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OD2-PPO > Slit Lamp > Flashcards

Slit Lamp Flashcards

1
Q

what is diffuse illumination

waht is it used on

A

wide beam on low mag which is used for general screening of the lids, lashes, and conj.

  • flat, 2D
  • beam width 3-4mm
  • mag 6-10x
  • beam angle 60 degrees
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2
Q

what is arcus

A

cholesterol in the corneal stroma

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3
Q

what is tylosis

A

infl of the eyelids

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4
Q

what is telangiectasias

A

dilated vesself on lid margin

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5
Q

what is madarosis

A

paritial loss of eyelashes

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6
Q

how can you get vortex keratophathy

-what does it involve

A

plaquenil or amiodraone (used for serious arrhythmias)

=nothing to do w/ cornea, redundant conj

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7
Q

what is direct focal illumination

A

focusing of the light beam and the microscope in the same specific area
-angle btwn microscope and light source is usually btwn 30-60 degrees

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8
Q

what are the 3 types of direct focal illumination

A
  1. parallelpiped: 3D view of tissue, wider beam of 1-2mm, mag 10-16x
  2. optic section: very narrow beam, 2D view of ocular tissue, mag 10-16x
    - on cornea allows you to determine depth of scar or fb
  3. conical beam: shorter slightly narrow parallelpiped, light directed into the pupil and slit lamp focused on ant chamber, highest mag, 45-60 degree angle of ill, uses tyndall effect
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9
Q

what are the layers of the cornea

A
  1. tear film
  2. epithelium
  3. anterior stroma
  4. posterior stroma
  5. endothelium
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10
Q

what is the van herick used to determine

A

estimate the depth of the anterior chamber

-compare the depth of the ant chamber to the width of the cornea

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11
Q

what illumination is used to check anterior uveitis

A

conical beam=> to check cells and flare (protein) in the ant chamber

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12
Q

where is the focus in a conical beam

A

just behind the corneal endo and just in front of the lens capsule

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13
Q

what is the tyndall effect

A

light is scattered by particles in suspension

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14
Q

what is indirect focal illumination

A

microscope focused on an area adjacent to the illumination system
-looking at something to the side of the light

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15
Q

what is indirect focal illumination good for evaluating

A

lid, conj, cl opacification, iris abnormalities

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16
Q

what is direct retro illumination

A

light is refelcted off deeper structures within the path of reflected light
-light about same size as pupil

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17
Q

how can you see iris transillumination defects

A

light reflects off retina and shines through defects/holes in the iris

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18
Q

what is indirect retro
how is the beam
how is the mag

A

when light is reflected off deeper strutures to view structures adjacent to the path of reflected light
-narrow or moderate beam w/ low or moderate mag

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19
Q

what type of illumination is best for corneal opacities and neo

A

indirect reto

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20
Q

what is sclerotic scatter

A

optic section focused on the corneal limbus and widened in such a way that it produces a halo around the circumference of th elimbus

  • 90 degree angle btwn patient cornea and dr’s eye
  • dr views this out of slit lamp
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21
Q

what is a good illumination to view corneal edema

A

sclerotic scatter

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22
Q

what is specular reflection

A

illumination lamp is posisitoned so the angle of incidence equals the angle of reflection

  • parallelpiped moved into the refelction so the reflection back lights the endo
  • view seen in only ONE of the doctors oculars
  • thin to meduium size parallelpiped w/ high mag
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23
Q

what illumination is best used to assess corneal endo and lens capsule

A

specular reflection

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24
Q

what stain is good to use for epithelial defects

A

fluorescein

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25
Q

what stain is good to sue for dying cells and mucin

A

rose bengal and lisamine green

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26
Q

what is negative staining

A

stain goes into grooves so if something is raised/protruding, stain drains off it and you will see black color where there are irreg

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27
Q

what stian is good to see conj staining

A

rose bengal and lissamine green

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28
Q

what is fluramene

what is it good ot view

A

fluorescein sodium 1% and lissamine green 0.5%

-good for cornea and conj

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29
Q

what do you pair with slit lamp to view back of eye? gonio?

A

90 or equiv lens to look at back of eye

-goldman lens to do gonio

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30
Q

what is normally affected in corneal degeneration
what can it be accompanied by
when does it generally begin

A

usually affected peripheral cornea
accompanied by vascularization
begins in middle age or older

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31
Q

what is arcus

A
  • most common degeneration
  • deposits of cholesterol esters, choles, low density lipoprotiens in ring around cornea, usualy w/ a clear zone btwn arcus and limbus
32
Q

where does arcus appear first

A

inf cornea in the stroma but near descemet’s membrane

-then still in stroma but nearer to bowman’s

33
Q

what % of 40-60 year olds have arcus
70-90 years?
earlier in men/women? white/black?

A

60%
90%
earlier in men and blacks

34
Q

what is arcus relationship to hyperlidpidemia

A

some say arcus if under 50=risk factor for coronary heart disease

35
Q

what does the presence of a unilateraly arcus suggest

A

vascular occulsion on the side w/o arcus

36
Q

what is the limbal girdle of vogt
where is it normally found
what is it realted to
what are the % of normal findings

A

sub-ep collagen degeneration

  • may or may not be related to UV
  • white crystal like appearnace w/ or w/o a clear zone almost always 3 and 9 oclock
  • normal finding in any age, 55% of eyes 40-60 years, 93% 70-90 years
37
Q

what is hudson-stahli line
what does it look like
when is it more common
% in age groups?

A

normal finding of iron deposition at level of bowman’s
-yellowish, brown irreg line just inf to mid pupil near where margins meet
-more common in ppl w/ dry eye
less tears= inc iron
-20 years old=20%
-60 years old=60%

38
Q

what is descemet’s striae

A

small linear striation in descemet’s membrane

  • often seen
  • usually vertical but can be tilted
  • no clinical sig except w/ stromal edema from soft cl or after refractive surgery
39
Q

what is mosiac shagreen

where is it mostly seen

A

aka crocodile shagreen

  • prob results from relaxation of the normal tension on bowman’s
  • grayish white polygonal opacities separated by clear spaces, very common
  • looksl ike croc leather
  • ant or post
  • mostly seen centrally
40
Q

what are hassle-henle bodies/guttata

-what is it assoiated w/

A

-nodular thickening of descemet’s membrane, believed to be composed of collagen
-abnormal byproducts of the endo cells pitted and project into the endo
hassal-henle-in periphery
guttata-centrally
-ass with corneal trauma and infl
-ass w/ aging

41
Q

how does guttata look in specular reflection and direct illumination

A

spec reflect: orange peel appearance (black hole)

direct: refractile ciruclar pits in endo
- sometimes ass w/ fine pigment througout endo

42
Q

what is guttata the first sign of

A

fuch’s endothelelial dystrophy

  • patient should be closely watched
  • consider monitoring w/ pachymetry
43
Q

does guttata affect vision

A

rarely

but if central and dense enough it can

44
Q 
what is corneal farinata 
where are depeosits more prominant 
best seen with what ill? 
does it intefere w/ vision 
what is the exact cause
normal finding?
A

age related corneal change
comprised of many tiny, dust like gray dots and flecks int he deep stroma
-farinaceous=”flour like”
-more prominant centrall
-best seen w/ retro
-bilateral and doesn’t interrere w/ vision
-exact cause unknown, prob lipofuscin which is a degenerative pigment found in aged cells
-normal finding, no management needed

45
Q

what is band keratopathy

A
  • considered corneal degeneration
  • calcium salts depositied in the interpalpebral zone
  • calcium deposists start in the basement membrane
  • start as gray and flat but as they progess they become white and elevate overlying ep and can later spread to bowman’s layer and ant stroma
46
Q

how does band keratopathy form

A

evaporation of tears tneds to concentrate solutes and to increase tonicity of tears

  • tears contain calcium, phosphate that will deposit if solubility level is exceeded
  • elevated serum calcium and phosphate can push the solutes to precipitate and deposit as tears evaporate
47
Q

what causes band keratopathy

A

localized ocular infl: uveitis, prolonged glauc, long standing corneal edema, silicon oil in eye

systemic causes: hyperparathyroid, juv rheumatoid arthritis and uveitis in children, chronic exposure of the cornea to mercry, thiazides, vit D toxicity, renal failure, sarcoid

rarely inherited
in elderly can be idiopathic

48
Q

what are possible lab tests for band keratopathy

A

serum calcium, albumin, magnesium, phophate levels, blood urea nitrogen, creatine, parathyroid levels

  • ACE
  • uric acid level if gout is suspected
49
Q

how do you treat band keratopathy

A

ocular treatment needed only if vision is reduced or if ep breaks down over deposits

  • treat by removing ep and scraping w/ a knife and applying celating agent
  • repeated application of calcium binding agent EDTA and scraping of the corneal surface after removing ep (mild cases)
  • excimer laser keratectomy for deep involvment or “polish” corneal surface after chelating is done
50
Q

what is salzmann’s nodular degeneration

A

rare but can happen at any age but avg age of onset is about 60

  • plaques located btwn the epi and bowman’s
  • in some pt believed to be a late sequela of old keratitis
51
Q

what does confocal microscopy indicate for salzmann’s nodular degeneration

A

elongated basal ep cells and activated keratocytes, particularly in the area of the ant stroma near the nodules

52
Q

what does spectral domain oct imaging reveal about salzmann’s nodular degeneration

A

fibrous intraepithelial nodules w/ sig overling ep thinning

53
Q

where to salzmann’s nodules usually occur

what is it associated w/ (3)

A

w/in or adjacent to an area of previous scarring or the edge of long-standing pannus

  • may be assoicated w/ mucopolysaccharid problem
  • may be associated w/ osteoporosis and pterygium
54
Q

how does salzmanns develop

A

slowly and asymptomatic unless in visual axis which can decrease vision

55
Q

what is treatment of salzmann’s

A
  • not usually necessary
  • excise if vision is decreased
  • mitomycin C and PTK (phototherapeutic keratectomy) is being used on more severe cases
  • occasionally ep can break down over the surface causing irritaion => use thick rewetting sol’n
56
Q

what is dellen

A

localized thinning of stroma next to raised area, secondary to poor wetting and resultant stromal dehydration

  • usually next to a raised mass such as a ping or thick cl edge
  • intact ep and endo, just thinning
  • no risk of perforation but may scar
57
Q

what is kayser fleischer ring

what is it caused by

A

yellowish brown, may be fold, red, blue, green, or mixture

  • 1-3mm side circumlimbal ring at level of descemets
  • caused by wilson’s disease
  • refer*
58
Q

how is wilson disease inherited
how is copper depositied
what is treatment

A

autosomal recessive metabolic defect linked to chrom 13

  • depositied in the liver, then the kidneys, and eventually the brain and cornea
  • treatmet: low copper diet and chelating agent
59
Q

what is krukenberg spindle associated w/

A

pxe and pds

60
Q

if you see krukenberg spindle what do you monitor for and check fo

A

check for iris transill or pxe
monitor for glauc
-may have large diurnal changes in IOP

61
Q

what is pannus

what can it be accompanied by

A

any growth beyond the normal arcade (superficial limbal vessels normally don’t extend onto cornea for more than 1mm)
-may be accompanied by sub ep fibrous tissue or stromal scarring (clarity of stroma reduced, looks cloudy)

62
Q

what is micropannus

what are the causes

A

only 1-2mm beyond normal arcade
causes: inclusion (chlamydial) conjunctivias, staph bleph, cl wear, vernal conjunctivitis, acne rosacea (dries out mb glands)

63
Q

what is gross pannus

what are the causes

A

greater than 2mm extension of vessels

causes: trachoa, phylcetenulosis, acne rasacea, cl wear, staph bleph, atopic keratoconjunctivitis

64
Q

what is posterior embryotoxon

A

congenital, fairly common, exaggerated schwalbe’s line (termination of descet’s membrane)

  • white line on cornea
  • present in 15% of indiv
  • viewed mostly on post on cornea at 3 and 9 o clock but can be a rign
  • NORMAL
65
Q

what is the diff btwn post embryotoxon and volks

A

more post in back=sl aka desemets

66
Q

what can post embryotoxon be associate dw/

A

glaucoma

67
Q

how can vortex keratopathy aka corneal verticillata be developed

A

medications can bind w/ cellular lipids of the basal ep layer of the cornea

  • hydroxychloroquine (plaqenil) and amiodarone are the 2 most common ones that can cause the whorl pattern
  • 100% of patients
  • normal
68
Q

where does vortex kertopathy occur

A

deep ep and ant stroma

69
Q

the whorl can be a diagnostic of what …

A

fabry

70
Q

what is fabry’s disease

A
  • rare genetic X linked disease
  • deficiency of alpha galactosidase A
  • mutation causes a glycolipid known as globotriaosylceramide (gb3 or gl-3) to accumulate w/in the blood vessels, other tissues, and organs and can lead to renal failure and severe heart disease
71
Q

how to treat fabry’s

A

no cure but there are enzyme replacements

very costly, about $250,000

72
Q

what are axenfeld loops

  • what is it usually beside
  • what % of eyes
A

~12% of eyes

-large loop of ciliary nerve extends from the ant ciliary body into sclera, usually beside one of the ciliary artiers

73
Q

what are epicapsular stars remnant of

A

tunica vasculos lentis

-on ant capsule

74
Q

what is embryonic zonular opacification

A

zonular cataract affects one layer of lens but is surrounded by clear lens

75
Q

what is a corneal scar

A

anything that penetrates beneath epi wil cause a scar

OD2-PPO (8 decks)

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