Ocular Disease I, Ii And Iii Part Ii

Front 1

what part of the retina do you tend to see cystoid degeneration in

Back 1

superior temporal quadrant. it starts at the ora, but can go all the way to the equator with age.

Front 2

is cystoid degeneration usually unilateral or bilateral

Back 2

usually bilateral and symmetrical

Front 3

describe the epidemiology of cystoid degeneration

Back 3

Common in children over age of 8 but progresses

Front 4

describe the pathophysiology of cystoid degeneration

Back 4

Cystoid spaces between retinal layers (outer

Front 5

is there an increased risk of retinal detachment with cystoid degeneration

Back 5

no

Front 6

is cystoid degeneration associated with any other ocular conditions

Back 6

retinoschisis

Front 7

what is the difference between a retinal detachment and retinoschisis

Back 7

RD is when all of the layers of the retina detach from the RPE. retinoschisis is when there is a cutting of the fibers at the inner nuclear layer or the outer plexiform layer.

Front 8

what is the difference between white with and without pressure in terms of management

Back 8

nothing. they are pretty much the same. the only difference is that one occurs with out pressure from scleral indentation and one does not.

Front 9

describe the orientation of lesions from white with and without pressure

Back 9

Usually parallel to ora

Front 10

can you see the retinal vessels over a white with or without pressure lesion

Back 10

yes, they stand out

Front 11

why is white with or without pressure commonly misdiagnosed as a retinal detachment

Back 11

because of the change of color, the lesion appears elevated. it is actually not elevated at all. -there would be no flap if you did scleral indentation though

Front 13

how common is white with or without pressure

Back 13

32% of total population Increases with age More common in more deeply pigmented races ((because it is easier to see)

Front 14

in what part of the retina do you tend to see white with and without pressure

Back 14

Between ora and equator Can extend to posterior pole inferior nasal least common

Front 15

is white with and without pressure preminant or transient

Back 15

white with and without pressure is transient. So don’t be supprised if you can’t see it on follow up, or if you see it in a different location than the previous visit.

Front 16

is white with or without pressure associated with any other conditions

Back 16

no

Front 17

describe the management of white with and without pressure

Back 17

No management unless vitreous degeneration,

Front 18

what does paving stone degeneration look like

Back 18

Appears as multiple round punched out lesions ((they have sharp discrete margins) Yellow white in appearance because seeing sclera ((so they are not holes because they are not red) Discrete margins often with pigment Can see large choroidal vessels at base Excavated not elevated - due to loss of outer retinal layers

Front 19

classic appearence of paving stone degeneration

Front 20

what part of the retina do you tend to see paving stone degeneration

Back 20

80% in inferotemporal quadrant Usually between ora and equator

Front 21

describe the incidence of paving stone degeneration

Back 21

22% of total population Increases with age

Front 22

describe the pathophysiology of paving stone degeneration

Back 22

Infarcts in choriocapillaris Inner retinal layers and vitreous are not affected

Front 23

describe the progression of paving stone degeneration

Back 23

Sometimes coalesce to yield scallops of pigment

Front 24

are there any other conditions associated with paving stone degeneration

Back 24

Sometimes coalesce to yield scallops of pigment

Front 25

describe the management of paving stone degeneration

Back 25

document. no tx necessary.

Front 26

what are the two main things you need to differentiate with when you think you see paving stone degeneration and how do you differentiate them

Back 26

DDX w/ histoplasmosis and toxoplasmosis Histo: usually in the posterior pole, not between the equator and the ora. histo spots tend to have less defined edges. less pigment associated with histo spots. Toxo: tends to have a lot of pigment. one lage lesion as opposed to many small lesions. toxo has less defined boarders

Front 27

describe the appearence of reticular senile pigmentary degeneration

Back 27

1. "net" like pigmented appearence 2. pigment aggregation around blood vessels

Front 28

is reticular senile pigmentary degeneration usually unilateral or bilateral

Back 28

bilateral in almost all cases

Front 29

in what part of the retina do you tend to see reticular senile pigmentary degeneration

Back 29

Can be anywhere but possibly more apparent nasal Can extend to equator (from the periphery)

Front 30

describe the epidemiology of retincular senile pigmentary degeneration

Back 30

Can be anywhere but possibly more apparent nasal Can extend to equator (from the periphery)

Front 31

describe the pathophysiology of reticular senile pigmentary degeneration

Back 31

Loss of pigment granules from some RPE cells with

Front 32

describe the management of reticular senile pigmentary degeneration

Back 32

none necessary

Front 33

is reticular senile pigmentary degeneration associated with any other conditions

Back 33

no

Front 34

what is the most important thing to differentiate reticular senile pigmentary degeneration with and how do you do this

Back 34

it is most important to differentiate between this and retinitis pigmentosa -there will be less bone spicule appearnce and their VISION WILL NOT BE AFFECTED as it would in RP -RSPD increases in prevelance with age

Front 35

what is another name for vitreoretinal tufts

Back 35

granular tags

Front 36

describe the appearence of vitreoretinal tufts

Back 36

Discrete white to gray irregular clumps on retinal surface Elevated Granular appearing

Front 37

what other finding to you tend to see with vitreoretinal tufts

Back 37

can be surrounded by cystoid degeneration

Front 38

vitreoretinal tuft with scleral indentation being performed

Front 39

describe the epidemiology of vitreoretinal tufts

Back 39

Noncystic tufts seen in up to 72% of population

Front 40

are vitreoretinal tufts unilateral or bilateral

Back 40

can be either (half the time)

Front 42

what part of the retina do you most commonly find vitreoretinal tufts

Back 42

Most common nasal Usually located just posterior to ora in vitreous base

Front 43

are vitreoretinal tufts associated with retinal break? why or why not?

Back 43

yes, because the vitreous is attached to the tuft. since there is force from the vitrous pulling on a small concentrated area there is a increased risk of retinal break.

Front 44

describe the pathophysiology of vitreoretinal tufts

Back 44

Small masses of cells of degenerated retina or

Front 45

describe the progression of vitreoretinal tufts

Back 45

Remain stationary in size and number

Front 46

what test do you need to do if you see a vitreoretinal tuft and why

Back 46

scleral indentation to see if there is a hole at the base of the tuft

Front 47

describe the management of vitreoretinal tufts

Back 47

if no holes, watch for holes. if there is a hole consider treatment with photocoagulation or cryoplexy.

Front 48

what subjective symptom would indicate that there is a hole from a vitreoretinal tuft

Back 48

Complaints of flashing lights ((particularly if there are always in one spot)

Front 49

what are meridonal folds a type of

Back 49

vitreoretinal tuft

Front 50

what are meridonal folds

Back 50

type of vitreoretinal tuft. they are elevated folds of the retina.

Front 51

describe the most common orientation of meridonal folds

Back 51

Most commonly aligned with processes (81%)

Front 52

can you see the vessels in the area of a meridonal fold

Back 52

vessels course over fold

Front 53

are meridonal folds more common in males or females

Back 53

males

Front 54

do meridonal fold occur singly or multiply

Back 54

singly 75% of the time

Front 55

are meridonal fold unilateral or bilateral

Back 55

either

Front 56

what quadrant of the retina are meridonal folds usually found

Back 56

superionasal

Front 57

what is a meridional complex

Back 57

Called “meridional complex” if meridional fold

Front 58

how are meridonal folds usually oriented with respect to the ora

Back 58

perpendicular

Front 59

describe the pathophysiology of meridonal folds

Back 59

Radially oriented folds of redundant retinal tissue

Front 60

describe the onset and progression of meridional folds

Back 60

Congenital Can increase in size with age

Front 61

are there any findings associated with meridional folds

Back 61

Vitreo-retinal tags at end of fold are common Holes at posterior end possible Can lead to retinal detachment

Front 62

what area of the retina is most suseptable to a retinal detachment if there is a meridional fold present and why

Back 62

temporal. there tends to be more thinning of retina in the inferior temporal area of the retina and more redundancy of retinal tissue in the superior nasal are

Front 63

describe the management of meridional folds

Back 63

Follow q 3 months for RD if hole and tag present If risks are present, cryopexy is preferred treatment due to accessibility

Front 64

what additional test do you need to do if you see a meridional fold and why

Back 64

scleral indentation to check for a retinal hole

Front 65

describe the classic appearence of lattice degeneration and how often does lattice appear in the classic form

Back 65

Well circumscribed oval or elliptical lesion Criss-cross pattern of white lines in "classic" Only present in 6 - 9% of cases -classic appearence is easy to diagnose, but it is not usually classic appearance

Front 66

is lattice degeneration unilateral or bilateral

Back 66

either; 50%. however tends towards bilaterality with age.

Front 67

what part of the retina is lattice degeneration located

Back 67

Between periphery and equator Vertical meridians between 5 - 7 and 11 - 1 o’clock

Front 68

describe the most common orientation of lesions from lattice degeneration

Back 68

parallel to the ora (circumferential)

Front 69

describe the epidemiology of lattice degeneration

Back 69

occurs in 6-10% of the population

Front 70

what percent of pts with lattice degeneration will have atrophic holes in the lesion

Back 70

18 to 30%

Front 71

what is circumfrential and radial

Back 71

refers to the orientation of a lesion (lattice degeneration) circumfrential: parallel to the ora radial: perpinducular to the ora

Front 72

what orientation of lattice degeneration is most common if the lesion is nearer to the equator

Back 72

If near equator tends to be radial and follow blood vessel

Front 73

of the two orinetations of lattice degeneration which is more concerning and why

Back 73

radial; more often associated with retinal detachment because lesion follows blood vessels and the blood vessels can act like the red strip that you use to open a pack of gum or a package of cigeretts

Front 74

describe the pathophysiology of lattice degeneration

Back 74

excavation of the retina due to atrophic retinal thinning. lines are functioning blood vessels with inflammed thickened walls (sclerosed). tent of vitreous with firm attachment to either side of the lesion. vitreous liquefaction common in area above the lesion.

Front 75

describe the pathophysiology of retinal detachment due to lattice degeneration

Back 75

if there is a hole from atrophic thinning the liquifed vitreous that is commonly found above the lesion could leak under the retina through the hole between the retina and the RPE causing a retinal detachment.

Front 76

what is the onset and progression of lattice degeneration

Back 76

becomes visable in teens. increases in obviousness and size with age.

Front 77

what are the fine white speks you can see in lattice degeneration

Back 77

fragmented pieces of inner retinal layers

Front 78

how can you tell where the borader of a lattice degeneration lesion is

Back 78

lesion extends beyond the pigmented area. the only way to tell the extent of the lesion is to do scleral indentation and look for increased whitening as you press on the retina (shows you where the vitreal attachments are). actual lesion is usually quite a bit broader than the pigmented are you see.

Front 79

describe the management associated with lattice degeneration

Back 79

follow regularly. consider laser treatment is holes present (depends on where the hole is) or risk factors of retinal detachment (flashes of light, pigment in vitreous, RD in other eye)

Front 80

what is important to remember before sending out a pt with lattice degeneration for cataract surgery

Back 80

if the have a hole there is an increased risk of developing a retinal detachment from the surgery. you need to tell the cataract surgen that lattice is present. when they pull on the lens capsule it pulls on the vitreous which pulls on the area of the lattice lesion. a lot of cataract surgens are doing prophylacitc treatment of holes assoicated with lattice degeneration before cataract surgery.

Front 81

name two events that increase the chance of developing a retinal detachment in the pt with lattice degeneration

Back 81

PVD or catarct surgery

Front 82

how do you tell if an atrophic hole associated with lattice degeneration is high risk for developing a retinal detachment or low risk

Back 82

remember that the vitreous makes a tent over the lattice lesion. and there is firm attachment of the vitrous on either side of the tent. you can see the edge of the lesion by doing scleral indentation and seeing where the retina no longer appears white. if the hole is close to, or goes past, the edge of the lesion there is a high risk of developing a retinal detachment because of the firm attachment. if the hole is entirely within the lesion and not close to the edge, then there is a low risk of RD.

Front 83

describe the appearance of atrophic retinal holes

Back 83

Look pinker or redder than surrounding tissue Round and discrete; "cut out"

Front 84

describe the pathophysiology of atrophic retinal holes

Back 84

hole in the retina due to atrophy. atrophic holes are like holes in your sock. It gets worn so thin that it wears all the way through creating a hole. There is nothiing pulling on it causing the hole as if you were to rip a hole in your socks.

Front 85

what quadrant of the retina do you tend to see atrophic retinal holes

Back 85

all quadrants

Front 86

is there a risk of RD with atrophic retinal holes

Back 86

seldom associated with RD

Front 87

describe the management associated with atrophic retinal holes

Back 87

Consider laser treatment if in periphery with traction or if any risks present (flashes of light, pigment in vitrous, RD in fellow eye) Must give patient symptoms of RD

Front 88

describe the subjective complaint that a pt will experience if they are having a retinal detachment

Back 88

"curtin" or shadow slowly comming across their vision. the curtin can come from any direction. there can be a red tint to their vision because broken blood vessels can release blood. recent onset or increase in number of floaters. -tell pt look of vision in any way in education. because you don't want them to start losing vision and think that it is not the same exact way that you described it and not come in when they are losing vision.

Front 89

what is a pseudo hole and how can you differentiate it with a real retinal hole

Back 89

where you have white without pressure throught the retina, but there is one area where you don't have it, it makes the area where you don't have it look like a retinal hole. you can tell because when you do scleral indentation there will be not flaps that lift off the retina.

Front 90

what is a horseshoe tear

Back 90

Elevated flap of light colored retinal tissue in “V” shape Horse "runs" to optic nerve (if you think of the direction that a horse wears it's shoes (tip of V towards head) the tear will be in a direction where the horse in facing the ONH)

Front 91

what is the difference between a retinal break a retinal hole and a retinal

Back 91

a break is a general term. it usually means that the surface of the retina facing the vitrous is not continuous. a hole is generally used where there is a more rounded appearance. a tear is where there is an elevated area of the retina that looks like it has been torn away.

Front 92

what part of the retina is a horseshoe tear most commonly seen and why

Back 92

much more common superior than inferior bc of the effect of gravity on the vitrous.

Front 93

horseshoe tear with retinal detachment. if there wasn't that area of detachment it would just be called a tear and not a detachment

Front 94

how can you tell the age of a tear

Back 94

if the flap is smaller than the tear (picture) this indicates that it is an older tear. when the flap is pulled away from the retina it looses its food source and starts to atrophy.

Front 95

describe the management of a horseshoe tear

Back 95

all horseshoe tears are sent out for treatment because there is a lose flap of retina that is still attached and could pull off more retina

Front 96

describe the pathophysiology of horseshoe tears

Back 96

often trauma induced tear.

Front 97

what is an operculated tear

Back 97

Retinal hole with flap of tissue completely torn off

Front 98

how can you tell the age of an operculated tear

Back 98

Operculum size compared to hole tells about age of hole Small operculum = longer duration

Front 99

what quadrant of the retina do operculated tears tend to occur

Back 99

any quadrant

Front 100

describe the pathophysiology of operculated tears

Back 100

often trauma induced

Front 101

if you seen an atrophic hole you always have to check in the vitrous for an operculum

Front 102

describe the management of an operculated tear

Back 102

less risk of retinal detachment than horseshoe tear, but management depends on surgeon and age of hole.

Front 103

new retinal detachments are much more obvious than old retinal detachments

Front 104

name four clinically observable signs of retinal detachment

Back 104

1. white folds of tissue that move when the pts eye moves 2. masks underlying choroidal details 3. shafer's sign 4. relative field loss

Front 105

name one clinically observable retinal sign of long standing retinal detachement

Back 105

Pigmented demarcation line if stable for at least 3 months

Front 106

how soon do you need to refer a pt w/ a retinal detachment

Back 106

if the macula is on withing 24 hours. if the macula is off you have longer.

Front 107

what is the difference between rhegmatogenous RD and nonrhegmatogenous RD

Back 107

Rhegmatogenous: secondary to retinal break Nonrhegmatogenous: secondary to traction, or fluid

Front 108

describe the pathophysiology of RD

Back 108

RD is when fluid accumulates between the RPE and the sensory retina

Front 109

what type of retinal detachment do you see shafer's sign with

Back 109

rhegmatogenous

Front 110

what is the mechanism for a RD from an optic pit

Back 110

non-rhegmatogenous: the vitreous gets under the retina through the pit

Front 111

what is a third type of retinal detachement besides rhegmatogenous and nonrhegmatogenous

Back 111

tractional. for example fibrosis from diabetes pulls retina off

Front 112

older retinal detachments can easily be confused with retinoschisis

Front 113

how does retinoschisis look different from a RD (6)

Back 113

it will look less like white floating tissue and more like a blister on the retina -fluid filled cyst -relatively immobile -blanches when depressed -white dots on inner surface (pieces of the cell bodies) -should be able to see choroidal details -absolute (not relative) scotoms (because you have cut the cell bodies from their axons)

Front 115

how can you differentiate between retinoschisis and retinal detachement base on field defect

Back 115

often it is to far out in the periphery to do a visual field. Retinoschisis is absolute scotoma. RD is relative scotoma. -you can tell by doing BIO. You shine your light over the area of detachment or schisis and place a pen or something in between your BIO and the condensing lens (this placement is important). That will cast a shadow over the affected area. Then you ask the pt if they can see a show that looks like a matchstick. If they can see it, it is a relative defect (RD), if they can’t see it, it is an absolute defect (retinoschisis) -this test works nearly 100% of the time (in a study with an N of 32 there was 100% specificity and selectivity)

Front 117

what is the most common quadrant to have a retinoschisis

Back 117

inferiotemporal

Front 118

describe the pathophysioloy of retinoschisis

Back 118

Retinal splitting between inner plexiform and outer

Front 119

do you tend to see a pigmented demarcation line with retinoschisis

Back 119

No demarcation line expected because there is no traction ont he retina ((if you see a pigmented demarcation line you should expect that it is an RD until proven otherwise)

Front 120

you may see two blood vessels in retinoschisis because the elevated vessel is casting a shadow on the retina (picture)

Front 121

describe the progression of retinoschisis

Back 121

progress very slowly

Front 122

are there any conditions associated with retinoschisis

Back 122

retinal holes in the inner or outer layers or both. very low potential for RD unless in both inner and outer layers because fluid can then get underneath the retina causing an RD

Front 123

describe the management of retinoschisis

Back 123

it is very important to differentially diagnose (DDX) between retinoschisis and retinal detachment (RD) because management is very different. retinoschisis: laser only if macular area in danger or it inner and outer holes present. if within 25 degrees of temporal arcades follow every 6 months and do fields, otherwise follow yearly.

Front 125

what is an avulsed vitreous base and what causes it

Back 125

where the bitreous base is pulled away from trauma. will appear as a floating white strip.

Front 126

what quadrant is an avulsed vitreous base usually

Back 126

superior nasal quadrant (gravity)

Front 127

describe the progression of avulsed vitreous base

Back 127

no changes

Front 128

are there any associated conditions with avulsed vitreous base

Back 128

vitreous hemorrhage, retinal tear (horseshoe or operculated)

Front 129

describe the management of avulsed vitreous base

Back 129

no treatment unless RD or tear. evaluate for other truama (no tears, angle recession etc)

Front 130

what are oral pearls and where are they located

Back 130

usually appear as white glistening round objects on dark background. on pars plana.

Front 131

describe the management of oral pearls

Back 131

Benign incidental finding No associated significant findings/risks No management needed

Front 132

what are pars plana cysts

Back 132

Look like blisters: raised clear lesion w/ smooth surface

Front 133

where are pars plana cysts located

Back 133

most likely temporal under the vitrous base

Front 134

are there any associated conditions with pars plana cysts

Back 134

more common in eyes with RD

Front 135

describe the management of pars plana cysts

Back 135

no management necessary

Front 136

New lecture: 15 OPT 633 - Tumors NeuralVascular 2010

Back 136

a

Front 137

what is a neoploasm

Back 137

A new and abnormal formation of tissue, as a tumor or growth.

Front 138

what is a melanoma

Back 138

tumor made up of malanin pigmented cells

Front 139

is melanoma a severe form of cancer

Back 139

yes, less common but more deadly

Front 140

what is an amelanotic melanoma

Back 140

a melanoma that lacks melanin

Front 141

what is a hamartoma? is it benign or maligmant?

Back 141

Composed of cells and tissues that normally occur in tissue (benign)

Front 142

what is a carcinoma

Back 142

A new growth or malignant tumor that occurs in epithelial tissue and may infiltrate local tissues or produce metastases.

Front 143

what is the most common conjunctival tumor

Back 143

conjunctival carcinoma

Front 144

what is another name for choroidal nevus

Back 144

benign choroidal melanoma

Front 145

what percent of pts have a choroidal nevus

Back 145

30% have to some degree

Front 146

describe the shape of a choroidal nevus

Back 146

typically flat or minimally elevated (less than 1mm). typically round or oval.

Front 147

describe the color of a choroidal nevus

Back 147

slate gray or brown

Front 148

are there any other retinal findings associated with choroidal nevus

Back 148

may see overlying drusen

Front 149

describe the onset and progression of a choridal nevus

Back 149

probably present at birth; maximal growth during prepuberal years; extremely rare to have growth after this time

Front 150

is it possible for a choroidal nevus to convert to malignancy

Back 150

it is possible. if the lesion is under 2 disc diameters (DD) 95% are benign and non-progressive when isolated with no other associated findings

Front 151

describe the management of choroidal nevus

Back 151

if under 2 DD Documentation and follow up on routine examinations if under 2 DD if 2 to 5 DD Suspect malignancy Need additional tests Ultrasound FA's Photodocument P32 Recall 6 months

Front 153

elevation, large size, feeder vessels and irregular shape or color on a lesion all indicate malignancy

Front 154

what does the green filter do

Back 154

it limits your view to neural retin because the green light is blocked by the RPE and doesn't go past it.

Front 155

what will happen to a choroidal nevus if you use the red-free filter

Back 155

it will disappear because it is outer to the RPE

Front 156

how common are choroidal malignant melanomas

Back 156

comprise the majority of all uveal tumors; 85%

Front 157

what is the most common primary intraocular tumor in adults

Back 157

choroidal molignant melanoma

Front 158

how big are choroidal malignant melanomas

Back 158

usually 10 DD or larger when first seen

Front 159

what population is choroidal malignant melanoma rare in

Back 159

extremely rare in african americans

Front 160

is malignant melanoma typically unilateral or bilateral

Back 160

typically unilateral. check the same quadrant in the fellow eye, if you see a similar pattern it might just be a physiological pigment variation.

Front 161

what color are choroidal malignant melanoma

Back 161

Pigmented, color varies from brown, mottled black, gray-green to white (amelanotic)

Front 162

choroidal malignant melanoma can look like a retinal detachment. a good retinal surgern will do ultrasonography before laser surgery to see if there is a mass behind the retina.

Front 163

choroidal malignant melanomas can grow to the point that they break through burch's membrane and extend in to the vitreous

Front 164

name three clinically observable retinal findings (other than the mass) that you see with choroidal malignant melanoma

Back 164

Serous detachments of the retina Choroidal folds Subretinal, vitreal and intraretinal hemorrhages hard exudates (neovascularization to feed the tumor leaks)

Front 165

name three other non-retinal clinically observable findings that you can see with choroidal malignant melanoma

Back 165

Secondary glaucoma (if the tumor impinges on the ciliary body or TM) Cataracts (if the tumor reaches the lens) Anterior and/or posterior uveitis (neovascular vessels leak a lot of inflammatory cytokines)

Front 166

what are the pts subjective complains comming in with a choroidal malignant melanoma

Back 166

none; can be asymptomatic; may have reduced VAs. may or may not have visual field defect.

Front 167

what two cancers should you ask about it you think you see a choroidal malignant melanoma

Back 167

lung cancer and breast cancer are the two big ones linked to choroidal malignant melanoma

Front 168

is choroidal malignant melanoma usually unilateral or bilateral

Back 168

Primary lesions are typically unilateral Secondary lesions from other cancers tend to be bilateral

Front 169

how can you DDX a choroidal malignant melanoma from a hemangioma with a transilluminator

Back 169

pigmented lesions do not transmit light. anesthetize the eye and place the transilluminator on the eye and look for any dark areas. dark areas indicate malignant melanoma; hemangioma will not have any dark areas.

Front 171

what will happen during the late phase of a fluorescein angiography

Back 171

the whole region will be bright because vessels have grown into the tumor to help it grow

Front 172

will a choroidal malignant melanoma show any changes on an ultrasound

Back 172

yes, it is changing the shape of the retina 3 dimensionally

Front 173

what is the name of the lab test you can use to DDX a choroidal malignant tumor and what is it

Back 173

P32 uptake. P32 is a chemical marker that is taken up more rapidly in malignant cells than it is in normal cells.

Front 174

CT and MRI are used to determine the extend of a choroidal malignant melanoma

Front 175

describe three tx for choroidal malignant melanoma

Back 175

1. enucleation (must be done carefully to prevent metastasis) 2. radioactive threapy (if caught early) 3. observation (for small tumors)

Front 176

you are very concerned of matastasis with choridal malignant melanoma; high incidence of death.

Front 177

name 6 ways you can tell if a lesion on the retina is benign or malignant

Front 178

when you take a picture of the retina you need to match the luminosity on the camera bc that will change the appearance of the lesion

Front 179

what percent of uveal tract melanomas are ciliary body malignant melanomas

Back 179

9%

Front 180

what part of the ciliary body is involved in a cilary body malignant melanoma

Back 180

May involve pigmented or non-pigmented epithelium or the stroma

Front 181

Because of the location of the ciliary body these tumors are hard to see unless the pupil is widely dilated. May grow to be very extensive size before they are actually seen. May be seen only after it grows large enough to extend into the pupil

Front 182

name 5 clinically observable signs that would indicate a ciliary body malignant melanoma

Back 182

1. irregular astigmatism 2. dislocation of the lens 3. focal opcity of the lens (pressure from the lesion) 4. focal dilation of eipscleral vessels 5. glaucoma

Front 183

what do you need to do if you see focal dilation of the episcleral vessels

Back 183

dilate really well and check the ciliary body for a tumor

Front 184

describe 5 methods you could use to detect a ciliary body malignant melanoma

Back 184

1. contact fundus lens to see ciliary body 2. transillumination of the sclera to check for dark spots 3. ultrasonography 4. P32 uptake 5. fluorescein angiography

Front 185

what is the tx for ciliary body malignant melanomas

Back 185

1. enucleation (usually) 2. sector resection (small tumors)

Front 186

Primary tumors of the eye are rare and usually benign (melanocytoma is an example)

Front 187

what is a melanocytoma

Back 187

dark black, elevated mass on the optic nerve

Front 188

do melanocytomas tend to be unilateral or bilateral

Back 188

almost always unilateral

Front 189

what part of the ONH is involved with a melanocytoma

Back 189

Usually involves the inferior part 10% may cover the majority of the optic disc

Front 190

in VA affected in individuals with melanocytoma

Back 190

no; if it is, there is only a slight reducetion 20/25 or so

Front 191

what is the prognosis for melanocytoma

Back 191

good. usually no progression and no loss of vision. rarely it will spread.

Front 192

what does a melanocytoma look like on fluorescein angiography

Back 192

hypofluorescence: blocks dye, no abnormal vascular findings

Front 193

describe the management of melanocytoma

Back 193

photodocument and routine follow up

Front 194

why is the choroid a place where matastasis is likely to occur

Back 194

because it is a spongy place that is very vascular

Front 195

in what part of the retina do you tend to see a metastatic carcinoma of the choroid

Back 195

posterior pole

Front 196

describe the appearance of a metastatic carcinoma of the choroid

Back 196

Flat, or slight elevation,

Front 197

metastatic carcinoma of the choroid: can be multifocal or solitary. grow faster than malignant melanoma. less common than malignant melanoma.

Front 198

a person with metastatic carcinoma of the choroid should have a Hx of cancer!

Front 199

what ocular testing should be done on a pt with metastatic carcinoma of the choroid (3)

Back 199

1. photodocumentation 2. ultrasound 3. P32 testing

Front 200

what is the tx for metastatic carcinoma of the choroid

Back 200

1. enucleation 2. irradiation threapy etc.

Front 201

what signs indicate a pt has a metastatic carcinoma of the ONH (4)

Back 201

Loss of VA. swollen ONH. venous tortuosity. central venous occlusion.

Front 202

describe the prognosis associated with metastatic carcinoma of the ONH

Back 202

poor. mean survival is 10 months.

Front 203

leukemia: Infiltration of the leukemic cells in the optic nerve displace the normal neurons causing vision loss

Front 204

what is the most common primary ocular tumor in chindren

Back 204

retinoblastoma (1 in 20,000). second overall only to malignant melanoma.

Front 205

is retinoblastoma unilateral or bilateral

Back 205

Bilateral (1/3) or Unilateral (2/3)

Front 206

what is the mortality rate associated with retinoblastoma

Back 206

15-20%

Front 207

does retinoblastoma have a heriditary component

Back 207

yes, AD

Front 208

name four conditions that can cause leukocoria

Back 208

1. retinoblastoma (2/3 of cases) 2. cataract 3. coat's disease 4. retinopathy of prematurity

Front 209

retinoblastom is reall tough to see on ophthalmoscopy (picture)

Front 210

name four clues that indicate retinoblastoma

Back 210

leukocoria, rubbing eyes (to stimulate phosphene), ophthalmoscopic findings, ultra sound (high calcium content to tumor)

Front 211

what is the tx for retinoblastoma

Back 211

1. enucleation 2. irradiation threapy etc. (if you detect it early you can save their vision; especially if bilateral)

Front 212

what is medulloepithelioma

Back 212

Ciliary Body equivalent to a retinoblastoma

Front 213

most common age of onset for medulloepithelioma is in the first decade of life, but later than retinoblastoma

Front 214

what is adult medulloepithelioma

Back 214

A carcinoma Multiple white to gray fluffy mass of inner surface of the ciliary body Usually associated with trauma to the eye or post inflammation

Front 215

what is (CHRPE)

Back 215

congenital hypertrophy of the retinal pigment epithelium. enlargement or the RPE cells

Front 216

how does CHRPE look

Back 216

single or multiple black/dark gray sport of hypertrophyed RPE. if multiple in a bear track/animal track pattern

Front 217

what part of the retina does CHRPE occur

Back 217

anywhere

Front 218

what is Halo Nevi

Back 218

CHRPE may have an area of hypopigmentation surrounding the pigment. this is a diagnostic clue

Front 219

are there any other conditions associated with CHRPE

Back 219

if you have 6 or more CHRPE there is a risk of colon cancer FAP (in 40 yr old male)

Front 220

what causes retinal pigment epithelial hyperplasia

Back 220

Results from insult or trauma to retina Originates from many different conditions Chorioretinal inflammations Scars Choroidal neovascularization

Front 222

describe the appearance of retinal pigment epithelial hyperplasia

Back 222

Appears as a jet black irregular pigmentation, size and shape varies (picture left is RP right is RPE hyperplasia)

Front 223

RPE hyperplasia is mechanism for pigment that develops with some lesions such as toxoplasmosis. RPE invastion into sensory retina.

Front 224

what is a phakomatosis

Back 224

Any genetic neurocutaneous disorders, in which anomalies are spread unevenly through the body. SEE: Hippel's disease; neurofibromatosis; sclerosis, tuberous; Sturge-Weber syndrome

Front 225

what is the other name for von hipple-lindau disease

Back 225

cerebroretinal angiomatosis

Front 226

what is von hipple-lindau disease

Back 226

Angiomatosis of Retina and Cerebellum Vascular tumors

Front 227

what is a hemangioma

Back 227

A benign tumor of dilated blood vessels.

Front 228

is there a hereditary component to von hipple-lindau disease

Back 228

yes

Front 229

what is the age of onset for von hipple-lindau disease

Back 229

30s

Front 230

what percent of people with von hipple-lindau disease have ocular manifestations

Back 230

25%

Front 231

describe the retinal signs associated with von hipple-lindau disease

Back 231

first microaneurysms, then small red nodules, then larger red-orange tumors. same process that is happening at the cerebellum. there will be hemorrhages and hard exudates from leaky vessels. you won't be able to tell the difference between the arteries and the veins.

Front 233

describe the systemic involvement of von hipple-lindau disease

Back 233

Involvement of cerebral, cerebellum, spinal cord tumors These cause neuropsychiatric symptoms, seizures, and mental retardation Other tumors have been found in the kidneys (66%), pancreas, liver and spleen

Front 234

what is the other name for sturge-weber syndrome

Back 234

encephalotrigeminal angiomatosis (less commonly used)

Front 235

what is sturge-weber syndrome

Back 235

Intracranial angioma, facial angioma, and choroidal angioma

Front 236

are facial lesions associated with sturge-weber syndrome usually unilateral or bilateral

Back 236

unilateral

Front 237

what is the age of onset of sturge-weber syndrome

Back 237

facial lesions are present at birth

Front 238

name three systemic symptoms associated with sturge-weber syndrome

Back 238

Can cause epileptic seizes Mental deficiency Hemiplegia

Front 239

what is a nevus flammeus or port wine stain

Back 239

cutaneous angioma present at birth in sturge-weber syndrome

Front 240

describe the choroidal findings associated with sturge-weber syndrome

Back 240

choroidal angioma. can be either localized or diffuse localized: yellowish to red orange lesion. elevated circular area. diffuse: entire fundus is deep red color. might miss unless compared to other eye

Front 241

what percent of people with sturge-weber syndrome have a choroidal angioma

Back 241

40%

Front 242

what is your primary ocular concern with sturge-weber syndrome

Back 242

congenital glaucoma

Front 243

what percent of pts with sturge-weber syndrom develop glaucoma at some point

Back 243

30%

Front 244

at what age do people with sturge-weber syndrome develop glaucoma

Back 244

Of those that develop glaucoma 60% by age 2 Buphthalmos, angle abnormalities 40% late childhood to early adulthood Angle is more normal Episcleral venous pressure increase from episcleral hemangioma

Front 245

what non-retinal ocular findings are seen in sturge-weber syndrome (2)

Back 245

heterochromia, dilated tortuous conjunctival vessels

Front 246

what is arteriovenous malformation

Back 246

Not a true phacomatoses Involves the retina and CNS with arteriovenous malformations These malformations are seen as markedly dilated and tortuous retinal arteries

Front 247

what is another name for arteriovenous malformations

Back 247

wyburn-mason syndrome

Front 248

are arteriovenous malformatinos usually unilateral or bilateral

Back 248

usually unilateral

Front 249

what does the retinal of a person with arteriovenous malformations look like

Back 249

enlarged tortuous vessels, more vessels, arteries and veins look the same

Front 250

what systemic consequences are seen with arteriovenous malformatinos

Back 250

hemorrhages in the brain cause stroke. epilepsy.

Front 251

describe the progression of arteriovenous malformations

Back 251

no progression. congenital.

Front 252

what is another name for tuberous sclerosis

Back 252

bourneville's disease

Front 253

what are the cutaneous manifestatinos of tuberous sclerosis (3)

Back 253

sebaceous adenoma: pale pink, usually around the nose and lip area of the face achromic nevi: congenital white patches or macules; hypopigented skin patches. shagreen patch: deffuse fibrous thickening of the skin usually located on the back

Front 255

what are the ocular manifestations of tuberous sclerosis

Back 255

May find small tumors on the conjunctiva May see hypopigmented iris spots May see retinal lesions (50%) astrocytoma

Front 256

what is astrocytoma

Back 256

abnormal growth of astrocytes (neural cells) in the retina. resembling a mulberry.

Front 257

what part of the retina do you find an astrocytoma in

Back 257

Usually located on the posterior pole near the optic nerve. Although, can be found anywhere

Front 258

describe the prognosis for astrocytoma

Back 258

pretty good. growth is very slow.

Front 259

what is another name for neurofibromatosis

Back 259

von recklinghausen's disease

Front 260

what is neurofibromatosis

Back 260

what the elephant man had

Front 261

name 5 ocular manifestations of neurofibromatosis

Back 261

1. ptosis of lid 2. orbital tumors 3. iris tumors (tan nodules) 4. retinal/choroidal tumors 5. glaucoma

Front 262

New lecture: 16 AntSeg Traumaschool 09 NOTES

Back 262

a

Front 263

what does triage mean

Back 263

The screening and classification of casualties to make optimal use of treatment resources and to maximize the survival and welfare of patients.

Front 264

remember to ask what the pts vision was like prior to the accident with trauma

Front 265

what is the diagnostic sequence for a trauma pt (8)

Back 265

1. VAs 2. do fields on follow up 3. EOMs 4. pupils 5. color vision/red desaturation 6. gross observation 7. slit lamp -evert the lid (if superfical corneal abrasion) -conicle beam -anterior vitreous (have pt look all around, will help you see cells in the vitrous) 8. dilated BIO and NC or contact fundus lens (looking for RD. also helps if there is post-traumatic uveitis)

Front 266

you may have to instil anesthetic on a trauma pt to get them to be able to take VAs

Front 267

what is a closed globe and an open globe injury

Back 267

closed: no full-thickness wound of the eye open: full-thickness wound of eye

Front 268

what is a rupture

Back 268

: Caused by blunt object increasing the IOP, wound is an inside-out mechanism and not necessarily at the impact site, tissue herniation is frequent and potentially substantial -choroidal herniation is common consequence of trauma

Front 269

what is a laceration

Back 269

Usually caused by a sharp object, wound is an outside-in mechanism at impact site

Front 270

what is a penetrating injury

Back 270

single entrance laceration

Front 271

what is a intraocular foreign body injury

Back 271

foriegn object retained in eye

Front 272

what is a perforating injury

Back 272

Two wounds (entrance and exit) caused by the same object

Front 273

what is the most common type of trauma you will see

Back 273

superficial corneal abrasion. pt scratched their cornea with finger nail or tree branch.

Front 274

what should you do if a pt with a superifical corneal abrasion comes in complaining of foriegn body sensation

Back 274

look for a foriegn body. if you don't see one, reassure them that it is normal for them to feel like there is something in there eye and that is just due to the inflammation. you can levage the eye just to make sure, but they will likely still feel a foreign body bc of the inflammation

Front 276

what should you suspect if a trauma pt complains of photophobia

Back 276

they will need a steroid because there is uveitis. it could just be that the abrasion is causing the glare though.

Front 277

with trauma you may need to use proparocaine to look at the eye bc of blepharospasm

Front 278

what can you tell about the injury when you put proparocaine in the eye

Back 278

if the pain goes away, then the injury is limited to the cornea. if it is still there, there is deeper injury or uveitis

Front 279

where does an abrasion due to CL overwear occur

Back 279

centrally

Front 280

if you see a vertical tracking pattern on the cornea where should you look for a foreign body

Back 280

under the upper lid

Front 281

the pattern of epithelial disruption on the cornea will tell you a lot about the cause of corneal trauma

Front 282

how fast does the corneal epithelium heal

Back 282

72 hours irregardless of the size of the defect if they are healthy. 6-12 hours for mild cases.

Front 283

what are the three goals for treatment of ocular trauma

Back 283

1. limit further trauma 2. reduce change of secondary infection 3. pt comfort

Front 284

morgan lens: a system for ocular lavage (picture)

Front 285

is pressure patching used to treat corneal abrasion

Back 285

not currently considered standard of care. bandage CLs are a much better way to go. -pressure patches stabalize the lid which helps re-establish epithelium

Front 286

how long can a pressure patch be worn

Back 286

24 hour max! don't let the sun set twice on a pressure patch.

Front 288

name two contraindications to pressure patch and why

Back 288

if due to scratch from fingernail, due to risk of pseudomonas. if due to vegetative trauma due to risk of fungal infection.

Front 289

what do you have to remember before removing a bandage CL

Back 289

use artifical tears to help reduce the change of removing epithelium when you take off the lens. you can use a forcepts to remove the lens or you can just use your finger.

Front 291

Dr. Yudcovitch fells that you should not use anesthetic before removing a bandage CL except in extreme cases where to pt won't let you get to the lens.

Front 292

name three lenses approved for bandage soft CL use

Back 292

ciba night and day, B&L purevision, acuvue oasys

Front 293

how do you want to fit a bandage CL

Back 293

steep to vault the cornea

Front 294

how do you use an antibiotic on a pt w/ a bandage CL

Back 294

add many of them directly over the lens

Front 295

what are collagen shields

Back 295

bandage CLs that disolve in the pts tear film with time. they come dehydrated and you can hydrate with saline or antibiotic. you can get ones that disolve in 12, 24 or 72 hours.

Front 296

do you want to do warm or cold compresses with trauma?

Back 296

heat may promote healing. cold may reduce swelling.

Front 297

how can you treat corneal edema from trauma

Back 297

hypertonics. they are not over the counter.

Front 298

what do you do for treatment of a corneal abrasion

Back 298

1. bandage CL for comfort 2. antibiotic to prevent infection 3. hot or cold compresses 4. hypertonics if swelling 5. cycloplegics if uveitis 6. topical or oral NSAIDS for pain

Front 299

name one hypertonic drug

Back 299

Muro-128

Front 300

when should you follow up with a pt with a superifical corneal abrasion

Back 300

18 to 24 hours for removal of patch. if small, non central abrasion, continue antibiotic 3-4 days and RTC. if large or central abrasion follow daily.

Front 301

when can a Cl wearer resume CL wear after a superficial corneal abrasion.

Back 301

2 to 3 days after complete resolution of abrasion.

Front 302

lacerations are usually past bowman's layer into the stroma. that means that they will leave a scar. so you need to tell the pt that ahead of time, so they don't think that you messed up their treatment.

Front 303

how can you tell clinically if a laceration has penetrated bowmans membrane

Back 303

stain with fluorescein and if the stain leaks past the edge of the lesion (stromal glow) then you know that the laceration has penetrated bowman's membrane.

Front 304

what do you do if there is a flap hanging off of a corneal abrasion

Back 304

debride it off. you don't want to stick the flap back on and hope that it heals right.

Front 305

what does it indicate if there is a shallow anterior chamber after trauma and why

Back 305

that there has been some leakage of fluid. bc fluid that leaks from the anterior chamber will allow the contents of the posterior chamber to push the iris forward causing a shallow angle.

Front 306

whta is the siedel sign

Back 306

used to see if an injury to the globe is full-thickness. put fluorescein in the eye and have the pt blink firmly and watch for aqueous leakage. use a lot of fluroscein. IOP will be low if there is leakage.

Front 307

how should you check pressures if there is trauma

Back 307

use NCT so you don't have to touch a traumatized eye.

Front 308

how could you reduce scaring if you have a corneal laceration that penetrates bowman's membrane

Back 308

steroids will help reduce scarring.

Front 309

what should you put on a deep corneal laceration as you are sending them out to the corneal specialist

Back 309

don't use a pressure patch, use a shield patch

Front 310

describe what you would do if a pt came in with a deep corneal laceration

Back 310

1. consider culture if high risk of infection 2. rule out complications (traumatic uveitis, secondary ulcer) 3. lavage entire ocular surface 4. antibiotic ointment or drop 5. cycloplegics for AC response (if they are in pain or sensative to light, they will most likely develop a uveitis even if you don't see one) 6. NSAIDS 7. tells them ahead of time that there injury is going to scar

Front 311

never pressure patch a full-thichness laceration!

Front 312

theraputic CLs are the way to go over a pressure patch for deep corneal lacerations

Front 313

how and why would you use a steroid on a deep corneal laceration

Back 313

because steroids can reduce scarring. they also reduce healing. wait until laceration has begun to heal to start steroid therapy (there is controversy in this area). remember there is also an increased risk of infection with steroid use.

Front 314

what is the RTC for a deep corneal laceration

Back 314

24 hours

Front 315

for a deep corneal laceration continue bandage CL therapy until the defect in about 1 mm in size.

Front 316

if you are treating a deep corneal laceration, you should be following them daily. things should be constantly improving, if it ever starts to get worse, you need to reffer to a corneal specialist.

Front 317

describe the follow up treatment associated with a deep corneal laceration

Back 317

RTC 1 day. at innitial follow up: dc or continue cycloplegics, consider steroids for severe AC response. Pressure patch/theraputic SCL. continue antibiotics and NSAIDS. hypertonics if significant edema. RTC 1 day. -2nd follow up: if better dc cycloplegics. if worse add prednisolone q4h. continue antibiotics. RTC 24 to 48 hrs. -3rd follow up: findings should improve day to day. continue antibiotics.

Front 318

what condition is a pt with a deep corneal laceration at risk for long term

Back 318

recurrent corneal erosion.

Front 319

what do you do if you get a pt full-thickness or perforating injury

Back 319

STAT referral to the corneal specialist. transport with fox metal shield. DO NOT pressure patch.

Front 320

why do they use systemic antibiotics for full-thickness corneal injuries

Back 320

to prevent endophthalmitis

Front 321

what is important to remember about the timeline of fungal infection

Back 321

the infection occurs a long time after the innitial trauma, because it takes that long for the fungus to grow.

Front 322

if you get glass in your eye it is very hard to see where it is to remove it. an anterior seg. OCT is helpful in determining where the glass is.

Front 323

what is the white ring that surrounds a foriegn body on the corneal called

Back 323

coat's ring

Front 325

what is the rust ring that can surround a metalic foriegn body called

Back 325

hemosiderosis

Front 326

moderate to deep embedded foriegn bodies usually cause a __________

Back 326

anteroir chamber reaction

Front 327

what should you always check before you remove a foriegn body

Back 327

depth, you don't want to remove a foreign body that it full thickness.

Front 328

describe 7 methods of removing a foreign body

Back 328

1. forced irrigation method: forcefully apply stream of liquid to the base of foreign body 2. sweeping swab method: wet a cotton q-tip and sweep over the FB 3. magnetic method: magnet used to remove metallic FB. not effective if embedded 4. needle method: come in tangential to the cornea with a needle. need to be careful. use a small needle. 5. bailey loop method: nylon loop at the end of a handle used to remove FB. 6 spud method: use spud to remove FB. get the smallest spud possible. 7. forceps method: use a forceps to remove FB

Front 329

what types of foreign bodies (FB) does the sweeping swab method not work

Back 329

it works for FBs on the conj. but does not work for FBs on the cornea bc you will remove large areas of epithelium.

Front 330

why is it important to remove a rust ring from a pts cornea? what problem could be caused by its removal?

Back 330

because bacteria like to live in the rust rings. -removal can cause chronic weakness that leads to erosions of the epithelium

Front 331

descibe the nuance associated with removal of a rust ring.

Back 331

you won't be able to get all of the rust out. however, over time, it will migrate anteriorly and slough it off over time.

Front 332

what is the name of the instrument used to remove a rust ring from the cornea

Back 332

alger brush

Front 333

does your alger brush have a stop mechanism?

Front 334

how do you treat after a foreign body is removed

Back 334

after FB is removed tx is same as a corneal abrasion

Front 335

what is this

Back 335

iris prolapse

Front 336

what is one cause of trauma where you would skip the case hx and go straight to treatment

Back 336

chemical burn

Front 337

curling iron burns to the eye are usually bad ones because heat supply doesn't reduce when it hits the wet surface of the eye like an ember would

Front 338

how do you tx a radiation burn

Back 338

like a superficial corneal abrasion

Front 339

is an acid or alkali burn worse

Back 339

alkali

Front 340

what is the pH of the normal eye

Back 340

around 7 (neutral)

Front 341

describe the pathophysiology of an alkali burn

Back 341

alkali saponifies (converts to soap) lipids in the epithelial cell membranes and it binds to the mucoproteins and collagen of the stroma. alkali continues to penetrate for hours to days after initial contact, even if rinsed off of the surface of the eye. can result in ulceration and melt.

Front 342

you need to have the pt start washing out there eye immediately if they call in with a chemical burn. don't even have them come into the office first, just wash it out where ever they are at. then have them come into the office right away.

Front 343

describe the progression of chemical burns

Back 343

Alkali involvement may present moderately, then return as severe in 3 to 5 days (because tissue damage continues even after chemical is washed off the surface of the eye). Unlike other chemical burns, where the damage is usually maximal within hours.

Front 344

describe the proceedure for lavage of a chemical burn

Back 344

Need to pull the lids away for the eye and rinse the upper and lower cul-de-sac. Use sterile saline solution, or purfied water if they have it. if not use tap water.

Front 345

for severe or moderate alkali burn refer directly to ___________

Back 345

oculoplastic surgen

Front 346

you need an emergency kit that has pH strips to determine the type of chemical burn that come into your office.

Front 347

describe the treatement and follow up of a chemical burn

Back 347

1. lavage immediately (before they leave for your office) for 20-30 min. 2. never put a bandage CL or a pressure patch on a chemical burn. the CL will act as a resivoir for the chemical causing damage to the eye. 3. rx antibiotic until there is no longer any staining 4. cycloplegics if AC reaction (steroid use is controversial) 5. RTC 24 hours until staining is gone

Front 348

what do you need to remember if you are going to dilate a pt with a chemical burn

Back 348

just use tropicamide, no phenlyephrine. because you don't want to constrict the blood vessels any more than they already are.

Front 349

New lecture: 17 Blunt Trauma 09 NOTES

Back 349

a

Front 350

what will a pt experience visually from blunt trauma

Back 350

The moment of impact is accompanied by intense pain and the sensation of a bright light

Front 351

what is the hierchy of visual acuity results for people who can't see any letters on the chart (from best to worst vision)

Back 351

1. counting fingers 2. hand motion 3. light projection 4. light perception

Front 352

what is the difference between light projection and light perception

Back 352

projection: they can localize the light source perception: they can only tell that there is, or is not light. they can't tell where it is comming from.

Front 353

what type of IOP should you never do on a blunt trauma pt

Back 353

digital

Front 354

what tests do you need to do on a blunt trauma pt (7)

Back 354

1. VA (do pinhole) 2. pupils 3. gross observation 4. IOP 5. EOMs 6. fields 7. dilated fundus exam

Front 355

what do you need to educate a blunt trauma pt about

Back 355

signs and symptoms of retinal detachment. they can occur a while after innitial trauma.

Front 356

what other ocular condition besides retinal detachment can occur from blunt trauma

Back 356

angle recession.

Front 357

what is the mechanism for angle recession from blunt trauma

Back 357

cornea, lens and iris displace posteriorly. cornea recovers, but lens still displaced. Angle tears.

Front 358

what is the medical term for a bruise

Back 358

ecchymosis

Front 359

what is the tx and follow up for a black eye

Back 359

cold compresses. typicall follow up in 5 days.

Front 360

describe the progression of a black eye

Back 360

it might actually look worse than innitial presentation after ecchymosis formation, but will eventually improve.

Front 361

if there is hemorrhage on the outside of the eye, remember to look _______

Back 361

on the inside of the eye

Front 362

what tx is needed if an eye is so swollen that the pt can't close their eyelid

Back 362

lubricating drops. you want to use a viscous gel (like refresh liquigel) because ointments need the lids to spread them across the eye. use copious amounts every 30 min to 1 hour.

Front 363

what is the tx for subconjunctival hemorrhage

Back 363

no tx, just education. -rest, no heavy lifting. sleep with head above heart for severe cases. avoid blood thinners. -may use cold or hot compresses

Front 364

how long does it take for a subconjunctival hemorrhage to resolve

Back 364

typically 1 week. severe cases can take 1 month.

Front 365

you could drain a severe sub-conj. hemorrhage. you would need lots of antibiotics to prevent infection and to let the pt know that there will be blood running down the side of their face.

Front 366

with a scleral laceration you may have low IOP. why?

Back 366

because damage to the ciliary body causes temporary stopage of aqueous production

Front 367

may see uveal prolapse with scleral laceration

Front 368

what can you do if you don't have a metal shield for a pt with a severe laceration.

Back 368

cut a styrofoam cup and make it shallow (metal shields are not expensive)

Front 369

descemet's tears can occur from trauma or __________

Back 369

forceps delivery (this is not done as much now)

Front 370

what is iridoschisis

Back 370

cleavage of the iris stroma

Front 371

describe the management of iridoschisis

Back 371

no tx. monitor for signs of angle closure

Front 372

what is it called when the iris separates from the ciliary body

Back 372

iridodialysis

Front 373

what is it called when you have a tear in the iris that creates a second pupil

Back 373

polycoria

Front 374

why does iridodialysis increase the risk of glaucoma

Back 374

because of scaring and fibrosis in the area of the trabecualar meshwork

Front 375

what is angle recession

Back 375

a tear between the longitudinal and circular muscles of the ciliary body. most often noted following blunt trauma.

Front 376

angle recession can result in accommodative dysfunction

Front 377

describe the management of angle recession

Back 377

no tx, monitor for glaucoma

Front 378

what is cyclodialysis

Back 378

disinsertion of the ciliary body from the scleral spur which may produce a cyclodialysis cleft resulting in hypotony.

Front 379

what is ocular hypotony

Back 379

abnormally low IOP, usually less than 6 mmHg.

Front 380

what is the mechanism for hyphema

Back 380

rupture of the vascular supply to the iris and/or ciliary body

Front 381

what ocular condition can you expect in almost all contusive injuries

Back 381

uveitis

Front 382

how is the IOP affected by trauma

Back 382

IOPs typically low during the first week post-trauma. IOPs increase as the ciliary body recovers

Front 383

is glaucoma associated with blunt ocular trauma? when is the onset?

Back 383

Latent complication: Early: 2 months to 2 years: Related to amount of angle damage

Front 384

what is the ring of pigment deposited on the lens after trauma called

Back 384

vossius ring

Front 385

what part of the orbit is broken in a blow out fracture

Back 385

the orbital floor above the infraorbital canal

Front 386

what is an avulsion of the optic nerve

Back 386

most devistating consequence of severe ocular trauma that results in total blindness. A tearing away forcibly of the ONH.

Front 387

New COURSE: Ocular Disease I

Front 388

New lecture: Intro to Lid Disease 2009

Front 389

what are the two parts of the orbicularis muscle

Back 389

orbital portion and palpebral portion

Front 390

what are the meibomian glands

Back 390

sebaceous gland (oil) in the tarsal plate that provides the oily layer of the tear film. opening just behind the lashes

Front 391

New lecture: Abnormal.Shape_posit. of lids.09.Victoria

Front 392

Define ectropion

Back 392

an abnormal eversion of the lower lid margin away from the globe.

Front 393

what is the name of the surgery to repair ectropion

Back 393

blepharoplasty

Front 394

what are some subjective symptoms of ectropion?

Back 394

tearing, eye or eyelid irritation, wiping eye, history of burns surgery or trauma around lids, bells palsy, asymptomatic.

Front 395

Meaning of SOAP?

Back 395

subjective objective assesment and plan.

Front 396

Objective objective signs of ectropion

Back 396

outward turning of the eyelid, exposure keratopathy, conjunctival injection, keratinization.

Front 397

what is it called when you can't close your eyelids all the way

Back 397

legophthalmos

Front 398

some possible ways that ectropion can be acquired?

Back 398

involutional (lid laxity from age), paralytic, cicatricial (scarring), mechanical (something is pushing or causing it), allergy (swelling).

Front 399

the most common cause of acquired ectropion?

Back 399

involutional. lid laxity with age.

Front 400

its rare that ectropion be congenital but if its due to blepharophimosis syndrome what is this?

Back 400

the abnormal narrowness of the palpebral fissure in the horizontal direction caused by the lateral displacement of the medial canthi

Front 401

its rare that ectropion be congenital but if its due to microphthalmos what is this?

Back 401

developmental anomaly where the globe is abnormally small.

Front 402

congenital ectropion may be associated with buphthalmos which is?

Back 402

An enlarged globe resulting from increased IOP. seen with pts that have congenital glaucoma.

Front 403

Involutional Ectropion. Laxity-related ectropion typically begins laterally,centrally or medially

Back 403

medially. with time central and lateral lid may evert.

Front 404

four words that are used to describe ectropion based on their location

Back 404

Punctal If you can see the puncta without manipulation, this is punctal ectropion Medial Can see an everted medial aspect of the lid Lateral Can see an everted lateral aspect of the lid Tarsal (complete) Can see the entire lower lid everted

Front 405

name two ways that lower lid laxity can be tested

Back 405

The lid distraction test how far the lid margin can be pulled away from the globe > 8mm = lid margin laxity The snap test How quickly the lid margin snaps back against the globe after it has been pulled away from it > 1-2 seconds indicates lid margin laxity

Front 406

7th nerve palsy can be tested by asking the pt to do what?

Back 406

show their teeth (rather than smile)

Front 407

If the ectropion is due to a bells palsy when should you treat ectropion

Back 407

wait for three months it usually will resovle on its own.

Front 408

A cicatricial cause of ectropion could be due to?

Back 408

chemical burn, surgery, eyelid laceration scar, or others

Front 409

describe the management of ectropion

Back 409

1. lubricating drops 2. taping possible 3. surgical treatment

Front 410

what is it called when the lids are partially or completely sutured together

Back 410

Tarsorrhaphy

Front 411

external paste-on upper lid weights available for lagophthalmos/ectropion

Front 412

subjective reports for entropion

Back 412

ocular irritation, FB sensation, tearing, red eye, potopobia, decreased vision (possible)

Front 413

objective signs for entropion.

Back 413

turned in eyelid, SPK, FB tracking, conj injection, corneal ulcer, decreased cornela sensation, corneal scaring

Front 414

causes of entropion

Back 414

involutional, acute spastic, or congenital, cicatricial

Front 415

entropion caused by acute spastic entropion is caused by what?

Back 415

the orbicularis oculi muscle overwhelms the oppositional action of the lower eyelid retractors. (usually an involutional component as well)

Front 416

you may have to ask the pt to ______in order to see acute spastic entropion.

Back 416

blink

Front 417

acute spastic entropion is usually the result of?

Back 417

ocular irritation, may be due to an infectious, inflammatory or traumatic processes.

Front 418

Congenital entropion is very rare but may arise due to underlying developmental abnormalities such as

Back 418

dysgenesis, paucity of tissue vertically in the posterior lamella of eye lid, or tarsal kink syndrome

Front 419

causes of cicatricial entropion could be?

Back 419

scaring of the palpebral conj usually the result of trauma, infection, chemical burn or stevens-johnsons syndrome, ocular cicatricial pemphigoid

Front 420

what is ocular cicatricial pemphigoid (OCP) (a cicatricial cause of entropion)

Back 420

Rare inflammatory syndrome involving primarily the oral and ocular mucous membranes

Front 421

entropion Must be distinguished from Epiblepharon which is?

Back 421

A congenital condition in which the pretarsal orbicularis muscle and the skin covering the eyelid push the eyelashes vertically or inwards

Front 422

Plan for entropion

Back 422

Medical therapy- lubrication (may break cycle of spastic entropion due to dry eye). hygiene/ antibio and steroid to treat bleph. which coud be causing the spastic entropion. Botox-weakens pretarsal orbicularis.

Front 423

Is it possible for blepharitis to cause the lashes to turn in?

Back 423

Yes.

Front 424

define trichiasis

Back 424

The acquired misdirection of eyelashes toward the globe

Front 425

describe some subjective complaint associated with trichiasis

Back 425

FB sensation, red eye, pain, photophobia, tearing

Front 426

what are some of the objective findings of trichiasis?

Back 426

conjunctival scarring, FB tracking on cornea, Signs of entropion and horizontal lid laxity, Lashes growing from the meibomian gland orifices (distichiasis), symblepharon and fornix scars.

Front 427

causes of trichiasis?

Back 427

Infectious (blepharitis, zoster, trachoma), autoimmune (OCP), inflammatory (stevens-johnson, vernal keratoconjunctivitis), trauma.

Front 428

describe the management of trichiasis

Back 428

1. lubricants 2. tx causative disease 3. surgical proceedures

Front 429

what are two procedures that can help with trichiasis?

Back 429

lash/follicle destroying/repositioning, epilation

Front 430

is epilation permanent or temporary

Back 430

usually temporary it often leaves the lash follicle.

Front 431

what is the most effective way of fixing trichiasis?

Back 431

radiofrequency ablation

Front 432

the treatment "normally done" for trichiasis?

Back 432

epilation

Front 433

where is the general location for an eyelid coloboma for the upper and lower lids? does it usually affect the upper or lower lid

Back 433

upper- Usually between the inner and middle third of the lid lower- Usually between the middle and outer third of the lid -usually affects the upper lid

Front 434

what is it called when there is failure of eyelid formation

Back 434

cryptophthalmos: cryptophthalmos the eyelid skin grows continuously from the forhead to the cheeks

Front 435

objective signs associated with eyelid coloboma

Back 435

trichiasis, symblepharon, malformation of the caruncle, exposure keratopathy, obstruction of the lacrimal system, other colobomas

Front 436

what type of tissue is defective during developement when a lid coloboma is formed?

Back 436

mesodermal tissue, some research show that it may also be due to ischemia.

Front 437

our primary goal with treatment of a lid coloboma?

Back 437

corneal protection. Artificial tears and ointment Moist chamber optical bandages Bedtime patching

Front 438

why would you want to wait until the infant is older if you have a small eyelid coloboma that is not causing too many problems

Back 438

risks with anesthesia are greater with infants

Front 439

are epicanthal folds usually unilateral or bilateral

Back 439

almost always bilateral, however, may be asymmetric

Front 440

should an infant with epicanthal folds be seen for the problem ever again?

Back 440

yes in 6 months. if it is limiting the view then surgery could be done. also you want to check for a real esotropia, because it will be hard for the parents to tell.

Front 441

are epicanthal folds associated with any ethnicity

Back 441

asian

Front 442

are epicanthal folds permanent

Back 442

usually the child will grow out of it.

Front 443

what is dermatochalasis?

Back 443

Definition: Redundant and lax eyelid skin overhanging the margin

Front 444

what age is the begining of dermatochalasis usually seen is?

Back 444

40 and progresses with age. if it runs in the family it has been seen to start in the 20's

Front 445

causes of dermatochalasis?

Back 445

Loss of elastic tissue in the skin, and Weakening of the connective tissues of the eyelid -more common in the upper eyelid, but can be seen in the lower lid

Front 446

subjective complaints with dermatochalasis?

Back 446

cosmetic, ocular irritation, entropion of upper eyelid, ectropion of the lower lid, bleph, dermatitis.

Front 447

objective findings of dermatochalasis

Back 447

Presence of an upper eyelid crease should be noted and measured (look for lesions). Levator still functioning Normal upper eyelid margin position should fall ~1 mm below the superior limbus. orbital fat should be assessed

Front 448

most common cause of dermatochalasis is? and others?

Back 448

normal aging is most common. trauma, priorbital edema, chronic dermatitis, thyroid eye disease, blepharospasms, and flopp;y eyelid syndrome.

Front 449

Plan for dermatochalasis?

Back 449

generally surgery (blepharoplasty). patients with blepharitis may benefit from hygiene and topical antibiotics. dermatitis may use steroids.

Front 450

New lecture: Lid Muscle Abnormalities.09.Victoria

Front 451

define ptosis

Back 451

An abnormally low position (drooping) of the upper eyelid

Front 452

ptosis is also called

Back 452

blepharoptosis

Front 453

types of ptosis

Back 453

Congenital Acquired

Front 454

what percent of cases of ptosis are congenital

Back 454

90% Congenital, and present at birth

Front 455

what percent of congenital cases of ptosis are unilateral

Back 455

70%

Front 456

causes of congenital ptosis (2 types, remember the names)

Back 456

irregularity of the levator muscle (mygenic) or abnormalities of the CN 3 superior division (neurogenic).

Front 457

how can you DDX between congenital and acquired ptosis

Back 457

look at old pictures. or look at lid position in downgaze: In congenital ptosis, the ptotic lid appears higher in downgaze In acquired ptosis, the ptotic lid is equal to the non-ptotic lid

Front 458

what is marcus gunn syndrome?

Back 458

anomalous innervation. lid elevation occurs with mastication or with movement of the jaw to the opposite side.

Front 459

categories of aquired ptosis are?

Back 459

neurogenic, myogenic, aponeurotic (where the levator aponeurosis has undergone structural changes which reduces its ability to lift the eyelid), and mechanical.

Front 460

An example of acquired neurogenic ptosis?

Back 460

Horners syndrome. ptosis miosis and anhidrosis. lack of sympathetic innervation. DM or aneurysms of the internal carotid artery.

Front 461

why do you get heterochromia with Horner's syndrome

Back 461

Because of the lack of sympathetic innervation to the iris melanocyte development, a difference in the iris color between the eyes may result (heterochromia)

Front 462

what is an example of acquired myogenic ptosis? and what are the signs?

Back 462

Myasthenia gravis. basically a muscle problem. bilateral but asymmetrical ptosis. the Pt may have a history of fluctuating ptosis and strabismus.

Front 463

what is the most common type of aquired ptosis and is it unilateral or bi?

Back 463

Aponeurotic ptosis and it is usually bilateral.

Front 464

Acquired mechanical ptosis is caused by what?

Back 464

excessive weight, like edema tumors or traumatic events such as lacerations effecting nerves or muscles.

Front 465

what is one example of pseudoptosis?

Back 465

dermatochalasis.

Front 466

what are the values of mild, moderate and severe ptosis in mm.

Back 466

-measure both palpebral fissures and find the difference Mild: 1-2mm Moderate: 2-3mm Severe: =4mm

Front 467

Other than amblyopia what could a ptotic eye cause in regaurds to vision?

Back 467

astigmatism from the compression.

Front 468

what is the proper way to evaluate the levator function on a ptotic pt? and what are normal results

Back 468

The patient looks downward as a ruler is positioned with a mark adjacent to the upper lid margin With the examiner's hand eliminating any brow (frontalis) action by the patient, the patient looks upward as far as possible without a change in head position Total lid elevation should be 8-14mm as patient looks from down gaze to up gaze

Front 469

with a ptotic pt if you want to watch for amblyopia how often should you schedule a follow up?

Back 469

3-4 months also look for signs of a head turn. -extrenal photographs can be helpful.

Front 470

average number of blinks per minute?

Back 470

15-20

Front 471

what is blepharoclonus? and what causes it?

Back 471

increased frequency of blinking, increased closure phase (time lid is actually closed), caused by irritation and inflammation.

Front 472

what population is blepharoclonus usually seen in?

Back 472

children

Front 473

what is myokymia? what is it caused by?

Back 473

twitching of a few bundles of the eyelid fibers. lid twitch, fasciculation of the orbicularis. stress, tension, fatigue, lack of sleep, caffeine...

Front 474

treatment for myokymia?

Back 474

remove the cause, inject botox, use antihistamines, or quinine (tonic water)

Front 475

is blepharospasm usually unilateral or bilateral

Back 475

blepharospams is bilateral

Front 476

define blepharospasm

Back 476

Any abnormal tic or twitch of the eyelid bilateral involuntary orbicularis contraction resulting in lid closure. spasmodic, idiopathic.

Front 477

describe the pt demographic that most commonly experiences blepharospasm

Back 477

>50, F>M,

Front 478

describe the severity associated with blepharospasm

Back 478

At one end - essential blepharospasm - manifested by simple increased blink rate and intermittent eyelid spasms On the other end of the spectrum - blepharospasm is a disabling condition with ocular pain and functional blindness

Front 479

Blepharospasm commonly is associated with

Back 479

dystonic movements of other facial muscles

Front 480

objective: changes with long standing blepharospasms include?

Back 480

eyelid and brow ptosis Dermatochalasis Entropion canthal tendon abnormalities

Front 481

Early symptoms of blepharospasm include

Back 481

increased blink rate, eyelid spasms, eye irritation, midfacial or lower facial spasm, brow spasm and eylid tic.

Front 482

Conditions relieving blepharospasm included

Back 482

sleep, relaxation, interior gaze, artificial tears, singing, humming.

Front 483

therapy for blepharospasms

Back 483

reassurance, botox and it would need to be re injected in 3-4 months. last choice would be surgical, it involves removal of the orbicularis.

Front 484

what is a macule

Back 484

a flat, discolored spot of varied size (<10 mm) and shape.

Front 485

what is a patch

Back 485

similar to a macule, but >10 mm

Front 486

what is a papule

Back 486

a solid, elevated lesion < 10 mm in diameter

Front 487

what is a nodule

Back 487

a solid lesion >10 mm in diameter that may or may not be elevated. projects above and below the surface.

Front 488

what is the difference between a nodule and a tumor

Back 488

tumors are larger nodules that are 20 mm or greater

Front 489

what is a vessicle

Back 489

a circumscribed, elevated lesion < 5 mm in diameter containing serous fluid. (a small blister)

Front 490

what is a bulla (blister)

Back 490

a vessicle > 5mm in diameter

Front 491

what is a pustule

Back 491

a superficial, elevated lesion containing pus

Front 492

what is a telangiectasia

Back 492

dilation of superficial blood vessels

Front 493

New lecture: OPT 533 - Blepharitis 2009

Front 494

what is another name for blepharitis

Back 494

lid surface disease

Front 495

what is blepharitis

Back 495

inflammation of the eyelids and especially of their margins

Front 496

what is the difference between anterior and posterior blepharitis

Back 496

anterior: inflammation centered around eyelashes posterior: inflammation involving the meibomian glands and gland orifices

Front 497

most common cause of anterior blepharitis? and two others

Back 497

staphylococcal (aureous or epidermadis) and seborrheic, mixed

Front 498

what is seborrhea

Back 498

abnormally increased secretion and discharge of sebum producing an oily appearance of the skin and the formation of greasy scales

Front 499

what is sebum

Back 499

a fatty secretion of the sebaceous glands of the skin

Front 500

what is another name for posterior blepharitis

Back 500

meibomianitis.

Front 501

what is angular blepharitis and name two organisms that cuase it

Back 501

blepharitis localized to the canthus. caused by staphylococcus and moraxella

Front 502

what is staphylococcal blepharitis

Back 502

infection of the lash follicles and lid margins with staphylococcus aureus and/or an overgrowth of staphylococcus epidermidis (epidermidis is part of the normal flora of most individuals; aureus is normally present in only a small number of individuals)

Front 503

what type of bacteria are staphylococcal?

Back 503

gram + cocci

Front 504

what are the three types of blepharitis?

Back 504

anterior, posterior, and angular

Front 505

how does staphylococcal blepharitis affect the tear film

Back 505

the bacteria produce lipase which breaks down lipids in the tear film creating free fatty acids. this triggers inflammatory and irritative response.

Front 506

what makes up pus

Back 506

dead PMNs and protein clots. -presence of pus indicates bacterial infection

Front 507

what are PMN's?

Back 507

polymorphonuclear leukocytes (WBC's) that move into the tissues during an inflammation response

Front 508

staph bleph subjective complaints

Back 508

may be asymptomatic, depends on severity. chronic irritation and burning, FB sen,tender lids (could have recurrent hordeola or chalazia), crusts on lashes, stuck lids, pt may complain of red irritated lids.

Front 509

name 11 clinically observable objective signs associated with staphylococcal blepharitis

Back 509

1. Crusts along the lash line at the base of the lashes 2. collarettes 3. madarosis 4. infected folicles 5. ulcers at the base of the lashes 6. trichiasis 7. lid erythema 8. secondary conjunctivitis 9. PEE 10. phlyctenule 11. marginal infiltrate

Front 510

Crust can encircle lash are called what?

Back 510

collarette

Front 511

will the crusts always be crusty?

Back 511

no they could have an oily appearance but there is still the presentation of yellow goodness.

Front 512

loss of lashes or eyebrows is called:

Back 512

Madarosis

Front 513

staph bleph can also cause a misdirection of the lashes called? the tx for this is?

Back 513

trichiasis, epilation

Front 514

what is the conjunctivitis secondary to staphylococcus blepharitis sometimes called.

Back 514

staphylococcal blepharoconjunctivitis

Front 515

what is the mechanism for PEE caused by staphylococcal blepharitis

Back 515

The baceria produce exotoxins that damage the cornea.

Front 516

what is the difference b/t PEE and an ulcer of the cornea?

Back 516

PEE is only missing epi. an ulcer is a hole that has missing epi and dermis (or stroma). (damage that is limited to the epithelium is considered an erosion)

Front 517

tx of staph bleph includes (5)

Back 517

1. lid hygiene: remove crusts, remove bacteria 2. increase blood flow by performing a warm compress 3. lid scrubs 4. antibiotic (ointment and oral when severe) 5. lubricants

Front 518

what do you need to remember to tell the pt when you are rxing warm compresses for blepharitis

Back 518

the compresses are going to make their eyes red bc you are opening up the blood vessels, but that is good because it lets the blood cells get in there and fight the infection.

Front 519

instructions for warm compresses

Back 519

soak lids with warm, wet compress with the eyelids closed for 10-15 min, bid-qid.

Front 520

instructions for lid scrubs

Back 520

1. Wash your hands thoroughly. 2. Mix warm water and a small amount of non-irritating (baby) shampoo (1-1 to 10-1) or use a commercially prepared lid scrub solution recommended by your optometrist. 3. Using a clean cloth (a different one for each eye) rub the solution back and forth across the eyelashes and edge of the closed eyelid. 4. Rinse THOROUGHLY with clear water. 5. Repeat with the other eye.

Front 521

name four antibiotic ointments used for staphylococcus blepharitis and their class

Back 521

Bacitracin Cell wall inhibitor Erythromycin Macrolide Gentamicin Aminoglycoside Tobramycin Aminoglycoside

Front 522

how many times should a pt apply the antibiotic ointment for moderate and severe staph bleph?

Back 522

Moderate: qhs or bid Severe: tid or qid

Front 523

If the staph bleph is extremely severe what drug may you need to use? what is the regimen

Back 523

oral antibiotics such as doxycycline 100 mg PO bid for 7-10 days

Front 524

how can antibiotics like tetracycline or doxycycline be helpful for staphylococcal blepharitis even if the bacteria is resistant to it? (staph bleph)

Back 524

tetracyclines inhibit the lipase synthesis by the bacteria and doxycycline inhibits exotoxin induced cytokines and chemokines. they also have an antiinflammatory response.-good for rosacea.

Front 525

important points for patient education when talking about staph bleph?

Back 525

Chronic condition - Usually exacerbations and remissions Goal: to control not cure Importance of daily lid hygiene Medication for acute flare-ups

Front 526

a pt with staph bleph may have WBC's infiltrate their cornea. where are they located? can they do damage?

Back 526

in the periphery btwn the epi and the stroma. they can damage the cornea when they die b/c they release enzymes.

Front 527

do corneal infiltrates stain with fluorescein

Back 527

may or may not stain. may stain in a sporadic punctate pattern

Front 528

what causes marginal infiltrates due to staphylococcus blepharitis

Back 528

hypersensitivity to staph. toxins. white spot is accumulation of WBCs (infiltrate means WBCs)

Front 529

tx for marginal infiltrate associated with staph bleph?

Back 529

treat the staph bleph and also add a topical steroid q2h to qid such prednisolone acetate, dexamethasone or loteprednol. or use a combo antibiotic/steroid like tobradex or zylet q2h to qid.

Front 530

what is a phlyctenule

Back 530

a small vesicle or pustule ; especially : one on the conjunctiva or cornea of the eye. it is a collection of WBCs. it is due to a hypersensativity reaction to different pathogens.

Front 531

what is the name of a raised white lesion due to hypersensitivity to staph toxins and where is it located?

Back 531

phlyctenule. may be on the conj limbus or cornea and may move across the cornea pulling vessles with it and creating a scar.

Front 532

How do you treat a phlyctenule associated with staph bleph?

Back 532

treat the staph bleph and also add a topical steroid q2h to qid such prednisolone acetate, dexamethasone or loteprednol. or use a combo antibiotic/steroid like tobradex or zylet.

Front 533

what was the most common cause of phlyctenule several years ago? what is it now? why?

Back 533

was TB, now it is staphylococcus. b/c we are better at controling TB.

Front 534

seborrheic blepharitis is often associated with what? and what is that?

Back 534

seborrheic dermatitis a disorder of the skin in areas with abundant sebaceous glands. dandruff is excessive shedding of the dead skin cells of the scalp; it is a symptom of seborrheic dermatitis

Front 535

what is another name for dandruff

Back 535

scurf

Front 536

subjective symptoms for seborrheic blepharitis?

Back 536

Frequently asymptomatic Possible morning “mattering” Dry eye complaints (poor tear film), Symptoms may depend on other concurrent processes

Front 537

objective signs for seborrheic blepharitis (3)

Back 537

greasy, waxy scales at the base of the lashes that flake off easily (scurf). skin of the lids a little greasy. PEE

Front 538

where and what kind of damage to the cornea occurs from seborrheic blepharitis

Back 538

Interpalpebral PEE that is located more centrally.

Front 539

Tx for seborrheic bleph?

Back 539

lid hygiene, lubricants, patient ed on chronicity of condition.

Front 540

Mixed bleph is a combo of what?

Back 540

staph bleph and seborrheic bleph.

Front 541

Tx for mixed bleph?

Back 541

same as just staph bleph. use an antibiotic such as tobramycin.

Front 542

describe the pathophysiology of meibonian seborrheic blepharitis?

Back 542

excessive oil production from the meibomian glands, and quality of oil is abnormal.

Front 543

what are the subjective symptoms associated with meibomian seborrheic blepharitis

Back 543

dry eye complaints

Front 544

objective findings for meibomian seborrheic blepharitis (3)?

Back 544

1. frothing of tears (oil slick in tear film) 2. reduced TBUT 3. conjunctival injection -lid tissue appears normal

Front 545

Tx for meibomian seborrheic bleph?

Back 545

keep lid margins clean and lubricants.

Front 546

angular blepharitis what is it?

Back 546

Localized eczematoid inflammation of the lid at the outer canthus and sometimes medial canthal region. may also involve the conj.

Front 547

there are two causes of angular bleph. what are they and how do the lids differ in their appearance between the two causes.

Back 547

1 staphylococcal form, dry and scaly 2 moraxella form, wet, macerated lid with whitish frothy discharge.

Front 548

Tx for Angular blepharitis?

Back 548

treat with an antibiotic ointment. (may need to try different antibiotics based on bacteria type)

Front 549

New lecture: Surgical Procedures Of Eyelid Lesions And Anomalies

Front 550

if you need to anesthatize the eye or a lid proceedure, where are the nerves located

Front 551

questions to ask the pt before any kind of surgical proceedure to the eye

Back 551

Are you allergic to any anesthetics? When you cut yourself do you stop bleeding quickly? Are you taking any anti-coagulant medications? - aspirin - coumadin (warfarin) - heparin

Front 552

New lecture: OPT 533 - Meibomianitis Skin 2009

Front 553

describe the pathophysiology associated with meibomian gland dysfunction?

Back 553

its not considered infectious entity, the gland metabolism is altered, secretions become thick and the block the opening, stagnant material grows bac. lipase is released triggering inflammation.

Front 554

meibomian gland dysfunction is often associated with what skin disorder?

Back 554

rasacea (acne),

Front 555

what is (acne) rosacea

Back 555

chronic inflammatory disorder involving skin and eye. the sebaceous glands are involved.

Front 556

describe the epidemiology associated with (acne) rosacea

Back 556

"celtic" northern ancestry (genetic component). adults 30-60 years old

Front 557

what percent of people with rosacea have ocular problems

Back 557

30%

Front 558

there are some bumps that are associated with rosacea they can come in two forms what are they called and which comes first.

Back 558

pustules and papule. papules usually proceed to pustules.

Front 559

where is the cellular debris in a papule?

Back 559

in the dermis

Front 560

what is a pustule associated with rosacea

Back 560

a typical pimple. red and inflammed with a white head. papules often progress to pustules

Front 561

what is this

Back 561

telangiectasias associated with rosacea

Front 562

Telangiectasias associated with rosacea what are they

Back 562

sisible dilated small blood vessels on the nose or cheeks. you can also get them on the eye lids. even on the bulbar conj.

Front 563

rhinophyma what is it?

Back 563

red, bullous nose (sebaceous gland hypertrophy); associated with rosacea

Front 564

Tx and regimen for rosacea?

Back 564

usually oral doxycycline 100mg bid X 4-6 weeks. you could also use a topical cream (metrodiazole gel) bid X 5-8 weeks.

Front 565

what are some things that may trigger rosacea

Back 565

hot spices, alcohol, heated beverages, chocolate, tomatoes, citrus fruits, Sun exposure, winds, stress, fear, anxiety, hellobacter pylori, ace inhibitors b/c they are vaso dilators.

Front 566

what type of ocular manifestations can rosacea have on lids (5)?

Back 566

Meibomian gland dysfunction Blepharitis, Hordeolum, Chalazion, Inflammation and infection of the lids

Front 567

what type of ocular manifestations can rosacea have on eye itself (5)?

Back 567

Poor tear film, Conjunctival injection, PEE (SPK), Corneal vascularization, Corneal thinning

Front 568

what could you do to tx a pt with rosacea if it is not affecting the eyes.

Back 568

nothing dont Tx them; if it's not affecting the eyes refer it out.

Front 569

what should you educate the pt about if they have ocular rasacea?

Back 569

lid hygiene, dietary restrictions and environmental triggers.

Front 570

how can you check for meibomian gland dysfunction clinically

Back 570

transillumination of meibomian glands

Front 571

normal transilluminated meibomian gland

Back 571

abnormal transilluminated meibomian gland

Front 572

what is this

Back 572

plugged meibomian glands (caps)

Front 573

objective signs of meibomian dysfunction (4)

Back 573

1. pouting of meibomian glands 2. inflammation of lids surrounding glands 3. serrated lid margin 4. conjunctival injection

Front 574

if you perfom a toothpast test and squeez a meibomian gland what color should the excretions be normally?

Back 574

clear

Front 575

when evaluating meibomian gland dysfuction what other conditions must you look for

Back 575

staph bleph, seborrheic bleph, and rosacea.

Front 576

Tx for meibomian gland dysfunction?

Back 576

1. warm compresses 2. in-office/at home expression of meibomian glands 3. manage dry eye. 4. consider doxycycline 100mg bid for 6 -10 weeks if severe or not responding to therapy. taper to lowest dose if possible. this works by inhibiting lipase production.

Front 577

Pt education for meibomian gland dysfunction?

Back 577

its a chronic condition, there is no cure all we can do is manage it.

Front 578

agents causing angular blepharitis?

Back 578

Moraxella lacunata Staphylococcus epidermidis Staphylococcus aureus

Front 579

drugs used for moraxella? drugs used for staphylococcus?

Back 579

M - zinc sulfate .25% solution S - bacitracin or erythromycin

Front 580

what condition is this

Back 580

impetigo

Front 581

what is impetigo

Back 581

Skin infection with Staphylococcus aureus or Streptococcus pyogenes

Front 582

true or false impetigo is not contagious?

Back 582

false it is contagious

Front 583

describe the epidmiology associated with impetigo

Back 583

most common in children under 6, sometimes in the elderly. also people exposed to poor hygienic conditions (common in homeless population)

Front 584

what are the objective signs associated with impetigo (1)

Back 584

a rash with crusts ("honey crusts") on the face and distal extremities

Front 585

describe the tx associated with impetigo

Back 585

dermatologist will tx this condition. oral antibiotics, wash involved areas, topical antibiotic after washing.

Front 586

what condition is this

Back 586

erysipelas

Front 587

what is erysipelas

Back 587

A skin infection involving the superficial dermal lymphatics swell up. that affects the legs and face most frequently.

Front 588

what bug causes erysipelas?

Back 588

streptococcus pyogenes

Front 589

how do you tell the difference b/t Erysipelas and Rosacea?

Back 589

Erysipelas will have started recently and Erysipelas will cause fever, chills, and pain.

Front 590

Is erysipelas contagous or not?

Back 590

yes but not as much as impetigo because erysipelas it is in a deeper layer of the skin

Front 591

Tx for erysipelas?

Back 591

refer to PCP or dermatologist. you would use penicillin

Front 592

New lecture: Thyroid Eye Disease.2009.FCH.Victoria

Front 593

how does the thyroid gland work

Back 593

Take iodine, found in many foods, and convert it into thyroid hormones: Thyroxine (T4) Triiodothyronine (T3) T3 and T4 are then released into the blood stream and are transported throughout the body where they control metabolism

Front 594

true or false Every cell in the body depends upon thyroid hormones for regulation of their metabolism?

Back 594

true

Front 595

what percentage of each of T4 and T3 does the thyroid gland produce?

Back 595

80% T4 and 20% T3

Front 596

which is more powerful T4 or T3?

Back 596

T3 4X more powerful

Front 597

what gland controls the thyroid and how does it do that

Back 597

When the level of thyroid hormones (T3 & T4) drops too low, the pituitary gland produces Thyroid Stimulating Hormone (TSH) Under the influence of TSH, the thyroid will manufacture and secrete T3 and T4 thereby raising their blood levels The pituitary senses this and responds by decreasing its TSH production

Front 598

the hypothalamus produces____and the pituitary produces____ which stimulates the thyroid gland.

Back 598

TSH releasing hormone and thyroid stimulating hormone.

Front 599

what percent of women have some degree of hypothyroid

Back 599

as many as 10%

Front 600

What are the two major causes of hypothyroid

Back 600

1. inflammation 2. The broad category of “medical treatments”

Front 601

what is the most common inflammatory cause of hyopthyroid disease

Back 601

autoimmune thyroiditis (hashimotos disease).

Front 602

what is hashimoto's thyroiditis

Back 602

an aoutimmunie illness in which there is infmallation, and then destruction and fibrosis of the thyroid gland, ultimately resulting in hypothyroidism.

Front 603

what is a goiter

Back 603

thyroid gland enlargement

Front 604

true or false and explain. a goiter only occurs in hyothyroidism.

Back 604

false it can be seen in hyperthyroidism also

Front 605

how would a medical treatment cause hypothyroid

Back 605

The treatment of many thyroid conditions warrants surgical removal of a portion or all of the thyroid gland If the total mass of thyroid producing cells left within the body are not enough to meet the needs of the body, the patient will develop hypothyroidism

Front 606

Most common underlying cause of hyperthyroidism is

Back 606

Graves' disease

Front 607

how does graves disease cause hyperthyroid disease

Back 607

Antibodies, that the patient's immune system makes, attach to specific activating sites on a thyroid gland which causes the thyroid to make more hormone

Front 608

is it more common for a goiter to produce too much or too little thyroid hormone

Back 608

onlty a small percent of goiters produce too much thyroid hormone

Front 609

what are the three major clinical signs of graves disease

Back 609

[1] over activity of the thyroid gland (hyperthyroidism), [2] thickening of the skin over the lower legs (pretibial myxedema), and [3] inflammation of the tissues around the eyes causing swelling

Front 610

what percent of people with graves disease will have serious eye problems

Back 610

About 1 out of 20 people with Graves' dz will suffer more severe eye problems If these serious problems are not recognized and treated, they can permanently damage the eyes and even cause blindness

Front 611

how do thyroid problems and eye problems due to graves disease link up chronologically

Back 611

Thyroid and eye involvement in Graves' dz generally run a parallel course Eye problems resolving slowly after hyperthyroidism is controlled

Front 612

Ophthalmic Graves disease (euthyroid condition) is when?

Back 612

When the eye signs of Graves' disease occur in a patient who is not clinically hyperthyroid

Front 613

In ______ of cases, thyroid ophthalmopathy occurs in the absence of both clinical and biochemical evidence of thyroid dysfunction

Back 613

10-25%

Front 614

Thyroid eye disease affects women or men more? how much?

Back 614

women 8:1 to men

Front 615

what is the typical age of onset of thyroid eye disease? is there a genetic component?

Back 615

20-45 yo, familial pattern

Front 616

what is another name for hyperthyroidism

Back 616

thyrotoxicosis

Front 617

Risk Factors for thyroid eye disease

Back 617

smoking (giving up smoking will reduce their risk), radioiodine (treatment for hyperthyroidism), and gender.

Front 618

Three classifications systems for graves dz are?

Back 618

NOSPECS (pneumonic) Clinical Activity Score (CAS) By structure

Front 619

NOSPECS' (graves disease classification system) usage is limited b/c?

Back 619

it lacks a means of measuring the rate of progression or treatment induced regression.

Back 620

picture

Front 621

what is the von graefe's sign

Back 621

immobility or lagging of the upper eyelid when looking downward. this is a sign of graves' disease.

Front 622

what is dalrymple's sign

Back 622

retraction of the eyelids causing an abnormally widened palpebral fissure, in primary gaze. this is a sign of graves' disease.

Front 623

describe a class 0 (N) rating on the NOSPECS classification system

Back 623

No signs or symptoms. routine physical and eye exams.

Front 624

Class 1 – O. in NOSPECS means what?

Back 624

Only signs, no symptoms (non-infiltrative stage) upper eyelid retraction (dalrymeple's sign) Upper lid "lag" on down gaze (von Graefe sign)

Front 625

Management of NOSPECS Class one signs.

Back 625

Lubrication Medication-Topical alpha adrenergic blockers – relaxes muscles(Dapiprazole) Topical beta adrenergic blockers-provides releif of hyperadrenergic symptoms (Propranolol) lastly surgery (levator surgery, muller's muscle recession)

Front 626

what is the first stage of infiltrative ophthalmopathy of the NOSPECS classification system of graves disease

Back 626

class 2 NOSPECS

Front 627

Class 2 -S in NOSPECS what is it?

Back 627

Soft tissue involvement (1st stage of infiltrative ophthalmopathy)

Front 628

subjective symptoms of class 2 S- of NOSPECS

Back 628

Lacrimation Photophobia FB sensation Retrobulbar discomfort

Front 629

objective signs of class 2 S- of NOSPECS

Back 629

Lid and conjunctival edema Lid and conjunctival hyperemia (redness) Conjunctival chemosis (edema of the conj) Extrusion of orbital fat Lacrimal gland swelling Inflammation near EOM insertion

Front 630

Management of class 2- S of NOSPECS

Back 630

Lubrication Elevate head during sleep Tinted cosmetic lenses Steroids (systemic and periocular)

Front 631

class 3 P In NOSPECS what is it

Back 631

Proptosis (exophthalmos)

Front 632

what is the most common cause of unilateral proptosis

Back 632

Hyperthyroidism is most common cause of unilateral proptosis

Front 633

whatpercent of all patients with bilateral exophthalmos will have graves' disease

Back 633

80%

Front 634

Management of class 3- P in NOSPECS

Back 634

Management - may be permanent and require no TX Lubrication Lid taping Steroids Tarsorrhaphy (stitching)

Front 635

average and upper limit of normal exophthalmometry values for healthy white and african american individuals

Front 636

Class 4 - E in NOSPECS what is it

Back 636

EOM involvement. (palsy leading to diplopia)

Front 637

what are the two most commonly affected EOMs by graves disease

Back 637

IR (60-70%) followed by MR

Front 638

which two muscles are most commonly affected by graves dz

Back 638

IR 60-70% of the time followed by MR.

Front 639

management of class 4 problems?

Back 639

Lubrication Eye patching or prisms Meds Steroids botulinum toxin Surgery - wait 6 months to 1 year

Front 640

Class 5 - C in NOSPECS is what?

Back 640

Corneal involvement Exposure keratopathy (can pose serious threat to vision)

Front 641

Management fo class 5 C in nospecs.

Back 641

Lubrication Meds-Antibiotics,Steroids Orbital radiation Orbital decompression

Front 642

class 6 S in NOSPECS is what?

Back 642

Sight loss (ON involvement)

Front 643

signs associated with class 6 S in NOSPECS

Back 643

Optic disc edema Painless, gradual loss of vision

Front 644

management of class 6 S of NOSPECS.

Back 644

Correction of thyroid imbalance Meds-Steroids,Cytotoxic or immunosuppressive agents Orbital radiation Orbital decompression -70% improve without tx

Front 645

b/c of criticism regarding the NOSPECS pneumonic a new system was proposed called the?

Back 645

CAS clinical activity score.

Front 646

how does the CAS system work?

Back 646

one point is given for each condition found on the pt from a given list. when all of the scores are added up to get a predictive value for therapeutic outcome.

Front 647

objective signs associated with grave's disease (13)

Back 647

1. puffy lids (enroth's sign) 2. lid retraction (dalrymple's sign) 3. lid lag -delay of upper lid in following globe movement in downward gaze (graefe's sign) -jerky downward movement of the eyelid (boston's sign) -delay of lower lid in following globe movement in upward gaze (grifith's sign) 4. tremor of closed eyelids (rosenbach's sign) 5. reduced blinking (stellwag's sign) 6. conjunctival injection 7. chemosis 8. exposure keratopathy 9. exophthalmos 10. ocular bruit 11. EOM gaze restictions 12. swollen nerve head 13. disc pallor

Front 648

enlarged ocular muscles due to graves dz is due to what?

Back 648

accumulations of glycoproteins, lymphocytes and fibrosis.

Front 649

what can the enlargement of EOMs cause?

Back 649

pressure on the optic nerve, and reduced eye movements.

Front 650

New lecture: Atypical Lid Bumps 2009

Front 651

name four types of cell growth?

Back 651

hyperplasia, metaplasia, dysplasia, neoplasia

Front 652

what is hyperplasia?

Back 652

increase in the number of cells

Front 653

what is metaplasia?

Back 653

a change in type of adult cells which is abnormal for that tissue.

Front 654

what is dysplasia?

Back 654

alteration in size, shape, organization of adult cells.

Front 655

what is neoplasia

Back 655

uncontrolled cell growth. mass of new cells which proliferate without control and serve no useful function

Front 656

what is anaplasia

Back 656

reversion of cells to a more primitive or undifferentiated form

Front 657

which one a benign or malignant tumor is surrounded by a capsule?

Back 657

benign, it doesnt infiltrate the surrounding tissue like a malignant tumor.

Front 658

true or false both malignant and benign tumors could recur is excised?

Back 658

mostly false a malignant could definitly come back if excised a benign usually will not.

Front 659

can a malignant tumor kill you? what about a benign tumor?

Back 659

A malignant tumor, if untreated, may kill the patient wherever it

Front 660

what grow more rapidly a malignant tumor or benign?

Back 660

malignant tumors grow faster.

Front 661

how are cancer cells named?

Back 661

by parenchymal cell of orgin

Front 662

what is the name given to tumors from epithelial tissue?

Back 662

carcinoma

Front 663

what is the name given to a tumor derived from CT, bone, cartilage, fat, or muscle?

Back 663

sarcoma

Front 664

what are the three general options for Tx of cancer.

Back 664

chemotherapy (attack cells that divide the quickest), radiotherapy (rays are lethal to all cells), and surgery (surgery being the first line of tx).

Front 665

objective signs that indicate a lesion is neoplastic

Back 665

1. quality of tissue is irregular 2. irregular changes in appearance 3. neovascular pattern within or around lesion 4. infection or inflammation at the site 5. bleeding 6. ulceration 7. uncharacteristically large in size 8. erosion of the margins or surface

Front 666

A,B,C,D's - rule of thumb for cancers?

Back 666

asymmetry, borders, color, and diameter.

Front 667

another name for a freckle?

Back 667

ephilis (ephilides is plural)

Front 668

management for suspicious lump/bump

Back 668

1. with serious doubt or suspicion regarding any lump or bump of the lid, recommend excision and biopsy 2. photodocument 3. diagram and acurately measure 4. RTC q 3 months

Front 669

how do freckels compare with normal skin

Back 669

larger sized melanocytes (normal in number)

Front 670

freckels are intensified by sun exposure

Front 671

what is this

Back 671

solar lentigines

Front 672

what is another name for solar lentigines

Back 672

(liver spots, age spots)

Front 673

what are solar lentigines

Back 673

expanding macules that occur in response to sunlight

Front 674

another name for a mole?

Back 674

Nevus

Front 675

can a nevus change shape/size?

Back 675

yes they may rise up, grow, hairs, disapear, or change color.

Front 676

name the four types of Nevus?

Back 676

dermal, junctional, compound, and dysplastic.

Front 677

out of the four types of nevus which one is most common, and what layer of the skin is it located in

Back 677

dermal. it is located in the dermis

Front 678

what is a junctional nevus and can it convert to melanoma

Back 678

located at the dermoepidermal junction. superficial and usually flat. may convert to melanoma.

Front 679

out of the four types of nevus which one is located in teh dermoepidermal junction and dermis, and is transitional to malignancy?

Back 679

compound. may convert to malignancy

Front 680

out of the four types of nevus which one appears like a fried egg (darker in the middle), and has an increased risk for melanoma if there is multiple ones and a FHx.

Back 680

dysplastic

Front 681

when is it common for a nevus to increase in size?

Back 681

with aging especially with kids when they hit puberty.

Front 682

what is a common place to find a nevus on the anterior segment

Back 682

lid margins. usually less than 10 mm in diameter

Front 683

is it a good or a bad sign to have hairs growing from a nevus

Back 683

good

Front 684

what is the RTC for a lid nevus

Back 684

1 year if normal appearance. 3-6 months if suspicious. refer for biopsy if changes occur.

Front 685

what is a malignant melanoma

Back 685

a malignant tumor that is derived from melanocytes?

Front 686

describe the virulence and commonality of malignant melanoma

Back 686

comprise 3% of primary skin cancers but account for 79% of skin cancer related deaths

Front 687

what are the objective findings for malignant melanoma

Back 687

asymmetric, pigmented, irrregular borders, variable coloration and the diameter is usually greater than 5mm

Front 688

name and describe the types of malignant melanoma

Back 688

superfical spreading melanoma: rapid increase in size, lower incidence of metastases nodular melanoma - vertical growth with more penetration into tissue, metastasize very early

Front 689

what is the most common malignant lid tumor

Back 689

basal cell carcinoma

Front 690

what is the most common skin cancer

Back 690

basal cell carcinoma

Front 691

what is the general ocular location for basal cell carcinoma

Back 691

more common on the lower lid

Front 692

name and describe the two types of basal cell carcinoma

Back 692

sclerosing: sooks like a worm noduloulcerative: looks like a nodule

Front 693

what is the general appearance of basal cell carcinoma

Back 693

PEARLY BORDERS, varying degrees of central umbilicated centers, rolled boarders, early forms may look like vascularized nodules.

Front 694

what location of basal cell carcinoma requires more rapid attention and why?

Back 694

the inner canthal region b/c it is more locally invasive and could eat bone and flesh

Front 695

is metastasis common in basal cell carcinoma

Back 695

no

Front 696

what is the plan of attack for basal cell carcinoma

Back 696

derm consult with in 3 months. antibiotic steroid combo is secondarily infected or inflammed.

Front 697

what is the etiology and the appearance of squamous cell carcinoma

Back 697

etiology is keratinizing epidermal cells Dx is scab that doesnt heal, reddish, scaly plaque,

Front 698

describe the epidemiology associated with meibomian gland carcinoma

Back 698

rare in north america, but common india and asia

Front 699

what does meibomian gland carcinoma resemble?

Back 699

it is like a persistent recurrent meibomian gland chalazion. get a biopsy if the pt says that they have had a chalazion for 6 months to a year. persistant bleph is also common. it metastisizes early

Front 700

what is the most common precurser of cancer

Back 700

actinic keratosis

Front 701

what is another name for actinic keratosis

Back 701

sun spots (solar keratosis)

Front 702

what is actinic keratosis

Back 702

squamous cell dysplasia

Front 703

actinic keratosis, what is the objective finding

Back 703

dry, scaly lesions 2-5 mm. minimally elevated.

Front 704

what is a common drug used for many skin cancers and is a cream

Back 704

imiquimod - for 6 weeks

Front 705

what is a keratocanthoma

Back 705

papular lesion. benign proliferation of squamous epidermal cells.

Front 706

can a keratocanthoma convert to a malignancy

Back 706

yes, can convert to squamous cell carcinoma. it is a percusor to cancer.

Front 707

is a keratocanthoma related to sun exposure

Back 707

no

Front 708

can a keratocanthoma spontaneously regress

Back 708

yes

Front 709

describe the objective appearance of keratocanthoma

Back 709

starts as a erythematous papule. grows into a firm, raised indurated nodule up to 2 cm. keratin filled center.

Front 710

what is another name for lentigo meligna

Back 710

hutchinson's freckle

Front 711

can lentigo maligna conver to malignancy

Back 711

precursor to melanoma. could have the lesion 20 years before it converts to malignancy.

Front 712

what is lentigo maligna

Back 712

dysplastic nevus

Front 713

what age group is lentigo maligna (hutchinsons freckle) usually seen in

Back 713

older pts

Front 714

what is the appearance of lentigo maligna (hutchinsons freckle)?

Back 714

dark macular lesion with irregular serpiginous pigment and margins.

Front 715

what is an acrochordon

Back 715

this is a skin tag/soft wart, benign, and usually pedunculated usually found on the obese

Front 716

manegment for acrochordon

Back 716

snip it freeze it or zap it.

Front 717

what is a papilloma

Back 717

a benign epithelial tumor that is lobulated, and may be right on the lid margin

Front 718

describe the management for papilloma

Back 718

((oculoplastics are lid surgery specialists; you want to send here not to a general opthamolagist) ((there is a risk of permanent damage to the ability to produce tear film and they are usually not malignant; pt education is necessary)

Front 719

what is seborrheic keratosis

Back 719

hyperkeratinized plaques. benign epidermal tumor.

Front 720

describe the etiology of seborrheic keratosis

Back 720

basal cell hyperplasia

Front 721

is seborrheic keratosis related to the sun or not?

Back 721

NO

Front 722

what is lichen planus

Back 722

common, pruritic eruption; chronic mucocutaneous disease that affects the skin and the oral mucosa, and presents itself in the form of papules, lesions or rashes.

Front 723

what is the etiology of lichen planus

Back 723

it is possibly immune response, may be viral

Front 724

what is the name of a benign skin tumor that is caused by HPV

Back 724

verrucae

Front 725

what is the difference b/t verrucae and papilloma?

Back 725

verrucae is considered an active papilloma that is typically seen in kids and is contagious papilloma is usually found on the lid margins

Front 726

what benign skin tumor is asociated with STD and HIV and is mildly contagous

Back 726

molluscum contagiosum (viral warts)

Front 727

what is the key objetive observation with molluscum contagiosum

Back 727

that it is umbilicated nodule with a central core, this central hole differentiates it from papilloma and verrucae

Front 728

what is the plan for molluscum contagiosum?

Back 728

if it is quiet leave it alone, if there is central discharge express it excision cryo or topical salicylic acid pt ed. because it is contagious

Front 729

New lecture: Opt 533 - Hordeolum Chalazion Cyst 2009

Front 730

an external hordeolu is an infection of what?

Back 730

the zeis gland

Front 731

what is an internal hordeolum an infection of

Back 731

the meibomian gland

Front 732

what is the infectious agent in 90-95% of hordeolum

Back 732

staph aureus

Front 733

what is the subjective symptoms of a hordeolum

Back 733

painful, swelling on one eyelid, erythema, tender. history of similar problems is common.

Front 734

hordeolums are found more frequently in people who have ?

Back 734

diabetes (reduced kidney, eye and immunological functions), chronic bleph, seborrhea.

Front 735

what is an external hordeolum

Back 735

a localized, raised, red bump near the lid margin that points to the skin side of the lid

Front 736

what is an internal hordeolum

Back 736

a locatized, red, raised bump that points to the conjunctival side of the lid.

Front 737

what is an important thing that you need to educate pts with a hordeolum about

Back 737

dont squeez it it could spread into pre ceptal cellulitis

Front 738

describe the management associated with external hordeolum

Back 738

1. not treatment, usually are self-limiting (most eventually drain by themselves) 2. warm soaks are the main treatment (qid for 15 min) 3. or topical antibiotics may be used for recurrent lesions and for those that are actively draining 4. epilation of eyelash associated with infected follicle may enhance drainage of pus

Front 739

large internal hordeolum can discharge anteriorly through the skin

Front 740

what type of infection can an internal hordeolum turn into

Back 740

preseptal cellulitis

Front 741

what is the Tx/plan for an internal hordeolum

Back 741

1. usually are self limited but you can do warm soaks 2. for recurent lesions and those actively draining you can use a topical antibiotic 3. for a pointed lesion you could do surgical drainage to speed up the process. 4. systemic antibiotics are indicated only when inflammation has spread beyond the immediate are of the hordeolum

Front 742

how should drainage of an internal hordeolum be done

Back 742

Stab incision at the site of pointing using an 18-gauge needle or a #11 blade External incisions lead to scarring, so making external eyelid incisions or punctures is inadvisable, unless the hordeolum already is pointing externally A large abscess may have multiple pockets and require multiple stabs. Internal incisions should be made vertically to minimize the area of cornea swept by a scar during blinking Leave the incision open with a clean margin

Front 743

what is another name for chalazion

Back 743

meibomian cyst

Front 744

what is a chalazion

Back 744

lipogranulomatous infiltration of the meibomian gland. may follow an internal hordeolum.

Front 745

objective signs associated with chalazion

Back 745

firm nodule within tarsal plate. non-tender, non-inflammed

Front 746

describe the tx for chalazion

Back 746

1. warm compresses 10-15 min. qid to q2h 2. you could do a steroid injection into the lesion 3. incision and curettage if the steroids dont work.

Front 747

what is a cyst that arises from a blocked sweat secreting gland.

Back 747

cyst of moll

Front 748

what is another name for a cyst of moll

Back 748

suderiferous cyst

Front 749

describe the appearance of a cyst of moll

Back 749

dome shaped, non tender, no inflammation, translucent, fluid filled, anterior margin.

Front 750

what is the Tx for cyst of moll

Back 750

thisis primarily a cosmetic concern, it can be aspirated with a fine needle but rcurrence is common. you can also excise it by removing the whole sac to reduce the reccurence.

Front 751

what cyst is not translucent and arises from blocked oil secreting glands associated with cilia

Back 751

cyst of Zeis

Front 752

describe the appearance of a cyst of zeis

Back 752

contains oily secretions and is less translucent than a cyst of moll

Front 753

what cyst can be found on any part of the body and it arises in a blocked oil gland, has a central punctum and if squeezed it will exude stringy, cheesy white material

Back 753

sebaceous cyst

Front 754

plan for a sebaceous cyst

Back 754

if you are going to remove it you need to remove the whole sac. you cant just excise out the cheesy material it will come back. if infected, an oral antibiotic shoudl be rxed

Front 755

New lecture: OPT 533 - Lacrimal Disease 2009

Back 756

picture

Front 757

what is a collection of amniotic fluid within an obstructed lacrimal sac called? It appears as a firm bluish mass on the side of the nose and inferior to the medial canthus.

Back 757

Congenital dacryocele

Front 758

how do you treat a congenital dacryocele?

Back 758

Hot compresses and massage, most infants will require probing.

Front 759

what is the result of a failure of the nasolacrimal duct to completely canalize during gestation? And what could it cause as a secondary problem?

Back 759

Congenital nasolacrimal duct obstruction, and it could cause bacterial dacryocystitis and or conjuctivitis, because the tears are held in the canals allowing bacteria to grow.

Front 760

how common is congenital nasolacrimal duct obstruction

Back 760

very common. 2-4% of full-term infants.

Front 761

in congenital nasolacrimal duct obstruction, which end of the duct is normally obstructed

Back 761

nasal end (valve of hasner)

Front 762

is congenital nasolacrimal duct obstruction usually unilateral or bilateral

Back 762

can be either.

Front 763

describe the objective signs associated with congenital nasolacrimal duct obstruction

Back 763

1. tearing 2. crusting 3. mucus reflux from the punctum with compression over the lacrimal sac

Front 764

How do you manage a congenital nasolactimal duct obstruction?

Back 764

warm compresses bid to qid, also use a topical antibiotic such as erythromycin bid for one week if there is a mucopurulent discharge. also have parents massage downward to open valve of hasner. If it doesn't resolve spontaneously by the age of 6 to 13 months probe it. (if probing is not successful, treatment is surgical)

Front 765

what percent of the time will congenital nasolacrimal duct obstruction resolve spontaneously

Back 765

90% with the assistance of massage

Front 766

discribe three signs and symptoms associated with congenital glaucoma

Back 766

tearing, photophobia, large cornea

Front 767

name three conditions that can cause acquired nasolacrimal duct obstruction

Back 767

1. chronic sinus disease 2. age-related stenosis 3. naso/orbital trauma

Front 768

how could you test for Acquired nasolacrimal duct obstruction?

Back 768

Jones test

Front 769

Acquired nasolacrimal duct obstruction could often lead to?

Back 769

Acute dacryocystitis. (inflammation of lacrimal sac).

Front 770

How do you treat Acquired nasolacrimal duct obstruction?

Back 770

first try warm compresses, a topical antibiotic- steroid if there is partial obstruction. then try dilation/irrigation and or probing. If this is not successful then turn to surgery. Dacryocystorhinostomy (DCR). the insertion of a silicone tube (Jones tube).

Front 771

describe the pathophysiology associated with acut dacryocystitis

Back 771

nasolacrimal duct becomes obstructed. tears stagnate in lacrimal sac. lacrimal sac becomes infected.

Front 772

what type of bacteria cause the infection acute dacryocystitis?

Back 772

staphylococci, streptococci, E. coli, pseudomonas, and other gram negatives.

Front 773

what would show as a tender red bump in the area inferior to the medial canthus? could extend about 2 cm below canthus.

Back 773

Acute dacryocystitis

Front 774

signs and symptoms associated with acute dacryocystitis (8)

Back 774

tenderness, erythema and swelling over the nasal portion of the lower lid. epiphora, purulent punctal discharge (particularly when pressure is applied to the lacrimal sac), fever and malaise, preseptal cellulitis, conjunctivitis

Front 775

what is the treatment for Acute dacryocystitis?

Back 775

-consider referal to specialist -Warm compress tid, -systemic antibiotic such as oral augmentin -also a topical antibiotic such as erythromycin if conjunctivitis exists -aspirate the lacrimal sac contents with 19 gauge needle for culture testing. -could consider incision and drainage. -if pointing abscess, consider incision and drainage -after infection resolved, irrigation and/or probing to relieve obstruction - Consider dacryocystorhinostomy DCR.

Front 776

If the infection in the lacrimal region has no sign of being acute reactions it should be considered

Back 776

chronic daryocystitis

Front 777

Which lobe of the lacrimal gland is affected more frequently in dacryoadenitis?

Back 777

the palpebral more than the orbital.

Front 778

Most often Acute dacryoadenitis is caused by?

Back 778

Acute dacryoadeitis is usually associated with systemic infections such as mumps, epsein barr virus and herpes zoster.

Front 779

name 8 objective ocular and systemic signs that indicate acute dacrysoadenitis

Back 779

temporal upper eyelid inflammation (S-shaped deformity), upper eyelid tenderness, warmth, tearing, discharge, fever, and possible proptosis (if the orbital lobe is involved) -Swollen palpebral lobe of the lacrimal gland can be easily visualized in the supratemporal fornix by elevating the upper lid while having the patient looking down

Front 780

management acute dacryoadenitis?

Back 780

treat the underlying infection or inflammation.

Front 781

what is more common chronic or acute dacryoadenitis?

Back 781

chronic

Front 782

underlying etiology of chronic dacryoadenitis

Back 782

seen primarily in young black females, and could be associated with sarcoidosis, thyroid ophthalmopathy, sjogrens syndrome, or a tumor?

Front 783

what is the triad of sjogrens syndrome?

Back 783

dry eye, dry mouth and arthritis.

Front 784

how can sjogrens syndrome affect the lacrimal gland

Back 784

Lacrimal gland infiltrated with lymphocytes à may be enlarged. -sjogren's is an autoimmune disease

Front 785

what is canaliculitis

Back 785

infection of the canaliculus (duct between the punctum and the lacrimal sac)

Front 786

what is the most common and the second most common causative agent in canaliculitis?

Back 786

1. actinomyces Israelii (filamentous grom + rod) 2. Candida albicans (yeast)

Front 787

name 5 objective signs associated with canaliculitis

Back 787

erythema and swelling of punctum and adjacent tissues, also conjunctivitis around the medial canthus. expression of the canaliculus causes discharge from the punctum, canalicular concretion

Front 788

describe the management of canaliculitis

Back 788

1. warm compresses 2. culture 3. remove concretion form canalicula 4. appropriate systemic and topical antibiotics

Front 789

New lecture: Preseptal and Orbital Cellulitis 09 Victoria

Front 790

what is preseptal cellulitis

Back 790

a relatively common eyelid infection that involves the periorbital tissue anterior to the orbital septum?

Front 791

what are some possible causes of preseptal cellulitis?

Back 791

URI, spread of an eyelid infection (hordeolum), trauma to the lids, insect bite.

Front 792

how do you differentiate between inflammation from insect bite and orbital cellulitis from insect bite

Back 792

If edema responds to antihistimine, it is probably just inflammation.

Front 793

what tissue is invaded during preseptal cellulitis?

Back 793

subcutaneous.

Front 794

if there is no sign of trauma or local lid infection what is the usual cause of preseptal cellulitis

Back 794

URI

Front 795

what is the most common offending pathogens for preseptal cellulitis? what about in children?

Back 795

staph aureus, staph epidermidis, streptococcus species, possibly H flu but it is not common now that we have the vaccine. Now a days streptococcus pneumoniae is the most common offender in children.

Front 796

true or false preseptal cellulitis could be secondary to things such as TB, Clamydia, juvenile idiopathic arthritis, or MRSA.

Back 796

true

Front 797

what must you rule out if you see preseptal cellulitis

Back 797

orbital cellulitis

Front 798

5 signs and symptoms of preseptal cellulitis (and 4 things they don't have)

Back 798

Red swollen eyelid, pain, epiphora, red eye, with a possible fever -no proptosis, no pain on EOMs, no EOM restriction, VAs usually normal

Front 799

is preseptal cellulitis primarily a pediatric disease or adult?

Back 799

pediatric disease. about 80% younger than 10. -want to co-manage with a pediatrician

Front 800

If you cannot rule out orbital cellulitis what do you need to do? -would be the case if the eye was swollen shut

Back 800

order a CT.

Front 801

what is the treatment for preseptal cellulitis in an adult or older child? what is the follow up?

Back 801

Amoxicillin/clavulanate (augentin) 500 mg p.o. tid for 10 days. also you must follow up in 24 hours.

Front 802

what is the treatment for younger children (older than 5) that have preseptal cellulitis? What is the follow up?

Back 802

amoxicillin/clavulanate (augmentin) 20 - 40 mg/kg/day by mouth divided into three doses X 10 days -again must follow up in 24 hours

Front 803

what do you need to use for preseptal cellulitis if a person is allergic to PCN?

Back 803

trimethoprim/sulfamethoxazole. an example is Bactrim.

Front 804

describe the management for anyone with moderate to severe preseptal cellulitis, children under 5 years old, or anyone not responding to therapy

Back 804

Hospitalize for iv antibiotics.

Front 805

what is orbital cellulitis

Back 805

an infection of orbital soft tissue posterior to the orbital septum

Front 806

is orbital cellulitis more common in adults or children?

Back 806

children. mean age of hospitilization is 7-12 years old.

Front 807

describe the prognosis associated with orbital cellulitis

Back 807

11% can have vision loss if not diagnosed right away. can lead to death if not treated (meningitis).

Front 808

what kind of surgery must you ask about if a pt has orbital cellulitis.

Back 808

dental work

Front 809

possible causes of orbital cellulitis?

Back 809

most common cause is ethmoid sinusitis (90%). dental work is another common cause (you need to ask about recent dental work if you have a pt you suspect orbital cellulitis). extension of an infection from the periorbital structures and sinuses, infection of the orbit following trauma, or surgery, or hematogenous spread of bacteremia.

Front 810

what are the most common bacterial pathogens that cause orbital cellulitis?

Back 810

stph aureus, strept species, and H flu

Front 811

fungal infections can also cause orbital cellulitis. they are rare, but have a high mortality rate

Front 812

signs and symptoms of orbital cellulitis (14)

Back 812

1. lid erythema 2. lid edema 3. fever/malaise 4. hx of URI infection or sinusitis 5. red eye 6. pain 7. pain on eye movement 8. decreased vision 9. restricted EOMs 10. proptosis 11. chemosis 12. elevated IOP 13. ONH edema 14. APD -red indicators help differentiate with prespetal cellulitis

Front 813

what four things does orbital cellulitis have that preseptal cellulitis does not have

Back 813

pain on eye movement decreased vision restricted EOMs proptosis

Front 814

objective: decreased vision, lid edema and erythema, proptosis, conjunctival chemosis, restriction on EOM's, pain on eye movement, and may have elevated IOP, optic disc edema. what is it?

Back 814

orbital cellulitis.

Front 815

the key findings for orbital cellulitis are?

Back 815

ophthalmoplegia and proptosis.

Front 816

treatment for orbital cellulitis?

Back 816

HOSPITALIZATION!!!! IV whith broad spectrum antibiotics such as ampicillin-sulbactam. may also require surgical drainage.

Front 817

New lecture: Parasitic Lid Disease 2009

Front 818

what is the common name for a mite infection

Back 818

demodex infestation/demodicosis

Front 819

what part of the face do mites infect

Back 819

eyelid, facial hair, and eyebrow

Front 820

describe the prevalence of demodex/mite infestation

Back 820

Prevalence

Front 821

what are the two common spicies of mites

Back 821

demodex folliculorum, demodex brevis

Front 822

demodex that is cigar shaped, likes to be in a colony of 3 or more per follicle, and usually reside on the collarettes/cuffs of the hair follicles what are they?

Back 822

demodex folliculorum. -collarettes/cuffs are the best clinical diagnostic sign

Front 823

the demodex brevis is smaller and solitary where do they reside?

Back 823

in the sebaceous glands which can cause blockage that can lead to dry eye, or the formation of a chalazion. (must be small to get into the gland.)

Front 824

what would be the subjective symptoms of a person that has a demodex infection.

Back 824

itching, burning, crusting, swelling of lid margins, and lash loss.

Front 825

what are the objective findings on a person that has a demodex infection?

Back 825

lid margin erythema, conj infection, blepharitis, cuffing around lashes, plugging of meibomian glands and madarosis.

Front 826

what is the treatment for a demodex infection?

Back 826

almost imposible to completely eradicate. the treatment is the same as treating bleph. lid hygiene, ung hs X 10 - 14 days (ointment use at night.) for anti-microbial treatment erythromycin is a good choice.

Front 827

what is the technical name for lid infection with lice (2 types)

Back 827

phthiriasis palpebrarum/pediculosis palpebrarum

Front 828

name three species of lice

Back 828

phthirus pubis (carb louse) pediculus corporis (body louse) pediculus capitus (head louse)

Front 829

what is the most common lice found on the lids?

Back 829

the crab louse, (phthirus pubis) because of the spacing of follicles matches up with their legs. usually spread by sexual contact. (pubic lice much more common than head lice)

Front 830

what serious disease can be caused by lice?

Back 830

typhus: One of several rickettsial infections transmitted to people by lice, fleas, or mites.

Front 831

if you find louse on a person what other questions should you ask?

Back 831

have you noticed any itching anywhere else on your body? (looking for concurent genital infection)

Front 832

what is the difference between the pediculus and the phthirus spicies of lices

Back 832

pediculus are free-moving; phthirus is stationary (ped means foot). -also note that these lice like the dark, so if they are able, they will move away from the beam of your slit lamp.

Front 833

what are some subjective findings for a person with a lice infection?

Back 833

itching, red eye infection, insomnia due to irritability, occasional preauricular lymphadenopathy.

Front 834

what are the objective findings of patient with a lice infection?

Back 834

nit cases at base, crusty lid margins, madarosis, conj injection, lid edema, erythema, you may also see brown fecal matter or red blood from the host.

Front 835

what is the treatment for a lice infection.

Back 835

remove and drowned in alcohol. then prescribe erythromycin or bacitracin ung tid for 10 to 14 days. also physostigmine .25 % ung 2 applications 1 week apart. refer if other areas of the body infected.

Front 836

is it possible for a person to get a crab louse infection in the eyelids without direct sexual contact

Back 836

it is possible for crab louse to be transmitted without direct sexual contact but it is unlikely.

Front 837

New lecture: Auto Imm Dz 09 Victoria

Front 838

what is a disease that involves loss of pigmentation where there is hair?

Back 838

Poliosis

Front 839

what is the cause of poliosis?

Back 839

It is an immune response to melanin. cauases loss of pigmentation of eyelashes.

Front 840

name three causes of poliosis

Back 840

staph bleph, albinism, or vogt-Koyanagi-Harada syndrome.

Front 841

what is the treatment for poliosis for an OD?

Back 841

If the the underlying cause is bleph then treat it, if it is albinism or VKH then refer.

Front 842

what condition is this

Back 842

vitiligo

Front 843

what is vitiligo

Back 843

characterized by the loclized loss of melanocytes, with patchy loss of skin pigment.

Front 844

is there a heriditary component to vitiligo

Back 844

frequent positive family Hx

Front 845

what is the age of onset of vitiligo

Back 845

usually presents before age 20

Front 846

is vitiligo a progressive or stable condition

Back 846

progressive

Front 847

what is vogt-koyanagi-harada syndrome

Back 847

a rare multisystem disorder. possible autoimmune disease against pigmented tissues.

Front 848

what is the age of onset and ethnicity typically associated with vogt-koyanagi-harada syndrome

Back 848

common in ages 20-50. affects darker pigmented individuals, asian, hispanic, native american, middle eastern

Front 849

3 out of 4 of the following need to be present to diagnose vogt-koyanagi-harada syndrome

Back 849

diagnosis of at least 3 of the four following - bilateral chronic anterior uveitis - posterior uveitis - neurological features such as deafness and menengitis - cutaneous lesions

Front 850

name and describe the phases of vogt-koyanagi-harada syndrome

Back 850

phase 1: prodromal phase (lasts a few days). meningitis, encephalopathy, auditory disturbances. phase. 2: acute uveitic phase (soon after phase 1). anterior uveitis, posterior uveitis, retinal detachment phase 3: convalescent phase (follows several weeks later). alopecia 60%, poliosis, vitiligo, fundus lesions, depigmented limbal lesions (sugiura sign) phase 4: chonic-recurrent phase. smoldering anterior uveitis with exacerbations.

Front 851

what is the hallmark eye sign of vogt-koyanagi-harada syndrome

Back 851

acute serous retinal detachment. note that serous refers to serous fluid.

Front 852

what is the treatment for VKH?

Back 852

oral steroids the dose depends on the severity. you can also give steroid drops for the uveitis. if steroids are not enough then immunosurpressants like cyclosporine may be needed. periocular injection of steroids are also a posibility.

Front 853

what condition is this

Back 853

ocular cicatricial pemphigoid (OCP)

Front 854

what is another name for ocular cicatricial pemphigoid

Back 854

benign mucous membrane pemphigoid (BMMP)

Front 855

what is ocular cicatricial pemphigoid

Back 855

an autoimmune disease characterized by recurrent subepithelial blisters or bullae of the skin and mucous membrnes with a tendency to scar.

Front 856

name two distinct forms of OCP

Back 856

idiopathic and drug induced pseudo OCP

Front 857

what percent of people with OCP have ocular involvement

Back 857

70%

Front 858

OCP is typically diagnosed in what decades of life?

Back 858

6th or 7th

Front 859

early detection of OCP is critical to preserve their sight. we are responsible for early detection. we can be the first to diagnose.

Front 860

7 signs and symptoms associated with ocular cicatricial pemphagoid

Back 860

1. oral mucosa lesions 2. dermatological involvement 3. shrinkage of the conjunctiva (every time a blister pops the conj. shrinks) 4. chronic red eye 5. irritation 6. burning 7. tearing

Front 861

what are the four stages of OCP?

Back 861

1 - conjuctivitis 2 - conjunctival scarring and shrinkage 3 - symblepheron formation 4 - end stage with corneal scarring and ankyloblepheron.

Front 862

what is symblepheron

Front 863

what is ankyloblepheron?

Front 864

stage one OCP is what?

Back 864

conjunctivitis, red eye, tearing, burning, irritation, and mucous discharge.

Front 865

stage 2 OCP is what?

Back 865

conj scarring and shrinkage, worsens within 3 to 4 years

Front 866

stage 3 OCP is what?

Back 866

involves progression to symblepheron this is the attachment of the palpebral conj to the bulbar conj.

Front 867

stage 4 OCP involves what?

Back 867

severe dry eye, ankyloblepheron, and corneal scarring. ankyloblepheron is when the corners of the lids begin to shut.

Front 868

what is the most common initial objective sign of OCP?

Back 868

conjunctivitis associated with subepithelial fibrosis.

Front 869

what type problems can chronic contraction of conjunctival tissue lead to?

Back 869

shortening of the fornicies, entropion, and trichiasis. (ocular cicatricial pemphagoid)

Front 870

what causes vision loss in ocular cicatricial pemphagoid

Back 870

keratinization of the cornea

Front 871

what testing can help diagnose ocular cicatricial pemphagoid

Back 871

conjunctival biopsy. 83% are diagnosed with biopsy. 17% continue with disease progression in spite of negative biopsy.

Front 872

what is the therapy for OCP?

Back 872

topical steroids but they are not usually adequate alone. oral steroids are needed. start heavy with 40 to 60 mg of prednisone QD and then taper to a lower maintanence dose after significant remission of symptoms. -ocular tx: dry eye therapy, eyelash epilation, soft CLs (careful of infection), corneal transplant not very sucessful because stem cells are destroyed

Front 873

what causes the dry eye in ocular cicatricial pemphagoid

Back 873

destruction of the goblet cells and meibomian glands

Front 874

what is erythema multiforme

Back 874

an acute but generally self-limiting disorder of the skin and mucous membranes.

Front 875

erythema multiforme is divided into two types what are they?

Back 875

minor and major.

Front 876

what form of erythema multiforme consists of tergetoid skin lesions with well defined borders? and may or may not involve one mucosal membrane.

Back 876

EM minor

Front 877

which form of erythema multiform involves 2 or more mucosal membranes. and is more severe.

Back 877

EM major -seteven's-johnson syndrome was characterized as EM major for more than 30 years but now has its own category

Front 878

Is erythema multiforme the same as steven johnson syndrome? if not what is the difference?

Back 878

no they were for a long time but now they are different. EM is when it is only on the limbs. It is SJS when the trunk is effected also. -unsure about this slide, I didn't make it

Front 879

why is SJS important to OD's?

Back 879

in 50% of the cases their is an ocular involvement.

Front 880

what is steven's-johnson syndrome

Back 880

acute inflammatory skin and mucous membrane disorder. rare. bullous lesions involving 10-20% of the body surface. erosive involvement of two or more mucous membranes (often the conj.). morality rate 1-5%.

Front 881

are there any systemic symptoms associated with steven's-johnson syndrome

Back 881

malaise, fever, sore throat, HA

Front 882

what is a more severe case of steven's-johnson syndrome?

Back 882

TEN - toxic epidermal necrolysis.

Front 883

what is toxic epidermal necrolysis

Back 883

massive denudation of the epidermis involving >20% of the total body surface. a more severe variant of steven's-johnson syndrome. -sometimes these pts will go blind because the physicians are more worried about them dying.

Front 884

are there any systemic symptoms associated with toxic epidermal necrolysis

Back 884

same as SJS. malaise, fever, sore throat, HA

Front 885

what is the mortality rate and the rate of ocular involvement in toxic epidermal necrolysis

Back 885

25-35% mortality rate. ocular involvement in 50%.

Front 886

SJS and TEN can be caused by drug reactions what are some of the common ones? They can also be caused by infections by what pathogens?

Back 886

sulfonamides, tetracycline, penicillin, NSAIDS. mycoplasma pneumoniae and HSV

Front 887

what type of skin lesions are involved with SJS and TEN

Back 887

target or bull's eye lesion which have an reythematous center surround by a pale zone, usually on extremities. vessicles and bullae and epidermal necrosis develop, predominantly on the trunk of the body (double check that).

Front 888

describe SJS and TEN ocular involvement

Back 888

lids are swollen, crusted, and ulcerated. conjunctivitis with possible pseudomembrane or membrane formation. bullae formation followed by rapid rupture and scarring in the area of the epithelial erosion. entropion, trichiasis, symblepharon, corneal opacification, lacrimal dysfunction.

Front 889

what is the management of SJS and TEN?

Back 889

no specific treatment exists for systemic, manage pain and remove causative agent is possible. -For ocular involvement use steroids, cold compresses may help, soft CLs, epilation, dry eye therapy

Front 890

ocular complications of SJS and TEN are easily overlooked by physicians due to the seriousness of the condition.

Front 891

New lecture: Allergic Lid Disease 2009

Front 892

describe the difference b/t type one and type 4 allergic reactions.

Back 892

type one is immediate and is due to the release of substances such histamine. this will take place in minutes to hours. type four is a delayed reaction caused by sensitized lymphocytes (t cells). this takes place hours to days later.

Front 893

what is contact dermatitis

Back 893

what is the term used for the inflammation due to the skin coming into contact with an allergic agent.

Front 894

what are the types of contact dermatitis

Back 894

irritant and allergic contact dermatitis

Front 895

which is the more common type of contact dermatitis?

Back 895

irritant contact dermatitis.

Front 896

what is dermatitis

Back 896

any inflammation of the epidermis

Front 897

describe irritant contact dermatitis

Back 897

Nonspecific response of skin to chemical damage that releases mediators of inflammation from epidermal cells

Front 898

describe allergic contact dermatitis

Back 898

Here there is itching and involves a cell mediated immunity response. examples is poison ivy, latex, drugs, could also be chemical like irritant dermatitis but here it is not directly damaging the skin.

Front 899

how soon after contact with an allergen does irritant and allergic contact dermatitis occur? what accounts for this difference?

Back 899

irritant: 1-24 hours, can occur within minuets allergic: usually in 48 hours -allergic takes longer because there is a cell mediated immunity response, this requires a latency period.

Front 900

subjective symptoms associated with irritant contact dermatitis

Back 900

1. Hx 2. red rash 3. pain 4. burning/stinging -maybe no itching

Front 901

occupations that commonly experience irritant contact dermatitis

Back 901

cleaning, hospital care, food prep, hairdressing (often affects hands)

Front 902

irritant contact dermatitis: common irritants

Back 902

soap and water, solvent, microtrauma, dry air, cleaners

Front 903

objectice signs of irritant contact dermatitis

Back 903

1. erythema 2. edema 3. glazed, parched, scalded appearance 4. dry, scaly skin

Front 904

treatment for irritant contact dermatitis

Back 904

1. avoid irritant 2. non-sensatizing moisturizers (patroleum jelly) 3. soaps with low irritant effect (dove) -no topical steroids

Front 905

objective signs for allergic contact dermatitis

Back 905

1. PRURITIS 2. erythema 3. edema 4. vessicles 5. weeping rash 6. chemosis 7. keratitis may develop

Front 906

treatment for allergic contact dermatitis?

Back 906

remove allergen, cold compresses 4-6 days, topical steroids 5 - 10 days (something like hydrocortisone), consider oral antihisamine, and ocular lubricants

Front 907

what is atopic dermatitis

Back 907

a type of eczema. an inflammatory, chronically relapsing, non-contagous, pruritic skin disorder.

Front 908

what is eczema

Back 908

A general term for an itchy red rash that initially weeps or oozes serum and may become crusted, thickened, or scaly.

Front 909

what is the age of onset for atopic dermatitis

Back 909

infancy. -most common skin disease in children

Front 910

is there a heriditary component to atopic dermatitis

Back 910

yes

Front 911

signs and symptoms of atopic dermatitis

Back 911

1. rash that is exudative 2. vesicular to maculopapular 3. itching later stages 4. dry lichenified skin 5. excoriated areas -most common location is face (cheeks), scalp and knees

Front 912

atopic dermatitis: pt is more prone to dexondary infection with staph or streptococcus. usual susceptibility to herpes simplex and molluscum contagiosum

Front 913

describe the progression associated with atopic dermatitis

Back 913

unpredictable, but usually subsides by age 3 or 4 with exacerbations and remissions frequently recurring throughout childhood, adolescence and adulthood.

Front 914

what is urticaria and what is a common name(s) for it

Back 914

Multiple swollen raised areas on the skin that are intensely itchy and last up to 24 hr; they may appear primarily on the chest, back, extremities, face, or scalp. -AKA hives or welts

Front 915

what are the clinical features of urticaria?

Back 915

intense pruritus, raised welts surrounded by erythematous flare.

Front 916

what is angioedema

Back 916

when skin appears normal but deeper layers of the skin are edematous,

Front 917

treatment for urticaria and angioedema

Back 917

cold compresses, antihistamine, systemic steroids

Front 918

is there itching with angioedema? what areas of the body are most commonly involved

Back 918

a little pruritus. most often involves face, lips, eyelid, toungue, throat, hands, feet

Front 919

Causes of urticaria and angioedema

Back 919

1.

Front 920

tx for urticaria and angioedema

Back 920

1. avoid cause 2. cold compresses 3. antihistamine 4. systemic steroids 5. epinephrine for acute pharyngeal or laryngeal angioedema

Front 921

New lecture: DryEye Seminar2009

Front 922

what is dry eye

Back 922

Tear film disorder due to tear deficiency or excessive tear evaporation causing damage to the interpalpebral ocular surface and associated with symptoms of ocular discomfort resulting from localized immune-mediated inflammation affecting both the lacrimal gland and the ocular surface -aka ocular surface disease

Front 923

describe the cycle that triggers dry eye symptoms

Front 924

how does inflammation of the lacirmal gland and ocular surface lead to tear deficiency/instability

Back 924

tear instability due to altered composition

Front 925

what are the three components of normal tear film

Back 925

superficial lipid layer, aqueous layer, mucin layer

Front 926

name three functions of the normal tear film

Back 926

maintain health of the epithelium, fight infection, lubricate

Front 927

what could cause a disruption of the lipid layer of the tear film

Back 927

deficiency is rare. meibomian gland dysfunction can cause excessive output and disrupt stability of tear film.

Front 928

how can we assess the aqueous layer of the tear film clinically

Back 928

look at the tear meniscus, which sits at the junction between the lower lid and the globe.

Front 929

what is the term for dry eye due to a deficiency in the aqueous layer

Back 929

keratoconjunctivitis sicca

Front 930

systemic and ocular causes of deficiency of the aqueous layer of the tear film

Back 930

Systemic Rheumatoid arthritis (25%) Sjögren’s Systemic lupus Ocular Decreased lacrimal and accessory lacrimal gland output Age, inflammation, scaring, etc

Front 931

what layer of the tear film is least commonly the cause of tear film instability and dry eye

Back 931

mucin layer

Front 932

describe the pathophysiology behind tear film instability due to deficiency in the mucin layer of the tear film

Back 932

decreased goblet cells

Front 933

common causes of decreased goblet cells leading to tear film instability

Back 933

Hypovitamin A Ocular pemphigoid Steven Johnson Syndrome Trachoma Alkali burns LASIK

Front 934

why does menopause lead to dry eye

Back 934

decreased androgens

Front 935

what are some environmental stresses that cause dry eye

Back 935

contact lens wear, wind, air pollution, low humidity (heating/air conditioning), lack of sleep, use of computers

Front 936

name two ocular surgeries that tend to be associated with dry eye

Back 936

LASIK, corneal transplant

Front 937

many medications are associated with dry eye. preservatives in topical medications can cause irritation leading to dry eye.

Front 938

why would a contact lens wearer be uncomfortable in airplanes and in the mall

Back 938

Planes and the mall have very low humidity so that the people crammed in there will be less sweaty. Low humidity will dry out your lenses.

Front 939

why do autoimmune diseases like rheumatoid arthritis and lupus tend to cause dry eye

Back 939

All can result in immune-mediated inflammation in the eye Inflammatory mediators secreted into tears Promote inflammation of ocular surface

Front 940

subjective symptoms associated with dry eye

Back 940

1. foriegn body sensation 2. excessive tearing 3. dryness 4. burning, stinging 5. blurry vision 6. photophobia (caused by damage to the corneal epithelium) 7. itching 8. redness 9. contact lens discomfort

Front 941

dry eye assessment: in the slit lamp watch them blink. notice the rate and look for complete closure.

Front 942

should you use anesthetic for the phenol red thread test, or the schirmer test to assess dry eye

Back 942

((if you put anesthetic in and measure right away you will measure the amount of drop not the amount of team film; you need to consider your procedure and base it against your own judgement, not the standards) ((anesthetic will stop reflux tearing and measure base tear volume)

Front 943

how do you tell if a pt has dry eye after doing the schirmer test

Back 943

Dry eye is indicated if less than 10 mm of the strip becomes wet with tears after 5 minutes of exposure

Front 944

5 tests that assess dry eye

Back 944

1. biomicroscopy 2. schirmer test 3. phenol red thread test 4. tear break up time 5. rose bangal/lissamine gree staining other: nanolite osmometer (measures osmolarity), tearscope (keeler; evaluates the lipid layer of the tear film), fluorophotometer (estimates drainage)

Front 945

tricks for tear break-up time: ((with fluorescence you want as small an amount as possible to be able to notice staining) ((you need to notice how often the pt normally blinks, and compare the break up time to blink rate; just examine the cornea and notice if the tear film breaks before the pt blinks)

Front 946

how does tear osmolarity change with aqueous evaporation

Back 946

osmolarity increases. tear film becomes hyperosmotic because the tears are evaporating; this will cause the tears film to draw fluid out of the cells of the eye

Front 947

what is the best way to evaluate ocular surface disease

Back 947

rose bengal staining

Front 948

why is a pt with dry eye at an increased risk of infection

Back 948

with dry eye the natural defenses of the eye are compromised (lactoferrin, etc.) and they are at increased risk for secondary infection

Front 949

Lubrication types of Artificial tears May require frequent dosing Low viscosity to high viscosity Hypo-osmotic, iso-osmotic, hyper-osmotic Preservative verse preservative free Vitamin A supplementation Omego-3 fatty acids (Thera-tears) Systane emulsion of castor oil

Front 950

how often should you use artificial tears for dry eye

Back 950

drops don’t work as well if you use them when your eyes are already bothering you; you need to use them as prophylaxis when you know you are in a condition that will cause irritation. start with frequent instillation and once symptoms are under control, back off frequency until you start to have symptoms again, then you will know how often you need to use the drops

Front 951

what are gel artificial tears and name one

Back 951

Between ointments and solutions Last longer with less blur Refresh Liquigel

Front 952

8 treatments for dry eye

Back 952

1. artificial tears (gels, ointments) 2. ocular inserts 3. punctal plug 4. glasses with large wrap reduce evaporation 5. lid hygeine 6. topical testosterone (increases lacrimal production) 7. omega-3 fatty acids 8. steroids

Front 953

punctal plugs may make things worse for the first couple days

Front 954

describe the neuronal feedback loop that regulated normal tearing

Back 954

In the normal eye, the ocular surface, lacrimal glands, and the neuronal feedback loop that links them effectively constitute a single functional unit for the maintenance of ocular surface homeostasis The main and accessory lacrimal glands Produce aqueous tears, growth factors, and other proteins that promote ocular surface health Supported by constant neural input, maintained in a noninflammatory state by circulating androgens The ocular surface is richly innervated with sensory nerve endings Contributes vital components to the tear film: eg, mucin that helps wet the ocular surface Homeostasis of the healthy functional unit (neuronal feedback loop): Lacrimal glands secrete tears that lubricate and support the ocular surface Sensory (afferent) traffic travels from the ocular surface via the ophthalmic branch of the trigeminal nerve (V) to the brain stem and midbrain where it is integrated Ocular surface irritation or inflammation will impact afferent signaling Efferent traffic travels via the facial nerve (VII) and synapses to lacrimal glands, controlling secretion and tear production. Control of the accessory lacrimal glands and goblet cell secretion is under active investigation Dysfunction in any elements can eventually lead to dysfunction of all, with subsequent inflammation and dry eye disease

Front 955

how does dry eye impact the neuronal feedback loop that regulates normal tearing

Back 955

Dry eye disease Results from localized immune-mediated inflammation that ultimately affects the entire ocular surface/lacrimal gland/neural feedback functional unit The main and accessory lacrimal glands Susceptible to inflammation due to decreased neural or androgen support Activation of lymphocytes leads to T-cell-mediated inflammation, cytokine production, the presence of cytokines in tears, and acinar cell apoptosis The ocular surface Cytokines in tears trigger inflammation (T-cell and epithelial cell activation, leukocyte recruitment) on the ocular surface, disrupt epithelial cell function, interfere with mucin production Irritation can also trigger chemically mediated inflammation leading to activation of trafficking lymphocytes (T cells) The neural feedback loop Sensory activity on the ocular surface is disrupted by pro-inflammatory cytokines and compromised epithelial cells, impacting afferent signaling Sensory input to the lacrimal glands is decreased by disruption of the neuronal loop and by the direct inhibitory effect of inflammatory cytokines in the glands on secretomotor nerve endings Dysfunction in any one element can lead to dysfunction in all elements, with subsequent development of chronic inflammation and dry eye disease Inadequate tear production, altered tear composition, or secretion of inflammatory substances into tears can result in ocular surface inflammation

Front 956

what drug and what type of drug is restasis? what is it used for?

Back 956

cyclosporin, immunomodulator (anti-inflammatory). used for severe forms of dry eye.

Front 957

New lecture: OPT 533 - Conj Disease Intro 2009

Front 958

what is the technical name for red eye (or conjunctival injection)

Back 958

conjunctival hyperemia

Front 959

what causes conjunctival hyperemia

Back 959

anything that makes the conj. "unhappy" (irritation, inflammation etc.)

Front 960

between what layers does a subconjunctival hemorrhage occur

Back 960

between the conjunctiva and the episclera

Front 961

when would a subconjunctival hemorrhage be concerning

Back 961

if it was recurrent.

Front 962

what should you do if you have a pt with conjunctival hyperemia, but no other findings

Back 962

you know the conjunctiva is “unhappy” but you don’t know why Rx lubricants and have the patient come back if the problem doesn’t get better or gets worse

Front 963

what is the leading cause of chemosis

Back 963

allergy

Front 964

what are papillae

Back 964

Elevations of the conjunctiva Vascular core surrounded by edema and mixed inflammatory cells under the epithelium

Front 965

where are papillae most prominent

Back 965

Most prominent on the palpebral conjunctiva of the upper lid

Front 966

note increasing diffusion of the light reflex with increasing severity of papillae

Back 966

picture

Back 967

picture

Front 968

what are the types of papillae (3)

Back 968

normal papillae, giant papillae, cobblestone papillae

Front 969

how could you tell is papillae are caused by allergy or bacteria

Back 969

-eosinophils are related to allergic reation. PMNs are related to bacterial infection. You can culture to determine which is involved.

Front 970

what are follicles

Back 970

Yellowish to grayish white Discrete Round elevations of the conjunctiva Avascular but dilated blood vessels may surround the base and sweep up over the elevations Usually 0.2 mm to 2 mm in size but larger follicles can be seen Consist of plasma cells and lymphocytes

Front 971

name 4 types of conditions you can see follicles in

Back 971

1. viral disease 2. chlamydial disease 3. parinaud's oculoglandular syndrome 4. toxid drug reactions

Front 972

how do you differentiate between papillae and follicles

Back 972

In general, if conjunctival bumps are on the upper lid, think papillae first If conjunctival bumps are on the lower lid, think follicles first A few diseases have both on both lids; eg chlamydial disease also, papillae have a vascular core and follicles do not (but they may be surrounded by vessels)

Front 973

what does mucopurulent discharge indicate

Back 973

pus indicates PMNs which indicates bacterial infection

Front 974

what does hyperpurulence indicate

Back 974

gonococcal infection

Front 975

what is a true membrane

Back 975

Fibrinous exudate firmly adherent to conjunctiva Bleeds and scars when removed . It is a fibrin exudative material that sticks to the conjunctiva

Front 976

name three conditions in which you would see a true membrane

Back 976

Some bacterial conjunctivitis Stevens-Johnson syndrome Burns

Front 977

what is a pseudomembrane

Back 977

Fibrinous exudate that is loosely attached to conjunctiva Avascular

Front 978

name three conditions in which you could see pseudomembrane formation

Back 978

Mild allergic conjunctivitis Mild bacterial conjunctivitis Epidemic keratoconjunctivitis

Front 979

what is hyphema

Back 979

red blood cells in the anteroir chamber

Front 980

New lecture: OPT 533 - Conj Pigment Anomalies 2009

Front 981

what is this

Back 981

racial pigmentation

Front 982

what is another name for racial pigmentation

Back 982

epithelial melanosis

Front 983

describe the epidemiology for epithelial melanosis

Back 983

frequently occurs in african american and others with dark complexions

Front 984

describe the age of onset and the progression associated with epithelial melanosis

Back 984

Seen in the first few years of life and static by early adulthood

Front 985

is epithelial melanosis fixed or free moving

Back 985

Pigmentation is within epithelium and moves freely over globe

Front 986

describe the pathophysiology of epithelial melanosis

Back 986

Pigmented cells come from melanocytic cells that normally exist in the basal layer of the conjunctival epithelium. everyone has these melanocytes, but the pigment is usually not noticable

Front 987

what is this

Back 987

conjunctival nevus

Front 988

what is a conjuctival nevus

Back 988

Discrete, flat or slightly elevated, variably pigmented lesion Presentation is usually during the first two decades of life May enlarge or become more pigmented during puberty Cystic spaces within the lesion are frequently seen Amount of pigmentation is variable and almost non-pigmented nevi can be seen

Front 989

what is the most common location for a conjunctival nevus

Back 989

Most common location is the juxtalimbal area

Front 990

why is this picture suspicious

Back 990

blood vessels surrounding the nevus are called sentinel vessels. they are suspicous and my indicate a more serious condition

Front 991

what is a conjunctival melanoma

Back 991

Solitary, black or grey nodules that is fixed to episclera or Non-pigmented lesion with a smooth surface Often contains blood vessels

Front 992

how common is conjunctival melanoma

Back 992

Rare tumor - 2% of eye malignancies

Front 993

is a conjunctival melanoma typically fixed, or movable

Back 993

typically do not move over the globe like a nevus does

Front 994

describe the epidemiology and age of onset associated with conjunctival melanoma

Back 994

Predominantly in whites, rarely in blacks Presentation is usually in the sixth decade

Front 995

what is the mortality rate associated with conjunctival melanoma

Back 995

Overall mortality rate is 25% Rate increases to 40% - 44% if tumor arose from PAM ((primary acquired melanosis)

Front 996

-the eyes and the lung are connected in terms of metastasis occurring from one structure to the other.

Front 997

describe some changes that would make you suspicious that a nevus is turning into a conjunctival melanoma

Back 997

Increased vascularity Increased size Increased solidity Become fixed to the underlying sclera (except at limbus) Elevation

Front 998

what condition is this

Back 998

primary acquired melanosis

Front 999

what is primary acquired melanosis (PAM)

Back 999

Mobile, patchy, diffuse, flat, brown lesions Indistinct margins

Front 1000

is primary acquired melanosis a stable or progressive condition

Back 1000

may grow

Front 1001

describe the epidemiology associated with primary acquired melanosis

Back 1001

occurs in white, middle-aged or older adults

Front 1002

how do you differentiate between a nevus and primary acquired melanosis

Back 1002

PAM will have indistince margins, and will grow into adulthood (nevus can grown in childhood). Normally the benign pigmentation will occur in “dark skinned” population, not in white population.

Front 1003

what changes would indicated that primary acquired melanosis is converting into melanoma

Back 1003

Sudden appearance of one or more nodules in otherwise flat lesions A melanoma becomes fixed to the underlying tissue, which is not a feature of PAM

Front 1004

does primary acquired melanosis increase the risk of melanoma

Back 1004

yes

Front 1005

what condition is this

Back 1005

ocular melanocytosis

Front 1006

what is ocular melanocytosis

Back 1006

Multiple blue-gray or slate-gray patches of pigmentation in the episclera Things become bluer as they get deeper. Browner as they go towards surface.

Front 1007

is ocular melanocytosis fixed or movable

Back 1007

Pigmentation cannot be moved over the surface of the globe

Front 1008

what condition is this

Back 1008

oculodermal melanocytosis

Front 1009

what is another name for oculodermal melanocytosis

Back 1009

nevus of ota

Front 1010

are there any conditions associated with ocular melanocytosis

Back 1010

Ipsilateral iris hyperchromia Melanomas of the uveal tract (you should probably dilated these pts) Ipsilateral glaucoma

Front 1011

what is a pinguecula

Back 1011

Conjunctival degeneration Yellow-white subepithelial deposits of abnormal collagen

Front 1012

what direction does a pterygium point

Back 1012

Triangular base on the conjunctiva or limbus Triangular apex toward the center of the cornea

Front 1013

can a pinguecula turn into a pterygium

Back 1013

yes

Front 1014

what is the deposit at the leading edge of a pterygium called and what type of material is deposited there.

Back 1014

stocker's line. iron deposit.

Front 1015

what type of light picks an iron deposit best

Back 1015

cobalt blue

Front 1016

what layers of the corne are damaged by a pterygium

Back 1016

destroys bowman's membrane

Front 1017

how does a pterygium affect vision

Back 1017

induces astigmatism, may decrease vision if crosses the visual axis

Front 1018

describe the management of pterygium and pinguecula

Back 1018

1. lubricants 2. sunglasses for protection 3. vasoconstrictors 4. steroids if inflammed 5. possible surgery for pterygium that is affection vision

Front 1019

what percentof pterygium will return after surgery? what can be done to reduce recurrence

Back 1019

1/3. mitomycin C (antimetabolite).

Front 1020

what is a concretion

Back 1020

Minute hard yellow spots in the palpebral conjunctiva Caused when debris from cellular degeneration remains trapped in the conjunctiva and becomes calcified

Front 1021

can concretions be revomed

Back 1021

If necessary can be removed using a needle under topical anesthesia

Front 1022

what is this

Back 1022

conjunctival cyst

Front 1023

what is a conjunctival cyst

Back 1023

Thin-walled cysts filled with clear watery fluid

Front 1024

are conjunctival cysts usually problematic

Back 1024

Usually do not cause any symptoms If large, they may be ruptured or excised

Front 1025

what cells does lissamine green stain

Back 1025

only stains dead cells. can be seen in severe dry eye.

Front 1026

what is this

Back 1026

bitot's spot

Front 1027

what is a bitot's spot and what causes it

Back 1027

Drying and wrinkling of the conjunctiva May have a foamy appearance and do not wet easily Manifestation of severe vitamin A deficiency Rarely seen in the USA

Front 1028

New lecture: Allergic Conjunctivitis 2009

Front 1029

just rubbing your eyes will cause degranulation of mast cells and make your eyes itch. So could be that their eyes are simply irritated and they are rubbing them.

Front 1030

what should you educated your pts on in regards to the tx of allergic conjunctivitis

Back 1030

-remember to tell your pts that therapy is only going to relieve symptoms, not cure the allergy. So they can not stop taking medications

Front 1031

what can happen if you use too much of a vasoconstricter

Back 1031

-if you use too much of visine (etc.; vasoconstricter) you can have a rebound hyperemia. Your eyes will become red. -vasoconstricters such as visine are just for looks

Front 1032

8 types of treatment for allergic conjunctivitis

Back 1032

1. remove allergen 2. cold compresses 3. artifical tears 4. vasoconstrictors 5. antihistamines 6. mast cell stabilizers 7. topical steroids 8. topical NSAIDs

Front 1033

what is the mechanism of action for topical vasoconstrictors

Back 1033

Mechanism of action - binds to alpha receptors on blood vessels and

Front 1034

topical vasoconstrictors specific agents

Back 1034

Phenylephrine

Front 1035

what ocular side effect can be caused by oral anithistamines

Back 1035

dry eye; caused by anticholinergic effect

Front 1036

what is histamine and what are its effects on the body

Back 1036

Chemotactic factor for eosinophils

Front 1037

how do antihistamines work

Back 1037

bind to histamine receptors

Front 1038

what is the generic name for benedryl

Back 1038

diphenhydramine

Front 1039

name five oral antihistamines and whether they are over the counter or prescription

Back 1039

1. zyrtec (OTC) 2. allegra (RX) 3. clarinex (RX) 4. claritin (OTC) 5. benadryl (OTC)

Front 1040

are mast cell stabilizers safe drugs

Back 1040

very safe drugs

Front 1041

name five topical antihistamines

Back 1041

zaditor alaway patanol pataday claratin eyes

Front 1042

name 4 optical mast cell stabilizers. which one acts the fastest?

Back 1042

a.

Front 1043

what are steroids used to tx allergic conjunctivitis

Back 1043

inhibits inflammation of all kinds, but has ocular side effects.

Front 1044

name the only topical steroid FDA approved for treating allergic conjunctivitis

Back 1044

Alrex (loteprednol etabonate 0.2%) qid = ONLY TOPICAL STEROID FDA APPROVED FOR OCULAR ALLERGY TX

Front 1045

generic and trad names of three topical NSAIDS

Back 1045

Acular, Acular PF, Acular LS (ketorolac tromethamine 0.5% and 0.4% soln) qid

Front 1046

what is the common name for seasonal allergic conjunctivitis (SAC)

Back 1046

hay fever conjunctivitis

Front 1047

what is seasonal allergic conjunctivitis

Back 1047

the ocular component of hay fever. triggered by airborne antigens.

Front 1048

describe the pathophysiology associated with seasonal allergic conjunctivitis

Back 1048

Conversion of arachidonic acid to prostaglandins and leukotrienes results in inflammation

Front 1049

what type of allergic reaction causes seasonal allergic conjunctivitis

Back 1049

type 1

Front 1050

8 signs and symptoms associated with seasonal allergic conjunctivitis

Back 1050

1. mild to moderate itching 2. tearing 3. conjunctival hyperemia 4. lid edema 5. white stringy discharge 6. chemosis 7. papillary reaction 8. possible rhinitis

Front 1051

what is perennial allergic conjunctivitis

Back 1051

Clinically similar to SAC but persists throughout the year B.

Front 1052

what is acute allergic conjunctivitis

Back 1052

Urticarial rxn caused by large amount of allergen reaching the conj Subjective similar to SAC EX. Young children after playing in grass or with pets

Front 1053

objective appearance of acut allergic conjunctivitis

Back 1053

Sudden onset of severe chemosis and swelling of lids

Front 1054

describe the management associated with acute allergic conjunctivitis

Back 1054

TX/Management No specific TX needed – resolve spontaneously within a few hours

Front 1055

is giant papillary conjunctivitis an allergic reaction

Back 1055

not an allergic reaction per se; actual etiology is controversial)

Front 1056

what is giant papillary conjunctivitis

Back 1056

Specific conj inflammatory rxn characterized by papillary hypertrophy in the superior tarsal conj

Front 1057

what causes giant papillary conjunctivitis

Back 1057

Response to chronic, physical trauma Causes a.

Front 1058

it is good practice to evert the lids on all contact lens pts to check the upper lid

Front 1059

is giant papillary conjunctivitis unilateral or bilateral

Back 1059

almost always bilateral

Front 1060

what is another name for vernal keratoconjunctivitis

Back 1060

spring catarrh

Front 1061

what is vernal keratoconjunctivitis

Back 1061

a rare form of allergic disease that is seasonal/climate related

Front 1062

is vernal keratoconjunctivitis usually unilateral or bilateral

Back 1062

bilateral

Front 1063

8 objective signs associated with vernal keratoconjunctivitis

Back 1063

1. cobblestone papillae on superior tarsal plate (pretty specific to vernal) 2. lid edema 3. thick white stringy discharge 4. conjunctival hyperemia 5. superior SPK 6. superior limbal infiltreates 7. tranta's dots 8. sterile corneal ulcer

Front 1064

describe the epidemiology associated with vernal kertoconjunctivitis

Back 1064

young males with a hx of atopy

Front 1065

subjective symptoms associated with vernal keratoconjunctivitis

Back 1065

1. extreme itch 2. blepharospasm 3. blurriness 4. photophobia

Front 1066

what is atopic keratoconjunctivitis

Back 1066

Relatively RARE but potentially serious condition which affects young men with atopic dermatitis

Front 1067

9 objective signs of atopic keratoconjunctivitis

Back 1067

1. thick white stringy discharge 2. lid edema 3. papillae (inferior palpebral conj) 4. conjuncitival hyperemia 5. chemosis 6. mod-severe SPK (near 100%) 7. limbal infiltrates 8. tranta's dots 9. cicatrizing conjunctivitis with symblepharon formation

Front 1068

how does the onset of atopic ocular symptoms relate to the onset of other atopic symptoms

Back 1068

Ocular SXs usually develop years after onset of other atopic features

Front 1069

do the symptoms associated with atopic keratoconjunctivitis occur year round or do they come and go

Back 1069

SXs persist year round ((seasonal or vernal are not year round)

Front 1070

New lecture: Bacterial conjunctivitis 09 Print

Front 1071

what is bacterial conjunctivitis

Back 1071

Infectious inflammation of the conjunctiva with bacteria as the causative agent

Front 1072

what is the difference between acute and chronic bacterial conjunctivitis

Back 1072

It can be classified as acute (less than 4 weeks duration) or Chronic (greater than 4 weeks duration)

Front 1073

bacterial conjunctivitis can occur in otherwise health individuals

Front 1074

what is the most common causative agent for bacterial conjunctivitis for all ages

Back 1074

s. aureus

Front 1075

list four common causative agents for acute bacterial conjuncitvitis

Back 1075

1. s. aureus 2. s. epidermidis 3. s. pneumoniae 4. h. influenzae

Front 1076

is acute bacterial conjunctivitis usually unilateral or bilateral

Back 1076

Unilateral initially Becomes bilateral by auto inoculation

Front 1077

how do you differentiate between bacterial and viral conjunctivitis

Back 1077

with bacterial the lids will be stuck shut in the morning. eyes to not stick shut with viral infection or allergic reaction

Front 1078

how does the color variation of the blood vessels differ between bacterial and viral infection

Back 1078

if vessels are beefy red think bacterial; if they are pink think viral.

Front 1079

what things do you want to ask about in the history if you think you might have bacterial conjunctivitis

Back 1079

Exposure to people with an infection Age Recurrence Systemic illness/treatment Drops used ((side effects) Contact Lens wear Think of STDs Recent travels

Front 1080

8 objective signs associated with acute bacterial conjunctivitis

Back 1080

1. conjunctival injection 2. purulent discharge 3. chemosis 4. subconjunctival hemorrhage (with s. pneumoniae, h. flu) 5. papillae 6. marginal infiltrates 7. SPK (exotoxins) 8. pseudomembrane or membrane (in severe cases, esp if s. aureus or c. diptheriae are the cause) -VA usually normal, usually no AC reaction, normal pupils, usually no-preauricular adenopathy

Front 1081

when do you typically do a culture on an acute bacterial infection

Back 1081

Cultures can be beneficial in non-responsive or hyper-acute cases Not usually done for routine cases.

Front 1082

what is the minimum dosing schedule for topical antibiotic

Back 1082

you don't want to give an antibiotic less than qid becuase bacteria will develop resistance

Front 1083

how do you treat an acute bacterial conjunctivitis (name 9)

Back 1083

empiric treatment with broad spectrum antibiotic Trimethoprim and Polymyxin B (Polytrim) ophth. sol. Gentamicin, Tobramycin ophth. sols. Bacitracin and Polymyxin B (polysporin) ophth. ung. Ofloxacin (Ocuflox), Ciprofloxacin (Ciloxan), Levofloxacin (Quixin) ophth. sols. Ciprofloxacin (Ciloxan) ophth. ung. Gatifloxacin(Zymar) Moxifloxacin (Vigamox) Tid X 7 days

Front 1084

name 2 fourth generation fluoroquinolones

Back 1084

4th generation fluoroquinolones Gatifloxacin(Zymar) Q2h for the first 2 days, then qid for 5 more days. Moxifloxacin (Vigamox) Tid X 7 days

Front 1085

how long do you need to have a pt on antibiotics for acute bacterial conjunctivitis

Back 1085

7-14 days. until resolved!

Front 1086

what do you need to tell pts with acute bacterial conjunctivitis to prevent the spread of infection

Back 1086

Avoid sharing towels and linens. Wash hands often. Avoid touching non-infected eye. Avoid contaminating public swimming pools

Front 1087

when should the initial follow up be for acute bacterial conjunctivitis

Back 1087

2-3 days

Front 1088

what does petechial hemorrhages in acute bacterial conjunctivitis indicate

Back 1088

H.flu or strep

Back 1089

Rx writing example

Front 1090

name two of the most common organisms causing chronic bacterial conjunctivitis

Back 1090

S. aureus S. epidermidis

Front 1091

describe the progression of symptoms associated with chronic bacterial conjunctivitis

Back 1091

Symptoms “wax and wane” ((better and worse)

Front 1092

6 signs of chronic lid tissue distruction

Back 1092

1. induration 2. superficial neovascularization 3. red lid margin 4. poliosis 5. madarosis 6. trichiasis

Front 1093

5 signs of meibomian gland dysfunction (MGD)

Back 1093

1. blockage of secretion 2. focal swelling of meibomian gland orifices (serration) 3. lid erythema 4. lid edema 5. signs of composition changes

Front 1094

2 signs of hypersensativity to exotoxins

Back 1094

1. marginal corneal infiltrates 2. phlyctenule

Front 1095

tx of chronic bacterial conjunctivitis

Back 1095

1. eliminate cause 2. tx conjunctivitis 3. ab-steroid combo if combined with an inflammatory component

Front 1096

what is the most common cause of hyper-acute bacterial conjunctivitis

Back 1096

gonahrea

Front 1097

is ocular involvement common in gonorrhea

Back 1097

not common

Front 1098

symptoms of genital gonorrhea infection

Back 1098

men: none, pain on urination, white yellow or green penile discharge, swollen or painful testicles women: none, (non-specific, can be mistaken for bladder infection), pain on urination, increased vaginal discharge, vaginal bleeding between peroids

Front 1099

gonorrhea can cause serious complications regardless of presence or severity of Sxs. Pelvic Inflammatory Disease (PID) Infertility Risk for ectopic pregnancies

Front 1100

organism that causes gonococcal conjunctivitis

Back 1100

Neisseria gonorrhoeae

Front 1101

other (than gonococcal) less common causes of hyper-acute bacterial conjunctivitis: Neisseria meningitidis, Staph aureus. Strep. H flu. Moraxella E.coli Pseudomonas

Front 1102

describe the progression of hyper-acute bacterial conjunctivitis

Back 1102

Urgent/Emergent Condition Neisseria can penetrate an intact cornea in 48 hours Ulceration, perforation endophthalmitis

Front 1103

Bacteria that can penetrate an intact cornea: Neisseria gonorrhea Corynebacterium diptheria Listeria H. Egypticus Acanthamoeba

Front 1104

12 signs and symptoms of hyper-acute bacterial conjunctivitis

Back 1104

1. extreme discharge 2. severe hyperemia 3. chemosis 4. lid edema 5. pain and tenderness 6. blurred vision 7. preauricular lymphadenopathy 8. cells and flare 9. hypopion 10. PEE 11. marginal infiltrates 12. ulceration/perforation

Front 1105

complications if hyper-acute bacterial conjunctivitis is not treated promptly (4)

Back 1105

Preseptal cellulitis with fever Corneal ulceration and perforation Dacryoadenitis Potential septicemia

Front 1106

what test do you need to do with hyper-acute bacterial infection

Back 1106

culture

Front 1107

what class of antibiotics is no longer recommended for the treatment of gonorrhea by the CDC

Back 1107

fluoroquinolones Ongoing data from CDC 's Gonococcal Isolate Surveillance Project (GISP), including preliminary findings from 2006, demonstrate that fluoroquinolone-resistant gonorrhea is continuing to spread and is now widespread in the United States. As a consequence, and as reported in the MMWR, April 13, 2007, this class of antibiotics is no longer recommended for the treatment of gonorrhea in the United States.

Front 1108

what is the only current CDC approved class of antibiotics to treat gonorrhea

Back 1108

cephalosporins

Front 1109

describe the treatment of gonococcal conjunctivitis

Back 1109

Non-septicemic adults & children over 20 kg. Ceftriaxone 1g IM in a single dose No topical tx is necessary! Irrigation with saline to dilute local virulence factor -usually treated for concurrent chlymidial infection if not ruled out

Front 1110

what is the systemic treatment for chlamydia

Back 1110

Azithromycin 1g p.o., single dose OR Doxycycline 100 mg p.o., bid X 1 week

Front 1111

what are the contraindications for doxycycline

Back 1111

doxycycline is a contraindication for children under 8 or pregnant/lactating women.

Front 1112

what is the follow up schedule for hyper-acute bacterial conjunctivitis

Back 1112

every day until consistant improvement

Front 1113

how long after starting treatment until the purulence calms

Back 1113

Purulence calms in 48+ with proper treatment Conjunctivitis may last 1-2 weeks

Front 1114

New lecture: Viral Conjunctivitis 2009

Front 1115

what is the common name for viral conjunctivitis

Back 1115

pink eye

Front 1116

viral conjunctivitis is very contageous. it is standard of care to rx antibiotic for viral conjunctivitis

Back 1116

no, that will only increase resistance. only if there was a break in the epithelium and antibiotic was used for prophylaxis would this be appropriate.

Front 1117

virus: Can not grow independently, requires protein synthesis from other source

Front 1118

Reduction of immune system and physical barriers enhance viral susceptibility, spread and duration EXAMPLES diabetes, nutrition, Virus can live in ganglion or host cells, remain dormant and then reactivate due to aggravating factors, such as stress, sunlight, intense cold or heat.

Front 1119

describe the treatment for viral conjunctivitis

Back 1119

No treatment. lubricants. Warm compresses? ((helps fight the infection, but make the eye more red and increase discomfort) Cold compresses? ((vasoconstrict; may be more pleasant for the pt) Remove pseudomembranous fibrin deposits ((can use topical anesthetic)

Front 1120

what do you need to remember to do after a pt with viral conjunctivitis comes through the office

Back 1120

disinfect the office. there are some adenoviruses that can survive 30 days on a surface.

Front 1121

what is pharyngoconunctival fever

Back 1121

viral conjunctivitis with pharyngitis and fever

Front 1122

describe the demographic associated with pharyngoconjunctival fever

Back 1122

usually in children age 5-15

Front 1123

9 objective signs associated with pharyngoconjunctival fever

Back 1123

1. pharyngitis 2. conjunctivitis 3. fever 4. keratitis (30%) 5. lid edema 6. preauricular lymphadenopathy (not tender) 7. serous watery discharge 8. possible pseudomembrane 9. possible conj. hemorrhages

Front 1124

describe the progression of pharyngoconjunctival fever

Back 1124

self-limiting, lasting 1-3 weeks.

Front 1125

what is epidemic keratoconjunctivitis

Back 1125

Acute

Front 1126

what age range normally get epidemic keratoconjunctivitis (EKC)

Back 1126

Age - 15+ years

Front 1127

what is the rule of 8 associated with epidemic keratoconjunctivitis

Back 1127

First 8 days: mild to moderate burning, irritation, and photophobia. 2)

Front 1128

is epidemic keratoconjunctivitis usually unilateral or bilateral

Back 1128

usually starts in one eye and spreads to the other

Front 1129

what percent of cases of epidemic keratoconjunctivitis have corneal involvement

Back 1129

80%

Front 1130

describe the corneal involvement associated with epidemic keratoconjunctivitis (EKC)

Back 1130

1)

Front 1131

will there be preauricular adenopathy with epidemic keratoconjunctivitis

Back 1131

ipsilateral preauricular lymphadenopathy. will be tender.

Front 1133

name two viral medications

Back 1133

Viroptic (triflouridene) ((effects all cells; toxic) ((SPK) Acyclovir (oral) ((good at targeting viral infected cells; relatively safe)

Front 1134

what is the most common cause of acute conjunctivitis

Back 1134

adenovirus

Front 1135

you can transmitt and contract both viral and bacterial conjunctivitis from the pool

Front 1136

7 objective signs associated with viral conjunctivitis

Back 1136

1. pink bulbar hyperemia 2. follicles (synonymous with viral conjunctivitis) 3. chemosis 4. periorbital edema 5. serous watery discharge 6. possible ipsilateral preauricular lymphadenopathy 7. pseudomembranes or true membranes

Front 1137

use of steroids for subepithelial infiltrates in epidemic keratoconjunctivitis is controversial

Front 1138

Infection of skin by Molluscum contagiosum virus

Back 1138

2.

Front 1139

tx for molluscum contageosum

Back 1139

When inactive leave it alone

Front 1140

what is acute hemorrhagic conjunctivitis

Back 1140

rare in the US. it is a hyper-acute viral conjunctivitis. conjunctival hemorrhaging common.

Front 1141

what is another name for cat scratch fever

Back 1141

Parinauds oculoglandular fever

Front 1142

what is parinauds oculoglandular fever

Back 1142

virus from cats. systemic involvlement: fever, malaise, HA. ocular involvement:

Front 1143

three objective signs associated with parinaud's oculoglandular fever

Back 1143

1. large follicular development 2. extensive preauricular involvement 3. neuroretinitis (edema of the ONH and macula)

Front 1144

what is newcastle's disease

Back 1144

virus transmitted by infected birds (likely candidates are poultry workers)

Front 1145

New lecture: Corneal Disease Victoria 09

Front 1146

what is another name for phlyctenular keratoconjunctivitis

Back 1146

phlyctenulosis

Front 1147

what is phlyctenular keratoconjunctivitis

Back 1147

A nodular inflammation of the perilimbal tissue characterized by the formation of a small, circumscribed lesion affecting the conjunctiva, limbus or cornea

Front 1148

what are the two types of phlyctenular keratoconjunctivitis

Back 1148

Two types: based on location of lesion: Conjunctival Corneal

Front 1149

describe the pathophysiology behind phlyctenular keratoconjunctivitis

Back 1149

A non-specific allergic hypersensitivity response to diverse antigens:

Front 1150

in what age range is phlyctenular keratoconjunctivitis most common

Back 1150

more common in children and yound adults

Front 1151

what do you need to remember to ask about

Back 1151

you need to be concerned about TB. ask if they have had recent travels or are an immigrant. -you also need to keep up on recent TB outbreaks in the US

Front 1152

9 signs and symptoms of phlyctenular keratoconjunctivitis

Back 1152

1. FB sensation 2. injectino 3. itching 4. tearing 5. discharge 6. pain (moderate to severe) 7. photobia (moderate to severe) 8. blepharospasm 9. blurry vision

Front 1153

does conjunctival phlyctenular keratoconjunctivitis or corneal PKC have more symptoms

Back 1153

conjunctival: less symptomatic corneal: more symptomatic

Front 1154

describe teh appearance of a conjunctival phlyctenule

Back 1154

small, raised nodular lesion. pinkish white in color. surrounded by dilated blood vessels

Front 1155

what is the most common place to find conjunctival phlyctenule

Back 1155

Usually close to limbus but can occur anywhere on bulbar conj. Most common at 8, and 4 o’clock.

Front 1156

ciliary spasm at least contributes to the pain associated with corneal phlyctenular keratoconjunctivitis (if not causes it)

Front 1157

describe the appearance of a corneal phlyctenule

Back 1157

Wedge shaped, white mound at limbus with radial pattern of vascularization Migrate towards center of cornea as a gray-white superficial ulcer Leave a triangular leash of vasculerized pannus

Front 1158

where do junctional (corneal) phlyctenular lesions occur

Back 1158

limbal lesions occur in the inferior aspect of the eye near the lid margin

Front 1159

Severe Corneal phlyctenular lesions: May result in:

Back 1159

Ulcers Scarring Vasculerization Perforation

Front 1160

phlyctenular keratoconjunctivitis has a pretty typical diagnostic appearance

Front 1161

does loteprednot or pred forte seem to raise IOP more

Back 1161

pred forte

Front 1162

what is the generic name for pred forte

Back 1162

prednisolone acetate

Front 1163

describe the management of phlyctenular keratoconjunctivitis

Back 1163

1. TB needs to be ruled out 2. 1% pred forte q2h for 4 days, qid for 3 days , then tapered -or 0.5% loteprednol 3. cycloplegic for comfort if necessary 4. necessary tx may be less for conj. lesions. they are typically self limiting 5. treat the underlying cause

Front 1164

if there is severe pain associated with phlyctenular keratoconjunctivitis, what should you expect is the cause

Back 1164

chlamydia or herpes simplex virus (tx systemically)

Front 1165

describe the prognosis associated with phlyctenular keratoconjunctivitis

Back 1165

Good, if conjunctival or limbal and is treated adequately. Potentially blinding if corneal and not treated adequately

Front 1166

6 causes of exposure keratopathy

Back 1166

Incomplete blink Lagophthalmos Nocturnal Lagophthalmos Ectropion Bell’s Palsy Graves’ disease

Front 1167

objective signs of exposure keratopathy

Back 1167

1. PEE (inferior or interpalpebral cornea) 2. conjunctival injection 3. micropannus, scarring and corneal thinning in severe cases

Front 1168

describe the management of exposure keratopathy

Back 1168

1. lubricating therapies (drops, gels, ointments) 2. mechanical (eyelid taping at night, eyelid weights, bandage CL) 3. tarsorrhaphy in severe cases

Front 1169

what is this

Back 1169

filamentary keratitis

Front 1170

what is filamentary keratitis

Back 1170

Strands of epithelial cells and mucus attached to the cornea ((can’t blink it off)

Front 1171

what stain works well with filamentary keratitis

Back 1171

stains well with rose bengal. does not stain well with fluorescein.

Front 1172

what causes the pain associated with filamentary keratitis

Back 1172

one end attached to the cornea, the other end is free floating. So when the pt blinks they move and pull on the cornea

Front 1173

what is the most common cause of filamentary keratitis

Back 1173

condition is always secondary to another disease. Most common etiology is dry eye. -other causes: Sjogren’s Syndrome Superior Limbic Keratoconjunctivitis Recurrent corneal erosions Neurotrophic keratopathy Chronic bullous keratopathy Patching Adjacent to surgical wound

Front 1174

what is the tx for filamentary keratitis

Back 1174

Treat underlying condition if present Debridement of the filaments. Apply topical anesthetic Remove filaments from their base -bandage contact lens

Front 1175

what is thygeson's superficial punctate keratitis (TSPK)

Back 1175

A chronic, bilateral, recurrent corneal epithelial keratitis

Front 1176

describe the appearence of thygeson's superficial punctate keratitis

Back 1176

Round conglomerates of distinct, granular, punctate epithelial lesions

Front 1177

what is thygeson's superifical punctate keratitis likely to be confused with

Back 1177

many people confuse it with a subepithelial infiltrate, but if you look closely the stroma is not involved.

Front 1179

describe the progression of thygeson's superificial punctate keratitis

Back 1179

Chronic course with exacerbations and remissions Lasts few to several years

Front 1180

what is the typical age of onset of thygeson's superificial punctate keratitis

Back 1180

onset in teens to twenties

Front 1181

why is it important to look at indirect illumination of the cornea on slit lamp

Back 1181

-it is very important to look at the cornea with an indirect illumination because you will miss a lot the stuff that your light will wash out.

Front 1182

how does thygeson's superficial punctate keratitis affect vision

Back 1182

slight decrease in VA

Front 1183

8 signs and symptoms of thygeson's superficial keratitis

Back 1183

1. FB sensation 2. tearing 3. photophobia 4. slight decrease in VA 5. burning 6. itching 7. multiple epithelial lesions (gray-white, course, granular, raised, can move) 8. subepithelial opacities (caused by edema, or inactive lesion) -no red eye, no anterior chamber reaction,

Front 1184

management of thygeson's superficial punctate keratitis

Back 1184

1. artificial tears (and ointment qhs) 2. mild topical steroid 3. bandage CL

Front 1185

describe the prognosis associated with thygeson's superificial punctate keratopathy

Back 1185

good visual prognosis

Front 1186

what do you need to be concerned about with using a bandage CL to tx exposure keratopathy

Back 1186

the cornea is already exposed because of PEEs. They are more susceptible to infection if they aren’t responsible with the CLs.

Front 1187

New lecture: Herpes Zoster and Other Viral Lid DZs 2009

Front 1188

what is the name of the disease that causes shingles

Back 1188

herpes zoster

Front 1189

what primary infection can result in shingles

Back 1189

. The initial infection with varicella zoster virus (VZV) causes the acute (short-lived) illness chickenpox which generally occurs in children and young people. Once an episode of chickenpox has resolved, the virus is not eliminated from the body but can go on to cause shingles—an illness with very different symptoms—often many years after the initial infection

Front 1190

describe the objective signs associated with chickenpox

Back 1190

Fever

Front 1191

what is the name of the disease that causes chickenpox

Back 1191

varicella zoster virus (VZV).

Front 1192

are there any ocular complications associated with chickenpox? are they common

Back 1192

Ocular complications - rare

Front 1193

describe the tx associated with chicken pox

Back 1193

Analgesic

Front 1194

what structure does the chicken pox virus lie dorment in

Back 1194

1. Within the dorsal root ganglion ((also trigeminal ganglion) 2. Within the sensory ganglia of the spinal cord - thoracic nerves

Front 1195

what percent of people who had chickenpox will develop shingles

Back 1195

20%

Front 1196

objective systemic signs associated with singles

Back 1196

1. vesicular eruptions along the nerve lines 2. vesicles become ulcerated and crusty

Front 1197

how long does the pain associated with singles last

Back 1197

weeks, months, even years.

Front 1198

what is herpes zoster opthalmicus

Back 1198

infects tissues innervated by the ophthalmic division of the

Front 1199

what percent of all zoster cases have herpes zoster ophthalmicus

Back 1199

7-15%

Front 1200

what part of the trigeminal nerve is most commonly involved in herpes zoster ophthalmicus

Back 1200

Usually affects first division of trigemial CN

Front 1201

what percent of people with herpes zoster ophthlmicus develop ocular lesions

Back 1201

50-75%

Front 1202

how soon do you need to start treatment for herpes zoster ophthalmicus

Back 1202

((it is very important not to misdiagnose herpes zoster ophthalmicus, because it can be extremely devastating if they are not place on acyclovir within 72 hours) ((lesions often respect the midline) ((needs to be treated with acyclovir within 72 hours) ((need to ask if they have a rash anywhere else, or if they have tingling or any pain)

Front 1203

objective signs associated with herpes zoster ophthalmicus

Back 1203

CAN MIMIC OR CAUSE ALMOST ANY OCULAR DISEASE!

Front 1204

what is the treatment for herpes zoster ophthalmicus (specific regimine)

Back 1204

1. Oral acyclovir (Zovirax) 600 to 800 mg 5x/day for 7 - 10 days -alternative drugs: famciclovir, valacyclovir 2. non-narcotic/narcotic analgesics -capsaicin cream 3. tx each specific ocular complecation

Front 1205

vaccination: Zostavax for shingles

Back 1205

1.

Front 1206

what is variola

Back 1206

smallpox: systemic viral disease characterized by skin lesions (up to 40% fatality rate depending on type). eradicated from the world (last known case in 1977).

Front 1207

what is monkeypox

Back 1207

an exotic viral illness spread by contact will ill animals or direct/respiratory contact with infected persons

Front 1208

what is cowpox

Back 1208

Virus used for smallpox vaccination 2.

Front 1209

what is another name for measles

Back 1209

rubeola

Front 1210

what is rubeola

Back 1210

acute, highly contagious virus marked by maculopapular rash, inflammation of the respiratory tract. vaccination: MMR

Front 1211

what is another name for german measles

Back 1211

rubella

Front 1212

what is rubella

Back 1212

mild, febrile childhood disease with maculopapular rash. prevention: MMR vaccine

Front 1213

what is the mumps

Back 1213

acute viral disease characterized by fever, swelling and tenderness of the salivary glands. prevention: MMR vaccine

Front 1214

New lecture: Herpes Simplex 2009

Front 1215

humans are the only host for herpes simplex virus (HSV)

Front 1216

name and discribe the two types of herpes simplex

Back 1216

Herpes simplex is divided into two types HSV type 1 and HSV type 2.[1] HSV1 primarily causes mouth, throat, face, eye, and central nervous system infections well HSV2 primarily causes anogenital infections.[1] However each may cause infections in all areas.[1]

Front 1217

describe the transmission associated with herpes simplex

Back 1217

Infection results from direct contact with infected individuals

Front 1218

which of the two types of herpes simplex is more likely to have ocualr complications

Back 1218

HSV 1 - above the waist, leading ocular type

Front 1219

describe the prevelance of hepres simplex

Back 1219

Systemic HSV infection

Front 1220

systemic and ocular signs associated with herpes simplex

Back 1220

1. cutaneous eruptions/vessicles 2. acute unilateral follicular conjunctivitis 3. preauricular adenopathy 4. PEE 5. dendritic epithelial keraitis

Front 1221

corneal involvement is rare in primary infection with herpes simplex. more common in secondary infection.

Back 1222

Tx optional 1. no steroids

Front 1223

areas affected in secondary (recurrent) herpes simplex

Back 1223

Reactivation --> sensory nerve to target tissue

Front 1224

how does recurring herpes simplex keratitis affect corneal sensativity

Back 1224

((with each recurrence you get damage to the nerve and corneal sensitivity will decrease; corneal sensitivity test)

Front 1225

with each recurrence of herpes simplex keratitis, then chances of another recurrence go up.

Front 1226

what is epithelail keratitis (herpes simplex)

Back 1226

Symptoms are variable - absent to severe; eye may be painful during

Front 1227

what is dendritis keratitis (herpes simplex)

Back 1227

Dendritic keratitis starts as PEEs that coalesce

Front 1228

tx for herpes simplex keratitis

Back 1228

1. debridement 2. viroptic: : 1 gt q2h (not to exceed

Front 1229

antivirals not to exceed ___ days!

Back 1229

21

Front 1230

what is metaherpetic/trophic keratitis

Back 1230

chronic (indolent) ulcer secondary to epithelial dendriform keraitis

Front 1231

what is the etiology of metaherpetic/trophic keratitis

Back 1231

lack of healing due to damage to the basement membrane

Front 1232

tx for metaherpetic/trophic keratitis

Back 1232

Promotion of epithelial healing

Front 1233

stromal keratitis can occur secondary to herpes simplex keratitis: Patients usually have experienced a number of previous attacks of

Front 1234

what is interstitial keratitis

Back 1234

stromal keratitis with neovascularization

Front 1235

steroids are okay to use for stomal keratitis secondary to herpes simplex

Front 1236

what is another name for disciform keratitis

Back 1236

endotheliitis

Front 1237

what is disciform keratitis

Back 1237

area of stromal edema (disc-shaped) with associated uveitis; can arise without epithelial defect deing present

Front 1238

pathophysiology behind disciform keratitis

Back 1238

May be a Type IV hypersensitivity reaction or a viral reactivation of

Front 1239

objective signs of disciform keratitis

Back 1239

1. central zone of epithelial edema overlying an area of stromal thickening 2. folds in descemet's membrane

Front 1240

types of keratitis associated with herpes simplex

Back 1240

1. epithelial keratitis 2. dendritic keratitis (may be the same as epithelial) 3. metaherpetic/trophic keratitis 4. stromal keratitis/interstitial keratitis 5. disciform keratitis

Front 1241

what is the most common site of recurrent herpes simplex infection

Back 1241

mucocutaneous borders of