Geriatrics Final Quiz Part I

Tx:
Necrotizing scleritis - oral NSAID 1 week --> systemic steroids --> IV steroids or immunosupp
Scleromalacia - tx underlying condition (almost always RA)

Antibodies bind to the conjunctival basement membrane --> inflammation --> scarring --> entropion & trichiasis

Become more exo due to ciliary muscle atrophy

BCC is most common type of eyelid skin cancer

Both rarely metastasize and both eventually bleed & ulcerate (more often in SCC)

If BM gets too thick so it's no longer sticking to the epithelium this may cause RCE

Seborrheic keratosis: flat to start, becomes more warty and looks "stuck on"; most common in lower lid

Actinic Keratosis: pre-malig, dry/rough/scaly/sandpaper
Cutaneous Horn: raised, may have SCC/BCC at base
Xanthelasma: yellow plques in medial upper lid
Papilloma: benign, pedunculated, slow growing, no ulceration, crusty over time

Viroptic works for H. Simplex since there are true dendrites with viral cells to attack.

If it becomes disciform keratitis put on topical steroid

As a person ages, it is normal for them to experience a gradual decline in their visual fields. This decline typically occurs at a rate of 1-3 degrees per decade. This means that over the course of 10 years, a person may lose 1-3 degrees of their visual field. This is considered to be within the range of normal age-related changes in vision.

Clear zone at limbus = Furrow's Degeneration (thinned area w/ epi intact, won't cause any problems)

When sleeping, globe may be exposed

The aqueous composition refers to the fluid that fills the anterior chamber of the eye. This fluid is responsible for maintaining the shape of the eyeball and providing nutrients to the surrounding tissues. The answer suggests that the aqueous composition does not change with age. This is because the composition of the aqueous humor remains relatively stable throughout life, ensuring proper eye function and maintaining a healthy intraocular environment.

Corneal Farinata: flour dust particles in deep stroma (no tx needed)
Guttata: Deposits on Descemets which leads to cell drop out, 'beaten metal apperance'
Bullous K'pathy: Sub-epi bullae develop due to stroma edema (tx w/ AB, transplant, Muro- only once bullae are healed)

Everything was true except Mooren's is assoc with Hep C

Surgical excision: take out surrounding tissue too
Cryosurgery: liquid nitrogen
Radiation: preserves surrounding area
Mohs: remove by thin layers, time consuming, good for lesions that may recur (BCC/SCC)

Whorl K'topathy doesn't cause many problems, so just monitor

Amiodarone Rx'd for heart arrhythmias

These terms were discussed as signs of ocular pemphigoid

Cortical worse with larger pupil

CIN & ping look similar but here are differences:
- Ping is N/T so if you see S/I consider more serious Dx
- Ping usually bilateral
- Ping does not stain w/ RB
- Ping has 'dragged vessels' and CIN has more clustered vessels

- CIN is pre-malignant and is a pre-cursor to SCC

Baggy eyelids in the geriatric population could be a sign of kidney/heart failure and thyroid disease. This is because as people age, the skin loses its elasticity and the muscles supporting the eyelids weaken, resulting in sagging or baggy eyelids. In cases of kidney or heart failure, fluid retention can occur, leading to swelling around the eyes and causing baggy eyelids. Thyroid disease can also cause changes in the skin, including the eyelids, due to hormonal imbalances. Therefore, baggy eyelids can be a general ocular change in the geriatric population that may indicate underlying kidney/heart failure or thyroid disease.

#1 cause decrease tear production = autoimmune disease
#1 cause increase tear evaporation = MGD

Opposite for Zoster: RB stains middle & NaFl stains outside

**For Simplex, if you only use RB it will stain the entire dendrite

Simplex: Mercedes sign, disciform keratitis, Wessely immune ring, necrotizing keratitis, ghost dendrite

Keratoacanthoma --> very fast growing (smooth margins)
SCC --> slow growing (inflamed/crusted margins)

AM: stagnant oil that is just sitting there w/o any blinking

Bandage CL to prevent filaments from attaching

Can also remove filaments, tx underlying condition, and use mucomyst

optociliary shunt is vaculature from the retina to the choroid, they are thicker vessels and more tortuous (vs neo which is thinner)

NEVER DILATE/PROBE/IRRIGATE dacryocystitis; will also need a dachryocystorinostomy

Plasmacytoma: proptosis, displacement of globe, ON compression
Menangiomas: dec VA, VFD, ophthalmoplegia, optic atrophy, optociliary shunt vessels
Mucocele: proptosis, displacement of globe, ON compression
Mucormyosis: pain, fever, proptosis, looks like orbital cellulitis, LOV from thrombosis of CRA, black dead tissue on palate/nasal mucosa

Superficial Spreading Melanoma = most common malignant melanoma

SCC: usually from conj intraepi neoplasia
Conj lymphoma: from non-Hodgkin's lymphoma or isolated, usually in females
Conj intraepi neoplasia: pre-malignant

As individuals age, several factors tend to increase. ATR astigmatism refers to astigmatism that is more pronounced in the horizontal meridian, and this tends to increase with age. Lens thickness also tends to increase as the lens becomes less flexible and more rigid over time. Intraocular pressure (IOP) can also increase with age due to changes in the balance of fluid production and drainage in the eye. Finally, aqueous production, which refers to the production of the fluid in the front part of the eye, tends to increase as individuals age.

Scleritis (necrotizing): most severe form of scleritis, painful, LOV, NO TOPICAL STEROIDS & NO INJECTIONS
Scleromalacia perfoans: NO inflammation
Ocular pemphigoid: loss of goblet cells, ulcerations on mucous membs, will need dx once inflammation is quieted down