Primary 1
What is the difference of "appositional" and "synechial", and how can you distinguish this on exam?
Appositional: transient or intermittent
Synechial: permanent
Indentation gonio
Name at least 4 symptoms and 4 ocular findings in acute angle closure.
Symptoms: eye pain, headache, blurred vision, rainbow colored lights, n/v.
Eye findings: high IOP, mid dilated sluggish or irregular shaped pupil, k edema, congested episcleral vessels, mild AC flare/cell, shallow peripheral AC
What is the most common cause of acquired zonular insufficiency?
Pseudoexfoliation syndrome
Describe the pathophysiology of NVG.
Secretion of angiogenic factors (VEGF) from ischemic retinal tissue, diffusing into AC leading to NVI/NVA
What is the arterial supply of the lateral rectus muscle?
Lateral muscular branch of the ophthalmic artery, and lacrimal artery
Distinguish Primary Angle Closure Suspect, Primary Angle Closure, and Primary Angle Closure Glaucoma.
PACS: iridoTM contact >180 deg, but no evidence of TM abnormalities, elevated IOP, or optic nerve damage
PAC: iridoTM contact >180 deg, but with elevated IOP or PAS
PACG: PAC + glaucomatous optic neuraopathy
What causes the rainbow colored halos in acute angle closure?
Corneal epithelial edema
How many LPIs do you place in an eye with lens subluxation causing angle closure? And why?
2 LPIs 180 deg apart, that way at least one LPI will remain open when the lens moves around.
At what anatomical line does PAS generally do not cross, and why?
Bonus 100: And what condition has PAS passing this line?
Schwalbe's line, PAS does not row over healthy corneal endothelium.
Bonus: iridocorneal endothelial syndrome / ICE
What are the guidelines for who gets screened for ROP?
Born at 30 wks or earlier
Birth wt of 1500 grams
Complicated clinical course
Name at least 3 classes of systemic medications that may cause angle closure.
Allergy / cold medicine (ephedrine, diphenhydramine), bronchodilators (ipra/tiotropium), SSRIs, TCAs, antispasmodics for bladder stuff (oxybutynin), muscle relaxants, anti nausea (promethazine)
Drugs with adrenergic or anticholinergic activity.
How does an LPI work in treating PAC? What is an alternative surgical procedure?
Relieves pupillary block and reduce further potential for PAS formation.
Lens extraction.
How do miotics make angle closure worse in patients with microspherophakia?
Miotics rotate the ciliary body forward, loosening the zonules, allowing the lens to become more globular and increase iris contact/pupillary block.
Where should one place an LPI after SiO, and why?
Inferiorly to prevent obstruction as SiO floats
What acronym is used to describe the etiologies of infant corneal opacities, and go through each letter.
Sclerocornea
Tears in DM
Ulcers
Metabolic disorders
Peters anomaly
Edema (CHED, PPCD, CHSD)
Dermoid
Name at least 3 anatomic findings associated with increased risk of angle closure. Bonus 100 points for each additional finding.
Shallow AC, thick lens, increased anterior curvature of lens, short AL, small corneal diameter, small radius of corneal curvature, increased iris thickness
How does plateau iris configuration lead to angle closure?
Anteriorly positioned ciliary processes narrowing the AC recess by pushing the peripheral iris forward.
How can angle closure occur in aphakic or pseudophakic patients?
Vitreous can block pupil
Describe how a scleral buckle can lead to angle closure.
Shallows the angle, accompanied by choroidal effusion and anterior rotation of the ciliary body leading to a flattening of the peripheral iris. Vortex vein compression can lead to chordal effusions and increased episcleral venous pressure.
Which craniosynostosis syndrome does not typically have associated poly/syndactyly?
Crouzon syndrome
What is glaucomaflecken? What causes it? And what is the name of his trusty scribe?
Small anterior sub capsular lens opacities. Caused by lens epithelial necrosis due to elevated IOP.
Jonathan
Where does synechial formation start in plateau iris? Bonus 200: how does this differ in pupillary block induced angle closure?
Starts at the scleral spur and progresses posteriorly.
Bonus: starts posteriorly and progresses anteriorly.
What are the 3 variants of ICE and what are the differences?
Chandler: minimal iris atrophy/corectopia
Essential iris atrophy: severe iris atrophy, Heterochromia, corectopia
Cogan- Reese: less severe iris atrophy, but also with tan pedunculated pigmented iris lesions
How can aqueous misdirection be distinguished from pupillary block on exam?
In pupillary block, the peripheral AC is shallow with iris bombe, but central AC is usually not shallow.
In aqueous misdirection, the whole lens iris diaphragm is shifted anteriorly leading to a shallow central AC in addition to shallow peripheral AC.
What is my favorite restaurant chain in KY?
TEXAS ROADHOUSE