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VOLUME 2
Ophthalmology
505
Medical
Professional
07/15/2012
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Term
Of what does the ocular adnexa consist?
 Definition
Eyebrows, eyelids, eyelashes, glands, and lacrimal system.
Term
What is the main job of the eyebrows?
 Definition
Divert perspiration from the eye.
Term
Other than limiting light and foreign debris, what is another important job of the eyelids?
 Definition
To spread tears across the cornea.
Term
Name the visible landmarks of the eyelids.
 Definition
Lateral canthus, medial canthus, plica semilunaris, and caruncle.
Term
What are the two muscles that open the eyelids?
 Definition
(1) Levator palpebrae superioris.
(2) Muscle of Muller.
Term
What are the two muscles that close the eyelids?
 Definition
(1) Orbicularis oculi.
(2) Riolan’s muscle.
Term
A tough fibrous tissue that makes it possible to evert the upper lid is a description of which layer in the lid?
 Definition
The tarsal plate.
Term
Which type of conjunctiva is on the eye itself? Does it cover the cornea also?
 Definition
The bulbar conjunctiva; no.
Term
What cells does the conjunctiva contain and what do they secrete?
 Definition
Goblet cells; mucin.
Term
What defense mechanism makes the hair follicles of the eyelashes special?
 Definition
They are surrounded by a network of super sensitive nerves that cause the lids to quickly close if debris touches the lashes.
Term
What do sebaceous glands secrete? Lacrimal glands?
 Definition
Oils; tears.
Term
What type of gland is in the tarsal plate?
 Definition
Meibomian (oil).
Term
What happens if an oil gland becomes infected?
 Definition
An external hordeolum or stye can develop.
Term
Where are the glands of Krause and Wolfring located?
 Definition
The palpebral conjunctiva.
Term
Name the structures of the lacrimal system beginning with the birth of a tear until it gets to the end of the system.
 Definition
Lacrimal gland, lacrimal canals (ducts), conjunctival sac, puncta, canaliculi, lacrimal sac, and nasolacrimal duct.
Term
What is the shape of the bony orbit?
 Definition
Pear-shaped—big at the anterior (front) and narrow at the posterior (rear).
Term
What angle do the medial walls of the bony orbit form to each other?
 Definition
They are parallel to each other.
Term
In adults, what angle is formed between the medial wall and lateral wall of the bony orbit?
 Definition
45°.
Term
In adults, what angle is formed by the lateral wall of one orbit to the lateral wall of the other orbit?
 Definition
90°.
Term
What are the seven bones contained in each orbit of the eye?
 Definition
(1) Sphenoid.
(2) Ethmoid.
(3) Lacrimal.
(4) Frontal.
(5) Maxilla.
(6) Palatine.
(7) Zygomatic.
Term
Name the bones of the roof of the orbit.
 Definition
Lesser sphenoid and frontal.
Term
Name the four bones of the medial wall of the orbit.
 Definition
(1) Maxilla.
(2) Ethmoid.
(3) Lacrimal.
(4) Lesser sphenoid.
Term
Name the three bones of the floor of the orbit.
 Definition
(1) Maxilla.
(2) Palatine.
(3) Zygomatic.
Term
Name the bones of the lateral wall of the orbit.
 Definition
Zygomatic and greater sphenoid.
Term
What is the weakest orbital bone? Strongest? Smallest?
 Definition
Ethmoid; zygomatic; palatine.
Term
What are the two types of openings in the bony orbit?
 Definition
(1) Fissures (cracks).
(2) Foramina (holes).
Term
What passes through the optic foramen in the lesser wing of the sphenoid?
 Definition
Optic nerve (CN II) and ophthalmic artery.
Term
Where is the superior orbital fissure located?
 Definition
Between the greater and lesser wings of the sphenoid.
Term
Which bone, or portion of bone, is the most likely to break (a blowout fracture) due to a blunt trauma to the eye?
 Definition
The portion of the maxillary bone that covers the infraorbital groove/canal.
Term
Name the three primary fossa of the bony orbit and their locations.
 Definition
(1) Lacrimal sac fossa located in the lacrimal bone.
(2) Lacrimal gland fossa located behind the orbital rim of the superior, temporal portion of the frontal bone.
(3) Trochlear fossa located in the superior, nasal portion of the frontal bone.
Term
Where is the primary position of gaze?
 Definition
Straight ahead.
Term
Name the six EOMs.
 Definition
(1) SR.
(2) IR.
(3) MR.
(4) LR.
(5) SO.
(6) IO.
Term
Which muscle does not originate at the annulus of Zinn?
 Definition
IO.
Term
Where does the SR muscle attach to the eye?
 Definition
To the sclera on top of the eye, anterior to the equator, approximately 7.7 mm from the limbus.
Term
Which nerve innervates the IR muscle?
 Definition
Oculomotor nerve (CN III).
Term
What is the primary function of the LR muscle?
 Definition
Abduction.
Term
What traits do the rectus muscles share?
 Definition
They pull the eye in the direction the muscle name implies, attach anterior to the equator, and begin at the annulus of Zinn.
Term
What structure does the SO pass through?
 Definition
Trochlear pulley.
Term
What is the primary action of the SO? Secondary action?
 Definition
Intorsion; Depression.
Term
What is the name of the 4th CN?
 Definition
Trochlear nerve.
Term
Which EOM is the longest?
 Definition
SO.
Term
Where does the IO originate?
 Definition
The anterior, medial floor of the bony orbit.
Term
From its origination point, what is the path the IO takes to get to its attachment point?
 Definition
Wraps under the eye and travels rearward and temporally, passing over the IR muscle, and up under the LR
muscle, and attaches posterior to the equator on the temporal side of the eye.
Term
What is the shortest EOM?
 Definition
IO.
Term
What is the primary action of the IO? Secondary action?
 Definition
Extorsion; elevation.
Term
What do the oblique muscles have in common?
 Definition
Both wrap around the eye to some extent; twist or rotate the eye; attach posterior to the equator; and have a secondary action of pulling the eye in the opposite direction of what their names would imply.
Term
What does (LR6SO4)3 mean?
 Definition
It is a formula to remember which CNs innervate which muscles. LR6 means the LR is innervated by the 6th CN, the abducens nerve; SO4 means the SO is innervated by the 4 th CN, the trochlear nerve; and 3 means all the other EOMs are innervated by the 3rd CN, the oculomotor nerve.
Term
What are saccades and what are they responsible for?
 Definition
Quick, voluntary, simultaneous movements of both eyes in the same direction; fixation, refixation, and
rapid eye movements.
Term
What are pursuits?
 Definition
Slow, involuntary, parallel movements of both eyes that allow us to follow moving objects.
Term
What is an agonist?
 Definition
The muscle that is the prime mover for a desired direction of gaze.
Term
What is an antagonist?
 Definition
Muscle in the same eye as the agonist that works directly against the agonist.
Term
What would be the agonist in the left eye for it to look to the left? Which muscle would be the antagonist to this muscle?
 Definition
LLR; LMR.
Term
What muscle is in the same eye as the agonist and helps the agonist?
 Definition
Synergistic.
Term
What do yoked muscles allow our eyes to do?
 Definition
Parallel, conjugate (conjunctive) movements often referred to as version movement.
Term
What kind of movement is vergence of the eyes considered to be?
 Definition
Disjunctive.
Term
What muscle is yoked to the LMR? The LIO? The RIR?
 Definition
RLR; RSR; LSO.
Term
What is duction?
 Definition
Movement of one eye.
Term
What structures make up the fibrous tunic?
 Definition
Cornea and sclera.
Term
How big is an adult’s cornea?
 Definition
12 mm wide (horizontally) and 11 mm tall (vertically).
Term
What is the primary job of the cornea?
 Definition
Refract light.
Term
The cornea is avascular. What does this mean?
 Definition
It does not contain any blood vessels.
Term
Which CN innervates the cornea?
 Definition
5th, the trigeminal nerve.
Term
Name the corneal layers from anterior to posterior.
 Definition
(Corneal) epithelium, Bowman’s layer, stroma (substantia propria), Descemet’s membrane, and endothelium.
Term
How long does it usually take before a scratched epithelium heals? Will it be scarred?
 Definition
Usually within 24 hours; no.
Term
Describe Bowman’s layer.
 Definition
It is acellular (without cells), very thin, and made up of collagen fibers; very resistant to trauma and acts as
a barrier to microorganisms; and scars if damaged.
Term
Which corneal layer(s) does the substantia propria rely on to keep it at the proper hydration level?
 Definition
The epithelium and endothelium.
Term
What happens if the stroma starts to absorb too much fluid?
 Definition
Its fibers swell and get cloudy, decreasing VA.
Term
How thick is the endothelium?
 Definition
One-cell layer.
Term
What is the endothelium’s function?
 Definition
To pump waste from the stroma and maintain the cornea’s normal, dehydrated, state.
Term
How long does it take the endothelium to regenerate new cells when the old ones are damaged or destroyed?
 Definition
Endothelial cells don’t regenerate; the neighboring cells move over and enlarge to fill in the empty space.
Term
What does the sclera do?
 Definition
Gives the eye support needed to maintain the structures within it, and provides an insertion point for the six
EOMs.
Term
What is the weakest point in the sclera?
 Definition
The lamina cribrosa.
Term
What tissue is described as surrounding the sclera?
 Definition
The episclera.
Term
List another name, or term, for the vascular tunic.
 Definition
Uveal tract.
Term
What is the color of our eyes based on?
 Definition
The amount of pigmentation built up on the front of the iris.
Term
What is the primary function of the iris?
 Definition
Controls pupil size, regulating the amount of light entering the eye.
Term
What two muscles are in the iris?
 Definition
(1) Dilator (longitudinal).
(2) Sphincter (circular).
Term
What are the sections of the ciliary body? Which has the majority of structures in it?
 Definition
Pars plicata and pars plana; the pars plicata.
Term
What produces aqueous humor?
 Definition
The ciliary processes (small projections just behind the iris).
Term
What must the ciliary muscle be doing if the Zonules of Zinn are being pulled tightly?
 Definition
Relaxing.
Term
When the eye accommodates (focuses), what is happening with the ciliary muscle, zonules, and crystalline lens?
 Definition
The ciliary muscle contracts (works), relaxing the zonules, allowing the lens to thicken in the middle, getting more curved.
Term
What is the name of the eye disorder where the pars plana becomes inflamed?
 Definition
Pars planitis.
Term
What structures does the choroid supply blood to?
 Definition
Iris, ciliary body, retina, and inner sclera.
Term
What is the anterior termination point of the choroid called?
 Definition
Ora serrata.
Term
What structure makes up the nervous tunic?
 Definition
The retina.
Term
At what two points is the nervous tunic firmly attached?
 Definition
(1) Optic disc.
(2) Ora serrata.
Term
If the center of the retina is the macula, what is the depressed area in the center of the macula called?
 Definition
Fovea centralis (foveola).
Term
What retinal layer is closest to the choroid? To the vitreous?
 Definition
RPE; internal limiting membrane.
Term
How many retinal layers are there? How many are transparent?
 Definition
10; 9.
Term
What is the RPE’s function?
 Definition
Absorb excess light and serve as a nourishing and garbage collection layer for the rods and cones.
Term
What is the photoreceptor layer?
 Definition
The rods and cones.
Term
What is the shortest wavelength the photoreceptors can see? The longest?
 Definition
400 nm; 750 nm.
Term
How many rods are in the retina? How many cones?
 Definition
Approximately 125 million; approximately 6 million.
Term
What is the visual pigment in rods called?
 Definition
Rhodopsin.
Term
What are the best conditions for cones to function in?
 Definition
Photopic or fully illuminated conditions (daylight).
Term
What is the visual pigment in the red cones? Green cones? Blue cones?
 Definition
Erythrolabe; chlorolabe; cyanolabe.
Term
What does the bipolar layer of the retina do?
 Definition
Passes on the electrochemical message produced by the rods and cones to the retinal ganglion layer.
Term
What part of the ganglion cells act like telephone cables for retinal messages going to the brain?
 Definition
The axons.
Term
What two structures deliver the retina its blood supply?
 Definition
(1) CRA.
(2) Choriocapillaris.
Term
What structures form the ocular media?
 Definition
Cornea, aqueous humor, crystalline lens, and vitreous humor.
Term
What is a continuous process that maintains the IOP within the eye?
 Definition
Aqueous production and outflow.
Term
How big is the crystalline lens? How much refractive power does it have?
 Definition
About 10 mm in diameter; about +16.00D.
Term
Name the three parts of the lens.
 Definition
(1) Capsule.
(2) Cortex.
(3) Nucleus.
Term
What is the vitreous encased in?
 Definition
A thin vitreous membrane.
Term
What function does the vitreous serve?
 Definition
Provides internal support, helping the eye maintain its shape and keeping the retina in contact with the choroid.
Term
If lost, how long does it take for vitreous to regenerate?
 Definition
Vitreous does not regenerate or reproduce itself.
Term
What kind of pathway is the visual pathway?
 Definition
Afferent (sensory).
Term
What does the optic nerve consist of?
 Definition
Ganglion cell axons from the retina.
Term
What fibers does the optic tract have?
 Definition
Temporal ganglion cell axons from one eye and the nasal ganglion cell axons from the other eye.
Term
Because the LGB passes on the visual messages from the optic tract to the optic radiations, to what is it often referred?
 Definition
A relay station.
Term
What is another name for the optic radiations?
 Definition
Geniculo-calcarine tract.
Term
What area of the brain contains the visual cortex?
 Definition
The occipital lobe (Brodmann’s area 17).
Term
The rods and cones make up which order neuron?
 Definition
First.
Term
How many orders of neurons are in the visual pathway and where do the synapses occur?
 Definition
Three orders; synapses occur when rods and cones send their electrochemical message to the retinal
ganglion cells (within the retina), and from the LGB to the optic radiations (within the LGB).
Term
What is a neuron composed of?
 Definition
Dendrite, cell body, and axon.
Term
Name the six structures in the afferent pupillary pathway.
 Definition
(1) Retina.
(2) Optic nerve.
(3) Optic chiasm.
(4) Optic tract.
(5) Pretectal nucleus.
(6) Edinger-Westphal (accessory CN III).
Term
What is an efferent message?
 Definition
A motor message that exits the brain.
Term
Name the three structures in the efferent pupillary pathway.
 Definition
(1) CN III.
(2) Ciliary ganglion.
(3) Iris sphincter muscle.
Term
Define VA.
 Definition
Measure of the eye’s ability to distinguish object details and shape, and assessed by the smallest identifiable object that can be seen at a specified distance (usually 20 feet for distance acuity and 16″ for near acuity).
Term
What does visual efficiency refer to?
 Definition
How comfortably one sees.
Term
Name the 10 factors that influence VA.
 Definition
(1) Region of the retina stimulated.
(2) Illumination.
(3) Spectral quality of the light.
(4) Contrast.
(5) Pupil size.
(6) Time of exposure.
(7) Patient’s age.
(8) Condition of the ocular media.
(9) Presence of ametropias.
(10) Individual variations.
Term
What is the nm range of the electromagnetic spectrum the eye can generally see as light?
 Definition
400 to 750 nm.
Term
What is the VA of a newborn?
 Definition
20/400.
Term
What is ametropia?
 Definition
Refractive error (e.g., hyperopia, myopia, or astigmatism).
Term
What happens to the light rays that enter an emmetropic eye?
 Definition
They are focused perfectly on the retina without the need for accommodation or corrective lenses.
Term
What two problems can cause hyperopia?
 Definition
(1) Axial problems (length of eye is too short).
(2) Curvature problems (curve of the cornea or crystalline lens is too flat).
Term
What does a facultative hyperope do naturally to correct for their ametropia?
 Definition
Accommodate (focus) enough to bring the light rays to a focus on the retina.
Term
What is a facultative hyperope likely to complain of?
 Definition
Complaints of eye fatigue or blurriness toward the end of the day, or their eyes fatigue quickly while
reading.
Term
What kind of vision does an absolute hyperope have in the distance? At near?
 Definition
Decreased distant vision and even worse near vision.
Term
Where do the light rays focus in the eye of a myope?
 Definition
In front of the retina.
Term
What types of lenses do myopes need?
 Definition
Minus lenses.
Term
What is considered to be high myopia?
 Definition
More than –6.00D.
Term
Define astigmatism.
 Definition
An optical defect in which refractive power is not uniform in all meridians of the eye.
Term
What is simple astigmatism?
 Definition
Where one meridian of the eye focuses the light rays correctly on the retina, and the meridian 90° away
focuses the light rays too soon (SMA) or too late (SHA).
Term
What does CMA stand for? CHA?
 Definition
Compound myopic astigmatism; compound hyperopic astigmatism.
Term
What kind of Rx is –2.00 –4.00 × 001 an example of?
 Definition
CMA.
Term
What does the mixed astigmatic eye do with light rays?
 Definition
Focuses one meridian in front of the retina and focuses the meridian 90° away beyond the retina.
Term
What does the axis of the Rx tell you?
 Definition
Where patients needed the blur in their vision corrected by cylinder power.
Term
What do myopes complain of?
 Definition
Decreased DVA, decreased night vision, or needing to squint to see objects.
Term
Are ametropias correctable with CLs?
 Definition
Yes.
Term
What is presbyopia?
 Definition
A decrease in accommodative ability that occurs with age.
Term
What kind of glasses does a presbyope need?
 Definition
Reading glasses to replace the lost plus (+), or accommodative, power of the eye when looking at near objects.
Term
How much usable accommodation does a 70-year-old person have?
 Definition
+0.12D.
Term
When does presbyopia usually become noticeable?
 Definition
About age 40.
Term
How much refractive power does a person need to see clearly at 16″?
 Definition
+2.50D.
Term
What does an uncorrected presbyope usually do with reading material?
 Definition
Hold it farther away as it takes less accommodative power to see objects farther from the eyes.
Term
Can a person avoid presbyopia?
 Definition
No, unless death occurs before age 40.
Term
Does presbyopia affect distant vision?
 Definition
Yes, in facultative hyperopes.
Term
Name the six cues to depth perception.
 Definition
(1) Magnification (relative size).
(2) Confluence of parallel lines to a point (perspective).
(3) Interposition of shadows (overlay).
(4) Blue-gray mistiness of objects at a great distance (distant haze).
(5) Parallax.
(6) Stereopsis.
Term
Are monocular cues to depth perception considered primary or secondary cues?
 Definition
Secondary.
Term
What is the primary cue to depth perception?
 Definition
Stereopsis.
Term
What is the greatest level of depth perception (i.e., smallest amount of separation) the human eye has been able to distinguish?
 Definition
As little as 5″ of arc.
Term
Which patients can only use monocular cues for depth perception?
 Definition
Patients with suppression, amblyopia, tropias, or other eye problems that limits them to only one functional
eye.
Term
Can a person with heterotropia have stereopsis? Explain.
 Definition
No; they don’t have binocularity (SBV).
Term
What three elements does color depend on?
 Definition
(1) Hue.
(2) Saturation.
(3) Brightness.
Term
What is hue determined by?
 Definition
The wavelength of the light emitted or reflected from an object.
Term
What does saturation refer to?
 Definition
The purity of a color.
Term
If you have one fire engine red object and a pink object, which is considered to be a more saturated color?
 Definition
The fire engine red.
Term
How is a color desaturated?
 Definition
By mixing it with white.
Term
What is the brightness of a color related to?
 Definition
The rate of transfer of light energy coming off a particular color; also to the amplitude, or amount of energy, of the light reaching our eye.
Term
White light consists of what colors?
 Definition
A mixture of red, orange, yellow, green, blue, indigo, and violet.
Term
If saturation and hues are varied, how many color differentiations can the human eye discern?
 Definition
500,000.
Term
What are the three primary colors of light?
 Definition
(1) Red.
(2) Green.
(3) Blue.
Term
Under what conditions do cones see? How about rods?
 Definition
Photopic; scotopic.
Term
What is the term used to describe a person with normal color vision?
 Definition
Trichromat.
Term
What percentage of men have normal color vision? What percentage of women?
 Definition
92; 99.5.
Term
What term is used to describe people who see all three primary colors, but see one of the colors in the wrong amount?
 Definition
Anomalous trichromats.
Term
A deuteranomalous person has trouble with which color?
 Definition
Green.
Term
What percent of the population is dichromatic?
 Definition
2.6.
Term
What is wrong with a tritanope?
 Definition
They are blue-blind and have trouble with yellow and blue.
Term
Give the term used to describe a person who is truly colorblind.
 Definition
Monochromat.
Term
How many people are truly colorblind?
 Definition
About one in 13 million.
Term
What chromosome carries the color defect?
 Definition
X.
Term
Congenital color defects usually affect perception of which color or colors?
 Definition
Red or green.
Term
If a person only has a color vision defect in one eye, what would you suspect as the cause?
 Definition
The problem is pathological (or acquired) and is being caused by some eye disease or systemic condition.
Term
What could a person do to see an object in very dim illumination?
 Definition
Look slightly to one side of the object and use the rods of the retina.
Term
What level of VA do rods provide?
 Definition
20/200 to 20/400.
Term
What color light seems brighter at night?
 Definition
Blue.
Term
What is nyctalopia?
 Definition
Night blindness.
Term
What is blepharitis?
 Definition
A very common inflammation of the lid margins.
Term
How is blepharitis treated?
 Definition
Scrub the lid margins clean with a warm, moist washcloth and some diluted baby shampoo.
Term
What is a hordeolum?
 Definition
An internal hordeolum is an infection of the meibomian gland; an external hordeolum is an infection of the
glands of Zeis. It is caused by an acute infection in the sebaceous (oil) glands of the lids.
Term
How is a chalazion different from a hordeolum?
 Definition
A hordeolum is a bacterial acute infection in the meibomian gland of the lid; the chalazion is a chronic
inflammation of the gland with no infection.
Term
What types of things can cause acquired ptosis?
 Definition
Systemic neuromuscular problems, trauma to the lid, nerve palsy (paralysis), or physical muscle
interference.
Term
Why is orbital cellulitis a medical emergency?
 Definition
Can be fatal within just a few days if left untreated.
Term
What does treatment of orbital cellulitis include?
 Definition
Hospitalization, and IV, oral, and topical antibiotics.
Term
What is the difference between preseptal cellulitis and orbital cellulitis?
 Definition
Preseptal cellulitis is anterior to the tarsal plate; orbital cellulitis can be found posterior to the tarsal plate and involve the whole orbital cavity.
Term
Simply put, what is epiphora?
 Definition
Overflow of tears.
Term
Name more severe conditions to which entropion can lead?
 Definition
Corneal abrasions, ulcerations, and scarring.
Term
What are the most common causes of entropion?
 Definition
Laxity of the lower lid retractors and buckling of the upper tarsal plate border.
Term
What is ectropion? What can it lead to?
 Definition
It is the turning out of the eyelid; exposure keratitis.
Term
What do you call the organisms that cause disease in normally healthy tissue?
 Definition
Pathogenic.
Term
What are the general characterizations of conjunctivitis?
 Definition
Some discharge, grittiness, redness, and swelling.
Term
What term is used to describe the shape of bacteria?
 Definition
Morphology.
Term
What shapes do bacteria come in?
 Definition
Round, rod, and spiral.
Term
What does it mean if a bacteria cell wall gram stains blue?
 Definition
Gram-positive.
Term
What difference does it make whether a bacteria is gram-negative or gram-positive?
 Definition
Important when choosing an antibiotic to fight the infection because some drugs are good at killing gramnegative
bacteria, while others are better at killing gram-positive bacteria.
Term
What bacteria is usually a harmless inhabitant of the lids and conjunctiva?
 Definition
Staphylococcus epidermidis.
Term
Which bacteria can usually be found in the respiratory tract of people?
 Definition
Strep.
Term
Which bacteria cause ophthalmia neonatorum (neonatal conjunctivitis)?
 Definition
Gonococcal.
Term
Which bacterium causes an acute, pus-producing conjunctivitis and is highly contagious?
 Definition
Hemophilus aegyptius (Koch-Weeks bacillus).
Term
What bacteria cause corneal melting and can grow in almost any moist environment?
 Definition
Pseudomonas aeruginosa.
Term
Which are the more common viruses with which ophthalmic technicians should be familiar?
 Definition
HSV, HZV, ADV, and HIV.
Term
What is the most common cause of viral eye infections? What is the estimated average of infections treated yearly?
 Definition
HSV; 500,000.
Term
What happens to corneal sensitivity when an eye is infected with the HSV? Why?
 Definition
Very insensitive; the virus affects the ophthalmic division of the trigeminal (5th) cranial nerve.
Term
Which virus causes dendritic, branch-like lesions?
 Definition
HSV.
Term
What is the significance of the tip of the nose blistering when referring to HZV?
 Definition
There is a 50% chance of ocular involvement.
Term
What is it that makes ADVs a cause for concern for you in the eye clinic?
 Definition
It is quite contagious.
Term
What are some good signs that a patient has EKC? What are its main characterizations?
 Definition
The eye or eyes are extremely red and produce copious amounts of watery discharge; conjunctiva and corneal involvements are the main characterizations.
Term
Which virus causes a sore throat, fever, and follicular conjunctivitis?
 Definition
PCF.
Term
What treatment is done to counter the ADV?
 Definition
Essentially nothing more than letting the infection run its course.
Term
HIV–1 is a retrovirus that attacks the immune system by doing what?
 Definition
Infecting and depleting the body of its T4 helper lymphocytes.
Term
AIDS directly affects the eye in what percentage of AIDS patients?
 Definition
30.
Term
What is the condition called when chorioretinal tissue is involved due to HIV infection?
 Definition
Cytomegalovirus retinitis.
Term
How is HIV transmitted?
 Definition
Only by exposure to blood and its components, and sexual contact.
Term
What are some classic signs of allergic conjunctivitis?
 Definition
Itching, mild to moderate redness of the eye, and stringy discharge.
Term
Where do fungi tend to develop?
 Definition
On plant matter and dirt.
Term
How does an individual get histoplasmosis?
 Definition
They breathe in a dry particle of bird feces with the fungus in it, which gets in the warm, moist lungs, and
enters the bloodstream.
Term
Why is a skin test to check a person for histoplasmosis a bad idea?
 Definition
For some reason, it reactivates the histoplasmosis fungus so that it can do more damage and spread further.
For a patient with a histo spot (lesion) near the macula, this reawakening could lead to blindness.
Term
Which fungus may develop after a person gets a corneal abrasion by a twig, leaf, branch, or other plant matter?
 Definition
Aspergillus.
Term
How long does it take aspergillus to evolve if it has been acquired by breathing it in?
 Definition
Months or even years.
Term
What drugs can be used to treat patients with the aspergillus fungus?
 Definition
IV administration of the antifungal drug amphotericin B; removing some of the infected vitreous to make room for injecting the drug directly into the vitreous chamber; or the patient can orally take a drug called Flucytosine.
Term
What makes candidiasis different from aspergillus?
 Definition
It doesn’t seem to occur in healthy patients.
Term
What is a subconjunctival hemorrhage?
 Definition
One or more of the small conjunctival blood vessels ruptures, and the blood is trapped between the conjunctiva and the sclera.
Term
What are some causes of a subconjunctival hemorrhage?
 Definition
Coughing, straining, vomiting, or vigorous sneezing.
Term
Describe a pinguecula.
 Definition
A benign (harmless) thickening of the conjunctiva, usually located in the medial canthus area, but not always; are common where people spend a great deal of time outdoors in dry, dusty environments and may be exposed to the harmful effects of UV light.
Term
Describe a pterygium.
 Definition
A growth of abnormal conjunctival tissue onto the cornea; is vascular and involves all the layers of the
bulbar conjunctiva.
Term
What is another name for dry eye syndrome? What exactly is a dry eye?
 Definition
Keratoconjunctivitis sicca; an eye that has a deficiency in tears.
Term
What are some problems associated with dry eye syndrome?
 Definition
Due to lowered lacrimal production, the conjunctiva and cornea are chronically irritated, which may lead to erosions of the cornea and eventual scarring of the cornea.
Term
What is a corneal ulcer?
 Definition
An area of epithelial tissue loss from the corneal surface associated with bacterial, viral, fungal, or parasitic
infection of the eye.
Term
When associated with the eye, where has the single-celled protozoan acanthamoeba typically been found?
 Definition
In patients who wear extended wear soft CLs, or had exposure to hot tubs, communal baths, or even plain tap water.
Term
If ocular pseudomonas is not treated, what severe consequences can occur?
 Definition
It can cause severe eye infections with corneal “melting” and rapid loss of the eye within days.
Term
What is keratitis?
 Definition
A corneal inflammation.
Term
Describe disciform keratitis.
 Definition
An inflammation of the stroma and appears as a disc-shaped, gray, opaque lesion.
Term
What is lagophthalmos?
 Definition
The inability to fully close the eyelids.
Term
What is keratoconus?
 Definition
A degenerative corneal disorder characterized by thinning of the cornea and development of a cone-shaped
protrusion.
Term
How is keratoconus treated in its early stage? Advanced stage?
 Definition
RGP CLs are a significant help in correcting vision and have been found to seemingly slow the progression
of the condition; with decreased vision that cannot be corrected with RGP CLs any longer, patients may be
considered as candidates for possible corneal transplant.
Term
What is the difference between a malignant tumor and a benign tumor?
 Definition
A malignant tumor is one continuing to grow and invade healthy tissue if not treated, and it may or may not spread to other body systems; a benign tumor generally is nonfatal, nonmalignant, and usually localized.
Term
List the four benign tumors associated with eyes.
 Definition
(1) Nevus.
(2) Papilloma.
(3) Molluscum contagiosum.
(4) Xanthelasma.
Term
Which benign tumor can cause chronic conjunctivitis? Why?
 Definition
Molluscum contagiosum; because of the toxicity of the material it sheds.
Term
Which benign tumor is indicative of a lipid disorder?
 Definition
Xanthelasma.
Term
What is meant when a malignant tumor metastasizes?
 Definition
Spreads to the rest of the body.
Term
When excising a carcinoma, why is more tissue removed than just the area that includes the tumor?
 Definition
To ensure no cancerous cells are left behind.
Term
Which tumor is the most common growth on the eyelids?
 Definition
Basal cell carcinoma.
Term
Squamous cell carcinomas metastasize via which system?
 Definition
Lymphatic.
Term
Sebaceous gland carcinomas come from what area of the eyelids?
 Definition
The sebaceous (oil) glands.
Term
Define inflammation.
 Definition
The protective response that begins when body tissue is invaded by a foreign substance.
Term
What is uveitis?
 Definition
A general term referring to inflammation of the uveal tract.
Term
What are the three divisions of uveitis?
 Definition
(1) Anterior uveitis (iritis/iridocyclitis).
(2) Intermediate uveitis (pars planitis).
(3) Posterior or panuveitis (chorioretinitis).
Term
What is the difference between iritis and iridocyclitis?
 Definition
Iritis is an inflamed iris; iridocyclitis is an inflammation of the iris and ciliary body.
Term
List four signs and symptoms of iritis/iridocyclitis.
 Definition
Any four of the following:
(1) Photophobia (light sensitivity).
(2) Tearing.
(3) Blurred vision.
(4) Constricted or irregular pupil.
(5) Red eye with the injection (engorgement of the blood vessels) of the episclera most pronounced near the
limbus.
Term
Why is anterior uveitis dangerous?
 Definition
The inflamed iris coming into contact with and adhering to the crystalline lens or cornea (synechia); if this
occurs, an acute glaucoma attack is very likely.
Term
What are the symptoms of pars planitis?
 Definition
Blurred vision or floaters without pain or photophobia; can be very minor, causing no symptoms, and then
resolving spontaneously, or quite serious, causing macular edema and significant decreases in vision.
Term
In cases of chorioretinitis, why does an inflammation of the choroid often involve the retina?
 Definition
Because of the close physical relationship of the choroid and retina.
Term
To ensure the posterior uveitis is resolved, what else needs to be done in the treatment process of
chlorioretinitis, other than using steroids to reduce inflammation and minimize damage?
 Definition
The underlying systemic problem must be brought under control.
Term
What is optic neuritis?
 Definition
Inflammation that involves the optic nerve head, which can produce vision loss as severe as light perception only.
Term
As related to optic neuritis, describe papillitis and retrobulbar neuritis.
 Definition
Papillitis is a localized swelling at the nerve head and easily seen through ophthalmoscopy; retrobulbar neuritis is an optic neuritis occurring behind the optic disk.
Term
What is a common cause of optic neuritis?
 Definition
Multiple sclerosis—a demyelinating disease.
Term
What are the specific signs of optic neuritis?
 Definition
Unilateral vision loss (variable), pain with eye movement, central scotoma (blind spot), color vision
defects, and pupillary defects.
Term
Why should optic neuritis be monitored closely?
 Definition
To ensure it’s optic neuritis and not a more chronic, systemic neurological problem or tumor, and ensure the neuritis is resolving properly.
Term
What causes the optic disc congestion in papilledema?
 Definition
Elevated pressure within the skull.
Term
Patients are describing their symptoms of papilledema; what would their complaints be?
 Definition
Transient vision loss, from 10 to 30 seconds, a decrease in color vision, and a headache that is worse in the
morning.
Term
What is RP?
 Definition
A hereditary, progressive retinal degeneration in both eyes.
Term
Why is loss of night vision a first sign of RP?
 Definition
RP is a disease of the rods.
Term
What is the primary diagnostic sign of RP?
 Definition
Pigmentation clumps (bony spicules) forming on the retina, which is visible through ophthalmoscopy.
Term
How do diabetes and HTN severely impair the visual system?
 Definition
By hindering the blood flow to the retina.
Term
What is the leading cause of blindness in Western society today?
 Definition
DR.
Term
What is a key in the development in DR? What supports this claim?
 Definition
Chronic elevated blood sugar level in diabetic patients; diabetics with well-controlled glucose levels have a lower incidence of DR.
Term
What are the three stages of DR from the least to the most severe?
 Definition
(1) Stage 1 – background DR.
(2) Stage 2 – preproliferative DR.
(3) Stage 3 – proliferative DR.
Term
What are the earliest stages of DR marked by?
 Definition
Microaneurysms (bulges in a blood vessel caused by weakening of the blood vessel walls), dot and blot
hemorrhages, loss of capillary function, and lipid exudates (leakage from the vessels).
Term
Fluorescein angiography is an invaluable tool in DR for determining what?
 Definition
Abnormalities of the microvascular system caused by DR.
Term
Why use an argon laser to kill portions of the peripheral retina?
 Definition
This essentially kills significant portions of the peripheral retina, reducing the retinal demand for oxygen,
which spares the central vision area of the retina and allows the retinal vasculature to concentrate its oxygen
flow to the central retina.
Term
How does the retina respond to ischemia?
 Definition
It dies or finds a way to get more oxygen.
Term
How can DR cause a retinal detachment?
 Definition
Growth of fibrous tissue creates traction on the retina.
Term
How can hypertensive retinopathy cause a BRVO?
 Definition
Arteries cross over top of the veins in the eye; if the arteries are under a great deal of pressure, they can
press on the vein and block it off.
Term
Which causes a more rapid loss of vision––a CRAO or a CRVO?
 Definition
CRAO.
Term
In the case of an embolus in a CRAO, what is the best hope in initial treatment?
 Definition
Move the embolus out of the CRA and get it down one of the arterial branches.
Term
What is considered an ocular catastrophe?
 Definition
A blockage of the CRAO.
Term
What does the term “nicking” mean when referring to CRVO?
 Definition
An artery that appears to be denting in a vein.
Term
What are some retinal signs that a CRVO has occurred?
 Definition
Dilated and engorged veins (they are full and can’t drain), intraretinal and nerve fiber layer hemorrhages,
swollen optic disc margins, and retinal thickening.
Term
Why does a retinal hole or tear allow a retinal detachment to occur?
 Definition
Enough force is generated (by minor trauma, eye movement, etc.) to allow vitreous fluid to begin to work its way through the tear and get under the retina.
Term
What are initial retinal detachment symptoms a patient notices?
 Definition
Flashes of light and an increase in the number of floaters in the affected eye.
Term
How are retinal holes and tears usually treated?
 Definition
With a YAG laser to tack down the retina, or a cryoprobe (freezing) surgery to freeze and scar the retina
back into place.
Term
What can cause the appearance of floaters?
 Definition
Remnants of the hyaloid artery that was present in the vitreous during our development in mom’s womb, or
from flecks of pigment that have somehow gotten into the vitreous.
Term
What does PVD stand for?
 Definition
Posterior vitreous detachment.
Term
Vitreous hemorrhaging can lead to what complications?
 Definition
Sudden, painless loss of vision as the blood filling the vitreous prevents light from reaching the retina.
Term
Although asteroid hyalosis looks like little asteroids suspended in the vitreous, what are you actually seeing suspended in the vitreous?
 Definition
Tiny, opaque, calcium deposits.
Term
What is endophthalmitis?
 Definition
An inflammatory response in the vitreous, almost always meaning some infectious organism has gotten inside the eye.
Term
What can infections and inflammation of the vitreous lead to?
 Definition
Liquefaction, opacification, and shrinkage of the vitreous.
Term
The white blood cells present in the vitreous during an infection can lead to the formation of what?
 Definition
A cyclitic membrane.
Term
When is endophthalmitis most likely to occur?
 Definition
Following an invasive eye surgery.
Term
What are cataracts? What generally causes them?
 Definition
Opacities or cloudiness of the crystalline lens; protein clumping and fiber swelling within the lens.
Term
What are the three general categories of cataracts?
 Definition
(1) Age-related.
(2) Congenital.
(3) Acquired (trauma or disease).
Term
How are nuclear sclerotic cataracts characterized?
 Definition
By some faint whitish-gray clouding of the lens, and an increased density at the center of the lens, causing it to thicken in the middle slightly.
Term
Why might a cataract cause a myopic shift?
 Definition
It increases the density at the center of the lens, causing it to thicken in the middle slightly, which gives the
lens more power and focusing light sooner.
Term
What type of cataract has the most profound effect on vision?
 Definition
PSC; Posterior Subcapsular Cataract.
Term
When are congenital cataracts formed? When are they present?
 Definition
During embryonic development in the mother’s womb; at birth.
Term
What could happen if a congenital cataract is not removed before the age of two?
 Definition
The chances of the patient developing normal vision, even after the cataract is eventually removed, is very slim.
Term
What happens when the crystalline lens is penetrated?
 Definition
Aqueous and vitreous fluid is allowed to enter the lens capsule; this fluid is absorbed by lens fibers, causing
them to swell and cloud due to the metabolic imbalance.
Term
What are the various methods of cataract removal?
 Definition
Intracapsular, extracapsular, or phacoemulsification
Term
Which cataract removal technique is least traumatic and allows for a small incision to remove the lens?
 Definition
Phacoemulsification.
Term
What is the term for a patient with a natural crystalline lens? With no lens? An artificial lens?
 Definition
Phakic; aphakic; pseudophakic.
Term
How can you tell if a patient has an anterior chamber lens?
 Definition
If you shine a penlight in the person’s eye and see a shimmering reflection just behind the cornea.
Term
Name the four internal tumors associated with the eyes.
 Definition
(1) Iris nevus.
(2) Choroidal nevus.
(3) Malignant melanoma.
(4) Retinoblastoma.
Term
What is an indication that an iris nevus is no longer benign?
 Definition
Any growth or changes in shape or size.
Term
What is the most frequently occurring intraocular tumor in adults? In children?
 Definition
Malignant melanoma; retinoblastoma.
Term
Where are malignant melanomas found in relation to the eye?
 Definition
Only in the uveal tract.
Term
What tumor has a root cause of genetic defects or genetic mutations?
 Definition
Retinoblastoma.
Term
What characteristic of retinoblastoma is usually noticed by parents between the 15th and 30th month of life?
 Definition
A white papillary reflex.
Term
Describe the general treatment of a retinoblastoma.
 Definition
Eyes still having functional vision and localized tumors are given radiation therapy; in eyes no longer
functioning visually or having an extremely large tumor, enucleation (removal of the eye) is the treatment
of choice.
Term
What are the characteristics of glaucoma?
 Definition
Elevated IOP, optic disk cupping, and VF loss.
Term
The condition of angle-closure glaucoma is marked with a rise in IOP caused by what?
 Definition
A mechanical blockage of the angle at the root of the iris.
Term
Which form of glaucoma is the most destructive?
 Definition
Angle-closure.
Term
What is the difference between a normal eye and one afflicted with angle-closure glaucoma?
 Definition
The one with angle-closure glaucoma has a shallow anterior chamber and a narrow entrance into the angle.
Term
Identify the signs and symptoms of angle-closure glaucoma.
 Definition
The patient begins to experience pain as the pressure rises higher. The pain can vary from a feeling of discomfort and fullness around the eye or eyes to a severe, disabling pain that can radiate to the back of the head or down toward the teeth. With severe pain, the patient becomes nauseated and may even vomit. Usually, the vision is reduced to mere perception of light. The patient sees halos or rainbows around lights, caused by the edema (swelling) of the cornea as it fills with fluid due to the excess pressure in the eye. The swollen cornea clouds slightly and begins to diffract the light entering the eye. The pupil is usually at a mid-dilated point and is pretty much stuck there while the pressure remains high. More than likely, the patient also experiences photophobia.
Term
Angle-closure glaucoma patients are usually treated with which medications?
 Definition
Glycerin, Timoptic®, Betoptic®, Pilocarpine®, Diamox®, or Mannitol®.
Term
What is a laser iridotomy? What is its purpose?
 Definition
Essentially burning a hole in the periphery of the iris with a YAG laser; provides another avenue for the
aqueous humor to get from the posterior chamber to the anterior chamber and reduces the pushing forward
of the iris by the fluid behind it.
Term
Why is a laser iridotomy done in the affected and non-affected eyes in cases of POAG?
 Definition
Studies have shown that within five to 10 years of the initial attack, there is a 50 – 70 percent chance the patient will have another acute angle-closure attack in the other eye, so treating both eyes helps reduce another attack in either eye.
Term
Where does the problem seem to be with aqueous outflow in COAG?
 Definition
An obstruction of aqueous outflow through the trabecular meshwork.
Term
Increased IOP interferes with the retina’s nerve fiber layer to do what?
 Definition
Carry the visual signal from the eye toward the brain.
Term
Why is screening for COAG using IOP an inexact science?
 Definition
Because patients with relatively low IOP (21 mm Hg or lower) can still have the disease and patients with relatively high pressures (22 mm Hg or higher) can still be free of the disease.
Term
What is the defining factor in a diagnosis of COAG?
 Definition
VF loss.
Term
What is another term for congenital or infantile glaucoma?
 Definition
Buphthalmos.
Term
Which symptoms might a child with congenital glaucoma present to the clinic?
 Definition
Be extremely sensitive to light, so much so his or her eyelids are tightly shut through the day; the eyes may
tear profusely; and, most noticeably, the corneal hazing makes most parents suspect something is wrong.
Term
What is the best treatment for lasting results in congenital glaucoma?
 Definition
Surgery.
Term
What is an ocular hypertensive?
 Definition
A patient that shows signs of glaucoma (e.g., higher than normal IOP and changes to the optic disc), but no
VF loss.
Term
Ocular hypotension is also known as what?
 Definition
Hypotony.
Term
What conditions could lead to ocular hypotension?
 Definition
A chronic intraocular inflammation (uveitis), wound leaks after an eye surgery, or the presence of a retinal
detachment.
Term
Battlefield mechanical injuries are categorized by what?
 Definition
The source of injury.
Term
Sources of munitions include what?
 Definition
Blast (surrounding debris scattered secondary to explosion), mines, cluster bomblet, anti-tank missiles,
grenades, bombs, booby-traps, bullets, and other related mechanisms.
Term
Name sources that can be included in non-munitions.
 Definition
Motor vehicle accident, blunt trauma, fall, helicopter crash, metal on metal, and other various means.
Term
What is an FB?
 Definition
Any object that is not a part of the body.
Term
What happens when a steel FB gets in the eye?
 Definition
The steel rusts in the eye and makes healing difficult.
Term
What should be tried first when attempting to remove a superficial FB?
 Definition
Irrigation with a sterile saline solution.
Term
Why might a patient complain of an FB sensation even after it is removed?
 Definition
The cornea may have been scratched.
Term
What should be done with a patient who has had a penetration of the eye by an FB?
 Definition
Refer them to a surgeon for treatment.
Term
What is wrong with pressure patching an eye that has been penetrated by an FB?
 Definition
The pressure patch could force aqueous or vitreous humor out of the eye.
Term
What should you do with a patient whose eye has a large wound and is leaking aqueous or vitreous humor?
 Definition
Lay the patient on his or her back and gently transport the patient to surgical help.
Term
When can a corneal abrasion or scratch have a long-term affect on VA?
 Definition
If it goes across the visual axis (line of sight).
Term
How is a corneal abrasion usually treated?
 Definition
Ensure there is no FB in the eye, give the patient an antibiotic ointment, pressure-patch the patient for 12 to
24 hours (if needed), and then reevaluate the patient’s eye.
Term
Name two FBs that are inert materials.
 Definition
(1) Glass.
(2) Plastic.
Term
If a person gets a thermal burn, what can you do for the person until the doctor becomes available to treat the injury?
 Definition
Keep the burned area moist.
Term
What is the immediate treatment for a chemical burn?
 Definition
Prolonged irrigation with sterile saline, or plain water if no saline solution is available.
Term
Why are acid burns usually less destructive than alkali burns?
 Definition
Acids tend not to penetrate the eye; they make contact and burn what they touch, causing a barrier that slows or prevents further damage by the acid, so acids generally do not penetrate the underlying tissue as readily as alkalis do; and the tears of the eye have a pH on the alkali side of neutral that help prevent penetration into the eye.
Term
What are some examples of alkaline agents?
 Definition
Sodium, potassium, and ammonia.
Term
What type of paper is used to test the amount of acid or alkali present in an eye?
 Definition
Litmus (pH).
Term
What pH reading is considered “neutral” for the eye?
 Definition
7.3 – 7.7.
Term
What, essentially, does UV radiation do to the cornea?
 Definition
Sunburns it, degrading the corneal epithelium.
Term
An “eclipse burn” to the retina is caused by which type of light ray?
 Definition
Infrared.
Term
What type of damage can occur due to X-ray exposure?
 Definition
Cataracts, necrosis (death) of the skin, loss of lashes, and glaucoma.
Term
Which type of upper eyelid laceration is more damaging: horizontal or vertical? Why?
 Definition
Horizontal; it is going across (against) the levator palpebrae superioris, which can lead to permanent muscle damage and lid drooping (ptosis).
Term
Contusions to the globe can lead to what conditions?
 Definition
Prolapse of the intraocular tissues, vitreous hemorrhage, retinal detachment, dislocated lens, and various blood vessel ruptures.
Term
Blood in the anterior chamber of the eye caused by blunt trauma to the eye is known as what?
 Definition
A hyphema.
Term
What are some problems with blood cells floating around in the anterior chamber?
 Definition
Besides reducing VA, they may plug up the trabecular meshwork and prevent maximum drainage of the aqueous, which could lead to a rise in IOP, inducing glaucoma.
Term
What action should you take if an eye is proptotic due to trauma? What should you not do?
 Definition
Loosely cover the eye with a moist dressing to keep the ocular tissues from drying out, and get the person
to a doctor immediately; do not try to “push” the eye back in the socket.
Term
What is a hazard associated with a proptotic eye?
 Definition
The drying out (desiccation) of the cornea because the lids may not be able to totally cover the eye due to
the degree the eye is protruding.
Term
When is a ‘blowout” fracture likely to occur?
 Definition
After a blunt injury to an eye.
Term
What is a ‘blowout” fracture?
 Definition
The eye is so compressed in the socket at the time of the blunt trauma that something has to give, and the weaker bones that are stressed literally “blowout” or fracture.
Term
What is a positive Seidel a sign of?
 Definition
The eye is leaking out fluid.
Term
How many Americans suffer from migraines?
 Definition
An estimated 25 million.
Term
Of the total of migraine sufferers, what percentage experience a stage called an aura?
 Definition
About 15.
Term
What is an aura? What do researchers believe cause them?
 Definition
A visual hallucination; a wave of electrical activity that spreads across the visual cortex.
Term
What are the four main groups of migraines?
 Definition
(1) Common.
(2) Classical.
(3) Complicated.
(4) Cluster headaches.
Term
Eighty percent of patients suffer from which type of migraine?
 Definition
Common.
Term
In what part of the VF does the visual aura begin? Where does it end?
 Definition
Near fixation; periphery.
Term
Which type of migraine represents the more severe visual complaints seen by optometrists and ophthalmologists?
 Definition
Complicated.
Term
What is one of the telltale signs of a cerebral migraine?
 Definition
The incidence of permanent neurological deficits.
Term
Which type of complicated migraine is known for causing temporary paralysis of one or more of the ocular muscles?
 Definition
Ophthalmoplegic.
Term
Which type of complicated migraine is associated with brain stem dysfunction?
 Definition
Basilar.
Term
List four migraine “trigger factors.”
 Definition
Any four from the following:
(1) Certain foods.
(2) Hormonal changes.
(3) Fatigue and stress.
(4) Bright lights.
(5) Loud noises.
(6) Trauma.
(7) Refractive error.
Term
List two tests which your doctor may ask you to administer when a diagnosis of migraines is suspected?
 Definition
(1) Amsler grid.
(2) Automated VF.
Term
What classification of cases should be seen the same day?
 Definition
Urgent.
Term
List four true emergencies needing to be seen within minutes.
 Definition
(1) Chemical burns.
(2) CRAO.
(3) Penetrating injuries to the globe.
(4) Sudden loss of vision
Term
How can you distinguish between urgent and non-urgent needs?
 Definition
Discrete questioning techniques and a solid case history.
Term
What is the purpose of eye irrigation?
 Definition
To remove foreign objects or substances from the eye.
Term
If a chemical is splashed into the eye, where can a patient irrigate his or her eyes?
 Definition
At a sink, shower, water hose, water fountain, or anywhere water is available.
Term
What is blepharospasm?
 Definition
Inability to open the eyelids due to a muscle spasm of the orbicularis oculi.
Term
What relieves the pain and lid spasms for patients who get a chemical burn to their eyes and experience blepharospasm?
 Definition
The use of a topical ophthalmic anesthetic.
Term
When irrigating without the Morgan Lens®, from which direction do you squirt the sterile saline?
Why?
 Definition
Across the eye, going from the nasal side toward the temporal side; flushes the harsh chemicals away from the lacrimal drainage system, minimizing damage to it, and minimizes the amount of chemical being washed across the face.
Term
What is the purpose of the pressure patch?
 Definition
To keep the lids of the injured eye closed and help with pain control.
Term
What is the purpose of the alcohol pad when putting on a pressure patch?
 Definition
Removes the make-up and facial oils that prevent your tape from sticking to the patient.
Term
Where does the last strip of tape go when applying a pressure patch?
 Definition
Middle of the patch.
Term
What advice do you give a patient who has just had a patch placed over one eye?
 Definition
Minimize talking because it loosens the patch; no heavy exertion because it leads to sweating, causing the
patch to loosen or fall off; no driving, if at all possible, because stereopsis (fine-tuned depth perception) is lost, as well as a substantial portion of the VF on the patched side.
Term
What should a patient with a pressure patch do if the patch falls off or comes loose before the follow-up appointment?
 Definition
Return to the clinic to have a new one applied; if it is after duty hours, leave the patch off and keep the eye
closed as much as possible.
Term
(1) Absence of all organisms and spores.
(2) Normally intended for inanimate objects.
(3) Hospital-acquired infection from other persons.
(4) Also called germicide.
(5) Clean technique.
(6) State of being free of infection.
(7) Process of destroying all microorganisms and spores.
(8) Practices that keep objects free of microorganisms.
(9) Agent usually intended for use on persons.
(10) Area free of disease-producing microorganisms.
 Definition
(1) Sterile.
(2) Disinfectant.
(3) Exogenous nosocomial infection.
(4) Bactericide.
(5) Medical asepsis.
(6) Asepsis.
(7) Sterilization.
(8) Surgical asepsis.
(9) Antiseptic.
(10) Clean area.
Term
What three elements are required for the spread of infection within a hospital?
 Definition
(1) Source of infection.
(2) Susceptible host.
(3) Mode of transmission.
Term
What is the most important and frequent means of nosocomial infection transmission?
 Definition
Contact.
Term
What is the single most important means of preventing the spread of infection?
 Definition
Hand washing.
Term
When other protective articles are also worn, when is a mask donned? Removed?
 Definition
First; last.
Term
What piece of protective clothing offers a practical means of preventing transient hand colonization?
 Definition
Gloves.
Term
How do the skin, tears, and mucous layer of the conjunctiva help protect the body and eyes from infection?
 Definition
Intact skin provides an effective barrier to microorganisms; tears contain antibacterial properties; and
mucus layer of the conjunctiva traps and kills invading organisms.
Term
How does effective hand washing help remove microorganisms from the skin?
 Definition
Mechanically scrubbing them away as you rub your hands together, diluting the organisms by rinsing them away with water, and killing many organisms when an antibacterial soap is used.
Term
What disinfectant is used to clean items that do not make contact with a patient’s bodily fluids?
 Definition
Alcohol.
Term
What is used to disinfect applanation tonometer tips?
 Definition
A solution of one part household bleach to 10 parts water (1:10).
Term
What is a big factor in a medication’s tolerability?
 Definition
The pH of the drug.
Term
What term applies to drugs that have a neutral tonicity?
 Definition
Isotonic.
Term
What kind of patient benefits from a hypotonic solution?
 Definition
A patient with dry eyes.
Term
What are ophthalmic medications sensitive to?
 Definition
Heat and light.
Term
What is one indication a medication is oxidizing?
 Definition
The medication in the bottle is brown or the threads on the bottle are a little brown.
Term
Name the four ways to increase the penetration of an eye drop.
 Definition
(1) Increase dosage.
(2) Increase frequency.
(3) Increase the viscosity.
(4) Increase contact time with the cornea.
Term
The cornea acts as a barrier to which type of medications?
 Definition
Those not soluble in fat (can’t get through epithelial layer) and those not soluble in water (can’t get through
the remaining layers).
Term
What are the main types of medication delivery?
 Definition
Topical application; subconjunctival, sub-tenon’s, retrobulbar, and intravitreal injections; continuous
release delivery; and systemically.
Term
In what forms are topical medications available?
 Definition
Solutions, suspensions, ointments, and continuous release delivery.
Term
Once a solution or drop is instilled in the eye, how do you minimize systemic absorption by the patient?
 Definition
Perform punctal occlusion for about one minute.
Term
How long does the Pilocarpine Ocusert® deliver its medication?
 Definition
24 hours a day for seven days.
Term
Why are subconjunctival or sub-tenon’s injections used?
 Definition
To deliver medications in large doses and for longer duration, primarily to treat intraocular infections or acute iritis cases.
Term
Where is the medication released during a retrobulbar injection?
 Definition
The area behind the eye.
Term
In what two basic ways are systemic medications usually administered?
 Definition
(1) By mouth.
(2) By injection.
Term
What does sub Q mean relative to injections? IM? IV?
 Definition
Under the skin; in a muscle; into a vein.
Term
What is the most frequent type of drug reaction? What is the range of signs and symptoms?
 Definition
Allergic response; moderate swelling and redness to convulsions and death.
Term
Can you assume that if a patient was given a drug before without a reaction the individual will not have a reaction if given that drug again? Why or why not?
 Definition
No; their previous exposure may have allowed them to develop a hypersensitivity to the drug so they may react to it this time.
Term
What should you do if you put Atropine in a patient’s eye and notice some redness and swelling occurring?
 Definition
Stop instilling the drug, recline the patient if possible, and get a doctor for assistance.
Term
What can toxic chemical reactions cause?
 Definition
Death, destruction, or changes to tissue (e.g., formation of deposits or discoloration).
Term
How can you help prevent adverse drug reactions in your patients?
 Definition
Take a good case history.
Term
What things should you check before instilling a medication into a patient’s eyes?
 Definition
Actual drug name, drug percentage, the word “ophthalmic”, manufacturer’s expiration date, and the date
the medication was opened (if the manufacturer’s seal has been removed).
Term
What makes up the CNS?
 Definition
The brain and spinal cord.
Term
What are the two divisions of the PNS (Peripheral Nervous System)?
 Definition
(1) ANS (Autonomic Nervous System).
(2) Somatic nervous system.
Term
What two levels, or divisions, make up the ANS (Autonomic Nervous System)?
 Definition
(1) Sympathetic nervous system.
(2) Parasympathetic nervous system.
Term
Explain the difference between a mimetic and a lytic.
 Definition
Mimetics mimic certain actions of the sympathetic or parasympathetic nervous system; lytics paralyze certain actions of the sympathetic or parasympathetic nervous system.
Term
Using what you know, explain why phenylephrine and tropicamide are routinely used together when you are dilating a patient’s eyes.
 Definition
Phenylephrine is a sympathomimetic and stimulates the dilator muscle of the iris. Tropicamide is a parasympatholytic that paralyzes the sphincter (constrictor) muscle of the iris. So, essentially, one drug
stimulates the muscle that dilates the pupil and the other drug paralyzes the muscle that tries to oppose that
action; now there is no resistance for the dilation to occur.
Term
Why do you use a mydriatic drug?
 Definition
To cause dilation, giving a wider field of view for examination of the macula, optic nerve, and retina.
Term
What percentage of phenylephrine hydrochloride (Neo-Synephrine®) solution is the preferred concentration for use? Why?
 Definition
2.5 percent; it provides the desired mydriatic effect without significantly increasing blood pressure, causing
headaches, or even death like the 10-percent concentration can.
Term
Name the three classic signs of a Horner’s syndrome.
 Definition
(1) Ptosis.
(2) Miosis.
(3) Anhidrosis (dry skin) on one side of the face.
Term
What mydriatic drug is used to confirm the presence of a Horner’s syndrome?
 Definition
Cocaine.
Term
List the four cycloplegics and explain for what purpose each is primarily used.
 Definition
(1) Tropicamide—to produce mydriasis and cycloplegia for routine fundus exams.
(2) Cyclopentolate—cycloplegic refractions for use in Flying Class 1 and 1A physical examinations.
(3) Homatropine—produces extended mydriasis and cycloplegia that may last up to 72 hours; commonly
used for patients with iritis to stop ciliary spasms and prevent synechiae.
(4) Atropine—for refraction in children; not used much anymore due to numerous side effects.
Term
What bothers most patients about being dilated?
 Definition
Heightened photosensitivity and lack of accommodation.
Term
What is the most common reaction to the drug depiprozole (Rev-Eyes®)?
 Definition
Stinging and eye redness.
Term
How do beta-blocking drugs (e.g., Timolol Maleate [Timoptic®]) work?
 Definition
They slow the production of aqueous humor by blocking the beta–1 (cardiac receptors) and beta–2 (pulmonary receptors) functions within the eye.
Term
When is Betaxolol HCl (Betoptic®) preferred over the other beta-blockers?
 Definition
For an asthmatic patient because Betoptic® selectively blocks beta–1 (cardiac receptors), but not the beta–2
(pulmonary receptors), making it a better choice in patients with breathing problems.
Term
What are the advantages of Levobunolol HCl (Betagan®)?
 Definition
It has a longer half-life than Timoptic® or Betoptic®, earning it FDA approval for once-a-day use, as
opposed to the required twice-a-day application of the other beta-blockers; using less medication helps keep the cost down and patient’s compliance in taking their medication up.
Term
When is a cholinergic agent used?
 Definition
When beta-blockers do not lower IOP enough by themselves or patients require specific treatment that
works on the outflow of aqueous humor rather than just slowing its production.
Term
What are the secondary effects of miotic medications?
 Definition
Miosis (constriction of the pupil), stimulation of accommodation, and brow ache.
Term
Which patients should not be given miotics?
 Definition
Patients with anterior uveitis (e.g., iritis).
Term
Which cholinergic agent is available in Ocusert® form?
 Definition
Pilocarpine.
Term
Why is Carbachol contraindicated in patients with corneal abrasions?
 Definition
The medication over penetrates into the eye.
Term
What can chronic use or high doses of cholinesterase inhibitors lead to?
 Definition
The formation of iris cysts (especially in children).
Term
Which cholinesterase inhibitor can be reversed?
 Definition
Physostigmine Salicylate (Eserine®).
Term
What two things do Isoflurophate and Echothiophate Iodide have in common, besides being miotics?
 Definition
Can be used to treat children with accommodative (convergent) esotropia and are irreversible.
Term
Which category of IOP-lowering drugs is sulfonamide-based?
 Definition
Carbonic anhydrase inhibitors.
Term
Which medication often is used on patients who report to the eye clinic with acute-angle closure glaucoma and can be used as a supplementary treatment for COAG?
 Definition
Acetazolamide (Diamox®).
Term
What is a contraindication of Methazolamide (Neptazane®) that does not apply to Acetazolamide (Diamox®)?
 Definition
Methazolamide (Neptazane®) should be avoided in patient’s undergoing steroid treatment.
Term
What is the primary use of the hyperosmotics?
 Definition
Lowering IOP quickly on patients who report with an acute-angle closure glaucoma attack.
Term
List the contraindications for Glycerin (Osmoglyn®).
 Definition
Not for use on diabetic or dehydrated patients, nor on those with heart, kidney, or liver disease.
Term
How is Mannitol administered to patients?
 Definition
Intravenously.
Term
What are the two main ways anesthetics can be administered to patients?
 Definition
(1) Topically.
(2) Through injection.
Term
Name two tests that require the use of a topical anesthetic before they can be performed.
 Definition
(1) Applanation (Goldmann) tonometry.
(2) Schirmer II tear test.
Term
In a non-penetrating eye injury case, give two reasons a topical anesthetic is needed besides merely alleviating the pain of the injury?
 Definition
(1) Allow placement of a Morgan Lens® (if irrigation is needed).
(2) Relieve any blepharospasm caused by the injury.
Term
What is the danger of a patient using a topical anesthetic several times over the course of a day or two?
 Definition
It causes a softening of the corneal epithelial cells. The soft, loose cells slough off, exposing Bowman’s
layer, inviting infection and corneal ulceration. It can actually cause a toxic reaction in the cornea causing
cell damage.
Term
What is the reason patients are warned not to rub their eyes for 20 minutes after having a topical anesthetic instilled in their eye?
 Definition
They could cause damage to the eye by rubbing it too hard or rubbing a foreign object into their cornea.
Term
Name the three topical anesthetics used in the eye clinic.
 Definition
(1) Proparacaine.
(2) Benoxinate with fluorescein.
(3) Tetracaine.
Term
Give two possible reasons why Proparacaine is the anesthetic of choice for most eye care professionals.
 Definition
(1) Very few complications with its use.
(2) It is the least irritating of the topical anesthetics.
Term
Because Benoxinate is not commercially available in a form all by itself and can only be found mixed with fluorescein, what does this make it well suited for?
 Definition
Goldmann applanation tonometry.
Term
What are the side effects of Tetracaine (Pontocaine®)?
 Definition
It burns and stings, and has also been known to cause an allergic reaction in some patients.
Term
What is the longest any of the topical anesthetics may last?
 Definition
20 minutes.
Term
What are the two uses of locally injected anesthetics in ophthalmic surgery?
 Definition
(1) Anesthesia of the eye and eyelid.
(2) Paralysis of the muscles (extraocular, eyelid, and facial).
Term
Why do many doctors perform a retrobulbar block before beginning an intraocular surgery?
 Definition
It paralyzes the EOMs behind the globe and the sensory nerves to the globe so the patient’s eye can’t suddenly move during the operation.
Term
What is one of the most popular injectable anesthetics available (give the generic and trade names)?
 Definition
Lidocaine (Xylocaine®).
Term
What is liquid sodium fluorescein susceptible to?
 Definition
Contamination by the pseudomonas aeruginosa bacteria.
Term
What is the preferred dispensing method for sodium fluorescein?
 Definition
Dry, filter paper strips impregnated with fluorescein, called Fluor-I-strips®.
Term
Give the six uses for sodium fluorescein.
 Definition
(1) Perform applanation (Goldmann) tonometry.
(2) Show defects in the corneal epithelium.
(3) Detect penetrating injuries to the eye.
(4) Fit gas permeable CLs.
(5) Study lacrimal patency.
(6) Perform FA.
Term
What causes fluorescein to fluoresce?
 Definition
UV or cobalt blue light.
Term
What color dye is Rose Bengal? What is it attracted to?
 Definition
Red; devitalized or dead epithelial cells of the cornea and conjunctiva.
Term
What problem can Rose Bengal aid in diagnosing?
 Definition
Keratoconjunctivitis sicca (dry eyes).
Term
What should be instilled before using Rose Bengal?
 Definition
An anesthetic.
Term
Why are preservative-free artificial tears preferred?
 Definition
Preservatives can cause an allergic reaction in certain patients.
Term
The weakest decongestants are a good choice for treating what condition?
 Definition
Mild allergic conjunctivitis.
Term
What role does zinc play when mixed with Phenylephrine and Naphazoline to form a moderate decongestant agent for the eyes?
 Definition
Helps block the itching and break up the mucus.
Term
Antihistamines, the strongest ocular anti-allergy (decongestant) drug available OTC, are a combination of what?
 Definition
Vasoconstrictors and antihistamines.
Term
What does a mast cell stabilizer prevent? What problem is this drug best used to control or treat?
 Definition
Prevents the release of histamines, prostaglandins, and leukotrienes from sensitized mast cells; chronic
allergic problems (e.g., seasonal allergic conjunctivitis, often called vernal conjunctivitis).
Term
What do NSAIDs control? How do they do it?
 Definition
Inflammation; inhibiting prostaglandin synthesis.
Term
What patients are most often prescribed Diclofenac sodium (Voltaren®)? What is this
medication’s advantage over most steroids?
 Definition
Cataract surgery patients for a few days after their operation; it doesn’t lead to IOP increases like most
steroidal drugs.
Term
What can lead to miosis during cataract surgery? What NSAID(s) can help prevent it?
 Definition
The doctor sliding instruments in and out of the eye irritates the iris, which causes inflammation that leads
to miosis; Flurbiprofen (Ocufen™) or suprofen (Profenal®).
Term
When is Ketorolac Tromethamine (Acular®) most commonly used?
 Definition
To control inflammation due to seasonal (vernal) allergic conjunctivitis.
Term
What concentrations does Prednisolone come in? What is each version good for treating?
 Definition
0.125 and 1 percent; the 0.125 percent is good where mild adnexa inflammation control is needed (e.g., early allergic conjunctivitis), and the 1-percent concentration is used for corneal inflammations (keratitis),
episcleritis, iritis, and similar conditions.
Term
Name the steroid that is useful in treating blepharodermatitis.
 Definition
Dexamethasone.
Term
When is it appropriate to prescribe Fluorometholone?
 Definition
When treating long-term inflammations (those that can last three to four weeks or more) (e.g., SPK and some ocular allergies).
Term
When is using a steroid-antibiotic combination drug considered prudent?
 Definition
In cases where the inflammatory response is secondary to compromised eye tissue (i.e., chemical keratitis
with significant epithelial compromise).
Term
What are the two basic antibiotic agents?
 Definition
(1) Bacteriostatic.
(2) Bacteriocidal.
Term
Why does it matter whether a bacteria gram stains blue (positive) or red (negative)?
 Definition
It helps the doctor pick an antibiotic appropriate to the type of bacteria because certain antibiotics are more
effective on gram-positive bacteria and some are better on gram-negative.
Term
Name the more common gram-positive bacteria and list their similarities.
 Definition
Staphylococcus aureus, staphylococcus epidermidis, streptococcus pneumoniae, and hemolytic streptococci; they are staph or strep of some kind, and are coccus or cocci, indicating round in shape.
Term
How long does it take for bacteria to be cultured in the laboratory and be tested against various antibiotic agents?
 Definition
24 to 48 hours.
Term
Explain the “shotgun” approach to treating an infection.
 Definition
Involves the doctor using a broad-spectrum antibiotic that fights many different types of bacteria until the
specific bacteria and what types of drugs affect it is known.
Term
Which bacteria can penetrate a compromised cornea in as little as 24 hours?
 Definition
Pseudomonas aeruginosa.
Term
What is a common cause for bacteria becoming resistant to antibiotic medications?
 Definition
Patients failing to use their antibiotics for the prescribed length of time; they stop when things seem to clear up and the remaining bacteria make a comeback, becoming more resistant to the prescribed medication.
Term
What is an eye condition (infection) that can lead to massive destruction of intraocular tissues, and to blindness or enucleation (removal of the eye)? What condition can lead to death?
 Definition
Endophthalmitis; orbital cellulitis.
Term
For what purpose is Bacitracin commonly used?
 Definition
Treating the staphylococcal form of blepharitis (staph lid disease).
Term
Give the disadvantages of Sulfacetamide.
 Definition
Many patients are allergic to sulfa drugs; it doesn’t work well against staphylococcal organisms or pseudomonas; and it doesn’t work well on mucopurulent infections.
Term
Give the three most common uses of Erythromycin (E-Mycin).
 Definition
(1) As a prophylactic (preventative) antibacterial when a pressure patch is used on a corneal abrasion.
(2) On sutures and surgical wounds after blepharoplasty (eyelid) surgery.
(3) On newborns, as a prophylaxis against gonorrhea and chlamydial infection.
Term
What two broad-spectrum, pseudomonas-killing drugs are essentially the same?
 Definition
(1) Gentamicin.
(2) Tobramycin.
Term
Which antibiotic is mixed frequently with other antibiotics to come up with a very effective, broad-spectrum medication?
 Definition
Polymixin-B.
Term
Name two drugs that are only available in a form where they are mixed with another drug.
 Definition
(1) Neomycin.
(2) Trimethoprim.
Term
Which category of antibiotics actually works to disrupt the DNA of bacteria?
 Definition
The fluoroquinolones.
Term
For what purpose is Ciprofloxacin HCl (Ciloxan®) used?
 Definition
Treating moderate to severe external bacterial infections; the most common use thus far is in treating corneal ulcers caused by bacterial organisms.
Term
How are viruses different from bacteria and fungi in the way they infect cells?
 Definition
Viruses actually penetrate inside the cell they are infecting; bacteria and fungi are only next to the cell they
are infecting.
Term
Give the three categories of viruses that you encounter in the eye clinic.
 Definition
(1) ADV.
(2) HSV.
(3) HZV.
Term
Which virus cannot be treated and must just “run its course?”
 Definition
The ADV.
Term
Why is the HSV a threat to vision?
 Definition
It invades the cells of the corneal epithelium, causing dendritic ulcers that expose the lower corneal layers.
Term
What is the danger in extended use of antivirals?
 Definition
They can be toxic to healthy tissue.
Term
Name the four antiviral medications.
 Definition
(1) Idoxuridine (Herplex®).
(2) Vidarabine (Vira-A®).
(3) Trifluridine (Viroptic®).
(4) Acyclovir (Zovirax®).
Term
Which antiviral is the current “drug of choice?”
 Definition
Trifluridine (Viroptic®).
Term
Which antiviral is used primarily in treating HZV?
 Definition
Acyclovir (Zovirax®).
Term
What is the only FDA-approved antifungal for topical, ocular use? What fungi is it effective against?
 Definition
Natamycin or pimaricin (Natacyn®); Candida, Aspergillus, Cephalosporium, Fusarium, and Penicillin.
Term
Name the good effects of free radicals on the human body. The bad effects.
 Definition
Breaks down accumulated toxins, dead cells, and waste products; damages healthy cells through a process called oxidation.
Term
Which supplements appear to have a positive effect on ARMD (Age Related Macular Degeneration)?
 Definition
Vitamins A, C and E; caratenoids; zinc; selenium bilberry; and ginkgo biloba.
Term
Why are the benefits of vitamin and mineral supplementation for eye health considered pure speculation?
 Definition
Partly because the business of supplementation is largely an unregulated industry and does not undergo years of rigorous testing as FDA-approved medications.
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