Mnemonics

From EyeWiki


Below is a list of helpful mnemonics and classic clinical triads to aid resident ophthalmologists in preparing for OKAPs and Board exams

Cornea

Principal Corneal Stromal dystrophies, abnormality and staining - "Marylin Monroe Always Gets Her Men in L. A. County"

  • Macular dystrophy - Mucopolysaccharide - Alcian blue
  • Granular dystrophy - Hyaline materials - Masson trichrome
  • Lattice dystrophy - Amyloid - Congo red


BIG is LARGE: BIGH3gene defect in

  • Lattice
  • Avellino
  • Reis-Buckler's
  • Granular
  • Empty


Gelatinous Mac & CHED-AR: Autosomal recessive (AR) corneal dystrophies

  • Gelatinous drop-like
  • Macular
  • CHED


Keratoconus Ocular Findings - "CONES"

  • Central Scarring & Fleischer Ring
  • Oil Drop Reflex / edema (hydrops)
  • Nerves prominent
  • Excessive bulging of lower lid on down gaze (Munson’s Sign)
  • Striae (Vogt’s)


Tearing and Excessive Lacrimation - "FACE"

  • Foreign Body or Corneal Abrasions
  • Acute glaucoma
  • Conjunctivitis
  • Emotion


Drugs that Cause Cataract - "ABCD"

  • Amiodarone
  • Busulfan
  • Chlorpromazine
  • Dexamethasone

Glaucoma

Anterior angle structures (posterior to anterior) - “I Can’t See This Stuff"

  • Iris
  • Ciliary body
  • Scleral spur
  • Trabecular meshwork
  • Schwalbe's line


Secondary Glaucoma - "NIPPLES T "

  • Neovascular
  • Iridoschisis
  • PXF
  • Pigmentary
  • Lens (phacolytic/phacomorphic)
  • Iridocorneal Endothelial Syndromes
  • Seclusio Pupillae (in iritis)
  • Trauma (angle recession)

Pediatrics

Congenital corneal opacity/clouding - "STUMPED"

  • Sclerocornea
  • Tears in Descemets (trauma)
  • Ulcer
  • Mucopolysaccharidosis/Metabolic
  • Peter's anomaly
  • Edema: Congenital hereditary endothelial dystrophy (CHED)
  • Dermoid


Congenital toxoplasmosis (Sabin’s Triad) - Triad

  1. Hydrocephalus
  2. Intracranial calcifications
  3. Chorioretinitis


Congenital syphilis (Hutchinson’s triad) - Triad

  1. Interstitial keratitis
  2. CN VIII deafness
  3. Hutchinson teeth


Duane’s retraction syndrome subtypes - Count the "Ds"

  • Type 1: abDuction affected
  • Type 2: aDDuction affected
  • Type 3: abDuction and aDDuction affected


Leukocoria - "nPRREDICCCTIV"

  • Norrie disease
  • Persistent fetal vasculature
  • Retinoblastoma
  • Retinopathy of prematurity
  • Endophthalmitis
  • Dysplasia of retina
  • Inflammatory cycliticmembrane
  • Congential cataract
  • Coats disease
  • Coloboma of choroid or optic disc
  • Toxocariasis
  • Incontinentia pigmenti
  • Vitreal- Famialial exudative vitreal retinopathy

Retina

Angioid streak etiology - “PEPSI HAM”

  • Pseudoxanthoma Elasticum
  • Ehlers-Danlos (note this is a famous myth! ) [1]
  • Paget's disease of bone
  • Sickle cell anemia or other hemoglobinopathy (Thalassemias)
  • Idiopathic
  • Homocysteinuria
  • Acromegaly
  • Marfans syndrome


Susac syndrome - Triad

  1. Encephalopathy
  2. Hearing loss
  3. Retinal artery branch occlusions ("boxcar” segmentation)


Acute retinal necrosis - Triad

  1. Occlusive retinal arteriolitis
  2. Vitritis
  3. Multifocal yellow-white peripheral retinitis


Presumed ocular histoplasmosis syndrome - Triad

  1. Multiple white, atrophic choroidal scars (punched out) = “histo spots"
  2. Peripapillary pigment changes
  3. CNV (causing maculopathy and no vitreous cells)


Cherry Red Spot - "Cherry Trees Never Grow Tall"

  • Central retinal artery occlusion
  • Tay-Sachs disease
  • Niemann-Pick Disease
  • Gaucher’s disease
  • Trauma (Berlin’s Edema)

Neuro-ophthalmology/Uveitis

Leber's hereditary optic neuropathy - Triad

  1. Hyperemia and elevation of disc (although disc is swollen it does not leak)
  2. Peripapillary telangiectasia
  3. Tortuosity of medium sized retinal arterioles


Optic nerve sheath meningioma - Triad

  1. Painless, slowly progressive vision loss
  2. Optic atrophy
  3. Optociliary shunt vessels


Miller-Fisher syndrome - Tetrad

  1. Facial diplegia
  2. ophthalmoplegia
  3. Ataxia
  4. Areflexia


Granulomatosis with polyangiitis (formerly Wegener’s) - Triad

  1. Necrotizing granulomatous vasculitis of upper and lower respiratory tract
  2. Focal segmental glomerulonephritis
  3. Necrotizing vasculitis of small arteries and veins


Argyll Robertson Reflex - ARP

  • ARP acronym left to right is A(ccomodation) R(eflex) P(resent)
  • ARP acronym right to left is P(upil) R(eflex) A(bsent)


Prisms A-Null nystagmus: Prism Apex towards Null point to decrease head turn

Oculoplastics

Blepharophimosis - Triad

  1. Ptosis
  2. Epicanthus inversus
  3. Telecanthus


Nerves passing through the Superior Orbital Fissure - "Live Free To See No Insult at All"

  • Lacrimal Nerve (CN V1)
  • Frontal Nerve (CN V1)
  • Trochlear Nerve (CN IV)


Superior Division of Oculomotor Nerve (CNIII)

  • Nasociliary Nerve (Branch of CN V1)
  • Inferior Division of Oculomotor Nerve (CNIII)
  • Abducens Nerve (CN VI)


Structures passing through the Annulus of Zinn: 3 'n 3 = 6

  • CN 3 superior branch
  • Nasociliary nerve
  • CN 3 inferior branch
  • CN 6


Structures passing above the Annulus of Zinn: LOFT

  • Lacrimal nerve (CN V1)
  • Ophthalmic vein (superior)
  • Facial nerve (CN V)
  • Trochlear nerve (CN IV)


Orbital wall bones

  • Medial wall - SMELL (nearest to nose)
Sphenoid, Maxilla, Ethmoid, Lacrimal, Lesser wing (Sphenoid)
  • Floor - Z's in the PM on the floor
Zygomatic, Palatine, Maxilla
  • Lateral wall - oh GeeZe
Greater wing of Sphenoid, Zygomatic
  • Roof - Frontless
Frontal, Lesser wing of Sphenoid

Ocular Oncology

Ocular Melanoma high risk features versus nevus

1) "To Find Small Ocular Melanoma Doing IMaging"

Note: "TFSOM- Using Helpful Hints Daily" was superseded by the above. [2]

  • Thickness - >2mm
  • Fluid - Subretinal fluid
  • Symptoms
  • Orange pigment
  • Melanoma hollow on ultrasound
  • DIaMeter > 5 mm on fundus photography


2) MOLES [3]

  • Mushroom shape
  • Orange pigment
  • Large size (>2mm thickness, > 5mm diameter)
  • Enlarging tumor
  • Subretinal fluid

Miscellaneous

Causes of Ectopia Lentis - "Watch Him See"

  • Weill-Marchesani
  • Aniridia
  • Trauma
  • Congenital Glaucoma
  • Hyperlysinemia


  • Homocystinuria
  • Iris coloboma
  • Marfan syndrome


  • Sulfite oxidase deficiency
  • Ehlers Danlos Syndrome
  • Ectopia lentis et pupillae

References

  1. Singman et al.. Angioid Streaks Are Not a Common Feature of Ehlers-Danlos Syndrome. JAMA Ophthalmol. 2019;137(3):239
  2. Retina. 39(10):1840-1851
  3. Cancers.2020, 12(5), 1311