eye

Question 1

chronic eye condition characterized by inflammation of the eyelids w a common complaint of irritation

Answer 1

blepharitis

Question 2

inflammation at the base of the eyelashes in young female

Answer 2

anterior blepharitis

Question 3

fibrinous scales and crust around the eyelashes

Answer 3

staphylococcal anterior blepharitis

Question 4

dandruff like skin changes around the base of the eyelids, resulting in greasy scales around the eyelashes

Answer 4

anterior seborrheic blepharitis

Question 5

inflammation of inner portion of eyelid at level of meibomian glands assoc w rosacea or seborrheic dermatitis

Answer 5

posterior blepharitis

Question 6

path of anterior blepharitis

Answer 6

lid colonizing staphylococcal bacteria

• direct infx
• rx to staph exotoxin
• allergic response to staph antigen

Question 7

what is associated with posterior blepharitis

Answer 7

rosacea-plugging/hypertrophy of sebaceous glands

seborrheic dermatitis- inflame of meibomian glands and tear film instability

Question 8

path of posterior blepharitis

Answer 8

hyperkeratinization of meibomian gland

• inc concern of free fatty acids and lipids
• impaired lipid layer of tear film and instability of tear film

Question 9

pt presents with irritation, red eyes, gritty feeling, and blurred vision

Answer 9

blepharitis

*no visual disturbance

Question 10

pt presents with excessive tearing, burning sensation, red/swollen eyes with light sensitivity

Answer 10

blepharitis

Question 11

what can provoke or exacerbate symptoms of blepharitis

Answer 11

smoking, allergens, contacts, retinoids

Question 12

tx of blepharitis

Answer 12

alleviate symptoms/good lid hygiene (warm compress, lid massage/washing)
abx
-topical:azithromycin,erythromycin,bacitracin
-oral: doxy or tetra cycline

Question 13

benign, self limited/easily tx red eye w discharge

Answer 13

conjunctivitis

Question 14

what is always characterized by red eye

Answer 14

conjunctivitis

Question 15

what causes bacterial conjunctivitis

Answer 15

staph aureus (mc adults)
strep pneumo
H influ
M cat

Question 16

how is bacterial conjunctivitis spread

Answer 16

direct contact w pt or secretions or contaminated objects/surfaces

Question 17

what type of conjunctivitis is sight threatening and requires immediate ophthalmic referral

Answer 17

bacterial w N. gonorrhea

Question 18

what causes viral conjunctivitis

Answer 18

adenovirus

Question 19

part of viral prodrome followed by adenopathy, fever, pharyngitis, URI

Answer 19

viral conjunctivitis

Question 20

path of allergic conjunctivitis

Answer 20

airborne allergens cause mast cell degranulation and release of histamine, eosinophil/platelet activating factor
IgE

Question 21

path of non infx/ non allergic conjunctivitis

Answer 21

mechanical/chemical irritation

Question 22

pt tells you that woke up with crusting of the eye and during the day had redness, irritation and discharge with diffuse injection of conjunctivae

Answer 22

conjunctivitis

Question 23

will cause 360 involvement of bulbar conjunctiva but will spare the tarsal conjunctiva

Answer 23

kertitis, iritis, angle closure glaucoma

Question 24

pt has redness, thick yellow discharge and complain their eye is stuck shut

Answer 24

bacterial conjunctivitis

Question 25

pt has redness, watery discharge and complain of sandy feeling

Answer 25

viral conjunctivitis

Question 26

pt has b/l redness, watery discharge, and itchy

Answer 26

allergic conjunctivitis

Question 27

when do you need cx for bacterial conj

Answer 27

if concerned about gonorrhea

Question 28

pt says they are unable to open eye, have a foreign body sensation, and corneal opacity

Answer 28

``` ulcerative keratitis (pseudo) watch w contacts- if so get rid of them ```

Question 29

what are you concerned about if pt has reduction of visual acuity

Answer 29

infx keratitis, iritis, angle closure

Question 30

pattern of injection in which pt has redness pronounced in ring at limbus concerned about

Answer 30

called ciliary flush | infx keratitis, iritis, angle closure

Question 31

concerned w if have photophobia

Answer 31

infx keratitis, iritis

Question 32

concerned w if have corneal opacity

Answer 32

infx keratitis

Question 33

concerned w if have fixed pupil

Answer 33

angle closure

Question 34

concerned w if have severe HA w N

Answer 34

angle closure

Question 35

tx bacterial conj

Answer 35

erythromycin ointment or trimethoprim polymyxin B

Question 36

tx viral conj

Answer 36

``` antihistamine decongestant drops (OTC) ```

Question 37

tx allergic conj

Answer 37

``` antihistamine decongestant drops (OTC) ```

Question 38

when can pt return to school/work with bacterial conj

Answer 38

24 hrs of abx (erythromycin)

Question 39

when can pt return to school/work w viral conj

Answer 39

after discharge cleared

Question 40

common eye injury from trauma, foreign bodies or improper contact lens use

Answer 40

corneal abrasion

Question 41

severe eye pain and fb sensation after cat scratched eye

Answer 41

traumatic corneal abrasion

Question 42

pt presents to ER with eye pain that is so bad couldn't drive himself and with photophobia or foreign body sensation that didn't go away after trying to wash it out

Answer 42

corneal abrasion

Question 43

size of pupil with corneal abrasion

Answer 43

normal to small

Question 44

visual acuity with corneal abrasion

Answer 44

normal, slightly abnormal, grossly abnormal depending on where abrasion is on visual axis

Question 45

white spots or opacity in contact lens wearer

Answer 45

corneal ulcer from bacterial infx

Question 46

what is used to confirm dx of corneal abrasion

Answer 46

fluorescein exam - cobalt blue filter - woods lamp

Question 47

anesthesia for corneal abrasion

Answer 47

proparacaine/tetracaine - relief win 30-60s - lasts 10-20min

Question 48

when should pt have same day ophthalmic exam w corneal abrasion

Answer 48

corneal infiltrate, white spot, opacity, can't remove foreign body, hypopyon, purulent discharge, drop in vision, not healed in 3/4 days

Question 49

pain control tx for small corneal abrasion

Answer 49

ophthalmic nsaids, oral nsaids, tylenol #3, percocet (24hr), lacri-lube (OTC)

Question 50

pain control tx for lg corneal abrasion

Answer 50

nsaids/narcotics (48hrs) | cycloplegic drops

Question 51

how do cycloplegic drops work in tx lg corneal abrasion

Answer 51

parasym that inhibit mitotic (pupil constricting) response to light won't relieve FB sensation

Question 52

tx corneal abrasion w contact lens

Answer 52

abx drops - ofloxacin - tobramycin - ciprofloxacin * dont patch

Question 53

types of benign lesions

Answer 53

xanthelasma chalazion hordeolum pterygium

Question 54

pt comes to office with soft yellow plaques medial aspects both eyes

Answer 54

xanthelasma

Question 55

xanthelasmas are a classic feature of what ds

Answer 55

primary biliary cirrhosis

Question 56

tx xanthelasma

Answer 56

benign lesion so only for cosmetic reasons

Question 57

inflam lesion dev from obstructed zeis or meibomian gland

Answer 57

calazion

Question 58

pt presents w painless, rubbery nodular lesion that started as swelling and erythema of eyelid

Answer 58

calazion

Question 59

what often calms and scars into hard chalazion

Answer 59

inflamed hordeolum

Question 60

tx calazion

Answer 60

warm compress | ophthalmo-I/C or direct glucocorticoid injection

Question 61

what should you check for if pt has persistent or recurrent calazions

Answer 61

cancer

Question 62

internal/external acute purulent inflame of eyelid

Answer 62

hordeolum

Question 63

what causes hordeolum

Answer 63

staph aureus

Question 64

tx hordeolum

Answer 64

warm compress | oral abx cover staph- keflex

Question 65

triangular wedge fibrovascular conj tissue starts nasal conj and extends to cornea

Answer 65

pterygium

Question 66

mc symp pterygium

Answer 66

redness and irritation

Question 67

tx pterygium

Answer 67

artificial tears maybe nsaids/topical decongestants effects vision--> surgical excision by ophthal

Question 68

pt presents with blurred vision and glare. complain of difficulty reading fine prints and sees halos when driving at night

Answer 68

cataract

Question 69

leading cause of blindness in the world

Answer 69

cataracts

Question 70

types of age related cataracts

Answer 70

nuclear, cortical, posterior subcapsular

Question 71

dx congenital cataract

Answer 71

dx babies-absense red reflex

Question 72

patho cataracts

Answer 72

cells of lens don't shed off dead cells

Question 73

toxic exposures that play role in cataracts

Answer 73

``` smoking/UV*** age alcohol steroids trauma dm malnutrion pref eye infx ```

Question 74

prevention cataracts

Answer 74

healthy diet stop smoking postmenopausal estrogen antioxidant vitamins

Question 75

when is surgery for cataracts needed

Answer 75

interferes w ability to perform activities of daily living | lens removed replaced with plastic lens

Question 76

pt presents sagging lower eyelid, excess tearing, dryness, irritation

Answer 76

ectropion

Question 77

tx exctropion

Answer 77

artificial tears, lacri-lube | surgery to shortern/tighten lower lid

Question 78

rolled in eyelid with redness, pain and sensitivity to light

Answer 78

entropion

Question 79

tx entropion

Answer 79

surgery- tightening or sutures

Question 80

nasolacrimal duct obstruction

Answer 80

dacryostenosis

Question 81

infx/inflam of lacrimal sac

Answer 81

dacryocystitis

Question 82

infx/inflam of lacrimal gland

Answer 82

dacryoadenitis

Question 83

mc cause of persistent tearing and ocular discharge in kids

Answer 83

dacryostenosis

Question 84

dacryostenosis patho

Answer 84

nasolacrimal canal incomplete

Question 85

infant with persistent tearing, matted eyelashes, and redness

Answer 85

dacryostenosis

Question 86

what will happen when palpate lacrimal sac w dacryostenosis

Answer 86

reflux of tears/ mucous discharge at punctum if persistent tearing

Question 87

tx for dacryostenosis

Answer 87

*lacrimal sac massage downward- force tears from sac into duct 2-3x day -lacrimal duct probing

Question 88

swelling, redness, tenderness on lateral/proximal aspect of nsoe

Answer 88

dacryocystitis

Question 89

dacryocystitis organisms

Answer 89

alpha-hemolytic strep staph epidermis staph aureus MRSA

Question 90

tx mild dacryocystitis

Answer 90

warm compress | systemic abx- clinda

Question 91

tx severe dacryocystitis

Answer 91

admit vanco and 3rd gen ceph I/D

Question 92

pt w swelling, erythema, pain temporal aspect of upper eyelid

Answer 92

dacroadenitis

Question 93

virus causes of dacryoadenitis

Answer 93

measles, mumps, influenza, herpes, cmv

Question 94

bacterial causes of dacryoadenitis

Answer 94

``` staph aureus (mc) strep pyogenes h flu chlamydia gonorrhea ```

Question 95

tx dacryoadenitis

Answer 95

warm compress analgesics abx- cephalexin or bactrim/clinda if mrsa

Question 96

pt w red eye, fb sensation, can't keep eye open, pain dealing with cornea

Answer 96

keratitis

Question 97

bacterial causes keratitis

Answer 97

staph aureus, pseudomonas, strep pneumo, diphtheroids

Question 98

viral causes keratitis

Answer 98

herpes | adenovirus but usually conj

Question 99

pt w fb sensation, can't keep eye open, photophobia, white spot

Answer 99

bacterial keratitis

Question 100

pt w red eye, fb sensation, photophobia, watery discharge

Answer 100

viral keratitis

Question 101

what will you see with fluorescein viral keratitis

Answer 101

branching opacity

Question 102

tx bacterial keratitis

Answer 102

urgent ophth referral | topical ophth abx

Question 103

tx viral keratitis

Answer 103

self limited

Question 104

path of uveitis

Answer 104

infx- cmv, toxoplasmosis, cat scratch, west nile, herpes systemic inflam-autoim/rheum cancer-lymphoma

Question 105

pt presents w red eye, +/- pain, visual disturbance, exudates, inflame post structures

Answer 105

uveitis

Question 106

tx uveitis

Answer 106

urgent referral infx- antiviral agents and topical steroids non infx- topical steroids/systemic steroids

Question 107

uveitis complications

Answer 107

``` calcium in epithelia of cornea adhesion iris to lens cataract glaucoma macular edema ```

Question 108

infx involving fat and ocular muscles around eye

Answer 108

orbital cellulitis

Question 109

with orbital cellulitis what must you distinguish between

Answer 109

preseptal=milder tx outpt | orbital=serious admit/iv abx

Question 110

pt presents with ophthalmoplegia, pain w eye movement, and proptosis

Answer 110

orbital cellulitis

Question 111

bacterial causes orbital cellulitis

Answer 111

staph aureus (mc) strep mrsa

Question 112

fungal causes of orbital cellulitis

Answer 112

mucorales | aspergillus

Question 113

pt w eyelid swelling, erythema, ocular pain

Answer 113

preseptal orbital cellulitis

Question 114

pt w eyelid swelling, inflam ocular muscles, pain w movement, proptosis, diplopia

Answer 114

orbital cellulitis

Question 115

how to differentiate between preseptal and orbital cellulitis

Answer 115

ct scan of orbits/sinuses

Question 116

tx preseptal/periorbital cellulitis

Answer 116

clinda or bactrim plus amoxil, augmentin, omnicef for 7-10d | improve 24 hr

Question 117

tx orbital cellulitis

Answer 117

admit and consult vanco IV plus ceftriaxone, cefotaxime, ampicillin-sulbactam or pipercillin-taxobactam might add metronidazole 24-48 hr then oral clinda

Question 118

serious complications of orbital cellulitis

Answer 118

cavernous sinus thrombosis, intracranial extension of infix, vision loss

Question 119

optic neuropathy related to intraocular pressure that can lead to vision loss

Answer 119

glaucoma

Question 120

progressive visual field loss followed by central loss due to optic nerve axon loss

Answer 120

open angle glaucoma

Question 121

significant elevated intraocular pressure w painful red eye

Answer 121

angle closure glaucoma= emergency

Question 122

path of angle closure glaucoma

Answer 122

lens too far forward pushing against iris

Question 123

how does open angle glaucoma present

Answer 123

asymp | progressive vision loss- tunnel vision

Question 124

pt presents with rapid onset of dec vision, severe eye pain, and HA

Answer 124

angle closure glaucoma

Question 125

pt presents with rapid onset severe eye pain, N/V, mid dilated pupil

Answer 125

angle closure glaucoma

Question 126

dx open angle glaucoma

Answer 126

``` elev IOP (norm 8-21) optic nerve damage thinning/cupping disc rim visual field defect norm ant chamber ```

Question 127

dx angle closure glaucoma

Answer 127

by ophthalmologist w gonioscopy

Question 128

tx open angle glaucoma

Answer 128

``` meds inc outflow -prostaglandins (latanoprost, bimatoprost) -alpha agonists (brimoidine) -cholinergic agonists meds dec prod -alpha agonists -beta blockers (timolol, bextalol) -carbonic anhydrase inhib trabeculoplasty surgery- filtration bleb ```

Question 129

tx angle closure glaucoma

Answer 129

consult win 1 hr timolol 0.5% 1 drop after 1 min then iodine 1% 1 drop after 1 min pilocarpine 2% 1 drop reassess 30min laser peripheral iridotomy-holes in iris

Question 130

loss of central vision in older adults due to degeneration of central portion of retina

Answer 130

macular degeneration

Question 131

subretinal drusen deposits on macula

Answer 131

dry macular degeneration

Question 132

growth ban blood vessels in sub retinal space

Answer 132

wet macular degeneration

Question 133

path of dry macular degeneration

Answer 133

inflamm/chronic infx/tissue ischemia

Question 134

path of wet

Answer 134

vascular endothelial growth factor (VEGF) plays role

Question 135

risk factors macular degeneration

Answer 135

``` age (50) smoking fam hx cardiovasc ds diet- vit c/e, veg (dec risk) cataract surgery aspirin use ```

Question 136

pt presents w gradual loss vision and difficulty reading and driving so needs magnifying glass

Answer 136

dry mac deg

Question 137

pt presents w acute loss central vision and distortion of straight lines

Answer 137

wet mac deg

Question 138

dx dry mac degen

Answer 138

drusens on retina, changes in pigmentation

Question 139

dx wet mac degen

Answer 139

fluid/hemorrhage under retina, neovasc (fluorescein angiogram)

Question 140

tx dry mac degen

Answer 140

no smoking vit a/c zinc beta carotene

Question 141

tx wet mac degen

Answer 141

vit a/c zinc intravitreous injection VEGF photodynamic therapy

Question 142

collection of blood in anterior chamber

Answer 142

hyphema

Question 143

what can a hyphen result in

Answer 143

IOP and vision loss

Question 144

path of blunt trauma causing hyphema

Answer 144

force on eye immed inc IOP creates tears in blood vessels but bleeding stops quickly rebreeding can occur 2-3 days later from disruption of clot

Question 145

path penetrating trauma causing hyphema

Answer 145

traumatic disruption of vasculature causing bleeding

Question 146

path spont hyphema

Answer 146

neovasc ant cham-dm clotting disorders platelet inhib/anticoag

Question 147

pt presents with blood layer, photophobia, unequal pupils, and dec visual acuity

Answer 147

hyphema

Question 148

tx hyphema

Answer 148

``` consult ophth eye shield 1w bed rest head 30 deg pain control/cycloplegia (cyclopentolate) ```

Question 149

causes of orbit fracture

Answer 149

``` motor vehicle creash assault sports intracranial injury intraocular injury ```

Question 150

types of orbit fractures

Answer 150

orbital zygomatic nasoethmoid orbital floor orbital roof

Question 151

most common orbital rim fracture due to high impact blow

Answer 151

orbital zygomatic fracture

Question 152

medial orbital rim w maxillary bone fracture and lacrimal disruption

Answer 152

nasoethmoid fracture

Question 153

"blowout fracture" from baseball hitting eye, can cause entrapment inferior rectus muscle

Answer 153

orbital floor fracture

Question 154

fracture common kids

Answer 154

orbital roof fracture

Question 155

when should ct be done with fractures

Answer 155

obvious fracture noted dec EOMs severe pain difficult/incomplete exam

Question 156

how long may pt have diplopia w fractures

Answer 156

10 days

Question 157

vitreous traction on retina causing retina to separate from epith and choroid

Answer 157

active retinal detachment

Question 158

fluid accum betw retina and underlying epith

Answer 158

passive retinal detachment

Question 159

what does separation of retina from underlying layers lead to

Answer 159

ischemia of neurons- degeneration of photorec=vision loss

Question 160

mc retinal detachment with hole/tear in retina

Answer 160

rhegmatogenous retinal detach

Question 161

what causes rhegmatogenous retinal detachment

Answer 161

vitreous traction- humor adheres to retine- contracts-pulls retina-tears fluid/humor leaks accum behind retina causing detachment

Question 162

vitreous traction is nonrhegmatogenous retinal detachment

Answer 162

like rhegmato but pulls retina off instead of tearing it

Question 163

exudative detach of retina

Answer 163

partial thickness retinal detach from inflam/malignant process

Question 164

lattice degeneration of retinal detach

Answer 164

atrophy of retinal tissue- prone to vitreous traction

Question 165

rf of retinal detachment

Answer 165

myopia (nearsightedness) cataract surgery age fam hx

Question 166

pt presents with floaters, black spots, and flashes of light and on exam see curtain

Answer 166

retinal detachment

Question 167

tx vitreous traction retinal detachment

Answer 167

observ- floaters resolve 3-12m may be persistent | sump get worse=vitrectomy

Question 168

tx retinal hole/tear wout detach

Answer 168

laser retinopexy/ cryoreinopexy

Question 169

tx hole/tear w retinal detach

Answer 169

laser retinopexy/cryortinopexy pneumatic retinopexy scleral buckle

Question 170

primary cause of impaired vision in 25-74yo

Answer 170

diabetic retinopathy

Question 171

2 types diabetic retinopathy

Answer 171

nonproliferative | proliferative

Question 172

pt presents w never fiber infarcts (cotton wool spots), intraretinal hemorrhage, hard exudates, microvasc abn

Answer 172

nonprolif diabetic retinopathy

Question 173

pt presents neovasc arising from disc/retinal vessels

Answer 173

prolif diabetic retinopathy

Question 174

multifactoral causes diabetic retinopathy

Answer 174

``` chronic hyperglycemia retinal microthrombosis growth factor genetics ethnic (aa, hispanics) meds (rosiglitazone) nephropathy (albuminuria) ```

Question 175

prevention diabetic retinopathy

Answer 175

a1c

Question 176

what retinal arteries does arterial occlusion effect

Answer 176

central and branch

Question 177

what retinal veins/ veins does venous occlusion effect

Answer 177

central/branch | hemiretina

Question 178

path arterial occlusion causing retinal vascularization

Answer 178

atheroschlerosis cardiogenic embolism giant cell arteritis hypercoag

Question 179

path venous occlusion causing retinal vasc

Answer 179

compression vessels | thrombosis

Question 180

pt presents acute, painless vision loss one eye w afferent pupillary defect

Answer 180

arterial occlusion retinal vasc

Question 181

pt presents with retinal whitening and cherry red spots on macula

Answer 181

arterial occlusion retinal vasc

Question 182

pt presents gradual dec visual acuity, macular edema, and neovasc confirmed by fluorescein angiogram

Answer 182

venous occlusion retinal vasc

Question 183

tx arterial retinal occlusion

Answer 183

emergency vasc surg/ophth | conser therapy- ocular massage, reduce IOP, vasodilator meds, hyperbaric therapy, ant chamber paracentesis

Question 184

tx venous retinal occlusion

Answer 184

intravitreal anti VEGF laser phototherapy intravitreal steroid injections