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142 Cards in this Set
- Front
- Back
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Crouzon syndrome |
most common FGFR2 gene NO syndactaly AD |
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How much temporal lobe can be resected without visual field deficit? |
2.5 CM |
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Reverse eyes --> miosis after pharmacologic miosis |
Dapiprazole DOES NOT return accomodation though, just constricts pupil |
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Iris melanoma |
Signs = documented growth, sectoral cataract, glaucoma, ectropion, INFERIOR/IT location Lower mortality than ciliary or choroidal melanoma |
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TED |
orbital FIBROBLASTS produce glycosaminoglycons (hyaluronan) --> EOM hypertrophy |
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Inner nuclear layer |
Mullers cells + bipolar cells + horizontal cells + amacrine cells --> all have cell bodies in INL Muller cells cause ILM |
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Toxocara |
Nematode, from dogs to humans Needs topical/ocular steroids |
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Photoreceptors |
Rods - discs are inside, 9 + 0 cilia Cones - discs are attached to cell membrane |
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Alagille syndrome |
butterfly hemovertebrae, mild dev delay, jaundice, cardiac defects, posterior embryotoxon AD, JAG1 gene |
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Oculodermal melanocytosis |
10% glaucoma 1/400 uveal melanoma Abotu 1/2 have V1, V2 hyperpigmentation |
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How to decrease the risk of CNV while doing lasers |
Large spots Low duration Low intensity |
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Trichoepithelioma |
Flesh colored papule with overlying telangietasias. Can be confused with BCC |
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Pilomatrixoma |
Reddish purple subq mass attached to overlying skin |
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Trichofolliculoma |
Solitary and sometimes umbilicated lesion |
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Trichollemmoma |
looks like a verruca |
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Rhodopsin |
Chr 3 Opsin + 11-cis retinaldahyde Made by photoreceptors, on the plasma membrane of OUTER segments Most sensitive to 510 nm! 11-cis is photolyzed to 11-trans --> activates transducin --> hyperpolarization of cell and signal is sent to brain In the meanwhile, 11-trans is transported to RPE and changed back to 11-cis Mut in chr 3 in P23H = RP |
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FAZ |
greater than 1000 microns = risk of vision loss |
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Foveola |
350 microns All cones 4mm temporal, 0.8mm inferior to ON Parafovea = around fovea, 0.5mm wide Perifovea = outermost of fovea, 1.5mm wide |
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Lens |
alpha = biggest, 1/3 of lens beta = most abundant, 55% of lens Gamma = 15% |
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Y-sutures |
anterior Y Posterior inverted Y |
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Orbit dimensions |
30 cm in volume medial walls are parallel, lateral walls are at ___ angle to each other. The medial walls are 25cm from each other Widest section of orbit = 1cm posterior to anterior orbital rim |
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Arteries from ophthalmic artery |
CRA - first branch off ophthalmic artery Long posterior ciliary - 2 of them from ophthalmic artery (supply anterior choroid) Short posterior ciliary - 20 of them, enter the eye as a ring around ON (supply posterior choroid) Anterior ciliary artery - 7 arteries. 2 for each muscle except LR (only 1) - forms major arterial circle along with long post ciliary artery (supplies ciliary body and iris) |
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Eyelid arterial supply |
Lateral - lateral palbebral artery from lacrimal artery Medial - medial palpebral artery from dorsal nasal artery Anastamosis creates marginal and peripheral arcades |
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Venous drainage |
Medial = angular vein Lateral = superficial temporal vein |
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Nerve supply |
All basically from V1 Frontal = supraorbital/supratrochlear Lacrimal = lateral eyelid + lacrimal + conjunctiva Nasociliary artery - long ciliary nerves (parasympathetic) supply cornea, iris, ciliary body Short ciliary nerves (10 of them) are from ciliary ganglion (sympathetic) |
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Types of laser |
Photocoagulation = laser --> heat --> coagulation (PRP) Photoablation = ablate tissue without damage to adjacent tissue (excimer laser) Photodisruption = rupture tissue (YAG or PI) |
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Giant cells |
Langhans - horseshoe shaped ring of nuclei on edge of cell Touton giant cells - ring of nuclei surrounded by foamy ring of lipid - xanthogranuloma FB giant cell - randomly associated |
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Sporadic wilms tumor |
higher risk for wagr syndrome r/o wilms tumor with renal US |
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Cystinosis |
Intralysosymal cystein accumulation - crystals in cornea and retinal pigment changes 3 forms 1) Benign 2) Late onset 3) Nephropathic --> only one with retinopathy Tx is cysteamine |
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CHED |
CHED1 - AD, shows up 1-2 years later, slowly progressive, no nystagnos CHED2 - AR, at birth, nonprogrssive, + nystagmus |
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Optic nerve hypoplasia |
Double ring sign Can be part of de morsier syndrome - absence of septum pellucidum and hypopituitarism GH deficiency = most common |
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DUSN (diffuse unilateral subacute neuroretinitis) |
subretinal nematode - baylisascaris in the midwest (racoon) - ancylostoma (dog) elsewhere Unilateral RP like appearance Treatment with photocoagulation |
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EOM anatomy |
Enters the spiral of tillaux 10mm posterior to its insertion nerve inserts 1/3 muscle length posteriroly 2 ant ciliary arteries except LR, just one |
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Diabetic retinopathy study |
Pts with PDR were randomised to PRP vs obs - decreased severe vision loss by 50% in those with high risk PDR High risk PDR = NV + VH, NV >=1/3rd nerve Defined PRP technique |
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Multiple new seborrheic keratosis |
called Leser-Trelat sign, can be a sign of GI adenocarcinoma |
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Muir-Torre syndrome |
multiple sebaceous neoplasms Can have GI or GU tract camcers |
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Erdheim Chester disease |
eyelid involvement of xanthogranuloma --> foamy histiocytes and touton giant cells |
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Rules about EOM surgery |
LR always needs more treatment than MR For 15D correction, you do 3mm on MR, 4mm on LR Maximum treatment is 6mm on MR, 8mm on LR |
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Pilocarpine |
Direct muscirine agonist Causes accommodation, miosis, increased aqueous outflow |
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Craniosynostoses |
Mildest = saethre chotzen - plagiocephaly, ptosis, mild brachydactyly, mild syndactyly. Lateral deviation of big toes. Mutation of TWIST Crouzon = AD, intellegence is nl Apert = crouzon + syndactyly + some MR Pfeiffer = AD, syndactyly, short broad thumbs and toes |
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Retinoschisis
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Can be distinguished from RRD by 5 things - (1) smooth dome (2) absence of vit pigment, (3) absolute scotoma, (4) reacts to photocoagulation, (5) absence of subretinal fluid Usually IT Senile is in outer plexiform later Hyperopia |
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Basal cell carcinoma |
Most common eyelid cancer (nodular first) lower > medial > upper > lateral Histopathology - "peripheral palisading" of basal cells |
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Brown syndrome vs IR resection |
both will have deficient elevation with adduction Brown will be worse during retropulsion |
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Childhood common tumors |
Orbital - common benign = capillary hemangioma or benign cystic lesions - common malignant = rhabdo Ocular - common benign - common malignant = Rb |
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Waardenburg syndrome |
1) Dystopia canthorum - puncta laterally displaced 2) white lock 3) |
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Tuberous sclerosis |
AD, hamartin or tuberin genes Retinal astrocytic hamartoma Zits (facial angiofibroma) Fits (seizures) Gits (MR) |
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Golderhar syndrome (oculoauriculovertebral syndrome |
IT limbal dermoids Ear deformities Upper eyelid coloboma Vertebral anomalies |
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Sinuses and drainage |
Anterior and middle ethmoid - middle meatus Posterior ethmoid - superior meatus Maxillary - middle meatus Frontal - frontoethmoidal recess --> middle meatus Sphenoid sinus - sphenoethmoidal recess Nasolacrimal duct - inferior meatus |
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Ophthalmia neonatorum |
Chemical - first 24 hours Gonorrhea - 2-4 days, lots of purulence Chlamydia - 7 days HSV - 14 days, rare |
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Aicardi syndrome |
XD Triad of CR lacunae + absence of corpus collosum + infantile spasms |
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Canalicular system |
puncta = 2 Canaliculi = 8 Lacrimal sac = 12-15 NLD = 18 |
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Wavelengths of light |
Rhodopsin most sensitiv eto 510 nm Excimer laser 193 nm Femtosecond 1053 nm Nd:Yag 1064 nm |
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Bones of the orbit
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Roof - frontal + lesser wing of sphenoid Medial - lesser wing of sphenoid + maxillary + ethmoid + lacrimal Floor - maxillary + palatine + zygomatic Lateral - zygomatic + greater wing of the sphenoid |
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Dilators |
Tropicamide, atropine, and cyclo = anticholinergics = dilate + cyclopleg Phenylephrine = a-1 adrenergic AGOnist |
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Most common immunoglobulin in tears |
IgA |
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Fibrillenstuktur |
en plaque + saccades |
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Felderstrukter |
Pursuits + en grappe tonic slow muscle fibers |
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Selective beta blocker |
Betaxolol - beta-1 selective blocker Carteolol - intrinsic sympathomimetic activity |
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Tear drainage test |
1) Dye disappearance test - put in flouroscein and check in 5 mins if its gone 2) Jones I test - put in flourescein and nasal swab at 2 and 5 minutes for dye in nose 3) Jones II - irrigate the lacrimal system and collecting fluid in the nose with a swab |
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Embryologic origin of structures
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Neural crest: corneal stroma, iris stroma, endothelium, Tm, all of sclera except for temporal portion Surface ectoderm: corneal and conj epithelium, lens, lacrimal drainage system Neuroectoderm: RPE, retina, ON/axon/glia Mesoderm: EOM, iris sphincter or dilator, temporal portion of sclera |
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Blood supply to ON |
RNFL - CRA
Laminar and pre-laminar - short post ciliary art Retrolaminar - pial vessels and short post ciliary Proximal portion of intraorbita - pial Distal portion of intraorbital - CRA Intracanalicular - ophthalmic artery Intracranial - internal carotid and ophthalmic art |
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Hering's law |
Equal and simultaneous innervation to synergistic muscle (ex RLR, LMR) DVD violates hering's law |
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Hering's law in paralytic strabisbus |
Primary deviation = normal eye fixating Secondary deviation = paralytic eye fixating Secondary deviation > paralytic deviation |
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Sherrington's law |
Innervation to ipsilateral antagonist decreases as innervation to agonist increases Duane's syndrome disobeys this |
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Angle kappa |
angle between visual axis and anatomic axis + angle kappa = ROP, toxocara. Eye looks rotated temporally, therefore light reflex nasally - angle kappa eye rotates nasally, therefore light reflex temporally |
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Rough estimate of deviation |
Krimsky - put a prism in front of abn eye till light reflex symmetric Hirshberg - each mm of decentration from center of pupil (1mm = 15D deviation) |
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Congenital nystagmus |
Dampened by convergence Exponentially increasing velocity of slow phase Absent during sleep Associated with cong eye diseases Reversal of OKN drum Tx: base out prism - forces pt to converge --> dampens nystagmus |
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Congenital vs latent nystagmus |
Cover 1 eye - latent is worse Reversal of OKN with congenital Dampens with convergence - congenital Increasing slow phase - congenital |
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Latent nystagmus |
Cover one eye, uncovered eye develops nystagmus, with fast phase towards uncovered eye Exponentially decreasing velocity of slow phase Monocular VA worse than binocular VA Associated with esotropia, DVD |
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Alexander's rule |
Nystagmus intensity increases when looking towards fast phase, decreases when looking at slow phase * adduction nulls |
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Spasmus nutans |
Triad of (1) dancing eye movements, (2) torticoillis, (3) head bobbing
Image brain looking for chiasmal pathology Usually resolves by age 3 |
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Periodic alternating nystagmus |
horizontal nystagmus that changed direction every 60-90secs - always observe for at least 2 mins Congenital - albinism Acquired - cervicomedullary jx abn |
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High AC/A ratio |
More eso at near than distance by at least 10D 2/2 increased convergence - measure AC/A by checking near by putting +3 lens - measure AC/A after patching eye for 30-min - Formula = (with lens - without lens)/lens used --> normal can be 3:1 to 5:1 Can treat with phospholine iodine --> can accommodate without convergence |
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Nystagmus blockade syndrome |
Because congenital nystagmus improves with convergence, pts often converge --> can look at eso. Diagnose by covering one eye (adduction continues even with one eye covered), look for other signs of covergence |
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Echothiopentolate (phospholine iodine) |
used to treat high AC/A esotropia Do not use succinylcholine - can prolong anesthesia Can lead to iris cyst formation, can alleviate by using phenylephrine drops at same time |
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Bielschowsky phenomenon |
As light in fixating eye is decreased, DVD in other eye decreases. Converse is also true |
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Red lens phenomenon |
Red image ALWAYS below white lens if the patient has true DVD no matter which eye the red lens is held in front of |
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DVD |
Often happens with congenital ET. Can have associated IOOA + Bielschowsky and red lens phenomenon Treatment: SR recession, IR resection, IO weakening or ant transposition if IOOA present * perform bil sx - unilat sx can manifest latent DVD in other eye |
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Alkaptonuria |
AR Urine darkens on standing Difficulty processing tyrosine and phenylalanine Can have black deposits on muscle insertion high dose vit C can help kid with arthropathy |
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Aqueous humor |
Excess of: H, Cl, ascorbate Deficient: bicarbonate, protein |
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Most common leukemia to the orbit |
ALL |
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How long do you have to stop wearing CTL before lasik eval? |
Soft non-toric - 3 days to 2 weeks
Soft torics - at least 2 weeks Rigids - 2-3 weeks + 1 mo for every 1 decade of wear |
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Repairing canaliculus after trauma |
One canaliculus only = 10% have CONSTANT epiphora, 40% have INTERMITTENT epiphora |
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Phaco terms |
POWER = length tip moves/total it can move LOAD = surface area that material is in contact with DUTY CYCLE = proportion of time phaco was used CAVITATION = bubbles at phaco tip |
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MEWDS |
F, unilateral Usually following URI grey-white dots at RPE level, + APD, + vitritis, +disc swelling FA with "wreathlike hyperflorescence) Resolves spontaneously |
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Leading cause of blindness in age 20-64 |
US: diabetic retinopathy World: cataract |
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Nevus of conjunctiva |
Junctional - epithelial/subepithelial junction only Compound - epithelial/subepithelial location Subepithelial - dermal only |
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Marcus-gunn jaw winking |
synkinesis between CN III and V If eyelid opens with jaw opening, then its external pterygoid and levator synkinesis If eyelid opens with jaw closing, then its internal pterygoid and levator |
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Congenital stromal corneal dystrophy |
AD Mutation in decorin gene Non/slowly progressive Central corneal whitish flakes = moderate vision loss |
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Hunter syndrome |
XR pigmentary retinopathy, posterior spokelike cataracts, comma shaped conj aneurysms |
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why do people lose accommodation? |
lens becomes hard with age and can't bulge forward anymore |
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VEGF involved in NVAMD |
VEGF 165 |
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Eye inflow and facility |
Aqueous humor formation 2 microL/min Outflow facility = 0.2-0.3 microl/min/mmHg |
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Reis Buckler |
AD, TGFBI gene (keratoepithelin) Bowmans is replaced by sheetlike connective tissue Electron microscopy - sawtooth pattern of bowmans. **Curly fibers only in thiel behnke Epithelial erosions more important in Reis |
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Peak sensitivity for rods and cones |
Rods - 505 nm
Cones - 555 nm |
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ERG |
ERP - outer segment of photoreceptors a-wave - photoreceptors b-wave - muller and bipolar cells c-wave - RPE |
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Photopic testing with ERG |
Cone function Flickr ERG - 30 flashes/sec (only cones respond but rods can't recycle rhodopsin that fast) |
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Scotopic testing with ERG |
30 minute dark adaptation
Then you can do testing |
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ERG in various diseases
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CRAO - normal a, absent b Ischemic CRVO - normal a, reduced b wave RP - increased implicit time Cone dystrophy - abnormal flicker ERG XL retinoschisis - reduced bwave MEWDS - decreased a wave Chalcosis - reduced amplitude Achromatopsia - no cone fx, normal rod fx Lebers congenital amaurosis - flat ERG |
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Psittacosis |
"Bird fanciers disease" - chlamydia psittaci Chronic follicular conjunctivitis equal in upper and lower palpebral conj Tx with doxy 100 bid |
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Pantoscopic tilt |
Tilt along 180 degree axis --> cyl around 180 deg, sign of cyl same as sign of sphere. Sphere changes in the direction of the sign of sph
Ex: -10 lens with 180 deg tilt induces negative cyl in 180 degree axis, with -11sph |
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Choroidal melanoma
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T > 2mm F - SRF S - + sxs O - + orange pigment M - margin within 3mm of ON U - ultrasound hollowness H - lack of halo D - absence of drusen |
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TINU (tubulointerstitial nephritis and uveitis) syndrome
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bil nongranulomatous uveitis Systemic sxs, usually first before eye sxs tx with pred usually recovers kidney/eye sxs HLA-DQ + HLADR14 associated |
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Pedunculated vs sessile lesions |
Pedunculated - HPV 6 and 16 Sessile - HPV 16 and 18 |
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Most common type of congenital cataract |
Lamellar or zonular cataracts |
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Color deficit inheritence |
All color defects are XR EXCEPT
Tritanomalous/opia - AD Rod monochromatism - AR |
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Optic disc drusen associations
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RP and PXE Usually in caucasians |
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Ocular tilt reaction |
(1) Head tilt towards hypotropic eye (2) Skew deviation (3) Bil torsional deviation (hypertropic eye usually INtorted) Ex: R hyper, worse in L gaze and R headtilt BUT with R incyclotorsion, L excyclotorsion |
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Oculocutaneous albinism
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Tyrosine-neg oculocutaneous albinism - both skin/fundus/iris pigmentless and no increase over age Tyro-pos albinism - some pigment Foveal hypoplasia with poor VA Think about Chediak-higashi and hermansky puldak |
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AREDS |
1. Vit C (500), vit E (400), Zn (80), bcarotene (15), Cu (4) 2. Lutein/zeazanthine + LUSFA |
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GPA analysis |
based on EMGT Uses two prev fields to figure out if there is progression |
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Nystagmoid eye movements |
Square wave jerk Opsoclonus Ocular flutter SO myokymia |
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Nystagmus associations |
Downbeat - cervicomedullary jx See saw - craniopharyngioma Opsoclonus - neuroblastoma PAN - cervicomedullary jx Upbeat - brainstem |
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Ideal pinhole size |
1.2mm |
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Wilson disease |
AR
Classic eye findings: sunflower cataract (Cu on ant capsule of lens), KF ring (peripheral descemets) *decreased serum ceruloplasmin Sx tx: penicillamine |
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What pituitary tumor most often presents with ON chiasm compression |
1) Non-secreting tumors 2) Prolactinoma |
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Kestenbaum procedure |
Surgery to treat head turn --> move the eyes towards head turn to bring null point closer to center
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Harada Ito procedure
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Used to improve excyclotorsion in CN4 palsy --> SO tendon is split, ant fibers are moved anteriorly and laterally
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EKC - usually adenovirus 8 |
Small conj hemorrhages
Preauricular LAD Pseudo or true membranes SEIs (7-14 days after start of eye sxs) |
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Delayed healing after LASIK/PRK
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Delayed epithelial healing - antihistamines, sumatriptan, HRT Delayed stromal healing - amiodarone, accutane |
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FAZ > _____ micros generally means vision loss
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1000 microns |
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Chromatic aberration |
Uses the principle that light with shorter wavelength is slowed more than light with longer wavelength
Used in duochrome test (RAM GAP) |
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Four steps of the astigmatic dial technique
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1) Fog eye to 20/60 2) Ask which line of the astigmatic dial appears darkest and sharpest 3) Add minus cyl perpendicular to axis, plus cylinder parallel to axis until all lines are similar 4) Reduce sphere till chart vision is clear * for + cyl, subtract 0.25D of sph for 0.5 cyl added |
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UV radiation = ____ type of cataracts |
cortical cataracts |
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Treatment for microsporidia |
Fumagillin |
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ATP pump on lens |
on anterior capsule Pumps Na out, K in |
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Brachytherapy vs External beam radiation |
Radiation retinopathy - 3035 Gy - happens earlier in brachytherapy than EBT |
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Nevus vs freckle |
Nevus - derived from undifferentiated melanocytes at epidermal/dermal border - compound - both epithelial/subepithelial - junctional nevus - at epidermal/dermal border - Intradermal - dermis Freckle - melanocytes producing too much pigment |
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How to clean a goldmann tonometer? |
Can clean goldman with 1) household bleach 2) hydrogen peroxide 3% 3) isopropyl alcohol 70% |
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Dorsal midbrain syndrome |
1) Upgaze paralysis 2) Defective convergence 3) Pupillary light-near dissociation 4) Convergence retraction "nystagmus" 5) Eyelid retraction ("colliers sign) |
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Epikeratophakia |
Taking a donor cornea, carving out the exact shape, then attaching it to recipient cornea |
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Munnerlyn Formula |
Ablation depth = optical zone square * D of tx/3 |
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Post-LASIK infectious keratitis organisms |
<10 days - gram positive bacteria >10 days - atypical mycobacteria |
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Risk factors for trab failure |
Young pts AA aphakia/pseudophakia prev conj scarring active inflammation or NV |
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Naso-orbito-ethmoidal fracture |
Fracture of lacrimal crest - the medial canthus looks like its avulsed but its actually a bone problem --> need to treat fracture first |
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Congenital iris ectropion syndrome |
iris ectropion, high iris insertion, smooth iris surface, glaucoma associated with NF, reiger anomaly, prader-willi syndrome |
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needle used for subtenons triamcinolone |
25 guage 5/8th inch needle ST quadrant |
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Tyrosinemia |
ARdefect in tyrosine aminotransferaseelevated tyrosine in blood and urine, normal ph
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Transpupillary thermoplasty |
Uses infrared light (~800 nm) Very little damage to adjacent tissue Used to treat choroidal melanomas |
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Which drug causes drug-induced lupus |
Infliximab
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Which layer is the macular star? |
Outer plexiform layer Occurs with bartonella (GNR) |
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Most common organism on EVS trial |
70% were staph epidermidis |
