OCULAR DISEASE KMK
Whatvfisvfthevfdifferencevfinvfetiologyvfbetweenvfavfcornealvfabrasionvfandvfcornealvferosion?vf-vfanswer--
CornealvfAbrasion:vfRecallvfthatvfcornealvfabrasions,vfbyvfdefinition,vfarevfALWAYSvffromvfTRAUMA.vfThevfmostvfcommo
freasonvfforvfavfcornealvfabrasionvfisvfavfFINGERNAILvfINJURY.vfIfvfyouvfhavevfyoungvfchildrenvfyouvfunderstandvfwhy!
CornealvfErosion:vfOncevfthevfabrasionvfhasvfhealedvfthevfpatientvfisvfnowvfatvfriskvfforvfavfcornealvferosionvfforvfthevfrestvfof
heirvflife.vfCornealvferosionsvfoccurvfinvfpatientsvfwithvfpastvfcornealvfabrasionsvf(e.g.vftrauma)vfandvfthosevfwithvfepithelia
ystrophiesvf(mostvfcommonlyvfEBMD).
Whatvfisvfthevfmostvfcommonvfcornealvfdystrophy?vf-vfanswer--
It'svfnotvfevenvfclose.....vfEBMD.vfSo,vfwhenvfwevfsayvfthatvfcornealvferosionsvfhappenvfinvfpatientsvfwithvfepithelialvfdystro
ies,vfwevfarevfalmostvfalwaysvfreferringvftovfEBMD
WhatvfisvfVossiusvfRing?vfWhatvfdoesvfavfpositivevfSeidel'svfsignvfindicate?vf-vfanswer--
Vossiusvfring:vfaftervfcornealvftraumavfthevfirisvfcanvfbevfpushedvfposteriorlyvfandvfcanvfmakevfcontactvfwithvfthevflens.vfAsv
resultvfavfringvfofvfpigmentvf(wherevfthevfirisvfcontactedvfthevflens)vfcanvfremain;vfthisvfisvfcalledvfvossiusvfring.vfAsvfavfbuzzv
rasevfforvfthevfexam....vfVOSSIUSvfRINGvf=vfTRAUMA.
Seidel'svfsign:vfAvfwoundvfleakvfisvfpresentvfifvfSeidel'svfsignvfisvfpositive.vfIfvfavfleakvfexists,thevffluoresceinvfdyevfwillvfappe
vfasvfavfdarkvf(dilutedvfbyvfthevfaqueous)vfstreamvfwithinvfthevfgreenvfdyevfofvfthevftears.
Whatvfisvfthevfmostvfcommonvfreasonvfforvflensvfsubluxation?
A)vfMarfan'svfsyndrome
B)vfTrauma
C)vfHomocystinuria
D)vfEhlers-DanlosvfSyndrome
E)vfWeill-MarhesanivfSyndromevf-vfanswer--Trauma
TraumavfisvfthevfNo.vf1vfcausevfofvflensvfsubluxation.vfMakevfsurevfyouvfknowvfthevfothervfoptionsvflistedvfabove....vfallvfofvft
sevfoptionsvfcanvfcausevflensvfsubluxation.vfMostvfofvfyouvfwouldvfcorrectlyvfstatevfthatvfMarfan'svfSyndromevfisvfavfcommo
fcause,vfbutvfbevfsurevftovftakevfavfminutevforvftwovftovfmemorizevfthevfothervfthreevfconditionsvfthatvfyouvfshouldvfalsovfasso
atevfwithvfthisvfcomplication.
Namevfthevf5vfmostvfcommonvfreasonsvfforvflensvfsubluxationvf-vfanswer--Trauma
Marfan'svfSyndrome
Honocystinuria
Ehlers-DanlosvfSyndrome
Weill-MarhesanivfSyndrome
Whatvfisvfavfhyphema?vfWhatvfisvfthevfmostvfcommonvfcausevfofvfnon-traumavfrelatedvfhyphemas?vf-vfanswer--
Hyphemavfisvfbloodvfinvfthevfanteriorvfchamber.vfRecallvfthatvfthevfbloodvfinvfavfhyphemavfisvffromvfthevfirisvfand/
orvfciliaryvfbody.vf
NSAIDvf(e.g.vfaspirin,vfibuprofen)vfuse,vfbloodvfclottingvfdisordervf(e.g.vfsicklevfcellvfanemia)vfisvfoftenvfthevfcausevfinvfavfno
traumavfrelatedvfhyphema.
WhyvfwouldvfavfB-scanvfbevfindicatedvfinvfavfpatientvfwithvfanvf8-ballvfhyphema?vf-vfanswer--8-
ballvfhyphemavfmeansvfthatvfthevfentirevfanteriorvfchambervfisvffullvfofvfblood.vfThus,vfnovfviewvfofvfthevfposteriorvfchamber
ouldvfbevfpossible.vfYouvfshouldvfassociatevfthevfusevfofvfB-scanvfwithvftwovfmainvfscenarios
1vf/
vf1
,vfTovfviewvfposteriorvfsegmentvfwhenvfmediavfopacitiesvf(e.g.vfdensevfcataracts)vforvfothervfpathologyvf(vitreousvfhemorrh
ge,vfforvfexample)vfdovfnotvfallowvfanvfadequatevfview.vf
vfTovfaidvfinvfdiagnosisvfofvfopticvfnervevfdrusen.
Remember,vfA-
scansvfarevfusedvftovfmeasurevfaxialvflength;vfavfpopularvfusevfisvfforvfcalculationvfofvfIOLvfpowervfforvfcataractvfsurgery.vfB
scanvfforvfblockedvffundusvfandvfONHvfdrusen.
Whatvfisvfcrepitus?vf-vfanswer--CRepitusvfrefersvftovfthevfCRackling,vfrattle-
likevfnoisevfthatvfcanvfoccurvfwhenvftwovffracturesvfbonesvfrubvfagainstvfonevfanother.vfAftervfanvforbitalvfwallvffracturevfpat
tsvfshouldvfbevftoldvfNOTvftovfblowvftheirvfnosevfforvfatvfleastvf48vfhrsvffollowingvfthevfincident.vfBlowingvfthevfnosevfincrease
pressurevfwithinvfthevfareavfofvftraumavfandvfcanvffurthervfbleadingvfandvfinflammation;vfthevfcracklingvfsignvfofvfcrepitusvfa
ovfincreasesvfduringvfnosevfblowing.
Onvfthevfexam....vfCREPITUSvf=vforbitalvfwallvffracture
Whichvfwallvfisvfmostvflikelyvftovffracturevfwithvftrauma?vf-vfanswer--Floor.vfMorevfspecifically,vfthevfposterior-
medialvfportionvfofvfthevffloor.vfMaxillaryvfbonevfwithinvfthevffloorvfisvfthevfmostvflikelyvfbonevftovffracture.
Whatvfisvfthevfthinnestvfbonevfinvfthevforbit?vf-vfanswer--Ethmoid
Whatvfisvfthevfweakestvfbonevfinvfthevforbit?vf-vfanswer--Maxillary
Whatvfisvfmucormycosis?vf-vfanswer--Avflife-threateningvfFUNGALvfinfectionvfthatvfcanvfoccurvfinvfDIABETICSvfand/
orvfIMMUNOCOMPROMISEDvfpatientsvfwithvforbitalvfcellulitis.
Whatvfconditionvfresultsvfinvfthevfclassicvfpatientvfcomplaintvfofvfpainvfinvfthevfmorningvfaftervfopeningvfthevfeyes?vf-
vfanswer--Recurrent vfcornealvferosion
Whichvfofvfthevffolllowingvfisvfthevfmostvfcommonvfprimaryvfpediatricvforbitalvfmalignancy?
A)vfRhabdomyosarcoma
B)vfNeuroblastoma
C)vfCapillaryvfHemangioma
D)vfCavernousvfHemangiomavf-vfanswer--Recallvfthatvfprimaryvfindicatesvfthevftumorvfbeganvfinvfthevforbit.
A)vfRhabdomyosarcomavf=vfrapidvfbonevfdestructingvftumor.
Whatvfisvfthevfmostvfcommonvforbitalvftumorvfinvfchildren?vf-vfanswer--
CapillaryvfHemangioma:vfbenign,vflookvfforvfdeprivationvfambylopia
Whatvfisvfthevfmostvfcommonvforbitalvftumorvfinvfadults?vf-vfanswer--CavernousvfHemangioma
Whatvfisvfthevfmostvfcommonvfsecondaryvfmetastaticvfpediatricvftumor?vf-vfanswer--
Neuroblastomavf=vfmalignant.vfThevftumorvfcommonlyvfarisesvffromvfthevfabdomen,vfsovfthesevfpatientsvfarevfinvftypically
nvfpoorvfsystemicvfhealth.
Whatvfconditionvfclassicallyvfresultsvfinvfbilateral,vfPERIORBITALvfswellingvfofvfthevfeyelidsvfandvfisvftypicallyvfassociated
withvfswitchingvfcosmetics,vfallergicvfirritants,vforvfrecentvfinstillationvfofvfeyevfdrops?
vfHint:vfonsetvfofvfsymptomsvftypicallyvfoccursvfwithinvf24-48vfhoursvfofvfirritantvfexposure).vf-vfanswer--
CONTACTvfDERMATITIS
1vf/
vf1
,Periorbitalvfswellingvfisvfassociatedvfwithvfcontactvfdermatitis.vfIfvftheyvfaskvfavfquestionvfonvfboardsvfaboutvfavfpatientvfrec
tlyvfswitchingvfcosmeticsvf(eyelinervfforvfexample)vfwithvfallergic-
typevfsymptomsvf(e.g.vfconjunctivalvfchemosis),vfcontactvfdermatitisvfshouldvfbevfhighvfonvfyourvflistvfofvfdifferentials.
-RecallvfthatvfthisvfconditionvfresultsvffromvfavfType-4vfDELAYEDvfhypersensitivityvfreactionvf(seevfHintvfabove).
-Remember,vfconjunctivalvfchemosisvfisvfavfphrasevfyouvfshouldvfimmediatelyvfassociatevfwithvfALLERGYvfonvfthevfexam
Whatvfisvfankyloblepharon?vfNamevfavfconditionvfwherevfthisvfsignvfisvffound?vf-vfanswer--
ANKYLOBLEPHARONvfandvfSYMBLEPHARONvfarevfthevftwovfmainvfsignsvffoundvfinvfPEMPHIGOID,vfavfconditionvftha
svfmostvfcommonvfinvffemalesvf60vfyrsvfandvfolder.
Ankyloblepharonvfoccursvfwhenvfthevfoutervfeyelidsvfbecomevfstuckvftogether.vfSymblepharonvfoccursvfwhenvfthevfbulba
andvfpalpebralvfconjunctivavfbecomevfstuckvftogether.
RecallvfthatvfpemphigoidvfisvfanvfidiopathicvfconditionvfthatvfattacksvfMUCOUSvfMEMBRANES;vfthevfeyevfisvfavfnaturalvfp
cevfforvfattackvfconsideringvfthevfmucousvfsurfacevfofvfthevforbitalvfandvfpalpebralvfconjunctiva.
Whatvfarevfthevftwovfmainvfsignsvffoundvfinvfpemphigoid?vf-vfanswer--Ankyloblepharonvfandvfsymblepharon.
Whatvfarevfthevfthreevfocularvfconditionsvfassociatedvfwithvfmucousvfmembranevfdamage?vf-vfanswer--1)vfPemphigoid
2)vfBechet'svfDiseasevf(mouthvfulcersvfwithvfuveitis)
3)vfStevenvfJohnson'svfSyndrome
Whatvfisvfthevfdifferencevfbetweenvfanvfexternalvfhordeolumvfandvfanvfinternalvfhordeolum?vf-vfanswer--
ExternalvfhordeolumsvfaffectvfglandsvfofvfZeisvfand/orvfMoll.
vfInternalvfhordeolumsvfaffectvfmeibomianvfglands.
WhatvfisvfthevffunctionvfofvfthevfglandsvfofvfZeis?vf-vfanswer--Lubricationvfofvfthevfeyelashes
WhatvfisvfthevffunctionvfofvfthevfglandsvfofvfMoll?vf-vfanswer--sweatvfglands
Namevfallvfofvfthevfcontributorsvftovfthevflipidvflayervfofvfthevftearvffilm?vf-vfanswer--
Meibomianvfglands,vfGlandsvfofvfZeis,vfGlandsvfofvfMoll.vfRemember,vfalthoughvfmeibomianvfglandsvfarevfthevfprimaryvfc
tributorsvftovfthevflipidvflayervfofvfthevftearvffilm,vfZeisvfandvfMollvfglandsvfalsovfprovidevfassistancevfwithvflipidvfproduction.
Whichvfofvfthevffollowingvfisvfthevfmostvfcommonvfetiologyvfforvfectropion?
A)vfInvolutional
B)vfFacialvfNervevfPalsy
C)vfCicatricialvf-vfanswer--Involutional
InvolutionalvfindicatesvfthatvfthevfconditionvfisvfAGE-
RELATED.vfRemembervfthatvfthevfFacialvfNervevf(CNvfVII)vfisvfresponsiblevfforvfinnervatingvfthevforbicularisvfoculi,vfthevfm
sclevfthatvfallowsvfforvfeyelidvfclosure.vfBell'svfPalsyvfisvfavfconditionvfthatvfaffectsvfthevflowervfportionvfofvfCNvfVII;vfpoorvfinn
vationvftovfthisvfmusculaturevfleadsvftovfectropionvfandvfsubsequentvfcornealvfexposurevfissues.
Whatvfisvfthevfleadingvfcausevfofvfinfectiousvfblindnessvfinvfthevfworld?vf-vfanswer--Trachoma.vfRecallvfthatvftrA-
ChomavfresultsvffromvfchlamydiavfserotypesvfA-C.
Whyvfdovfpeoplevfgovfblindvffromvftrachoma?vf-vfanswer--Entropion
Canvfyouvfdefinevfthevffollowingvfterms?
A)vfTrichiasis
B)vfDistichiasis
1vf/
vf1
,C)vfPoliosis
D)vfMadarosisvf-vfanswer--Trichiasisvf-vfturningvfinwardvfofvfeyelashes
Distichiasisvf-vftwovfrowsvfofvfeyelashesvf(occursvfwhenvf2ndvfrowvfarisesvfnearvfmeibomianvfglandvfopenings)
Poliosisvf-vfwhiteningvfofvfeyelashes
Madarosisvf-vflossvfofvfeyelashes
WhatvfdovfBlepharospasmvfandvfMyokymiavfhavevfinvfcommon?vf-vfanswer--
BothvfconditionsvfaffectvfORBICULARISvfOCULIvfmusculature.vfMyokymiavfONLYvfaffectsvfthevforbicularisvfoculi;vfBlep
rospamvfaffectsvfthreevfmusclesvf-vfthevforbicularisvfoculi,vfprocerusvfandvfcorrugatorvfmusculature.
RecallvfthatvfBLEPHAROSPASMvf=vfBILATERALvfTWITCHINGvfthatvfprogressesvftovfeyelidvfclosure.
MYOKYMIAvf=vfUNILATERALvfTWITCHING.
Youvfwillvfhavevflotsvfofvfpatientsvfinvfclinicalvfpracticevfwhovfreportvftwitchingvfofvfthevfeyelid.vfImmediatelyvfaskvfifvfthevftwit
ngvfisvfunilateralvforvfbilateral.vfIvfhavevfnevervfheardvfavfpatientvfsayvfbilateralvf(b/
cvfblepharospasmvfisvfextremelyvfrare!).vfForvfmyokymia,vfaskvfaboutvfthevffollowing...vfallvfofvfwhichvfarevfcommonvfcause
ofvfthevfcondition:
vfIncreasevfinvfcaffeinevfintake?
vfIncreasevfinvfstressvfatvfhomevfand/orvfwork?
vfLessvfsleepvfasvfofvflate?
WhatvfisvfMeige'svfSyndrome?vf-vfanswer--
Thisvfisvfthevfconditionvfcharacterizedvfbyvfbenignvfessentialvfblepharospasmvfcombinedvfwithvflowervffacialvfabnormaliti
f(difficultiesvfchewing,vfopeningvfmouth,vfetc).
Whatvfisvfthevf2ndvfmostvfcommonvfeyelidvfcancer?vf-vfanswer--SQUAMOUSvfCELLvfCARCINOMAvf(SCC)
SCCvfisvfthevf2ndvfmostvfcommonvfeyelidvfcancervfbutvfitvfisvf40-50x'svflessvfcommonvfthanvfBasalvfCellvfCarcinomavf(BCC
Whichvflidvflesionvfisvfoftenvfmistakenvfforvfavfrecurrentvfchalazion?vf-vfanswer--SebaceousvfCellvfCarcinoma
Thisvftumorvfmostvfcommonlyvfarisesvffromvfthevfmeibomianvfglandsvfandvfisvftypicallyvfyellow,vfhardvfandvfonvfthevfupperv
elid
Whichvflayervfofvfthevfskinvfdoesvfbasalvfcellvfcarcinomavf(BCC)vfaffect?
vfWhichvflayervfofvfthevfskinvfdoesvfsquamousvfcellvfcarcinomavf(SCC)vfaffect?vf-vfanswer--
BCCvfaffectsvfthevfstratumvfbasalvflayer.
SCCvfaffectsvfthevfstratumvfspinosumvflayer.
Whatvftypevfofvftumorvfdoesvfactinicvfkeratosisvfbecome?vf-vfanswer--
ACTINICvfKERATOSISvf=vfSQUAMOUSvfCELLvfCARCINOMA.vfActinicvfkeratosisvfisvfavfscaley,vfpink/
redvfpremalignantvflesionvfthatvfwillvfbecomevf(ifvfnotvfremoved)vfsquamousvfcellvfcarcinoma.vfAlthoughvfSCCvfandvfBCCv
avevfavfsimilarvfappearance,vfBCCvfdiffersvfinvfthatvfitvftypicallyvfhasvfsurfacevftelangiectasia.vfThevfclassicvfappearancevff
fBCCvfisvfavfshiny,vffirmvfnodulevfwithvfsuperficialvftelangiectasia.vfFinally,vfremembervfthatvfSCCvfisvfmorevflikelyvftovfunde
ovfmetastasisvf(upvftovf24%)vfasvfcomparedvftovfBCC.
WhatvfdoesvfBCCvftypicallyvflookvflikevfinvfthevfadvancedvfstagesvfofvfthevfcancer?vf-vfanswer--RodentvfUlcer
Whichvfnasolacrimalvfdrainagevfdisordervfcausesvfthevfappearancevfofvfavf"poutingvfpuncta?"vf-vfanswer--
CANALICULITIS
Thevfpunctavfwillvfappearvfswollenvfandvfmucopurulentvfdischargevfcanvfbevfexpressedvf(thruvfthevfpuncta)vfaftervfpalpatin
fthevflacrimalvfsac.vfThesevfpatientsvfclassicallyvfhavevfavfunilateralvfredvf(nasalvfconj)vfeyevfwithvffrequentvfrecurrences.vfP
1vf/
vf1
Whatvfisvfthevfdifferencevfinvfetiologyvfbetweenvfavfcornealvfabrasionvfandvfcornealvferosion?vf-vfanswer--
CornealvfAbrasion:vfRecallvfthatvfcornealvfabrasions,vfbyvfdefinition,vfarevfALWAYSvffromvfTRAUMA.vfThevfmostvfcommo
freasonvfforvfavfcornealvfabrasionvfisvfavfFINGERNAILvfINJURY.vfIfvfyouvfhavevfyoungvfchildrenvfyouvfunderstandvfwhy!
CornealvfErosion:vfOncevfthevfabrasionvfhasvfhealedvfthevfpatientvfisvfnowvfatvfriskvfforvfavfcornealvferosionvfforvfthevfrestvfof
heirvflife.vfCornealvferosionsvfoccurvfinvfpatientsvfwithvfpastvfcornealvfabrasionsvf(e.g.vftrauma)vfandvfthosevfwithvfepithelia
ystrophiesvf(mostvfcommonlyvfEBMD).
Whatvfisvfthevfmostvfcommonvfcornealvfdystrophy?vf-vfanswer--
It'svfnotvfevenvfclose.....vfEBMD.vfSo,vfwhenvfwevfsayvfthatvfcornealvferosionsvfhappenvfinvfpatientsvfwithvfepithelialvfdystro
ies,vfwevfarevfalmostvfalwaysvfreferringvftovfEBMD
WhatvfisvfVossiusvfRing?vfWhatvfdoesvfavfpositivevfSeidel'svfsignvfindicate?vf-vfanswer--
Vossiusvfring:vfaftervfcornealvftraumavfthevfirisvfcanvfbevfpushedvfposteriorlyvfandvfcanvfmakevfcontactvfwithvfthevflens.vfAsv
resultvfavfringvfofvfpigmentvf(wherevfthevfirisvfcontactedvfthevflens)vfcanvfremain;vfthisvfisvfcalledvfvossiusvfring.vfAsvfavfbuzzv
rasevfforvfthevfexam....vfVOSSIUSvfRINGvf=vfTRAUMA.
Seidel'svfsign:vfAvfwoundvfleakvfisvfpresentvfifvfSeidel'svfsignvfisvfpositive.vfIfvfavfleakvfexists,thevffluoresceinvfdyevfwillvfappe
vfasvfavfdarkvf(dilutedvfbyvfthevfaqueous)vfstreamvfwithinvfthevfgreenvfdyevfofvfthevftears.
Whatvfisvfthevfmostvfcommonvfreasonvfforvflensvfsubluxation?
A)vfMarfan'svfsyndrome
B)vfTrauma
C)vfHomocystinuria
D)vfEhlers-DanlosvfSyndrome
E)vfWeill-MarhesanivfSyndromevf-vfanswer--Trauma
TraumavfisvfthevfNo.vf1vfcausevfofvflensvfsubluxation.vfMakevfsurevfyouvfknowvfthevfothervfoptionsvflistedvfabove....vfallvfofvft
sevfoptionsvfcanvfcausevflensvfsubluxation.vfMostvfofvfyouvfwouldvfcorrectlyvfstatevfthatvfMarfan'svfSyndromevfisvfavfcommo
fcause,vfbutvfbevfsurevftovftakevfavfminutevforvftwovftovfmemorizevfthevfothervfthreevfconditionsvfthatvfyouvfshouldvfalsovfasso
atevfwithvfthisvfcomplication.
Namevfthevf5vfmostvfcommonvfreasonsvfforvflensvfsubluxationvf-vfanswer--Trauma
Marfan'svfSyndrome
Honocystinuria
Ehlers-DanlosvfSyndrome
Weill-MarhesanivfSyndrome
Whatvfisvfavfhyphema?vfWhatvfisvfthevfmostvfcommonvfcausevfofvfnon-traumavfrelatedvfhyphemas?vf-vfanswer--
Hyphemavfisvfbloodvfinvfthevfanteriorvfchamber.vfRecallvfthatvfthevfbloodvfinvfavfhyphemavfisvffromvfthevfirisvfand/
orvfciliaryvfbody.vf
NSAIDvf(e.g.vfaspirin,vfibuprofen)vfuse,vfbloodvfclottingvfdisordervf(e.g.vfsicklevfcellvfanemia)vfisvfoftenvfthevfcausevfinvfavfno
traumavfrelatedvfhyphema.
WhyvfwouldvfavfB-scanvfbevfindicatedvfinvfavfpatientvfwithvfanvf8-ballvfhyphema?vf-vfanswer--8-
ballvfhyphemavfmeansvfthatvfthevfentirevfanteriorvfchambervfisvffullvfofvfblood.vfThus,vfnovfviewvfofvfthevfposteriorvfchamber
ouldvfbevfpossible.vfYouvfshouldvfassociatevfthevfusevfofvfB-scanvfwithvftwovfmainvfscenarios
1vf/
vf1
,vfTovfviewvfposteriorvfsegmentvfwhenvfmediavfopacitiesvf(e.g.vfdensevfcataracts)vforvfothervfpathologyvf(vitreousvfhemorrh
ge,vfforvfexample)vfdovfnotvfallowvfanvfadequatevfview.vf
vfTovfaidvfinvfdiagnosisvfofvfopticvfnervevfdrusen.
Remember,vfA-
scansvfarevfusedvftovfmeasurevfaxialvflength;vfavfpopularvfusevfisvfforvfcalculationvfofvfIOLvfpowervfforvfcataractvfsurgery.vfB
scanvfforvfblockedvffundusvfandvfONHvfdrusen.
Whatvfisvfcrepitus?vf-vfanswer--CRepitusvfrefersvftovfthevfCRackling,vfrattle-
likevfnoisevfthatvfcanvfoccurvfwhenvftwovffracturesvfbonesvfrubvfagainstvfonevfanother.vfAftervfanvforbitalvfwallvffracturevfpat
tsvfshouldvfbevftoldvfNOTvftovfblowvftheirvfnosevfforvfatvfleastvf48vfhrsvffollowingvfthevfincident.vfBlowingvfthevfnosevfincrease
pressurevfwithinvfthevfareavfofvftraumavfandvfcanvffurthervfbleadingvfandvfinflammation;vfthevfcracklingvfsignvfofvfcrepitusvfa
ovfincreasesvfduringvfnosevfblowing.
Onvfthevfexam....vfCREPITUSvf=vforbitalvfwallvffracture
Whichvfwallvfisvfmostvflikelyvftovffracturevfwithvftrauma?vf-vfanswer--Floor.vfMorevfspecifically,vfthevfposterior-
medialvfportionvfofvfthevffloor.vfMaxillaryvfbonevfwithinvfthevffloorvfisvfthevfmostvflikelyvfbonevftovffracture.
Whatvfisvfthevfthinnestvfbonevfinvfthevforbit?vf-vfanswer--Ethmoid
Whatvfisvfthevfweakestvfbonevfinvfthevforbit?vf-vfanswer--Maxillary
Whatvfisvfmucormycosis?vf-vfanswer--Avflife-threateningvfFUNGALvfinfectionvfthatvfcanvfoccurvfinvfDIABETICSvfand/
orvfIMMUNOCOMPROMISEDvfpatientsvfwithvforbitalvfcellulitis.
Whatvfconditionvfresultsvfinvfthevfclassicvfpatientvfcomplaintvfofvfpainvfinvfthevfmorningvfaftervfopeningvfthevfeyes?vf-
vfanswer--Recurrent vfcornealvferosion
Whichvfofvfthevffolllowingvfisvfthevfmostvfcommonvfprimaryvfpediatricvforbitalvfmalignancy?
A)vfRhabdomyosarcoma
B)vfNeuroblastoma
C)vfCapillaryvfHemangioma
D)vfCavernousvfHemangiomavf-vfanswer--Recallvfthatvfprimaryvfindicatesvfthevftumorvfbeganvfinvfthevforbit.
A)vfRhabdomyosarcomavf=vfrapidvfbonevfdestructingvftumor.
Whatvfisvfthevfmostvfcommonvforbitalvftumorvfinvfchildren?vf-vfanswer--
CapillaryvfHemangioma:vfbenign,vflookvfforvfdeprivationvfambylopia
Whatvfisvfthevfmostvfcommonvforbitalvftumorvfinvfadults?vf-vfanswer--CavernousvfHemangioma
Whatvfisvfthevfmostvfcommonvfsecondaryvfmetastaticvfpediatricvftumor?vf-vfanswer--
Neuroblastomavf=vfmalignant.vfThevftumorvfcommonlyvfarisesvffromvfthevfabdomen,vfsovfthesevfpatientsvfarevfinvftypically
nvfpoorvfsystemicvfhealth.
Whatvfconditionvfclassicallyvfresultsvfinvfbilateral,vfPERIORBITALvfswellingvfofvfthevfeyelidsvfandvfisvftypicallyvfassociated
withvfswitchingvfcosmetics,vfallergicvfirritants,vforvfrecentvfinstillationvfofvfeyevfdrops?
vfHint:vfonsetvfofvfsymptomsvftypicallyvfoccursvfwithinvf24-48vfhoursvfofvfirritantvfexposure).vf-vfanswer--
CONTACTvfDERMATITIS
1vf/
vf1
,Periorbitalvfswellingvfisvfassociatedvfwithvfcontactvfdermatitis.vfIfvftheyvfaskvfavfquestionvfonvfboardsvfaboutvfavfpatientvfrec
tlyvfswitchingvfcosmeticsvf(eyelinervfforvfexample)vfwithvfallergic-
typevfsymptomsvf(e.g.vfconjunctivalvfchemosis),vfcontactvfdermatitisvfshouldvfbevfhighvfonvfyourvflistvfofvfdifferentials.
-RecallvfthatvfthisvfconditionvfresultsvffromvfavfType-4vfDELAYEDvfhypersensitivityvfreactionvf(seevfHintvfabove).
-Remember,vfconjunctivalvfchemosisvfisvfavfphrasevfyouvfshouldvfimmediatelyvfassociatevfwithvfALLERGYvfonvfthevfexam
Whatvfisvfankyloblepharon?vfNamevfavfconditionvfwherevfthisvfsignvfisvffound?vf-vfanswer--
ANKYLOBLEPHARONvfandvfSYMBLEPHARONvfarevfthevftwovfmainvfsignsvffoundvfinvfPEMPHIGOID,vfavfconditionvftha
svfmostvfcommonvfinvffemalesvf60vfyrsvfandvfolder.
Ankyloblepharonvfoccursvfwhenvfthevfoutervfeyelidsvfbecomevfstuckvftogether.vfSymblepharonvfoccursvfwhenvfthevfbulba
andvfpalpebralvfconjunctivavfbecomevfstuckvftogether.
RecallvfthatvfpemphigoidvfisvfanvfidiopathicvfconditionvfthatvfattacksvfMUCOUSvfMEMBRANES;vfthevfeyevfisvfavfnaturalvfp
cevfforvfattackvfconsideringvfthevfmucousvfsurfacevfofvfthevforbitalvfandvfpalpebralvfconjunctiva.
Whatvfarevfthevftwovfmainvfsignsvffoundvfinvfpemphigoid?vf-vfanswer--Ankyloblepharonvfandvfsymblepharon.
Whatvfarevfthevfthreevfocularvfconditionsvfassociatedvfwithvfmucousvfmembranevfdamage?vf-vfanswer--1)vfPemphigoid
2)vfBechet'svfDiseasevf(mouthvfulcersvfwithvfuveitis)
3)vfStevenvfJohnson'svfSyndrome
Whatvfisvfthevfdifferencevfbetweenvfanvfexternalvfhordeolumvfandvfanvfinternalvfhordeolum?vf-vfanswer--
ExternalvfhordeolumsvfaffectvfglandsvfofvfZeisvfand/orvfMoll.
vfInternalvfhordeolumsvfaffectvfmeibomianvfglands.
WhatvfisvfthevffunctionvfofvfthevfglandsvfofvfZeis?vf-vfanswer--Lubricationvfofvfthevfeyelashes
WhatvfisvfthevffunctionvfofvfthevfglandsvfofvfMoll?vf-vfanswer--sweatvfglands
Namevfallvfofvfthevfcontributorsvftovfthevflipidvflayervfofvfthevftearvffilm?vf-vfanswer--
Meibomianvfglands,vfGlandsvfofvfZeis,vfGlandsvfofvfMoll.vfRemember,vfalthoughvfmeibomianvfglandsvfarevfthevfprimaryvfc
tributorsvftovfthevflipidvflayervfofvfthevftearvffilm,vfZeisvfandvfMollvfglandsvfalsovfprovidevfassistancevfwithvflipidvfproduction.
Whichvfofvfthevffollowingvfisvfthevfmostvfcommonvfetiologyvfforvfectropion?
A)vfInvolutional
B)vfFacialvfNervevfPalsy
C)vfCicatricialvf-vfanswer--Involutional
InvolutionalvfindicatesvfthatvfthevfconditionvfisvfAGE-
RELATED.vfRemembervfthatvfthevfFacialvfNervevf(CNvfVII)vfisvfresponsiblevfforvfinnervatingvfthevforbicularisvfoculi,vfthevfm
sclevfthatvfallowsvfforvfeyelidvfclosure.vfBell'svfPalsyvfisvfavfconditionvfthatvfaffectsvfthevflowervfportionvfofvfCNvfVII;vfpoorvfinn
vationvftovfthisvfmusculaturevfleadsvftovfectropionvfandvfsubsequentvfcornealvfexposurevfissues.
Whatvfisvfthevfleadingvfcausevfofvfinfectiousvfblindnessvfinvfthevfworld?vf-vfanswer--Trachoma.vfRecallvfthatvftrA-
ChomavfresultsvffromvfchlamydiavfserotypesvfA-C.
Whyvfdovfpeoplevfgovfblindvffromvftrachoma?vf-vfanswer--Entropion
Canvfyouvfdefinevfthevffollowingvfterms?
A)vfTrichiasis
B)vfDistichiasis
1vf/
vf1
,C)vfPoliosis
D)vfMadarosisvf-vfanswer--Trichiasisvf-vfturningvfinwardvfofvfeyelashes
Distichiasisvf-vftwovfrowsvfofvfeyelashesvf(occursvfwhenvf2ndvfrowvfarisesvfnearvfmeibomianvfglandvfopenings)
Poliosisvf-vfwhiteningvfofvfeyelashes
Madarosisvf-vflossvfofvfeyelashes
WhatvfdovfBlepharospasmvfandvfMyokymiavfhavevfinvfcommon?vf-vfanswer--
BothvfconditionsvfaffectvfORBICULARISvfOCULIvfmusculature.vfMyokymiavfONLYvfaffectsvfthevforbicularisvfoculi;vfBlep
rospamvfaffectsvfthreevfmusclesvf-vfthevforbicularisvfoculi,vfprocerusvfandvfcorrugatorvfmusculature.
RecallvfthatvfBLEPHAROSPASMvf=vfBILATERALvfTWITCHINGvfthatvfprogressesvftovfeyelidvfclosure.
MYOKYMIAvf=vfUNILATERALvfTWITCHING.
Youvfwillvfhavevflotsvfofvfpatientsvfinvfclinicalvfpracticevfwhovfreportvftwitchingvfofvfthevfeyelid.vfImmediatelyvfaskvfifvfthevftwit
ngvfisvfunilateralvforvfbilateral.vfIvfhavevfnevervfheardvfavfpatientvfsayvfbilateralvf(b/
cvfblepharospasmvfisvfextremelyvfrare!).vfForvfmyokymia,vfaskvfaboutvfthevffollowing...vfallvfofvfwhichvfarevfcommonvfcause
ofvfthevfcondition:
vfIncreasevfinvfcaffeinevfintake?
vfIncreasevfinvfstressvfatvfhomevfand/orvfwork?
vfLessvfsleepvfasvfofvflate?
WhatvfisvfMeige'svfSyndrome?vf-vfanswer--
Thisvfisvfthevfconditionvfcharacterizedvfbyvfbenignvfessentialvfblepharospasmvfcombinedvfwithvflowervffacialvfabnormaliti
f(difficultiesvfchewing,vfopeningvfmouth,vfetc).
Whatvfisvfthevf2ndvfmostvfcommonvfeyelidvfcancer?vf-vfanswer--SQUAMOUSvfCELLvfCARCINOMAvf(SCC)
SCCvfisvfthevf2ndvfmostvfcommonvfeyelidvfcancervfbutvfitvfisvf40-50x'svflessvfcommonvfthanvfBasalvfCellvfCarcinomavf(BCC
Whichvflidvflesionvfisvfoftenvfmistakenvfforvfavfrecurrentvfchalazion?vf-vfanswer--SebaceousvfCellvfCarcinoma
Thisvftumorvfmostvfcommonlyvfarisesvffromvfthevfmeibomianvfglandsvfandvfisvftypicallyvfyellow,vfhardvfandvfonvfthevfupperv
elid
Whichvflayervfofvfthevfskinvfdoesvfbasalvfcellvfcarcinomavf(BCC)vfaffect?
vfWhichvflayervfofvfthevfskinvfdoesvfsquamousvfcellvfcarcinomavf(SCC)vfaffect?vf-vfanswer--
BCCvfaffectsvfthevfstratumvfbasalvflayer.
SCCvfaffectsvfthevfstratumvfspinosumvflayer.
Whatvftypevfofvftumorvfdoesvfactinicvfkeratosisvfbecome?vf-vfanswer--
ACTINICvfKERATOSISvf=vfSQUAMOUSvfCELLvfCARCINOMA.vfActinicvfkeratosisvfisvfavfscaley,vfpink/
redvfpremalignantvflesionvfthatvfwillvfbecomevf(ifvfnotvfremoved)vfsquamousvfcellvfcarcinoma.vfAlthoughvfSCCvfandvfBCCv
avevfavfsimilarvfappearance,vfBCCvfdiffersvfinvfthatvfitvftypicallyvfhasvfsurfacevftelangiectasia.vfThevfclassicvfappearancevff
fBCCvfisvfavfshiny,vffirmvfnodulevfwithvfsuperficialvftelangiectasia.vfFinally,vfremembervfthatvfSCCvfisvfmorevflikelyvftovfunde
ovfmetastasisvf(upvftovf24%)vfasvfcomparedvftovfBCC.
WhatvfdoesvfBCCvftypicallyvflookvflikevfinvfthevfadvancedvfstagesvfofvfthevfcancer?vf-vfanswer--RodentvfUlcer
Whichvfnasolacrimalvfdrainagevfdisordervfcausesvfthevfappearancevfofvfavf"poutingvfpuncta?"vf-vfanswer--
CANALICULITIS
Thevfpunctavfwillvfappearvfswollenvfandvfmucopurulentvfdischargevfcanvfbevfexpressedvf(thruvfthevfpuncta)vfaftervfpalpatin
fthevflacrimalvfsac.vfThesevfpatientsvfclassicallyvfhavevfavfunilateralvfredvf(nasalvfconj)vfeyevfwithvffrequentvfrecurrences.vfP
1vf/
vf1
