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Treatment fo Herpes Simplex
- Topical Tx
- Viroptic
- Topical Trifluridine 1gtt q2h X 7 days untilled healed then possible QID x 7 days - Zirgan Topical Granciclovir gel .0.15% 1gtt 5 x/day-till resolution. Then TID x 7days
- Systemic Tx
- Zovirax- Acyclovir- 400mg 5x/day for 7-10 days
- Valtrex - Valacylovir - 500 mg TID for 7-10 days
- Famvir - Famciclovir - 250 mg TID for 7-10 days
- HEDS II - Showed that oral acyclovir - ZOVIRAX DOSE BID X 1 YEAR REDUSED THE RATE OF OF RECURRENCE ON ANY FORM OF OCULAR HERPES IN THE FOLLOWING YEAR BY 41%STEROID USE IN
- A. DISCIFORM KERATITIS
- B. OTHER STROMAL INFLAMATION
- C. HERPETIC IRITIS
- ASSUME DENDRITIC LESIONS REASONABLY HEALED
- DNA virus
- latent in the sensory gaglia
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Herpes Zoster Ophthalmics
- Varicella Viris=Chicken Pox
- 70% infected in the 1st division of the 5th cranial nerve
- TX DOSING ORAL
- Zovirax=Acyclovir 800mg 5x/day for 7-10days
- Valtrex=Valacylovir 1000mg TID for 7-10 days
- Famvir=Famciclobir 500mg TID for 7-10 days
- Pesudodendrites, difusse staining
- tends to follow a single nerve branch
- see pts on alternate days untill inflamation subsides
- start tx within 48hrs
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Most common in Utero Infections
- TORCH
- Toxoplasmosis (Cat)
- Rubella
- Cytomegalovirus (herpies type)
- Herpes Virus
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Increase Plasma Homocysteine
- Common in Pseudoexfoliative glaucoma
- Higher risk of cardiovascular disease
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DSAEK
Descemets' Stripping Automated Endothelial Keratoplasty
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DMEK
Descemet membrane endothelial keratoplasty
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DSEK
Descemet’s Stripping Endothelial Keratoplasty.
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Histoplasmosis
Histoplasma Capsulatum Fungus (Birds, Bats)
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Uvea
- 3 Vascularized layers
- 1. Choroid
- a. Outer most large vessels (Haller's layer)
- b. Medial medium vessels (Sattler's layer)
- c. Inner - nourishes the RPE and outerRetinal layers
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Bruch's Membrane
between the basement membrane of the choriocapillaris and basement membrane of the RPE
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IRIS
Muscle
- 1. Sphincter-constriction-parasympathetic innervationm body at rest
- 2. Dilator - sympathetic flight or fight
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10 layers of Neurosensory Retina
list outside next to choroid to inner next to vitreous
- 1. Pigmented epithelium,
- 2. Photoreceptors; bacillary layer (outer and inner segments of cone and rod photoreceptors)
- 3. External (outer) limiting membrane
- 4. Outer nuclear (cell bodies of cones and rods)
- 5. Outer plexiform (cone and rod axons, horizontal cell dendrites, bipolar dendrites)
- 6. Inner nuclear (nuclei of horizontal cells, bipolar cells, amacrine cells, and Müller cells)
- 7. Inner plexiform (axons of bipolar cells and amacrine cells, dendrites of ganglion cells)
- 8. Ganglion cells (nuclei of ganglion cells and displaced amacrine cells)
- 9. Nerve fiber layer (axons from ganglion cells traversing the retina to leave the eye at the optic disc)
- 10. Internal limiting membrane (separates the retina from the vitreous).
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Anti-VEGF
2 types
- Anti-Vascular endothelial growth factor (VEGF)
- 1. Bevacizumab (Avastin)
- 2. Ranibizumab (Lucentis)
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Avastin
- Generic name: Bevacizumab
- Not approved for wet AMD
- larger molecules
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Lucentis
- Generic name: Ranibizumab
- smaller molecules
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Best's Disease
- Vitelliform Macular Dystrophyis an autosomal dominant disorder, which classically presents in childhood with the striking appearance of a yellow or orange yolk like lesion in the macula
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IOP
- highest pressure for all patients occured while they were sleeping
- Likely due to elevation of episcleral venious pressure which causes a backup of the aqueous drainage system
- Supine iopduring office hours is about the same as peak nocturnal IOP in glaucoma patients
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Horner's
- Miosis of the affected pupil
- Ptosis of upper lid
- upside down ptosis of the lower lid
- anhydrosis of the affected side-decrease sweating
- heterochromia of the iris- Congenital -affected eye
- decrease IOP affected side
- a clinical syndrome caused by damage to the sympathetic nervous system
- lack of sympathetic stimulation Paredrine Apraclondine 0.5% and Iopidine 1% can be used to stimulate the alpha 1 receptors which will cause the affected eye to dilate
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AION
Anterior Ischemic Optic Neuropathy
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A measurement
= eyesize, reference to frame size. is the longest horzonital measurement from one end of the rim to the other
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Frame PD
A measure + the bridge measure
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B measurement
vertical height of the frame
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ED measure
Longest diagonal measure
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Back Vertex Power
F v= F 2 + F 1 / 1-thickness / n (F)
- Fv =vertex power
- F1 = front suface power
- F2 = back surface power
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Far Point
x = 1/F
- x =distance from cornea
- F = power of correcting lens
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Simple Astigmatism
Coumpound Astigmatism
MIxed Astigmatism
- example: +2.00-2.00x135
- example: +4.00-2.00x135
- example: +3.00-4.00x135
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With The Rule Astigmatism
Against The Rule Astigmatism
Axis of The Rx is 1800 + or - 300
Axis of The Rx is 0900 + or - 300
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Prentice's Rule
Amount Prism = cm ( F)
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Power in Oblique Meridian
- F in power of meridian = Fs sphere power + Fc power of the cylinder (sin2 of the angle)
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If you put Pantoscopic tilt on a Minus lenes with
axis 180
Get induced minus cylinder
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Put Face Form on a Minus lens
axis 090
Get induced cylinder
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If you put Pantoscopic tilt on a plus lenes with
axis 090
Get induced minus cylinder
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Put Face Form on a Plus lens
axis 180
Get induced minus cylinder
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Duochrome Test
RAM -GAP
VA 20/30 OR BETTER
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Base cure of a Lens is where?
- Sphere: is front of lens
- Plus Cylinder: is the flatter of the front (toric) surface curves
- Minus cylinder: is the front sphere curve, the back flatter curve is called the toric base curve. The other back curve is called the cross curve.
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The abberations of most concern in ophthalmic lenses
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Oblique astigmatism
- Curvature of field
- Distortion
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