We typically ask about beta-blockers (breathing problems), Plaquenil (retina toxicity) and Flomax.

You can check pressure with Goldmann applanation at the slit-lamp or a hand-held device like the Tono-Pen.

Presbyopia is when the lens hardens as we age. A stiff lens can’t change shape and most people lose the ability to focus at near.

The three “vital signs” are vision, pupil, and eye pressure. These measurements must be checked prior to dilating the eyes.

Using a pinhole, you can often improve a patient’s vision when reading the eye chart. Big improvements usually mean they need updated glasses.

Red, watery eyes. Burning and a feeling of the eyes feeling “tired.” Many patients complain of blur with prolonged reading or TV.

This test is used to check for relative afferent pupillary defect (RAPD). If one pupil dilates as you swing your light back and forth, that eye may have an APD.

OD is right eye. OS means left eye. OU means both eyes. Dumb, I know … that’s Latin for you!

Applanation is a method for checking eye pressure by pushing on the eye. The Goldmann applanation tonometer is built into the slitlamp and is the gold standard for checking eye pressure.

Technically, the “direct ophthalmoscope” gives the most magnified view. Eye doctors, however, prefer small hand-held lenses (the 90-diopter) at the slitlamp.

“Cell” are individual cells floating in the anterior chamber. “Flare” is protein floating in the anterior chamber from inflamed blood vessels.

EXT (external exam) LL (lids & lacrimation) CS (conjunctiva & sclera) K (cornea) AC (anterior chamber) I (iris) L (lens) V (vitreous)

Flashing lights and floaters are the primary symptoms. Patients may also describe decreased vision and a “curtain” or “veil” over their vision.

Some of the glaucoma drops we use are sulfa-based. Older antibiotics are also sulfa-based, but aren’t used often these days.

With documenting retinal findings, the four main structures checked are: Macula, Vessels, Periphery, and Disk (optic nerve).

About 24 millimeters. Eyes that are myopic tend to be longer, while hyperopes have shorter eyes.

It drains tears into the nose, underneath the inferior turbinate.

The trochlea is a fibrous pulley at the superior medial wall of the eye socket (kind of near the bridge of the nose).

The extraocular muscles mostly originate at the annulus of Zinn, at the back of the eye socket.

There are actually 3 chambers in the eye – anterior chamber, posterior chamber, and vitreous chamber.

The orbicularis muscle closes the eye. The levator palpebrae opens the eye.

Tears go from lacrimal & accessory glands, over eye, through punctum, cannaliculi, lacrimal sac, nasolacrimal duct, then nose.

These bones are: 1-Maxillary 2-Frontal 3-Zygomatic 4-Ethmoidal 5-Lacrimal 6-Sphenoid 7-Palatine

The lens has three layers. The outer capsule, middle cortex, and the central nucleus.

The cornea has well-organized layers of collagen and is relatively dry. When the cornea gets too wet, it gets cloudy and turns white.

The cornea has five layers: epithelium, Bowman’s layer, stroma, Descemet’s membrane, endothelium

Starting from “inside” the eye and moving our way outwards: 1-Ganglion Nerves 2-Photoreceptors 3-Choroid 4-Sclera

The ciliary body is a band of muscle right behind the iris. It controls the lens shape and produces aqueous humor.

The uvea is comprised of three structures: the iris, ciliary body, and the choroid.

Because of total internal reflection. Light from the trabecular meshwork reflects back into the eye at the tear-film-air interface. You need a gonio lens.

Normal corneal thickness is about 540 microns, thus this patient has thick corneas. Real pressure is probably close to 13.

PXF is a common condition where flaky material forms on the surface of the lens. It can cause glaucoma and lens dislocations during surgery.

PDS is a type of glaucoma that occurs from pigment rubbing off the back of the iris. The pigment can clog the trabecular meshwork.

This occurs from neovascular blood vessels forming on the iris and growing up into the trabecular meshwork … blocking outflow of aqueous.

The ISNT rule describes the thickness of the neuro-retinal rim in healthy eyes: the optic nerve is thickest Inferiorly and thinnest Temporally.

Farsightedness, family history of glaucoma attack, medications that dilate pupil, medications that dilate the pupil, prior attack in other eye.

High eye pressure, optic nerve cupping, race, family history, and thin corneas.

Applanation works by measuring the amount of pressure it takes to flatten a defined area of cornea. Like kicking a car tire to estimate pressure.

Normal corneal thickness is about 540 microns. Corneal thickness is needed to evaluate glaucoma risk and to calibrate pressure readings.

Normal eye pressure is usually considered 10 to 21 mmHg.

Chronic (open-angle) glaucoma is common and occurs from chronically high pressure. Acute (angle-closure) glaucoma is rare and a major emergency.

Aqueous is produced by the ciliary body. It fills the posterior chamber, through the pupil into the anterior chamber. Aqueous drains out the “TM” into the canal of Schlemm.

Glaucoma is gradual death of the optic nerve, often associated with high intraocular pressure.

This is a posterior vitreous detachment that occurs when the vitreous jelly contracts inside the eye. The leading cause of floaters.

Drusen are yellow lipid deposits that form in Bruch’s membrane in the retina. They are often a finding/precursor to macular degeneration.

Macular degeneration is premature aging of the central retina. It causes decreased central vision and is a common cause of vision loss.

Hard exudates are yellow spots seen in the retina. They are lipid deposits left behind after swelling (such as from diabetic retinopathy).

Macular edema, premature cataracts, vitreous hemorrhage, and tractional retinal detachment.

Neovascularization is typically treated with PRP laser. Occasionally, anti-VEGF medications are injected to decrease retinal swelling.

Dot-blot hemorrhages are deeper and more common with diabetes, Flame hemorrhages occur in superficial layers and often seen with HTN.

The macula derives its nutrition from the choroid underneath. When detached, the rods and cones die from lack of blood supply.

We use two categories: NPDR (non-proliferative diabetic retinopathy) and the more advanced PDR (proliferative diabetic retinopathy).

A gentle antibiotic like erythromycin ointment can help lubricate the surface. Contact lens wearers need something stronger like cipro.

Endophthalmitis is when an infection forms INSIDE the eye. They are always terrible and most occur from recent surgery or prior glaucoma procedures.

CMV retinitis typically presents when CD4 counts are below 50, though it rarely can present with counts under 200.

These patients have higher incidence of pseudomonas. This bacteria tends to be aggresive and requires more rigorous antibiotic coverage.

This is a hypopyon, a collection of pus in the anterior chamber. It can be from infection (endophthalmitis) or from bad internal inflammation (uveitis).

An infection tracking behind the eye causes obvious symptoms: proptosis, chemosis, double vision, and decreased acuity.

In adults, viral conjunctivitis is most common. In children, bacterial conjunctivitis is more common.

An abrasion is non-infected scratch on the corneal surface. An ulcer implies a localized infection in the cornea.

Viral conjunctivitis causes redness and watering. Bacterial infection creates mucous and allergic conjunctivitis causes itching/swelling.

Diagnoses is by symptoms (temple pain, jaw claudication, polymyalgias, malaise), labs (ESR, CRP, PLT) and temporal artery biopsy. Treatment is steroids.

This is simply a relative afferent pupillary defect (RAPD).

This is loss of sympathetic tone to the eye that makes the pupil small. It can be caused by tumors or lesions along the sympathetic chain.

An Adie’s pupil is a dilated pupil caused by paralysis of the parasympathetics that normally constrict the pupil.

CT is best for orbit and bone injuries. MRI is best for looking at the brain.

The 4-4 rule can be used to figure out the location of the nuclei. You’ll need to click the more button to figure this one out.

You need to consider multiple sclerosis and order an MRI to look for demyelinating lesions.

Loss of vision, decreased color vision and contrast sensitivity. Central vision loss is common and some pt’s have pain with eye movement.

A 3rd nerve palsy with pupil involvement implies a compressive lesion (such as an an aneurysm or tumor) pushing on the nerve.

6th nerve palsies make the eye turn inward and can occur from HTN, DM, tumor, and high intracranial pressure.

4th nerve palsies are hard to detect. They cause a mild vertical diplopia and can occur from DM, HTN, tumor, congenital damage, and mild head trauma.

3rd nerve palsies make the eye turn down and out. Causes include DM and HTN. A blown pupil implies tumor or aneurysm.

Whether the diplopia is monocular (astigmatism or cataract) or binocular (nerve palsies, etc.)

Headaches, scalp tenderness, malaise, weight loss, night sweats, fevers, jaw claudication and muscle aches.

When the prescription between the eyes is very different. This makes glasses hard to fit and can cause amblyopia in kids.

Retinopathy of prematurity occurs in premature newborns. Ischemic retina promotes neovascularization that leads to scars & retinal detachments.

This is a tumor that occurs in the photoreceptors.

Congenital cataract, retinoblastoma (rare but dangerous), retinal detachment, ROP. Plus some others …

Retinal bleeding in all four quadrants of the retina, and at all levels of retinal depth. Schisis cavities, bone fractures, and others …

This is the “illusion” that the eyes are out of alignment (but they are actually OK). Common in children with prominent epicanthal folds.

A test for measuring eye alignment by examining the reflection of light off the cornea.

A tropia is an constant alignment problem between the eyes. A phoria is only present when tired or when fusion is broken.

Strabismus (eyes out of alignment), anisometropia (eye prescriptions different) and visual obstruction (cataract or droopy lid).

Vision loss from poor nervous system wiring in childhood. It occurs from poor vision in one eye at a young age that isn’t corrected.

Orbital fractures are repaired if there is muscle trap, enophthalmos, or displacement of the globe.

Attempt to get vision, but don’t press on the eye. CT scan. The eye is usually explored and repaired under anesthesia.

Type SC seems to have more eye problems (ischemia and bleeding in the retina) than SS (which has more systemic painful crises).

Avoid carbonic anhydrase inhibitors, both topical drops and diamox, as this medication acidifies the aqueous fluid and promotes sickling in the AC.

Dilation paralyzes the iris and this helps with pain control. Dilation also helps break synechia (adhesions) of the iris.

Traumatic iritis is internal ocular inflammation after blunt injury. It causes pain, photophobia, and redness. Treatment is usually dilation and steroids.

An inflamed, red conjunctiva is good as this means that the chemical didn’t “burn away” the conjunctival and episcleral vessels.

Base chemicals (high pH) are worse for the eye. Acids tend to coagulate tissue and limit spread.. Bases tend to denature proteins and penetrate deeper and deeper.

Irrigation, irrigation, irrigation. The quicker you can irrigate the offending agent, the better the visual prognosis.

Usually start with a q-tip. Then most people progress to blunt needle or forceps. Residual rust rings are polished off with a spinning Alger brush.

History of high-speed metal (grinding, hammering), decreased pressure, flat anterior chamber. If in doubt get a CT scan.

You need to line up the lid margin first with a big stitch. Then approximate the posterior and anterior layers of the lid with sutures.

Lid lacerations that occur medially (near the nose) are problematic as it may cut through the canaliculus.

Orbital rim fractures, enophthalmos, diplopia, and sensation along the V2 distribution.

The orbital floor, the maxillary bone, is the most common orbital fracture.

A perforation can be diagnosed by using the Seidel test to see if any aqueous fluid is leaking out.

Abrasions are easiest seen by bathing the eye with yellow fluorescein dye, and viewing the cornea using a blue light.

Blood in the anterior chamber is called a hyphema.

Yes. Even if the implant prescription is perfect for distance vision, the child will need bifocals for reading close up.

This is when the axis of the positive cylinder in a pair of glasses is oriented at 90 degrees.

Babies have small eyes and are usually born hyperopic (far-sighted). Fortunately, they can accommodate their lens and still see near objects.

High sugar leads to accumulation of sorbitol in the lens, swelling the lens and creating more myopia (nearsightedness).

This is stiffness to the lens that occurs with age that makes it hard to read without glasses.

Accommodation is when the lens becomes “rounder” in order to focus nearby objects onto the retina.

A cylinder power (the refracting power of a lens) is 90 degrees from the axis of the cylinder.

These are ways to describe astigmatism in glasses. Ophthalmologists work in “plus” cylinder while optometrists like “minus” cylinder.

A hyperopic (farsighted) eye is a small eye, such that images focus behind the eye. It is treated with plus power lenses.

This is nearsightedness (also called short-sighted in other countries) which means that you can see near, but have problems with distant objects.

PCO after cataracts are common and treated using a YAG laser to pop a hole through the capsule, thus clearing the visual axis.

Cataracts that are posterior are more visually significant. Seemingly small PSC cataracts can severely affect the vision.

This is phacoemulsification, the method the lens nucleus is removed with ultrasonic energy.

The outer capsule is left behind with cataract surgery. This creates a pocket in which to place the new implanted lens.

The lens is held in place by zonules, like springs on a trampoline.

Long-term use of steroids is associated with premature cataract formation, usually a PSC at the back of the lens.

A NSC is a nuclear sclerotic cataract. These cataracts are common and occur gradually with aging.

A PCO is a posterior capsule opacification, an “after cataract” that can form months to years after successful cataract surgery.

PSC stands for Posterior Subcapsular Cataract, an opacity that forms at the back of the lens. Common in diabetics and oral steroid users.