general Knowledge


Treatment fo Herpes Simplex


Topical TxViroptic - Topical Trifluridine 1gtt q2h X 7 days untilled healed then possible QID x 7 daysZirgan Topical Granciclovir gel .0.15% 1gtt 5 x/day-till resolution. Then TID x 7daysSystemic TxZovirax- Acyclovir- 400mg 5x/day for 7-10 daysValtrex - Valacylovir - 500 mg TID for 7-10 daysFamvir - Famciclovir - 250 mg TID for 7-10 daysHEDS II - Showed that oral acyclovir - ZOVIRAX DOSE BID X 1 YEAR REDUSED THE RATE OF OF RECURRENCE ON ANY FORM OF OCULAR HERPES IN THE FOLLOWING YEAR BY 41%STEROID USE IN A. DISCIFORM KERATITISB. OTHER STROMAL INFLAMATIONC. HERPETIC IRITISASSUME DENDRITIC LESIONS REASONABLY HEALEDDNA viruslatent in the sensory gaglia


Herpes Zoster Ophthalmics


Varicella Viris=Chicken Pox70% infected in the 1st division of the 5th cranial nerveTX DOSING ORALZovirax=Acyclovir 800mg 5x/day for 7-10daysValtrex=Valacylovir 1000mg TID for 7-10 daysFamvir=Famciclobir 500mg TID for 7-10 daysPesudodendrites, difusse stainingtends to follow a single nerve branchsee pts on alternate days untill inflamation subsidesstart tx within 48hrs


Most common in Utero Infections


TORCHToxoplasmosis (Cat)RubellaCytomegalovirus (herpies type)Herpes Virus


Increase Plasma Homocysteine


Common in Pseudoexfoliative glaucomaHigher risk of cardiovascular disease


DSAEK


Descemets' Stripping Automated Endothelial Keratoplasty


DMEK


Descemet membrane endothelial keratoplasty


DSEK


Descemet�s Stripping Endothelial Keratoplasty.


Histoplasmosis


Histoplasma Capsulatum Fungus (Birds, Bats)


Uvea


3 Vascularized layers1. Choroid a. Outer most large vessels (Haller's layer) b. Medial medium vessels (Sattler's layer) c. Inner - nourishes the RPE and outerRetinal layers


Bruch's Membrane


between the basement membrane of the choriocapillaris and basement membrane of the RPE


IRIS
Muscle


1. Sphincter-constriction-parasympathetic innervationm body at rest2. Dilator - sympathetic flight or fight


10 layers of Neurosensory Retina
list outside next to choroid to inner next to vitreous


1. Pigmented epithelium, 2. Photoreceptors; bacillary layer (outer and inner segments of cone and rod photoreceptors)3. External (outer) limiting membrane4. Outer nuclear (cell bodies of cones and rods)5. Outer plexiform (cone and rod axons, horizontal cell dendrites, bipolar dendrites)6. Inner nuclear (nuclei of horizontal cells, bipolar cells, amacrine cells, and M�ller cells)7. Inner plexiform (axons of bipolar cells and amacrine cells, dendrites of ganglion cells)8. Ganglion cells (nuclei of ganglion cells and displaced amacrine cells)9. Nerve fiber layer (axons from ganglion cells traversing the retina to leave the eye at the optic disc)10. Internal limiting membrane (separates the retina from the vitreous).


Anti-VEGF
2 types


Anti-Vascular endothelial growth factor (VEGF)1. Bevacizumab (Avastin)2. Ranibizumab (Lucentis)


Avastin


Generic name: BevacizumabNot approved for wet AMDlarger molecules


Lucentis


Generic name: Ranibizumabsmaller molecules


Best's Disease


Vitelliform Macular Dystrophyis an autosomal dominant disorder, which classically presents in childhood with the striking appearance of a yellow or orange yolk like lesion in the macula


IOP


highest pressure for all patients occured while they were sleepingLikely due to elevation of episcleral venious pressure which causes a backup of the aqueous drainage systemSupine iopduring office hours is about the same as peak nocturnal IOP in glaucoma patients


Herpes Zoster


Shingles


Horner's


Miosis of the affected pupilPtosis of upper lidupside down ptosis of the lower lidanhydrosis of the affected side-decrease sweatingheterochromia of the iris- Congenital -affected eyedecrease IOP affected sidea clinical syndrome caused by damage to the sympathetic nervous systemlack of sympathetic stimulation Paredrine Apraclondine 0.5% and Iopidine 1% can be used to stimulate the alpha 1 receptors which will cause the affected eye to dilate


AION


Anterior Ischemic Optic Neuropathy


A measurement


= eyesize, reference to frame size. is the longest horzonital measurement from one end of the rim to the other


Frame PD


A measure + the bridge measure


B measurement


vertical height of the frame


ED measure


Longest diagonal measure


Back Vertex Power

Fv= F2 + F1 / 1-thickness / n (F)

Fv =vertex powerF1 = front suface powerF2 = back surface power


Far Point


x = 1/F

x =distance from corneaF = power of correcting lens


Simple Astigmatism
Coumpound Astigmatism
MIxed Astigmatism


example: +2.00-2.00x135example: +4.00-2.00x135example: +3.00-4.00x135


With The Rule Astigmatism

Against The Rule Astigmatism


Axis of The Rx is 1800 + or - 300

Axis of The Rx is 0900 + or - 300


Prentice's Rule


Amount Prism = cm ( F)


Power in Oblique Meridian


F in power of meridian = Fs sphere power + Fc power of the cylinder (sin2 of the angle)


If you put Pantoscopic tilt on a Minus lenes with

axis 180


Get induced minus cylinder


Put Face Form on a Minus lens

axis 090


Get induced cylinder


If you put Pantoscopic tilt on a plus lenes with

axis 090


Get induced minus cylinder


Put Face Form on a Plus lens

axis 180


Get induced minus cylinder


Duochrome Test


RAM -GAP

VA 20/30 OR BETTER


Base cure of a Lens is where?


Sphere: is front of lensPlus Cylinder: is the flatter of the front (toric) surface curvesMinus cylinder: is the front sphere curve, the back flatter curve is called the toric base curve. The other back curve is called the cross curve.


The abberations of most concern in ophthalmic lenses


Oblique astigmatism


Curvature of fieldDistortion