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762 Cards in this Set

  • Front
  • Back
concomitant strabismus
The size of the deviation does not vary by more than a few prism diopters with direction of gaze or fixating eye.
Stupid TORCHES mneumonic
TOxoplasmosis
Rubella
Cytomegalovirus
Herpesviruses, including
Epstein-barr
Syphilis
papillae vs. follicles
papillae:
allergy
bacterial (except chlamydia in adults)
follicles:
+preauricular lymph node:
HSV
adenovirus
chlamydia
-pre auricular lymph node:
molluscum
toxic
+preauricular and submandibular nodes = parinaud oculoglandular syndome:
B hensslae (most common)
mycobacteria
tuleremia
ysersinia pseudotuberculosis
T pallidum
Chlamydia trachomatis
Horner-Trantas dot
grey, jelly-like limbal conj nodule filled iwth eosinophils and epithelioid cells seen in vernal keratoconjunctivitis
shield ulcer
superior confluent epithelial defect seeen in VKC
vernal keratoconjunctivitis
mas cell/lymphocyte-mediate seasonal allergic response
time of onset after birth for chemical conjunctivitis
24 hours
time of onset after birth for gonococcal conjunctivitisi
within first 3-4 days
time of onset after birth for chlamidial conjunctivitis
7 days (earlier if prolonged rupture of membranes)
time of onset after birth for HSV conjunctivitis
2 weeks
what is the timing of emmetropization?
1. the eye starts out hyperopic
2. hyperopia increases until age 7
3. myopic shift towards plano until eye reaches final dimensions (usually by age 16)
MALE pneumonic for A and V pattern strabismus
Medial to Apex, Lateral to Empty space (i.e. medial recti displaced down and laterals up in V pattern strabismus, medials displaced up and laterals down in A pattern strabismus).
typical iris coloboma
located in inferonasal quadrant and may involve ciliary body, choroid, retina and/or optic nerve. caused by failure of the embryonic fissure to to close in fifth week of gestation
atypical iris coloboma
areas other than the inferonasal quadrant and not usually associated with more posterior uveal colobomas. probably result from fibrovascular remnants of the anterior hyaloid system and pupillary membrane
which extraocular muscle is typically involved in high myopes who have symptomatic strabismus
lateral rectus; high myopia can result in stretching and slippage of the lateral rectus, resulting in esotropia
What are the contents of the superior orbital fissure?
Superior to the annulus of Zinn (stupid mnemonic: LFTS)
lacrimal nerve (branch of V1)
frontal nerve (branch of V1)
trochlear nerve (IV)
superior ophthalmic vein
Through the annulus of Zinn
superior division of CN III
inferior division of CN III
sympathetic roots of ciliary ganglion
abducens nerve (CN VI)
optic nerve
ophthalmic artery
Inferior to the annulus of Zinn
inferior ophthalmic vein (occasionally)
What passes through the annulus of Zinn
superior division of CN III
inferior division of CN III
sympathetic roots of ciliary ganglion
abducens nerve (CN VI)
optic nerve
ophthalmic artery
what are the contents of the inferior orbital fissure?
infraorbital branch of CN V2
zygomatic branch of CN V2
an orbital nerve from the pterygopalatine ganglion
inferior ophthalmic vein
dorsal midbrain syndrome synonyms
prectal syndrome
Parinaud syndrome
clinical features of dorsal midbrain syndrome
convergence retraction nystagmus
mid-dilated pupils with light-near dissociation
retraction of the lids in primary position (Collier sign)
skew deviation
disruption of convergence (convergence spasm or convergence palsy)
increase square-wave jerks
common etiologies of dorsal midbrain syndrome
pineal tumors
hydrocephalus
MS
stroke
what are the phakomatoses
4 Traditional phakomatoses
Neurofibromatosis (von Recklinghausen disease)
tuberous sclerosis (Bourneville disease)
angiomatosis of the retina and cerebellum (von Hippel-Lindau disease)
encephalofacial or encephalogtrigeminal angiomatosis (Sturge-Weber syndrome)
Other conditions sometimes classified as phakomatoses
ataxia-telangectasia (Louis-Bar syndrome)
incontinentia pigmenti (Bloch-Sulzberger syndrome)
racemose angioma (Wyburn-Mason syndrome)
diagnostic criteria for NF1
(2 or more of the following)
1. 6 or more cafe-au-lair spots > 5mm in diameter in prebuscents OR >15mm in postpubescents
2. 2 or more neurofibromas of any type OR 1 plexiform neurofibroma
3. freckling of the axillary, inguinal or other intertriginous areas
4. optic nerve glioma
5. 2 or more iris Lisch nodules
6. a distinctive osseous lesion, such as sphenoid bone dysplasia or thinning of the long-bone cortex
7. a first-degree relative with NF1
what are the waves of neural crest migration to form the AC
First wave: corneal endothelium
Second wave: iris and part of the pupillary membrane
Third wave: keratocytes
what are the layers of the retina?
what are the layers of the retina?
internal limiting membrane
nerve fiber layer
ganglion cell layer
inner plexiform layer
inner nuclear layer
outer plexiform layer
outer nuclear layer
external limiting membrane
rod and cone inner and outer segments
RPE and basil lamina
what are the components of the layers of the retina?
internal limiting membrane = footplates of Muller cells
nerve fiber layer = axons of ganglion cells
ganglion cell layer = cell bodies of ganglion cells
inner plexiform layer = axons of bipolar and amacrine cells; dendrites of ganglion cells and their synapses
inner nuclear layer = nuclei of bipolar, Muller, horizontal and amacrine cells
outer plexiform layer = connections between photoreceptor synaptic bodies and horizonal and bipolar cells
outer nuclear layer = nuclei of photoreceptors
external limiting membrane = attachment sites of adjacent photoreceptors and Muller cells
rod and cone inner and outer segments = self descriptive
RPE and basil lamina = self descriptive
what is the watershed layer of the retina
inner nuclear layer and out is supplied by choriocapilaris; inner plexiform layer and inward is supplied by central retinal artery
what are the diagnostic criteria for NF2
Bilateral acoustic neuromas
OR
A first degree relative with NF2 and one of the following:
unilateral acoustic neuroma
neurofibroma
meningioma
schwannoma
glioma
early-onset posterior subcapsular cataract
What are the types of Duane's Syndrome?
All forms have anomalous co-contraction of the medial and lateral rectus muscles producing retraction of the globe in actual or attempted adduction.

Type 1: poor abduction, frequently with primary position esotropia
Type 2: poor adduction and exotropia
Type 3: poor abduction and adduction with esotropia, exotropia or no primary position deviation
What are Brushfield spots?
hypopigmented spots on the iris associated with down's syndrome.
hypopigmented spots on the iris associated with down's syndrome.
order the cylcoplegics/mydriatics from shortest acting to longest
phenylephrine: 3-5 hours
tropicamide: 4-6 hours
cyclopentolate: 2 days
homatropine: 3 days
scopolamine: 4-7 days
atropine: 7-14 days
what is brown syndrome?
Deficient elevation in adduction that improves in abduction (but often not completely).
Diagnosis
positive forced duction test demonstrating restricted passive elevation in adduction
what features differentiate brown syndrome from inferior oblique paralysis
positive forced duction test demonstrating restricted passive elevation in adduction
divergence in straight-ahead elevation (V pattern)
Gerstmann syndrome
lesion of the dominant parietal lobe causing aculculia, agraphia, finger agnosia and left-right confusion
Anton Syndrome
denial of blindness
Riddoch phenomenon
patients perceive moving targets but not static ones.
Balint Syndrome
Rare phenomenon resulting from bilateral occipotopiarietal lesions:
simultanagnosia
optic ataxia
ocular motor apraxia
Lateral Medullary (aka Wallenberg) syndrome
Damage to lateral region of brainstem
Signs
ipsilateral loss of facial pain and temperature sensation (descending tract of CN V)
contralateral loss of homebody pain and temperature sensation (lateral spinothalamic tract)
ipsilateral cerebellar ataxia (spinocerebellar tract)
ipsilateral first order Horner syndrome
ocular tilt reaction (sometimes)
Dorsal Midbrain Syndrome (aka prectecal or Parinaud syndrome)
Gradenigo syndrome
chronic inflammation of the petrous bone causing an ipsilateral abducens palsy and facial pain, especially in children who have experienced recurrent infections of the middle ear
dorello canal
opening in the cavernous sinus below the petroclinoid ligament where the sixth enters. Site of injury due to shearing or elevated ICP.
Heimann-Beilschowsky phenomenon
monocular nystagmus in an eye with longstanding poor vision
Alexander's law
nystagmus is more pronounced when gaze is directed toward the side of the fast-beating component.
Melkersson-Rosenthal syndrome
recurrent unilateral or bilateral facial paralysis accompanied by chronic facial swelling (usually bilateral even when facial paralysis is unilateral) and lingua plicata (furrowing of the tongue).

Etiology unknown.

Begins in childhood or adolescence.
Kearns-Sayre syndrome
inherited mitochondrial myopathy
includes:
CPEO
pigmentary retinopathy
cardiac conduction abnormalities
variably includes:
cerebellar ataxia
deafness
elevated CSF protein levels
Louis-Bar syndrome
ataxia-telangectasia
Terson syndrome
combination of vitrous and subarachnoid hemorrhage
Heidenhain variant of CJD
patients present primarily with isolated visual symptoms
Interstitial nucleus of Cajal
inhibitory burst neurons for vertical saccades
neural integrator for vertical and torsional gaze
nucleus prepositus hypoglossi
neural integrator for horizontal gaze
nucleus raphe interpositus
omnipause cells
omnipause cells
cells of the nucleus raphe interpositus that normallyh inhibit bursts from the paramedian pontine reticular formation. Saccades are thought to be initiated by supranuclear inhibition of the omnipause cells, which allows burst cell impulses to activate the horizontal and vertical gaze centers.
rostral interstitial nucleus of the medial longitudinal fasciculus
excitatory burst neurons that generate vertical and torsional saccades
region of the rostral interstitial nucleus of the medial longitudinal fasciculus and the interstitial nucleus of cajal
inhibitory burst neurons for vertical and torsional saccades
posterior commisure
projecting axons from the interstitial nucleus of cajal (INC) to the contralateral CNs II, IV, VI and the contralateral INC
dorsolateral pontine nuclei
neurons for smooth pursuit
pontine paramedian reticular formation
excitatory burst neurons that generate horizontal saccades
inhibitory burst neruons for horzontal saccades
medullary reticular formation
inhibitory burst cells for horizontal gaze
y-group cells
cells that project ot CNs II and IV for vertical smooth pursuit and vertical vestibular eye movements
nephrogenic fivbrosing dermopathy
potential complication of gadolinium administration in a patient with renal disease
statokinetic dissociation
aka Riddoch phenomenon
patient can see moving objects in blind hemifield but not stationary objects
visual allesthesia
patents see their environment rotated flipped or inverted
dissociated nystagmus
difference in the amplitude of nystagmus between the two eyes
causes:
intranuclear ophthalmoplegia (classic)
myesthenia gravis
surgical weakening of one medial rectus
Progressive Supranuclear Palsy
supranuclear gaze palsy that initially affects down gaze
later up gaze is also affected
horizontal movements subsequently become impaired and eventually global gaze palsy develops
pseudobulbar palsy (inability to control facial movements such as speaking, swallowing and chewing)
extrapyramidal rigidity, gait ataxia and dementia
paralysis of convergence
Budge-Waller nucleus
where the first order symapthetic neurons of the orbital pathways synapse with the second order neurons in the cervical spinal cord (at C8-T12)
Idiopathic Stabbing Headache
aka “ice pick headache” and “Jabs and jolts syndrome”
episodic, momentary sharp jabbing pains
most commonly in the distribution of the ophthalmic division of CN V
orbit
less commonly
parietal, temporal, facial, occipital and retroauricular regions
last less than a second or occurs as a series of stabbing sensations
epidemiology
occurs more commonly in migrainers
also occurs in those with cluster headache in the same area as cluster pain
treatment
responds to indomethacin
many patients improve with standard prophylactic headache drugs
what HLA associated with tubulointerstitial nephritis and uveitis syndrome
HLA-DQ in white north americans
HLA-DR14 in Spanish people
what HLA is associated with glaucomatocyclitic crisis
HLA-B54
what HLA is associated with Vogt-Koyanagi-Harada syndrome
HLA-B54
Still disease
systemic onset JIA usually seen in children under 5. Characterized by fever, rash, lymphadenopathy and hepatosplenomegaly. Joint invovlement may be minimal or absent, initially.
20% of all JIA cases
few than 6% have uveititis
pauciarticular vs. polyarticular
paucyarticular <= 4 joints
polyarticular > 4 joints
what HLA associated with pars planitis
HLA-DR15
HLA-DR51
what HLA associated with MS + uveitis combo?
HLA-DR15
HLA associated with lupus?
HLA-A1, HLA-B8, HLA-DR3
also null alleles associated with deficiencies in complement
HLA associated with birdshot?
HLA-A29
HLA associated with acute posterior multifocal placoid pigment epitheliopathy (APMPPE)?
HLA-B7
HLA-DR2
HLA associated with serpiginous choroiditis
HLA-B7
HLA associated with sarcoidosis
increased expression of class I and II HLA molecules, especially HLA-DRB1
Löfgren syndrome
acute sarcoidosis consisting of erythema nodosum, febrile arthropathy, bilateral hilar adenopathy and acute iritis. It is highly responsive to systemic corticosteroids and has a good long-term prognosis.
what is the inheritence pattern for axenfeld reiger
autosomal dominant
what are the mutations cause axenfeld reiger?
PITX2 and FOXC1
Heerfort syndrome
aka uveoparotid fever: a form of acute sarcoidosis associated with uveitis, parotitis, fever and facial nerve palsy
what HLA associated with sympathetic ophthtalmia?
HLA-DR4, HLA-DRw53, HLA-DQw3, HLA-DRB1*04, HLA-DQB1*04
what HLA associated with VKH?
HLA-DR4, HLA-DRV1*0405, HLA-DRB1*0410, HLA-DR1
What do the divisions of the oculomotor nerve innervate?
when does retinal vascularization complete?
nasal quadrants at 36 weeks
temporal quadrants at 40 weeks
what VEGF isoform is thought to be the most pathologic in neovascular AMD?
VEGF 165
what is the treatment for homocysteinuria?
oral pyridoxine, folic acid and vitamin B12
what visual acuity tests are appropriate for little ***** less than 2?
VEP
preferential looking
fixation behavior
what visual acuity tests can be used for little ***** between 2-5
Allen cards
HOTV
tumbling Es
at what age can Snellen be used?
>5
what is hering's law?
equal and simultaneous innervations flows to yoke muscles concerned with the desired direction of gaze
what is sherrington's law?
contraction of a muscle is accompanied in decrease of contraction of its antagonist
What is donder's law?
what is listing's law?
What is alexander's law?
nystagmus is more pronounced when gaze is directed towards the direction of the fast component.
what is fusional amplitude?
the number of prism diopters (of prism placed in from of an eye to **** it up) a patient can overcome to achieve fusion
when should visually significant congenital cataracts be fixed?
unilateral: before 6 weeks
bilateral: before 10 weeks
what are the yoke muscle pairs
What is PHACE(S) syndrome?
PHACE(S) actually stands for:
Posterior fossa malformations
Hemangiomas
Arterial anomalies
Coarctation of the aorta and Cardiac defects
Eye abnormalities
Sternal clefting and Supraumbilical raphe.

Eye abnormalities include:
increased retinal vascularity
microophthalmia
optic nerve hypoplasia
exophthalmos
choroidal hemangiomas
strabismus
colobomas
cataracts
glaucoma

PHACE(S) should be suspected in any infant presenting with a large, segmental plaque like facial hemangioma involving one or more dermatomes.
spiral of tilaux
medial rectus inserts 5.5 mm from the limbus
inferior rectus inserts 6.5 mm from the limbus
lateral rectus inserts 6.9 mm from the limbus
superior recuts inserts 7.7 mm from the limbus
what is the CSM notation for visual acuity
What HLA associated wtih systemic forms of becet's disease?
HLA-B12: mucocutaneous lesions
HLA-B27: arthritis
BLA-B51: ocular lesions

these results are not reproducible in all populations and are of little diagnostic value
what kind of hypersensitivity in becets disease?
initially the lesions resemble delayed-type hypersensitivity. later lesions resemble immune complex type reactions
what HLAs associated with acute retinal necrosis?
HLA-DQw7 antigen and phenotype Bw62, DR4 in white people (united states)
HLA-Aw33, B44 and HLA-Aw33,DRw6 in Japanese patients.
what type of hypersensitivity is steven's johnson
type III
what is the definition of threshold disease in ROP
(>= 5 contiguous clock hours of stage 3 ROP OR >= 8 cumulative clock hours of stage 3 ROP) in zone 1 or 2 in the presence of plus disease
what is plus disease in ROP
vascular dilitation and tortuosity in the pole (indicative of active progression)
what is the average volume of the vitreous cavity
5-6 mL
what is the average volume of the vitreous
4 mL
what is the average volume of the AC
200 mL
what HLA associated with ocular histoplasmosis?
HLA-DRw2 is twice as common in patients with histo spots alone
HLA-B7 and HLA-DRw2 are 2-4 times more commoin in patients with disciform scars caused by OHS
what is the basic secretion test?
steps
1. instillation of topical anesthetic
2. blotting of residual film from the inferior fornix
3. application of standard filter paper strip
4. wait 5 minutes
interpretation of results
less 3mm is abnormal
3-10mm is equivocal
what is the Schirmer 1 test?
steps
1. blotting of residual film from the inferior fornix
2. application of standard filter paper strip
3. wait 5 minutes
interpretation of results
less 5.5mm is abnormal
what is the Schirmer 2 test?
steps
1. instillation of topical anesthetic
2. blotting of residual film from the inferior fornix
3. application of standard filter paper strip
4. irritate the nasal mucosa for 2 minutes
interpretation of results
less 15mm is abnormal
what is the average volume of the posterior segment
60 microliters
what mutation causes granular corneal dystrophy
TGFB1 (locus 5q31)
what material is deposited in granular corneal dystrophy
hyaline
what stain for granular corneal dystrophy
Masson's trichrome
what mutation causes reis-buckler's corneal dystrophy?
TGFB1
what mutation causes lattice dystrophy type one
TGFB1
what mutation causes Avellino corneal dystrophy
TGFB1
what kind of immune hypesensitivity reaction is OCP
type II cytotoxic
how many ganglion cell axons make up the optic nerve?
1-1.2 million
what HLA associated with chronic arthritis in lyme disease?
HLA-DR4, -DR2 (in north america)
what HLA associated with poorer response to antibiotics in lyme disease?
HLA-DR4.
what corneal dystrophy is this?
what corneal dystrophy is this?
Reis-Bucklers or Theil-Beneke (only possible to differentiate on electron microscopy).
What layer is ****** up in Reis-Bucklers corneal dystrophy
bowmans
What layer is ****** up in Theil-Beneke corneal dystrophy
bowmans
how are Reis-Buckler and Theil Beneke differentiated?
EM; Theil-Beneke has curly fibers.
what protein is ****** up in Reis-Buckler and Theil-Beneke?
keratoepithelin
what are the corneal dystrophies associated with defects in TGFB1?
Ries-Buckler
Theil-Beneke
lattice
granular
what is the rate of aqueos production?
2-3 microliters per minute.
what is Chediak-Higashi syndrome
oculocutaneous albinism associated with extreme susceptibility to infection.
what is Hermansky-Pudlak syndrome?
features
oculocutaneous albinism
platelet deficit
easy bruising
bleeding diathesis
lysosomal storage dysfunction
pulmonary fibrosis
colitis
more common in Puerto Ricans
what does the right 3rd nerve nucleus innervate?
RIO, RIR, RMR, LSR (only the fibers to the LSR decussate).
RIO, RIR, RMR, LSR (only the fibers to the LSR decussate).
what does the right 4th nerve nucleus innervate?
the LSO (because the fibers decussate before exiting the brainstem).
what is the classic manifestation of a lesion of the third nerve nucleus
Ipsilateral third nerve palsy and contralateral palsy of the superior rectus and levator palpebrae.
to what wavelength is rhodopsin most sensitive
510nm (green).
what is the wavelength of the excimer laser used in refractive surgery?
193nm (ultraviolet)
what is the wavelength of the yag laser
1064
what is the wavelength of the femto?
1053 (infrared)
what glaucoma drop has the highest incidence of blepharitis/dermatitis
apraclonidine
what glaucoma drops are safe in pregnanacy?
all drops are pregnancy class C (bad in animals, no studies in humans) except brimonidine and dipivefrin which are class B (animal studies ok, no studies in humans).
what glaucoma drops should not be given to breast feeding mothers
brimonidine and timolol
which steroids produce less of a rise in IOP
loteprednol
fluoromethalone
rimexolone
what glaucoma drops should be avoided in people with herpetic keratitis
prostaglandin analogs (risk of reactivation)
what is alexander's law
nystagmus more pronounced when gaze is directed in the direction of the fast beat component
when do the lacrimal glands start working?
6 weeks after birth
what percentage of infants have obstruction at the valve of Hasner at birth/
50%
what is the Jones I test?
Aka primary dye test
1. put fluorescein into fornices
2. put cotton tipped applicator in the region of the ostium of the NLD at 2 and 5 minutes
occasionally yields false positives, so not uniformly performed.
what is the Jones II test?
Used to determine level of obstruction
Steps
1. If Jones I was performed, the residual fluorescein is flushed from the fornix
2. Lacrimal drainage system irrigation is performed with clear saline
3. fluid is retrieved from the nose
* Not routinely done because it is a pain in the ass
what is the immune response to parasitic infections?
Th2-mediated response leading to local eosinophilia.
what is the mechanism of the anti-inflammatory effect of methotrexate?
extracellular release of adenosine (not inhibition of DNA replication by ******* up folate metabolism by inhibiting dihydrofolate reductase).
what is the most common infectious cause of neuroretinitis?
b. henselae
what imaging modality is best for the orbital apex?
MRI (CT sucks)
what is echothiophate?
aka phopholine iodide. indirect-acting muscarinic agonist that works by inactivating acetylcholineesterase.

Used in accomodative esotropia to directly stimulate the ciliary body, reducing the central demand for accomodation and thereby reducing excessive convergence of the eye

No longer available for glaucoma therapy
what medication should not be used with echothiophate?
succinylcholine (will lead to prolonged paralysis)
what is the main side effect of echothiophate?
formation of iris cysts
how can the formation of iris cysts by echothiophate be prevented?
co-administration of phenylephrine
what is Alagille syndrome?
Jaundice, Cardiac defects, posterior embryotoxon, broadened forehead, pointed chin, butterfly hemivertebrae, mild developmental delay.
what is the inheritance of Alagille syndrome
autosomal dominant (mutation of JAG1 gene, chromosome 20p12)
what 3 GAGs are found in the corneal stroma?
keretan sulfate
dermatan sulfate
chondroitin sulfate
what mutation has been linked to juvenile-onset open-angle glaucoma?
TIGR (renamed myocillin MYOC)
what mutation has been linked to normal tension glaucoma?
OPTN (optineurin)
what mutations have been linked to axenfeld-reiger syndrome?
PITX2 and FOXC1
what are the bones of the orbital roof?
frontal and lesser wing of the sphenoid
what are the bones of the medial wall of the orbit
lesser wing of sphenoid, maxillary, ethmoid, lacrimal (SMEL)
what are the bones of the floor of the orbit
maxillary, palatine, zygomatic
what are the bones of the lateral wall of the orbit?
greater wing of sphenoid and zygomatic
what is the inheritance pattern of lattice corneal dystrophy
autosomal dominant
what site of perioocular origin has the highest risk for subsequent sytemic non-hodgkins lympohoma?
eyelid
what are the two most common causes of vision loss in congenital rubella syndrome?
cataract and micoophthalmos
what is the chance of a child of a person with hereditary retinoblastoma getting retinoblastoma?
0.5 chance of inheriting gene x 0.9 penetrance = 0.45
what is a fleischer ring?
ring of iron deposited at base of keratoconus cone
what is Rizzuti sign?
conical reflection is seen on nasal cornea when light is shone from the temporal side.
what are vogt lines
parallel lines in deep stroma of some keratoconus patients
what corneal diameter defines microcornea?
9mm in infants, 10 mm at age 2
what is the normal corneal diameter in childreN?
9.5-10.5mm in newborns
10.0-11.5 in 1 year olds
what mutations cause congenital glaucoma?
CYP1B1
GLC3A
GLC3B
GLC3C
what mutation causes pseudoexfoliation glaucoma?
LOXL1
what mutation causes normal tension glaucoma
OPTN
what factors increase the risk for PBK?
endothelial counts < 1000
corneal thickness greater than 650 microns
what is the normal endothelial cell count?
1500-3500
What is De Morsier syndrome
septo-optic dysplasia
how long can dropped nuclear remnants be left in the eye before vitrectomy before increasing the risk of CME
3 weeks.
how long after injury to retinal ganglion cells or their axons does it take for optic nerve atrophy to appear?
4-6 weeks
what is the minimum AC depth required for implantation of an intraocular contact lens (ICL)?
3mm
what is the angle alpha?
the angle between the visual and optical axis.  positive when the object is on the nasal side of the optical axis.
the angle between the visual and optical axis. positive when the object is on the nasal side of the optical axis.
what are axenfeld loops
ciliary nerves in the sclera near the limbus
angiod streaks associations
P seudoxanthoma elasticum
E hlers dahnlos
P aget's disease
S ickle cell
I diopathic
does UVA or UVB penetrate deeper and **** up the lens?
UVA
which type of aniridia is associated with Wilm's tumor, familial or sporatic?
sporatic; however, due to reports of Wilm's tumor in familial cases, screening is advocated
what mutation causes aniridia?
PAX6
why is sporatic aniridia associated with wilm's tumor?
the responsible gene, PAX6, is adjacent ot the gene for wilms tumor (WT1). IN cases of of aniridia with wilms tumor, both genes are deleted.
what diseases cause true conjuntival membranes?
bacterial conjunctivitis, chemical burns, ligneous conjunctivitis
what diseases cause conjunctival pseudomembranes?
OCP, stephen's johnson, EKC, superior limbic keratitis
what are membranous cataracts?
lens proteins are resorbed and the anterior and posterior capsules fuse
what diseases are associated with membranous cataracts?
lowe syndrome, hallerman streif syndrome, microphthalmos and congenital rubella syndrome
which uveitis causes in increase in IOP?
herpetic. most other uveitisis causes a decrease in IOP due to decreased production of acqueous by the ciliary body
what kind of cataract is caused by galactosemia?
oil droplet
what type of cataract is cause by myotonic dystrophy
christmass tree-appearing crystaline cataracts, posterior subcapsular cataracts that will lead to complete opacification
what causes snowflake cataracts
diabetes
what things cause ectopia lentis?
Marfan syndrome
Homocystinuria
Weil-Marchesani
Sulfite-oxidase deficiency
syphilis
Ehlers Danols syndrome
trauma
aniridia
iris coloboma
congenital glaucoma
hereditary ectopia lentis
ectopia lentis et pupillae
hyperlisinemia
what are the criteria for mild, moderate and severe non-proliferative diabetic retinopathy (NPDR)
Nonproliferative diabetic retinopathy

Mild: Indicated by the presence of at least 1 microaneurysm
Moderate: Includes the presence of hemorrhages, microaneurysms, and hard exudates
Severe (4-2-1): Characterized by hemorrhages and microaneurysms in 4 quadrants, with venous beading in at least 2 quadrants and intraretinal microvascular abnormalities in at least 1 quadrant
how long does the retisert (fluocinolone acetide) implant last?
median of 30 months
what is the incidence of side effects with the retisert (fluocinolone acetide implant)
virtually all phakic patients develop a cataract
30% require glaucoma filtering surgery after 2 years of implantation
what blood disorder increaes the risk of leukemia when taking chloambucil?
polycythemia vera
what cnacer is increased with cyclophosphamide?
33 fold increase risk of bladder cancer
what ar ethe AAOs preferred practice guidelines for treating retinal breaks with laser demarkation
acute symptomatic horschoe tears: treat promptly
acute symptomatic operculated tears:: treatment may not be necessary
traumatic retinal breaks: usually treated
asymptomatic horshoe tears: can be followed without treatment
asymptomatic operculated tears or atrophic round holes: treatment never recommended
what is a paradoxical pupillary reaction?
constriction in dark. Most significant in children with poor vision. Highly suggestive of optic nerve or retinal pathology
what is the differential diagnosis for paradoxical pupillary reaction?
congenital stationary night blindness
congenital achromatopsia
Best disease
dominant optic atrophy
optic nerve hypoplasia
Leber congenital amaurosis
Albinism
retinitis pigmentosa
what causes sunflower cataracts?
copper foreign bodies (chalcosis)
wilson's disease
what causes christmas tree cataracts?
myotonic dystrophy
what is the differential for corneal verticillata?
amiodarone (most common)
chloroquine
hydroxychloroquine
chlorpromazine
subconj gentamycin
ibuprofen
indomethacin
naproxen
tamoxifen
Fabry disease
what is the WAGR complex?
Wilm's tumer, Aniridia, Genitourinary abnormalities and Retardation; caused by PAX6 mutation.
what can be caused by PAX6 mutations?
aniridia, peter's anomaly, axenfeld anomaly, posteriro embyrotoxon, congenital cataracts, WAGR complex
what type of cataract is caused by topical or systemic steroids?
posterior subcapsular
what mutation causes Fabry disease?
alpha galactosidase A
what metabolic product accumulates in Fabry disease?
ceramide trihexoside
what is the maximum luminance that the humphrey VF can project?
10K apostlibs
what is the maximum luminance that the goldman VF can project?
1K apostlibs
what is Raymond syndrome?
6th nerve palsy with contralateral hemiparasis due to a lesion in the mid pons affecting the 6th nerve fasciculus and the corticospinal tract
what is weber syndrome?
3rd nerve palsy and contralateral hemiparesis caused by a midbrain lesion
what is Benedikt syndrome?
ipsilateral 3rd nerve palsy and contralateral rubral tremor (slow frequency termor with activity and at rest) due to midbrain lesion affecting the 3rd nerve fascicle and red nucleus
what is claude syndrome?
ispilateral 3rd nerve palsy and contralateral ataxia due to damage to the dorsal midbrain affecting the superior cerebellar peduncel and the 3rd nerve fasciculus
what mutation has been associated with weil marchesani syndrome?
adams10
what are the eponyms of the iris nodules seen in sarcoidosis?
Berlin - iris angle
Busacca - iris stroma
Koeppe - pupillary margin

start at the angle and proceed to pupil margin in alphabetical order
how is meesman corneal dystrophy inherited?
autosomal dominant
what is meesman corneal dystrophy
multiple small epithelial vesicles or microcysts
causes slight irritation and slighty decreases in visual acuity
sometimes painful recurrent erosions can occur
what gene is responsible for meesman corneal dystrophy?
mutations in keratin K3 and K12
what are the layers of the TM from inner to outer
1. uveal
2. corneoscleral
3. juxtacannalicular
what layer of the TM is responsible for the majority of aqueous resistance?
juxtacannalicular
what does the superior division of CN III innervate?
superior rectus and levator
what does the inferior division of CN III innervate?
medial, lateral and inferior rectus and inferior oblique
what is the average thickness of the corneal epithelium?
50 microns
what is the inheritance pattern of ectopia lentis e pupillae?
autosomal recessive
what is Heimann-Beilchowsky phenomon
Monocular nystagmus in an eye with longstanding poor vision. It may become manifest in adulthood and may not remit even if the visual problem is corrected.
what type of leukemia is most likely to metastasize to the orbit
ALL
what is the most common orbital lymphoma?
non-hodgkin's b-cell lymphoma, usually presenting as part of primary CNS lymphoma
which beta blocker glaucoma drop is beta-1 selective?
betaxolol
which beta blocker drop has intrinsic sympathomimetic activity and reduces cardiac and pulmonary symptoms
carteolol
what is the proper treatement for eye clap in a newborn
systemic ceftriaxone; eye clap can rapidly cause ulceration and perforation, so systemic treatment is necessary
why do you do a dilated peripheral fundus exam on patients with pigmentary glaucoma?
typically occurs in high myopes so they are at increased risk of retinal breaks
below what pupil diameter can you get global depression defects on HVF?
2.5
what was the most common organism isolated from culture in the EVS?
staph epi. (coag neg, catalase pos)
at what CD4 count do HIV patients typically become symptomatic?
< 200
what is the inheritance pattern of LIsch corneal dystrophY?
x-linked dominant
what percentage of patient's with ankylosing spondylitis are HLA-B27 positive?
90%
what is the inheritance pattern of Theil-Beneke corneal dystrophy?
autosomal dominant
what is the diameter of the foveal avascular zone/
250-600 microns
What are the only proven treatments for sjs
Iv steroids and amniotic membranes
What is cogan's lid teitch
Sign seen in myasthenia gravies where eyelids overshoot when looking up after prolonged down gaze.
What is the volume of the orbit?
30 mL
how do quinolones and fluoroquinolones work?
inhibit DNA gyrase and topoisomerase II and thus inhibit bacterial replication
how do tetracyclines work?
inhibit 30s ribosomal subunit
how do polymixins work?
disrupt the structure of a bacterial cell wall by interacting with its phospholipids; selectively toxic to gram negative bacteria due their specificity for a lipopolysaccharide in their outer membranes
what is Usher syndrome?
RP + congenital sensorineural hearing loss
what is the inheritance pattern of Usher syndrome
autosomal recessive
what corneal diameter is suggestive of congenital glaucoma?
>12mm
what is the treatment for HZO?
acyclovir 800mg 5x/day for 7-10 days
or
valcyclovir 1g/day x 7 days
or
famcyclovir 500 mg TID x 7 days
or
brivudin 125mg daily x 7 days
what gene causes autosomal dominant optic atrophy (kjer syndrome)
OPA1
where are the most common sites of globe rupture after blunt eye trauma?
under insertions of rectus muscles and at the limbus
what breakdown pathway is responsible for diabetic cataracts?
sorbitol
it is usually minimally activated in the lens, but in hyperglycemic states becomes more activated. sorbitol becomes trapped in the lens and creates an osmotic gradient that causes lens swelling
what is marcus-gun jaw winking?
2 forms
abberrent co-innervation of the external-pterygoid and levator leads to eyelid elevation with:
movement of mandible to opposite side
jaw thrust
opening mouth
aberrent co-innervation of the internal-pterygoid and levator leads to eyelid elevation with teeth are clenched
uncommonly, in some patients ptosis may worsen with movement of the jaw
what is Hermansky-Pudlak syndrome?
oculocutaneous albinism, platelet dysfunction and lysosomal accumulation of ceroid lipofuscin, usually found in puerto ricans
autosomal recessive
what is Chediak-Higashi syndrome?
oculocutaneous albinism, recurrent pyogenic infections (due to impaired phagocytosis) and peripheral neuropathy
autosomal recessive
what is the inheritance of Hermansky-Pudlak syndorme?
autosomal recessive
what is the inheritance of Chediak-Higashi?
autosomal recessive
which fungi have septate hyphae?
fusariam, aspergillus, curvularia
which fungi have non-septate hyphae?
mucor, absidia, rhizopus
why is pilocarpine 4% (but not 1%) contraindicated during acute angle closure glaucoma?
shifts the lens-iris diaphragm forward. pilocarpine 1% is used to bring the pupil down to do a laser PI.
what is Henle's layer?
outer plexiform layer in the macula
what layer do exudates deposit in in macular star formation?
outer plexiform layer
what are pseudodendrites?
not completely devoid of epithelium with distinct margins like real dendrites in herpes are
what causes pseudodendrites?
tyrosinemia
what is the most common endocrinopathy in septo-optic dysplasia?
GH deficiency
what are the criteria for clinically significant diabetic macular edema?
Criteria (based only on slit lamp exam) are one of the following:
1. retinal edema within 500 micrometers of the center of the macula
2. hard exudates within 500 micrometers of the center of the macula, if associated with adjacent thickening
3. a zone of thickening larger than 1 disc area if located within 1 disc diameter of the macula
what is the treatment for clinically significant diabetic macular edema?
focal laser photocoagulation
in what direction is the lens dislocated in ectopia lentis e pupillae
opposite the direction of the pupil
what percentage of hyperthyroid patients will develop eye disease?
30%
what percentage of thyroid eye patients will become hyperthyroid at some point?
90%
where is the marginal artery located?
3mm superior to the superior eyelid margin
where is the peripheral arterial arcade located?
just superior to the tarsus between muller's muscle and the levator
what is the primary collage of the sclera?
type I
what chromosome is the Rb gene on
13
what chromosome is responsible for NF1
17
what chromosome is responsible for NF2
22
what genes are responsible for tuberous sclerosis?
TSC1 on chromosome 9
TSC2 on chromosome 16
what is the weakest part of the maxilla?
posteromedial part
what organism is most commonly involved in pre-septal cellulitis after trauma?
staph aureus
what collagen is associated with stromal wound healing?
type III
is ICE syndrome typically unilateral or bilateral?
unilateral
is axenfeld rieger usually unilateral or bilateral?
bilateral
is peters anomaly usually unilateral or bilateral?
bilateral
what is the treatment for congenital dacryocystocoele?
gentle massage plus topical antibiotics for 1-2 weeks, followed by lacrimal duct probing if failure to resolve
what imaging modality is best for the orbital apex?
MRI
what is Melkersson-Rosenthal syndrome?
recurrent unilateral or bilateral facial paralysis accompanied by chornic facial swelling and lingua plicata (furrowing of the tongue)
what cytokines do Th1 helper cells produce?
IL-2, INF-γ, TNF-β, IL-12
what cytokines do Th2 helper cells produce?
IL-4, IL-5 and IL-10
what is the length of the lacrimal cannaliculi?
2mm vertical + 8-10mm horizontal
what is the length of the lacrimal sac?
12-15mm
what is the length of the nasolacrimal duct?
12-18mm
what glaucoma drops come in a BAK-free formulation?
brimonidine, timolol, travaprost
what direction does the pupil usually decenter when constricted?
superonasally
what antibiotics can be used for b. cereus endophthalmitis?
vancomycin or clindamycin
what medicine is given to prevent heart block when performing the tensilon test for myasthenia gravis?
atropine
what is the diameter of the optic nerve head?
1.5mm
what is the diameter of the intraorbital optic nerve?
3mm
what myelinates the optic nerve?
oligodendrocytes
does PIC have vitritis?
minimal
does POHS have vitritis?
never
does MFC have vitritis?
yes
what is the least common presenting symptom of orbital rhabdomyosarcoma?
pain (10%)
what is the most common presenting symptom of orbital rhabdomyosarcoma?
proptosis (80-100%) followed by globe displacement (80%)
what glaucoma drops should not be used with an open posterior capsule?
non-selective alpha agonists such as epinephrine and dipivefrin because they can cause or exacerbate CME
what glaucoma drops can exacerbate CME
dipivefrin
epinephrine
prostaglandin analogs
what types of collagen are in the corneal stroma/
I, III, V, VI
what is Löfgren syndrome?
acute sarcoidosis with
erythema nodosum
febrile arthropathy
bilateral hilar adenopathy
acute iritis
what is Heerfordt syndrome?
acute sarcoidosis with
uveitis
parotitis
fever
facial nerve palsy
where does the sphenoid sinus drain?
sphenoethmoidal recess (which is above the superior turbinate)
what drains into the medial meatus?
frontal sinus
anterior and medial ethmoidal sinuses
maxillary sinus
what drains into the inferior meatus
NLD
what drains into the superior meatus?
posterior ethmoidal sinus
what are the earliest signs of malignant hyperthermia?
elevation of end-tidal CO2
tachycardia
where are the limbal palisades of vogt located?
1-2mm posterior to the limbus where the conj and tenons fuse
how long does it take for the corneal endothelium to completely regenerate?
7 days
what is the hallmark of limbal stem cell deficiency?
presence of goblet cells on impression cytology, using PAS or alcian blue stain
how can you diagnose limbal stem cell deficiency
A. impression cytology (preferred):
1. presence of goblet cells (hallmark)
2. presense of conj epithelial cells (also a sign)
B. excisional biopsy
what does the ventral ophthalmic artery become (embryology)?
the nasal long posterior artery
what does the dorsal ophthalmic artery become (embryology)
the ophthalmic artery
what medication frequently used in HIV and CMV retinitis causes a secondary anterior uveititis?
cidofovir
what antivirals cause bone marrow suppression?
gancyclovir
zidovudine (AZT)
what is the most common location for limbal dermoids?
inferotemporal
what is the treatment for blebitis
blebitis has no hypopyon or vitritis and can be treated with topic antibiotics
what is the treatment for bleb-related endophthalmitis?
controversial, but typically vitrectomy
what are the most common cancers associated with BDUMP
ovarian, urterine and lung
what immunomodulator can worsen MS?
infliximab
how long should a patient stay out of contacts prior to refractive surgery evaluation and surgery?
the exact time has not been established but current practice is usually
3 days to 2 weeks for soft contact lenses
2-3 weeks for rigid contact lenses
what immunomodulatory drug is the best monotherapy for behcets disease?
chlorambucil
what are the settings for ALT?
50 micron spot
0.1 s duration
300-1000mW of power
what are the settings for SLT?
400 micron spot
3 nanosecond duration
0.5-1.2 mJ of power
what is the most common type of functional pituitary adenoma?
prolactinoma
is PFV usually unilateral or bilateral
90% unilateral
what are the risk factors for suprachoroidal hemorrhage?
advanced age
myopia
atherosclerotic cardiovascular disease
aphakia
glaucoma
HTN
tachycardia
what is the best screening test for sarcoidosis?
CXR
what is the morphology of bartonella henselae?
gram negative rod
what is the primary limiting side effect of zidovudine (AZT)
bone marrow suppression
what is the Somogyi phenomenon?
institution of medications in diabetics causes hypoglycemia which subsequently leads to a rebound hyperglycemia
what is the dawn phenomenon?
the occurrence of morning hyperglycemia not associated with hypoglycemia at night. It is thought to be due to a growth hormone surge.
what are optocilliary shunt vessels?
Optociliary shunt vessels (aka retinochoroidal collaterals) are a dilation of the naturally-occurring veins that drain from the peripapillary retinal circulation into the choroidal circulation. Similar to hemorrhoids or esophageal varices, optociliary shunt vessels evolve in response to chronically-poor drainage of the central retinal vein. The differential for optociliary shunt vessels is an important one and includes: optic nerve sheath meningiomas, low-grade optic nerve gliomas, chronic papilledema, chronic glaucoma, and old central retinal vein occlusions.
which rectus muscle has only one anterior cilliary artery?
lateral rectus. all the others have two.
what HLA is associated with posner schlossman syndrome
HLA-B54
Diffraction limits the visual acuity in a person's eye when the pupil size is below what threshold diameter?
2.5mm
what does the orbital part of the orbicularis do?
forced (voluntary) eyelid closure
what does the palpebral (pre-septal, pre-tarsal) part of the orbicularis do?
involuntary blinking
what is the followup period after initiating full-time patching for amblyopia?
one week per year of age
how do radial incisions affect the topography of the cornea?
flatten in the meridian of the incision and 90 degrees away
how do arcuate incisions affect the topography of the cornea
flatten in the meridian of the incision and steepen in the meridian 90 degrees away
what gene causes congenital hereditary stromal dystrophy
decorin gene, chromosome 12
what gene causes macular stromal dystrophy?
carbohydrate sulfotransferase 6 (CHST6)
what gene causes gelatinous drop-like corneal dystrophy?
tumor-associated calcium signal transducer 2 (TACSTD2)
what corneal dystrophies are caused by mutations in TGFβ1
granular (Groenouw type I), Reis-Bücklers, lattice type I, and Avellino
what are the largest crystalins in the lens?
alpha
what is the background luminance of the goldmann and humphry VF machines?
31.5 apostlibs
how long should a uveitic eye be quiet before elective (e.g. cataract) surgery
3m
what part of the lacrimal gland should be biopsied
orbital. the ductules pass through the palpebral part, so it should not be biopsied
what medications cause delayed corneal stromal healing?
acutane and amiodarone
what medications cause delayed corneal epithelial healing?
antihistamines, sumatriptan, HRT
when should unilateral congenital cataracts be removed?
within 6 weeks of birth
when should bilateral congenital cataracts be removed?
within 10 weeks of birth
what are the major side effects of cyclosporine?
HTN and kidney damage
what is the difference between wavefront-optimized and wavefront-guided laser ablation
optimized means more peripheral spots to attempt to minimize higher order aberations
guided means a wavefront-sensing aberrometer is used to quantify higher-order preop abberations and fix them
what layers of the lateral geniculate nucleas receive fibers from the ipsilateral eye?
prime numbers: 2,3,5
what layers of the latearl geniculate nucleas receive fibers from the contralateral eye?
1,4,6 (non-primes)
what VF defect is produced by a lesion of the optic nerve where it meets the chiasm?
junctional scotoma: central scotoma of ipsilateral eye and temporal hemianopia of the contralateral eye
what is the pupillary light reflex pathway?
The signal travels with the optic nerve, decussates in the chiasm, travels with the optic tracts, then splits from the optic tracts to reach the pretectal nuclei at the level of the superior colliculus.

Efferent fibers decussate and go to the Edinger-Westphal nuclei (note that there are TWO decussations before reaching the Edinger-Westphal nuclei).

Pre-ganglionic parasympathetic fibers leave the Edinger-Westphal nuclei, traveling with CN III, and then the inferior division of CN III in the orbit. These fibers synapse with the ciliary ganglion.

The ciliary ganglion gives off the post-ganglionic short posterior ciliary nerves which innervate the iris sphincter and ciliary muscle.
Ps mneumonic for MEN syndromes
MEN I (3 Ps) - Pituitary, Parathyroid, Pancreas
MEN IIa (1M,2Ps) - Medullary Thyroid Ca, Pheochromocytoma, Parathyroid
MEN IIb (2Ms,1P) - Medullary Thyroid Ca, Marfanoid habitus/mucosal neuroma, Pheochromocytoma
what is alagille syndrome?
intrahepatic cholestasis (causing jaundice), posterior embryotoxon and/or Axenfeld anomaly, pigmentary retinopathy, congenital heart disease, flattened facies, and other bony abnormalities.
what is the reconstructive ladder for eyelid defects?
upper lid:
<33%: direct closure
33-50%: semicircular flap or tarsoconjunctival flap
>50%: cutler beard
lower lid:
<33%: direct closure
33-50%: semicircular flap or tarsoconjunctival flap
>50%: hughes procedure
what is the treatment for insecticide?
pralidoxime and/or atropine
what is the most common cause of bacterial keratitis in contact-lens wearers?
pseudomonas
what is the capsulopalpebral fascia?
the equivalent of the levator aponeurosis in the lower eyelid. The capsulopalpebral fascia originates from the muscle fibers of the inferior rectus. It extends forward, wraps around the inferior oblique, and then inserts into the inferior tarsal border.
what glaucomas does laser trabeculoplasty suck for?
low tension glaucoma
uveitic glaucoma
angle recession glaucoma
ICE syndrome
neovascular glaucoma
glaucomas associated with elevated episcleral venous pressure (e.g. sturge weber, CC fistula)
what is Pulfrich phenomenon ?
he illusion that an object moving perpendicular to a person's line of sight is actually moving toward them or away from them. Theoretically, it could be seen in any disease affecting the conduction of visual information in one optic nerve more than the other. It is usually described in patients who have partially recovered following a bout of optic neuritis.
at what endothelial cell count threshold will corneal edema typically occur (without any additional insult)
500 cells/mm2
what is Mikulicz syndrome
lacrimal gland enlargment, salivary gland enlargement, and keratoconjunctivitis sicca
Which molecule is found in aqueous humor at concentrations 10-50 times higher than in plasma?
ascorbic acid (vitamin c)
A pupil-involving third nerve palsy is assumed to caused by an aneurysm until proven otherwise by neuro-imaging. Where is the most common location of the causative aneurysm?
at the junction of the posterior communicating artery and the internal carotid artery
what is the inheritance pattern of macular dystrphy
autosomal recessive
What is the 5-year risk of contralateral involvement in patients with acute monocular non-arteritic anterior ischemic optic neuropathy?
12-19%
in what quadrant does a BRVO usually occur in?
superotemporal
what are the steps of astigmatic dial refraction?
First, fog the patient to about 20/60 by adding plus sphere.

Second, ask the patient which line of the astigmatic dial appears darkest and sharpest.

Third, add minus cylinder perpendicular to the axis or plus cylinder parallel to this axis until all of the lines are equally sharp.

Fourth, reduce the sphere using the Snellen acuity chart until vision is clearest.

If you are using a plus cylinder phoropter, for every 0.50 diopter of cylinder that you add, you must also subtract 0.25 diopters of sphere.
what is the definition of ocular hypertelorism?
increase in both the medial and lateral intercanthal distances (distance between the two eyes)
what is the definition of orbital hypertelorism?
increased distance between the medial orbital walls
what is telecanthus?
increased distance between the medial canthi
what type of ganglion cells does frequency doubling technology typically stimulate?
M cells
what type of ganglion cell does short wave automated perimetry preferentially stimulate?
koniocellular
what is Raymond syndrome?
a 6th nerve palsy with a contralateral hemiparesis due to a lesion in the mid pons affecting the 6th nerve fasciculus along with the corticospinal tract.
what is Claude syndrome?
Claude syndrome is caused by damage to the dorsal midbrain affecting the superior cerebellar peduncle and 3rd nerve fasiculus typically resulting in ipsilateral 3rd nerve palsy and contralateral ataxia.
what is Millard-Gubler syndrome?
a lesion in the ventral pons that disrupts: 1) the 6th nerve fasciculus resulting in an ipsilateral abduction deficit; 2) the corticospinal tract before decussation in the medulla causing contralateral spastic hemiplegia; and 3) the 7th nerve fasciculus resulting in an ipsilateral facial weakness.
what infectious agents are associated with Bell's palsy?
varicella zoster virus, Mycoplasma pneumonia1, and Borrelia burgdorferi (Lyme disease).
how do you obtain a better 3D view through a small pupil with the indirect?
In situations where the patient's pupil is small, light rays from the observer's pupils can be brought closer together by either retracting the mirror closer to the observer's forehead or by increasing the interpupillary distance of the indirect. This allows light rays from each observer's pupils to strike closer to the tip of the mirror and be closer together as they enter the patient's pupil.
what are Cowdry type 1 bodies?
inclusion bodies seen in HSV and VZV
what are Halberstaedter-Prowazek Bodies?
inclusion bodies seen in trachoma
what is the refractive power of the anterior corneal surface?
+48D
what is the refractive power of the posterior corneal surface?
-5.8D
what are the main nutritional sources of the cornea?
(1) glucose from the underlying aqueous humor; and (2) oxygen diffusing through the tear film. The peripheral cornea does receive some oxygen from the limbal circulation.
how many degrees apart are the testing points in the 24-2 and 30-2 HVF?
6
What is the normal adult number of axons in the optic nerve?
1.1M

The largest number of axons achieved in the optic nerve is 3.7 million at 16 wks. These nerves are pruned to 1.1 million by the 33 week and stay at that number.
What are dellen?
saucerlike areas of corneal depression adjacent to raised areas of conjunctiva. There is thinning of the epithelium and stroma secondary to drying due to a poor blink.
where does the levator aponeurosis attach?
lower 1/2 of the anterior part of the tarsal plate
what is the optimal Q value
-0.5
what is the Q value of the average human cornea?
-0.26
what does Q mean?
asphericity of the cornea. Q<0 = prolate, Q>0 = oblate
what are the surgical margins for CIN?
3-4 mm margins and cryotherapy to the bordering conjunctiva.
what are the medical treatments for CIN?
topical interferon-a2b, mitomycin-C, and 5-fluorouracil eyedrops.
what percentage of optic neuritis patients have pain?
92%
what is the treatment for gyrate atrophy?
arginine restriction and vitamin B6 supplementation
what is the treatment for homocystineuria?
methoinine restriction, high cysteine, vitamin B6 supplementation
What is the blood supply to the intracanalicular portion of the optic nerve?
ophthalmic artery
what is aicardi syndrome?
x-linked dominant
widespread round or oval depigmented chorioretinal lacunae
infantile spasms
agenesis of the corpus callosum
typically lethal in males
colobomas and microphthalmos may also occur
where is the foveola in relation to the optic nerve?
4.0 mm temporal and 0.8 mm inferior to the optic nerve
what is the diameter of the foveola?
350 microns
what is the diameter of the fovea?
1.5mm
what is the treatment for ciliary block glaucoma (aka aqueous misdirection)
Medical treatment is successful 50% of the time and involves intense mydriasis and cycloplegia (phenylephrine 10% and atropine), aqueous suppressants, and oftentimes hyperosmotics.

If these treatments fail, disruption of the anterior hyaloid face with YAG laser or pars plana vitrectomy is needed.
what is Loewenstein-Jensen medium for?
Mycobacteria and Nocardia
what is chocolate agar for?
Haemophilus species and Neisseria gonorrhoeae.
what is Sabouraud's medium for?
fungi.
what is Middlebrook agar for?
non-tuberculous mycobacteria
what is congenital stromal corneal dystrophy (CSCD)?
a very rare disorder that presents at birth. It features bilateral opacification of the central stroma (at all levels) with whitish flakes. The peripheral cornea is clear. The central opacities result in moderate-to-severe visual loss. This condition is typically non-progressive or very slowly progressive.
what mutation causes congenital stromal corneal dystrophy?
decorin gene located on chromosome 12
what is the inheritance pattern of congenital stromal corneal dystrophy?
autosomal dominant
what is Raymond syndrome?
6th nerve palsy with a contralateral hemiparesis due to a lesion in the mid-pons affecting the 6th nerve fasciculus along with the corticospinal tract.
what is weber syndrome?
a midbrain lesion causing a fascicular 3rd nerve palsy and a contralateral hemiparesis.
what is Benedikt syndrome?
a lesion of the midbrain affecting the 3rd nerve fascicle and the red nucleus which causes an ipsilateral 3rd nerve palsy and a contralateral "rubral" tremor (a slow tremor present with activity and rest).
what is claude syndrome?
damage to the dorsal midbrain affecting the superior cerebellar peduncle and 3rd nerve fasciculus typically resulting in ipsilateral 3rd nerve palsy and contralateral ataxia.
what is Epicanthus palpebralis
a medial eyelid skin fold that is equally prominent in the upper and lower eyelid
what is Epicanthus tarsalis
medial eyelid skin fold that is more prominent in the upper eyelid.
what is Epicanthus inversus
a medial eyelid skin fold that is more prominent in the lower eyelid
what is Epicanthus supraciliaris
a medial eyelid skin fold that is more prominent from the eyebrow to the lacrimal sac.
what is thioglycolate broth for?
anaerobic bacteria
what is Thayer-Martin agar for?
Neisseria
how do you culture acanthamoeba?
nonnutrient agar with E. coli overlay.
what swabs are used for viral cultures
dacron
how do you minimize image jump and image displacement from bifocals?
Image jump can be minimized with flat-top segments since the optical center of the bifocal segment is closer to the optical center of the distance lens. Image jump can be eliminated with executive-type bifocal segments where the optical center is located at the top of the bifocal segment.

A separate concept is image displacement which is the prismatic effect induced by the combination of the bifocal type and the power of the distance lens prescription in the reading position. For plus-power lenses, image displacement is minimized with round-top bifocal segments. For minus-power lenses, image displacement is minimized with flat-top bifocal segments.

Typically, image displacement is more bothersome than image jump.
what are the standard laser settings for PRP
1200 or more 500 micron burns, separated by one-half to one burn width apart, at 0.1 sec duration
what is the average length of the orbital part of the optic nerve?
25-30mm
what is the size of the goldmann applanator tip?
3.06mm
what are Cerulean ("blue-dot") cataracts?
bilateral, small, bluish-white opacities in the peripheral cortex. They are typically asymptomatic and can be associated with Down's syndrome, but can also be found in normal individuals during puberty.
what mitochondrial mutation is the most common cause of Leber's hereditary optic neuropathy?
11778
what mutations cause Leber's hereditary optic neuropathy?
90% are caused by one of
11778
14484
3460
what axis to tight sutures steepen the cornea in?
same axis as the suture
what is the basic secretion test?
steps
1. instillation of topical anesthetic
2. blotting of residual film from the inferior fornix
3. application of standard filter paper strip
4. wait 5 minutes
interpretation of results
less 3mm is abnormal
3-10mm is equivocal
what is the schirmer 1 test?
NO anesthetic
wait 5 minutes
interpretation of results
less than 5.5mm of wetting after 5 minutes is abnormal
what is the schirmer 2 test?
+anesthetic
irritate nasal mucosa
interpretation of results after 5 minutes
less than 15mm after 2 minutes is abnormal
what is the most common side effect of methotrexate?
GI upset
what are the common side effects of cylcosporine?
renal toxicity
gingival hyperplasia
GI upset
what type of glands are meibomian glands
sebaceous
what type of secretion to meibomian glands use?
holocrine
what type of secretion do the lacrimal glands use?
exocrine
what type of secretion do the glands of Krauss use?
exocrine
what type of secretion do the glands of Moll use?
apocrine
what retinal antigen has been identified in cancer associated retinopathy?
CAR
what gene increases the risk of pseudoexfoliation?
lysil oxidase like protein 1 (LOXL1)
what are the largest crystallins?
alpha
what are the most predominant crystallins?
beta
what are the smallest crystallins?
gamma
what is the wavelength of the excimer laser?
193nm (ultraviolet)
what antibiotics are used for chlamydia?
azithromycin 1 gram (single dose), doxycycline 100 mg bid for 7 days, and erythromycin 500 mg qid for 7 days.
at what age will infants get sensory nystagmus if bilateral cataracts are not removed?
3m
what is the average dioptric power of the lens
15-20
what clinical feature differentiates an orbital apex process from a cavernous sinus one?
involvement of the optic nerve indicates a process in the orbital apex.
where should a soft contact lens touch the cornea?
The 3 point touch is ideal for soft contact lens fitting. It should lightly touch the corneal apex and should lightly touch at the limbus on both sides.
how many short posterior ciliary arteries and nerves enter the globe around to optic nerve?
20 arteries, 10 nerves
what is the most sensitive test for lupus?
ANA
what are the most specific tests for lupus?
anti-dsDNA, anti-Smith
what is the SUN grading scheme for anterior uveitis?
what is paradoxical inversion of the OKN response?
slow phase moves in the direction opposite of the rotating drum, dampening of the nystagmus with rotation of the drum opposite the direction of the fast jerk
this is opposite the normal response where rotating a drum in the opposite direction of the nystagmus worsens it
reversal of the OKN response only happens in congenital nystagmus
what are the three main causes of involutional ectropion
horizontal eyelid laxity
eyelid rectractor disinsertion
over-riding orbicularis
what do mutations in ABCA4 cause?
stargardts
what passes through the cavernous sinus?
cranial nerves 3, 4, V1, V2, 6, internal carotid artery and the third order sympathetic neurons
what isolated CN palsy is most likely with cavernous sinus pathology?
When only one nerve is affected, the abducens is the most commonly affected because it passes relatively unprotected through the heart of the cavernous sinus while the other nerves are protected within the tough dural wall of the cavernous sinus
what pituitary hormone is most likely ****** in septo-optic dysplasia?
GH
what glands produce mainly reflex tears?
lacrimal
how does one make a definitive diagnosis of plateau iris syndrome?
one must document a lack of change in the angle configuration after LPI.
what is the most common type of rhabdomyosarcoma?
embryonal
what kind of cataract is most commonly caused by vitrectomy
nuclear, unless silicone oil is placed. then it is PSC.
what type of cataract commonly forms in RP patients
posterior subcapsular
where is the thinnest part of the sclera?
just posterior to the extraocular muscle insertions
what can happen to the eyelid after inferior rectus surgery?
There are extensive fascial connections between the inferior rectus muscle and the lower eyelid. Inferior rectus recession can cause lower eyelid retraction and thus widening of the palpebral fissure. The opposite can occur with inferior rectus resection (i.e. lower eyelid elevation).
what exits through the foramen rotundum?
V2
what passes through the foramen spinosum
middle meningeal artery
what passes through the foramen ovale
V3
what passes through the foramen lacerum?
the internal carotid artery, the artery of pterygoid canal, the nerve of pterygoid canal and some venous drainage
what does middlebrook agar grow?
non-tuberculous mycobacteria
when is the peak onset of CME after cataract surgery
6-10 weeks
what is the strongest modifiable risk factor for the development of cataracts?
smoking
what ligament changes the angle of the levator aponeurosis?
whitnall's ligament
what is CD45 a marker for?
lymphocytes
what is lockwoods ligament?
the fusion of the sheath of the inferior rectus muscle, the inferior tarsal muscle, and the check ligaments of the medial and lateral rectus muscles. It provides support for the globe and the anterioinferior orbit.
what is the inheritance of Lisch epithelial dystrophy?
x-linked dominant
what is the difference between lisch and meesman corneal dystrophies?
Lisch and Meesmann both have intraepithelial microcysts.

The difference between these two dystrophies is that Meesmann has diffuse, evenly- spaced cysts while Lisch has broad, band-shaped, feathery lesions in whorled patterns that are more densely crowded together.
what is the optic strut?
the piece of bone that separates the optic canal from the superior orbital fissure
how much does yag capsulotomy increase the risk of retinal detachment?
4x
what is the thickness of the sclera just posterior to the rectus muscle insertions?
0.3mm
what is posterior amorphous corneal dystrophy
Posterior amorphous corneal dystrophy patients tend to have flat and thin corneas which lead to hyperopia. There is no increase in glaucoma rates. It is inherited autosomal dominantly. It presents in the first decade of life as a sheet-like opacity in the posterior cornea. These patients tend to have only minimal loss in vision and therefore corneal transplant is rarely indicated.
what is the inheritance of posterior amorphous corneal dystrophy?
autosomal dominant
what is the classic triad of rubella in the first trimester?
ocular (cataracts), auditory (deafness), and systemic (cardiac
what is the classic manifestation of rubella in the second trimester?
salt and pepper fundus.
what stains can be used for iron
Prussian blue or Perls test
what type of cataract is caused by hyperparathyroidism?
christmas tree
what is ankyloblepharon?
partial failure of the eyelids to complete developmental separation with residual strands of tissue connecting the eyelid
what is epiblepharon?
Epiblepharon is when pretarsal skin and orbicularis override the eyelid margin.
what is euryblepharon?
lengthening of the horizontal palpebral fissure and generally involves the lower lateral eyelid. It is also associated with shortening of the vertical palpebral fissure and with blepharophimosis syndrome
what is epicanthus
a prominent fold of eyelid skin perpendicular to and overlying the medial canthal tendon.
what is the treatment for toxoplasmosis?
classic regimen: pyrimethamine, sufadiazine, prednisone, plus folinic acid (because sulfonamides and pyrimethamine inhibit folic acid metabolism)
some add clindamycin to this regimen
what is dissociated nystagmus?
is a nystagmus where the amplitude of the wave form differs in each eye
what is disconjugate nystagmus?
(also known as disjunctive nystagmus) occurs when the direction of nystagmus differs between two eyes
what is the staging for DLK?
1. peripheral faint WBCs, granular appearance
2. central scattered WBCs, granular appearance
3. central dense WBCs in visual axis
4. permanent scarring or melting
what is the treatment for DLK>
stages 1-2: topical steroids
stages 3-4: lift flap, irrigate -> topical steroids; some surgeons use topical and oral steroids instead of lifting flap
what risk factors increase the risk of corneal edema after phaco?
CCT > 650
endothelial cell count less than 1000 cells/mm2
where is the thinnest part of the cornea?
1.5 mm temporal to the geographic center.
what can you do to avoid refractive error on someone with prior RK?
Clear corneal cataract incisions with RK risk hydration of the cornea and a prolonged (3 month) post operative hyperopic shift in refraction. This is why some surgeons recommend scleral tunnel incisions with post RK patients. Most surgeons will also aim myopic (-1.00sph) to avoid extended patient complaints.
when should coumadin be stopped prior to cataract surgery?
3-5 days
summarize the COMS trial?
The COMS large choroidal melanoma trial evaluated approximately 1000 patients with tumors >16 mm in basal diameter and/or >10mm in apical height and compared enucleation alone versus external beam radiotherapy followed by enucleation. The trial concluded that adjunctive radiotherapy did not impact overall survival, thus establishing that primary enucleation alone is sufficient to manage large melanomas.

The COMS medium choroidal melanoma trial evaluated over 1300 patients with tumors ranging from 6-16 mm in basal diameter and/or 2.5-10 mm in apical height. They compared enucleation versus iodine 125 brachytherapy and found that all-cause mortality and metastases at 5 years were equivalent. The secondary findings included a 10.3% local tumor recurrence rate at 5 years in those undergoing brachytherapy, which was weakly associated with reduced survival, and a decline in visual acuity to 20/200 in 43% of patients at 3 years.

The COMS small choroidal melanoma trial was an observational study of approximately 200 patients with tumors measuring 4-8 mm in basal diameter and/or 1.0-2.4 mm in apical height. It found a melanoma-specific mortality of 1% at 5 years and showed that clinical growth tended to occur in tumors with greater initial thickness and basal diameter, with orange pigmentation, without drusen or retinal pigment epithelial changes, or with “hot spots” seen on fluoroscein angiography (i.e. pinpoint areas of hyperfluorescence).
what is the size of the different goldman stimuli?
The smallest target size is 0 which equals 1/16 mm2. Every successive Roman numeral has an area 4 times the previous such that target size I = 1/4 mm2, II = 1 mm2, III = 4 mm2, IV = 16 mm2, and V = 64 mm2.
what is the order of colors in the visible spectrum?
ROYGBIV (low energy to high energy)
what is the earliest sign of anterior segment ischemia?
cell and flare
What condition should you think of in a child presenting with proptosis, an ecchymotic eyelid, and a Horner's?
neuroblastoma (rhabomyosarcoma would be without the horners)
what suture should be used for scleral fixed IOL?
9-0 prolene
how much does IOP normally vary over the coures of a day?
2 to 6 mmHg over the course of a day. A sign of glaucoma is if the IOP fluctuates by more than 10 mmHg over 24 hours.
what is the distribution of IOP in normal individuals?
non-Gaussian distribution that is skewed toward higher pressures.
what happens to IOP in pregnancy?
decreases
how much prism do you add for high reading adds?
High adds decrease the working distance. Decreasing the working distance requires increased convergence demands. To help with this, base in prism is prescribed. The general rule is to prescribe 2 diopters more of prism than add for each eye so a +10 add will need an additional 12 diopters of base in prism per eye or 24 diopters total.
when does endophthalmitis occur after cataract surgery (board answer)?
3-10 days after cataract surgery, with a median of 6 days (from EVS)
what is the optimal pinhole size?
1.2mm
What is the most common ocular manifestation of fetal alcohol syndrome?
optic nerve hypoplasia
What percentage of "microvascular" or "vasculopathic" 3rd nerve palsies demonstrate some degree of pupil involvement?
~20%
what is a hruby lens?
The Hruby lens is a high-powered planoconcave lens (-55 D) that is typically attached to the slit-lamp for convenience. Unlike most other slit-lamp biomicroscopy lenses, it gives a direct (non-inverted) image.

The disadvantage of this lens is that the field of view is very restricted (~5-8 degrees or about one disc diameter).
what is the 4:2:1 rule?
defines severe NPDR as any 1 of the following:
diffuse intraretinal hemorrhages and microaneurisms in 4 quadrants
venous beading in 2 quadrants
intraretinal microvascular abnormalities (IRMAs) in 1 quadrant
very severe NPDR is any two of the above
severe NPDR: 15% progression to high-risk PDR within 1 year
very severe NPDR: 45% progression to high-risk PDR within 1 year
any patient with sever NPDR or worse should be considered for early treatment with PRP
what is the difference between senile marginal degerenation and terrien marginal degerenation?
Senile furrow degeneration involves slight thinning of the cornea in the lucid area between the limbus and the start of arcus. It can induce astigmatism but treatment of the condition is rarely indicated.

Terrien Marginal Degeneration is generally unilateral or asymmetrically bilateral. The cornea starts to thin superiorly and the thinning spreads circumferentially. The epithelium remains intact and a fine pannus traverses the area of corneal thinning. At the end of the pannus is a line of lipid deposition. Perforation of the thinned cornea is rare. Crescent shaped lamellar transplantation can be used if perforation does occur. It generally starts in the 2nd or 3rd decade of life.
in what percentage of people do the cannaliculi combine to form a common cannaliculus?
90%
what are the relative contraindications for ICG
prior severe allergic reaction to iodide or shellfish
liver disease
metformin
what are the diagnostic criteria for AIDS>
The diagnosis of AIDS is defined by one or more of the following:
CD4 count less than 200 cells/µl
CD4 percentage of total lymphocytes <14%
presence of an "AIDS-defining" illness (e.g. Kaposi sarcoma or Pneumocystis carinii pneumonia).
What are the two most common causes for internuclear ophthalmoplegia (INO)?
The most common causes of INO in older adults is stroke. The most common cause of INO in teens and young adults is demyelination.
what is the blood supply of the optic nerve?
The blood supply to the nerve fiber layer portion of the optic nerve is by the central retinal artery.

The short posterior ciliary arteries supply blood to the prelaminar and laminar portions of the optic nerve.

The blood supply to the retrolaminar portion of the optic nerve is supplied by the pial vessels and the short posterior ciliary vessels.

The pial vessels supply blood to the proximal portion of the intraorbital optic nerve.

The central retinal artery supplies blood to the distal portion of the intraorbital optic nerve.

The ophthalmic artery supplies blood to the intracanalicular portion of the optic nerve.

Branches of the internal carotid and ophthalmic arteries supply blood to the intracranial portion of the optic nerve.
what are the four types of hyperopia?
(1) Absolute hyperopia. Minimum (non-cycloplegic) plus correction required for clear vision at distance.

(2) Manifest hyperopia. Maximum (non-cycloplegic) plus correction the eye can accept without blurring of vision.

(3) Facultative hyperopia. Manifest hyperopia - absolute hyperopia

(4) Latent hyperopia. Cycloplegic hyperopia - manifest hyperopia
what is the blood supply of the optic nerve?
The blood supply to the nerve fiber layer portion of the optic nerve is by the central retinal artery.

The short posterior ciliary arteries supply blood to the prelaminar and laminar portions of the optic nerve.

The blood supply to the retrolaminar portion of the optic nerve is supplied by the pial vessels and the short posterior ciliary vessels.

The pial vessels supply blood to the proximal portion of the intraorbital optic nerve.

The central retinal artery supplies blood to the distal portion of the intraorbital optic nerve.

The ophthalmic artery supplies blood to the intracanalicular portion of the optic nerve.

Branches of the internal carotid and ophthalmic arteries supply blood to the intracranial portion of the optic nerve.
What etiology is most common for congenital blepharoptosis?
myogenic
what stain for sebaceous cell carcinoma?
oil red O
what stains for glycosaminoglycans
Alcian blue
colloidal iron
(glycosaminoglycans are in macular dystrophy)
what is phacolytic glaucoma?
hen lens material leaks through an intact capsule of a hypermature cataract. The lens material is then taken up by macrophages. Macrophages and lens material then clog the trabecular meshwork.
what is lens partical glaucoma?
Lens particle glaucoma generally occurs when portions of the lens (mainly cortex) remain unnoticed after cataract surgery. These pieces then make their way to the anterior chamber and directly clog the trabecular meshwork.
what is Phacoanaphylactic uveitis (also known as phacoantigenic uveitis)
hen the capsular bag is violated which leads to inflammation.
what is Phacomorphic glaucoma
when the lens becomes so large that it pushes the iris forward and closes the angle.
What produces the oil portion of the tear film?
meibomian glands
what produces the aqueous component of tears
accessory glands of Krause and Wolfring
where are the glands of wolfring found?
non-marginal tarsal borders
where are the glands of krauss found?
fornices
what do goblet cells produce?
mucin
what things can be difficult to distinguish from corneal dermoids?
corneal keloids
what is saltzman nodular degeneration
Salzmann nodular degeneration is secondary to hyaline material deposited in Bowman's layer. It is generally thought to be due to chronic irritation of the cornea. It is rarely secondary to contact lens use.
Approximately how many corneal endothelial cells do you have at birth?
4,000 cells/mm2
how many corneal endothelial cells do young adults have?
3000 cells/mm2
how many corneal endothelial cells do 60 year olds have?
2,500 cells/mm2
what is the rate of endothelial cell loss?
You have approximately 4,000 cells/mm2 at birth. "Young adults" have about 3000 cells/mm2. It decreases approximately linearly till the age of 60 when you have about 2,500 cells/mm2. At that point, humans lose cells at a slower rate than when young. Thus, a 70- and 80-year-old would have more endothelial cells than you would think.
what's the differential diagnosis of cloudy cornea at birth?
STUMPED" Sclerocornea, Trauma, Ulcer, Mucopolysaccharidoses, Peters, Endothelial (CHED), Dermoid
how do you confirm the diagnosis of HIV
ELISA must yield positive results *twice* and be confirmed with a Western Blot or immunofluorescence assay.
what medications increase uveoscleral outflow of aqueous?
atropine
epinephrine
dipivefrin
prostaglandin analogs
how does dorzolamide work?
CAI that reduces aqueous production
how does timolol work?
aqueous suppressant
what does pilocarpine do for glaucoma?
increases trab outflow but *decreases* uveoscleral outflow
What is the most common orbital metastasis in men
Lung
what LHON mutation has the highest rate of spontaneous visual recovery?
14484
what is the ratio of females to males with graves
10:1
what's different about the iris vessels in Fuch's heterochromic iridocyclitis?
not associated with a fibrous membrane and do not typically lead to PAS
what IOL formula is better for long eyes
SRK/T
what does herpetic uveitis do to IOP vs uveitis from other ****?
herpetic increases, whereas others tend to decrease IOP
what SSRI is particularly associated with angle closure?
paxil (paroxetine) (all SSRIS are to some degree assocaited with angle closure due to their anticholinergic effect; paxil is the most).
what is tolosa hunt?
Tolosa-Hunt syndrome is idiopathic sterile inflammation of the cavernous sinus marked by severe ipsilateral periorbital pain along with deficits of any or all of the nerves passing through the affected cavernous sinus (CN 3,4,V1,V2,6 and the sympathetics). It is a diagnosis of exclusion after infectious causes of inflammation, lymphoma, and carcinoma have been excluded. Many patients who were previously given the diagnosis of Tolosa-Hunt are later found to have malignancies leading some experts to regard Tolosa-Hunt as a "waste basket" term used for other undiagnosed pathology.
what is the treatment for corneal microsporidia?
topical fumagillin
what dose of pilocarpine do you use to diagnose a tonic pupil?
Tonic pupils demonstrate denervation hypersensitivity by constricting with dilute pilocarpine 0.125%
what strength of pilocarpine do you use to diagnose a pharmacologically dilated pupil?
A normal pupil and pupil involving 3rd nerve palsy will both constrict to full strength pilocarpine 1% while a pharmacologically dilated pupil will not.
what happens to RK incisions when they swell?
flattening.
Why do nanophthalmic eyes tend to have complications during cataract surgery?
Nanophthalmos describes an abnormally small eye that has normal internal organization. This condition contrasts microphthalmos which is a small, disorganized eye.

Patients with nanophthalmos have high hyperopia (e.g. +8.00 D), a short axial length (e.g. 19 mm), crowded anterior segments, and thick/rigid sclera. These properties lead to constriction of blood flow through scleral vessels and predispose the eye to choroidal detachments and hemorrhages.

For glaucoma surgery, many surgeons will create prophylactic draining sclerotomies to minimize choroidal effusion formation.
what is a choreostoma?
normal tissue in an abnormal location.
what is a hamartoma?
abnormal proliferation of tissue in its normal location.
what is a teratoma?
a tumor derived from all 3 germ layers
where does muller's muscle attach?
superior border of the tarsal plate
which has more frequent and more severe corneal erosions: Reis-Buckler or Theil-Beneke?
Reis-Buckler
what chromosome in Avelino corneal dystrophy?
5q
Which subnuclei within the CN III nucleus is the only subnuclei that is fused and therefore supplies axons to muscles in both eyes?
levator subnucleii
which CNIII fibers serve the contralateral muscle?
superior rectus
what cranial nerve has the longest intracranial course
IV
what shape cornea is at risk for free cap in LASIK
flat
what shape cornea is at risk for buttonhole flap in LASIK
steep cornea
what is the inheritance of posterior polymorphous dystrophy?
autosomal dominant usually, but rarely autosomal recessive
what happens to lenses when you tilt them?
If the lens is positive, plus cyl will be added with the same axis as the tilt. If the lens is negative, minus power will be added with the same axis as the tilt.

Positive lenses will add sphere power and negative lenses will add negative sphere power.
what are the risk factors for the different types of vein occlusion>?
how much excursion does the levator provide?
12-15mm
what is the most common cause of PUK
RA
how do you differentiate PUK from Moorens?
PUK involves both the cornea and the sclera whereas Mooren's ulcer only involves cornea.
what type of secretion are meibomian glands?
holocrine
what type of secretion are goblet cells
holocrine
what type of secretion are glands of Zeiss?
holocrine
what type of secretin are the glands of wolfring?
exocrine
what type of secretion are that glands kraus?
exocrine
what type of secretion is the lacrimal gland?
exocrine
what is the FA pattern for a retinal cavernous hemangioma?
slow filling of the lesion with pooling of the dye in the upper part of the vascular space
what does PVF do to the ciliary processes
elongates them
what are cowdry bodies?
eosinophilic nuclear inclusions composed of nucleic acid and protein seen in cells infected with herpes simplex virus, varicella-zoster virus, and cytomegalovirus.
what are the most to least frequent sites for periocular BCCs?
inferior lid
medial canthus
superior lid
lateral canthus

(same as order of rectus muscle involvement in thyroid eye disease)
what percentage of people have physiologic anisocoria?
50%
what difference in pupil sizes makes physiologic anisocoria less likely?
physiologic anisocoria is almost always less than 1 mm
how do you differentiate foster-kennedy from pseudo-foster-kennedy?
FK will show only an enlarged blind spot and PFK will show a visual field defect consistent with NAION (for testing purposes you will likely be shown an altitudinal defect).
how long do migranous aureas typically last?
10-60 min
According to the Early Manifest Glaucoma Trial (EMGT), each 1-mmHg decrease in intraocular pressure was associated with WHAT PERCENTAGE reduction in progression of glaucoma?
10%
what is this blue crap in the optic nerve of a glaucoma patient?
what is this blue crap in the optic nerve of a glaucoma patient?
cavernous atrophy of Schnabel; the substance is vitreous
what type of collagen primarily makes up the corneal stroma?
type 1
what spatula is money for corneal bacterial cultures?
platinum Kimura spatula (because it heats and cools rapidly), metal blade, calcium alginate, or Dacron swab
what is the lifetime odds of developing a uveal melanoma from a blue nevus?
1:400
what percentage of glucose metabolism goes through the HMP pathway in the corneal epithelium and endothelium?
35-65%
what is the average refractive state of a newborn?
3D of hyperopia
what is the average refractive state of a 1 year old?
1D hyperopia
What is the most common cell of origin for optic nerve gliomas?
pilocytic astrocyte
what is the treatment for optic nerve gliomas?
these tumors are usually slow-growing and compatible with long-term survival, so these tumors are typically observed unless progressive visual loss or growth more posteriorly into the CNS occurs. Treatment of gliomas itself can result in vision loss in the affected eye.
how can FA be used to distinguish between AION and NAION?
non-arteritic ischemic optic neuropathy likely stems from diminished perfusion to the optic nerve head, but artertic anterior ischemic optic neuropathy is due to a vasculitis of posterior ciliary arteries supplying the optic nerve head and the adjacent choroid. Therefore, cases of arteritic ischemic optic neuropathy often demonstrate patchy choroidal perfusion on fluorescein angiography.
graves occurs in what percentage of patient with thyroid eye disease?
90%
what percentage of hyperthyroid patients will get thyroid eye disease?
30%
what bugs are associated with reactive arthritis?
Chlamydia trachomatis, salmonella, shigella, yersinia and Campylobacter
what shape of corneal infiltrates are characterstic of zoster>
nummular
what does timolol do to LDL and HDL?
increases LDL
decreased HDL
What is the average length from the posterior globe to the optic foramen in an adult?
18mm
where is the lesion in one and a half sydnrome?
pontine region which contains the medial longitudinal fasciculus (MLF) and paramedian pontine reticular formation (and CN VI nucleus).
what is Raymond-Cestan syndrome?
damage to MLF and corticospinal tracts; leads to INO + contralateral hemiparesis
what is 8 and a half syndrome?
one-and-a-half syndrome + ipsilateral facial palsy (i.e. 1.5 + 7)
what is the drainage pathway of the aqueous from the eye to the cavernous sinus?
Aqueous humor leaves the eye by passing through the trabecular meshwork and then into Schlemm's canal. From there, aqueous flows into collector channels then to deep and midscleral venous plexuses and then into the episcleral venous plexus.

The blood then drains into the anterior ciliary veins --> superior ophthalmic veins --> cavernous sinus.
what is the thickness of the anterior and psoterior lens capsules?
anterior 14 microns
posterior 4 microns
why should trifluridine (viroptic) be stopped after 14 days
toxic to epithelium and can result in neurotrophic ulcers
what glands are f'd in chalazia>
meibomian glands or zeis
what is the index of refraction of water?
1.33
What are the two most common ocular findings seen in Lowe syndrome?
congenital cataracts and glaucoma
what is the inheritance of lisch epithelial corneal dystrophy?
x-linked dominant
what is the inheritance of gelatinous droplike dystrophy?
autosomal recessive
what mutations cause gelatinous drop-like corneal dystrophy>
tumor-associated calcium signal transducer 2
what is the age of onset of gelatinous drop-like corneal dystrophy?
teens to twenties
what is the recurrence rate for gelatinous drop-like corneal dystrophy after PK?
virtually 100%
what do the numerator and denominator mean in snellen notation?
Snellen optotypes are designed so that the letter as a whole subtends an angle of 5 minutes of arc at the distance denoted by the denominator. Thus a "20/20" optotype, viewed at 20 feet, would subtend 5 minutes of arc on the observer's retina.
what is a Ferry's line?
iron line at leading edge of a filtering blead
what is a stocker line?
iron line at leading edge of a pterygium
what is a hudson stahl line?
iron line at upper border of normal tear layer
What is the location of venous drainage from post tarsal eyelid tissues?
the orbital veins, deeper branches of the anterior facial vein, and pterygoid plexus.
what is the venous drainage of the medial pretarsal tissues of the eyelid?
angular vein
what is the venous drainage of the lateral pretarstal tissues of the eyelid?
superficial temporal vein
what is the F:M ratio of thyroid eye disease
6:1
what is the difference between nanophthalmos and microphthalmos
nanophthalmos is a small eye with Normal structures, micorphthalmos is a small Messed up eye.
what is the index of refraction of the cornea?
1.376
what is the index of refraction of the aqueus
1.336
what is the index of refraction of crown glass?
1.523
what is the index of refraction of silicone?
1.438
what is the index of refraction of acrylic?
1.46
what is Meretoja syndrome?
Meretoja syndrome is also known as familial amyloid polyneuropathy, type IV or lattice corneal dystrophy, gelsolin type. As the latter name implies, it is caused by mutations in the gelsolin gene and is inherited in an autosomal dominant fashion.

Clinical findings in Meretoja syndrome include: (1) lattice corneal dystrophy; (2) masked facies; (3) lagophthalmos; (4) cranial and peripheral nerve palsies; and (5) loose skin.

In contrast to other forms of lattice corneal dystrophy, the lattice lines in Meretoja syndrome are fewer in number and involve less of the central cornea.
what is the most common medication to cause corneal vorticillatat?
amiodarone
what is the minimum refractive change allowed to be a candidate for lasik?
0.5D over one year
What are the most common tumors of the lacrimal sac?
squamous cell papillomas and carcinomas
tetracyclines are contraindicated in children less than what age?
10
what bugs cause reactive arthritis?
gram-negative bacterial dysentery (most frequently associated with Salmonella, Shigella, and Yersinia) or Chlamydia trachomatis.
where does sebaceous cell carcinoma most often present
upper eyelid?
what is the normal vertical fusional amplitude?
2PD
what are the dimensions of the nasolacrimal drainage system?
what is the treatment for gonococcal conjunctivitis?
one time dose of 1 gram of intramuscular (IM) ceftriaxone. In penicillin-allergic patients, a one time dose of IM spectinomycin or 5-7 days of oral fluoroquinolones can be used.

patients with gonococcal conjunctivitis also be treated for Chlamydia. The best treatment options for Chlamydia are doxycycline or azithromycin.
how do you adjust for toric contacts that have twisted?
A general rule of thumb is that if the mark has shifted to the Left then you add the corresponding amount of cylinder axis. And if the mark has shifted to the Right then you subtract the corresponding amount of cylinder axis. This can be remembered with the mnemonic LARS. One clock hour is about 30 degrees.
what is fleck corneal dystrophy?
Fleck dystrophy is characterized by dandruff-like deposits throughout the stroma
what is the inheritance of fleck corneal dystrophy?
autosomal dominant
what is the inheritance of CHED1?
autosomal dominant
when do clinical signs appear in in CHED1
age 1 or 2
which CHED develops nystagmus?
CHED2
which CHED is progressive and which is stationary?
CHED1= progressive
CHED2 = stationary
what is the inheritance of CHED2
autosomal recessive
what is the upper limit for ESR?
males: [age] / 2
females: [age + 10] / 2
what are the average adult corneal diameters?
12Hx11V
what causes blue scleras?
Osteogenesis imperfecta type I, Ehlers-Danlos type VI, and brittle cornea syndrome.
What is the most common quadrant for scleral rupture in an open globe caused by blunt trauma?
superonasal
what is the prismatic effect of slab-off?
base-up prism over the reading area of bifocals.
During which trimesters is rubella infection associated with sequestration of the virus in the lens and viability of the virus for months after birth?
1st and 2nd
what results from rubella infection during the 1st trimester?
cataracts, deafness, cardiac problems
what results from rubella infection during the 2nd trimester?
salt-and-pepper fundus
What is the inheritance pattern of blepharophimosis syndrome?
autosomal dominant
What type of hypersensitivity reaction is seen with scleritis?
type III (immune complex)
Where is the germinative zone of the lens epithelium?
anterior to the equator;
Epithelial cells in the germinative zone (anterior to the equator) divide and then migrate to the equator. At the equator the epithelial cells attain a very long ribbon-like shape called lens fibers.
what gene is fked in congenital stromal corneal dystrophy>
decorin (DCN)
what are teh types of hypersensitivity reactions?
Type I immune reactions are anaphylactic or atopic reactions. In these reactions, preformed IgE antibodies bound on mast cell receptors react with the antigen causing degranulation of the mast cell with histamine release. An example of a Type I reaction is allergic conjunctivitis.

Type II immune reactions are cytotoxic. This reaction is where antibodies bind to foreign antigen and activate the complement pathway. An example of a type II reaction is ocular cicatricial pemphigoid.

Type III immune reactions are also known as "immune-complex reactions." These reactions result from immune complex deposition in tissues which activate the complement and other effector systems. Examples of Type III reactions are Stevens-Johnson syndrome and scleritis.

Type IV immune reactions are delayed hypersensitivity reactions. These involve recruitment of pre-sensitized immune cells. An example of a type IV reaction is allergic contact dermatitis.
what genen is f'ked in macular corneal dystrophy?
carbohydrate sulfotransferase 6 (CHST6).
what gene is fu'ked in gelatinous drop-like dystrophy?
tumor-associated calcium signal transducer 2 (TACSTD2)
do long or short wavelengths slow more in media?
short
what enzyme is f'ked in LHON?
NADH dehydrogenase
What is the most common benign orbital tumor in adults?
Cavernous hemangiomas
What percentage of carbonic anhydrase enzyme in the eye has to be inhibited before a significant lowering of intraocular pressure (IOP) occurs?
99%
what are the main ocular effects of direct-acting muscarinic agonists?
miosis, accommodation, and contraction of the longtudinal muscle of the ciliary body leading increased aqueous outflow
After how many days does rebleeding generally occur after a traumatic hyphema?
2-7 days
what is meige's syndrome?
blepharospasm with facial dystonia
how do you calcluate the power of a piggyback IOL for residual errors?
for myopic errors the power is the same as the error
for hyperopic errors the power is 1.5 times the error
where is the thinning in keratoconus?
apex
where is the thinning in pellucid?
inferior to apex
where is the thinning in keratoglobus?
periphery
what type of anesthesia has the highest risk of globe penetration?
retrobulbar
what should you do in the event of posterior capsular rupture?
stop phaco , continue irrigation, insert dispersive viscoelastic, then remove phaco tip
what are the risk factors for expulsive choroidal hemorrhage?
hypertension
tachycardia
obesity
high myopia
anticoagulation
advanced age
glaucoma
chronic ocular inflammation
what is the inheritance of von hippel lindau
autosomal dominant
what is the inheritance of stargaardt diseaes
autosomal recessive
what is the most common cause of bacterial endophthalmitis in the united states?
cataract surgery
what is the power of the anterior corneal surface?
48D
what is the power of the posterior corneal surface/
-5.8
what HLA is most associated with VKH
DR4
what is the medial treatment of aqueous misdiretion?
intensive aqueous suppressants (e.g. beta-blockers, alpha agonists) along with <b>cycloplegics</b> (e.g. atropine) and possibly hyperosmotics (e.g. mannitol). Miotics, like pilocarpine, should <b>never</b> be used in this situation since it can make this situation worse.
What type of cataract develops most frequently in patients with atopic dermatitis?
shield-like anterior subcapsular cataracts
what is the only oral agent useful for CMV infections?
valgancyclovir
By what fraction of a wavelength of visible light is the thickness of the antireflective coating?
1/4
what uveititis treatment is contraindicated in multiple sclerosis?
TNF-alpha inhibitors (eg.g infliximab, etanercept)
what is the prefered treatment for fusarium keratitits?
natamycin
what is the preferred treatment for candida keratitis?
amphotericin
what is the preferred treatment for aspergillus keratitis?
amphotericin
what percentage of patients with the fluocinolone intravitreal implant will need glaucoma therapy?
60%
what percentage of patients with the fluocinolone intravitreal implant will need glaucoma surgery?
30%
what is the maximum dose of plaquenil?
6.5mg/kg/day
what people are at highest risk of angle closure?
hyperopes
women
asians and Inuits
what is the inheritance of posterior polymorphous corneal dystrophy?
autosomal dominant
WHY IS brimonidine contraindicnated in infants?
central nervous depression and apnea
what is the inheritance of belpharophimosis syndrome?
autosomal dominant
what is the inheritance of oculopharyngeal muscular dystrophy
autosomal dominant or autosomal recessive
what location of periocular lymphoma is least likely to be associated with systemic lymphooma?
conj
what is the inheritance of ectopia lentis e pupillae?
autosomal recessive
why don't you resect the lateral rectus in duane's
worsneing of co-contraction
what is the clinical triad of primary congenital glaucoma?
epiphora, photophobia and blepharospasm
what kind of cataracts do you get in Lowe syndrome?
disciform
which laser refracgive procedure is prone to haze?
PRK
what is mitomycin C used for in refractive surgery
to prevent haze in PRK
what is the dimer in the excimer laser?
argon-fluoride
What is the 5-year risk of contralateral involvement in patients with acute monocular non-arteritic anterior ischemic optic neuropathy?
12-19%
what do sutures do to the cornea?
flatten over hte suture, steepen central to it.
what systemic disease is associated with superior limbic keratitis
thyroid disease
what is the anatomy of the medial canthal tendon?
An upper and a lower limb fuse. Then the tendon splits into an anterior and posterior limb. The anterior and posterior limb go around the lacrimal sac. The anterior limb inserts on the anterior lacrimal crest. The posterior limb inserts on the posterior lacrimal crest.
what is the smallest size corneal perf that can be treated with glue?
<3mm
what chlamydia serotypes cause trachoma?
A-C
what chlamydia serotypes cuase neonatal inclusion conjunctivitis?
D-K
what chlamydia serotypes case lymphogranuloma venerium?
L1-L3
What is the most common cause of chronic angular blepharitis?
Moraxella lacunata
what is cogan's syndrome?
Cogan syndrome is an autoimmune disorder that produces stromal keratitis, vertigo, and hearing loss. The etiology of the syndrome is unknown, but it shares features with polyarteritis nodosa. The earliest corneal findings include bilateral, faint, white, subepithelial infiltrates in the peripheral cornea. Later, multifocal nodular infiltrates may develop in the posterior cornea.
What is the suppression dose of acyclovir that was used to prevent recurrence of herpes simplex epithelial keratitis in the HEDS (Herpetic Eye Disease Study) study?
acyclovir 400 mg PO BID
what is WAGR syndrome
syndrome is an autosomal dominant condition seen in 13% of aniridia patients that includes Wilms tumor, aniridia, genitourinary abnormalities, and mental retardation.
what is Gillespie syndrome?
an autosomal recessive form of aniridia that is associated with cerebellar ataxia and mental retardation occurring in 2% of patients with aniridia.
where do conjunctival melanomas metastesize to?
lymph nodes
what is kestenbaum's rule?
the reading add in a low vision pt should be the inverse of the BCVA (i.e. 20/40 = 4/2 = +2)
what are the risk factors for suprachoroidal hemorrhage?
The classic risk factors predisposing to a suprachoroidal hemorrhage include:

advanced age
myopia
arteriosclerotic cardiovascular disease
aphakia
glaucoma
hypertension
tachycardia

Too: tachycardia
Much: myopia
Alcohol: advanced age
Gives: glaucoma
A: aphakia
Heart: hypertension
Attack: atherosclerotic cardiovascular disease
What is the stimulus used in short-wavelength automated perimetry (SWAP)?
size V blue
does terrien's marginal degeneration have loss of epitheliyum
no
does PUK have loss of epithelium
yes
does mooren's ulcer have loss fo epithelium?
yes
what are the feilds of action of the extraocular muscles?
A muscle’s "field of action" is the position of gaze in which the muscle is the primary mover of the eye (e.g. cardinal directions of gaze).
A muscle’s "field of action" is the position of gaze in which the muscle is the primary mover of the eye (e.g. cardinal directions of gaze).
Which of the following general anesthetic agents can lower the intraocular pressure in a child?
halothane
what is vossius ring?
truama causes iris to smash against the lense and leave pigment deposit
retinal dialysis is most likely in what quardrants?
inferotemporal or superonasal