Eye Diseases Flashcards
(170 cards)
1
Q
This disease is caused by the creation of a fistula between the carotid artery and the cavernous sinus creating a congestion of the orbital veins.
A
Carotid Cavernous Fistula
2
Q
Distinguishing features is pulsatile proptosis (feeling the eye pulsate), dilated veins on the surface of the eye, and an increase in IOP
A
Carotid Cavernous Fistula
3
Q
What does the work up include for a Carotid Cavernous Fistula?
How is it treated?
A
CT Angio
Neurosurgical Intervention
4
Q
What are the risk factors for Carotid Cavernous Fistulas?
A
Trauma
HTN
5
Q
This disease typically lies dormant in the trigeminal ganglion and is typically found in adults
A
Herpes Simplex
6
Q
Herpes Simplex typically also presents with what 4 symptoms?
A
Foreign Body Sensation
Redness
Photosensitivity
Mild blurriness
7
Q
If you suspect Herpes simplex in a patient you would preform a _____ ____ exam. What type of lesion would you be looking for on the cornea?
A
Wood’s Lamp (Flourescein)
Dendritic Lesion
8
Q
How do you treat Herpes Simplex in the eye?
A
Topical antivirals
9
Q
Are steroids indicated for herpes simplex?
A
Yes, but only once the infection is under control
10
Q
This disease has skin lesions that follow a unilateral dermatome, typical the Opthalmic branch of trigeminal nerve.
A
Herpes Zoster Opthalmicus
11
Q
Herpes Zoster Opthalmicus typically causes what three diseases?
A
- Conjunctivitis
- Keratitis
- Iritis
12
Q
What are the associated symptoms of Herpes Zoster Opthalmicus?
A
- PAIN in the eye or skin
- Photosensitivity
- Blurred Vision
- Watery discharge
13
Q
What is the most severe complication of Herpes Zoster Opthalmicus?
A
Permanent vision loss
Corneal scarring
14
Q
This disease is typically caused traumatic bleeding, which is contained under the conjunctival layer.
A
Subconjunctival hemorrhage
15
Q
In a patient with a subconjunctival hemorrhage, what else should you be concerned with?
A
Additional ocular injury
16
Q
How is a subconjunctival hemorrhage treated?
A
Artificial tears for comfort
17
Q
Do you need to stop ASA (Aspirin) in a patient with a subconjunctival hemorrhage?
A
NO
18
Q
This COMMON disease is caused by inflammation or infection in the conjunctiva.
What are the FIVE types?
A
Bacterial, Viral, Allergic, Chemical/Toxic Kerato, and Herpetic Conjunctivitis
19
Q
This form of conjunctivitis typically starts in one eye and spreads to the other, does not involve the lids, typically is associated with URI Sx, and is self-limited not requiring antibiotics
A
Viral conjunctivits
20
Q
This form of conjunctivitis is typically unilateral, has mucopurulent drainage, responds well to antibiotic treatment
A
Bacterial Conjunctivitis
21
Q
What are the similar symptoms both viral and bacterial conjunctivitis share?
A
Burning, Itching, Redness, Watering of the eyes
22
Q
What three forms of bacterial conjunctivitis are most concerning?
What is unique about one of them regarding treatment?
A
Neonatal
Gonorrhea
Chlamydia - ABx resistent
23
Q
This form of conjunctivitis occurs more acutely/suddenly, presents with marked conjunctival/lid swelling and white non-purulent drainage, and also does not respond to ABx
A
Allergic conjunctivitis
24
Q
How do you treat allergic conjunctivitis?
A
Cool Compresses
Topical Antihistamine
Allergy Reducing drops
25
How do you treat bacterial conjunctivitis?
Abx
```
Sulfacetamide
Ofloxacin
Ciprofloxacin
Trimethaprim/Polymysin
Tobramycin
```
26
Are Bacterial, Viral, and allergic conjunctivitis contagious?
Bacterial and Viral - YES
| Allergic - No
27
This form of conjunctivitis with primary HSV in child hood and recurrent in adulthood and is associated with stomatitis and fever blisters.
Herpetic Conjunctivits
28
This form of conjunctivitis occurs following a chemical injury to the eye causing epithelial and limbal damage/tissue loss?
Chemical/Toxic Keratoconjunctivitis
29
Would a chemical injury from an acid or a alkali be more concerning?
Alkali - because it can lead to blinding
30
How do you treat Chemical/Toxic Keratoconjunctivitis?
Irrigation to normalize the pH of the eye
| It should be neutral between 6.5-7.5
31
This is a very common benign growth that causes the eye to get red and irritated.
Pingueculum
32
This is a common slow benign fibrovascular tissue growth from the conjunctiva to the cornea which may start to obscure vision.
Pterygium
33
This disease causes dry eyes and excess tearing.
Keratoconjunctivitis Sicca
34
This disease involves inflammation of the sclera in the eye and is frequently associated with systemic inflammatory diseases such as RA, Lupus, or sarcoidosis
Scleritis
35
What symptoms would a patient experience if they had scleritis?
What symptoms would you not see?
Redness
Tenderness to palpation
Blurry Vision
NO Discharge/Itching
36
What is the most concerning complication of scleritis?
Necrotizing scleritis (Loss of the eye)
37
This disease is a SEVERE internal eye infection in which the anterior chamber and/or vitreous fluid becomes filled with purulence typically following a puncture wound or surgery
Endophthalmitis
38
What is a Hypopyon? (Typically found in someone with Endophthalmitis)
A layer of WBCs or purulence in the anterior chamber
39
Endophthalmitis can be caused by an extension of a ______ ______ or endogenously by a _____ _____.
Corneal infection
Septic emboli
40
What is the most concerning complication of Endophthalmitis?
Loss of vision
41
This is typically caused by BLUNT trauma which results in blood filling the anterior chamber of the eye causing mild pain and blurry vision.
Hyphema
42
What is the most concerning complication of a hyphema?
What is the mechanism of this?
Vision Loss
Blood filled the anterior chamber blocking the mechanisms that typically drain aqueous humor, which causes a rise in IOPs. This rise in pressures can in turn cut off blood supply to the eye
43
This type of hyphema occurs when blood completely fills the anterior chamber giving it an almost black appearance.
8-Ball hyphema
44
A __________ laceration only involves the superficial layers of the eye.
Conjunctival
45
T/F: A patient with a conjunctival laceration will have normal vision?
True
46
This typically results from grinding, drilling, and cutting metals and is painful.
Corneal foreign body
47
How do you test for a corneal foreign body?
Slit Lamp
48
How do you treat a corneal foreign body?
Irrigate or swab foreign body
Removed with slit lamp and a needle
Topical ABx +/- NSAIDs
49
What precautions should be taken to prevent corneal foreign bodies?
Wear safety glasses
50
A _______ abrasion is typically very pain painful, is traumatic (ie: finger to the eye), and involves a loss in the epithelial layer
Corneal
51
What are the symptoms of a corneal abrasion?
Blurry Vision
Foreign Body Sensation
Photophobia
Can't Open the Eye
52
How do you diagnose a corneal abrasion?
Wood's Lamp (Flourescein Uptake)
53
T/F: A patient with a corneal abrasion will typically feel immediate relief with anesthetic drops?
True
54
How do you treat a corneal abrasion?
```
Topical ABx (Erthyomicin/Tobramycin)
Pain Management
```
55
A _______ or _______ laceration results in aqueous humor, iris, retinal, or vitreous contents leaking out of the eye.
Corneal/Scleral
56
A corneal/scleral laceration occurs from ______ trauma to the eye.
Sharp (Knife, Fish Hook)
57
What Sx might a person with a scleral/corneal laceration experience?
PAIN
Photosensitivity
Blurry Vision
Watery eyes
58
If seen in an emergency/urgent care/primary care setting, how should you treat a corneal/scleral laceration?>
Shield and immediate referral
59
What is the prognosis of a corneal/scleral laceration if treated urgently?
Good
60
This is the inflammation of the cornea, typically bacterial, inflammatory, or viral, and presents uniquely with translucent or opaque lesions on the cornea
Keratitis
61
T/F: Keratitis is frequently associated with systemic inflammatory disease
True
62
What is the most prominent Sx in Keratitis?
What additional symptoms might you see?
PHOTOSENSITIVITY
Pain
Redness
Blurry Vision
Mucus Discharge
63
What is the most concerning complication in a patient with keratitis?
Developing necrotizing scleritis
64
_______ keratitis is a milder form and has an accumulation of WBCs in the cornea
Marginal
65
T/F: Marginal keratitis does not leave the epithelium intact so it would stain with flourescein
False: Marginal Keratitis leaves the epithelium INTACT, so it WOULD NOT stain with flourescein
66
How do you treat marginal keratitis?
ABx
NSAIDs
Lid Scrubs
67
Keratitis can often developed from wear what too long?
Contact lens
68
________ keartitis often results from pseudomonas or Amoebas caught while swimming in a lake
Bacterial
69
What will bacterial conjunctivitis progress to if not treated aggressively?
Corneal Ulcer
70
What test should you preform is you are concerned for bacterial keratitis?
Culture
71
How do you treat bacterial keratitis?
1. AGGRESIVE and FREQUENT Abx as they do not respond to typical ABx concentrations (MAY NEED PHARMACISTS HELP)
2. Daily follow up
72
T/F: Bacterial Keratitis from Amoebas will respond to steroids?
False, they WILL NOT respond to steroids
73
This is caused by inflammation in the anterior segment, Iris, and ciliary body, has WBCs floating in the aqueous humor, and is often associated with systemic inflammatory conditions.
Iritis/Uveitis
74
What are the FOUR common causes of Iritis/Uveitis?
1. Idiopathic (>50%)
2. Traumatic
3. Infectious
4. HLA-B27 Associated
75
What are the symptoms of iritis/uvetitis?
```
Pain
Redness
Tearing
Photophobia
Soreness
```
76
T/F: A patient with iritis/uveititis will get relief from topical anesthetics?
False
77
On physical examination, what do you do you expect to find when examining the patient's pupils with iritis/uveitis?
Poor reactivity
78
How is iritis/uvetitis treated?
topical steroids
| cycloplegic (dilation)
79
_______ iritis is typically associated with blunt trauma but does not cause a hyphema.
Traumatic
80
What would you expect to see in floating in the aqueous humor in a patient with traumatic iritis?
RBCs
81
Symptoms (pain, redness, photophobia, etc...) of traumatic iritis typically onset how many days after the trauma?
1-2
82
In a patient with an orbital blow out fracture, what are you most concerned with?
Extraocular muscle entrapment
Unresolved diplopia
Large fracture
Globe displacement
These would typically be surgically repaired
83
This RARE disorder occurs when the natural lens it not where it should be
Ectopia Lens
84
Ectopia lens is typically seen in patients with ______ syndrome
Marfins
85
How is ectopia lens treated?
Surgically
86
This is the most common cause of vision lose and is often related to aging.
Cataracts
87
What additional risk factors (other than age) are associated with cataracts?
1. DM
2. Steroids
3. Smoking
4. UV light
5. Trauma
88
T/F: Cataracts is fully reversible with surgery
True
89
This disease is chronic and slow progressing, typically involves gradual peripheral vision lose, and is typically asymptomatic at first
Chronic open-angle glaucoma
90
In a patient with chronic open-angle glaucoma, what would you be monitoring to ensure minimal optic nerve damage?
IOPs
91
This form of glaucoma occurs acutely and IOPs are typically 60-80 mm Hg, and is associated with headaches, nausea, and emesis
Angle closure glaucoma
92
How do you work up a patient for angle closure glaucoma once you have confirmed elevated IOPs?
Gonioscopy
OCT of the nerve fiber layer
Tx: Laser iridotomy
93
What is the most concerning complication of angle-closure glaucoma if not treat emergently?
Blindness (optic nerve damage)
94
This very common disease is an inflammation of the eyelids caused by a plugging of the meibomian (oil) glands
Blepharitis
95
What bacteria is typically associated with blepharitis?
Staph
96
What symptom is unique to blehparitis?
Scalyness of the eyelid
97
How do you treat blepharitis?
Abx
98
A ________ is the obstruction of a meibomian gland in the tarsal plate
A _______ is swelling associated with a lash follicle
Both of these are commonly referred to as what?
Chalazion
Hordeolum
Stye
99
What symptoms would you expect to see in a patient with a Chalazion/Hordeolum?
Tender/Sore "bump" on the eyelid
| Burning/Itching
100
How do you treat a Chalazion/Hordeolum?
Abx
| Hot Compresses
101
This is the inflammation of the lacrimal gland typically associated with swelling/tenderness/soreness of the upper orbit
Dacryoadenitis
102
What two additional symptoms along with the swelling and tenderness of the upper orbit would a patient with dacryoadenitis experience?
Fever
| Mucopurulent Drainage
103
This disease occurs due to immune complexes of thyroid disease
Thyroid Eyes Disease (Graves)
104
What unique symptoms would you see in a patient with Graves Disease?
What causes this?
Proptosis (A Bulging of the eyes)
This is caused by an increase in the volume of orbital tissue (Muscle/Fats) pushing the globe forward
105
What additional symptoms, other than proptosis, would you see in a patient with Graves Disease?
Diplopia
Pain
Dryness
106
What are the two types of occular dysmotility
Esotropia - one eye goes in toward the nose
| Exotropia - one eye goes outward toward the ear
107
T/F: You should refer any child with strabismus
True
108
T/F: You should refer any asymptomatic adult with strabismus
False
109
This occurs when there is an infection of the skin near the eyelids and develops from styes, lacerations, or conjunctivits
Pre-septal cellulitis
110
What Sx are you likely to see in a patient with orbital cellulitis?
Swelling
Pain
Eyelid closure
Discharge
111
Will a patient with pre-septal cellulitis have normal vision and motility?
Most likely
112
This occurs from an infection in the orbital tissues and is typically associated with an abcess in the adjacent sinus
Orbital cellulitis
113
What are the primary symptoms in a patient with orbital cellulitis?
1. Eye Bulging
2. Swelling
3. Fever
4. Visual Changes
5. Pain with EOMs
114
How should you work up a patient with suspected orbital cellulitis?
CT/MRI (Emergency)
115
How do you treat orbital cellulitis?
1. Hospitalization for IV Abx and possible I&D
2. ENT/Oculopplastic surgery
3. Neurosurgery if extending into brain
116
T/F: Fungal orbital cellulitis has a high mortality rate
True
117
This disease is the inflammation of the optic nerve which can be papillitis or retrobulbar
Optic neuritis
118
What are the four causes of inflammatory optic neuritis?
Lyme
Syphilis
Malaria
MS
119
What are the five causes of autoimmune optic neuritis?
```
Lupus
Polychondiritis
Crohns
UC
Wegners
```
120
What are the four causes are toxic optic neuritis
Methanol
Ethanol
Lead
Chloramphenicol
121
What are three additional causes of optic neuritis that dont fall under inflammatory, autoimmune, or toxic?
Ischemic
Neuropathy
GCA
122
What are the three general symptoms of Optic neuritis?
Blurry Vision
Vision Loss
Pain with EOM
123
This is the most common cause of demyelinating disease with regards to sudden vision loss and central scotoma
MS
124
This phenomenon occurs when neurological symptoms worsen with heat (ie. hot showers)
Uhtoff Phenomenon
125
This sign occurs when a patient feels an electric sensation down the spine with neck bending
Lhermitte's Sign
126
This phenomenon occurs when patients view pendulums as moving in an elliptical manner
Pulfrich Phenomenon
127
How do you work up MS/Retrobulbar Optic Neuritis?
MRI - multiple episodes of lesions separated by time and space
Dawson's fingers (periventricular white matter lesions)
128
How do you treat MS/Retrobulbar optic neuritis
IV Steroids/Immunmodulatory drugs
129
What additional diseases should be ruled out when testing for MS/Retrobulbar Optic Neuritis
Syphilis
| GCA
130
This disease is also referred to as temporal arteritis and is an inflammatory condition of the head
Giant Cell Arteritis
131
What are unique symptoms of GCA?
Unilateral vision loss
Jaw soreness with chewing
Temporal tenderness (ie. with brushing hair)
Headache
132
What age range are most likely to have GCA?
Are men or women more likely to have GCA?
>50 y.o.
Women > Men
133
If GCA is not treated will the patient continue to have unilateral vision loss or will it spread?
It will quickly spread to the other eye
134
What two lab values are key to diagnosing GCA?
ESR
| CRP
135
What is the gold standard for GCA diagnosis?
Temporal artery biopsy (3-4 mm)
136
How do you treat GCA?
1 year of steroids with a VERY GRADUAL taper
137
This disease occurs because of bilateral optic neuritis due to increased intracerebral pressures
Papilledema
138
What are the five risk factors/causes of papilledema?
```
Tumors
Pseudotumors
Lyme Disease
Infection
Malignant HTN
```
139
What is the primary symptom of papilledema?
blurry vision
140
How should you work up papilledema (TWO THINGS)?
1. Imaging to r/o tumor
| 2. LP to measure CSF pressures
141
Understand hemianopsia and the different forms and visual field losses
Work through it
142
What are the two forms of diabetic retinopathy?
Non-proliferative
| Proliferative
143
What is the primary exam finding in a patient with MILD Non-proliferative diabetic retinopathy?
Microaneurysms
NO blot hemorrhages
144
What is the primary exam finding in a patient with MODERATE Non-proliferative diabetic retinopathy?
Microaneurysms AND blot hemorrhages
145
What is the primary exam finding in a patient with SEVERE Non-proliferative diabetic retinopathy?
4 quadrant with >20 microaneurysms
2 quadrants with venous bleeding
1 quadrant with intraretinal microvascular abnormalities
146
What is the primary exam finding in proliferated diabetic retinopathy?
New blood vessel growth
147
What are the FOUR causes of vision lose in a patient with diabetic retinopathy?
Are these painful or painless?
```
Macular Edema (Painless)
Vitreous Hemorrhage (Painless)
Retinal Detachment (Painless)
Neovascular Glaucoma (Painful)
```
148
What causes neovascularization?
The retina feels like it is "sick" because it is being damage by the excess sugar. Due to this it releases VEG-F which stimulates vessel growth
149
How do you treat non-proliferated diabetic retinopathy?
Observation
150
How do you treat macular edema in diabetic retinopathy patients?
Laser therapy
| Anti-VEG-f injections
151
How do you treat proliferated diabetic neuropathy patients?
Panretinal Photocoagulation Laser
152
How do you treat neovascular glaucoma in diabetic retinopathy patients?
Anti VEG-f with PRP
| Glaucoma Surgery
153
This is acute onset of decrease vision or blind spots commonly do to arterioclerotic changes in the vessels?
Branch Retinal Vein Occlusion
154
These arteriosclerotic changes that cause arteries to "cross over and occlude" veins is also referred to as what?
AV nicking
155
What are THREE risk factors for BRVO?
What is NOT a risk factor?
1. HTN
2. Cardiovascular disease
3. Glaucoma
DM is NOT a risk factor
156
This is the acute onset of vision loss usually associated with a thrombosis at the CRV.
Central Retinal Vein Occlusion
157
Is DM a risk factor for BRVO or CRVO or Both?
Only CRVO
158
This occurs when there is sudden painless vision loss and has a very poor prognosis
Central Retinal Artery Occlusion
159
Irreversible damage can occur in only __ minutes in a patient with a CRAO.
Is there an effective treatment?
90
No
160
What do you need to work up in a patient with CRAO? Why?
You need to look for the source of the embolus because if you can throw a clot to your retinal artery it is likely you are at risk for clotting in other places
EX: Labs, Carotid Dopplers, Etc...
161
This occurs from age-related "wear and tear" to the retina and outer retina
Age-related macular degeneration
162
What are the two types of age-related macular degeneration?
Which typically comes first?
Dry (FIRST)
Wet
163
What physical examination finding would be consistent with age-related macular degeneration?
Drusen
164
What occurs uniquely with WET age-related macular degeneration?
Neovascularization which increases fluid and swelling
165
What are the FOUR risk factors for age-related macular degeneration?
>50 y.o
Smoking
Caucasian
FHx
166
How is dry age-related macular degeneration treated?
How is wet age-related macular degeneration treated?
DRY:
1. Amsler
2. AREDS vitamins
3. Routine Examination
WET:
1. Anti-VEG-f
2. Cold Laser therapy
167
What are the three types of retinal detachment?
1. Rhegmatogenous (Most Common)
2. Serous (Inflammation)
3. Traction (DM)
168
Understand how a retinal detachment occurs
A tear develops in the retina and then vitreous fluid leaks out underneath and gets behind the retina, lifting/detaching it
169
What Sx might you expect a patient with a retinal detachment to be experiencing.
They may be seeing "floaters", "flashers", or "curtains"
| THINK: "someone threw pepper in there visual fields"
170
How is a retinal detachment treated? What types?
Surgically
Laser Retinopexy
Pneumatic Retinopexy
Scleral Buckle
Vitrectomy
