Ocular Disease

Front 1

What causes a cherry red macula?

Back 1

CRA occlusion
Tay Sach's disease (formation of residual bodies, which are lipofuscin accumulating in lysosomes)

Front 2

What diseases involve mitochondrial DNA

Back 2

Kearns Sayre syndrome (myopathy due to mitochondrial DNA deletions with ragged red fibers)

Leber's hereditary optic neuropathy (optic nerve disease mitochondrial DNA mutations. Late teens early 20s, central VA loss)

Front 3

What can cause nystagmus
(3 diseases)

Back 3

Albinism, aniridia, achromatopsia

Front 4

Ocular ischemic syndrome:
-age group and gender
-cholesterol or heart or HTN or diab?
-where are hemes in eye?
-blockage of what artery?

Back 4

- 65 yo male
- high cholesterol
- midperipheral hemes
- carotid and/or ophthalmic artery

Front 5

Tolosa-Hunt Syndrome:
What causes the diplopia?

Back 5

Carotid-cavernous fistula (communication between artery and vein)

Front 6

Histoplasmosis:
-infecting agent
-triad

Back 6

-fungus
1) peripapillary atrophy
2) punched out peripheral lesions
3) maculopathy

Front 7

Toxoplasmosis vs toxocariasis vs histoplasmosis

Cause?
Where in retina?

Back 7

Toxoplasmosis: parasite, cat litter
Toxocariasis: ingestion of larvae from dog or cat
Histo: fungus

Toxo starts in retina & can spread to choroid; Histo starts in choroid & can spread to retina

Front 8

Which tests are treponemal?
Nontreponemal?
Which are used to test Tx efficacy?
Which are positive for life?

Back 8

Treponemal: FTA-ABS, MHA-TP, HATTS
Non-treponemal: RPR, VDRL

TTreponemal TTrue for life (all have T in them)
Non-treponemal: measures Tx.

Front 9

HTN:
What is in stage 3?
Stage 4?

Back 9

3-heme, CWS, hard exudates (out of vessels)
4-ONH swelling

Front 10

Alcoholism and the optic nerve

Back 10

Toxic optic neuropathy: bilateral temporal nerve pallor
-ONH goes straight from healthy to dead (primary optic atrophy). Secondary opt atrophy gets edematous first then dies

Front 11

Corneal abrasion Ddx: ulcer, marginal keratitis

Staining & defects

Back 11

-K abrasion: stains but no SEI
-Ulcer: Epi defect & SEI
-Staph Marginal Keratitis: SEI with no epi defect

Front 12

Commotio Retinae

Back 12

White patches in retina with history of recent trauma (photoreceptor outersegment disruption). Usually asymptomatic but if in macula results in acute vision loss and is called Berlin's edema

Front 13

Hyphema strong associations:

Back 13

Trauma, sickle cell, clotting disease, NSAIDS, Vossius ring (pigment ring on lens from pupil), Angle recession (60%).
-Elevate head at 30 deg

Front 14

8-ball hyphema

Back 14

Black, fills entire ant chamber. B-scan, if idiopathic test blood (PT/PTT) Prothrombin, partial thromboplastin, sicklecell if AA or mediteranian. Always inquire about NSAID/aspirin

Front 15

Orbital floor fracture

Back 15

-Crepitus (crackle/pop when blowing nose)
-Entrapped inferior rectus (limit upgaze)
-Damage to infraorbital nerve (touch cheeks and compare)
-Don't blow nose for 48 hrs (infection)

Front 16

Common causes of preseptal cellulitis

Back 16

Hordeolum (#1), dacrocystitis, skin trauma(insect bite)

Front 17

Orbital cellulits

Back 17

-Common cause of exophthalmos in kids
-Hx of fever, *sinus(ethmoid)/dental infection, trauma
-Staph (adults), influenza(flu) (kids)
-Diabetics/Immunocompromised can develop mucormycosis(fungus) leads to black eschar (mouth, nose)

Front 18

Ddx orbital from preceptal

Back 18

Preceptal:no fever, proptosis, EOM restriction, increased pain with eye-movement

Front 19

Normal exophthalmometry readings:

Back 19

Whites:12-22
Blacks:12-24
Asians:12-18
Assymetry <4mm

Front 20

Thyroid eye disease (TED)

Back 20

"NO SPECS"
-Females
-Kocher's sign (the stare)
-Von Graefe's sign(lid lag during downgaze)
-Corneal exposure (SPK,SLK)
-Inferior rectus first, then medial
-Inflammation at orbital apex>nerve damage

Front 21

Carotid Cavernous Fistula

Back 21

-Abnormal communication between artery and vein.
-Increases cavernous sinus pressure, backing up veins and decreasing outflow from orbit>**Pulsatile proptosis, redness, chemosis, CN6 palsy, bruit

Front 22

Cavernous Hemangioma

Back 22

**Most common benign orbital tumor in adults
-Unilateral proptosis (tumor post. to globe)

Front 23

General symptoms of Orbital Tumors

Back 23

APD, progressive decrease in VA, progressive proptosis (unilaterl)

Front 24

Capillary Hemangioma

Back 24

**Most common benign orbital tumor in children (capillaries are small, kids are small)
-Usually diagnosed early because of strawberry cutaneus lesions
-70% are gone by age 7

Front 25

Rhabdomyosarcoma

Back 25

"RhaBD-rapid bone descruction"
-**Most common primary malignant pediatric orbital tumor
-Tumor of mesenchyme (bone)

Front 26

Neuroblastoma

Back 26

**2nd most common overall malignant tumor in peds (after Rhabdo)
**Most common secondary pediatric tumor
-Usually kid already has abdomen cancer
-Lid ecchymosis (kid who was suspected of being abused)

Front 27

Meningioma

Back 27

**Most common benign brain tumor
-Middle aged women
-Slow vision loss, proptosis nerve swelling, APD, diplopia

Front 28

Most common intracranial tumor to spread to orbit

Back 28

Sphenoid meningioma

Front 29

Primary orbital meningiomas classic triad:

Back 29

1-VA loss
2-optic atrophy
3-optociliary shunt vessels (connect choriod with retina)

Front 30

Dermoid Cysts

Back 30

Normal tissue in abnormal location
(definition of choristoma)
-GOLDENHAR's syndrome (ocular dermoid, skin tag, vertebral dysplasia)

Front 31

optic nerve glioma
(juvenile pilocytic astrocytoma)

Back 31

-Age 2-6
*Most common intrinsic tumor of optic nerve
-50% association with neurofibromatosis
type 1 (lisch nodules, fibromas, cafe aulait spots)

Front 32

Orbital pseudotumor

Back 32

-Similar to thyroid eye disease (20-50, unilateral, proptosis) but also has sudden pain and inflammation of periorbit (chemosis, lacrimal, hyperopic shift)
-Idiopathic inflammatory process
-If bilateral, raise suspicion for systemic vasculitis (Wegeners granulomatosis, Polyarteritis nodosa) or lymphoma

Front 33

Tolosa-Hunt Syndrome

Back 33

-Idiopathic inflamm dz (dx of exclusion; "Hunt" for a ddx)
-Inflammation of Cavernous sinus (CN 3,4,5i,5ii,6) resulting in possible paresis of these nerves

Front 34

Ocular rosacea

Back 34

-Common, middle aged women of european ancestry
-Telangetasia, rhinophyma(huge nose)
-**Triggers (food, sun, alcohol, spicy food)

Front 35

Contact Dermatitis
Type 1,2,3,4?

Back 35

Type 4 delayed hypersensitivity reaction

Front 36

Ocular cicatricial pemphigoid

Back 36

-Autoimmune damage to mucous membranes
-Symblepharon (eyelid-eyeball)
-Ankyloblepharon(eyelid-eyelid)
-Can be drug induced (beta blocker timolo, pilo)

Front 37

Dermatochalasis

Back 37

-Weakend orbital septum allows prolapse of fat
-Redundant upper eyelid skin

Front 38

Chalazion

Back 38

-sterile inflammation of meibomian gland
-ask about acne rosacea, seborrheic dermatitis

Front 39

Hordeolum

Back 39

Acute staph infection of meibomian glands (internal) or zeis/moll (external)

Front 40

Ectropion

Back 40

-out turning of lid
-mechanical (tumor)
-cicatricial
-paralytic (Bell's palsy)
-congenital
-involutional (age related)

Front 41

Entropion

Back 41

-can cause keratitis to pannus
-can be caused by Tracoma
-classically caused by lashes growing posteriorly or Distichiasis (second row of lashes from meib glands)

Front 42

Floppy eyelid Syndrome

Back 42

**Obese men with sleep apnea
-Spontaneos upper lid eversion and pillow exposure

Front 43

Benign Essential Blepharospasm

Back 43

*Bilateral
-spasms of orbicularis, procerus, corrugator
-80% preceeded by episodes of incr blinking
-often accompanied by DES
-if also suffers lower face abnormalities>Meige's syndrome
-Myokymia=UNIlateral twitching (not closure) or orbicularis oculi

Front 44

Basal Cell Carcinoma

Back 44

-More common in males 2:1
-**Most common eyelid cancer (90%)
-Most common: nodular form with small firm shiny pearl
-"rodent ulcer" is late sign
-Surface telangetasia
-lower lid, UV exposure

Front 45

Squamous cell carcinoma

Back 45

-2nd most common eyelid cancer (50x less)
-erythematous Plaque
-Often derived from actinic keratosis
-lower lid more common

Front 46

Actinic Keratosis

Back 46

-Premalignant elevated pink scaly lesion on sun-exposed skin
-*MOST common pre-malignant skin lesion

Front 47

Sebaceous Gland Carcinoma

Back 47

*Bad boy of lid
**Recurrent chalazion
*unilateral bleph
-madarosis, lymphadenopathy
-Arises from meibomian glands

Front 48

Malignant Melanoma

Back 48

Extremely rare but are most lethal primary skin cancer

Front 49

Keratocanthoma

Back 49

-Initially similar to BCC or SCC, then they grow quickly, then involute/resolve.
-Cutaneous horn

Front 50

Common causes of nasolacrimal duct obstruction

Back 50

Involutional Stenosis (older people)
Membranous blockage of valve of Hasner (younger)

Front 51

Dacryocystitis

Back 51

-occurs when duct is plugged,
-Always shows as swelling below medial canthal tendon
-if above tendon could indicate tumor
-If chronic, suspect cancer
*don't irrigate/refer untill tx started

Front 52

Canaliculitis

Back 52

-Unresponsive to AB tx
-Swollen ("pouting") puncta
-Discharge with palpation
*Most common cause Actinomyces Israeli bacteria

Front 53

Dacroadenitis

Back 53

*S-shaped ptosis
-Most common is chronic
(inflamm: *sarcoid, TB, graves)
-Acute: bacteria, virus, fever
-Rule out tumor with biopsy

Front 54

Jones 1 test

Back 54

Fluorescein is instilled, after 5 min eye is examined for NaFl, if it's gone and patient has NaFl in throat/nose that equals (+)test. Positive for flow.
-If (-) perform Jones 2

Front 55

Jones 2 test

Back 55

-Irrigate, if saline comes back out same punctum= canalicular blockage
-If saline comes out other punctum=nasolacrimal blockage

Front 56

PAM (primary acquired melanosis)

Back 56

-Elderly white pts
-Pre-malignant (30%)
-Biopsy
-Anywhere on conj, sketchy borders

Front 57

Conjuctival nevus

Back 57

Benign, suspicious if on cornea, tarsal conj, or fornix

Front 58

Conjuctival Melanoma

Back 58

-Arise from PAM 75% or nevus 20%

-Primary indicator of malignancy is thickness

Front 59

Conjuctival squamous Papilloma

Back 59

-Benign tumor from HPV human papilloma virus
-Often resolve on own

Front 60

Conjuctival Intraepithelial Neoplasia (CIN)

Back 60

**Most common pre-cancerous lesion on globe (leads to SCC)
-95% at limbus
-Gelatin mass with neo

Front 61

Conjuctival Squamous Cell Carcinoma

Back 61

-Rare, slow moving malignant tumor
-Arises from CIN

Front 62

Conjuctival Melanoma arises from what?
Squamous cell carcinoma from what?

Back 62

PAM>Melanoma
CIN>Conjuctival SCC

Front 63

Simple Bacterial Conjuctivitis

Back 63

-Very acute onset (hour)
-Usu kids; rare in adults
-Usually staph
-Mucupurulent discharge
-Eyes stuck together in morning

Front 64

Gonococcal Conjuctivitis

Back 64

-Bact; hyperacute onset (minute)
-Purulent discharge, *pseudomembrane, *preauricular lymph nodes (usu only occurs w/viral)
-N. gonorrhea can invade intact cornea
-Urethral discharge in men, 50%asymptomatic in women

Front 65

Adenoviral Conjuctivitis

Back 65

-Adults
-Nodes
-One eye then other
*Follicles
-Divided into 3 subtypes

Front 66

Classic adenovirus syndromes (3)

Back 66

1-Acute non-specific follicular conjunctivitis: most common
2-Epidemic Keratoconjunctivitis (EKC): adults, **SEI's
3-Pharyngoconjunctival fever (PCF): kids, "swimming pool cojunctivitis," triad-fever, pharyngitis, conjunctivitis

Front 67

Molluscum Contagiosum

Back 67

-DNA pox virus
-If multiple, consider HIV
-Dome-shaped waxy nodule

Front 68

Allergic Conjuctivitis

Back 68

-Papillae, chemosis
-Itching (if itch, burn, sting=dry eye)
-Type 1 allergic response

Front 69

Papillae

Back 69

-Central vessel
-Eosinophils, mast cells, neutro, lymphocytes
-Allergic, bacterial (pABillae)

Front 70

Follicles

Back 70

-Avascular
-White/grey
-Immature *Lymphocytes/macrophages
*Chlamdia, toxic, viral

Front 71

Vernal Keratoconjuctivitis (VKC)

Back 71

-Very rare
-8yo asthmatic male with huge freakin papillae on lid eversion, happens every spring
-Intense itching
-*Trantas dots(limbus), Cobblestone papillae, shield ulcer (cornea)

Front 72

Atopic Keratoconjuctivitis (AKC)

Back 72

-Young adults(20-40) w/hx of atopic dermat
-Prominent eyelid/periorbital involvment
-*Dennie's lines (extra fold on lower lid)
-Papillae more common inferiorly
(unlike VKC,GCP)

Front 73

GPC giant papillary conjuctivitis

Back 73

-Contact lens use, suture, ocular prosthetic
-Itchy, *ropy, decrease CL tolerance
-Upper tarsal (sup pannus, SLK)
-CL: deposits(allergenic), material,
sln tox (SPK, classic: follicular conjunctivitis)

Front 74

Chlamydia

Back 74

-Bacteria, but can cause nodes (PAN)
-Chronic red eye
-Heavy folliclulosis, inf fornix
-Painful urination

Front 75

Opthalmia neonatorum

Back 75

Acute conjuctivits in newborn, usually chlamydia

Front 76

Chlamydia Trachoma

Back 76

-Leading cause of preventable blindness worldwide
-Chronic follicular conjuctivitis
-Spread by housefly
-Arlt lines (white horizontal lines on
superior tarsus)
-Herbert's pits (limbal from resoltn of
limbal follicles)
-Leads to scarring & entropion/trichiasis

Front 77

Look up & pull down lid=
Look down and pull up lid=
(most frequently missed, easiest to dx)

Back 77

Chlamydia
SLK

Front 78

SLK

Back 78

-Thickend red superior bulbar conj
-Symptoms worse than signs (like acanthomeba)
-Think thyroid disease or CL wear

Front 79

Phlyctenulosis

Back 79

-Lymphocytic nodule
-Delayed hypersensitivity rxn
-Bleph(staph), TB, acne rosacea

Front 80

Ligneous conjuctivitis

Back 80

-Plasminogen deficency (catalyzies breakdown of fibrin)
-Woody

Front 81

Parinaud's oculoglandular syndrome (cat scratch fever)

Back 81

*Granulomatous
-Huge lymph nodes
-Cat scratch, tularemia (rabbit)

Front 82

Pediculosis

Back 82

-Angry eyelids
-Lice, nits
-Caused by Phthirus pubis

Front 83

Pterygium

Back 83

-Destroys bowman's
-ATR astigmatism
-Stocker's line (iron)

Front 84

Episcleritis

Back 84

-Sectoral redness, usu unilateral, no pain
-Can be simple (80%) or nodular (20%)
-Nodular can be moved slightly
-* self limiting
-Idiopathic 60%
-Diseases (40%) RA, acne r., HZ

Front 85

Scleritis

Back 85

-Females
-Diffuse & nodular more common than necrotizing
-Necrotizing with inflammation deadly
-Necrotizing without inflammation (Scleromalacia Perferans) is usu from chronic RA.
-**Severe ocular pain**Bilateral
-Granulomatous inflammation (RA, wegener's)

Front 86

Anterior Uveitis

Back 86

-Pain, redness, photophobia
-Post synechiae, periph ant. synech, CME
-Non-gran: above and maybe fine KP
-Granulomatous has above with large KP (mutton fat, Koeppe/Busacca nodules)
-70% are idiopathic
-Decr IOP (CB stuck)

Front 87

Acute non-granulomatous uveitis

Back 87

-"ARG BIL"
-Ankylosing spondylitis(lower back pain)
-Reiter's syndrome (triad, **pee)
-IBS (Crohn's,ucerative colitis)
-Behcet's (asian, hypoyon, mouth ulcers)
-*Lyme (tick bite, arthritis, *Bell's palsy)
-Glaucomatocyclitic Crysis (mild iritis with recurrent iop spikes 30-40mm)

Front 88

Chronic non-granulomatous uveitis

Back 88

-JRA: RF-,ANA+
-Fuch's Heterochromic iridocyclitis: cataract in young patient(30-40), mild cells, change in iris color, *no symptoms

Front 89

Chronic Granulomatous Uveitis

Back 89

Sarcoid: AAF, ACE, chest xray
TB: PPD (15,10,5), chest xray
Herpes:
Syphilis: Maculopapular rash (hands&feet), Interstitial keratitis, VDRL, RPR, FTA-ABS

Front 90

Drugs that induce uveitis

Back 90

Rifabutin (TB)
Sulfonamides
Cidofovir (Antiviral for CMV)

Front 91

Posterior Uveitis

Back 91

-Rashes, tick bites, AIDS, MS River valley
-Floaters, decreased vision
-WBC in vitreous (snow globe)

Front 92

6 diseases that cause post uveitis

Back 92

Toxoplasmosis
Histoplasmosis
Sarcoidosis
Syphilis
Pars Planitis
Cytomegaloviris

Front 93

Toxoplasmosis
(post uveitis)

Back 93

-*Most common cause of uveitis in USA
-One big lesion, headlight in fog, cat poop
-Parasite Toxoplasmas gondii

Front 94

Histoplasmosis
(post uveitis)

Back 94

*triad*
1-Peripapilary atrophy
2-Punched out lesions
3-Maculopathy (often neo)
-MS river valley or bird/bat droppings
-Fungus
-*chorioretinitis, no vitritis (toxo)

Front 95

Sarcoidosis
(post uveitis)

Back 95

-Candle wax drippings (sheath vessels)
-Cotton ball opacities

Front 96

Syphilis
(post uveitis)

Back 96

-Salt and pepper fundus
(Salt y Pepper)
-Flame-shaped hemes
-Great mimic

Front 97

Pars Planitis
(post uveitis)

Back 97

Snow banking on inferior pars plana

Front 98

Cytomegaloviris
(post uveitis)

Back 98

-Immunocompromised
-White patches of necrotic retina, heme
-Lots of blood, little cells (vs. toxo:lots of cells, PORN:minimal of both)