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Ocular Disease KMK Exam Latest 2025 Questions and Answers Graded A+
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What condition classically results in bilateral, PERIORBITAL swelling of the eyelids and is typically associated with switching cosmetics, allergic irritants, or recent instillation of eye
Periorbital swelling is associated with contact dermatitis. If they ask a question on boards about a patient recently switching cosmetics (eyeliner for example) with allergic-type symptoms (e.g. conjunctival chemosis), contact dermatitis should be high on your list of differentials.
PEMPHIGOID, a condition that is most common in females 60 yrs and older. Ankyloblepharon occurs when the outer eyelids become stuck together. Symblepharon occurs when the bulbar and palpebral conjunctiva become stuck together. Recall that pemphigoid is an idiopathic condition that attacks MUCOUS MEMBRANES; the eye is a natural place for attack considering the mucous surface of the orbital and palpebral conjunctiva.
Ankyloblepharon and symblepharon.
ALWAYS from TRAUMA. The most common reason for a corneal abrasion is a FINGERNAIL INJURY. If you have young children you understand why! Corneal Erosion: Once the abrasion has healed the patient is now at risk for a corneal erosion for the rest of their life. Corneal erosions occur in patients with past corneal abrasions (e.g. trauma) and those with epithelial dystrophies (most commonly EBMD).
close..... EBMD. So, when we say that corneal erosions happen in patients with epithelial dystrophies, we are almost always referring to EBMD
Vossius ring: after corneal trauma the iris can be pushed posteriorly and can make contact with the lens. As a result a ring of pigment (where the iris contacted the lens) can remain; this is called vossius ring. As a buzz phrase for the exam.... VOSSIUS RING = TRAUMA. Seidel's sign: A wound leak is present if Seidel's sign is positive. If a leak exists,the fluorescein dye will appear as a dark (diluted by the aqueous) stream within the green dye of the tears. What is the most common reason for lens subluxation?
A) Marfan's syndrome B) Trauma C) Homocystinuria D) Ehlers-Danlos Syndrome
Trauma is the No. 1 cause of lens subluxation. Make sure you know the other options listed above.... all of those options can cause lens subluxation. Most of you would correctly state that Marfan's Syndrome is a common cause, but be sure to take a minute or two to memorize the other three conditions that you should also associate with this complication.
Marfan's Syndrome Honocystinuria Ehlers-Danlos Syndrome Weill-Marhesani Syndrome
hyphema is from the iris and/or ciliary body. NSAID (e.g. aspirin, ibuprofen) use, blood clotting disorder (e.g. sickle cell anemia) is often the cause in a non-trauma related hyphema.
can occur in DIABETICS and/or IMMUNOCOMPROMISED patients with orbital cellulitis. What condition results in the classic patient complaint of pain in the morning after opening the
Which of the folllowing is the most common primary pediatric orbital malignancy? A) Rhabdomyosarcoma B) Neuroblastoma C) Capillary Hemangioma
began in the orbit. A) Rhabdomyosarcoma = rapid bone destructing tumor.
Hemangioma: benign, look for deprivation ambylopia
Hemangioma
Neuroblastoma = malignant. The tumor commonly arises from the abdomen, so these patients are in typically in poor systemic health. Involutional indicates that the condition is AGE-RELATED. Remember that the Facial Nerve (CN VII) is responsible for innervating the orbicularis oculi, the muscle that allows for eyelid closure. Bell's Palsy is a condition that affects the lower portion of CN VII; poor innervation to this musculature leads to ectropion and subsequent corneal exposure issues.
Trachoma. Recall that trA-Choma results from chlamydia serotypes A-C.
Can you define the following terms? A) Trichiasis
Less sleep as of late?
benign essential blepharospasm combined with lower facial abnormalities (difficulties chewing, opening mouth, etc).
SCC is the 2nd most common eyelid cancer but it is 40-50x's less common than Basal Cell Carcinoma (BCC).
Sebaceous Cell Carcinoma This tumor most commonly arises from the meibomian glands and is typically yellow, hard and on the upper eyelid Which layer of the skin does basal cell carcinoma (BCC) affect? Which layer of the skin does
basal layer. SCC affects the stratum spinosum layer.
KERATOSIS = SQUAMOUS CELL CARCINOMA. Actinic keratosis is a scaley, pink/red premalignant lesion that will become (if not removed) squamous cell carcinoma. Although SCC and BCC have a similar appearance, BCC differs in that it typically has surface telangiectasia. The classic appearance for BCC is a shiny, firm nodule with superficial telangiectasia. Finally, remember that SCC is more likely to undergo metastasis (up to 24%) as compared to BCC.
The puncta will appear swollen and mucopurulent discharge can be expressed (thru the puncta) after palpating the lacrimal sac. These patients classically have a unilateral red (nasal conj) eye with frequent recurrences. Picture the anatomy here... the canaliculi is right next to the puncta; so remember that canaliculitis infections will definitely result in punctal issues. Contrast this to a nasolacrimal duct obstruction, which classically has very little to no effects on the puncta (the nasolacrimal duct is obviously very far away from the puncta in the drainage system).
Actinomyces israeli -- the only time I have ever heard of this bacteria is with this (canaliculitis) condition.
If Jones 1 test is positive (meaning the system is PATENT) there is no need to proceed to Jones 2 testing. If after Jones 1 testing the patient blows their nose and fluoroscein is seen on the tissue, what
properly.
Recall that PAM can be benign or premalignant, a biopsy is needed for confirmation. PAM is new pigmentation, often with non-distinct margins, in elderly white patients. Remember, PAM = concern for conjunctival melanoma! Which condition(s) below have premalignant potential? A) Racial Melanosis B) Primary Acquired Melanosis
Recall that Racial Melanosis is common in African Americans and is most concentrated at the limbus. Recall that conjunctival squamous papillomas arise from human papilloma virus (HPV).
Recall that CIN often appears at the limbus as a gelatinous mass with neovascularization. Because ROSE BENGAL stains abnormal, dead and devitalized tissue, it can be used to determine the extent of the tumor margins in CIN.
Squamous Cell Carcinoma
UPPER RESPIRATORY TRACT or NASAL MUCOSA INFECTION When you have an ADULT with a conjunctivitis it is rarely bacterial in etiology but commonly a result of a VIRAL (adenoviral) infection; in the majority of these cases, the patient will have recently suffered from a cold (hence, the question above). Emergency room physicians and general medical practitioners commonly mistake a conjunctivitis in an adult as being bacterial; they often treat these patients with an aminoglycoside like tobramycin or gentamycin. Have you ever heard the old adage if you treat a conjunctivitis in an adult with an antibacterial med it will get better in 7 days, if you leave it alone it will get better in 1 week?
CLASSIC SIGN = KERATITIS (specifically Subepithelial infiltrates (SEI's) What causes molluscum contagiosum? If a patient has multiple molloscum nodules, what
Multiple molluscum nodules (dome-shaped and typically waxy in appearance) should raise suspicion for HIV. What antibody is involved in allergic conjunctivitis? What is the classic symptom expected with
allergic conjunctivitis results in a TYPE 1 Hypersensitivity Reaction. classic symptom is itching Correct Answer = classic signs are papillae and conjunctival chemosis
is characteristic of allergy, more specifically it is associated with ATOPIC DERMATITIS. You can google Dennie's line and search under images to see a good example online. Did your DAD ever take you to Denny's restaurant? Dennie's = Atopic Dermatitis
What is the classic age and gender and systemic condition(s) of a patient with Vernal
conditions (asthma, hay fever, etc). Three classic signs: Papillae on the limbus (Trantas Dots) Papillae on palp conj (Cobblestone papillae) Corneal involvement (ranges from mild keratitis to a SHIELD ULCER) Remember, pABillae are commonly associated with Allergic and Bacterial conditions. What is the cause of Giant Papillary Conjunctivitis (GPC)? What are three classic symptoms of
Etiology - Protein deposits from contact lens (commonly silicone hydrogel lenses) Classic Symptoms - Itching, decreased contact lens wearing time, mucous If you consistently flip eyelids on your contact lens patients you will find that GPC is quite common. In many cases you will find mild GPC that is not causing any symptoms; the question above specifically asked for classic symptoms of SYMPTOMATIC patients because of this fact.
Recall that the difference between Chlamydial Inclusion Conjunctivitis and Chlamydial Trachoma Conjunctivitis is entirely due to what Chlamydia serotypes are causing the infection: Serotypes D-K: Inclusion Conjunctivitis Serotypes A-C: TrA-Choma Conjunctivitis
Trachoma
HALLMARK of chlamydia Arlt lines - scarring within superior palpebral conjunctiva (need to evert eyelid to view) Herbert's pits - limbal conjunctiva depressions from resolved follicles Remember, don't just memorize the buzz words (e.g. Arlt lines, Herbert's pits, etc) for conditions. Most importantly, start with the "big-picture" for the disease (e.g. follicles for trachoma, choroiditis for histoplasmosis) and add the buzz words to that framework.
SLK is most common in middle-age females; the reason is because thyroid disease is most common in middle-age females. Note that SLK is most commonly associated with two clinical scenarios:
Remember, the name of the condition tells you all you need to know -- SUPERIOR limbic keratoconjunctivitis. Clinical Notes: To diagnose SLK, have the patient look down (findings are superior) To diagnose Chlamydia, have the patient look up (findings are inferior) What is the most common etiology of phlyctenulosis? Describe the pathophysiology of this
What is another known cause of phlyctenulosis? Correct Answer = Tuberculosis. However, note that this is much less common. Clinical Note: The key thing to remember in a case of phlyctenulosis is to look for underlying blepharitis. Why? Because of you don't treat the underlying blepharitis the condition will keep recurring.
