Mnemonics

Article initiated by:

R. Allan Sharpe, MD

All authors and contributors:

Eric Jiaming Zhang, Angelo Sarmiento, Edward Stevenson, MD, R. Allan Sharpe, MD, Stephen C. Dryden, M.D., Adam Altman, Jacob Fondriest, MD, Tjebo F.C. Heeren

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Review:

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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- Familial Exudative Vitreoretinopathy

Retina

Angioid streak etiology - “PEPSI HAM”

• Pseudoxanthoma Elasticum
• Ehlers-Danlos (note this is a famous myth! )
• 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 (CN III)

• Nasociliary Nerve (Branch of CN V1)
• Inferior Division of Oculomotor Nerve (CN III)
• 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.

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

2) MOLES

• 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