D. Chlamydia is the leading cause of ophthalmia neonatorum in the US. HSV and gonorrhea may also lead to development of this condition.

D. Cluster headaches are characterized by periods of attacks that occur for several weeks before going into remission. These headaches most commonly affect males between the ages of 30 and 50 years. These headaches can be accompanied with red eyes, nasal congestion, and transient or permanent Horner’s syndrome.

D. Demodex folliculorum and D. brevis are the most common mites found on the human eye lash. Phthirus and pediculus are parasites that are contagious and easily spread. If seen in children it is a red flag! Molluscum, a DNA pox virus, is a viral infection of the skin common in children and immunocompromised patients.

D. The image is displaced 9 cm to the left. The equation for this example is PrismPower = image displacement (in cm)/distance to screen (in m). This is why the answer is in centimeters. Next, we note that a prism moves images towards its apex. When the base is positioned to the right, the image moves to the left.

B. Macugen is an anti-neoplastic agent that prevents angiogenesis through inhibition of VEGF. PEDF has the opposite effect and is required to be in the proper balance of concentration as VEGF.

D. The fine yellow-white rings of crystals in Schnyder’s are composed of cholesterol. Macular Dystrophy presents with multiple gray-white opacities composed of mucopolysaccharides. Granular Dystrophy presents with snowflake granules composed of hyaline. Lattice Dystrophy presents with lattice-like branches of amyloid. Calcium is associated with Band K, which affects Bowman’s layer.

B. Cavernous hemangioma is the most common benign orbital tumor in adults. Cavernous hemangiomas develop slowly and lead to unilateral proptosis. Capillary hemangiomas are the most common benign orbital tumor in CHILDREN.

D. This patient has Ankylosing Spondylitis – an inflammatory condition that causes sacroiliitis in young males that improves with exercise. AS is the most common cause of acute, unilateral anterior nongranulomatous uveitis. You can recall the UCRAP conditions as the most common causes of acute, unilateral anterior nongranulomatous uveitis and for their association with HLA-B27. The last option refers to sarcoidosis – causes chronic, bilateral granulomatous anterior uveitis.

C/D: CAIs are known for several side effects. The most important to note include: metabolic acidosis, aplastic anemia, myopia shifts, bone marrow suppression, and depression. Other SE include metallic taste, tingling of limbs, thrombocytopenia, ED, and anorexia.

D. Hyperthyroidism is characterized by elevated levels of T3/T4 hormones and low levels of TSH. This condition is caused by constant thyroid stimulation leading to increased production of T3/T4. Elevated levels of T3/T4 inhibits the production of TSH by the thyroid gland leading to decreased levels of TSH.

A: Involutional, or aging, is the most common cause of entropion (an inward turning of the eyelid). Other causes include mechanical (tumor), cicatricial (trachoma, Stevens-Johnson, chemical burns), or congenital.

D. Rheumatoid arthritis is not expected in Primary Sjogren’s syndrome. Primary Sjogren’s syndrome is defined as dry eye, dry mouth, and presence of autoantibodies. To diagnosis Secondary Sjogren’s, a patient must present with all the previous findings AND an autoimmune disease such as RA, SLE, and other connective tissues diseases.

A/B/D. PG analogs, alpha agonists, and pilocarpine (a direct cholinergic agonist) all lower IOP by increasing aqueous outflow.

A. Dilation withOUT cycloplegia. Phenylephrine is an adrenergic agonist that causes dilation with no effect on ciliary muscles. When used to differentiate, vessels will become blanched with episcleritis. With diagnosis of Horner’s Syndrome, it helps determine if lesion is pre- or post ganglionic. 10% Phenyl is used to break old or severe PAS.

C. Fabry’s disease is associated with development of verticillata, also known as whorl or vortex keratopathy. Several medications (recall CHAI-T) as well as the condition sphingolipidoses can cause verticillata as well.

D. Osteogenesis imperfecta is not correlated with angioid streaks. Recall PEPSI as the most common causes of angioid streaks. Pseudoxanthoma elasticum, Ehlers-Danlos syndrome, Paget’s Disease, Sickle-cell disease, and idiopathic.

D. Rods take about 30-40 minutes for complete dark adaptation. Cones take about 5-10 minutes for light adaptation.

E. Cortical cataracts have been associated with hyperopic shifts in vision. Cerulean cataracts are congenital and present as small, blue-green opacities that rarely affect vision. Nuclear sclerosis is the most common aging cataract and most often leads to a myopic shift as the lens swells. Rosette cataracts are caused by trauma. PSC cataracts lead to reduced vision at distance and near, worse while reading with constricted pupils.

A. 10 pd BI. As we are calculating the prism necessary for exophoria, it is recommended to use Sheard’s Criterion. The equation is Prism = ⅔ Phoria – ⅓ Compensating Fusional Vergence. In this case, the phoria is 18Δ and the compensating fusional vergence (positive fusional vergence for exophoric patients) is the blur point of the BO measurement. To alleviate phoria we expect to move images to the fovea. Therefore the 10Δ will be BI. Remember this is total and NOT per eye.

A: Toxoplasmosis is the most common cause of posterior uveitis. Toxoplasmosis presents with unilateral vitritis in presence of a yellow-white retinal lesion near an old inactive scar. When looking within the eye, findings appear as “headlights in the fog”. Other conditions listed also lead to development of posterior uveitis.

C. Rifampin, a drug used in the treatment of Tuberculosis, is known to cause orange-pink discoloration of tears and urine.

A. Age is the most highly associated risk factor for hypertension. The remaining options are also risk factors.

A. +6.00. Recall Kestenbaum’s Rule when determining initial ADD power. In this case, BCVA is 20/120. Therefore starting ADD is 120/20 = +6.00 D.

D: The Scleral Spur is the origin of the longitudinal muscle fibers. The muscle inserts into the anterior choroid.

D. Optic disc drusen are HYPERreflective on B scan ultrasound.

B/C. Sumatriptan, a drug commonly used as a therapy for Migraines, functions as an anti-inflammatory and vasoconstrictor. Sumatriptan is an agonist of 5-HT1B and 1D receptors.

B. A tumor that causes compression of both the posterior and middle cerebral arteries is most likely to cause a macula-only homonymous hemianopsia. The macular center of the occipital lobe is superficial and fed by both arteries. Vascular events often only damage one of the sources, thus leading to macular sparing homonymous hemianopsia.

B. Accommodative esotropia is the most likely diagnosis at this time. There are a few pieces of information that are key. First, the infant is demonstrating an eye turn some of the time. This means there is either a stimulus to the eye turn or it may be a decompensated phoria. The second piece of evidence is the orthophoric position with +3.00D lenses. This indicates that when accommodation demand is low, the eye turn is not present (or reduced).

C. Presence of a halo is a positive sign and will steer diagnosis towards benign. To recall, remember the phrase “To Find Small Ocular Melanomas, Use Helpful Hints Daily”: Thickness (elevation >2mm), Fluid (subretinal), Symptoms, Orange pigment (lipofuscin), Margins are irregular, Ultrasound Hollowness, Halo absence, Drusen present.

A,C,E: Note the sizes above. Bowman’s is about 10um and Descemet’s begins at 5um and increases to about 15um with age.

A/B/C. Topamax, Carbonic Anhydrase Inhibitors, and Pilocarpine are all known to carry the risk of myopic shift.

C. Myasthenia gravis is caused by antibodies that target acetylcholine receptors. This condition leads to reduced muscle innervation over the course of a day leading to symptoms worse at night. Ocular findings include ptosis and diplopia. Recall the ice pack test and tensilon (Edrophonium) test.

A. Trifluridine, also known as Viroptic, contains Thimerosal – a mercury-based preservative found in drops. The remaining options are oral medications used in treatment of herpes virus.

A. Macular dystrophy is the only corneal dystrophy that is autosomal recessive. The rest of the options are autosomal dominant.

B. An increase in lens diameter will allow for better lid attachment. Flattening the base curve, decreasing center thickness to reduce weight, or changing to minus carrier design can help with lid attachment.

B. Between the CCB and the SCG. A lesion of the sympathetic pathway leads to development of Horner’s syndrome. These lesions can be defined by one of three regions: preganglionic central, preganglionic, and postganglionic. See answer choices for description.

D. Wold Sentence Copy is an example of a VMI test. The Beery VMI is another example. Piaget and Gardner, as well as Standing Angels in the Snow, are examples of tests of visual spatial skills. Visual analysis encompasses 6 sub-categories focused on analyzing images of different complexities.

C. Cephalosporins are safe to use during pregnancy. To recall, “She is not FATS, she is PACking a baby”. FATS are not safe to use during pregnancy and includes: Fluoroquinolones, Aminoglycosides, Tetracyclines, and Sulfonamides. PAC is safe to use and includes: Penicillins, Azithromycin (Macrolides), and Cephalosporins.

B. Pseudodendritic keratitis is a complication of Herpes Zoster Virus. One would expect to find dendritic keratitis in HSV. Dendrites appear as branching areas of staining on the cornea with terminal end bulbs. Use of Rose Bengal or Lissamine Green staining is important in this diagnosis. Recall that HSV can lead to development of follicles.

D. Muro 128 is used to reduce corneal edema in conditions such as Fuch’s. The remaining conditions can lead to ulceration of cornea with use of Muro 128.

B. Contact dermatitis is an example of a Type IV hypersensitivity reaction, also referred to as delayed or cell-mediated hypersensitivity. T-lymphocytes are the primary immune response in this type of reaction. Type I hypersensitivity uses IgE. Type II hypersensitivity is the more common IgM/IgG response. Type III hypersensitivity utilizes antigen/antibody complexes.

C. The calculated AC/A is 3.6. The equation of note is AC/A = PD(cm) + WD(m)[Phoria @ N – Phoria @ D]. When plugging in values, Exo is considered “-” and Eso is considered “+”. Therefore, AC/A = 6.4 + .4(-8-(-1)) = 3.6. CAREFUL that PD is in centimeters.

C. A patient diagnosed with T1DM should have a dilated fundus exam within 5 years of diagnosis. Patients diagnosed with T2DM are recommended to have a DFE upon diagnosis.

A. The entrance pupil is defined as the image of the aperture stop formed by all lenses in front of it. The exit pupil is the image of the aperture stop formed by all lenses behind it. An entrance port is the image of the field stop formed by all lenses in front of it. The image of the field stop formed by lenses behind it is known as the exit port.

E. Anterior iris epithelium – the rest of the options are composed of connective tissue

A. Heat intolerance is not associated with Hypothyroidism (low amounts of sympathetic innervation). Rather, the classic symptoms include COLD intolerance, weight gain, decreased appetite, weakness and lethargy.

E. Canaliculitis is most often caused by Actinomyces israelii. First signs include a pouting puncta, epiphora, and sulfur granular discharge.

A. ACTH (adrenocorticotropic hormone). ACTH secretion is diurnal and regulated by corticotropin releasing hormone. This secretion is increased during stress and highest in the morning.

D. The greatest threat to vision with chronic use of Plaquenil is Bull’s Eye Maculopathy.The mechanism of action is similar to that of steroids. Standard of care (DFE within 1 year of initiation of drug therapy) is as above, exception being a 24-2 for patients of Asian descent.

C. 1 mm of axial length corresponds to about 3 diopters. This emphasizes the importance of accurate A scan measurements prior to surgery.

B. Wernicke-Korsakoff Syndrome is caused by a deficiency of Vitamin B1 (thiamine). This condition is seen most commonly in alcoholics.

A. Limbal blanching indicates that the chemical burn has resulted in ischemia. Although the remaining options are of major importance, limbal blanching has the most long term consequences on the health of the eye.

C. Tryptophan is the sole precursor for the synthesis of serotonin. We acquire this amino acid through our diet only.

D. Latent hyperopia (refractive error that is correctable with accommodation) is +3.00 D. Manifest hyperopia (refractive error that is present in subjective refraction) is +4.00 D.

C. Timolol may mask the signs of HYPOglycemia in Diabetic patients. Timolol is also known to mask signs and symptoms of hypothyroidism as well as increasing symptoms of muscle weakness in patients with myasthenia gravis. Long term drift describes an increase of IOP after chronic use of Timolol. Short term escape is an initial lowering of IOP before no longer having an effect. D describes the “crossover” effect.

E. Vitamin C is soluble in water. To recall, “DEAK” are the four fat soluble vitamins.

A: The palpebral portion of the orbicularis oculi is responsible for spontaneous and reflex blinking. Voluntary blinking also includes the orbital portion of the orbicularis oculi

C. Along with Arlt’s lines other common findings in Trachoma include both follicular and papillary reactions of the palpebral conjunctiva, PAN, and potential SEIs. Dennie’s line are extra creases in adnexal skin in Atopic Dermatitis. Scheie’s line describes pigment in pigment dispersion syndrome. Stocker’s line represents the leading of a pterygium.The Hudson-Stahli line is iron deposition within the cornea that normally occurs with age.

B. Albuterol is a short acting Beta-2 agonist used as a rescue inhaler for Asthma and COPD. Other short acting agonists include Levalbuterol, Terbutaline, Metaproterenol (no longer used due to excessive cardiovascular effects) and Isoproterenol (nonspecific Beta agonist used in treatment of arrhythmias). Salmeterol is a long acting Beta-2 agonist used in maintenance therapy of the above conditions.

A. An INO is caused by a lesion of the medial longitudinal fasciculus (MLF). The MLF is responsible for coordinating the conjugate movement of eyes with associated head/neck movements. A lesion to the MLF causes an INO – loss of ipsilateral adduction and a contralateral nystagmus.

C. To the LEFT. Recall COWS – cold = opposite, warm = same. As we know nystagmus is named by the fast phase (not the slow fixation period). Thus, since the nystagmus is in the same direction with warm water, we know it is to the left.

A. Cobblestone papillae are found on the UPPER palpebral conjunctiva. VKC is a form of seasonal allergies that most often affects young males. These young males present with complaints of intense itching and photophobia. Slit lamp examination reveals cobblestone papillae of the upper lid, trantas dots with gelatinous masses at the limbus, and redness of the eye. In extreme cases, epithelial keratitis leads to thinning and eventual ulceration of cornea – a shield ulcer.

A,B,D: The classic triad of Neurofibromatosis 1 includes cafe au lait spots, neurofibromas, and iris Lisch nodules. It is important to examine a patient for these signs in the presence of at least one of these findings. Other findings may include optic nerve gliomas and congenital glaucoma.

B. First, calculate the BC of the DxCL → 337.5/7.67 = 44.00 D. The equation for lacrimal lake is LL = BC – K. In the 180 meridian, 44.00 – 44.50 = -0.50 D. In the 90 meridian, 44.00 – 43.00 = +1.00 D. Therefore, LL = +1.00 -1.50 x 090.

B. An optic nerve coloboma is caused by the incomplete closure of the fetal fissure during development. The degree of visual impairment varies depending on severity and location. The defect is most commonly located in the inferior nasal region of the disc.

B. Histoplasmosis does NOT cause vitritis. This is one major distinguishing factor when comparing to toxoplasmosis. Histoplasmosis is a fungal infection that is common to the Ohio-Mississippi River Valley.

B. Of the options, Scopolamine has the longest mydriatic effect. Recall, ASH CiTy for length of cycloplegia and mydriasis with the cholinergic antagonists.

C. The lesion is most likely located in the temporal lobe. To recall, think “pie in the sky”. If these findings were in the inferior field, it is suggestive of a lesion in the parietal lobe.

C. Aspirin use in children leads to the development of Reye’s syndrome – a rapid degenerative brain disease that is marked with confusion, seizures, and multi-organ failure.

C. Pyrimethamine is NOT used in treatment of Tuberculosis. It is important to note that Isoniazid and Rifampin can be used in isolation for treatment of Latent TB. Active TB is treated with a combination of the RIPE medications.

B. -4.08 D. You must first determine r by using the equation [Fair = -12.00 D = (1.50 – 1) / r]. You determine that r = -0.0417m. Using the new equation [Fwater = (1.50 – 1.33) / -0.0417m].

A. Metformin is the only known DM drug that does not cause hypoglycemia. For this reason, Metformin is considered first line therapy for T2DM.

C: The sclera is thinnest at recti muscle insertions with a thickness of about 0.3mm. The thickest is the posterior pole at about 1mm.

D. Using the LARS rule, the answer is -1.00 -1.00 x 085. The mark has rotated clockwise, or Left, so will need to add the 10 degrees to an axis. Most forget that we adjust the axis of the original subjective refraction rather than the diagnostic lens. Therefore, 85 is the new axis.

C. An aneurysm is the most likely cause of this CN3 palsy. The fixed, dilated pupil is indicative of a compressive CN 3 palsy. As the pupillary fibers course along the outside of cranial nerve 3, any growth, lesion, or pressure on the outside of the nerve will prevent the pupil from constricting. Vascular diseases affect the nerve from the inside and spare the pupillary fibers. HSV is more often correlated with Bell’s Palsy.

A. Naloxone, also known as Narcan, is administered to those experiencing an opioid overdose. Narcan acts as an opioid antagonist to reverse effects.

B. Involutional. The most common cause of ectropion is a laxity of the muscles needed to adhere the lid to the globe that develops with age. Congenital and Cicatricial are quite rare in occurrence. Paralytic ectropion is caused by Bell’s Palsy.

D. Purkinje image IV is the only image that is real and inverted. The remaining three are virtual and upright.

A/D. Both Ciprofloxacin and Ofloxacin are second generation Fluoroquinolones. Recall “CO2” for second generation and “Three LEVO clover” for third generation. There are no first generation Fluoroquinolones. This information is important as second generation target Gram Negative bacteria while later generations could be used to target both Negative and Positive.

A. The vestibulo-ocular reflex has the shortest latency of all eye movements with a latency of 15msec. The purpose of the VOR is to stabilize the retinal image as the head moves so it must occur quickly.

D. The power in the 180 meridian is -1.00. On an optical cross, +2.00DS falls on the 90 meridian. Subtract the astigmatic difference of -3.00 to find the resulting -1.00DS.

B. The minus lens test is the only option that does not measure accuracy but instead measures amplitude.

C. Bromocriptine, a dopamine agonist, is commonly used in treatment of Parkinsons. Amantadine is also considered a dopamine agonist used to treat Parkinsons.

D. Crossed diplopia. Recall that the right eye sees the red dots and the left eye sees the green dots. If the red dots were located to the right of the green, that is considered uncrossed (or ESO) diplopia. Red dots above or below the green are indicative of a hypertropia. A patient reporting only one set of lights indicates suppression of either eye. A report of 4 dots is what we hope for.

C. The power of the thin, Crown glass lens (n = 1.523) is -13.08 D. First draw a picture of this image (should look like two “C”s). First find F1 = (n2 – n1)/r, then F2 with the same equation. Done correctly will result in F1 = +13.075 D; F2 = -26.15 D; F = F1 + F2 → F = 13.075 + (-26.15) = -13.075 D.

B. Opsonization is the process by which complement proteins cover an antigen to initiate the immune system. Opsons alert the immune system to phagocytose the target cell.

C. The glycocalyx is found on the APICAL portion of the microvilli of the cornea. The glycocalyx is responsible for keeping the mucin layer adhered to the corneal surface.

B. According to Piaget, object permanence indicates the beginning of the pre-operational stage (2-7 years). There are four stages: sensorimotor (0-2 years), pre-operational (2-7 years), concrete operations (7-12), and formal operations (12 years and older). Object permanence is the knowledge that an object still exists even if it is not in the same room.

D. The correct answer is +1.00 -3.00 x 090. Although cylinder lines are cleared at -2.00 D, the difference between both meridians is the DC of the prescription.

B. Zidovudine, also known as Retrovir, inhibits the viral RNA-dependent, DNA polymerase responsible for reverse transcription. RIbavirin is used in treatment of Hepatitis C. Foscarnet is used in treatment of CMV that is not responding to other antivirals. Natamycin is an antifungal.

C. Sildenafil, also known as Viagra, functions by inhibiting phosphodiesterase-5 (PDE-5). PDE-5 breaks down cGMP which will lead to weakening of smooth muscle.

A,C,D: There are two definitions within the ANSI Z87.1 Safety Standard for Impact: high mass impact and high velocity impact. High mass impact is the drop ball test. This test requires a pointed projectile that weighs 500g dropped from 50 inches. The high velocity impact is assessed using a 0.25 inch diameter steel ball fired at 150 feet per second.

D. Sherrington’s Law states that reciprocal muscles in the SAME eye will both be innervated to provide stability of eye position and gaez. Hering’s law states that yoked muscles in both eyes will receive equal innervation. Donder’s and Listing’s refer to unique orientations of the eye in space and how the eye achieves these positions.

B. You can increase the seg height by any of the following: narrow the pads, move pads down, increase vertex distance, reduce pantoscopic tilt, or shrink the bridge. Consider the opposite in cases where the seg height appears too high.

B. End-point nystagmus is noted in extreme position of gaze. It is not noted at other times. Caloric nystagmus refers to the use of warm or cold water to induce eye movement. Optokinetic is related to viewing fast moving or rotating objects as the eye attempts to fixate a target. Rotational refers to rotation of the individual’s body. Latent refers to nystagmus that appears when one eye is occluded.

B. Polycarbonate has the lowest Abbe value of all these options. Abbe value is inversely proportional to the level of chromatic aberrations. In other words, the higher the Abbe value, a lower amount of chromatic aberrations will be induced.

C. The above most accurately describes Leber’s hereditary optic neuropathy – transmitted through maternal inheritance. A single AA base substitution can describe many conditions including, but not limited to, Sickle Cell anemia. Abnormal collagen synthesis may lead to changes in vision due to corneal malformation and weakness of lamina cribrosa. Neither Trisomy 21 (Down Syndrome) nor Turner Syndrome (absent X) are known to cause these findings.

C. Feq = +14.00 DS. To calculate, recall the equation Feq = F1 + F2 – cF1F2. As there is no separation in the equation, we simply calculate F1 + F2.

C. The true power is +7.47 D. To solve, first determine r using the clock reading: [Flc = +6.00 D = (1.53 – 1) / r; r = +0.08833m. Now solve for true with Flens = (1.66 – 1) / r = 0.66/0.08833 = +7.47 D)

A. Acetylcysteine, also known as Mucomyst, functions by breaking disulfide bonds. This medication is also used in treatment of severe dry eye disease and corneal burns.

B. The greatest threat to the patient’s vision is a CRAO. Elevated IOP leads to reversal of blood flow due to the change in perfusion pressure. Ischemic damage from CRAO is irreversible.

B. Minocycline may cause a blue sclera. Other causes of a blue sclera include Scleromalacia Perforans, chronic topical steroid use, and thin scleras in newborn infants.

D. The correct answer should be 60 since the clock dial equation is (lower number on the clock x30) which will give you in this case (2×30=60 degrees)

What is the Procedure of using a Lens Clock?
1) Multiply the smaller number (the lower number is always the number used in the clock dial equation) by 30 degree to find the orientation of the minus cylinder axis

B. It is imperative you DO NOT perform gonio or scleral depression until at least 1 month post-injury to avoid rebleeds. The most common cause of a hyphema is trauma so be sure to assess for iris sphincter tears, iridodialysis, rosette cataracts, lens subluxation, and other common traumatic findings.

E. Naloxone is not known to cause PTC (otherwise known as Idiopathic Intracranial Hypertension). To recall, “SCANT” or “CATS-N”: Synthroid, Contraceptives, Accutane, Nalidixic Acid (in kids), Tetracyclines”

C. A hyperope wearing glasses will have the highest demand. A hyperope will have increased accommodative demand to overcome the prescription. When comparing, plus specs vs contact lenses, plus power spectacles require more convergence.

C. The low frequency cut off is due to lateral inhibition in the retina. Lateral inhibition is produced by the interneurons: horizontal and amacrine cells. The high frequency cut off is due to optical aberrations and photoreceptor spacing.

C. Beta blockers reduce IOP by decreasing aqueous production. Cholinergic agonist (i.e.Pilocarpine) affects IOP by increasing corneoscleral outflow. Alpha agonists both decrease aqueous production and increase uveoscleral outflow. CAIs decrease aqueous production. PGs increase uveoscleral outflow.

C. -1.00 x 090. The equation of note is RA = SRcyl – Kcyl. We know that SRcyl = -0.50 x 180. Using the K values, we determine the corneal cyl is -1.50 x 180. Solving for RA = (-0.50 x 180( – (-1.50 x 180) = +1.00 x 180 or -1.00 x 090

A/C/D. The three medications that may cause aplastic anemia include: Acetazolamide, Methazolamide, and Chloramphenicol. Additionally, Trimethoprim, Pyrimethamine and Methotrexate may also cause aplastic anemia.

B. Dementia is not a classic sign of Parkinson’s. To recall the signs, think of the mnemonic TRAP – Tremor at rest, Rigidity, Akinesia, and Postural instability.

C. A back surface toric is appropriate as the information supports the “123” rule. The “1” is the residual astigmatism. The “2” is double the RA and represents corneal astigmatism. The “3” is double that of the corneal astigmatism and represents the vertex refraction (be sure to adjust the refraction before deciding which lens.

C. Absolute hyperopia (hyperopia that cannot be neutralized with accommodation alone) is +3.00 D; the difference between the two values. Facultative hyperopia (amount of hyperopia neutralized by accommodation) is +2.00D; the total accommodative ability.

B,C,E: RP, Gyrate atrophy, and choroideremia lead to complaints of poor night vision (nyctalopia). Night blindness is a consequence of damage to the rod photoreceptors in the retina. It is important to note that nyctalopia is not limited to these three conditions.

C. Topiramate is clinically indicated for treatment of epilepsy to prevent seizures. It is important to know this medication as it may lead to blurred vision, diplopia, and nystagmus. More severe adverse effects include choroidal swelling leading to a myopic shift and acute angle closure glaucoma.

B. Maxwell’s spot, as well as visuoscopy and Hidinger’s brush, are used to measure eccentric fixation. 4 BO test is used for ocular alignment, such as in microstrabismus syndrome. Bagolini lenses are used for ARC. W4D is used for sensory status.

A/D. Alpha 1 and Beta 2 receptors in the eye are the targets for topical glaucoma meds. B1 receptors are located in the heart. Alpha 2 are located in the brain and peripheral nerves.

A. Warpage occurs on AND off the eye. Flexure only occurs ON the eye. Higher Dk lenses have more chance of flexure.

A,B,D: Telangiectasia is a critical finding in Coat’s, BCC, and ocular rosacea. Although these may begin to appear as we age, it is important to rule out these conditions on assessment. Molluscum appears as an umbilicated nodule without telangiectasia.

E. One would not expect bronchodilation but rather bronchospasm. The list of signs of anaphylactic shock include, but not limited to: hypotension, tachycardia, sneezing, itching, wheezing, bronchospasm, nausea, vomiting, diarrhea, urticaria, pruritus, headache, syncope, and/or seizure.

B. It is not a HYPEROPIC shift but rather a MYOPIC shift. The remaining options are correct. Of note, the dry eye is from decreased secretion from the lacrimal gland.

B. Combigan is composed of Timolol (B-blocker) and Brimonidine (Alpha agonist). Cosopt is a combination of Timolol (B-blocker) and Dorzolamide (CAI). Latanoprost (PG) and Netarsudil (Rho Kinase inhibitor) make up a newer glaucoma medication, Rhopressa. Brinzolamide (CAI) and Brimonidine (Alpha agonist) compose Simbrinza.

B. This is an example of active secretion.

B. Spherical aberrations are the cause of distortion and reduced acuity in a dilated pupil. Small, miotic pupils are affected by diffraction although miotic pupils do increase depth of focus.

D is the correct response, having hyperopic aniso > 1.00
Diopter can lead to amblyopia in the eye with higher prescription, in this case OS which is +7.00.

Norms include:
ANISO: H >1.00, A >1.50, M >3.00; ISO: H >5, A >2.50, M >8.

B. 20/50. The equation of note is test distance / M unit = 20 ft / size of Snellen letter. It is also an important number to recall as it represents average news print letter size and is a standard in low vision.

C. Nexium and its sister drug Prilosec are classified as Proton Pump Inhibitors. PPIs function by inhibiting H+/K+ ATPase proton pumps.These medications are used in treatment of peptic ulcer disease and GERD.

C. It would be appropriate to begin a prism trial with 10 BI in each eye. Recall the equation, ADD + 2 = prism in EACH eye.

A. Restasis, used in the treatment of dry eye, works by ceasing production of IL-2 leading to inhibition of T-cell activation. This is one of the final steps of the dry eye cascade.

C. Azithromycin is classified as a Macrolide. Recall “Buy AT 30, CEL at 50”. CEL stands for Chloramphenicol, Erythromycin (Macrolides), and Lincomycin. These meds target the 50s subunit. Doxycycline and Gentamicin target the 30s subunit. Sulfacetamide is a sulfonamide that inhibits DHP synthase.

E. -2.00 D. A far point that is reduced from infinity is more indicative for myopia. Using the equation 1/0.5m = 2.00 D. A +2.00 eye requires -2.00 D to return the far point to infinity.

B. Doxycycline must be digested after eating/with food. To recall, “PAT your stomach” for drug classes that must be taken with an empty stomach and include: Penicillins, Azithromycin (Macrolides), and Tetracycline. This is a trick question as Doxycycline, a Tetracycline, is the one exception that must be taken with food.

C. Accounting for your working distance (50cm = -2.00 D), the 90 (or vertical) meridian is plano while the 180 (or horizontal meridian) is -0.50 D. Using the most plus meridian as the sphere, the prescription should be plano -0.50 x 090.

A,C,D: The Congenital Syphilis triad consists of Hutchinson’s teeth (small and widely spaced), deafness, and interstitial keratitis. The remaining options are associated with HSV.

A. Loratidine is a second generation antihistamine. This question is here to demonstrate the mechanism of action of H2 blockers in treatment of stomach ulcers and acid reflux. We are also taught to remember H2 blockers from the “-tidine”. Here is one exception, do not forget on test day.

B,C,D: The clinical triad for CCF is chemosis, pulsatile proptosis (the globe appearing to pulse in and out of the orbit), and ocular bruit (the sound of blood “whooshing” in the eye). CCF results from an abnormal communication of the vascular system within the cavernous sinus. It is most commonly caused by head trauma and can lead to elevated IOP, diplopia, and sensation loss of the face.

D. One would expect a low NRA. This is due to the reduced fusional vergence needed to keep eyes aligned. All other findings can be found in a CI patient. Other findings include: reduced positive fusional vergence, and a low lag/lead of accommodation.

A. The most common site of an orbital fracture is the maxillary bone; the posterior medial portion of the floor. The palatine and zygomatic bones are the other two bones that compose the floor of the orbit. Ethmoid and lamina papyracea are interchangeable and represent the THINNEST bone in the orbit. This bone prevents infections from moving into the sinuses.

C. A barrel distortion is created by a minus lens. A plus power lens creates a pincushion effect. The other two options are distractors.

C. Corneal melts are most common with either topical NSAIDs or anesthetics. Delayed wound healing is related to steroid use. Skin darkening is a side effect of prostaglandin analogs. Follicular conjunctivitis is an uncommon finding with Brimonidine and CL solutions.

D. The Critical Period for development of clear, binocular vision is between 7 and 8 years of age. This is why it is critical to provide thorough eye examinations to young children. The earlier the diagnosis, the better outcome to treatment.

D. Trigeminothalamic pathway is responsible for reflexive head movement in response to stimuli. The medial lemniscus pathway carries information regarding touch, pressure, and vibration from the body. The spinothalamic pathway carries pain and temperature information from the body.

A. Durezol, a steroid, is most likely to cause a PSC rather than ASC. To recall, “I made ‘A PACT’ with ASC”: -Azines, Pilocarpine, Amiodarone, CAIs, Trimethoprim.

A. Erythromycin is applied topically for newborns to prevent opthalmia neonatorum.

B/D: THe legal definition for blindness is the inability to read any letters on the 20/100 line in the better seeing eye and/or a visual field less than or equal to 20 degrees. If there is a central scotoma, subtract scotoma from overall diameter.

B. Triamcinolone, also known as Kenalog, is a steroid that is used in the treatment of many conditions. Including those in the questions, Kenalog is also used in treatment of Posterior Uveitis, Dermatoses, Multiple Sclerosis, and Arthritis. Chronic use can cause depigmentation of the eyelid in dark-skinned individuals.

A. The most common primary malignant brain tumor is the glioblastoma multiforme. Meningiomas are the most common benign brain tumor. Schwannoma are rare tumorsof the schwann cells (the myelinating cell of the peripheral nervous system). Pituitary adenomas are infamous for causing bitemporal hemianopia or junctional scotomas.Acoustic neuromas affect CN8 with some ocular manifestations.

B. Phenothiazines, a class of Antipsychotics, function as dopamine receptor antagonists (anti dopamine). Adverse effects include: Parkinson-like symptoms (recall TRAP), Pigmentation effects (pigment on endo, ASC, and HYPERpigmentation of RPE), Oculogyric Crisis.

C, D. CN III and IV exit from the midbrain. CN V, VI, VII, VII exit from the pons. The remaining cranial nerves exit from the medulla.

B. Sulfonamides act by inhibiting DHP synthase, the first step of folic acid synthesis. Trimethoprim, Methotrexate, and Pyrimethamine all act by inhibiting DHF reductase, the second step of folic acid synthesis. Aminoglycasides and Tetracyclines function by binding and inhibiting 30s subunits. Penicillins and Cephalosporins inhibit transpeptidase.

C. Duane retraction syndrome Type 1 as there is only an issue of aBDuction of the right eye. To remember, recall that you “count the D’s” to determine the diagnosis.

D. The Nagel Anomaloscope is the only color vision test that is able to distinguish between dichromats and anomalous trichromats. The Farnsworth and HRR are able to diagnosis both b/y and r/g color defects but cannot distinguish between the two above. Ishihara can only diagnose red-green defects.

D. LON is NOT considered a perinatal infection as it is transmitted through maternal mitochondrial DNA. The acronym for this group of infections is TORCH: Toxoplasmosis, Other (Hep B, syphilis, varicella, HIV), Rubella, Cytomegalovirus, and Herpes Simplex.

B. Most tears, holes, and detachments occur in the superior temporal region of the retina.

D. Echothiophate, an irreversible drug, is used to diagnose and treat accommodative ET. Pilocarpine is reversible and considered a direct cholinergic agonist. The “-stigmine” drugs are used in the treatment of Myasthenia Gravis. Edrophonium is used to test for MG.

A: Vortex veins are responsible for draining most of the blood from the eye. There are often 4-6 vortex veins in each eye noted at mid-periphery.

B. Anisometropic hyperopia is more likely to cause amblyopia as one eye never receives a clear image. In patient with aniso myopia, there is a point of clarity for either refractive error. Strabismus first presents with diplopia but with time can become suppressed. Eso = nasal, Exo = temporal. Deep amblyopia is considered 20/100 – 20/400.

D. Necrotizing without inflammation. This is a unique form of Scleritis where the patient presents with minimal pain and injection. Often associated with rheumatoid arthritis, SP leads to scleral thinning that gives a blue appearance.

A: The weakest point of attachment is found at the macula. From weakest to strongest: Retinal vessels, Macula, Optic Nerve, Posterior lens, Ora Serrata/Vitreal Base. A PVD is most likely to occur at the base.

B. Clopidogrel, also known as Plavix, is an anticoagulant that functions by inhibiting ADP receptors on platelet cell membranes. This receptor is critical for platelet aggregation and clot formation.

B. Betaxolol is β1 selective with limited β2 activity. It is also known for neuroprotective qualities although there is limited clinical evidence. Recall that Betaxolol is cardioselective. The remaining options are non-selective.

B. Using an optic cross, be sure to have -4.25 at the 180 and -6.00 at the 090. Vertexing results in -4.00 in the 180 and -5.50 at the 90. The final prescription is -4.00 -1.50 x 180.

C. When compared to a direct ophthalmoscope, the BIO has a larger field of view, larger depth of focus, SMALLER magnification, and an inverted image.

B: Inferior Oblique is the only muscle to originate from maxillary bone.

B. -4.00 +2.00 x 090. To transpose, first move the total cylindrical value to the spherical portion. In this example, -2.00 + (-2.00) = -4.00. Once you have the sphere, reverse the symbol of the DC and flip the axis of the original equation.

A/D. Both media opacities and higher refractive error at a longer test distance can both present with darker reflexes. The deviated eye in strabismus, as well as higher refractive error at 1 meter and retinoblastoma, present with brighter reflexes.

A. Osteogenesis imperfecta is NOT associated with presenile cataracts. Recall “MAD Mr. Wilson develops early Cataracts”. The “C” stands for calcium issues.