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Learning Objectives > Eyeballs > Flashcards

Eyeballs Flashcards

1
Q

Double vision? Concerned?

A

Test one eye alone - do they still have double vision? Binocular double vision - This is concerning! This means one eye is not moving right

Need an urgent head scan - risk of aneurysm

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2
Q

Retinal detachment? Next steps?

A

Is their vision intact? 20/30-50 if yes this is more urgent to try and operate and preserve vision. All will need surgery in the next week or so.

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3
Q

Eye discomfort, jaw pain, headache, vision changes in an older person?

A

High index of suspicion for temporal arteritis - give oral prednisone, and get a biopsy within a week.

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4
Q

Vision required for driver’s license?

A

20/50 or better in one eye

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5
Q

HSV 1 in the eye?

A

Look for dendritic lesions - have a little bulb on the end, could also have a geographic lesion

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6
Q

First line treatment for HZV of the eye?

A

Oral anti-virals, work as well as topicals for the eye, with less risk of ototoxicity

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7
Q

Loss of light differentiation - concerned?

A

If the patient can’t see light this indicates severe compromise of the ocular tissues this is very concerning.

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8
Q

Classic presentation of acute angle glaucoma?

A

Pain, N/V, cloudy cornea, red eye, hard eye (on light palpation), decreased vision, and non-reactive dilated pupil

Steroid use is not associated with acute increased pressure more chronic

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9
Q

Hyperopia vs Myopia?

A

Farsighted - hyperopia

Nearsighted - myopia

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10
Q

Severe photophobia is most characteristic of?

A

Iritis - ciliary flush (not limbic sparing - opposite of conjunctivitis)

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11
Q

When can’t you dilate the pupil?

A

Usually use epinephrine (sympathetic agonist), tropicamide (anti-cholenergeric)
- acute angle glaucoma, neurological injury suspected, lens implant supported by the iris

  • will actually help an iritis
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12
Q

Unilateral conjunctivitis moves from one eye to the opposite eye

A

Usually viral (very contagious) and weepy (not pus, pus is dead WBC)

Lingers in one eye - bacterial, chalmydial.

Allergic - both at the same time

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13
Q

Third nerve presentation?

A

Down and out eye with aniscoria, and ptosis

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14
Q

Horner’s?

A

Ptosis, anyhydrosis and miosis (small pupil)

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15
Q

Sections of the eye?

A 
Anterior section (Aqueous humour) = the anterior and posterior chamber 
Posterior section (vitreous humour) = vitreous chamber
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16
Q

Layers of the eye?

A 
Fibrous layer (sclera and cornea) 
Vascular layer (choroid, iris, ciliary body) 
Neural layer (retina - contains pigmented layer and neural layer)
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17
Q

What does the vitreous humour do?

A

Preserves shape and function, keeps retina attached to the choroid

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18
Q

Retinal detachment is separation of

A

Neural sensory layer and RPE

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19
Q

Dislocated lens presents

A

Monocular diplopia

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20
Q

Urgent optho consult if you see?

A

Corneal ulcer, retinal detachment, acute glaucoma, acute iritis

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21
Q

The uvea contains

A

The iris, the uvea and the cilliary body

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22
Q

Central retinal vein occlusion looks like on fundoscopy?

A

Blood and thunder, will be painless, monocular, possibly due to atherosclerosis of the vein in the eye

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23
Q

Renal artery occlusion sign?

A

Positive swinging flashlight, often painless, severe monocular loss of vision

Try massaging the globe of the eye, decrease IOP, call optho - this is an emergency

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24
Q

Glaucoma definition?

A

Optic neuropathy involving changes to the structure of the nerve head changing vision - commonly associated with high IOP

25
Q

Usual flow of Aqueous humour

A

Ciliary epithelium through the trabecular mesh work, the canal of Schliemann and into the aqueous veins and out into the venous system

26
Q

Normal IOP?

A

8-21mmHg

27
Q

Open angle vs closed angle glaucoma

A

Open angle is most common - trouble with trabecular network, insidious.

Acute is blockage of drainage is an emergency

28
Q

Sx of acute angle closure glaucoma

A

Severe eye pain, headaches, nausea, halos around lights. Hard eye. Can have a fixed pupil

29
Q

Tx of acute angle closure glaucoma?

A

Increase outflow - pilocarpine, latanoprost, brimanidine
Decrease production - timolol, topical carbonic anhydrase inhibitor

Can give mannitol

Surgery is the definite solution

30
Q

Retinal detachment sx?

A

Painless, sudden onset, flashes of light with floater and curtain of blackness

31
Q

Blepharitis Patho?

A

Inflammation of lid margins, either due to S. aureus (crust) or seborrheic (flaky) tearing, itching, thickened red lid margins, warm compress and baby shampoo

32
Q

What is a hordeolum?

A

Style - inflammation of an eyelid gland, or eyelash follicle, will localize to the eyelid margin, will usually resolve on own.

33
Q

Chalazion?

A

Inflammation of the meibomian gland often preceded by an internal hordeolum, non-tender, if recurrent need to biopsy

Tends to localize to the eyelid margin in the centre and becomes non-painful (unlike a stye)

34
Q

Pre-septal vs Orbital cellulitis

A

Pre-septal - soft tissue infection, usually after a local trauma, edema but normal ocular mobility and vision, give abx

Orbital - MEDICAL EMERGENCY - secondary to sinus or facial infections/ trauma, the eye tissues themselves are infected. Proptosis, decreased vision, mobility. IV abx, CT, and abscess drainage

35
Q

Causes and presentation of conjunctivitis

A

Viral - one eye then the other, red itchy eye with watery tearing - adenovirus - no tax
Bacterial - more likely to be monocular, green and goopy - S. aureus - give topical abx
Allergic - both eyes at the same time, triggered by something in environment or with nasal congestion
Neonatal - chlamydial usually, this is why we give prophylactic erythromycin

Conjunctivitis always spares the limbus

36
Q

Subconjuctival hemorrhage?

A

Don’t worry about it. It looks bad but goes away by itself - from valsalva/ pushing

37
Q

Episcleritis?

A

Localized inflammation of the sclera, often in young people, self-limited, oral NSAIDs can help, optho if recurrent for steroids

38
Q

Scleritis?

A

Severe destructive vision threatening inflammation of the eye, often seen in women with other inflammatory diseases, severe pain, hyperaemic patches on the eye, treat with prednisone

39
Q

Pinguecula

A

Benign subepithelial deposit of tissue, no concerns seen in older people, lots of sun exposure.

40
Q

Pterygium

A

Encroachment of epithelial tissue cover the cornea, excise if causing vision problems due to growth.

41
Q

HSV in the eye?

A

Classic dendritic lesions with bulbs at the end.

42
Q

HZV of the eye

A

Look for vesicles elsewhere, give the, valcyclvir right away.

43
Q

Welder flash burns

A

A type of photokeratitis - very painful, but only supportive care and limited use of topical anesthetic (due to risk of corneal ulcer)

44
Q

Tx for corneal abrasion?

A

Topical abx, patch and see - most clear within 2 days. If not then be concerned for an ulcer, which is secondary infection. Ask about contact lenses

Corneal ulcer IS AN EMERGENCY

45
Q

Sx of uveitis?

A

Ocular aches or brow pain , redness, photophobia, decreased vision - often idiopathic or immune, refer to optho

Iritis can present with stuck pupil that is irregularly shaped

(Iritis is SEVERE)

46
Q

Tx of iritis?

A

Use mydriatics to dilate - get pupil wide to stop the adhesions from occluding the visual field - pheynalephrine

47
Q

What is a hypopyon?

A

Pus in the anterior chamber, will see at base of iris - see by optho in the same day

48
Q

Hyphema?

A

Blood in anterior chamber, see at base of iris - urgent to optho

49
Q

What is a cataract?

A

Any opacity of the lens - most common cause of reversible blindness worldwide

50
Q

Features of a vitreous hemorrhage?

A

Look for retinal tear, or detachment, trauma, bleeding into the chamber, painless floater and visual loss

51
Q

Most common location for orbital fracture

A

Inferior wall blowout with lateral rectus entrapment

52
Q

Lateral canthotomy

A

For retro-orbital bleed - if proptosis

53
Q

Psychogenic vision loss

A

Test for involuntary responses, flicking towards eyes, sometimes they will stop their proprioception too

54
Q

Bilateral inter nuclear opthalmoplegia

A

MS

(Unilateral is indicative of a stroke

55
Q

Tortuous vessels in the conjunctiva

A

Consider cavernous sinus carotid fistula

56
Q

Risk factors for subcapsular cataract

A

Steroids, DM, trauma, smoking - seen in younger folks

57
Q

Increased IOP?

A

Start with 500mg acetozolamide, then drops

58
Q

High IOP - next steps?

A

Pain? Hx Cataract surgery?

59
Q

Causes of retinal detachment

A

Retinal tear, watery vitreous (age), traction (shrivelled vitreous - also age)

Learning Objectives (29 decks)

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