The following is a photograph after fluorescein staining of a 40 year old patient with complaints of gritty sensation OU for the past several months. All of the following might be expected except:

Tuesday, September 22, 2009

increased tear break-up time
decreased tear meniscus
5mm Schirmer test
filamentary keratitis

Correct Answer: increased tear break-up time

The picture depicts aqueous tear deficiency dry eye. This condition is characterized by a decreased tear break-up time, decreased tear meniscus, decreased Schirmer test and increased mucus in the precorneal tear film and/or filament formation.

The patient depicted in the photograph below would be best treated with:
1. Acetylcysteine 10% drops
2. Prednisolone drops
3. Sodium cromolyn drops
4. Olopatadine drops
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A 40 y.o. female pictured below comes to the office with swelling of both upper lids, mild shortness of breath and symptoms of dry eyes. One would expect to see as part of her work up:
1. A monocytic B cell infiltrate of her lacrimal glands
2. Pain on palpation of her lacrimal glands.
3. An elevated ACE.
4. A history of breast cancer.
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The following is true of the photograph below:
1. This particular stain stains only devitalized and dead cells and mucus.
2. This eye has been stained with 2% rose Bengal.
3. This stain pools in epithelial erosions and stains exposed basement membrane.
4. This stain may be a more sensitive indicator of early or mild cases of keratoconjuncitivitis sicca.
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After permanent punctal occlusion with cautery:
1. 5-10% rate of recanalization is expected.
2. 10-20% rate of recanalization is expected.
3. 20-30% rate of recanalization is expected.
4. 30-40% rate of recanalization is expected.
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The most common cause of mucin deficiency is:
1. Vitamin D deficiency
2. Vitamin C deficiency
3. Vitamin K deficiency
4. Vitamin A deficiency
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