Dellen is characterized by

a) inferior punctate epithelial defects

b) delayed hypersensitivity reaction to bacterial angtigens

c) localized corneal thinning beside the limbus

d) non-inflammatory peripheral corneal thinning

e)Whorl-like deposits

C) localized corneal thinning beside limbus

Tx:

-topical lube

-blinking exercises (esp if RGP wearer)

-bandage CL if severe for 24 hours.

Patient comes in with red eye and mild irritation. You notice they have has blepharitis for some time now, which has most likely lead to a peripheral corneal infiltrate you find. What is this called?

a)Rosacea Keratitis

b) CLPU

c)Mooren Ulcer

d) Marginal Keratitis

d) Marginal Keratitis is due to hypersensitivity to staph exotoxins from diseases like bleph.

-->CLPU is also caused by staph exotoxins.

-->also less commonly Phlyctenulosis is caused by hypersensitivity to staph exotoxins leading to nodule formation (mostly in children though).

Treatment for Rosacea Keratitis (inferior punctate epithelial defects with skin involvement)

a)bandage CL, topical steroids

b)topical steroids, topical antibiotics, oral doxy, lube

c) Tobradex

d) systemic steroids, if severe corneal graft

What is Vortex Keratopathy? choose all that apply

a) a Metabolic Keratopathy

b) a Drug Induced Keratopathy

c) epitheilal lesions in isolation and in combination due to defect in basement membrane

d) bilateral opacities in inferior epithelium

e) associated with FLK syndrome

b - drug induced

d - bilateral opacity of inferior epithelium -->swirls from pupil outwards.

Amiodarone can cause it -->non-selective beta blocker for heart arrhythmias.

T/F Microcornea is associated with myopia

T/F Megalocornea is associated with myopia

Micro is associated with hyperopia

Megalo is asociated with myopia

Someone comes in and you meausre their cornea diameter to be 14mm, what does this lead you to diagnose?

a) Microcornea

b) Megalocornea

c) Keratoconus

b) megalcornea is over 13mm

Microcornea is under 10mm

What are 4 most common elderly corneal degenerations?

a) Arcus Senilis

b) Vogt Limbal Girdle

c) Cornea Farinata

d) Crocodile Shagreen

e) Cornea Guttata

f) Epithelial Basement Membrane Dystrophy

g) Salzman Nodular Degeneration

What is Arcus Senilis?

a) bilateral crescent shaped white lines near nasal and temporal limbus. Often limbus is clear.

b)lipid deposition in stroma, sharp peripheral edge, diffuse inner edge.

c) Flour-white deposits in deep stroma

d) anterior 2/3 of stroma has white polygonal opacities

b

-if you notice this in a younger patient, get them to get their blood work done for cholesterol and lipids

What is Band Keratopathy

a) hyaline deposits

b) amyloid deposits

c) calcium salt deposit

d) collagen deposit

c) calcium salt --> causing bubbly appearance of central Bowman's Membrane.

Why?

-chronic anterior uveitis

-severe keratitis

-metabolic -- increased Ca

-hereditary

-age

Classify these dystrophies into their categories --1)epithelial 2) Bowmans 3)Stromal 4)Endothelial

EBMD, Lattice Dystrophy, Reis-Buckler's, Macular Dystrophy, Fuchs, Recurrent Corneal Erosion, Granular Dystrophy, Meesman Dystrophy, PPCD

1) Epithelial -- EBMD, RCE, Meesman

2) Bowmans --> Reis Buckler's

3) Stromal --> Lattice, Macular, Granular

4) Endothelial --> Fuch's, PPCD

What is Fuch's?

a) vesicular patterns in endothelium

b) AD inherited scarring in Descemet's Membrane

c) crumb-like white opacities in cornea

d) endothelial cell loss

What stage of Keratoconus has: 45-52D K's, mires distorted, irregular astigmatism apparent, possible munson sign.

a) incipient

b) intermediate

c) advanced

d) severe

b) intermediate

incipient is 45D K's, negative munson

Advanced is over 52D K's (w/ scarring and striae)

Severe is over 60D K's (with DM rupture)

Which of these symptoms point to another diagnosis other than Keratoconus?

a) central cornea thinnning

b) inferior apex

c) green ring in Bowman's

d) Folds in Descemet's

b) Inferior apex --> points to Pellicud marginal degeneration -- inferior thinning and inferior apex.

Keratoconus -->apex will be inferior and nasal

The LENS

In Marfan syndrome the lens is subluxated...

a)inferiorly

b) down and in

c) superiorly

d) up and out

d) up and out (superior temporal)

If the lens is subluxated, AND zonules are degererated (thus accommodation lost) what systemic disease does that point to?

a) Marfan Syndrome

b) Weill Marchesani Syndrome

c) Homocystinuria

d) Hyperlysinaemia

What causes a Voissius ring (pigment on front surface of lens)?

a) drugs

b) PDE

c) blunt injury

d) age

Someone presenting with a unilateral cataract, what is not on the top of your DDx?

a) Fuch's heterchromic uveitis

b) trauma

c) Diabetes Mellitus

d) retinal detachment

c) DM --> more likely bilateral.

Also Bilateral

-age, atopic dermatits, RP, myotinic dystrophy

Which cataract location severely affects vision and is near the nodal point of the eye?

a)Anterior subcapsule

b)Posterior subcapsule

c)Nuclear

d)Cortical

e)Christmas Tree

A lens that has opacification, a wrinkled anterior capsule and shrunken apperance is characterized as:

a) immature

b) mature

c) hypermature

d) morganian

c) hypermature

In order to be morganian -->liquefaction in cortex, shrunken nucleus inferiorly.

A patient walks who complains of reduced clarity in their vision. You notice they have frontal balding, bilateral ptosis and delayed muscle relaxation. They most likely have Myotonic Dystrophy, which leads you to check which part of the lens FIRST?

a) posterior subcapsule

b) anterior subcapsule

c) nucleus

d) cortex

d) cortex.

90% of myotonic dystrophy patients develop fine cortical cats --> which eventually leads to posterior subcapsular opacifications.

True. 2/3 are bilateral.

When the neonate is unwell (retinoblastoma, infections, posterior uveitis) --> it is often unilateral.

Which congential cataract has "riders"

a) capsular cataracts

b)posterior polar cataract

c)focal dot opacity

d)lamellar cataract

d) lamellar.

AD inheritance (with metabolic issues) that has riders -

cortical loops.

You notice a nodule that can be moved. it is more likely

a) episcleritis

b) scerlitis

T/F Anterior Non-nectorizing scleritis can be sight threatening

true, 25% of the time.

Thus treat:

oral NSAIDS

oral prednisone

sub-conj steroid injection

Anisocoria is a sign of

a) efferent defect

b) afferent defect

What is the false statement about Adie's Tonic Pupil?

a) unilateral dialted pupil

b) patient often has URT before symptoms

c)0.125% pilocarpine will have no effect

d) Shining light in affected pupil - minimal constriction

e) assoicated with loss of deep tendon reflex

f) unilateral blurry vision

Tournay's Phenomenon shows which 2 features?

a) medial gaze induces enlarged pupil

b) co-innervation of lateral rectus and iris sphincter

c) lateral gaze induces enlarged pupil

d) co-innervation of medial rectus and iris sphincter

C and D

It is congenital. During lateral gaze the abducting eye (away from medial plane) is dilated. This is because the MR is relaxed and thus sphicter is relaxed --> congenital co-innervation.

Which drug is not a mydriatic?

a) cocaine

b) tricyclic antidepressants

c) caffeine

d) anti-histamines

e) marijuana

c) caffeine.

Other miotics:

histamine, MAO inhibitor, morhphine, nicotine, opiates

What is false about Horners Syndrome?

a) becomes more noticable in 15 seconds

b) affected pupil is small

c) better prognosis if the affected pupil fails to dilate with 1% hydroxyamphetamine.

d) Cocaine fails to dilate horner's pupil

a) it is LESS noticable in 10-12 seconds. In dim illumination it is noticable at 4-5 seconds. beyond that the pupils become a more equal size.

Cocaine does not work since it is a re-uptake inhibitor. If the NT is not released in the first place (like in horners) nothing will happen.

When the pupil dilates with 1% hydroxyampetamine it means there is 1st-2nd order damage (due to tumor stroke, lung carcinoma) Much worse than 3rd order which fails to dilate --due to migraines, HZV

FALSE!!

its diabetUs.

When a pupil fails to dilate with cocaine, what can you diagnose?

a)Horners

b) Argyll Robertson

c) Marcus Gunn

d)Adie's

a) horners

You go to drop your patient with atropine, but both pupils will not dilate well...

a)normal

b)Horners

c)Adie's

d)Argyll Robertson

When an eye constricts to 1/8th pilocarpine...

a) Normal

b) pt is on drugs

c) Marcus Gunn

d) Adie's

d) Adie's Tonic Pupil --very sensitive to small amounts of miotics due to denervation. Pupil will be slightly dilated in one eye and react hugely to 1/8th pilocarpine, while the normal eye will not react at all.

When you patient does not constrict to 0.5% pilocarpine...

When you notice a coloboma of the iris temporally it is most likely not

a) congential

b) trauma

c) iridodialysis

What is not a feature of oculocutaneous albinism?

a) pigment lacking in fundus

b)vision is typically 6/60

c) pendular nystagmus is present

d) strab due to muscle dystrophy

e) +3/-3 WTR astigmatism

d) strab can be present, but it is because of abnormal nerve fiber crossing at Chiasm

--90% or more cross, not just the nasal fibers. This affects binocularity

Heterocrhomia Iridum: which 2?

a)different colour in each eyes

b) different colours in same eye

c) rare

d) not uncommon

a) different colour in each eye

and

c) rare

Ice ice baby.

ICE syndrome "Iridocorneal endotheliopathy"

-leading to corneal decompensation and glaucoma (50% of the time).

Idiopathic.

What is false about non-pathological iris naevi?

a) very common

b) pigmented & flat

c) 3-4mm

d) can distort pupil

e) pigmented & elevated

c) 3-4mm

must be under 3mm, over that you need to investigate.

When treating iris melanomas which option does not match up properly?

a) small tumor: iridectomy

b) angle involvement: iridocyclectomy

c) diffuse tumor: iridocyclectomy with radiation

8 year old Ricky Bobby comes in to your office with blood at the bottom of his anterior chamber. He promises you he did not get into an accident in his go-cart. You notice cells & flare in the AC. What diagnosis do you need to investigate first?

a) retinoblastoma

b) leukemia

c) Juvenile Xanthogranuloma

d) Intraocular FB

e) Peripheral retinal detachment

c) JXD

(in the absense if trauma, hyphema is commonly due to JXD in children.

In a patient without retinal disease (like CME) or corneal disease, VA should not be below:

a) 6/7.5

b) 6/9

c) 6/12

d) 6/15

T/F In unilateral anterior uveitis the affected pupil will be smaller than the other.

What condition should you keep in mind for:

self-limited recurrent episodes of markedly elevated intraocular pressure (IOP) with mild idiopathic anterior chamber inflammation and a distorted mid-dilated pupil.

Posner-Schlossman Syndrome

-looks like angle-closure glaucoma but its not.

What grade is it when there is cells and flare with dense haze such that you cannot view the iris or lens properly?

a) Grade 1

b) Grade 2

c) Grade 3

d) Grade 4

c) Grade 3. (if there is only little haze and you can see iris,lens it is Grade 2)

whe the AgH stops moving (more jell-like) it is Grade 4.

Keratic Precipitates come in 4 flavours, what is not one of them?

a) Fine KP

b) Granulomatous KP

c) Pigmented KP

d) Chalky KP

e) Star-shaped KP

d) Chalky

KPs are more likely to be found in inferior cornea. and can produce stroma edema. They block the pumps on the endothelial cells!

Which KPs are typically found in Fuch's heterchromic uveitis?

a) Fine KP

b) Granulomatous KP

c) Pigmented KP

d) Star-shaped KP

Hypopyon is not associated with

a) systemic inflammatory vasculitis

b) ankylosing spondylitis

c) Behcet's

d) any systemic disease

e)posner-schlossman

e) posner schlossman.

right answers:

a=c same thing.

b) ankylosing is associated with HLA B27+

FALSE. they used to be but we know know there are nodules that are non-granulotomatous.

False -- can be non-gran as well.

Which are found along the pupillary margin?

a) Bussaca

b) Koeppe

FALSE, definitely continue treatment.

--all that is happening here is that the white cells are reducing and consolidating to get out of the AC. They will leave through the trabecular meshwork or through iris vessels if they are present in the stroma. This can create a nodule if it becomes blocked.

Unless you notice other granulomatous signs continue treatment.

What is not true regarding IOP during anterior uveitis:

a) trabecular meshwork can get plugged with inflammatory cells causing increased IOP

b) Destruction of TJ's can decrease IOP

c) Prostaglandins decrease uveoscleral outflow, increasing IOP

d) Reduction in production of AqH during anterior uveitis.

e) IOP is typically normal or slightly low in anterior uveitis

False.

It changes in things like carotid cavernous sinus fistulas.

22mmHg.

If you were an expert, you could do 24mmHg.

Start on Beta blockers if the patient has no risk factors.

What is not included in treatment guidelines for anterior uveitis?

a) topical prednisone acetete 1% q1h x 24

b) topcial prednisone phosphate 1% q1h x 24

c) cycloplegic (appropriate strength for signs)

d) IOP control

e) Aqueous suppressant for pressures over 24mmHg

Which anterior uveitis (red eye)cases do you need to fully work-up?

a) little Ralph who poked got poked in the eye with an occluder

b) Trefford who has Bussaca nodules

c) RonJohn who gets bouts of GERD and red eye

1) Any child case w/out trauma

2) Bilateral presentation

3) Granulomatous presentation

4) Recurrent unilateral presentation

a) No, its from the injury

b) YES it might be granulomatous

c) Yes, any recurrent presentation at all.

What is a normal measurement of proptosis using an exophthalmometer?

a) <16mm

b) <17mm

c) <18mm

d)<19mm

In an MRI with T2

a) vitreous is dark

b) vitreous is bright

c) bone is dark

d) A and C

e) B and C

E) Vitreous is bright and bone is dark.

Bone is dark in T1 as well.

When you have a pulsation w/ bruit what is on your DDx?

a) trauma

b) tumor

c) A/V malformation

d) post-surgery

Orbital Varices - find true statement:

a) has bruit

b) requires Tx of balloon catheter

c) varying proptosis

d) cystic tumor invading the orbit

e) reduced VA

Crouzon Syndrome

a) skull prematurely fuses causing facial deformation

b) pt has white forelock

c) mild facial dysmorphology, but other more serious issues exist

What do you not commonly find in Waardenburg Syndrome?

a) white forelock

b) different coloured eyes

c) deafness

d) bruit

Which symptom is not part of PEDAL?

a) Ocular pain

b) mucopurulent discharge

c) central infiltrate

d) epithelial defect

e) lid edema

e) lid edema

P - Pain

E- Epithelial defect

D - Discharge (mucopurulent)

A - anterior chamber (KP and flare)

Location (central is suspect)

Pt with unilateral red irritated eye with photophoba. Upon investigation with slit lamp which findings would point to CLPU rather than microbial keratitis?

a) AC reaction

b) excavation of bowmans layer

c) peripheral infiltrate

d) central infiltrate

e) infiltrate that is 1.5mm in size

Inflammation in response to G+ Staph exotoxin defines which condition?

a) MK

b) CLPU

c) CLARe

d) IK

e) AIK

Young CL wearer comes in with unilateral red eye, no AC reaction or staining. During Hx you find out they had a RTI last week. It can point to --choose all that apply

a) CLARE

b) CLPU

c) VKC

d) FK (filamentary)

e) AIK

Which condition do you choose when you have ruled out MK, CLPU and CLARE? There is no epithelial involvement but stroma shows focal infiltrate. No treatment is required aside from discontinuing CL wear and artificial tears.

a) IK

b) AIK

c) AI

What is the difference between AIK and AI?

a) AIK is smaller

b) AI has multiple infiltrates

c) AIK does not stain

d) only AIK has no signs or symptoms

e) only AI requires no treatment

e)

All others are opposite.

What is the difference between CPLU and CLARE?

a) CLARE has one small mid-peripheral infiltrate

b) CLPU is from G- endotoxins

c) in CLPU the epithelium is intact

d) CLARE has circum-corneal and bulbar injection

10 year old Dennis comes in with a nodule at the 4o'clock position at the corneal-limbal margin. What is it?

a) Filamentary Keratitis

b) Pingueculae

c) Phylctenulosis

d) Rentention Cyst

c) phylctenulosis

Since it mainly occurs in children.

There is no filaments -a

it is on the cornea - not b or d

During Goldmann tonometry and you see that the fluorescein rings are too narrow you should:

a) turn up the gauge, reading is too low

b) dry off the probe, there is too much fluorescein

c) instill more fluorescein, you took too long

d) you are not on the centre of their cornea

Normal cornea thickness is 545microns, if you do a pac-scan and notice the cornea is 515 you should

a) add to your initial measurement

b) your measurement is fine

c) subtract from your measurement

What is the lower limit of a normal TBUT?

a) 5seconds

b) 10 seconds

c) 15 seconds

d) 20 seconds

b) 10 seconds

During the Jones 2 test what is the sign for a blocked common canaliculus?

a) patient tastes saline

b) no fluroescein is found on the kleenex

c) saline flows back out lower punctum

d) saline flows out upper punctum

Answer - d) saline flowing out of upper punctum is a sign the common canaliculus is blocked.

c) is a sign that the canaliculus is blocked.

b) is for Jones 1 test - negative result

a) is positive result for Jones 2 test.

What is true about the silicone Herrick plug?

a) you can see the plug at the surface

b) easy to remove

c) it can irritate the eye

d) easy to insert

d) easy to insert -- Herrick plug is canalicular

A-C refers to the Eagle punctal plug.

what is seidel's sign?

a) whorl like deposits on the cornea

b) ptosis, miosis, facial anhydrosis

c) severe protosis

d) leakage of AqH from the eye

When your patient has a large FB with extensive epithelial loss you:

a) pressure patch

b) cycloplege

c) topical antibiotics

d) tylenol

ALL THE ABOVE!

pressure patch for no more than 24 hours, and make sure you give the antibiotic drops.

Small FB with no AC reaction -- just antibiotic drops.

FB causing AC reaction -- give B-D

NO! Ludde is just a transparent PD ruler.

The Hertel is the exophthalmometer that gets around parallax with mirrors and prisms.

Normal reading is 18-20, less than 2mm diff between eyes

To get the correct slit lamp focus if you are a -2.75D myope you dial in ....to examine without correction

a) zero

b) -2.75

c) -3.00

d) -4.75

Cornea:Chamber ratio is 1: 1/3 you can give that a grade of

a) Grade 0 it is closed

b) Grade 1 it is likely to close

c) Grade 2 it is possibly for it to close

d) Grade 3 it will likely not close

c) Grade 4 it is most open

d) Grade 3 is 1:1/4 to 1:1/2 unlikely to close

Grade 4 is 1:1 and over

Grade 2 is 1:1/4 and will possibly close

Grade 1 is under 1:1/4 and will likely close

Grade 0 is closed.

Iris --> CB --> Scleral Spur -->trabeculum --> Schwalbe's line -->cornea