250 terms

Questions

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What layer in the upper face sags with age and is tightened with face lift?
SMAS (superficial musculoaponeurotic system). In upper face, facial nerve is superficial to SMAS. In lower face, facial nerve is deep to SMAS. Do surgery accordingly (Stay deep to SMAS in upper face, and inverse in lower face).
What is the most common type of congenital cataract?
Lamellar (shell)
Avg endothelial cell count per mm2 in young adult?
3000
Avg endothelial cell count per mm2 in senior citizen?
2250
Name three things on differential for hemorrhages in multiple ocular layers
1. RAMA
2. Valsalva retinopathy
3. Terson syndrome
What areas are to be avoided in CPC and why?
3:00 and 9:00, location of ciliary nerves (painful to treat there)
Name the most common ocular side effects of these three TB drugs:
1. Rifampin
2. Ethambutol
3. INH
1. Pink tears and conjunctivitis
2. Toxic optic neuropathy
3. Toxic optic neuropathy
What enzyme is inhibited by corticosteroids in the production of prostaglandins? What about by NSAIDs?
Corticosteroids block phospholipase A2
NSAIDs block cyclooxygenase
What is the Goldman-Witmer coefficient?
Method used in Europe for diagnosis of ocular toxoplasmosis. Ratio of anti-toxo IgG in aqueous to anti-toxo IgG in serum.
Name three systemic disease associated with recurrent subconjunctival hemorrhage
1. Diabetes
2. Hypertension
3. Poor clotting
Anterior lenticonus is associated with what systemic abnormality?
Alport's syndrome (refer to nephrologist)
What is 1 year risk of severe (1 of 4:2:1) NPDR progressing to PDR? What about very severe NPDR (2 of 4:2:1)?
Severe: 15%
Very severe: 45%
Do upside-down single piece lenses affect the final refraction? What about 3-piece lenses?
Single piece lenses don't. Three-piece lenses do. The haptics are in front of the plane of the optic in a three-piece, to keep the optic away from the iris if it is placed in the sulcus. Thus, if placed upside down, optic will be in front of the desired plane, resulting in the need for an increased myopic correction.
Majority of aqueous is produced by what mechansism?
Active secretion
How is the foveola defined?
Where inner nuclear and ganglion cell layers are absent
How big is the FAZ?
250-600 microns (same as foveola)
What is the typical progenitor of Reiter's syndrome?
Dysentery (Shigella, Salmonella, Chlamydia, etc). >90% are HLA-B27 positive.
What finding should make you think skew deviation and not CN IV palsy?
Incyclotorsion of hypertropic eye (would be excyclotorsion in CN IV palsy, since SO is an intorter).
Nerves to EOMs insert how far from origin?
1/3 of way from origin to insertion
Cough, coryza, conjunctivitis -- think what?
Measles, which can cause retinopathy (heme, macular star, disc edema), and eventually look like RP after infection has waned.
Delayed onset nystagmus month-years after brainstem stroke -- think what?
Oculopalatal nystagmus
Name some features of oculopalatal nystagmus
Vertical, pendular, bilateral
Caused by stroke, usually delayed onset
Associated with rhythmic movements of face, tongue, pharynx, larynx, or extremities
Hypertrophy of inferior olivary nucleus on MRI is very specific
What three structure define Mollaret's triangle?
Cerebellar flocculus
Inferior olivary nucleus
Red nucleus
What is the name of the syndrome in which the peripheral cornea becomes progressively more edematous after cataract surgery, while the central cornea remains clear?
Brown-McLean syndrome
Most common benign orbital tumor in adults?
Cavernous hemangioma
Most common malignant orbital tumor in adults?
Lymphoma
Most common benign orbital tumor in children?
Dermoid
Most common malignant orbital tumor in children?
Rhabdomyosarcoma
Most common intraocular tumor in all comers?
Metastases
What was the first gene to be associated with congenital glaucoma?
CYP1B1
What is the minimum required endothelial cell count for donor corneas?
2000/mm2
Allergic conjunctivitis: what type of hypersensitivity?
Type 1 (preformed IgE antibodies)
Stevens-Johnson: what type of hypersensitivity?
Type 3 (immune complex)
OCP: what type of hypersensitivity?
Type 2 (cytotoxic)
Contact derm: what type of hypersensitivity?
Type 4 (delayed, T cell mediated)
What is the 5 year risk of contralateral involvement with acute NAION?
12-19%
What is the risk, within weeks, of untreated monocular AAION?
54-95%
What two associations are important to remember about morning glory disc?
1. Serous RD
2. Occult transsphenoidal basal encephalocele
Retinal AVM with ipsilateral AVMs of brain, orbit, or mandible?
Wyburn-Mason (sporadic)
What angle due to visual axes form in an adult?
68 degrees
How do you distinguish iris atrophy in HSV from VZV?
Patchy in HSV (like patch of vesicles)
Sectoral in VZV (like a dermatome)
What are the three branches of the ophthalmic division of CN V?
Lacrimal, frontal, nasociliary
Lacrimal doesn't branch
Frontal branches into supratrochlear, supraorbital
Nasociliary branches into short and long ciliary
What four muscles are innervated by the third nerve nucleus (include laterality)?
Ipsilateral MR, IR, IO
Contralateral SR
What is the function of the orbital portion of orbicularis?
Volitional eyelid closure
What is the function of the pretarsal/preseptal portions of the orbicularis?
Involuntary blinking
What is the clinical utility of the Watkze-Allen test?
Differentiate FTMH from pseudohole
CHED has two forms, AR and AD. Which is present at birth, has nystagmus, is not painful, and doesn't progress?
AR
What demographic is at highest risk for hypotony maculopathy after glaucoma surgery?
Young myope (think pigmentary)
What is the HLA association with VKH?
HLA-DR4
What is the HLA association with pars planitis?
HLA-DR2
When is the peak incidence of post-phaco CME?
6-10 weeks
Compact stroma but with epithelial edema in acute post-op period after phaco, think what?
High IOP from retained cohesive viscoelastic
What is the average age of diagnosis in RB for patients with A) known family hx? B) bilateral disease? C) unilateral disease?
Known family hx: 4 mths
Bilateral disease: 14 mths
Unilateral disease: 24 mths
What muscles are supplied by the inferior division of CN III?
Inferior oblique
Inferior rectus
AND medial rectus
What is the cycle time for periodic alternating nystagmus?
2-4 minutes (null, fast one side, fast other side, null)
Name the only two non-infectious entities that commonly present with hypopyon.
1) HLA-B27 related uveitis
2) Behcet
What is the relationship of the obliques to the vertical recti insertions?
Obliques are inferior
What is the isoform of VEGF thought to be involved in wet AMD?
VEGF 165
What are the three glaucomas that benefit most from laser trabeculoplasty?
1) Pigmentary
2) Pseudoexfoliation
3) POAG
Most common location for optic pit?
Inferotemporal
Whenever there is vitreous to the wound, what do you have to make sure of?
That there is no external vitreous. This could be a conduit for bacteria --> vitreous wick syndrome.
Common phaco complication in Fuchs heterochromic iridocyclitis and why?
Anterior chamber hemorrhages from nicking the long vessels across the angle during wound creation
Does sinusitis point more toward nec fasc or Mucor?
Mucor
Recurrent facial paralysis + perioral edema + lingua plicata = ?
Melkersson-Rosenthal syndrome
Lip biopsy will show granulomatous inflammation
Where is the most common location for an aneurysm causing a pupil-involving third?
Junction of PCOM and ICA
What is the corneal area flattened by a Goldmann tonometer?
3.06 mm2
How thick is Bowman's layer?
8-14 microns
What is Alexander's law?
Nystamus is always more pronounced on gaze toward the fast-beating component
What is the average tear volume in an adult?
7 microliters
What is the volume of one drop of medication from a standard bottle?
50 microliters (that's why you never need to write for more than 1 drop, since tear volume is only 7 microliters)
Where is the most common location for iris melanoma?
Inferotemporally
Name some clinical features suggestive of malignancy in an iris lesion.
Growth, increased vascularity, sectoral cataract, glaucoma
What percentage of eyes with demyelinating optic neuritis present with disc edema?
35%
How is risk difference defined?
Same as absolute risk reduction. Just subtract the treated risk from the untreated. E.g. 10% untreated, 5% if treated, risk difference is 5.
What does AAION show on FA?
Patchy choroidal perfusion due to vasculitis of SPCA supplying choroid and nerve head
Horizontal corneal diameter greater than X defines megalocornea.
>13 mm is megalocornea
Which more commonly leads to rupture of Bruch's and CNVM: small or large laser spot size?
Small (think of it as more concentrated)
Most common cause of downbeat nystagmus in a young person
Arnold-Chiari
What anatomic area should you think of with see-saw nystagmus?
Parasellar area, midbrain -- e.g. craniopharyngioma
What lesion should you think of with opsoclonus?
Neuroblastoma (usually from adrenals)
What anatomic area should you think of with periodic alternating nystagmus?
Cervicomedullary junction, cerebellar nodulus
What anatomic areas should you think of with upbeat nystagmus?
Cerebellum, midbrain, medulla
What is the recommended interval of "quietness" for uveitis prior to cataract surgery?
3 mths
True or false: LPI is indicated for topiramate-induced angle closure.
False (does not involve pupillary block. It's due to pseudo-plateau. Stop topiramate. Do aqueous suppressants. Do cycloplegics to deepen chamber.
What are some risk factors for suprachoroidal hemorrhage?
Old person, myope, glaucoma surgery, trauma, blood thinners
True or false: Viroptic, topical beta blockers, and topical NSAIDs are all associated with poor corneal epithelial wound healing.
True
What is the direction of ectopia lentis in Marfan's?
Superotemporal (Marfanoids are so tall they think they are superior). Homocysteinuria inferonasal.
What is the pathophysiology/embryology of Peter's anomaly?
Failure of lens vesicle to separate from surface ectoderm. Causes absence of corneal endothelium and Descemet's.
What is the most common FA pattern in CSCR?
Expansile dot
Equally prominent upper and lower medial eyelid skin fold
Epicanthus palpebralis (TPI from superior to inferior prominence)
Lower medial eyelid skin fold more prominent than upper
Epicanthus inversus (TPI from superior to inferior prominence)
Upper medial eyelid skin fold more prominent
Epicanthus tarsalis (TPI from superior to inferior prominence)
Mid peripheral DBH and light-induced amaurosis in old hypertensive diabetic. Think what?
Ocular ischemic syndrome
What is the treatment for river blindness (onchocerciasis)?
Ivermectin (annually for more than 10 years, since it doesn't kill the adult worms)
Where do the frontal, anterior and medial ethmoidal, and maxillary sinuses drain?
Middle meatus
What corneal layer does specular microscopy look at?
Endothelium
True or false: Adie's tonic pupil is associate with loss of accomodation
True. Parasympathetic postganglionic disruption of fibers leaving ciliary ganglion = mydriasis and loss of accomodation
Partial failure of eyelids to separate with residual strands connective upper/lower lid
Ankyloblepharon
Long horizontal palpebral fissure, short vertical fissure, associated with blepharophimos
Euryblepharon
What foods have a cross-reactivity with latex, making patients with allergy to these foods predisposed to latex allergy?
BACK-P
Banana
Avocado
Chestnuts
Kiwi
Passion fruit
How does the Crystalens work?
Changing position within capsular bag with ciliary muscle contraction
How long does a Retisert work?
30 months
What percent of phakic patients with Retisert will get a cataract by 2 years? What percent will need a glaucoma filter?
100% will get cataract by 2 years
30% will get glaucoma tube
What are the three most common causes of spontaneous vitreous hemorrhage?
1. Diabetes
2. Retinal break without detachment
3. PVD

(4. RRD, 5. Neo after CRVO/BRVO)
Where does Muller's muscle attach?
Superior border of tarsal plate
Where does the levator attach?
Lower half of anterior tarsal plate
What are the two epithelial layers of the ciliary body?
Inner nonpigmented
Outer pigmented
Think of pigment as something you can see, on the outside
Name three causes of light-near dissociation
1. Neurosyphilis
2. Adie's
3. Parinaud's
What percent of patients with PCN allergy will be allergic to cephalosporins?
3-5%
What topical beta blocker is best to use in asthmatics?
Betaxolol
Where are Dalen-Fuchs nodules, histologically?
Between RPE and Bruch's
What histologic layer of the posterior pole is classically spared in sympathetic?
Choriocapillaris
In the orbit, where is the ophthalmic artery in relation to the optic nerve?
Inferior
Where do you apply laser in sickle cell retinopathy with NV?
Peripheral to the NV -- kill the retina it's feeding, kill the NV.

DON'T laser proximal to the NV -- you can cause breaks and CNVM
What two systemic diseases are associated with Christmas tree cataracts?
1. Myotonic dystrophy
2. Hypoparathyroidism
How much more common is thyroid ophthalmopathy in women than men?
6x
Initial medical vs. surgical treatment of glaucoma is equal. What trial?
CIGTS
Treating ocular hypertension cuts risk of glaucoma in half. What trial?
OHTS
Caucasians with bad glaucoma do better with trab than with SLT. What trial?
AGIS
Untreated patients are more likely to have worsening visual fields than treated patients. What trial?
EMGT
True or false: aqueous suppressants and topical carbonic anhydrase inhibitors are a good idea in leaky cataract wound and hypotonous eye.
True -- decrease aqueous flow, allowing wound to seal
What is the two year risk of cataract after vitrectomy?
90%
How do you give steroids around surgery time for a patient chronically on steroids?
100 mg hydrocortisone IV before, during, and after surgery
Slit like iris displaced one way, lens dislocated in opposite direction. Diagnosis? Inheritance?
Ectopia lentis et pupillae
Autosomal recessive
How is peripheral ulcerative keratitis distinguished from Moorens'?
Moorens' ulcer only involves the cornea
PUK involves cornea and sclera
What systemic disease is usually associated with PUK?
Rheumatoid arthritis
What is the most appropriate initial treatment for choroidal rupture?
Observation
May eventually get CNVM and need Avastin
How is LHON inherited?
Mitochondrial
How is LCA inherited?
Autosomal recessive
What is the average volume of the posterior chamber?
60 microliters
What is another name for "direct fracture?"
NOE fracture
What protein is disrupted in Reis-Bucklers corneal dystrophy?
Keratoepithelin
What is the inheritance of Reis-Bucklers?
AD
What is the typical history and exam in RBCD?
age 10-20, positive family history, confluent and coarse opacities in central cornea, recurrent erosions
Bilateral oscillations with jaw movements in a patient with diarrhea. Think what? Do what?
Oculomasticatory myorhythmia. Associated with Whipple disease. Treat with antibiotics.
Where is the common canaliculus in relation to the medial canthal tendon?
The common canaliculus lies in between the anterior and posterior portions of the medial canthal tendon, which attaches to the anterior and posterior lacrimal crests
What patient with JIA is most likely to have chronic smoldering uveitis?
Female, pauciarticular (<5 joints)
What happens to the slow phase velocity of congenital nystagmus over time?
It accelerates
What happens when the angle of incidence is greater than the critical angle?
Total internal reflection -- light reflects instead of refracting
In calculating IOL power with silicon oil, how must your calculation be adjusted?
Silicon causes a hyperopic shift, so add 3.00 D to the power of the lens you would normally choose
Asymptomatic bruit: most likely cause of death in next 5 years?
MI
Slippage of which muscle is the worst (because it is hardest to recover)?
Medial
What is the diameter of the fovea?
1500 microns (1 optic disc)
Where is the superior orbital fissure (bone-wise)?
Between the greater and lesser wings of the sphenoid
Where is the optic canal (bone-wise)?
Within the lesser wing of the sphenoid
Where does the frontal sinus drain?
Middle meatus
What is the first sinus to aerate?
Ethmoid
Where do the ethmoid sinuses drain?
Superior and middle meatus
Where does the maxillary sinus drain?
Middle meatus
What glabellar muscle creates horizontal wrinkles?
Procerus
What glabellar muscle creates vertical wrinkles?
Corrugator (like corrugated iron roof)
Which limb of the medial canthal tendon is more important: anterior or posterior?
Posterior
What is the only periorbital gland that functions by apocrine secretion?
Glands of Moll (sweat) -- Molly is a sweaty ape
What is the normal length of the lacrimal sac?
10 mm
What is the normal length of the nasolacrimal duct?
15 mm
What is the mechanism behind SLT?
Nobody knows
What cranial nerve is most frequently affected in neurosarcoidosis?
CN VII
Does corneal transplant help in opacification associated with aniridia?
NO. The opacification is due to limbal stem cell deficiency. Transplant those stem cells instead.
Inferior corneal thinning with protrusion of cornea above the thinning
Pellucid marginal degeneration
How long can you leave nuclear fragments in eye without increasing risk of CME?
3 weeks
BRAO, bilateral sensorineural hearing loss, and encephalopathy: diagnosis?
Susac syndrome. Women age 20-40. Unknown cause. Treat with IV steroids.
True or false: myelinated nerve fiber layer may cause amblyopia
True, apparently
RD, hyperextensible joints, micrognathia, hearing loss: diagnosis?
Stickler syndrome
Hyperopia typically increased until what age?
5-7
What is the most common hereditary optic atrophy?
Dominant optic atrophy, OPA-1 gene on chromosome 3 involved in 50-75%
What is the average refractive power of the central cornea?
43 diopters
What interface provides the greatest refractive power?
Air-tear interface
What sinus is just medial to the optic canal?
Sphenoid -- be careful of optic nerve damage during transsphenoidal surgery
True or false: a corneal keloid and a corneal dermoid are similar in appearance
True
What is the pathology of Salzmann's nodular degeneration?
Hyaline in Bowman's from chronic irritation
What is first line therapy for dacryocystocele?
Massage (if not infected)
Monocular nystagmus in a child -- rule out what?
Optic nerve glioma
What is a good mnemonic for Hermansky-Pudlak?
The four P's:
Platelets (low)
Pulmonary fibrosis (cause of death)
Pigment less
Puerto Ricans
Retinoblastoma in one eye, retinocytoma in the other eye. Chance of offspring having it?
45%
Retinocytoma = retinoblastoma for genetic purposes
Where is the capsule thinnest?
Posteriorly
What is the only class B glaucoma drug?
Brimonidine, interestingly enough
But don't give to nursing mothers -- gets in breast milk
How much residual stromal bed should always be left in refractive surgery?
300 microns
For each 14 microns of cornea removed, how much diopteric correction do you get?
1 D of myopia
Denial of complete cortical blindness is also known as what?
Anton syndrome
Perception that an object moving perpendicular is actually moving toward or away from you is known as what? What does it usually signify?
Pulfrich effect. Recovery from optic neuritis.
Where are the glands of Wolfring found?
Non-marginal tarsal borders
Place fluorescein in eye. Put swab in nose a few minute later. Name of test?
Jones I
Global corneal thinning present at birth
Keratoglobus
How much radiation, in gray, does ti take to get radiation retinopathy?
30-35 Gy
Where is the germinitive zone of the lens?
Pre-equatorial
M cells are bigger, less common, good in dim light, and good for seeing Motion
Okay
P cells ar smaller, more common (80%), good in bright light for color, fine detail
Good to know
Weed, alcohol, and heroin have what effect on IOP?
Lower
True or flase: loose zonules (eg Marfan's, PXE) are associate with anterior capsular phimosis.
True. The loose zonules don't hold things put.
What do you do during phaco if you suspect suprachoroidal hemorrhage?
1. Close wound
2. Inject cohesive
3. Consider posterior sclerotomies, starting in IT quadrant
Who meets AREDS criteria? (list four)
1. 1 large druse (>125 microns, size of large vessel at disc)
2. Multiple intermediate drusen
3. Severe unilateral AMD
4. Non-subfoveal GA
Total paralysis of CN VI. You've waited 6 months. What is the preferred management?
Muscle transposition surgery
Would do R-R if some function had been regained, but for total paralysis, muscle transposition is indicated
Into what vein do the vortex veins drain?
The vortex veins drain into the superior ophthalmic vein
Central areolar choroidal dystrophy is autosomal dominant and looks like very early GA. What gene causes it?
Peripherin
What prevents tear reflux?
Valve of Rosenmuller
Does atrophia and phthisis put you at increased risk of intraocular malignancy?
Yes, atrophia and phthisis put you at increased risk of intraocular malignancy, so you should get annual B-scan.
Aspergillus vs. Mucor
Aspergillus: septated
Mucor: non-septated
What is the most common cause of acquired diplopia in adults?
TED
What is the mnemonic to remember frequency of EOM involvement in TED?
I'M SLO
Middle-aged female with enophthalmos and unilateral limited motility
Breast cancer metastatic to orbit
Name three corneal measurements that are cutoffs for increased risk of pseudophakic bullous keratopathy after cataract surgery.
1. Endothelial cell count <1000
2. Coefficient of variation >0.3 (polymegathism, different cell sizes)
3. Pachymetry >650
Most common cause of dorsal midbrain syndrome in a) children, b) young women, c) adults?
Dorsal midbrain syndrome:
kids: pinealoma, congenital aqueductal stenosis
young women: MS
adults: midbrain stroke
What are some signs of dorsal midbrain syndrome?
Paralysis of upgaze
LND
Poor convergence
For a very dense cataract, you might want more suction force on your phaco tip. Do you choose a bigger angle tip or smaller angle for that?
Bigger angle
More oval, less circular --> more force
What artery is to be avoided on the first incision in DCR?
Angular artery
How can occlusion of the ophthalmic artery and the central retinal artery be distinguished?
By FA
Ophthalmic artery also supplies choroid, so if it's occluded, will have silent choroid
What are the only two proven treatments for ocular-involving SJS?
Amniotic membrane transplant
Pulse steroids IV
What bones make up the orbital roof?
Frontal
Lesser wing of sphenoid
What bones make up the medial orbital wall?
Maxillary
Lacrimal
Ethmoid
Lesser wing of sphenoid
What bones make up the orbital floor?
Maxillary
Zygomatic
Palatine
What bones make up the lateral orbital wall?
Zygomatic
Greater wing of sphenoid
Name five things can cause retinochoroidal collaterals (optociliary shunts)
1. Chronic papilledema
2. Old CRVO
3. Chronic glaucoma
4. Optic nerve sheath meningioma
5. Optic nerve glioma
ELISA against what for macular dystrophy?
Sulfated keratan sulfate
What procedure is done for significant torsional deviation (e.g. bilateral CN IV palsy)?
Harada-Ito
Split SO fibers
What is the direction of the NLD as it moves inferiorly?
All the bad connotation directions: down, back, and out
When should ROP screening be done?
4-6 weeks after birth, or
31-33 wga, whichever is later
What glaucoma drop should be avoided if the patient has a history of herpetic keratitis?
Prostaglandins
Can cause reactivation
Multiple tricholemmomas -- small crust lesion on face -- marker for breast/thyroid cancer. Eponym?
Cowden's disease
Where is the most common site for eyelid BCC?
Lower lid
What site heralds the poorest prognosis for eyelid BCC?
Medial canthus
May have deeper invasion
Name two diseases on the differential for acute idiopathic enlarged blind spot. What diagnostic test is indicated (besides fields)?
MEWDS
AZOOR
Get a mERG
Name three weaker steroids that are good to use to avoid steroid response
FML
rimexolone (Vexol)
medrysone
What is a good rule of thumb for how much skin to leave behind in chalasis surgery?
10 mm from incision to brow
10 mm from incision to margin
20 mm total
What is the most common type of rhabdomyosarcoma?
Embryonal
What is the most lethal type of rhabdomyosarcoma?
Alveolar -- 10 year survival 10%
Wave au revoir
What type of rhabdomyosarcoma has the best prognosis?
Pleomorphic
True or false: surgery is the treatment of choice for rhabdomyosarcoma
FALSE
Chemo and radiation
What anti-emetic is contraindicated in infants? Why?
promethazine (Phenergan)
severe respiratory depression, death
Do kids with nystagmus prefer to gaze in the direction of the fast phase or slow phase?
Slow phase. Left-beating nystagmus kids will want to look to the right, so they'll have a left head turn.
Alexander's law: nystagmus is worse looking toward fast phase. Basically, they will point their head toward the fast phase.
Name another inherited disease besides Axenfeld-Rieger with posterior embyrotoxon
Alagille syndrome
Also presents with jaundice, cardiac defects
Autosomal dominant
JAG1 on chromosome 20
What is the best color laser to use to get through vit heme?
Red
If you have to use a CAI in a patient with history of kidney stones, which do you pick?
Methazolamide
What is the most common cause of viral dacryoadenitis?
EBV
What causes Bitot spots? foamy deposits at limbus
Vitamin A deficiency
related to Corynebacterium, which forms gas that makes lesion foamy
Why does the IOP go up in HSV uveitis?
Trabeculitis
How can orbital apex syndrome be distinguished from cavernous sinus pathology?
By optic nerve involvement -- if vision is fine, it isn't orbital apex
How long do TVOs last?
1-30 seconds
What strabismus surgery puts acuity at greatest risk if there is a complication?
Inferior oblique advancement
It involves reattachment more posteriorly, and if you perf the eye that's where the macula is.
Treatment of nystagmus:
Prisms with apices away from head turn
Surgery with rotation of eyes toward head turn
OK
What effect does oral prednisone alone (no IV) have in initial optic neuritis on recurrence?
Oral prednisone as monotherapy DOUBLES the risk of recurrence. So it is never used as monotherapy.
What effect does convergence have on congenital nystagmus?
Convergence dampens congenital nystagmus
Is congenital nystagmus present during sleep
No
True or false: PRP in areas of traction is a good idea.
FALSE
PRP can cause further contraction -- worsening the traction, causing vit heme or RD.
Flat, thin cornea, hyperopia, sheet-like posterior corneal opacity in first decade of life, AD inheritance. Diagnosis?
Posterior amorphous corneal dystrophy
Unilateral arcus senilis should make you do what?
Get a carotid Doppler to look for CONTRALATERAL carotid disease. -- the clear eye might have the pathologic blood supply.
What are the three causes of involutional entropion?
1. Horizontal lid laxity
2. Disinsertion of the lower lid retractors
3. Overriding preseptal orbicularis

Do reinsertion of retractors and lateral tarsal strip to address all of them.
What clinical feature best distinguishes atopic from vernal keratoconjunctivitis?
VKC typically involves only the superior conj
AKC affects superior and inferior

Also VKC is seasonal
Third nerve fascicular lesion and contralateral weakness
Weber syndrome
W for weakness, W for Weber
Third nerve fascicular lesion and contralateral ataxia/coordination problems
Claude syndrome
C for coordination, C for Claude
Third nerve fascicular lesion and contralateral tremor
Benedikt's sysndrome
Benedict Arnold trembled before he committed treason