Post-it notes (NEBO)

len zonules are made of...
not...

Fibrillin, elastin, glycoprotein
NOT Collagen

What type of hypersensitivity is a corneal graft rejection?

Type 4

What are Krachmer spots? and where are they located?

subepithelial infiltrates (SEIs) seen in corneal graft rejection
Stroma

What is a Khodadhoust line?
Where is it located?

seen in corneal graft rejection
Endothelium

What is the most common cause of bacterial conjunctivitis in kids? adults?

Kids --> H. influenzae
Adults --> Staph aureus or epidermis

If NRA tested at 40cm, what is the max plus expected?
What does it mean if it is higher(more plus)?

+2.50
overminused or uncorrected hyperopia

What is the formula for Residual astigmatism ?

RA= ref cyl - corneal cyl

What is diapedesis?

leukocyte extravasation
-passage of blood cells through intact walls of capillaries
- typically accompanying inflammation

What 4 things cause bulls eye maculopathy

1. Chloroquine/hydroxychloroquine toxicity
2. Thioridazine toxicity (antipyschotic)
3. progressive cone dystrophy
4. stargardts

What 3 drugs cause oculogyric crisis?

1. zyrtec/cetrizine
2. chlorpromazine
3. thioridazine
(2&3 are antipsychotics)

What 7 conditions may present with periaricular lymphadenopathy?

1. VKC/EKC
2. POS
3. PCF
4. viral conjunctivitis
5. gonorrhea
6. chylamydia
7. dacryoadenitis

What anatomy explains an altitudinal VF defect seen in NAION?
Is superior or inferior VF defect more common?

the circle of Zinn (SPCAs) can be divided into superior/inferior by entry points of medial and lateral SPCAs
Inferior

For every 1mm of axial length pre-operatively is how many diopters of refractive error?

3D

Name 4 antigen presenting cells (APCs)

1. Dendritic cells
2. Langerhan cells
3. Macrophages
4. Neutrophils

sensory homunculus

FUTLFoot (medial)

Choosing the correct base curve with the Tscherning ellipse eliminates __ and __.

oblique astigmatism
and
curvature of field

4 conditions that cause night-blindness

1. Retintis Pigmentosa
2. Choroideremia
3. Gyrate Atrophy
4. Vit A deficiency
also acutane

What is the triad for RP

bone spicules
attenuation
waxy pallor ON

What is the inheritance pattern for choroidermia? and what part of the retina is affected?

x-linked recessive
peripheral VF loss - macula is spared until late stages of the disease

What is the inheritance pattern for gyrate atrophy and describe the retinal appearance

AR - autosomal recessive
excessive torinithine in blood
scalloped areas in the peripheral choroid atrophy

How many muller cells are present in the retina?

about 10 million

What are the 4 roles of Muller cells?

1. structural support
2. regulation of pH (removal of K+/absorb metabolic waste)
3. Glycogen metabolism/storage/synthesis
4. recycle GABA/glycine

Describe the strongest to weakest vitreous attachment

1.vitreous base
2. posterior lens
3. ON head
4. macula

If at 5 years old your refractive error is between __ and __ then you will be an emmetrope. If below that, they will be a myope at age 14 and if above that, they will be a hyperope at age 14

+0.50 to +1.25

what 3 findings can be found from amiodarone toxicity?

whorl keratopathy
ASC cataracts
NAION
(tx for heart arrhythmia)

What are 4 systemic causes of lens subluxation

1. Marfans
2. Ehler's Danlos Syndrome
3. Weill-Marchesani syndrome
4. Homocystinuria

What 5 drugs are associated with Aplastic Anemia

CC TMP
CAIs - acetazolamide
Chloramphenicol
Trimethoprim
Methotrexate
Pyrimethamine

What does an aspheric lens correct for?

Spherical aberration

What does an orthoscopic lens correct for?

Chromatic aberration and distortion
CA are the colored fringes

What does a percival lens correct for?

curvature of field

What does a point focal lens correct for?

radial astigmatism

What is the PEDAL criteria for infiltrate vs ulcer?

P=pain level
E=epithelial defect
D=discharge
A=AC rxn
L=located centrally

The sclera is the weakest...

at the lamina cribosa

The sclera is the thinnest...

under the recti muscle insertions (0.3mm)

The sclera is the thickest...

at the posterior pole (1mm)

what layer of the cornea stains after a hyphema? (corneal blood staining)

stroma

when is the patient at risk for a rebleed after a hyphema?

3-5days
it takes 24-48hrs for a clot to form and then the patient is at risk for a rebleed

what are the main differentials for unilateral open angle glaucoma?

traumatic (angle recession glaucoma)
pseudoexfoliative glaucoma

Uhtoff's phenomenon

worsening in neurological symptoms with heat or increases in body temperature

Schwalbe's is a landmark of the...

Termination of Descemet's membrane

Which artery supplies both the ciliary body and bulbar conjunctiva?

anterior ciliary artery - explains circumlimbal injection and decreased aqueous production in uveitis

what is the spiral of tillaux?

recti muscle insertions on the globe
MR inserts closest to the limbus, then IR, then LR, then SO which inserts furthest from limbus

Where do the recti muscles insert>

common tendinous ring

Where does the superior oblique insert?

lesser wing of the sphenoid bone and the CTR

Where does the inferior oblique insert?

ANTERIORLY at the maxillary bone

What is the orbital portion of the ethmoid bone?

lamina papyracea
very thin bone - how orbital cellulitis gets into orbit from sinus cavity

What are 3 corneal dystrophies that affect Bowmans membrane?

1. Thiel-Behnke - honeycomb
2. Reis-Buckler - honeycomb
3. Grayson-Wilbrandt - no pattern - does not affect VA

Name 6 conditions that affect Bowman's membrane

1. Band Keratopathy (Ca2+ deposits)
2. Pterygium
3. crocidile shagreen
4. Reis-buckler
5. keratoconus
6. refractive surgery

What is the likely etiology if papillae are on the inferior palpebral conj? (1) superior? (3)

inferior > atopic keratoconjunctivitis
superior > allergic conj / Vernal / GPC

An error of 1 mm in axial length measurement will lead to how much of a error in refractive power?

3 D

What is the clinical triad of Histoplasmosis?

-Punch out lesions
-Peripapillary atrophy
-Maculopathy
(its a fungal choroiditis)

What disease is characterized by telangitatic, light bulb appearance of retinal vessels?

Coats disease
also characterized by:

Hard Exudates
�Hemes
�RD (tractional)
�Neovasc glau

What percent of people over 75 yo have signs of ARMD?

20%

What percent of patients with dry ARMD will have severe vision loss?

12%

Branch retinal artery occlusion is most commonly caused by a ________ emboli.

cholesterol emboli

what is Aminocaproic acid used for?

anti-fibrolytic agent to reduce the risk of rebleed after a traumatic hyphema

What is the most common cause of acute unilateral non granulatomatous anterior uveitis?

Ankylosing spondylitis

T/F topical NSAIDs and steroids are used to treat scleritis

No, they do not work so use a oral NSAID or steroid

Name 3 side effects of amiodarone

1. Whorl Keratopathy
2. Anterior subcapsular cataracts (chloropromazine too)
3. NAION

What is caused by hyperventilation?
a. metabolic acidosis
b. metabolic alkalosis
c. respiratory acidosis
d. respiratory alkalosis

respiratory alkalosis
~think hyperventilation is trying to fix metabolic acidosis, so it makes sense that it would cause alkalosis

What type of aberrations affect low powered lenses the most?

radial astigmatism
and curvature of field (eliminated by choosing correct base curve from tschernig ellipse)
coma and sph abberations are not considered bc small pupil sizes only allow paraxial light rays into the eye
distortion is from high powered lense

Which law governs the concept of temporal summation? spatial?
a. DeVries-Rose law
b. Ricco's law
c. Bloch's law
d. weber's law

Bloch's = temporal
Ricco's = spatial
DeVries and Webers play a role in light adaptation

What does the dorsonasal artery supply? ethmodial?

dorsonasal > lacrimal sac
(terminal branch of the ophthalmic artery)
ethmoidal > sinuses (sphenoid/ethmoidal/frontal)

Which of the following HA are associated with RED EYES, NASAL congestion, and transient ipsilateral HORNERs SYNDROME?
a. migrane
b. tension
c. cluster
d. temporal arteritis

CLUSTER HAs
affect men 30-50yo

What are contraindications for oral carbonic anhydrase inhibitors?

pregnancy
liver disease
kidney disease
severe COPD
~sulfa allergies are a soft contraindication

Describe the difference in spectacle mag vs relative spectacle mag in terms of the retinal images they compare.

spec mag = sc retinal image to cc retinal image
RSM = cc retinal image to emmetrope retinal image

For every 0.1 mm change in BC you need to change the power by...

0.50 D (SAM FAP)

Name 3 layers of the sclera that contain elastin.

1. lamina cribosia
2. lamina fusca
3. SCLERAL SPUR

What is the difference between Epi and Norepi?

Epi works on all adrenergic receptors ( Alpha 1/2, Beta 1/2) ~think of epipen - it opens up the lungs/everything)
Norepi works on all EXCEPT BETA-2

Drugs that need to be taken on an EMPTY stomach (3)

Penicillin
Azithromycin
Tetracyclines
(PAT)

Drugs that cause NAION (3)

VIAgra
Viagra
Imetrex
Amiodarone
(BONUS- sleep apnea too)

What is Javals rule? What is Javals rule used for?
What is the average internal astigmatism ?

Javals Rule = (1.25xcorneal cyl) + (-0.50x090)
To determine refractive cyl from K readings
avg astig = -0.50 x 090

What are 4 ways to decrease magnification in PLUS lenses?

DECREASE: vertex dist / thickness / BC(flatten)
INCREASE: index of refraction
(duhh think of hi index lenses for high Rx)

What are 4 ways to decrease minification in MINUS lenses?

DECREASE: index of refraction / vertex distance
INCREASE: thickness / BC (steepen)

Drugs that cause PTC (pseudotumor cerebri) (5)

N CATS
Nalidixic acid
Contraception
Acutane/Isotretinoin
Tetracyclines
Synthroid

What is Clarks rule for peds dosage

0

What is UGH syndrome?

Uveitis / Glaucoma / Hyphema
due to an ill fitting AC IOL - it rubs on the iris and causes the hyphema/uveitis
RBCs/WBCs accumulate on the TM > decrease outflow > increase IOP > Glaucoma

Name the 5 vesicle brain
At how many weeks?

@ 5 weeks
Telencephalon > cerebral hemispheres
DIENCEPHALON > retina/eye & thalamus
Mesencephalon > midbrain
Metencephalon > pons/cerebellum
Myelencephalon > medulla

What are 4 things that can cause a (+) forced duction

(+) is the eye cannot move
1. orbital floor fracture
2. Brown syndrome
3. Duane retraction
4. Graves

7 ocular characteristics of Sarcoidosis

DD U 7 VV O
Dacroadenitis
Dry eye
Uveitis
- anterior granulotomous
7 CN VII palsy
Vasculitis
- sheathing of retinal veins (leak yellow/white exudates caused by periphlebitis CANDLE WAX DROPPINGS)
Vitritis
(cotton ball opacities)
ONH edema

What does the blur point represent while preforming smooth vergences?

Limit of Fusional vergence
- accom vergence is trying to keep image together but fusion is broken so the image is blurry

What two drugs have neuroprotective properties?

BB
Betaxolol
Brimonidine

Oral prednisone may cause Hyper or Hypo; thyroid, BP, BS, potassium levels?

HYPER-thyroid
HYPER-tension
HYPER-glycemia
HYPO-kalemia (low potassium)
also peptic ulcers and osteoporosis

What are the side effects of acetozolamide?

MMM
Metallic taste
Metabolic acidosis
Myopia - transient
also depression, numbness of extremities, weight loss, hypokalemia, kidney stones, and dermatitis

A lensometer determines...
a. front surface power
b. back surface power
c. equivalent power
d. neutralizing power
e. prism power and base
f. base curve
g. cylinder axis

d. neutralizing power
e. prism power and base
g. cylinder axis

What are 3 causes of intersitial keratitis?

1. SYPHILIS - most common
2. Tuberculosis
3. herpes simplex

What is the classic triad of Reinitis Pigmentosia? What are other signs?

1. bone spiculues in periphery
2. waxy pallor of ON
3. attenuation
also CME, PSC, & ONH drusen

What are the fat soluble vitamins? which is LEAST toxic? Which may cause lung cancer?

DAEK
vit E is LEAST toxic - it is an antioxidant and found in green leafy veggies - protects RBCs from hemolysis (but may increase bleeding)
Vit A may lead to lung cancer in smokers - why it was removed from AREDs

What causes folds in descemets membrane? give some examples

STROMAL EDEMA
- intersitial keratitis
-early post-op for cataract removal
-epithelial edema

A telescope is marked 5X20. What is the magnification and the diameter of the exit pupil(mm)?

Mag=5x
exit pupil is 20/5=4mm

Excess production of parathyroid hormone causes which two clinical findings?
a. fleischer ring
b. increased IOP
c. band keratopathy
d. corneal edema
e. cataracts

Cataracts - parathyroid hormone stimulates osteoclasts to degrade the bone matrix - releases Ca2+ which forms a cataract
Band Keratopathy - Ca2+ deposits on the cornea

What happens to the wavelength and frequency as light travels into a new medium?

wavelength decreases and frequency stays the SAME

What is a lambert surface?

A surface that scatters light equally in all directions; has same luminance from every viewing angle
Ex - a matte paper
L=RE where r is the reflectivity and e is the illuminance falling on a surface

Why can't we see the retinal blood vessels? think VSP

low temporal frequency - basically zero bc the blood vessels move with the eye and do not cause a change in luminance under normal viewing conditions
during BIO/90 examination you can see the shadows casted by the moving light and a change in luminance

What type of astigmatism does pantoscopic tilt induce? faceform?

pantoscopic tilt is around the horz axis- induces +cyl at 180 or
-cyl at 090
faceform tilt is around the vert axis - induces +cyl at 090 or
minus cyl at 180

Is a higher or lower therapeutic index safer?

higher

What is the most likely compensatory head movement for a patient with BROWNs syndrome?

aka - superior oblique tendon sheath syndrome
patient will have limited elevation with adduction - eye will have hypotropia in primary gaze
ex- left eye affected will cause a left head tilt

Which diuretic is best for hypokalemia?

spironolactone

What are two ocular symptoms of Marfan's syndrome?

lens subluxation
retinal detachments

What is the mechanism of action of topical antivirals like trifluridine?

inhibiting viral DNA replication by inhibiting thymidine synthetase OR more simply DNA polymerase

What wavelength of light is most likely to damage the retina of an eye with cataract?

UV-A, probably 370 nm
UV-C and UV-B are absorbed by the cornea and the thickened lens so only UV-A will reach the retina

What is the key characteristic differentiating basal cell carcinoma from squamous cell carcinoma

basal cell carcinoma has a surface telangiectasia

Which of these may lead to permanent vision loss?
a. perenial keratoconjunctivitis
b. seasonal keratoconjunctivitis
c. atopic keratoconjunctivitis
d. vernal keratoconjunctivitis

C. Atopic keratoconjunctivitis = may cause epith erosins, neovasc, opacification , conjunctival scarring and symblepharon formation