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(C) CM 1B: ID/EENT > Lecture 3: Other Ocular Conditions > Flashcards

Lecture 3: Other Ocular Conditions Flashcards

1
Q

What is entropion?

A

INward turning of eyelid.
Usually in elderly pts dt lid fascia degeneration.

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2
Q

What is the temporary tx for Entropion? When is Sx indicated?

A

Temporary = botox
Sx = lashes rubbing on cornea.

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3
Q

What is ectropion?

A

OUTward turning of eyelid.
Common in elderly also.

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4
Q

When is surgery indicated for ectropion?

A

Excessive tearing, exposure keratitis, or a cosmetic problem.

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5
Q

What is a blepharospasm? Treatment?

A

Abnormal contraction of eyelid muscles.
Treated via botox or alleviating stress/decreased caffeine.

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6
Q

What is ptosis? MC 3 neurological etiologies?

A

Eyelid drooping
Etiologies:
* Horner’s syndrome
* Third nerve palsy
* Myasthenia gravis (usually fluctuates, worse at night)

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7
Q

What are the 4 general etiologies of ptosis?

A
  • Congenital
  • Acquired
  • Mechanical
  • Aponeurotic
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8
Q

Dysfunction of what muscle generally causes ptosis?

A

Levator palpebrae superioris

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9
Q

How is ptosis graded?

A

upper lid margin to light reflex = margin reflex distance (MRD)
* Mild: 2mm
* Moderate: 3mm
* Severe: 4mm

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10
Q

What is the nonsurgical treatment option for ptosis?

A

Oxymetazoline drops.
Alpha-adrenergic receptor agonist.

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11
Q

When is surgery indicated for ptosis?

A

Obscured visual field or cosmetic.

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12
Q

What is a pterygium?

A

Conjunctival encroachment onto nasal side of cornea.
PTerygium goes Towards the eye.

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13
Q

What typically causes a pterygium?

A

Prolonged exposure to wind, sun, sand, and dust.

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14
Q

How is a pterygium treated?

A
  • Artificial tears
  • NSAIDs or weak corticosteroids
  • Surgery if severe/visual field impairment.
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15
Q

What is a pinguecula?

A
  • Yellowish-orange, slightly raised conjunctival lesion CONFINED to the conjuctiva.
  • Can occur either nasally or temporally.
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16
Q

What is keratoconjunctivitis sicca?

A

Dry eye syndrome.

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17
Q

What nutritional deficiency can cause dry eye?

A

Vit A

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18
Q

What are the pathophysiologies that lead to dry eye?

A
  • Defective spreading of tear film
  • Increased evaporative film
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19
Q

What does each stain show for dry eye?

A
  • Fluorescein: defects in corneal epithelium
  • Rose Bengal and Lissamine green: defects in corneal and conjunctival epithelial cells.
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20
Q

What is a schirmer’s test?

A

Dipping filter paper into an eye to measure how many tears are being produced.

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21
Q

What is tear break up time used for?

A

Estimates mucin content.

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22
Q

What are the first-line treatments for dry eye syndrome?

A

Artificial tears
Ointment

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23
Q

What are the more advanced treatments for dry eye syndrome?

A
  • Cyclosporine/restasis drops (usually used for corneal transplants)
  • Humidifiers, environmental changes
  • Punctal plugs to block tear drainage
24
Q

What are cataracts?

A

Increased opacity of lens.
Leading cause of blindness WW!!!!!
Usually bilateral.

25
Q

What is the #1 cause of cataracts?

A

Being old. Degenerative effects of aging on cell structure.

26
Q

How does cataracts typically present?

A
  • Progressively worsening vision
  • Glare at night/bright lights
  • Nearsightedness
  • Monocular double vision
  • cloudy lens
  • Early will look normal, but late will show a white pupil.
27
Q

How are cataracts treated?

A

Surgery

28
Q

What is the hallmark finding for macular degeneration?

A

Loss of central vision, usually bilateral.
Peripheral vision stays the same usually.

29
Q

What are the associated risk factors for macular degeneration?

A
  • Age
  • White
  • Female (slightly)
  • FMHx, HTN, HLD
  • Cigarette smoking
30
Q

What are the two types of macular degeneration?

A
  • Atrophic: dry/nonexudative
  • Neovascular: wet/exudative
31
Q

What is the key finding in atrophic macular degeneration?

A

Retinal drusen.
Hard, yellow retinal deposits made from lipids/proteins.

32
Q

How does neovascular macular degeneration usually present?

A

Hemorrhages and blotches.
Usually results in more severe and rapid vision loss.
New vessels grow between retina and Bruch’s membrane.

33
Q

How is wet macular degeneration treated?

A

VEGF inhibitors.

34
Q

How is atrophic macular degeneration treated?

A

Non-specific.

35
Q

What structure drains aqueous humor?

A

Trabecular meshwork.

36
Q

What is the key finding that indicates glaucoma on ophthalmologic examination?

A

Cupping of the optic disc

37
Q

What is the physiology behind narrow angle/closed angle glaucoma?

A

Lens pushes out too far, and iris closes the angle so there is a block. The buildup of fluid causes a SUDDEN increase of intraocular pressure, damaging optic nerve.
EMERGENCY (will cause permanent blindness)

38
Q

What are the risk factors for acute angle closure glaucoma?

A
  • Asians
  • Family history
  • Female
  • 40-50
  • Hyperopia
  • Certain meds
39
Q

What is primary angle closure? Secondary?

A

Primary is the lens being located too far ahead and closing the angle against the iris.

Secondary is the occlusion of the anterior chamber by either pushing of the ciliary body forward or iris deformation that pulls it into angle closure.

40
Q

What are the symptoms of narrow angle glaucoma?

A
  • HALOS AROUND LIGHTS
  • Vision loss or decreased vision
  • HA
  • Eye pain
  • N/V
41
Q

What are the signs of narrow angle glaucoma?

A
  • CORNEAL edema or cloudiness (red, steamy cornea)
  • Conjunctival redness
  • Shallow anterior chamber
  • Mild-dilated pupil with poor light reaction
  • IOP > 50 mmg, hard eye on palpation.
42
Q

What is the gold standard for diagnosing narrow angle glaucoma?

A

Gonioscopy to view iridocorneal angle.

43
Q

When is indentation gonioscopy done?

A

Checking if angle is completely closed or scarred.

44
Q

What position do we place a patient in if narrow angle glaucoma is suspected?

A

SUPINE.

45
Q

What is the first-line treatment for narrow angle glaucoma?

A

Acetazolamide (decreases aqueous humor production as a carbonic anhydrase inhibitor)

46
Q

What is the treatment for narrow angle glaucoma once IOP drops?

A

Pilocarpine (cholinergic) drops q15 for 1 hr, then QID.
Causes outflow of aqueous humor/decreases resistance.

47
Q

What is the definitive treatment for narrow angle closure?

A

Laser peripheral iridotomy

48
Q

What is the treatment protocol for narrow angle glaucoma while waiting for an ambulance?

A
  1. Place patient supine
  2. Acetazolamide PO/IV
  3. Pilocarpine drops
  4. Analgesic
  5. Antiemetic
49
Q

What kind of condition is open angle glaucoma usually?

A

A chronic condition that usually presents bilaterally.

50
Q

How does open angle glaucoma usually present?

A

Progressive, peripheral vision loss.
Transient increases in IOP.

51
Q

What are the risk factors for open angle glaucoma?

A
  • Age > 50
  • Caucasian and African-american
  • FMHx
  • Elevated IOP
  • HTN
  • DM
  • CVD
  • Hypothyroidism
52
Q

What tests can we perform to check for open angle glaucoma?

A
  • Fundoscopic exam (Cupping of optic disk > 50%)
  • Visual field testing
  • Tonometry
53
Q

What is the main goal of therapy for open angle glaucoma?

A

Reducing IOP.

54
Q

What are the first-line pharmacologic treatments for open angle glaucoma?

A
  • Topical prostaglandins (latanoprost, tafluprost, bimatoprost)
  • Topical BBs (interferes with cAMP, which is used in production of aqueous humor, timolol)
  • Topical alpha-2 adrenergic agonist (causes iris dilation/mydriasis, apraclonidine)
  • Cholinergic agonists (causes pupil constriction, PiloCarpine = pupil constriction)
  • Topical carbonic anhydrase inhibitors (decreased production of aqueous humor)
55
Q

What is the surgical option for open angle glaucoma?

A

Laser peripheral iridotomy

(C) CM 1B: ID/EENT (27 decks)

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