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130 Cards in this Set
- Front
- Back
Dellen |
-Depression; reversible
-Dehydration/thinning of cornea adjacent to raised corneal/limbal lesions (ptyrigium/bleb) |
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Exposure Keratopathy
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-Eyelid issue that leads to K problem
-Incomplete lid closure -Bell's palsy (CN7) -Thyroid -Lagophthalmos -Floppy eyelid syndrome |
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Filamentary Keratopathy
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Chronic inflammation (ie dry) of cornea leads to strands of epithelial cells in mucous form (like rubbing hands together)
-Filaments will stain |
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Superficial Punctate Keratitis
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-Epithelial defects
-Most common causes: DES, BAK preservative (Travatan Z has no BAK), aminoglycosides (mean to K) |
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Preservative: Thimerosal
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-Mercury
-Toxic -Don't use more than 3 weeks -In Viroptic |
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Thygeson's superficial punctate keratopathy
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-U R a HERO if you dx this
-Recurrent episodes of foreign body sensation (6-12 yrs) with no inflam/redness -Intraepith crumb-like opacities in central K |
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Neurotropic Keratopathy
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-CN5v1 damage leads to desensitization and delayed corneal healing
-Corneal FINDINGS are worse than symtoms -Hx: stroke, herpes, diabetes |
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Recurrent Corneal Erosion
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-Past K abrasion (especially wood,fingernail) or ABMD (Cogan's) leads to poor adhesion
|
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Thermal/UV keratopathy
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-Welding, Skiing, Sunlamp
-Worse 6-12 hours after incident |
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Dry eye dx (how much wetting?)
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PRT (phenol red thread) and Schirmer's: 10mm in 5 minutes
If unanesthetized, Schirmers = 15 mm |
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Keratoconus
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-See it at puberty (eye now full-grown)
-Frequent eyeglass changes -50% had topical allergies as kid -Fleischer's ring -Vogt's striae (stromal vertical lines) -Munson's sign=downgaze, lower lid -Hydrops=ruptured Descemet's |
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Systemic causes of Keratoconus
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"TDOME"
Turner Down's Ostiogenesis imperfecta Marfan's Ehlers Danlos |
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Iron deposits in cornea:
Fleischer's ring Hudson Stahli lines Stocker's line Ferry's line Kayser-fleischer ring |
Fleischer's -base of cone
Rust ring-foreign body Hudson Stahli- benign line, lower K of elderly Stocker's-ptergium Ferry-Bleb Kayser-fleischer- copper from **Wilson's disease (liver); causes cataracts at young age (hepatolenticular degen) |
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Pellucid Marginal Degeneration
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-*Kissing doves,Crab claws
-Inferior corneal thinning -Early adult-hood (not puberty like keratoconus) -High ATR |
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Which of the following can happen in pellucid and keratoconus:
Fleischer ring Hydrops Scarring Vogts striae |
Pellucid: only hydrops
Keratoconus: everything |
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Which K dystrophies are Autosomal Dominant and Autosomal Recessive?
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All are AD except Macular Dystrophy
|
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Anterior Basement Membrane Dystrophies (names)
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-Most common K dystrophy
-Weak/abnormal adhesion between epithelium and basement menbrane -ABMD, Map-dot, EBMD, Cogan's -50% of patients with K erosions have ABMD |
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Meesman's Dystrophy
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-Ant K dystrophy (epithelium)
-1st year of life -100's of cysts |
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Reis-Buckler
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Anterior K dystrophy
Bowman's replaced with collagen |
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Four types of Stromal dystrophies and respective substance
|
Marilyn Monroe got high in Los Angeles Sniffing Fat
Macular-mucopolysaccaride Granular-hyline Lattice-Amyloid Schnyder-Hyperlipedemia |
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Macular dystrophy
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-Stromal K dystrophy
*Only autosomal recessive (Mac Daddy=different from others) -Most severe stromal dystrophy -Mucopolysaccharide deposits within stroma (cloudy cornea) |
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Granular Dystrophy
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-Most common stromal dystrophy (Gr = Greatest)
-Hyline deposits in central stroma |
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Lattice Dystrophy
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-Stromal K dystrophy
-Lattice-like lines of amyloid deposits in stroma |
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Schnyder's dystrophy
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-Stromal K dystrophy
-Ring of crystals in central stroma -Associated with hyperlipidemia |
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Fuchs Endothelial Dystrophy
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Older women
Endothelial guttata, edema (Guttata in periph=Hassal-Henle) Pleomorphism(shape), Polymegathism (size) Increased Pachs At birth: 3,000 endoth cells Age 70: 2,000 Edema: 500 |
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Posterior Polymorphous Dystrophy
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-*Early in life
-Patches of vesicles -Typically benign -Can get secondary angle closure (15%) from metaplasia of endoth cells growing into angle |
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Megalocornea
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-X-linked (males)
-Horizontal diameter of 13mm (11.7 is normal) -High myope -Lens/glaucoma problems -Connective tissue dz: Marfans, Ehlers-Danlos syndrome, osteogenesis imp |
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Microcornea
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-Diameter less than 10mm
-Hyperope, glaucoma (shallow angle) |
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Haab's Striae
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Horizontal cracks in Descemet's from increase IOP
-Congenital glaucoma |
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Posterior Embryotoxin
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Anteror displaced Schwalbe's line
(glaucoma risk) |
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Axenfeld's Anomaly/Syndrome
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Anomaly=posterior embryotoxin+prominent iris strands
50% develop glaucoma (syndrome) |
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Rieger's anomaly
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Posterior embryotoxin + Axenfeld's + displaced pupil/iris atrophy
-50% develop glaucoma |
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Reiger's Syndrome
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-Anomaly + Mental retardation and skeletal abnormalities
-50% develop glaucoma (Axenfeld syndrome) |
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Progression of diseases for line/strands/glaucoma/iris/pupil?
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PARR
Post Embr = line Axen anom = strand (syndr=glaucoma) Rieger's anomaly = pupil/iris Rieger's syndrome = body |
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Peter's anomaly
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-Central corneal opacity with iris adhesions
-50% glaucoma |
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Aniridia
|
75% glaucoma
Foveal hypoplasia Chorodial coloboma |
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Limbal dermoid
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Dense connective tissue that is commonly located at inferotemporal limbus
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Bacterial Keratitis
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-Most common etiology of infectious keratitis (*aka ulcer)
-*Infiltrate w/ overlying epi defect (ulcer) |
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Gram(+) bacteria
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Staph, Strep, Clostridium, Corny, antrax
|
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Bacteria that can penetrate intact epithelium
|
"Canadian Professional National Hockey League" CPNHL
Corneybacterium diphtheriae Pseudomonas aeruginosa Neisseria gonorrhea Haemopilis Listeria |
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Fungal Keratitis
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-Feathery edges
-Plate on Sabouraud's agar Three main risk factors: 1-Trauma involving vegetable matter 2-Long-term steroids use 3-Chronic ocular surface dz (dry eye, neurotrophic keratopathy) |
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What fungus is part of normal flora?
aspergillus fusarium candida pneumocystis pneumonia |
Candida
|
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Acanthamoeba Keratitis
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-"I can't believe ya" (acanthamoeba) would do that w/your CLs
*-Pain is greater than signs suggest (looks like SPK but more pain)* -CL hygiene (tap water, swiming) -Ring ulcer (late finding, transplant time) -Culture in heat killed e.coli plate |
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HSV
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-Edges of ulcer stain well with rose
-Center stains w/fluorescein -*Disciform keratitis (disc shaped stromal keratitis due to endothelitis and edema) -Interstitial Keratitis -Giemsa stain culture>giant cells -If epithelium is intact>steroids -Stromal scarring = decr acuity -#2 cause of corneal blindness (#1=trauma) |
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HZV
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-Reactivation of chicken-pox virus
-If young, think imunocomp. -*Prodrome (fever, malaise, tingling) -Post herpetic neuralgia BAD pain -Hutchingson's sign=higher risk of ocular involvment (nasociliary nerve of CNV) -*No terminal bulbs (stuck-on appearance) -*The entire lesion stains with rose and poorly with NaFl (HSV stains edges with Rose, all with NaFl) |
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Interstitial Keratitis
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Stromal swelling without primary involvment of epi or endo.
**Syphilis 90%** -*Triad:Saddle nose, hutchinson's teeth, Frontal bossing (signs of congenital syphilis) |
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3 disease that cause Peripheral Ulcerative Keratitis (PUK)
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Mooren's ulcer
Staphylococcal Marginal Keratitis Collagen vascular disorders (RA, lupus, Wegener) |
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Mooren's Ulcer
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-Vasculitis of Limbal vessels>necrosis>ulcers
-Independant of systemic disorder -Mid-stage ulcer with overhanging edge (think, Jared Moore cliff hanging) -Unilateral, benign, older |
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Staph marginal keratitis**
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-Immune-mediated result of under-treated chronic bleph (staph)
-Multiple stromal infiltrates with no epi staining (Infiltrate is sign of immune system, NOT infection) |
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Corneal signs of Collagen vascular disorders
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-RA, Lupus, polyarteritis nodosa, wegener granulomatosis)
-Peripheral corneal thinning (that's where the antibodies can access) -Associated scleritis/episceritis -K sicca |
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Terrien's Marginal Degeneration
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-Men over 40
-Progressive thinning in periphery -ATR astigmatism -Only one that starts superiorly |
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Salzmann's nodular Degeneration
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-Female predilection
-Blue-grey stromal opacities (nodule) -Seen with K sicca |
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Band K
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-Gout, hypercalcemia, JRA, iritis
-Calcium deposits like "swiss cheese" on anterior surface of bowmans |
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Corneal Arcus
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-Lipid deposition on bowmans and decemet's
-Unilateral arcus *Carotid Disease* -If under 40 lipid profile is warranted |
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Corneal graft rejection
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Khodadoust line-endo (WBC; dd=endo)
Krachmer's spots-stroma Type 4 hypersensitivity |
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Absolute counterindications for refractive sx
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<21yo, refractive instability, keratoconus, contact lens warpage, immunosuppression (systemic steroids), active HSVeK, Connective tissue disease, unrealistic expectations
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Potential complications of LASIK (laser in situ keratomileusis)
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Ectasia (keratoconus), DLK (diffuse lamellar keratitis), higher incidence of dry eye
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Potential complications of PRK (photorefractive keratectomy)
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Regression, glaucoma (steroids), corneal haze
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Potential complications of RK (radial keratotomy )
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(radial incisions) Hyperopic shift, diurnal fluctuations
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NS
-Refractive error shift -Etiology |
-Myopic shift, "second sight"
-Diffusion of glutathione from aqueous to nucleus of lens diminishes w/age |
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Cortical
-Refractive error shift |
Hyperopic shift
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PSC
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Affect near vision more than distance
-systemic steroids -X-rays |
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Presenile Cataracts
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DM, myotonic dystrophy (PSC christmas tree), wilson's, hypocalcemia, *atopic dermatitis*
Get MAD about cataracts early in life |
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Tramatic cataracts - clinical manifestation
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Vossius ring
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Toxic cataracts
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Chlorpromazine: stellate cataracts
Amiodarone: deposits Miotics: vacuoles Gold salts: gold deposits |
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Disease that can cause lens subluxation
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Marfan's (up and out), Ehlers-danlos, homocystinuria
|
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Most serious complication of Marfan's
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RD
(also superotemporal lens sublux) |
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When measuring axial length to determine IOL power for cataract surgery, 1mm represents how many diopters?
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3 D
|
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Drug C/I before sx
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Anticoagulents, Tamsulin (flowmax), prostaglandins
|
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Acute postoperative bacterial endophalmitis
-Prognosis -Infecting agent |
1/1000, 50% go blind in that eye
-Staph epidermis -Hypopyon -Occurs within days |
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PCO (after-cataract)
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-2-6 months after sx
-Elschnig pearls (type of PCO in children) |
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Post Sx Cystoid Macular Edema
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-Called Irvine-Gass syndrome
-Happens in 6-10 weeks -Can be prostaglandin-induced |
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Asteroid hyalosis
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-Unilateral 75%
-Usually asymptomatic -Calcium-phosphate soaps |
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Synchysis Scintillans
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-Golden brown cholesterol crystals that often settle in inferior vitreous
-Occurs after chronic uveitis, vitreous heme, trauma |
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PVD
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-Prevalence approximates age (50yo=50%, 75yo=75%)
-Acute onset of floaters, flashes of light, decreased VA -Weiss ring -Tobacco dust (Shafer's sign) w/retinal break -10% have RD |
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Vitreous Heme
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-Diabetes**
-Trauma, HTN, BRVO, PVD, ARMD, Sickle, -Pre-retinal is boat-shaped |
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What systemic conditions can cause tractional detachments?
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Diabetes, sickle cell ret, ROP, Ocular ischemic syndrome, vascular occlusion
|
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Does a CRVA or a CRVO release VEGF?
Ischemia vs hypoxia? |
CRVO: sick retina can release VEGF
CRAO: dead retina can't release VEGF Ischemia is reduced blood flow, which results in hypoxia. However, hypoxia can occur if blood has insufficient O2 |
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CRVO
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-All 4 quadrants
-Collateral veins can form over weeks-months and drain retina to choroid -Usu involves artery compressing vein (due to HTN, DM) -90-day glaucoma from NVI -Ischemic=10DD of non-purfusion, 20/200 or worse -Non-ischemic 20/40 or better -Concern: Macular disease (isch, edema, ret heme), Neo (heme, glaucoma, RD, vitr heme) |
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BRVO most common quadrant
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-Superior temporal
-Most common vasc occlusive dz -Concern: same as CRVO (macular ischemia/edema, neo) |
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CRAO
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-White in all 4 quadrants
-HTN 67% -Emboli are usually (1)*calcific from heart (2) Hollenhorst cholesterol from carotid -CRAO more common than BRAO -20/400 or worse unless cilioretinal artery is present (15-20% of population; from choroid) -APD, cherry red spot *Narrowed arteries may be only sign patient had CRAO -Giant cell arteritis, collagen vascular disease, sickle |
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BRAO
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90% involve temporal
-Mostly Hollenhorst -Leave permanent VF defect when resolve |
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Diabetic Ret
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-Leading cause of new cases of blindness in US in ages 20-74
**-NEO in DM is always pre-retinal -Damage to pericytes -Snowflake cataracts -Worry about: 1-Macular edema/ischemia 2-Neo:pre ret hemes, tractional ret detatchmnt, NVI/glaucoma |
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Rule of 4-2-1
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Patient is labeld severe NPDR (10-50% develop PDR in 1 year) if they have one or more:
4)severe hemes in 4 quadrants 2)venous beading in 2 quadrants 1)Irma in 1 quadrant |
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Proliferative diabetic ret
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5% of diabetics have PDR (95% NPDR)
Vitreous or preret hemes, tractional RD, neo, glaucoma |
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Treatment for PDR is delayed untill High Risk Characteristis (HRC)are shown, what are they?
|
1)NVD greater than 1/4 DD
2)Any NVD/NVE with vitreous or pre-ret heme |
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CSME criteria
|
-Most common reason for legal blindnes in Diabetic Ret
-To be diagnosed with CSME, one of the following must be present: 1)Thickening within 1/3DD of foveal center 2)Exudate within 1/3DD 3)Thickening of at least 1DD within 1DD |
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Hypertensive Ret
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-Vessels constrict (autoregulate) to decr flow
-Vision is usually unaffected unless macular edema (macular star - exudates) serous RD, vein occlusion, papilledema |
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HTN Ret grading
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1) Increased light reflex, narrowing
2) Nicking 3) Hemes, CWS, exudates 4) Papilledema, macular star Color shows at 3 |
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Retinal macroaneurysm
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-Circinate exudates
-60+ yo women -HTN/atherosclerosis |
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Ocular Ischemic Syndrome
|
-65 yo man
-Gradual vision loss, pain, amaurosis fugax -Unilat midperiph dot/blot -NVD, NVI -Atherosclerosis, Arteritis |
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Amaurosis Fugax
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1) Monoc vision loss (seconds to minutes)
2) Carotid artery embolus |
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Coats
|
-8yo boy with unilateral leukocoria (ddx retinoblastoma, ROP), strab
-Tons of exudates (can lead to exudative RD) |
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ROP
|
-Born less than 36 weeks
**Temporal retina subject to neo and tractional RD -Temporal retinal vessels develop around 9mo |
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ARMD
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-Chief cause of vision loss in 50+ Caucasians
-Dry:asymptomatic or gradual VA loss, *drusen, mottling, -Worst form of dry ARMD: Geographic atrophy -Wet:Sudden, distortion (amsler) PED can happen w/dry or wet |
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Pathophysiology of Dry and Wet AMD
|
Dry: disease of RPE, Bruch's, and choriocapillaris
Wet: abnormal RPE and choriodal neovascular membrane (CNV) w/subret fluid |
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4 types of leakage associated with wet ARMD
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1)Sub-RPE heme:grey-green
2)Sub-RPE detachment: plasma under RPE (also called **PED); can happen in dry or wet 3)Sub retinal heme 4)Sub retinal detachment (plasma-serous retinal detatchemt) (2 fluids, 2 potential spaces) |
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4 big risk factors for dry going wet?
|
*multiple soft drusen
*focal hyperpigmentation HTN smoking |
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Central Serous Choroidopathy
|
-Type A middle aged men
-Sudden unilater vision loss/metamorphopsia -Bruch's breakdown -40% recurrence -Macular serous detatchment -Fluorescein angiography: gradual pooling or smokestack -Self-resolve 1-3 months |
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Histoplasmosis
|
-Whites, Ohio/MS valley
-Fungus -30% recurrence -Chorioretinitis (no vitritis like toxo) *Triad: 1) Peripapillary atrophy 2) Punched out lesions 3) Maculopathy (CNV) |
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High myopia
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>6D
-Axial length> 26mm -Oblique insertion of disc 1) Fuchs' spots (hyper pigmentation) 2) *Lacquer cracks (yellow streaks) 3) *Macular holes 4) Posterior staphyloma |
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Lacquer cracks
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Fine yellow lines that represent large breaks in bruch's
-Neo can occur |
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Epiretinal membrane
|
-Glial cells from retina grow out a hole in ILM
-Contraction of membrane can wrinkle retina -Mild=cellophane -Severe=pucker -Cause: PVD, RD, sx, trauma idiopathic |
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Macular Hole
|
-Women (...)
-Round red spot, vision 20/200 -Stages:1)yellow, 2)hole/pseudo operculum, 3)hole with operculum, 4)hole+detatchment -PVD, if other eye already has PVD no risk |
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Cystoid macular edema
|
-Post cataract sx (Irvine-Gass)
-Prosaglandin induced |
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Macular Photostress Test
|
-Look at light for 10 sec
-Time to read 1 line less than BVA -Should be <1min |
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Retinitis Pigmentosa
(triad) |
-Dominates (*Autosom Dom) periph & central
-Usually heritable but also associated with Usher's syndrome (hearing loss) 5% -*Most common retinal dystrophy -Night blindness/tunnel vision -By 30yo 75% are symptomatic -Triad: bone-spicule pigment, arteriolar attenuation, waxy optic disc pallor |
|
Cause of RP?
Testing? Retinal signs centrally? |
Cause: progressive loss of RPE
Test: ERG (scotopic reduced) Signs: CME, ERM, mac holes, PSC |
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Stargardt's
|
-Typically diagnosed between age 6-20
*Vision loss out of proportion to fundus appearance. -Most common hereditary macular dystrophy -Fundus flavimaculatus (stargardt's without macula involvment) Signs: -Yellow flecks shape: pisciform (fish tail) -*Beaten-bronze macular pattern -Salt and pepper pigment changes (syphilis) -Dark choroid |
|
Differentials for bull's eye maculopathy
|
Stargardt's, cone dystrophy, chloroquine/hydroxychloroquine, thioridazine toxicity
|
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Best's Disease
(Vitelliform dystrophy) |
-"Best macular dystrophy to have until 50 yo"
-"Who has the best egg (eog)" -Young 5-10yo -Bilateral, Yellow round egg yolk lesion (lipofuscin in RPE) under fovea; scrambled egg = bad -CNV -Abnormal EOG. Normal ratio (light peak:dark trough ratio) is 1.8; Best is about 1 |
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Gyrate Atrophy
|
-Young, by 10
-Night blindness (nyctalopia) -Scalloped areas of periph chorioret atrophy -Deficient in mitochondrial enzyme ornithine aminotransferase |
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Rhegmatogenous Retinal Detatchments
|
-RD caused by hole/tear
-Floater, flashes, curtain -Demarcation line>chronic RD |
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Signs and causes of Rhegmatogenous RD
|
Signs: undulating retina, Shafer's sign (pigment cells; aka tobacco dust), low IOP
Causes: atrophic holes, vitreo-retinal traction tears (PVD), weaker connection between RPE and photoreceptors |
|
*LATTICE DEGEN*
|
-*Found in 6-10% people
-Only 1% of people w/lattice will develop RD -Bilateral, temporal, superior |
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Non-Rhegmatogenous
|
-Tractional from Proliferative DB ret
-Serous from ARMD |
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Retinoschisis
|
-Splitting of outer plexiform layer
-4-7% general population >40yo -Dome shaped bullous elevation located inferior/temporal that doesn't move (not RD) -Absolute VF defect -May have retinal breaks (outer or inner) |
|
Angiod Streaks
|
"PEPSI"
-Pseudoxanthoma elasticum is most common cause -Streaks from the disc like spokes -Elastic layer of Bruch's membrane |
|
Risk factors for POAG:
|
-IOP: only one we can control
-Race: Afr Am 4-5x more likely -Family history: 16% -Age -Thin corneas |
|
POAG
|
-IOP >21 mm Hg
-If damage at lower IOP=normal tension gl -Signs: focal vertical thinning, notching, NFL defect, C/D ratio, drance heme |
|
Port-Wine Stains
|
Vascular birthmarks highly associated w/ipsilateral glaucoma (45%).
Rarely associated w/systemic disorders (Sturge-Weber Syndrome) |
|
Pseudoexfoliation Syndrome
|
-Caucasians, Scandinavian decent, 60 yo
-White, flaky amyloid deposits on pupil margin, lens capsule, TM -Sampaolesi's line: pigmentation on Schwalbe's line (also seen in pigment dispersion syndrome) -Happens in older people (epithelial cells and BM get old and release stuff) |
|
Pigmentary Dispersion Glaucoma
|
-Caucasians, 30 yo
-High ant chamber pressure causes iris to bow posteriorly, zonules scrape off pigment (50% develop glaucoma) -Signs: transillumination defects, Krukenberg's spindle (vertical pigment line), TM pigment, Scheies line (pigment on lens) |
|
Normal Tension Glaucoma
|
-NFL/VF damage at lower pressures (<21)
-Before dx, take diurnal IOP readings -Signs similar to POAG but drance heme (splinter heme) is more common -Ddx: myocardial infarction, anemia, syphilis, vasculitis |
|
Primary Angle-Closure Glaucoma
|
-Acute or subacute (intermitten)
-Periph iris pushes anteriorly, blocking TM -Cause: lens growth w/age -Cause: mid-dilated pupil, highest risk after dilation and pupil constricts to mid position -2 causes: pupillary block (more common; hyperopes) and plateau iris syndrome -Vomit, intense oc pain, HA, halos, nausea -Lower IOP (50-100) and do PI -Greatest threat: CRAO |
|
Glaucomflecken
|
Type of cataract (anterior subcapsular opacities from lens epith ischemia) associated with previous primary angle-closure glaucoma
|
|
Neovascular Glaucoma
(Secondary Angle-Closure Glaucoma) |
-Cause: CRVO, Diab, CRAO (ret ischemia)
-Sign of neovasc glaucoma: rubeosis of iris -Examine pupil margin for neovasc tufts -Neo in angle makes fibrovasc membrn, impedes aqueous outflow |
|
Uveitic Glaucoma
(Secondary Angle-Closure Glaucoma) |
-Cause: periph ant synechiae, post syn
-Iris inflammed & sticky (adheres to TM/lens) |
|
Glaucomatocyclitic Crisis
|
A type of Inflammatory Glaucoma
(Secondary Angle-Closure Glaucoma) -aka Posner-Schlossman syndrome -Cause: acute trabeculitis -40-60 IOP, angles open -Recurrent unilat attacks |
|
Fuch's Heterochromic Iridocyclitis
|
A type of Inflammatory Glaucoma |