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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?


Avg endothelial cell count per mm2 in senior citizen?


Name three things on differential for hemorrhages in multiple ocular layers

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?


Most common benign orbital tumor in children?


Most common malignant orbital tumor in children?


Most common intraocular tumor in all comers?


What was the first gene to be associated with congenital glaucoma?


What is the minimum required endothelial cell count for donor corneas?


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?


What is the risk, within weeks, of untreated monocular AAION?


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?


What demographic is at highest risk for hypotony maculopathy after glaucoma surgery?

Young myope (think pigmentary)

What is the HLA association with VKH?


What is the HLA association with pars planitis?


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

Most common location for optic pit?


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?


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?


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?


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


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.


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?


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


Long horizontal palpebral fissure, short vertical fissure, associated with blepharophimos


What foods have a cross-reactivity with latex, making patients with allergy to these foods predisposed to latex allergy?

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?


What topical beta blocker is best to use in asthmatics?


Where are Dalen-Fuchs nodules, histologically?

Between RPE and Bruch's

What histologic layer of the posterior pole is classically spared in sympathetic?


In the orbit, where is the ophthalmic artery in relation to the optic nerve?


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?


Initial medical vs. surgical treatment of glaucoma is equal. What trial?


Treating ocular hypertension cuts risk of glaucoma in half. What trial?


Caucasians with bad glaucoma do better with trab than with SLT. What trial?


Untreated patients are more likely to have worsening visual fields than treated patients. What trial?


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?


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?

May eventually get CNVM and need Avastin

How is LHON inherited?


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?


What is the inheritance of Reis-Bucklers?


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?


Slippage of which muscle is the worst (because it is hardest to recover)?


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?


Where do the ethmoid sinuses drain?

Superior and middle meatus

Where does the maxillary sinus drain?

Middle meatus

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