D: CN IV, the trochlear nerve as it is not only the thinnest nerve, it also has the longest course of all cranial nerves as it leaves the brainstem dorsally.

B. Tropicamide, a cholinergic antagonist, works by preventing binding of acetylcholine at muscarinic sites. Direct stimulation of cholinergic receptors is the MOA for Pilocarpine. Anesthetics act by preventing influx of Na+ ions.

A, E: Both the posterior and middle cerebral arteries supply the occipital lobe. Having two vascular branches is the reason behind macular sparing in some patients with traumatic brain injuries.

C. Surface Ectoderm. Embryonic optic vesicles form as an extension of the neural tube. As these approach the surface ectoderm, the lens placide and lens vesicles form. The narrow cleft, aka embryonic fissure, forms in the walls of the optic cup. Hyaloid vessels form the vascular capsule of the lens.

C. Natamycin is an antifungal that works by inhibiting ergosterol thereby forming pores in cell walls. This leads to cell death. Recall that Natamycin is NOT a macrolide – a drug class that inhibits the 50s subunit of bacterial ribosomes. Penicillins inhibit transpeptidase.

E. Bergmeister’s Papillae can remain at the optic nerve. Mitterndorf and Epicapsular star are lens findings. Cloquet’s canal is within the vitreous. Weiss ring is the consequence of a posterior vitreous detachment of the optic nerve.

B: Frontalis muscle is responsible for the look of surprise. The frontalis is activated in cases of ptosis and dermatochalasis to assist with raising eyelids. The corrugator creates the look of concentration. Procerus, think rhinoceros.

E. Voltaren is not known to cause Whorl Keratopathy (aka Verticillata). Recall, CHAI-T when asked about verticillata. Do not forget, Fabry’s Disease may also lead to this finding.

A. Trauma is the number 1 cause of unilateral glaucoma. This is due to damage to the TM when the iris root is affected.

D. Ciprofloxacin is safe to use in patients with Sulfa allergies. Sulfa drug classes include: Penicillins, CAIs, Sulfonylureas, and Sulfonamides.

A. Optivar is the only allergy eye drop listed here that is a combination of H1 inhibition and stabilization of mast cells. Mast cells stabilizers work by preventing Ca2+ from binding mast cells. Calcium serves to initiate degranulation of mast cells leading to allergy symptoms. Recall, BEZPOP for combination antihistamines.

C. YAG laser is used for LPI, PCO, and SLT. Argon and Krypton are used for PRP, ALT, retinal tears, and in rare instances LPIs. Excimer/LASIK laser is used for LASIK and PRK. Helium neon is used to illuminate the retina to view the fundus.

D. Nardil, also known as Phenylzine, is a Monoamine oxidase inhibitor. MAO is an enzyme found in the synaptic cleft that breaks down norepinephrine and serotonin to be taken back up. By inhibiting MAO, norepinephrine and serotonin may remain active in the cleft for longer. When used in combination with Phenylephrine, there is too much sympathetic activity.

C: Muscle of riolan is the most superficial portion of the orbicularis oculi and is responsible for keeping the eyelid adhered to the globe.

A. Natural Killer cells do not require an antigen presenting cell to attack antigens. NK cells serve as the rapid response team for antigens that have yet to be phagocytosed. The remaining cells are part of a specific immunity response.

A. Digoxin, a medication used in treatment of congestive heart failure, functions by inhibiting Na+/K+ ATPase resulting in increased intracellular Ca2+. Side effects include Retrobulbar Optic Neuritis and/or B/Y color defects.

B. The CRA has networks within both the Nerve Fiber Layer and the Inner Nuclear Layer. Dot and blot hemes are seen in the OPL as bleeding from INL leaks down layers.

B/C. Recall, “Buy AT 30, CEL at 50”. Aminoglycosides and Tetracyclines act by binding the 30s subunit of bacterial ribosomes and preventing protein synthesis. The other three classes work by binding the 50s subunit.

D. Furosemide is the only diuretic to affect the ascending loop of Henle. Furosemide functions by inhibiting Na+/2Cl-/K+ co-transporter while also increasing Ca²⁺ secretion. Use of Furosemide may lead to development of hypokalemia and/or nephrotoxicity.

A: CNVII – Facial Nerve provides motor innervation to muscles of facial expression. CNV – Trigeminal Nerve is separated into 3 branches. V1 is ophthalmic, V2 is maxillary, and V3 is mandibular. V1 and V2 provide sensory information while V3 provides motor input.

A, B, D: The lateral rectus is unique in that it is the only nerve innervated by CN VI. Nerve innervation begins in the pons and travels past the precarious skull process which is more susceptible to damage from increased cranial pressure (vs. trauma). Unlike the other extraocular muscles, the lateral rectus has two origins on the annulus of zinn and receives blood supply from only one artery.

B. The uvea is made up of iris, ciliary body, and the choroid.

B. Recall that torsion is a primary function of obliques; OBliques ABduct (or O’s to the nose); and obliques have opposite roles in supraduction.

A. This pattern is classic for WTR astigmatism. The opposite pattern of clearance and touch indicates ATR. General clearance or touch is more characteristic of a spherical cornea. You would expect an inferior spot of lens touch.

A. Ricco’s law states that the number of photons is the same for all stimulus sizes that are less than a critical diameter. This varies as stated above. Bloch’s law describes a critical time threshold for stimulation. Ferry-Porter law states the critical flicker frequency with the log of retinal illumination. Granit-Harper law states that the CFF increases as the stimulus area increases.

E. All of the above traits are true. To recall, the 4 C’s of side effects: Clots, Cancer, Crystal, Corneal Whorl. Tamoxifen inhibits estradiol thereby reducing estrogen effects in the breast. Patients in remission must remain on this medication for up to 5 years after successful treatment.

C. Suppression of the left eye. Placing a loose 4BO in front of the right eye causes a small movement of the right eye toward the apex of the prism. Due to yoked muscles movement, the left eye will also move. If the left eye is not suppressing, it should quickly re-fixated to target. If there is NO movement of either eye with lens placement, it is a suppression of the right eye. If the left eye does not refixate after a right eye shift, the left eye is considered suppressed.

D. This CT pattern is indicative of against-the-rule astigmatism. WTR astigmatism is characterized by a bow tie pattern with vertical steepening. Keratoconus would present with inferior steepening. Pellucid marginal degeneration scans are known for a kissing dove or crab claw appearance.

B: Tenon’s capsule – To remember, consider C.C. TESLA From anterior to posterior: C. epithelium, C. stroma, Tenon’s capsule, Episclera, Scleral proper, Lamina fusca, and Anterior choroid

D. The adrenal gland does not have a ganglion synapse with the ganglionic fibers of the spinal column. Rather, it receives a signal to release epinephrine directly into the bloodstream.

D. Total prism induced is 0.8 BI. First, recall Prentice’s law (Total prism = power of lens x decentration in centimeters). In this example, the answer is 0.8. Next, draw a picture of the lens (two triangles sharing one side). We can see that the patient is looking through the base-in portion of the lens.

B. Abnormal renal function can cause an increased risk of developing side effects related to chronic use. To recall: treatment duration greater than 5 years, abnormal renal function, high body fat percentage, over 60 years of age, and/or liver disease can increase risk of BEM.

C: Smooth muscle that is innervated by the sympathetic nervous system. Mueller’s muscle provides an extra 2-3mm of lift to the eyelids. Loss of innervation to this muscle will lead to a mild ptosis (i.e. Horners)

B. NADPH. These agents are found along the sorbitol pathway. This pathway is important in understanding the breakdown of glucose in the body. One molecule of glucose can either undergo reduction to sorbitol in a low oxygen environment or can be converted directly to fructose 6-phosphate.

C. The outer nuclear layer in the retina contains all the cell bodies of the photoreceptors.

D. Apocrine secretion – products secreted in membrane-bound vesicles. Holocrine secretion is when the entire cell that contains the product is secreted. Meibomian glands are an example. The main lacrimal gland secretes via merocrine – products move directly into lumen.

B. Kaposi’s sarcoma is a malignant lesion that develops secondary to an active herpes infection in an immunocompromised individual. The remaining options are all opportunistic infections that develop as CD4 cell count declines.

C. All but Vitamin B are found in the tear film. Lysozymes serve as bacteriolytic cells. Defensins and IgA serve to detect foreign material and cells. Lactoferrin protects the eye from free radical iron molecules.

C. Chronic corticosteroid use leads to development of posterior SUBCAPSULAR cataracts. PCO develops after a PCIOL has been in an eye for a period of time. The remaining options are correct facts.

A, C: MACI is formed by the anastomosis of the long posterior ciliary and anterior arteries. It is located within the iris stroma and is non-fenestrated.

B. Loteprednol is considered the safest steroid for prescribing. Unfortunately, many cases of inflammation are severe and require stronger prescription steroids. In these cases, it is important to educate patients about proper use and follow up schedules to avoid rebound inflammation.

C. The EW nuclei is located within the midbrain and is responsible for PARASYMPATHETIC innervation to the ciliary body and iris sphincter.

D. Bacitracin prevents bacterial wall synthesis by inhibiting transfer of peptidoglycan into the growing wall. Oxacillin and Cephalexin inhibit transpeptidase. Gentamicin inhibits bacterial protein synthesis by binding 30s subunits of the bacterial ribosome.

A. Losartan, an Angiotensin II receptor antagonist (ARB) is used to treat hypertension. It does not have any effect on bradykinin activity, thus leaving lungs unaffected for cough. The remaining options are ACE inhibitors which act by preventing formation of angiotensin II through ACE inhibition as well as blocking metabolism of bradykinins causing vasodilation.

E. Although staph epidermidis is a common cause, Staph Aureus is seen most frequently. H. influenza and N. gonorrhoeae are gram “-” bacteria more common in children’s bacterial eye infections. Moraxella is more common in angular blepharitis.

C. Folic acid supplementation can significantly reduce the risk of spina bifida in a newborn. Spina bifida is a defective closure of the spinal cord that leads to lower body dysfunction and decreased mental function.

D. Glycocalyx, which is secreted by the epithelial cells, allows adherence of the mucus layer. Goblet cells secrete mucins which make up the mucus layer.

D. Increased oxygen transmission via silicone as the water content decreases. Increasing water content leads to lower ratio of Silicone to water. Therefore, more water in the lens means less oxygen from tears through the silicone.

B. The long ciliary nerves of the cornea are branches of the ophthalmic division of the trigeminal nerves (CN V). The nerves enter into the cornea and traverse about ⅔ of the distance before moving anteriorly. These nerves loes myelin sheath about 1.5mm into the cornea.

B. Floppy iris syndrome is an adverse effect of Benign Prostatic Hypertrophy – a condition that causes frequent but poor urination. It is important to remember this medication as Floppy Iris Syndrome can impact cataract surgery. Tamsulosin is considered an Alpha-1 blocker.

B,E: The Greater wing and the Zygomatic bones comprise the lateral wall (Great-Z)

B. This is the definition of Harmonious ARC. Unharmonious ARC is when the angle of anomaly is less than the objective angle and occurs mostly post-strab surgery. Paradoxical is split into two types: Type 1 is subjective angle greater than objective – Type 2 is an eccentric fixation in the opposite direction of what is expected.

D. Chemical burns with alkali agents are more dangerous than acidic agents. This list is challenging. First, remove the two acids. Next, we know that fertilizers and pepper spray (PAVA) are both acidic. Calcium hydroxide is not only basic, but also the most common cause of alkali burns.

D. Anterior border layer is the primary contributor to eye color with trace input from the iris stroma.

A. Alpha cells within the Islet of Langerhans are responsible for production of glucagon. Beta cells produce insulin and amylin. Delta cells produce somatostatin. F cells produce pancreatic polypeptide.

A,C,D: These conditions lead to development of trabeculitis and iritis that reduces aqueous outflow. This reduction in outflow leads to spikes in IOP as high as the 40s-50s. Sarcoidosis may cause inflammation anywhere in the body. Most often, Sarcoidosis leads to bilateral uveitis and may also include posterior or panuveitis. Toxoplasmosis does not often cause anterior uveitis, rather posterior or panuveitis.

C. Plica Semilunaris allows for movement WITHIN the globe. The fornix and caruncle are location and redundant tissue, respectively. Mueller’s is responsible for lifting the eyelid. The muscle of riolan is responsible for keeping the eyelid adhered to the globe.

All but C: Recall the mnemonic “the nose SMELs” for medial wall of orbit.

C: Innervates the SUPERIOR oblique; all other statements are correct.

B. Loratidine is an example of a second generation antihistamine. To recall, “phen” in the drug name is a clue to determining first generation – exception of promethazine. First generation antihistamines penetrate the blood/barrier more easily than second generation antihistamines. This leads to less side effects such as sedation.

A: Melanopsin is found in the intrinsically photosensitive ganglion cells. These cells are thought to be regulators of the circadian rhythms found in mammals.

B: Fetal nucleus is the only site of Y-sutures. The embryonic nucleus contains the most mature fibers.

C. EDTA is a Calcium ion chelating agent that can be used in treatment of Gout and Band Keratopathy. BAK is infamous for causing SPK with the benefit of increased corneal penetration. Thimerosal is considered very toxic as it contains mercury. SP is found in artificial tears/ointment and is considered less toxic.

B. Klinefelter syndrome is NOT associated with keratoconus. To recall these conditions, use the mnemonic “T-DOME”: Turner Syndrome, Down Syndrome (aka Trisomy 21), Osteogenesis Imperfecta (aka Brittle Bone disease), Marfan Syndrome, and/or Ehlers-Danlos Syndrome. Other lower yield conditions include atopic dermatitis (excessive rubbing) and mitral valve prolapse (can be correlated to Marfan syndrome).

E. All of the above are correct. It is important to understand the general pathways innervation travels to the orbit and adnexa. Try to draw out these pathways with blanks that you can fill in and erase later.

E, 4.5 years is roughly when a child should be able to draw and identify a square. Some important shapes to know include: Straight line near the end of 2 years of age, Circle at 3 years, and Triangle near 5 years.

D. If a patient is on Warfarin, it is best to prescribe a Penicillin. Cephalosporins may destroy normal intestinal flora thus altering Vitamin K absorption. This may lead to excessive thinning of the blood in conjunction with Warfarin.

D. Epinephrine is derived from Tyrosine. Tyrosine molecules are converted to dopamine which leads to production and release of norepinephrine. Norepinephrine is converted to epinephrine via methyltransferase.

B,C,E: Superior limbic keratoconjunctivitis (SLK) is related to FRICTION. Dry eye, thyroid eye disease, and contact lens hypersensitivity are most commonly associated with SLK.

A/B/C: These three medications may cause retinal pigmentary changes. When it comes to pigmentary changes throughout the eye, the drug class Phenothiazines (antipsychotics) are infamous for this adverse effect. From pigment on endothelium to the retina, the “-Azines” affect all regions of the eye.

B. Use of Pilocarpine may cause a MYOPIC shift. Other side effects include: brow aches, headaches, miosis, cataracts, retinal detachment, and secondary angle closure.

A,B,C. All of these options will influence pars plicata to produce more aqueous humor. Build up of H+ in pigmented epithelium leads to reversal of bicarbonate ion movement, thus halting aqueous production. A similar mechanism can be seen with increased intracellular Cl- ions.

C. Oseltamivir, also known as Tamiflu, is used in the treatment of Influenza. The remaining options are antifungals. Of note, Natamycin is NOT a Macrolide as the name indicates.

C. Zonula Occludens/Adherens are responsible for tight barriers. Desmosomes maintain structure integrity. Hemidesmosomes are responsible for connecting cells to their basement membranes. Gap junctions serve a role in small ion transport and cell-cell signalling. Keratocytes are cells responsible for structural integrity of the cornea.

C. Minus lenses indirectly test NEGATIVE fusional vergence. Adding minus lenses increases accommodation and convergence. In order to maintain images on the fovea,negative fusional vergence is required to overcome the changes. Prisms directly test the direction of their apex.

D. The descending limb of the loop of Henle is permeable to water and impermeable to NaCl. The opposite is true of the ascending limb.

D. The lens will need to be moved 2 mm to place the optical center in front of the patient’s eye. Do not forget that TOTAL decentration is 4 mm but each lens only moves half of that. Easy rule of thumb – patient PD < frame PD = move lens in and vice versa

A,D: Thayer-Martin, also known as a chocolate culture agar, is used for culturing and primarily isolating pathogenic Neisseria bacteria, including Neisseria gonorrhoeae and Neisseria meningitidis, as the medium inhibits the growth of most other microorganisms. Gram staining is used to identify bacteria. Sabouraud’s is used in the identification of fungi. Heat treated E. coli plates are used to culture Acanthamoeba.

E: Palpebral conjunctiva and within caruncle are two sites of mucous production

D. 20/500 is considered Profound low vision. Recall the following pairs: Normal = 20/12 -20/25, Near-Normal = 20/30 to 20/60, Moderate = 20/70 – 20/160, Severe = 20/200 – 20/400, Profound = 20/500 – 20/1000, Near Blindness > 20/2000. Blindness is no perception of light or motion.

C. Cyclobenzaprine, also known as Flexeril, is a muscle relaxant used in treatment of muscle spasms. It works by decreasing somatic motor activity by inhibiting tonic activity of alpha and gamma neurons. Caution as this medication may cause Narrow Angle Glaucoma.

E. Cromolyn Sodium is classified as a mast cell stabilizer. The remaining options are NSAIDs. Recall that “-fenac” and “-rolac” help identify generic equivalents.

D. Although inflammation does cause a widening of meibomian ducts, meibum that has become more viscous will block the further secretions. This blockade leads to acinar atrophy, a primary cause of dry eye.

A. SLE is an example of a Type III hypersensitivity reaction – involves ag/ab complexes. SLE most often presents in young women in their teens and twenties. These patients may experience a malar rash, joint pain, and other consequences of inflammation in the body. Blood work will reveal a positive ANA.

C. 5x. Recall the equation Effective magnification = F/4 = 20/4. Standard distance is 25 cm as the standard presbyopic and emmetropic patient needs a +4.00 add for magnification.

B. The minimum number is 400-700 cells/mm². This range is seen in older patients or those diagnosed with Fuchs’ endothelial dystrophy. From birth, the average range is 3,000-4,000. After 80, that number drops to about 1,000-2,00 cells. Recall that endothelial cells do not regenerate.

B: Preauricular nodes – the site of palpation in cases of red eye. Medial conjunctival lymphatics travel to the submandibular nodes.

C. The minimum amount of clearance is 50 microns. In practice, it is best to aim for 100-150 but 50 microns will still allow for corneal clearance even with blinks.

D. The liver is the only region above that does not drain into the right lymphatic duct.

E. Indirect illumination is used to assess non-opaque corneal lesions by focusing oculars adjacent to the beam of light (i.e EMBD). Sclerotic scatter is used to evaluate the clarity of the cornea. Optic section is used to determine depth (i.e. Van Herick, corneal scar). Conical beam is used to assess anterior chamber for cells and flare. Specular reflection is used to assess the corneal endothelial cells (i.e. Fuchs).

A. Simvastatin, also known as Zocor, is one of three cholesterol medications that function by inhibiting HMG-CoA reductase. This enzyme is responsible for production of cholesterol. These medications are first line therapies. Gemfibrozil binds to PPAR-alpha leading to breakdown of VLDL. Cholestyramine binds bile acids in intestines to prevent reabsorption. Isotretinoin is a distractor as it is used in treatment of acne.

D. The hypothalamus is responsible for regulating body temperature, hunger, and sleep. The epithalamus contains the pineal gland which regulates circadian rhythms. The thalamus acts as a relay station for sensory input to different cortical regions. The subthalamus and basal ganglia communicate to control muscle movement.

A. Vitamin A is the main component of opsins. Vitamin B can be found in all cells and usually depleted in alcoholics. Vitamin C is important in collagen synthesis, antioxidants, wound healing, bone formation, and many other functions. Vitamin D is supplied by the sun and helps in digestion. Vitamin E is an antioxidant found in vapes that in conjunction with nicotine, can increase the likelihood of developing cancer.

E. Grave’s disease is not considered a contraindication for PG use. The remaining options describe conditions associated with inflammation. Recall that PGs are produced naturally in response to inflammation in the body.

C: The corneal ENDOTHELIUM has the most mitochondria to supply energy to the Na/K pumps that maintain corneal water concentration.

C,D: Stellate KPs are unique to Herpes simplex and Fuch’s iridocyclitis. Other options listed here are also considered granulomatous. However, these conditions present with Koeppe (found at pupillary margin) or Busacca nodules (other locations on iris).

A. An S-shaped ptosis is classically associated with dacryoadenitis – inflammation of the lacrimal gland. Dacryoadenitis can occur acutely or chronically. Acute infections present with S-shaped ptosis, pain, redness, and preauricular lymphadenopathy. Acute infections are often bacterial or viral in nature. Chronic infections have a similar set of signs/symptoms, however, to a much lesser degree. Chronic infections are related to inflammatory disorders such as the other answer choices.

C. Phenylephrine is an adrenergic agonists that acts only on ⍺1. Brimonidine is highly selective for ⍺2 and Apraclonidine acts on ⍺2 receptors with limited ⍺1 activity. Naphazoline and Tetrahydrolozine are non-specific alpha receptor agonists.

A,D,E: A normal result for phenol red thread test is >10mm in 15 secs, Schirmer 1 test is >10mm in 5 minutes, Schirmer 2 testing (with anesthesia) is >5mm in 5 minutes. Tear osmolarity should be greater than 308 mOsm/L. Tear meniscus is measured under a slit lamp and should be greater than 0.2mm. Tear break up time (TBUT) is evaluated under slit lamp and blue light conditions. The tear film should remain intact for up to 10 secs.

D. Cholesterol. The condition we are seeing is known as Xanthelasma. The yellow plaques develop over time with elevated cholesterol levels. The patient can be referred for excision/cryotherapy after cholesterol levels are brought back to normal levels.

A. Accommodative response is present at birth and reaches maturity at about 3 months of age. It is important to review key ocular motor and visual development milestones.

B. In the proximal convoluted tubule, the ATPases drive Na+ out into the interstitial space and K+ in to the proximal convoluted tubule for excretion. Water will follow the Na+

D. H. influenzae is the most common culprit for cellulitis in children. Staph aureus is the most common cause of cellulitis in adults.

B/D. TCAs function by increasing levels of serotonin, norepinephrine/epinephrine, and anticholinergic activity. These three functions lead to increased sympathetic output.

C. Active secretion is responsible for 80-90% of aqueous humor production. A small portion of aqueous is produced through diffusion and ultrafiltration. Hydration and holocrine are both distractors.

D. Behcet’s disease is an inflammatory disease that occurs more commonly in young males of Middle Eastern or Asian descent. It is defined as recurrent mouth, eye and/or genital sores. One must have two of these to receive a formal diagnosis. Behcet’s is associated with acute recurrent hypopyon as well as all forms of uveitis.

C. The correct order is Inferior rectus, Medial rectus, Superior rectus, Lateral rectus, and then the obliques. The mnemonic for this condition is “IM SLO”.

B. Mueller’s muscle is the culprit. Horner’s is known to affect the sympathetic nervous system. Mueller’s muscle is innervated by sympathetic input and acts to lift the eyelid 2-3mm. This is the reason for the mild ptosis in Horner’s patients.

B. The lens zonules begin their course from the pars plana and traverse to the posterior lens capsule to participate in accommodation.

C. Ototoxicity is not considered a side effect of Tetracyclines. Tetracyclines function by inhibiting protein synthesis through binding of 30s subunits of bacterial ribosomes.

B. Poliosis is the whitening of eyelashes often caused by chronic eye infections. Madarosis describes a loss of eyelashes. Tylosis is thickening of the lid margin. Trichiasis is an inward turned eyelash. Sudoriferous is a term used to describe a cyst.

C. Ligneous conjunctivitis is caused by a systemic plasmin deficiency leading to development of thick mucous membranes. Other conditions associated with PAN include viral, inflammatory systemic, and hyperacute bacterial infections.

D: Seven – Frontal, Ethmoid, Sphenoid, Lacrimal, Maxilla, Palatine, and Zygomatic

C. Klinfelter syndrome is the only option in this list without evidence of prominent epicanthal folds. Be sure to know other conditions besides Down syndrome and Fetal Alcohol syndrome. Blepharophimosis is an eyelid condition that demonstrates REVERSE epicanthal folds.

C. Adie’s Tonic Pupil. Since the iris sphincter is desensitized in Adie’s, it will respond to even a low concentration of pilocarpine. Recall that ADie’s is an Acutely Dilated pupil normally found in young females.

C. Pterygopalatine innervates the lacrimal gland to stimulate aqueous secretion.

C. All topical anesthetics are considered esters for their shorter duration and ability to be metabolized locally. Amides have a longer duration and are metabolized by the LIVER.

A,E: Either the nasociliary branch of the trigeminal (V1) and/or the facial nerve (VII). The nasociliary nerve is responsible for sensory information from the cornea. Corneal regeneration is reduced as there is little feedback from the corneal nerves that indicate damage. Common causes of damage include HSV, DM, LASIK, contact lens overwear, and chronic corneal injury. The facial nerve can also cause NK due to reduced reflex tearing and inability to close the eyelid leading to chronic damage of ocular surface and further damage to VI. The cotton-swab test is used for aid in diagnosis of NK.

B. A consequence of congenital aberrant degeneration, the motor branches of the trigeminal nerves will simultaneously communicate with the superior division of the oculomotor nerve which controls the levator.

A. An ESR of 30 mm/hr is considered normal in a female of this age. This patient suffers from Giant Cell Arteritis. Abnormal GCA results include: elevated ESR, CRP, and platelet count as well as inflammation of the temporal artery noted on biopsy. Recall that elevated ESR in males is greater than their age divided by 2 (> age/2) and in females it is their age plus ten (> (age+10)/2). Elevated CRP is considered greater than 2.45 mg/dL. Elevated platelet count is any value > 400,000.

B. Emadine is considered only an antihistamine with no mast cell stabilizer action. The remaining choices all work by preventing mast cell degranulation by preventing binding of Ca²⁺.

D. Verruca is a painless, multi-lobulated lesion with a frondular appearance that may or may not regress over time. It is most believed to be a consequence of HPV. Molluscum is the result of a DNA pox virus that is seen in children or in immunocompromised populations. Contact dermatitis is caused by exposure to allergens. Papillomas are benign “skin tags” that develop spontaneously as we age.

D. The patient is most likely suffering from a recurrent corneal erosion which is caused by poor hemidesmosome attachment. This attachment problem is preceded by corneal abrasion, corneal dystrophies, and/or age-related changes to the basement membrane. Ultraviolet keratopathy is caused by the excessive absorption of short wavelengths – symptoms occur 6-12hrs after exposure. Dry eye is caused by increased levels of MMPs and can cause symptoms at any time of day. Poorly managed blood sugar may lead to neurotrophic keratopathy – patients will have no pain complaints.

A. Donepezil, also known as Aricept, is used to treat Alzheimer’s. It functions by inhibiting CNS acetylcholinesterase. Adverse effects include cataracts, blur, and ocular irritation. Aricept has been known to reduce intraocular pressure which may rebound with cessation of medication.

A. The apparent depth is -2.0 cm. Apparent depth is determined using the index of refraction of both mediums and the given depth. Therefore, n2/l’ = n1/l → (1.0/l’ = -1.5/0.03m = -50 cm) → 1/-50 = l’ = -2.0cm.

A. Fixation disparity is measured under ASSOCIATED conditions. Associated is defined as when two eyes are focused on the same target and fusing images. The other options rely on disassociating the eyes to complete measurements.

E. Tears are not a significant source of vitamin A or glucose. Tears provide oxygen and specific ions (K+, Ca2+, Mg2+, Zn2+, etc.). Tears also play a role as an optical surface, to flush foreign materials and as a lubricant for blinking.

D. The cycloplegic effect from Tropicamide is DEPENDENT on concentration. The remaining options are correct.

A. Basal cell carcinomas are the most common malignant eye tumors. Next is squamous, then sebaceous, and most rare is malignant melanoma. A nevus is a benign finding on the eyelid that requires monitoring.

D. Interleukin 2 is released by helper T cells in response to antigen binding. This release, paired with binding of helper T cells to Class II MHC, stimulates the production of more immune factors.

D. Progression to late stage K-cone can cause tears in DM, otherwise known as corneal hydrops. Early signs include Fleischer’s ring (an IRON ring that develops early and best visualized with cobalt blue filter), scissor reflex on retinoscopy, and INFERIOR steepening of the cornea on topography. Late signs include Vogt’s striae (VERTICAL folds in the cornea), Munson’s sign (cone appearance of the cornea when patient viewed from above), and hydrops (tears in Descemet’s membrane). Horizontal folds are called Haab striae and are related to glaucoma.

E. Vitamin K reverses the effects of Warfarin. Warfarin, also known as Coumadin, is a Vitamin K antagonist. It prevents clots by interfering with formation of clotting factors that are dependent on Vitamin K.

D. The INL is not found in the foveola. The six retinal layers in the foveola include: RPE, PRs, ELM, ONL, Henle’s, ILM

C. Hollenhorst plaques (an example of an emboli) is the most common cause of BRAO. Other causes include GCA, elevated IOP, and other diseases that affect the retina. Calcific emboli are most associated with CRAO. Thrombi are the main cause of BRVOs.

C: Ocular Cicatricial pemphigoid is an example of type II hypersensitivity as it involves autoantibodies that target basement membranes. Stevens-Johnson is considered either type 3 or 4 hypersensitivity that affects mucous membranes. Contact dermatitis is a type 4 hypersensitivity reaction as it takes 24-72 hours to develop after exposure. Atopic Keratoconjunctivitis is considered both Type 1 and 4. Phlyctenular keratoconjunctivitis is a type 4 hypersensitivity to staphylococcus.

E. Disciform keratitis is described as secondary stromal edema in the presence of endotheliitis. The remaining options all impact Bowman’s layer directly. Recall that Bowman’s layer does NOT regenerate.

B, C, D are all findings that elevate the diagnosis from preseptal to orbital cellulitis. In orbital cellulitis, key findings include reduced VA, EOM restrictions, proptosis, and optic nerve involvement. These findings demonstrate the importance of proper treatment of adnexal infections.

C. Difluprednate, also known as Durezol, is the most dangerous topical steroid drop. This drop should be avoided in arthritic patients due to its potency.

C. Diabetes is only considered a RELATIVE contraindication. Absolute contraindications include young age, unstable refractive error, unrealistic expectations, k-cone, active herpes, contact lens warpage, connective tissue disease and/or immunocompromised state (including chronic steroid use. Relative contraindications include ocular surface disease (anything related to lid hygiene), fluctuating blood sugar levels, POAG, pregnancy, and/or retinal thinning.

C.Sickle cell anemia results from a single pair amino acid substitution of glutamic acid for valine. This is the most common form of sickle cell anemia.

D. The expected mag power is -60.00 DS. The equation of Mag Power = – Foc/Fobj. Solving this out, Mag = – (X)/+12.00 = 5 = 5×12 = – 60 DS. As this is a Galilean telescope, recall that the ocular lens will be minus.

A. Amoxicillin, a broad spectrum penicillin, in combination with Clavulanic Acid is known as Augmentin. Clavulanic Acid is a penicillinase inhibitor. Penicillinase is an enzyme found in bacteria that inhibits MOA of penicillins.

B. Acetaminophen, also known as Tylenol, functions as an analgesic and antipyretic that does not have anticoagulant nor anti-inflammatory properties. Tylenol is safe to use in all ages and during pregnancy.

B. Brinzolamide is a carbonic anhydrase inhibitor that is not associated with follicular conjunctivitis. Recall that chlamydia presents with both follicles AND papillae. Herpes and adenovirus can cause viral conjunctivitis of which follicles are a classic finding. Alphagan, CL solution, and molluscum can all lead to toxic conjunctivitis which presents with follicles.

E. The Superior and Inferior ophthalmic veins travel above and below the common tendinous ring, respectively. The remaining options first traverse through the superior orbital fissure and travel through the CTR en route to the globe.

C. Peak incidence of CME post-cataract surgery is 6-10 weeks. The most common cause of CME is post-cataract surgery and is known as Irvine-Gass syndrome. Most cases are resolved with NSAIDs within 6 months. On FA, HYPERfluorescence appears in a petaloid pattern.

D. New basal cells originate from stem cells located at limbus. Basal cells migrate to the center of the cornea where they divide and become wing cells. These wing cells move to the surface and eventually slough off as surface cells.

D. Proparacaine blocks nerve conduction by stopping influx of NA+ ions leading to anesthesia. Steroids inhibit phospholipase A2. CAIs inhibit carbonic anhydrase. Acid reflux medications work by inhibiting proton pumps in the gastric system.

A. IgA is found in highest concentration in most bodily secretions. IgD is an antigen found on Beta Lymphocytes. IgE is involved with mast cells and allergic reactions. IgG is the most common immunoglobulin found in the vascular system. IgM is located in the blood and immature B lymphocytes

D. Methylphenidate, also known as Ritalin, is commonly used in treatment of ADHD, narcolepsy, and depression. Methylphenidate works by increasing release of dopamine. When given in high doses and/or chronically, mydriasis and dry eye disease may occur. Use with caution in patients with Narrow Angles.

B. There is an issue with the Superior Oblique of the right eye. To answer this question, you must implement Parks 3-Step. First, we note right hyper in primary gaze which indicates either RIR/RSO or LIO/LSR. Next is the head tilt. The patient is tilted to the right meaning RSR/RSO or LIO/LIR. Last, which gaze is the hyper worse? In this case left gaze which indicates RIO/RSO or LSR/LIR. RSO is the only muscle in all three.

E. H. influenzae is the most common cause of simple bacterial conjunctivitis in children. The most common cause in adults is Staph aureus.

D. NVE with associated preretinal or vitreous hemorrhage is a high risk characteristic. Other high risk characteristics include NVD > ¼ DD within 1 DD of the optic nerve and any NVD or NVE with associated preretinal or vitreous hemorrhage. The other options refer to non-proliferative diabetic retinopathy. Severe NPDR follows the 4-2-1 rule: 4 quadrants with severe hemorrhaging, 2 quadrants of venous beading, and 1 quadrant of IRMA.

A, C, E: The three noted signs are Von graefe, Dalrymple, and Kocher. Von Graefe’s sign is upper eyelid lag during downgaze. Dalrymple’s sign is lid retraction resulting in the “look of surprise”. Kocher’s sign is globe lag compared to lid movement when looking up. Seidel’s sign is aqueous leakage seen in laceration/penetration of the globe. Munson’s sign is the peaked appearance of a cornea from a bird’s eye view of the (looking down from above).

B,C,D: CSME, macular edema in the presence of diabetic retinopathy, needs to meet at least one of the three main criteria. The three criteria include: retinal thickening within 1/3DD of the foveal center, hard exudates within ⅓ DD of the foveal center with adjacent retinal thickening, or retinal thickening of at least 1 DD within 1 DD of the foveal center.

D. 22Δ LET. The normal Hberg position is at 0.5mm nasal. Any 1mm displacement past that is equal to 22Δ.

A,E: Recall that “vowels follow the bowels”, Hep A and E are transmitted via fecal oral route. Hep B and C are spread via blood, IV drugs, and sex. Hep D is a superinfection with Hep B.

C. Mannitol, also known as Osmitrol, is a diuretic that affects the entire nephron. It works by increasing plasma osmolarity to draw water out.

A. The most common cause of NVG is a central vein occlusion. Other causes include proliferative diabetic retinopathy, retinal detachments, and ocular ischemic syndrome. All of these conditions cause a release of VEGF. Release of growth factors leads to development of new blood vessels. In NVG, new vessels grow into the drainage angle leading to poor outflow. This change to the angle leads to elevated IOP and development of NVG, aka 90 day glaucoma.

A. The insect appears to be 53.20cm above the surface. To solve, first draw a diagram with the insect above the water with a line acting as the surface of the pond. Now use the equation (l’/n’) = (l/n). It should read (l’/1.33) = (40/1); l = 53.20

C. One would expect a high LAG of accommodation as the patient does not have the ability to accommodate. The remaining options are expected findings in AI.

D: Common Tendinous Ring is the site of origin of all four recti muscles. Circle of Zinn is composed of short posterior ciliary arteries. The Spiral of Tillaux involves the insertion of the recti muscles.

D. Negative Jones I and Positive Jones II. Jones I tests the patency of the nasolacrimal system. A Positive Jones I means a Patent system. With NLDO, you would expect a negative Jones I. Jones II is used to attempt to open an obstructed system. Saline is irrigated with pressure into the canal. If a patient is able to gag and taste the saline, you have opened the system – positive Jones II. If patient does not gag/taste and there is retrograde discharge with increased pressure is a negative Jones II. At this point it is important to refer for dacryocystorhinostomy

A,C,D: The classic triad of signs in RP include bone spicules in the periphery, waxy optic disc pallor, and arterial attenuation. Late stage signs include PSC cataracts, optic disc drusen, macular changes, and progressive loss on visual fields. These are not considered classic findings but rather associated. PSC is responsible for central vision loss in patients with RP.

B. Cushing’s Disease is characterized by excess corticosteroids in the body. Patient may present with a moon face and buffalo hump. Addison’s disease is due to a deficiency of steroids in the body. This leads to weakness, fatigue, and weight loss. Pheochromocytoma is caused by excessive amounts of norepinephrine and epinephrine. These hormones are elevated due to tumor secretion. Hyperparathyroidism is associated with elevated calcium levels.

B: Microglial cells phagocytose waste and cells in the retina. Alveolar cells are found in lungs. WBCs are found in the bloodstream. Kupffer are phagocytic cells in the liver.

B. Optic neuritis is the most common presenting symptom of MS. Other findings include APD, INO, and diplopia. Uthoff’s phenomenon and LHermitte’s signs can also be seen in patients with MS. To be diagnosed with MS, a patient must have either two lesions separated by space or time.