increase in lipid secretion)

Back 31

ocular rosacea

Front 32

what is the tx for ocular rosacea?

Back 32

1. oral doxycycline 100 mg BID for the 1st day, then 50-100 mg QD x 21 days OR tetracycline 250 mg QID OR retinoic acid

Front 33

what is a differential diagnosis of psoriasis?

Back 33

phlyctenulosis

Front 34

what's the tx for psoriasis?

Back 34

1. Supportive
2. Systemic tx for psoriasis

Front 35

what are the 4 connective tissue diseases that can manifest as conjuntivitis in the eye? How are the ocular findings treated? How are the systemic findings treated?

Back 35

Systemic lupus erythematosis, Polyarteritis nodosa, Relapsing polychondrtitis, Reiter's syndrome
Supportive (topical steroids may be needed)
Steroids (these are thought to have an autoimmune etiology)....
NOTE: Oral tetracycline is used in Reiter's syndrome. In SLE, aspirin, chloroquine and steroids are used systemically

Front 36

what does sensitivity testing help us determine?

Back 36

which anti-infective agent will be effective in tx

Front 37

T or F: bacterial cultures (gram) take longer to get results than fungal

Back 37

F (fungal 1-2 wks; bacterial can be same day)

Front 38

cytology is normally done to analyze what? PMNs are indicative of what? Lymphocytes are indicative of what? Eosinophils/basophils are indicative of what?

Back 38

the patient's cellular response to the infection of inflammation (NOT an analysis of the organism responsible for the condition); bacterial infxn; viral infxn; allergix rxn

Front 39

what is syphilis caused by?

Back 39

Treponema pallidum

Front 40

In acquired syphilis, what occurs in the primary stage? If these people don't get tx, the second stage shows a general rash WHERE? If still no tx, the third stage can show cardiac, systemic, dermatologic and neurological problems. What are the ocular manifestations of the neurologic symptoms?

Back 40

genital chancre lasting 1-2 months; especially on the palms and soles; pupil involvement, ONH involvement, uveitis, retinal vasculitis

Front 41

Congenital syphilis shows findings similar to acquired plus what??

Back 41

Hutchinson's triad: pegged/notched teeth, deafness, and Interstitial Keratitis

Front 42

What is the most important blood test for syphilis?

Back 42

FTA-abs (will test for any history of syphilis except during first 3-4 weeks)

Front 43

What is the tx for syphilis?

Back 43

IV or IM penicillin with probenecid

Front 44

What is this: post-traumatic, post-inflammatory, or age-related changes (making the tissue less functional) that are often accompanied by other ocular or systemic diseases

Back 44

Degenerations

Front 45

what is an iron deposition in the cornea called? where is the iron most likely from? is it horizontally or vertically oriented? where is it located in the cornea?

Back 45

Hudson-Stahli line; the tear film; horizontally; deep epithelium

Front 46

what is the tx for Hudson-Stahli line?

Back 46

nothing ;)

Front 47

what is Coat's White Ring associated with? What is an important differential diagnosis?

Back 47

previous corneal metallic foreign bodies; ring infiltrate=interstitial keratitis (from TB, Herpes...)

Front 48

White limbal Girdle of Vogt is directly associated with what? Since it's worse at 3 and 9 o'clock, what must it be distinguished from? In what direction do the fine white lines run?

Back 48

age; calcific band keratopathy; radially (appears like corneal arcus, so needs high mag.!)

Front 49

what is corneal arcus associated with if seen in patients less than 30-40 years old? what is it?

Back 49

hyperlipidemia; cholesterol deposition

Front 50

where is corneal arcus in relation to the limbus? where does it initially occur? what's important regarding the borders?

Back 50

it's separated from the limbus by a clear interval 0.2 to 0.3 mm wide; inferiorly; it has a sharp peripheral border and diffuse inner border

Front 51

what is the tx for corneal arcus?

Back 51

pt MUST be referred for lipid profile testing if under 30-40

Front 52

calcific band keratopathy is a degenerative result of several inflammatory and degenerative conditions such as what 4 things in the notes?

Back 52

1. chronic uveitis
2. chronic glaucoma
3. corneal edema
4. elevated serum calcium

Front 53

what layer of the cornea does calcific band keratopathy occur? what gives it the "swiss cheese" look? why does it appear in the interpalpebral zone?

Back 53

bowman's; the nerves piercing thru bowman's; that's where the tear film evaporates (this is possibly why)

Front 54

what is tx of calcific band keratopathy?

Back 54

1. None unless vision decreased
2. Chelation with EDTA (remove epithelium, apply EDTA in drops, let heal) OR
3. Can manually scrape deposits
4. Severe: PTK

Front 55

what are elevated blue to gray fibrous lumps in the superficial stroma just beneath epithelium (lumps are made of collagen)? what is the cause?

Back 55

Salzmann's nodular degeneration; from inflammation many years earlier (most commonly assoc. with phlyctenular kerato-conjunctivitis)

Front 56

what is the tx for Salzmann's nodular degeneration?

Back 56

1. None
2. Lumps can be removed if not heavily vascularized
3. PTK/Lamellar KP

Front 57

what causes lipid keratopathy?

Back 57

previous blood vessel ingrowth to the cornea (response to trauma, IK, ulceration...) which causes lipid deposition from leakage of blood vessels

Front 58

lipid keratopathy and corneal arcus appear similarly, but what is the main difference?

Back 58

corneal arcus=circumferential whereas lipid k=one area of cornea

Front 59

visibility of the mosaic of the corneal structure refers to what? what two layers can it occur in?

Back 59

anterior (bowmans) and posterior (descements) crocodile shagreen of vogt

Front 60

what is bilateral but asymmetrical thinning of peripheral cornea? what may form as a result since the area involved is flattened?

Back 60

Terrien's Marginal Degeneration; against the rule astigmatism

Front 61

what's the tx for Terrien's Marginal Degeneration?

Back 61

1. Peripherl LK in extreme thinning cases
2. Must be distinguished from Mooren's ulcer (peripheral corneal thinning disorder but is INFLAMMATORY in origin and involoves epithelial disruption whereas Terrien's epithelium is intact---must be treated with steroids and Abs)
3. Can put ill-fitting CL to induce neovasc. and pannus to strengthen thin tissue

Front 62

What 4 things define an Iridocorneal Endothelial Syndrome (ICE syndrome)? What is the fundamental defect in an ICE syndrome?

Back 62

1. unilateral
2. corneal edema
3. progressive iris deformity
4. glaucoma
corneal endothelial abnormality

Front 63

what are the three ICE syndromes we learned about?

Back 63

Chandler's syndrome; Progressive Iris Atrophy; Cogan-Reese

Front 64

Which ICE syndrome: involves the cornea more than the iris?Shows extensive atrophy and hole formation in the iris? Has "raised nevi" on the iris? Has the smallest chance of glaucoma? Has moderate-severe corneal edema? Has the most chance of glaucoma?

Back 64

Chandler's; Progressive iris atrophy; Cogan-reese; Chandler's; Chandler's; Cogan-reese

Front 65

systemic metabolic diseases typically cause corneal ____ and subsequent decrease in VA.

Back 65

clouding

Front 66

Megalocornea is transmitted how? What does it have a systemic association with? What refractive errors do these patients usually have?

Back 66

x-linked recessive (more common in males); Marfan's syndrome; myopia and astigmatism

Front 67

how big does the cornea have to be to be diagnosed as megalocornea? what is the differential diagnosis?

Back 67

13mm or greater; congenital glaucoma (but megalocornea has a sharply delineated limbal region with normal IOP and congenital glaucoma has breaks/striae in the cornea)

Front 68

T or F: in microcornea, bilateral cases=unilateral cases

Back 68

T

Front 69

how small does the cornea have to be to diagnose microcornea? what is the pt more susceptible to in later years?

Back 69

less than 10 mm; angle closure glaucoma (lens gets bigger)

Front 70

in keratoconus, what will the mires look like when doing keratometry? what about retinoscopy?

Back 70

egg-shaped (non-alignment of the mires); scissoring

Front 71

In keratoconus, what is: ferritin (iron) deposition around the base of the cone?

Back 71

Fleischer's ring

Front 72

In keratoconus, what are fine vertical folds in the stroma and descemet's membrane? Do they disappear with digital pressure?

Back 72

Vogt's striae; yes they do (but the breaks in bowman's membrane don't)

Front 73

What is Munson's sign?

Back 73

a V-shaped configuration of the lower lid in downgaze from the cone in keratoconus

Front 74

What is Rizzuti's sign?

Back 74

sharply focused beam of light near the nasal limbus produces lateral illumination of the cornea

Front 75

What is the condition in keratoconus where breaks in descemet's membrane cause acute stromal swelling, bullae, photophobia and pain? (and leaves a scar)

Back 75

Hydrops

Front 76

what are the tx options for keratoconus?

Back 76

1. Rigid contact lenses (or piggyback lenses)
2. PKP
3. Corneal collagen crosslinking (using riboflavin and UV-A light)

Front 77

what is the tx for acute hydrops?

Back 77

1. narcotics (pain relief)
2. cycloplegic
3. prophylactic Ab
4. BSCL (optional)

Front 78

what did the CLEK study tell us?

Back 78

pts with keratoconus will continue to get steeper corneas; 1/5 of pts developed corneal scarring

Front 79

what condition shows corneal ectasia inferiorly above an area of stromal thinning around 4-9 o'clock?

Back 79

pellucid marginal degeneration

Front 80

T or F: hydrops can only occur with keratoconus

Back 80

F...can occur with pellucid and keratoglobus

Front 81

what is contraindicated tx in keratoglobus and why?

Back 81

RGPs b/c of risk of perforation with even minor trauma (epikeratophakia sx usually best prognosis)

Front 82

what condition is often assoc. with angle closure glaucoma and is referred to as cornea plana if the cornea is extremely flat?

Back 82

Sclerocornea

Front 83

in posterior embryotoxon, which structure is hypertrophied and anteriorly displaced?

Back 83

Schwalbe's line

Front 84

T or F: axenfeld-rieger syndrome is always unilateral

Back 84

F

Front 85

axenfeld-rieger syndrome has what characteristics?

Back 85

(used to be discussed as separate diseases, so I assume there can be a mixture of these instead of all 4)
1. posterior embryotoxon to which peripheral iris strands adhere to
2. glaucoma
3. hypoplasia of iris stroma
4. developmental defects of teeth and bones

Front 86

what condition is this: Leukoma in the central or paracentral cornea bordered by 1 or more iris strands coming from the iris collarette, along with endothelium and descemet's membrane absent in the area of opacity

Back 86

peter's anomaly (lens may/may not be attached to cornea) (thought to occur from anterior hyaloid plexus coming in contact with the cornea in the 3rd month of development)

Front 87

what is this: a dystrophy defined by microscopic (corneal) epithelial cysts that can rupture and cause RCE

Back 87

Meesman's Dystrophy or Juvenile Hereditary Epithelial Dystrophy

Front 88

what is the tx for Meesman's dystrophy?

Back 88

1. Supportive tx only during symptomatic phase (cysts rupture)
2. BSCL may offer some relief (symptomatic phase)
3. Superficial keratectomy is symptoms severe

Front 89

what is this: pt comes in with Hx of "I went to sleep fine and woke up in severe pain"....upon inspection of cornea you see negative staining over an elevated area with "dots" next to the area as well as curvilinear parallel lines surrounding the elevated area

Back 89

Epithelial Basement Membrane Dyrstrophy or Map-Dot-Fingerprint dystrophy....this pt woke up with RCE ("cells don't suck onto BM as well as normal cornea")

Front 90

what is the tx for Map-Dot-Fingerprint dystrophy?

Back 90

None unless erosion occurs (you would tx like RCE)

Front 91

what is the tx for: 1. mild RCE 2. moderate RCE 3. severe RCE

Back 91

1. prophylactic Ab drops (Azasite=good) with ATs, possible topical/oral NSAID, possible mild cycloplegic
2. prophylactic Ab drops with BSCL, possible topical/oral NSAID, cycloplegic (after BSCL is taken off we can use Azasite to add anti-mmp activity)
3. Ab ung, cycloplege, PP (first couple of days?)....then oral doxycycline 50 mg BID for 1st 2 weeks and 50 mg QD for 2 more weeks with topical steroid drops QID for 2 weeks and BID for 2 more weeks
(debridement can be added to all stages if there are ragged edges)
(NaCl 5% drops can be used during healing to help adhere epithelium and BM)
(Corneal transplants= last resort)
(ATs are important to keep eye hydrated so epithelium has less ability to rip off)

Front 92

how is EBMD and reis-buckler's dystrophy differentiated?

Back 92

reis-buckler's=astigmatism changes and EBMD doesn't have these changes

Front 93

what is this: fine reticular opacities at bowman's membrane...astigmatism changes and reduced VA occur

Back 93

reis-buckler's dystrophy

Front 94

what is the tx for reis-buckler's dystrophy?

Back 94

1. Standard management for RCE when and If it occurs
2. Corneal transplant if VA severely affected

Front 95

T or F: anterior mosaic dystrophy rarely affects VA

Back 95

T

Front 96

out of the 5 corneal stroma dystrophies, which has autosomal recessive inhereitance (compared to autosomal dominant)?

Back 96

macular dystrophy

Front 97

what is this corneal stroma dystrophy: 1. refractile lines and dots early--clear limbus? 2. indistinct margins, hazy stroma between lesions, extends to limbus? 3. discrete, sharp borders--doesn't extend to limbus

Back 97

1. Lattice dystrophy
2. Macular dystrophy
3. Granular dystrophy

Front 98

what is this: yellow-white opacity made up of cholesterol crystals in the corneal stroma associated with corneal arcus?

Back 98

Central crystallin dystrophy (of Schnyder)

Front 99

what is the tx for Central crystallin dystrophy (of Schnyder)?

Back 99

1. work up pts for hyperlipidemia, hypercholesterolemia
2. corneal transplant=rare and crystals usually grow back anyway

Front 100

what is this: posterior crocodile shagreen with FHx of multiple family members with same condition?

Back 100

Central Cloudy Dystrophy (similar to anterior mosaic pattern)

Front 101

what is this: isolated or coalescent posterior corneal vesicles usually without corneal edema; can be described as "lines with balls"; sometimes see iridocorneal adhesions

Back 101

Posterior Polymorphous Dystrophy

Front 102

what is necessary for the Dx of Fuch's Dystrophy?

Back 102

1. guttata
2. epithelial/stromal edema(these are also the first two stages...the third stage is subepithelial scarring from cronic corneal edema)

Front 103

what's the tx of fuch's dystrophy (and bullous keratopathy)?

Back 103

1. NaCl 5% drops or ung given qhs and in a.m. (later in dz process, may need to be taken throughout day)
2. Hair dryer held at arm's length to dry out corneal surface
3. topical beta blockers (reduce imbibition pressure)
4. Ultimate tx: PKP
5.For bullous keratopathy: BSCL can provide symptomatic benefit during acute phase of rupturing

Front 104

what are the three mandatory treatments for anterior uveitis?

Back 104

1. address any underlying and/or accompanying infections (refer, co-manage, etc. if needed)
2. cycloplege (Atropine 1%=preferred)
3. steroids (Pred acetate 1%= most effective)

Front 105

whats the most common etiology of uveitis?

Back 105

idiopathic (in another place in notes I wrote "trauma" though...)

Front 106

what's the second most common etiology of anterior uveitis?

Back 106

HLA-B27 related disease (rheumatologic dz=pain from joints, soft tissue around joints, conn. tissue as well as autoimmune dz, arthritis and osteoporosis)

Front 107

what tests need to be ordered for: 1. ankylosing spondylitis
2. reiter syndrome

Back 107

1. x-ray (for abnormal sacroiliac joint), ESR (elevated), HLA-B27 (positive) (genetic testing?)
2. ESR (elevated), HLA-B27 (positive)

Front 108

T or F: toxoplasmosis causes an acute, nongranulomatous anterior uveitis

Back 108

T

Front 109

what testing could you order to determine/rule out juvenile rheumatoid arthritis?

Back 109

ANA (positive), rheumatoid factor (negative), ESR (elevated)

Front 110

what are the two conditions we have to know for chronic, nongranulamatous anterior uveitis?

Back 110

juvenile rheumatoid arthritis and fuch's heterochromic iridocyclitis

Front 111

what are the four conditions that we need to know for chronic, granulomatous anterior uveitis?

Back 111

sarcoidosis, syphilis, tuberculosis, systemic lupus erythematosis

Front 112

what testing needs to be done for:
1. sarcoidosis?
2. syphilis?
3. TB?
4. SLE?

Back 112

1. CXR (hilar lymphadenopathy), ACE (elevated)
2. FTA-Abs with VDRL
3. CXR and PPD (positive)
4. ANA (positive)

Front 113

T or F: HIV can cause an A/C rxn

Back 113

T

Front 114

whats the most common primary intraocular tumor?

Back 114

malignant melanoma (use ultrasound/OCT)