For The Test That Shall Not Be Named

Return of the Red Eye 1

100

What is your initial diagnosis?

Episcleritis

200

Which topical diagnostic test can help differentiate episcleritis from scleritis?

Phenylepherine 2.5% blanching test  

300

Recurrent episcleritis is most commonly associated with which category of systemic conditions?

Autoimmune/connective tissue disease 

(Ex: rheumatoid arthritis, lupus, ankylosing spondylitis, ulcerative colitis, Crohn’s disease.)

400

What is your treatment and follow-up plan?

1. Copious lubrication with PF AT every 2 hours in affected eye or OU 

2. Oral NSAID (ex: Ibuprofen 200mg TID)  

3. Refer to PCP for annual exam with bloodwork if this is not the first incidence of episcleritis to rule out autoimmune disorders 

4. RTC in 2-3 weeks for anterior segment check and IOP check. 

500

If the patient develops frequent episodes, what laboratory blood testing would you consider ordering?

1. ANA, RF 

2. ESR/CRP 

3. HLA-B27 

4. CBC 

Return of the Red Eye 2

100

What is your initial diagnosis?

Herpes Zoster Ophthalmicus 

200

The patient returns to your clinic after 1 week of resolution and complains of severe pain. What is this associated condition called?

Postherpetic neuralgia 

300

What are three differentiating factors between Herpes Simplex and Herpes Zoster?

1. Younger population (HSV) vs. older population (HZV)

2. True dendrite (HSV) vs. pseudodendrite (HZV)

3. Crossing of midline (HSV) vs. respecting midline (HZV)

400

What is your follow-up recommendation prior to resolution, and what is your follow-up recommendation after resolution for this patient?

1-7 days; 3-6 months

500

What are the three oral treatment options for your diagnosis (please include exact dosing information)?

Famciclovir 500mg PO, TID x 7-10 days

Acyclovir 800mg PO, 5x/day x 7-10 days

Valacyclovir 1000mg PO, TID x 7-10 days

Return of the Red Eye 3

100

What is your initial diagnosis?

Recurrent corneal erosion 

200

What is your diagnosis most likely associated with?

Dry eye disease

300

What are two management techniques that can be done in office?

1. Epithelial debridement 

2. Anterior stromal puncture

400

What is your follow-up recommendation pre/post epithelial healthing?

1-2 days until epithelium heals, and then 1-3 months depending on severity and frequency of RCE

500

What are three treatment options for your diagnosis?

1. Cycloplegic drops

2. Antibiotic drop QID

3. Sodium chloride 5% QID

4. Bandage contact lens

5. Artificial tears/ointment 4-8x/day 

Toric Down For What?

100

What is your initial lens selection?

OD -2.00 -1.25 x 180

OS -1.75 -2.75 x 160

200

Upon slit lamp examination, you see that your diagnostic lens is fluting on the nasal-inferior edge. When your patient looks up, the lens drops. Your current base curve is 8.7mm. What is your new base curve parameter that you would select: 8.8mm, 8.4mm, 8.7mm or 9.0mm?

8.4mm

300

You had selected Precision 1 for Astigmatism for this patient, which has stabilization points at 8 and 4 o'clock. The patient is feeling the lens upon lens insertion. What other toric stabilization method may you choose for your patient?

Blink stabilization (J+J - Acuvue Lenses) 

400

The soft lens has a single 6 o'clock toric mark. The diagnostic lens marking on eye are rotated 20 degrees nasal OD and 10 degrees temporal OS. What new lens power would you order and where would you expect the rotation marks on this new lens?

OD -2.00 -1.25 x 160, 20 degrees nasal 

OS -1.75 -2.75 x 150, 10 degrees temporal 

500

After 6 months of wear, your patient returns complaining of mild discomfort OD. With slit lamp evaluation, you see the following: 1mmx1mm corneal opacity with surrounding haze that does not stain with NaFl. What is your diagnosis and how would you treat it (exact dosing)?

Subepithelial infiltrate treated with topical steroid QID OD

I am smarter than Dr. Bennett

100

You place a spherical corneal GP on your patient's right eye and see the following NaFl pattern: green at 6:00/12:00, black at 3:00/9:00. What is the orientation of the patient's astigmatism: WTR or ATR?

WTR

200

You empirically ordered a spherical GP lens for this patient with the following refractive information: -4.25 -0.75 x 180. K-value: 43.25@180; 44.00@090. If you select a base curve radius (BCR) equal to 0.50D "flatter than K", what BCR did you select in mm?

7.89mm

300

Based on your observation of the crystalline lens, what is your diagnosis? Name one reason why this would make cataract surgery difficult.

Pseudoexfoliation syndrome; poor dilation of the pupil, weak zonules

400

You order a spherical GP lens with an overall diameter of 9.8mm, a BCR of 7.85mm, center thickness 0.15mm, power -3.50D, secondary radius/width of 8.90/0.3mm, peripheral curve radius/width 10.9/0.3mm. What is the optical zone of this lens?

8.6mm

500

You decide to order a bitoric lens for this patient with the following refractive information: -0.50 -3.00 x 180; K-value 42.50@180; 45.50@090. If you fit "on K" for the flat meridian and 0.75D "flatter than K" for the steep meridian, what base curve radii and powers will you order?

42.50/44.75; -0.50/-2.75