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Flashcards in eye Deck (135):
1

roof of orbit

frontalsphenoid (lesser)

2

lateral wall of orbit

zygomaticsphenoid (greater)

3

floor of orbit

zygomatic maxillarypalatine"zip my pants"

4

medial wall of orbit

sphenoid (lesser) maxillaryethmoidlacrimal"use medial wall to SMEL"

5

blepharitis

common, hypersn. rxn to staph toxins, not true infectionsymptoms: itching, burning, tearing, crusting, "greasy"

6

blepharitis tx

lid hygiene: WC + baby shampoo lid scrubs, OTC lid cleanersif severe: tobradex or maxitrol ointment x1wkoral doxycycline 50 mg bid x 10 days

7

chalazion

chronic blocking of meibomian glandssymptoms: eyelid lump, swelling, tenderness

8

hordeolum

acute blocking of meibomian glandssymptoms: eyelid lump, swelling, tenderness

9

tx of chalazion/hordeolum

WC + Abx/steroid ointmentTHEN oral doxycycline 50 mg bidTHEN steroid injectionsTHEN incision and curettage

10

molluscum

uncommon, papovaviruschronic follicular conjunctivitispersists until all lesions are removed--> if multiple lesions present and don't go away-->consider immuncomp-->HIV test

11

molluscum tx

incision and curettagecryotherapychemical ablatives

12

preseptal cellulitis

commonsymps: tenderness, red eyelid, mild feversigns: eyelid erythema, edema, warmth tenderness, conjunc. chemosis, eyelid skin tightness, eyelid lymphedema (fluctuant)

13

preseptal cellulitis etiology

trauma (puncture, insect bite)adjacent infectionS. aureus, Strep, H. flu, HSV, VZV

14

ddx: preseptal vs. orbital cellulitis: orbital if..

hx of sinus infEOM restrictionAPD, proptosis, pain with eye movementother tests: CT of brain/orbits, CBC w/diff, Gram stain&culture

15

mild preseptal cellulitis tx

augmentin 500 mg PO tid x10 days(PCN allerg): bactrim DS x10 days

16

mod-severe preseptal cellulitis tx OR

IV Unasyn or Ceftriaxone(PCN allerg): IV Moxifloxin or Vancomycin x 10-14 days*IV-->PO if improvement

17

if secondary conjunctivitis present with preseptal cellulitis, tx w/

erythromycin ointment

18

if abscess present with preseptal cellulitis

I + D and Cx/Gs

19

make sure to do this with preseptal cellulitis tx

daily follow-up until improve

20

orbital cellulitis symptoms

uncommonred eye, pain, double/blurred vision, headache, diplopia

21

orbital cellulitis signs

eyelid edema, erythema, warmth, tenderness, conjunc. chemosis, optic disc edema, purulent discharge, fever, *proptosis, restricted ocular motility w/ pain on attem. mvmnt, +/- APD

22

orbital cellulitis etiology

extension of sinusitis (ethmoiditis)orbital/dental fracturevascular extension from bacteremia/facial cellulitis

23

orbital cellulitis organisms

adult: Staph and Strepchildren: Haemophilusdental abscess: mixed aerobes and anaerobesimmunecomps: fungi (mucor, aspergillus)

24

orbital cellulitis work-up

CBC and blood Cxhead/orbit CTGs and CxLP if ment stat and pn w/ nk flexion (mening)

25

orbital cellulitis tx

admit for IV Abxadults: vanco + Unasyn or Zosyn(PCN allerg): Vanco + Cipro + metronasal decongestant

26

if optic neuropathy suspected/severe proptosis suspected with orbital cellulitis...

perform a canthotomy/cantholysis -->relieves eyelid "compartment syndrome"

27

orbital cellulitis assessment

daily pupil, Va, motility, IOP, WBC-->change to oral Abx if improving (augmentin, bacterim)

28

if orbital cellulitis not improving with 48-72 hrs of IV..

re-image to look for abcess, surgical drainage

29

orbital pseudotumor AKA idiopathic orbital inflammatory disease (IOID)

acute onset of pain, red eye, proptosis, diplopia, blurred vision, typ. unilateral in adults, bilat. in kids w/ assoc. fever, malaise

30

if IOID bilat in adult need to rule out..

systemic disease: Saroid, Wegners, breast Ca metastasis

31

CT scan of IOID

thickened mm., tendons, and posterior sclera ("ring sign")-->helps ddx from orbital cellulitis or TED(thyroid orbitopathy): only mm. involved

32

if uncertain it's IOID + no response to steroids

biopsy

33

IOID (orbital pseudotumor) tx

60-100mg prednisone w/ PPI (GI prophylaxix), slow taper**do not want to give orb. cellulitis pts steroids!!

34

canaliculitis

canaliculi inf.tearing, expressible discharge, erythema, recurrent conjunctivitis, "pouting punctum"

35

canaliculitis organisms

actinomyces isrealii (MC?)Nocardia, Candida, Fusarium, Asp*take smear and Cx of discharge, Gram and Giemsa stain

36

Canaliculitis tx

topical ciprofloxacin and oral doxycycline x2 weeksWC + probing and irrigation w/ PCN + iodine 1%canalicular curettageI&Dif fungus: nystatin drops

37

dacryocystitis organisms

staph & streppseudomonasH. flu

38

dacryocystitis tx

WC + topical and PO AbxI&D if abscessavoid probing and irrigation during acute phase

39

dacryocystitis tx after acute inflammation controlled

dacryocystorhinostomy(DCR) crack bone, thread lacrimal system...

40

dacryoadenitis

rare inf. of lacrimal glandpain, redness, swelling over outer 1/3 of upper lidtyp. seen in kids

41

dacryoadenitis etiology

inflammatory conditions (most common), bacterial (staph, strep, Neisseria), viral (mumps, mono, Herpes Zoster)

42

dacryoadenitis tx (aimed at etiology)

if unclear or bac: Abx FIRST: Augmentin or Keflex inflam: Medrol dose pack or systemic steroidsviral: symptomatic relief

43

if dacryoadenitis tx is not responding: rule out..

lacrimal gland mass

44

conjunctivitis

red eye, discharge (worse in am) itching, FBS?hx of recent URI

45

forms of conjunctivitis

viral, allergic, atopic/vernal, bacterial, gonococcal

46

2 types of conjunctivitis

follicularpapillary

47

follicular conjunctivitis

follicles- small dome shaped nodules w/out prominent central vesseletiology: virus, bac, chlamydia, toxins-represents aggr. of lymphos and plasma cells in superficial stroma btw tarsus and conjunctiva-may have germinal centers or macrophages

48

papillary conjunctivitis

papillae- cobblestone arrang. of flattened nodules w/ vascular core-beefy red, in young kidsetiology: allergic/atopic (watery discharge), vernal/limbal (horner trantas dots), gonococcus (sev. purulent discharge), bacterial (scant discharge)-nodules of conj. epi w/ many eosins, lymphos, plasma cells w/ central vascular channel

49

viral conjunctivitis

adenovirus, typ. after URI+preauricular adenopathyone eye-->both eyeswatery discharge, pseudomembranes, SCH?, symblepharon?

50

viral conjunctivitis tx

cool compress, art. tears, +/- antihistaminesteroids drops if sub epithelial infiltrates-membrane can be manually peeled

51

viral conjunctivitis is highly contagious for how long

10 days from onset

52

bacterial conjunctivitis

follicular/papillaryetiology: staph, strep, moraxella, H. flu-Cx & Gs if purulent, persistent, or recurrent

53

bacterial conjunctivitis tx

ciloxan or vigamoxpolymyxin B sulfate w/ trimethoprim

54

gonococcal conjuntivitis

hyperacute, severe purulent discharge + LAD?

55

gonococcal conjunctivitis tx

IV/IM ceftriaxonetopical FQs q 1 hr if K involved?saline irrigation until discharge resolvescover for chlamydia as well: azythromycin x 1 or doxycycline x 1 wk

56

allergic conjunctivitis

pediatric red eye, itchy/scratchy, +/- lid involvement, +/- seasonal, typ. both eyes, hx of allergies, absence of URI, no nodes, papillae present-common: young boys w/ eczema-->vernal

57

allergic conjunctivitis tx

elim. inciting agentcool compress + art. tearsoptivar (mast cell stabilizer) +/- antihistaminetopical steroid if severeif vernal: topical cyclosporine + steroid

58

subconjunctival hemorrhage

typ. asymptomatic, clears in 1-2 wks, no tx needed causes: valsalva, trauma, HTN, bleeding d/o, idiopathic

59

if subconjunctival hemorrhage is recurrent

work up: bleeding time, PT, PTT, INR, CBC (leukemia), Protein C and S

60

pterygium and pingueculum

due to prolonged sun exposure-elastotic degeneration of conjunctivatx: symptomatic: acular + art. tears, resection of affecting /, vision, cosmesis?, recurrent inflammation

61

keratitis/ulcer

redness, pain, photophobia, dec. vision-focal white opacity (infiltrate) in corneal stroma, dendritic keratitis

62

keratitis/ulcer etiology

bacterial: most common, assumefungal: organic matter trauma, chr. eye diseaseacanthamoeba: extreme pain, contacts +/- poor hygiene +/- swimmingHSV: unilat, eyelid rash, prev. episodes, nodes, dendritesatyp. mycobacteria: prev. ocular surgery/grafts, indolent course

63

keratitis/ulcer dx

corneal scraping for smears & cx:-if suspect unusual org. from hx and presentation, > 2mm / in visual axis, if unrespons. to tx

64

keratitis/ulcer tx

cycloplegicstopical abx according to size, zymar, vigamox, fort. tobramycin/gentamycin + fort. cefazolin/vancooral abx: ciprofloxin, impending perforation

65

fungal keratitis/ulcer

#NAME?

66

acanthamoeba

severe pain, contacts w/ poor cleaning/swimmingdx: confocal microscopy, cx on nonnutr agar w/ E. colitx: polyhexamethyl biguanide + brolene + neosporin (essen. pool cleaner!)

67

PS response causes..

ciliary musc to contract-->zonules relax-->inc. AP diameter and diopteric power of lens-->refracts light (accommodation)

68

total refractory power of lens ? from air-tear interface ?from lens ?

60 D40 D from interface15-20 from lens

69

cataract

compression and hardening of lens, change in lens proteins cause change in refractive index, scatter, and red. transparency

70

nuclear sclerotic cataract

"aging", compr/harden. of lens nuc as new layers of cortical fibers formedimpairs distance more than near vision, second sight (AP growth)

71

posterior subcapsular cataract

"fish eggs" dec. vision in bright lights (glare), obscured when mitosis/constricted,impairs near more than distant vision

72

cortical cataract

"spokes on a wheel" worse when eyes dilated/mydriasis, glare and halos around lights

73

indications for cataract surgery

#NAME?

74

phacoemulsification

(1967, Kelman)small incision made in cornea (no stitches req.)-->US probe inserted into A/C and used to break up cataract-->aspiration of lens-->insertion of pre-measured intraocular lens

75

iritis

photophobia, redness (perilimbal) dec. visioncauses: trauma, vasculitides (HLA-B27, TB, JRA in kids, sarcoid in AA's)flare in ant. chamber, keratic precipitates- KP, band keratopathy, synecheia, if no hx trauma, do vasculitis w/u

76

vasculitis w/u for iritis

CBC, ESR, ANA, PPD, RF, ACE, lysozyme, RPR/FTA-abx, CANCA, HLA-B27

77

iritis tx

cycloplege (dilate to keep from scarring), pred forte?q1-6oral prednisoneimmunosuppressives

78

endophthalmitis

dec. vision and painabsent red reflex, vitrifies, hypopyon (eye filled with WBCs), conj. injection

79

endophthalmitis types

-postoperative (acute: S. epi, S. aureus, strep, pseudomonas; chronic: p. acnes)-traumatic (same ^ + bacillus)-endogenous (endocard, IV feeding, immsupp, brspec abx)-->cx everything (blood, urine, catheters, IV line)

80

endophthalmitis tx

postop: VA? , tap and inject (cx, smears) intravitreal vanco + amikacin +/- dexa-topical fort. abx + steroidsconsider PO/IV FQstrauma: same ^, tetanus toxoidendogenous: brdspec IV abx (ID consult)aminoglycoside + clindamycin in IV drug users intravitreal vanco + amikacin

81

aqueous humor production

produced by ciliary bodies in post. chamber-->around pupillary margin into ant. chamber-->drained through trabecular meshwork

82

glaucoma

grp of diseases: optic neuropathy, assoc. with visual field loss, increased intra ocular pressure is a risk factor, not requirementcup: disc ratio around 0.8 (vs. 0.4) due to atrophylook for patholitis (swelling of optic n., irreg. borders)

83

types of glaucoma

-open angle: abnorm. that clogs it up-->inc. pressure-->optic neuropathy-angle closure w/ pupillary block: iris buds against ant. lens, AH build up in post chamber-->^^pressure-->vomiting, ha-angle closure w/out pupillary block: something from cornea into iris and pulling it up

84

indications for glaucoma surgery

progressive glaucomatous optic neuropathy (GON) or visual field changes on MTMTfailed IOP control after laster txintolerance/noncompl to medsgoal of filtering surgery: create pathway for AH to flow from ant chamber thru sclera into subconj and subtenons space

85

types of glaucoma surgery

trabeculectomy w/ MMC: partial thickness scleral flap allows for controlled filtering of AH form ant cham into subconj space-->conj. bleb formedtub implant: inserted into ant chamber thru sclera, allows for flow of AH from ant chamb into plate at subconjunc space

86

age related macular degeneration

most common cause of dec. VA in USsymp: metamorphosis (waviness) w/ loss of central vision

87

dry macular degeneration

most common (80%) drusen: yellow EC deposits btw Bruchs and RPE? RPE atrophy: photorec.loss

88

dry mac deg tx

AREDS (vitamin C, E, beta carotene? (now omega 3s), zinc, copper)

89

wet macular degeneration

exudative, break in Bruch's membrane-->neovasc/bleeding

90

wet mac deg tx

intravitreal anti-VEGF agents +/- laser

91

diabetic retinopathy

retinal damage due to chronic hyperglycemia- implies other organs are affectednonprolif: mild or modif severe (4:2:1 rule): 4 quads of diffuse intraret heme and micro aneurysms, 2 quads venous beading, 1 quad IRMAclin. sig macular edema: w/in 500 um fovea, hard exudates w/ adj. edema, edema 1 disc area w/in 1 disc diam. of fovea

92

proliferative diabetic retinopathy

any NVD w/ VH, 1/4-!/3 disc area NVD1/2 disc area NVE w/ VH

93

diabetic retinopathy tx

laser, intravitreal anti-VEGF injections

94

classic visual field loss

bitemporal heminopsia

95

causes of chiasmal defects

pit tumor, sheehan's, pit apoplexy, craniopharyngioma, meningioma, glioma

96

distance chiasm lies above pit gland

1 cm

97

micro vs macroadenoma

micro presents to endocrinologist, macro presents w/ VF changes?

98

optic neuritis

inflame of optic n.symps: central visual loss, pain with eye mvmnt, APD w/ dec. color vision (red)

99

optic neuritis ddx

viral, MS, vasculitis (SLE) granulomatous (syph, sarcoid) idiopathic

100

optic neuritis w/u

MRI w. flairatyp >1 mo: ANA, anti-DNA, VDRL, RTA-ABS, CXR, ACE, ESR

101

optic neuritis px

visual recovery (20/40) in 95% untr. ptsMRI: risk of MS:0 lesions 16%, 3+: 50%

102

optic neuritis tx

do not give oral prednisone! inc. recurrenceIV methylprednisolone rec. vision faster if treated w/in 1st 2 wks but no effect on recurrences

103

MS

autoimmune attack of myelin causing inflame. demyel. of CNS F>M (2:1)dx: 2 attacks sep by > 1 mo in sep parts of CNS-episodes last wks-mos: diplopia, ataxia, vertigo, parethesias, bladder/bowel dysfunction, extrem. wkness, e- shock-like sens.

104

eye findings w/ MS

optic neuritis (75%), diplopia, internuclear ophthalmoplegia (INO)

105

MS lab tests

MRI w. flair, periventr. plaquesspinal fluid: elevated IgG, oligoclonal bands

106

MS tx:

ABC: Avonex, Betaseron (interferon B), Copaxone

107

MS disease course

primary progressive (10%) from onsetsecondary prog. (50%): relapsing/remitting w. slow continuous deteriorationbenign (30%): no serious disability

108

CN III nucleus

in midbrain, level of sup. colliculusmultiple nucleii: -single central located nuc: both levators-paired SR nuc that cross to supply C/L SR-paired nuc that do not cross: supply MR, IR, IO-Edinger-Wesphal nuc supplies PNS input to both eyes

109

CN III fascicle syndromes

ischemic, infiltrate or inflamm. conditionsaffects fascicles--> I/L CN III paresis + other mdbn structures

110

CN III: Nothnagel's

superior cerebellar peduncle, leads to I/L CN III paresis + cerebellar ataxia

111

CN III fascicle:

travels ventrally traversing red nuc and corticospinal tract

112

CN III: Benedikt's

-red nuc, leads to I/L CN III paresis + C/L tremor + C/L dec sens

113

CN III: Weber's

pyramidal tract, leads to I/L CN III paresis + C/L hemiparesis

114

CN III supplies

superior: SR and levatorinferior: IR, MR, IO

115

PNS from E-W nuc travels w.

inf div of CN III

116

CN IV

@ mdbrainfascicles: only CN that decussates and exits dorsally

117

CN IV enters

cavernous sinus, SOF outside annulus of Zinn, inn. SO, longest intracranial course, most common CN injured w/ head trauma

118

isolated CN IV palsy

congenital: large vert. fusion amp, head tilt in old photosacquired: vertical diplopia, chin down, head tilted away from lesion

119

CN VI

nuc @ pons medial to CN 7, lesion--> I/L gaze palsy

120

CN VI fascicles

travel anterolat to PPRF then thru pyramidal tract

121

Brain stem syndromes:Millard-Gublar

CN 6, 7, + pyramidal tractI/L CN 6, 7 palsies, and C/L paresis

122

brain stem syndromes:Foville's

CN 5, 6, 7, +SNS I/L CN 5,6,7, palsieshorizontal conjugate gaze palsy

123

brain stem syndromes: Raymond's

CN 6 + pyramidal tractI/L CN 6 palsy + C/L paresis

124

CN VI nerve exits..

lower pons, climbs over clivus and petrous ridge, vuln. to inc. ICP, common CN palsy affected in pseudo tumor cerebri (30%)travels along base of skull thru Dorello's canal under Gruber's ligament-->enters cavernous sinus closest to ICA and SNS (only place to get isolated CN 6 palsy + Horner's)-enters SOF, innervates LR

125

CN VI: Gradenigo's syndrome

mastoiditis of petrous apex following otitis media-CN 6 palsy + I/L dec. hearing + facial pain and paralysis

126

Pons lesion: INO

lesion in MLF, due to MS or stroke: CN VI stim. I/L LR but C/L CN III cannot stim. MR:adduction deficit (I/L) abducting nystagmus (C/L)

127

Pons lesion: One and a half syndrome

lesion of MLF and ipsilat CN VI nuc:ipsilat add. deficit, ipsilat conj. gaze paresis, *only movement is contralat abduction

128

cavernous sinus thrombosis

blood clot of ICA from spread of infection of sinuses-ptosis, chemosis, CN 3, 4, 5, 6 palsies

129

PNS: pupillary light reflex miosis

optic nerve-->chiasm-->optic tract-->pretectal nuc (synapse), cross to both EW nuclei (synapse), travel via CN III-->ciliary ganglion-->postgang fibers via short ciliary nerves to ciliary body and iris sphincter: constriction

130

APD/Marcus Gunn Pupil

any damage to ON from retina to pretectal nuc.-swinging flashlight test: pupil dilates

131

CN 3 palsy"blown pupil", usually ptosis and dec. EOMsetiology: aneurysm,: posterior communicating artery, tumor, vascular

"blown pupil", usually ptosis and dec. EOMsetiology: aneurysm,: posterior communicating artery, tumor, vascular

132

Adie's tonic pupil

-middle age women (70%)dysfunc. of PNS at ciliary ganglionpost-viral or post orb sympts. mydriasis, more in lightsluggish, segmental pupillary response (vermiform)light-near dissociationdiminished deep tendon reflexessuper sensitive to pilo 0.1%

133

SNS: pupillary light reflex, mydriasis

1st order neuron: hypothalamus to T1 level of SC2nd order neuron: SC to C2 level of sup. cerv. ganglion (symp)3rd order neuron: cervical gang. through ciliary ganglion to nasociliary and short ciliary nn., follows carotid artery

134

SNS disorders: PLR, Horner syndrome

PAM:ptosis (Muller's musc)anhydrosis (always if 1st-order involved)miosis (greater in dark)-iris heterochromia (congen)pain: dissecting carotid aneurysm (3rd order)

135

Horner syndrome w/u

apraclonidione: if pupil dilates: Hornersthen hydroxyamphetamine: pupil dilates: 1st/2nd orderno dilation: 3rd orderMRI of head (cavernous sinus), neck, lung apices