Ohp2 Mt1 - Packet 2

Front 1

This type of vital dye penetrates cornea thru epithelial defects and evals the integrity of the cornea

Back 1

NaFl stain

Front 2

NaFl staining can be enhanced with a ____ filter.

Back 2

Wratten #12

Front 3

You see a highly fluoresced spot compared to the surrounding area with NaFl staining - what does this indicate?

Back 3

Defect or depression in cornea

Front 4

Epithelial surfaces that are deprived of mucin protein protection will stain with this vital dye.

Back 4

Rose bengal

Front 5

Exposed epithelial cell membranes and mucous will stain with this vital dye.

Back 5

Rose bengal

Front 6

An important function of this vital dye is to assess the protective effect of the tear film

Back 6

Rose bengal

Front 7

T/F - Rose bengal is indicated for patients w/ dry eyes

Back 7

True

Front 8

Which type of vital dye is indicated for filamentary keratitis?

Back 8

Rose bengal

Front 9

On your patient's right eye, you see a grade 3 staining on zone 4 of the Van Bijstervald Grading Scale - where is this stain located?

Back 9

Superior nasal bulbar conj, near the limbus

Front 10

Which is more irritating, Rose Bengal or Lissamine Green?

Back 10

RB

Front 11

Your patient has 3+ injection and you want to assess an abrasion on the on the conj. What is the best dye to use?

Back 11

Lissamine green - best for injected eyes

Front 12

What kind of illumination do you use for Lissamine green?

Back 12

low-mod

Front 13

How long should you wait before you eval an eye w/ Lissamine green?

Back 13

1-4 min

Front 14

T/F - You can use a Wratten filter for evaluating an eye with Lissamine green

Back 14

TRUE - Wratten #25 filter

Front 15

TBUT is for evaluating which tear layer?

Back 15

mucin layer stability

Front 16

For TBUT, you must wait ___sec and let them (?) first before you eval the eyes.

Back 16

30-60 sec, let them blink several times first

Front 17

You are carefully evaluating a TBUT, making sure you don't see any black spots/lines. 15 seconds in, your patient blinks. What is your next step?

Back 17

The time the patient blinks is considered TBUT, so record as 15 sec TBUT for the first trial. Repeat for 2 more trials.

Front 18

Your patient's TBUT times average to 10. Is this normal or abnormal?

Back 18

Normal (<10 sec is abnormal)

Front 19

T/F - You can take a TBUT from a keratometer.

Back 19

True - no vital dye necessary, look for distortion of mires; >10 sec is normal

Front 20

What is considered an abnormal TBUT on a keratometer?

Back 20

<10 sec (same as NaFl TBUT)

Front 21

T/F - A female on her estrogen phase of the menstrual cycle increases TBUT.

Back 21

False - decr TBUT

Front 22

T/F - Preservatives decr TBUT

Back 22

True

Front 23

Anesthesia (incr/decr) TBUT

Back 23

decr

Front 24

T/F - Artificial tears incr TBUT

Back 24

True

Front 25

T/F - Ointments incr TBUT

Back 25

False - decr

Front 26

The TBUT of a person in Vegas should be (more/less) than a person in Florida.

Back 26

Temperature and humidity have NO effect on TBUT!

Front 27

What is the OPI?

Back 27

Ocular Protection Index (OPI = TBUT/time between blinks in sec)

Front 28

Your patient has an OPI of 2 - what does this mean?

Back 28

Ocular Protection Index (OPI = TBUT/time between blinks in sec), Patient is not at risk for ocular surface damage since OPI>1. If OPI<1 then there is a risk.

Front 29

What is the problem with OPI?

Back 29

measuring interblink time

Front 30

Schirmer I is (with/without) anesthetic and measures...

Back 30

without; measures reflex and basic secretion, and max amount of tear production

Front 31

In Schirmer I, a __cm strip is placed...

Back 31

5 cm, placed within lower cul-de-sac near outer 1/3 of lid (nearest outer canthus)

Front 32

T/F - Schirmer I involves dim illumination, and the patient can blink normally.

Back 32

True - but prob best to keep eyes closed to prevent abrasion

Front 33

How long do you keep the strip in the eye for Schirmer I?

Back 33

5 min

Front 34

Your Schirmer I test result = 10 mm. What does this mean?

Back 34

Mild-moderate KCS

Front 35

What are the interpretation ranges for Schirmer I?

Back 35

≤5 mm = abnormal, 5-10 mm = mild-moderate KCS, >10 mm = normal

Front 36

T/F - Schirmer I results are not affected by temperature and humidity.

Back 36

False - results ARE affected by temp and humidity (evaporation)

Front 37

You want to test basal tear secretion - what tests can you do?

Back 37

Jones Basal Secretion test, Short Basal Secretion test, Phenol Red test

Front 38

Jones Basal Secretion evaluates...

Back 38

basal tear secretion - evals the min amt of tear secretion

Front 39

T/F - Jones Basal Secretion involves anesthetic.

Back 39

True

Front 40

What is abnormal on the Jones Basal Secretion test?

Back 40

≤5 mm

Front 41

How long do you wait for the short Jones Basal Secretion test?

Back 41

1 min

Front 42

Short Jones Basal Secretion test results are multiplied by __ to extrapolate a __ min value.

Back 42

3x, 5 min

Front 43

You want to measure reflex secretion only. What test should you do?

Back 43

Schirmer II (tickle nasal mucosa)

Front 44

T/F - On both the Jones Basal Secretion and Schirmer II tests, you must wait 30 sec - 1 min and remove excess tears after instilling anesthetic.

Back 44

True

Front 45

How long do you tickle the nasal mucosa in Schirmer II?

Back 45

10-15 sec (!!!)

Front 46

How do you interpret Schirmer II?

Back 46

<10mm wetting after 2 min suggests impaired reflex tearing

Front 47

You just did a Schirmer II and got a 9 mm reading. Your patient, who now hates you for shoving a swab up his nose, is asking if the test result is normal or not...

Back 47

Abnormal (<10mm wetting after 2 min = impaired reflex tearing)

Front 48

Phenol red thread test measures (basal/reflex/both) tearing.

Back 48

Basal

Front 49

How do you use the phenol red thread?

Back 49

15 sec in lower lateral lid margin

Front 50

Your patient has an 8 mm phenol red thread reading. Normal or abnormal?

Back 50

Abnormal (Normal = 9-18 mm)

Front 51

What is the lactoplate test used for?

Back 51

For tear quality; meas level of lactoferrin which indicates lacrimal gland sensitivity. Lactoferrin levels highly correlated w/ tear lysozyme (anti-microbial)

Front 52

How do you use the lactoplate filter disc?

Back 52

Place in inferior fornix and allow 5 min wetting time, then place in lactoplate reagent pad. After 2-3 days meas size of precipitate ring w/ template and convert into mg/ml

Front 53

How do you interpret the lactoplate test?

Back 53

Avg lactoferrin level = 1.4 mg/ml, <0.9 mg/ml is abnormal, suggests insuff lacrimal secretory activity

Front 54

What is the touch tear microassay?

Back 54

Lactocard - lactoferrin analysis of tear film, more accurate at determining presence of aqueous deficiency; results in 10-15 mins; comparable accuracy (vs lactoplate?)

Front 55

T/F - The punctal plug, after inserted, must be flush with the lid margin.

Back 55

False - below the lid margin

Front 56

When does a punctal plug patient RTC after initial insertion?

Back 56

7-10 days (dissolves in 7-10 days)

Front 57

How long do you wait after the NaFl is instilled for the Fluorescein Dye Disappearance test?

Back 57

5 min

Front 58

T/F - On the Fluorescein Dye Disappearance test, a 4+ is maximum retention of NaFl.

Back 58

True

Front 59

What is considered abnormal on the Fluorescein Dye Disappearance test?

Back 59

4+ = maximum retention; asymmetry or prolonged presence suggest poor drainage

Front 60

T/F - You can expect a minimal retention of NaFl in the Fluorescein Dye Disappearance test with older people.

Back 60

False - tend to be more retention since older pts usually have decr function of nasolacrimal duct

Front 61

Where do you check for NaFl in the Jones I test?

Back 61

Dye under inferior tubinate in nose, obtained w/ swab

Front 62

How long do you wait for the Jones I test?

Back 62

5 min; 10 min for older pts

Front 63

NaFl is instilled in pt's eyes, then you wait for 5 mins to see if dye has reached the inferior nasal turbinate. This describes which test?

Back 63

Jones 1 (primary dye test)

Front 64

What describes a positive Jones 1?

Back 64

Dye is visible or retrieved from inferior nasal turbinate

Front 65

T/F - A positive Jones 1 means you saw dye in the inferior nasal turbinate and now you must do Jones 2.

Back 65

False - only do Jones 2 if you get a NEGATIVE result

Front 66

The puncta typically returns to its original diameter in about __ min.

Back 66

30

Front 67

A functional block means that dye (appears/doesn't appear) on Jones 1 and (appears/doesn't appear) on Jones 2.

Back 67

doesn't appear, appears

Front 68

An anatomical block means that dye (appears/doesn't appear) on Jones 1 and (appears/doesn't appear) on Jones 2.

Back 68

doesn't appear, doesn't appear

Front 69

A __ gauge cannula is inserted (vert/horz) for __mm, then tipped __ degrees below horz plane.

Back 69

23, vert, 2mm, 15

Front 70

After inserting it vertically, you can insert the cannula horizontally about __mm nasally.

Back 70

8 mm

Front 71

T/F - You can use either saline or fluorescein during lacrimal irrigation.

Back 71

True

Front 72

T/F - If you are pushing forcefully with the plunger during lacrimal irrigation and find that you cannot push the saline thru, you need to push harder to push the blockage out.

Back 72

FALSE - do not force the plunger!

Front 73

If fluid is expressed thru the opposite puncta in lacrimal irrigation, blockage is (distal/proximal) to the common canaliculus.

Back 73

Distal

Front 74

If the plunger doesn't move and no fluid is expressed in the opposite puncta in lacrimal irrigation, blockage is (distal/proximal) to the common canaliculus.

Back 74

Proximal

Front 75

If fluid is expressed in the puncta you inserted the cannula in during lacrimal irrigation, blockage is (distal/proximal) to the common canaliculus.

Back 75

Proximal

Front 76

If you get a blockage with irrigation, what procedure is indicated?

Back 76

Lacrimal probing

Front 77

T/F - Lacrimal probing does not require anesthetic

Back 77

False - it does req topical anesthesia

Front 78

What instrument is used in lacrimal probing?

Back 78

Bowman probe

Front 79

What is a 'hard stop' in lacrimal probing?

Back 79

Probe contacts the medial wall of lacrimal fossa (= normal)

Front 80

What is a 'soft stop' in lacrimal probing?

Back 80

Probe hits an obstruction or collapse the lacrimal sac against the lacrimal fossa (= abnormal)

Front 81

T/F - Taking VAs is required for a foreign body eval.

Back 81

True

Front 82

Your patient came in with a piece of tiny metal stuck thru his eye. You notice that the metal has gone thru to the stroma. What is the proper management of this patient?

Back 82

Immediate referral to ophthalmologist (refer any FB that penetrates Bowman's or deeper)

Front 83

What very important sign should you look for in the anterior chamber in a foreign body eval? Why?

Back 83

Cells and flare, indicating secondary uveitis; use conic section or small parallelpiped w/ hi mag

Front 84

During your patient's foreign body eval, you see a dark stream fluorescein coming out of the area of the FB. What is this called and what does it mean?

Back 84

Seidel's sign = corneal perf

Front 85

T/F - You may use a sterile swab to remove corneal foreign bodies.

Back 85

False - not recommended for cornea, but can be used for certain conj FBs

Front 86

T/F - You can use a hypodermic needle to remove foreign bodies.

Back 86

True

Front 87

Use ___ with ___ to disinfect foreign body spuds; can also do ___ or ___.

Back 87

Zephirin chloride, anti-rust tabs; flaming, autoclaving

Front 88

Your patient recently had a foreign body removed, and you see a white ring in the area where the FB was originally. What is this?

Back 88

Coat's ring - iron toxicity to tissue (due to residual iron)

Front 89

What is indicated to prevent secondary uveitis after removing a FB?

Back 89

cycloplegic agent - 5% homatropine (2% in milder cases)

Front 90

What is important to DDx vs secondary uveitis due to foreign body?

Back 90

Angle closure glaucoma - Sx similar (pain, red eye, blurred vision, etc)

Front 91

Tylenol #3 is composed of (?) and the dose for post FB removal is...

Back 91

300mg acetaminophen, 30 mg codeine; 1-2 tab q4h

Front 92

What is the dosing of Ultram for post FB removal? What is the max dose?

Back 92

50-100 mg q 4-6 hrs; 400 mg/day max

Front 93

What is the dosing of Vicodin for post-FB removal?

Back 93

1-2 tabs PO qid

Front 94

What is the dose of extra-strength Tylenol for post-FB removal? Max dose?

Back 94

500 mg qid; 4000 mg/day max

Front 95

What is the dosing of Advil or Motrin for post-FB removal? Max dose?

Back 95

400 mg qid; max 3200 mg/day

Front 96

When Rxing NSAIDs, watch out for people with what kind of systemic probs (as mentioned in slide)?

Back 96

Kidney dz, alcohol, risk of hemorrhaging, GI dz

Front 97

For small FB injuries, what kind of antibiotic is indicated? What is the dose?

Back 97

Broad-spectrum antibiotic SOLUTION e.g. gentamycin 1-2 gtt q 4hrs

Front 98

For large FB injuries, what kind of antibiotic is indicated? What is the dose? What else do you need to do?

Back 98

Antibiotic OINTMENT such as polysporin, gentamycin, tobramycin (1/2 in in cul-de-sac); must pressure patch 24hrs

Front 99

T/F - It is best to fit a loose contact lens for bandage CL to allow best tear exchange.

Back 99

False - tight fitting CL best

Front 100

T/F - You can use a bandage CL for continuous AB drop therapy.

Back 100

True - broad spectrum AB drops QID

Front 101

What are collagen shields used for?

Back 101

An alternative to pressure patching; 12, 24, 72 hr dissolvable collagen lenses, soak in AB soln and use w/ gtts

Front 102

How soon should your pressure patch pt RTC?

Back 102

24 hours, no exception

Front 103

What is done right after the pressure patch is removed?

Back 103

Rinse the eye and take VAs

Front 104

Your pressure patch patient returns as directed; under slit lamp you still see staining with NaFl. What is the proper management of this patient?

Back 104

Re-patch and RTC in 24 hrs again; keep returning every 1-2 days until stain disappears (typically heals in 24-48 hrs)

Front 105

Double eversion reveals...

Back 105

conj between the edge of the tarsal plate and the superior fornix

Front 106

Single eversion reveals...

Back 106

superior palpebral conj between superior edge of tarsal plate and lid margin

Front 107

T/F - Hypertonic saline drops are indicated for corneal abrasions

Back 107

False - NOT indicated

Front 108

T/F - If your patient had an abrasion due to a CL, it is ok to patch.

Back 108

False - CL related abrasions should not be patched

Front 109

T/F - You should not patch fingernail or tree branch corneal abrasions.

Back 109

True

Front 110

If you see irritation under the taped areas of the pressure patch, you should treat it with...

Back 110

hydrocortisone cream

Front 111

You remove your patient's pressure patch and notice no staining, but you do see striae in Descemet's membrane. What is the proper management of this finding?

Back 111

No Tx required - typically resolve 48-72 hrs.