Mnemonics

Original article contributed by:

R. Allan Sharpe, MD
All contributors:
Eric Jiaming Zhang, Angelo Sarmiento, Adam Altman, R. Allan Sharpe, MD, Edward
Stevenson, MD, Stephen C. Dryden, M.D. and Tjebo F.C. Heeren
Assigned editor:
Review:
Assigned status Update Pending
.
Below is a list of helpful mnemonics and classic clinical triads to aid resident
ophthalmologists in preparing for OKAPs and Board exams

Contents
 [hide] 

 1 Cornea
 2 Glaucoma
 3 Pediatrics
 4 Retina
 5 Neuro-ophthalmology/Uveitis
 6 Oculoplastics
 7 Ocular Oncology
 8 References

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- " To Find Small Ocular
Melanoma Using Helpful Hints Daily"

 Thickness - >2mm
 Fluid - Subretinal fluid
 Symptoms
 Orange pigment
 Margin - <3mm from optic disc
 Ultrasonic Hollowness - low internal reflectivity (versus solid)
 Halo - ABSENCE of halo (circular band of depigmentation)
 Drusen - ABSENCE of drusen

References
1. Jump up↑ Singman et al.. Angioid Streaks Are Not a Common Feature of
Ehlers-Danlos Syndrome. JAMA Ophthalmol. 2019;137(3):239