Ocular conditions

Question 1

subconjunctival hemorrhages

definition

Answer 1

common finding

bleeding between the conjunctiva and the sclera

Question 2

cause of subconjunctival hemorrhage?

Answer 2

traumatic, spontaneous or secondary to a systemic illness

Question 3

treatment of subconjunctival hemorrhage?

Answer 3

usu asx and don’t require tx
for mild irritation- artificial tears can be used
aspirin and NSAID use should be discouraged for recurrent cases

Question 4

viral conjunctivitis

definition

Answer 4

infection of the mucus membrane of the surface of the eye

MC virus- adenovirus

Question 5

SSX of viral conjunctivitis?

Answer 5

usu self limited
last longer than bacterial infxn (2-4 weeks), less inflammation and without purulent d/c
itching
foreign body sensation
tearing
redness
photophobia

Question 6

tx of viral conjunctivitis?

Answer 6

chamomile tea bag 
artificial tears
cold compresses
good hand hygiene
antiviral tx- for varicella-zoster and herpes infxn
if all fails- opthalmic Abx or refer

Question 7

SSX of bacterial conjunctivitis?

Answer 7

can be differentiated from viral by the purulent d/c

sexually active + urethritis- gonorrhea or CT

Question 8

TX of bacterial conjunctivitis?

Answer 8

topical antibiotic tx

systemic Abx for gonorrhea or CT

Question 9

Hordeolum

definition

Answer 9

outside the eyelid
infection of the glands of Zeis
aka Stye

Question 10

SSX of hordeolum

Answer 10

pain
warm
swelling
edema

Question 11

TX of hordeolum

Answer 11

usu self limiting
eyelid hygiene
warm compresses
massage
topical Abx
systemic Abx- pre-septal cellulitis 
incision and drainage for large hordeolum

Question 12

Chalazions

definition

Answer 12

deep within the lid
granulomatous inflammatory rxn of meibomian gland
MC on upper lid

Question 13

SSX of chalazions

Answer 13

single, firm, nontender nodule

Question 14

with the appearance of lots of floaters you should consider what condition?

Answer 14

retinal detachment

Question 15

what can help to visualize corneal abrasions?

Answer 15

blue light, the abrasion will appear yellow green

Question 16

TX of corneal abrasions?

Answer 16

self limited (typically heal within 24 hrs)
ice compresses
non-steroidal anti-inflammatory eye drops
prophylactic Abx
close follow up necessary bc of risk of developing a corneal ulcer

Question 17

what’s a corneal ulcer?

Answer 17

full thickness epithelial loss

Question 18

SSX of corneal ulcer?

Answer 18

pain
discomfort
blurry vision
may lead to loss of vision

Question 19

DX of corneal ulcer?

Answer 19

appear as white or grey spots on the cornea

uptake of fluorescein dye

Question 20

TX of corneal ulcer?

Answer 20

antibiotic drops

occasionally Abx injection or surgery

Question 21

what’s a cataract?

Answer 21

clouding of the lens inside the eye which leads to decreased vision

Question 22

fun fact about cataracts?

Answer 22

MC cause of blindness

Question 23

SSX of cataracts?

Answer 23

difficulty with color vision and changes in contrast

difficulty with driving, reading, recognizing faces, glare from bright lights

Question 24

what’s acute angle-closure glaucoma?

Answer 24

elevated intraocular pressure (IOP) due to obstruction of outflow from the anterior chamber
one of two types of glaucoma (chronic being the other) where the optic nerve is damaged
associated with farsighted patients

Question 25

SSX of acute angle-closure glaucoma?

Answer 25

``` sudden onset of severe ocular pain h/a nausea and vomiting blurred vision with halos around lights loss of vision conjunctival injection corneal edema mid-dilated nonreactive pupil shallow anterior chamber IOP > 21 mmHg ```

Question 26

TX of acute angle-closure glaucoma?

Answer 26

immediate reduction in IOP suppression of inflammation reversal of angle closure

Question 27

SSX of temporal arteritis?

Answer 27

h/a scalp tenderness jaw claudication reduced visual acuity in right eye

Question 28

what's retrobulbar hematoma?

Answer 28

results from trauma, a complication of orbital surgery, or retrobulbar injection

Question 29

SSX of retrobulbar hematoma?

Answer 29

``` painful proptosis dec visual acuity scintillating scotoma lid ecchymosis chemosis mydriasis afferent pupillary defect increased IOP ```

Question 30

TX of retrobulbar hematoma?

Answer 30

``` immediate opthalmologic consultation ice packs pain control bed rest IV acetazolamide, mannitol and steroids ```

Question 31

What's a hyphema?

Answer 31

injury to the anterior chamber that disrupts the vasculature supporting the iris or ciliary body blood forms a characteristic meniscus

Question 32

SSX of hyphema?

Answer 32

pain photophobia blurred vision

Question 33

TX of hyphema?

Answer 33

head slightly elevated eye shielded pain meds without anti-platelet/anticoagulation activity IOP measured

Question 34

Classic finding for central retinal artery occlusion?

Answer 34

cherry-red spot

Question 35

SSX of central retinal artery occlusion?

Answer 35

sudden, PAINLESS loss of vision

Question 36

TX of central retinal artery occlusion?

Answer 36

dilation of the central retinal artery by rebreathing expired CO2, breathing carbogen, or sublingual nitroglycerin

Question 37

Classic finding for central retinal vein occlusion?

Answer 37

retinal hemorrhages extending outward from the optic disk | "blood and thunder" appearance

Question 38

SSX of central retinal vein occlusion?

Answer 38

asx or present with gradual vision loss that is more pronounced in the morning

Question 39

what's retinal detachment mean?

Answer 39

occurs from a break or tear in the neuronal layer with subsequent sub-retinal fluid accumulation

Question 40

SSX of retinal detachment?

Answer 40

``` flashes of light floaters *a curtain or shadow moving over the field of vision* peripheral or central vision loss pain ABSENT ```

Question 41

DX of retinal detachment?

Answer 41

direct and indirect ophthamoscopy

Question 42

TX of retinal detachment?

Answer 42

lying down while transported | laser treatment to tack down retina

Question 43

SSX of orbital cellulitis?

Answer 43

``` fever erythematous, swollen, tender eyelid recent Hx of sinusitis or URI proptosis tenderness pain with EOMs chemosis visual changes ```

Question 44

TX of orbital cellulitis?

Answer 44

CT is mandatory pts require hospitalization broad spectrum antibiotics opthalmologic and otolaryngology consultation is warranted

Question 45

common finding of alkaline chemical injury to the eye?

Answer 45

stromal haze with opacification of the cornea

Question 46

why are alkaline chemical agents so damaging to the eye?

Answer 46

they are both hydrophilic and lipophilic, allowing rapid penetration of cell membranes inducing saponification of cell membranes and cell death