Disease Flashcards
(137 cards)
1
Q
Ectropion common with
A
- Involutional due to loss of muscle tone within orbicularis oculi
- paralytic
- Mechanical
- Cicatricial
- Congenital
2
Q
What are optic disc drusens?
A
They are hyalin bodies located within the optic disc. Can be hereditary ( AD).
Gradually move anterior as pt ages.
Diagnosed with B-scan, appear hyperreflective
3
Q
Common collagen vascular disorders that can cause optic disc edema
A
Rheumatoid arthritis
Systemic lupus erythematosus
Polyarteritis nodosa
Wegeners granulomatosis
4
Q
What is Papillitis
A
Secondary to inflammation of the anterior optic nerve and will present with disc edema. Occurs 1/3 cases of optic neuritis.
5
Q
What are signs of TRO
A
Unilateral optic disc edema
APD
Unilateral or bilateral proptosis, upper eyelid retraction
inferior and medial rectus effected first
Reduced color vision
Variable VA loss
Elevated IOP
6
Q
Papilledema signs
A
Elevated optic nerve rim tissue Elevated or opaque NFL Paton's folds Hyperemia of optic disc CWS Exudates Splinter hemorrhage Absent SVP VF shows "Large Blind Spot"
7
Q
IIH signs
A
Enlarged Blind Spot on VF
Diplopia due to CN VI palsy
Papilledema
Optic Atrophy ( late signs)
8
Q
Reverse APD
A
Constriction of good eye during swinging flash light test when fellow eye has APD
Direct response of good eye is stronger than consensual response
9
Q
In which cases of optic nerve abnormality, optic nerve appears normal
A
Retrobulbar Optic Neuritis.
Posterior ischemic optic neuropathy.
10
Q
CN 3 palsy pathophysiology
A
- Lesion along the pathway of CN III
- Micro vascular infarcts from DM and hypertension.
- Trauma
- Aneurysm ( posterior communicating artery)
11
Q
CN IV palsy common cause and symptoms
A
Trauma
Vertical Diplopia
Compensatory head tilt away from the side of the lesion
12
Q
CN VI palsy cause/symptoms
A
Cause: Pseudotumor cerebri Horner's syndrome DM/HTN Trauma Tumor Symptoms: Head turn toward the affected side
13
Q
Viral Conjunctivitis
A
Common cause is adenovirus. Patient highly contagious for 12-14 days Classic syndrome: 1-Acute non-specific follicular conjunctivitis 2-pharyngoconjunctival fever 3- EKC
14
Q
Bacterial conjunctivitis
A
Signs;
Mucopurulent discharge.
Treatment:
Erythromycin ointment
15
Q
Allergic conjunctivitis
A
Signs;
Watery, itchy , chemosis, allergic shiners.
Treatment:
Patanol
16
Q
Follicles
A
- Blister like, more common in viral conjunctivitis.
- Avascular, white-gray nodules typically found in tarsal and fornix conjunctiva.
- Associates with Chlamydia, toxic or viral infections
17
Q
Papilla
A
inflamed areas of elevated conj that have central vessel.
Can be small to very large ( as in GPC and VKC).
Non-specific but common in allergic or bacterial conjunctivitis.
18
Q
psudomembrane
A
appears with severe conjunctivitis.
19
Q
Blepharitis Treatment
A
Treatment:
warm compresses, lid scrubs, and artificial tears.
Erythromycine at bed time
Doxycycline can help by changing oil viscosity.(anti inflammatory and stops MMPs)
20
Q
Chalazions
A
backed up lipids cause of blocked MGs
- non-infections (sterile) inflammations of the meibomian glands.
- painless and immobile
- recurrent, warrants possible malignancies ( sebaceous gland carcinoma)
21
Q
Pre-septal cellulitis
A
Treatment:
Keflex, Augmentin
22
Q
HSV infections
A
NO steroids..
Acyclovir, viroptic
23
Q
Endophthalmitis is a.
A
serious infection inside the eye. Hypopon
24
Q
Removal of acoustic neuroma may result in damage to the ……
A
Parotid gland and CN VII, causing facial paralysis on affected side
25
Neurotrophic keratitis is
Poor corneal sensitivity and wound healing. Secondary damage to V1
26
Congenital Gaucoma
Haab's stria( folds in descemet's membrane)
27
Band Keratopathy is associated with
```
Hypercalcimia
Gout
JIA
Uveitis
Dry Eye
```
28
Blue sclera is associated with what diseases?
Osteogenesis imperfecta or Ehler's Danlos syndrome
29
What is Commotio Retinae
- Disruption of the RPE and photoreceptors outer segments causes of Trauma.
- Usually resolves without sequelae within 24-48 hours.
- known as Berlin's edema
30
Purtscher's Retinopathy
Associated with acute chest-compressing trauma
- diffuse retinal hemorrhage
- exudate
- cws
31
Perseptal Cellulitis
-ocular infection-( acute hordeolum, dacryocystitis)
-Systemic infection
-skin trauma
Signs:
Eyelid edema, Erythema, Ptosis, warmth, bump on eyelid
32
Orbital Cellulitis
1-Sinus Infection( Ethmoid sinusitis)
2-Orbital Infection ( dacryoaddentits, dacryocyctitis, progression of preseptal cellulitis)
3-Orbital Fracture
4-Dental Infection
Signs:
Red Eye, pain, Fever, Decreased vision, APD, proptosis, diplopia, pain on eye movement, EOM restriction
33
Diabetic and immunocompromised patients with orbital cellulitis may develop what
Mucormycosis (aggressive fungal infection)
34
Strongest risk factor for developing Thyroid eye disease
cigarette smoking
35
Thyroid eye disease occurs in
- 30-70% of patients with Graves thyroid disease
| - most common cause of u or b proptosis in middle-aged patients
36
Thyroid eye disease signs
- inflammation and thickening of the EOMs resulting Optic nerve compression
- U or B proptosis
- upper eyelid retraction resulting in Dalrymple's sign
- APD
- conj injection
- decreased color vision
- EOM involvement ( Im So Lazy) [ no muscle tendons]
- Corneal involvement ( SLK)
37
Von Graefe's sign
upper eyelid lag during downgaze
38
Kocher's sign
globe lag compared to lid movement when looking up
39
Orbital Psudotumor
-Affects young to middle aged patients
-idiopathic inflammatory process
-Acute onset of unilateral pain
-proptosis, EOM restrictions ( involved tendons), chemosis, hyperopic shift, optic nerve swelling (if posterior), increased IOP, reduced corneal sensation.
Testing: CT or MRI
40
Bilateral Orbital Pseudotumor in adults raises suspicion of which systemic diseases
systemic vasculitis:
Wegener's granulomatosis
Polyarteritis nodosa
Lymphoma
41
Evisceration
Removal of the inner contents of the eye, sclera and other orbital content
42
Exenteration
removal of ALL contents of the orbit. including EOMs and orbital fat
43
Ocular Rosacea
Affects Sebaceous Glands ( Meibomian glands)
- chronic eyelid disease ( MGD, Blepharitis, recurrent hordeola/chalaza) resulting in ocular surface disease:
- Telangiectasia
- phyctenules
- staph marginal keratitis.
- SPK
- prelimbal corneal infiltrates.
44
Steven Johnson Syndrome
Type 3 hypersensitivity
-most commonly drug induced ( sufonamide,...)
-from infectious agents ( HSV, staph, adenovirus, pneumoonrpelbmnia)
Chronic signs: corneal scars, ulcers and NV, symblepharon.
45
Symblepharon associated with
Mucous membrane disorders:
- Ocular cicatricial pemphygoid (OCP)
- SJS
- severe AKC
46
Hordeolum
acute staph infection
- Internal
- External
- painfull
47
Trachoma signs
Entropion and Trichiasis ( causes corneal ulceration)
48
Meige's syndrome is characterized by
BEB and lower facial abnormalities
49
The two prognostic factors for malignant melanoma
- depth of invasion
| - lesion size
50
rodent ulcer is associated with
BCC
51
Causative agents for Dacryocystitis
- staphylococcus aurerus
- staphylococcus epidermidis
- Pseudomonas
- H. influenza in children
52
Dacryocystitis symptoms
Pain
Epiphora
Crusting
Occasional fever
53
Dacryocystitis signs
Edema and tenderness of the lacrimal sac below the medial canthal tendon
54
Primary Acquired Melanosis can progress to
Conjunctival Melanoma
55
Conjunctival intraepithelial Neoplasia
- known as Bowen's disease or conjunctival squamous dysplasia
- can progress to sq cell carcinoma
56
Gonococcal conjunctivitis
- causative agent is Neisseria gonorrhea
- Thayer-Martin agar for diagnosis
- severe purulent discharge
- preauricular lymphadenopathy
- psudomembranes
57
```
Dennie's lines
Atopy Shiners
bilateral itching
Inferior Papillae
Corneal neovascularization, keratoconus, cataract
common with Wilson disease
Keratoconus is more common
most common in young to middle aged adults ( teens to 40s)
```
Atopic Keratoconjunctivitis (AKC)
58
```
Shield ulcers
bilateral prominent papillae
Cobblestone papillae (upper palp conj)
Trantas dots.
intense itching, photophobia, thick mucus discharge
common with young males
```
Vernal Keratoconjunctivitis (VKC)
59
VKC has strong association to
Atopic conditions
Asthma, eczema, seasonal allergic rhinitis.
40-75% of patients have eczema or asthma.
40-60% of patients have family history of atopy.
60
Trantas dots
Collection of epithelial cells and eosinophils near the limbus
61
Toxicity to topical mediation or CL solutions can result in
Allergic Conjunctivitis that is characterized by a Follicular reaction
62
GPC can results from
- Extended CL wear ( common with SH)
- Exposed sutures
- Glaucoma filtering bleb
- Scleral Buckles
- Ocular prosthetics
- classic signs; papillae > 0.3mm of upper tarsal conjunctiva, giant papillae > 1mm
63
Patient reports clear vision with CL and blurry with glasses, ghost images and diplopia.
topography shows irregular astigmatism.
what can you suspect
Corneal warpage
| High riding CL
64
3 and 9 o clock staining is common complication with what type of CLs
Low-riding GP lenses.
65
Chlamydial-Adult Inclusion Conjunctivitis
- Caused by chlamydia serotypes D-K
- Acute Follicular conjunctivitis that becomes Chronic
- unilateral giant follicles in inferior fornices.
- preauricular lymphadenopathy and mucopurulent discharge possible.
- report chronic red eye started several weeks to months
- persist 3-12 months if left untreated and become bilateral.
66
Chlamydial- Trachoma Conjunctivitis
- Prevalent btw ages 1-5
- Caused by chlamydia serotypes A-C
- Follicular and papillary conjunctivitis
- preauricular lymphadenopathy
- mild superior pannus
- Arlt lines
- Herbert's pits
67
Ophthalmia neonatorum
- acute conjunctivitis in newborns
| - Chlamydia is the leading cause
68
Pterygium
- Fibrovascular growth of bulbar conjunctiva on to cornea
- destroys Bowman's membrane
- leading to WTR
- Present Stocker's line
69
Scleritis vs Episcleritis injection
bilateral and diffuse injection with Scleritis
| unilateral and sectoral injection with episcleritis
70
Axenfeld's nerve loop
Posterior ciliary nerve loop visible in sclera
71
Fine Keratic Precipitates (KPs)
| Koeppe nodules
characteristics of non-grannulomatous etiology
72
Mutton-fat KPs
| Iris stromal nodules ( Koeppe, Busacca)
characteristics of grannulomatous etiology
73
Stellate KPs are observed in
- Fuch's heterochromic iritis
| - Herpatic Uveitis
74
Congenital Syphilis Triad
- Hutchinson's teeth
- deafness
- interestitial keratitis
- saddle nose deformity
- frontal bossing
75
Pars Planitis
- Chronic intermediate Uveitis
| - characterized by inflammation over pars plana (snow banking)
76
Iris Malignancy
- From Iris Nevi
- located within iris STROMA tissue in the inf quadrant 80%
- diameter >3mm
77
Neurotrophic Keratopathy cause and symptoms
```
Herpes simplex
Herpes zoster
Diabetes
LASIK
Corneal findings worse than symptoms
```
78
Confluent SPK
| Associated with what disease
UV Keratopathy
| Symptoms are typically worse 6-12 hours
79
#1 cause of aq deficient dry eye
Primary Non-sjogrens and secondary
80
Number one cause of dry eye
Intrinsic MGD
| Extrinsic cause > vitamin A deficiency
81
Which layer of cornea does Keratoconus originate in?
Bowman 's layer
82
Hydrops on cornea
Tears in DESCEMET's membrane that results in edema and rupture of epithelium
83
Posterior corneal dystrophies
Fuch's
| Posterior Polymorphous Dystrophy
84
Posterior Polymorphous Dystrophy is
20-30 yo patients
Metaplasia of endothelial cells
patches of vesicles is the hallmark sign
85
painfull Bullae and scarring
caused from stromal edema in Fuch's
86
two conditio that have Corneal findings worse than symptoms
```
Neurotrophic Keratopathy
Acanthamoeba Keratitis (early signs), (ring ulcer, late sign)
```
87
Chocolate agar for
N. Gonorrhea.
| Haemophilus
88
heat-killed E.Coli agar
Acanthamoeba
89
Sabaroud's agar
test for fungi
90
interestitial keratitis are
WBC in endothelium with diffuse newovascularization
91
most common cause of endothelitis
Disciform endothelitis
92
what are the common corneal sign in active HZ
Pseudodendritic keratitis
93
Bank Keratopathy associated with
```
Uveitis
after trauma
Gout
hypercalcemia
>>>calcium deposit at 3 and 9 oclock position
```
94
Krachmer's spots
stromal corneal graft rejection associated with sub epi infiltrates
95
Kodadoust line
endothelium corneal graft rejection line characterized by WBCs on endothelium line.
96
Hyperopic shift
Radial Keratotomy
cortical cataract
CNVM
97
how much residual cornea is required after PRK
400nm
98
how much corneal thickness is required for LASIK
250um
99
myopic shift
```
Nuclear Sclerosis
Scleral buckle surgery
Diamox
NSAIDs
Topamax
Oral Sulfonamides
```
100
Elsching pearls
type of posterior capsular opacification common in children who undergo cataract extraction.
101
common post-operative complication
PCO
| CME ( Irvine-Gass syndrome, 6-10 weeks following surgery)
102
Bull's eye maculopathy differential diagnosis
- Stargard's disease
- cone dystrophy
- Chloroquine toxicity
- hydroxychloroquine toxicity
- thioridazine toxicity
103
Retinoschisis
splitting of OPL and INL resulting in elevation of the inner retina
104
common ocular finding of Behcet's Disease is
Acute recurrent Hypopyon
105
Cluster headaches can cause
transient or permanent ipsilateral Horner's syndrome
106
Early cataract
M A D
Myotonic dystrophy
Atopic dermatitis
Diabetes
107
Moore's Lightning streaks
Lightning streaks which are Vertical Flashes of light seen in the peripheral visual field.
Occurs because of vitreous syneresis, traction on peripheral retina.0
108
What test are considered for foreign body diagnosis?
CT scan
B-scan
NO MRI
109
Canaliculitis presentation
```
Inflammation or infection of the canaliculi caused by bacterial, fungal or viral.
Unilateral smoldering red eye
Epiphora
Mild tenderness/pain on nasal portion
Swollen puncta ( pouting puncta)
Mucopurulent discharge
```
110
Canaliculitis etiologies
```
Actinomyces israelii ( strep tothrix)- expression of yellow sulfur granules.
Staphylococcus aureus
Candida albicans
Aspergillus
Nocardia asteroides
Herpes simplex
Herpes zoster
Surgery, trauma, neoplastic disorders
```
111
Allergic conjunctivitis presentation
Moderate or severe Ocular itching,hyperemia and tearing.
| May also complain of associated rhinitis and sneezing.
112
GPC avrg length time for development secondary to CL
8 months
May occur early as 3 weeks.
Risk Factors:
-Extended wear hydrogel CL. High water ionic CL, High modulus of elasticity, poor replacement compliance.
113
Cause of decreased vision in AKC
Superficial punctuate keratitis.
114
Superior limbic keratoconjunctivitis
Chronic inflammatory reaction.
Associated with thyroid disease, Keratoconjunctivitis sicca, CL wear ( hypersensitivity reaction to preservative in CL solution or poor CL fit).
Symptoms: redness, foreign body sensation,frequent blinking
115
Corneal signs of HZO
```
Occurs in 65% pt with acute HZO;
Punctate epithelial keratitis
Pseudodendrtitic keratitis
Anterior stromal keratitis
Keratouveitis
Endothelitis
Neurotrophic keratopathy
Less common signs;
Exposure keratopathy, disciform keratitis, IK
```
116
Acanthamoeba corneal signs
```
Punctuate defect
Whorl-like defect
Pseudodendrtitic lesions
Late signs: patchy, anterior stromal infiltrate becoming confluent over 2-3 months forming Ring ulcer.
Also presenting radial keratoneuritis
```
117
Marginal keratitis
caused by a hypersensitivity reaction against staphylococcal exotoxins and cell wall proteins with deposition of antigen-antibody complexes in the peripheral cornea (antigen diffusing from the tear film, antibody from the blood vessels) with a secondary lymphocytic infiltration. The lesions are culture negative but S. aureus can frequently be isolated from the lid margins.
118
Phlyctenulosis
delayed hypersensitivity reaction to staphylococcal antigen; the most common systemic association is rosacea.
-Presentation is usually in children or young adults with photophobia, lacrimation and blepharospasm.
119
Thygeson superficial punctate keratitis
Symptoms :consist of recurrent attacks of irritation, photophobia, blurred vision and watering.
Signs • Mainly central, coarse, distinct, granular, greyish, slightly elevated epithelial lesions that stain with fluorescein. -A mild subepithelial haze may be present especially if topical antivirals have been used. •The conjunctiva is uninvolved and the eye is not hyperaemic.
120
Art lines
White scarring of the superior tarsal conjunctiva
121
Herbet's pits
Depression of the limbal conjunctiva after resolution of limbal follicles
122
Chrysiasis
occurs secondary to the deposition of gold in the skin, lens, and cornea, causing a gray discoloration of the skin and brown/gold deposits in the deep stroma of the cornea.
123
Conditions that cause corneal blindness in the US
1-Trauma
| 2-HSV
124
Thygeson's SPK signs
Bilateral
Small multiple asymmetric, gray white clusters of superficial intraepithelial raised "crumb like" central corneal lesions.
125
Aberrant regeneration of CN 3
Evaluation for trauma and tumor
-signs are lid -gaze and pupil-gaze dyskinesia
( patient will have upper eye lid retraction with downgaze and pupil construction with down gaze and addiction )
126
Ocular signs of Myotonic Dystrophy
```
Miotic pupil
Ptosis
External ophthalmoplegia
"Christmas tree " cataract
Pigmentary retinopathy
```
127
Type of cataract with Diabetic
Cortical cataract
- bilateral, multiple, gray white cortical crystalline lens opacities described as "snow flake opacities'"
- earlier and faster progression of senile NS and cortical cataract.
128
Cataract with Wilson disease
Green- brown opacities " sun flower cataract"
129
Positive Seidel's sign
Early post op period due to trauma
Suture failure
Valsalva maneuver
130
Hopotony
Loss of aq humor
IOP < 6
Causing anatomical and physiological changes
131
Common cause of elevated IOP in post op cataract patients
Retained viscoelastic materials
132
Potential cause of elevated IOP in post op patients
```
Retained viscoelastic
Steroid response
Pseudoexfoliation material
Pupillary block
Red blood cells in TM
```
133
PCO
41-51% of patients over 5 year old
Occurs within 2-6 months
Elsching pearls common in children
134
signs and symptoms of neovascularization
vary with the stage of the disease.
Early symptoms usually consist of decreased visual acuity from the underlying retinal condition, and, occasionally, from corneal epithelial edema and anterior chamber inflammation if retinal function is normal.
Later symptoms include ocular discomfort, brow ache, and nausea from inflammation and elevated IOP.
135
orbital bruit
represents increased blood flow through the collateral arterial system and intracranial arterial supply. In the correct clinical context, the presence of an orbital bruit should make the examiner suspect either a severe stenosis or occlusion of either the ipsilateral or the contralateral internal carotid artery (ICA).
136
Growth factors are found in
Glial cells
RPE cells
Vascular Endothelial cells
137
What improves macular capillary blood velocity in CME patients occurring after central retinal vein occlusion.
Systemic carbonic anhydrase inhibitors or corticosteroids, but not nonsteroidal anti-inflammatory drugs
